Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation

Study DesignRetrospective review.PurposeTo determine the accuracy of thoracolumbar pedicle screw insertion with the routine use of three-dimensional (3D) intraoperative imaging and navigation over a large series of screws in an Asian population.Overview of LiteratureThe use of 3D intraoperative imaging and navigation in spinal surgery is aimed at improving the accuracy of pedicle screw insertion. This study analyzed 2,240 pedicle screws inserted with the routine use of intraoperative navigation. It is one of very few studies done on an Asian population with a large series of screws.MethodsPatients who had undergone thoracolumbar pedicle screws insertion using intraoperative imaging and navigation between 2009 and 2017 were retrospectively analyzed. Computed tomography (CT) images acquired after the insertion of pedicle screws were analyzed for breach of the pedicle wall. The pedicle screw breaches were graded according to the Gertzbein classification. The breach rate and revision rate were subsequently calculated.ResultsA total of 2,240 thoracolumbar pedicle screws inserted under the guidance of intraoperative navigation were analyzed, and the accuracy of the insertion was 97.41%. The overall breach rate was 2.59%, the major breach rate was 0.94%, and the intraoperative screw revision rate was 0.7%. There was no incidence of return to the operating theater for revision of screws.ConclusionsThe routine use of 3D navigation and intraoperative CT imaging resulted in consistently accurate pedicle screw placement. This improved the safety of spinal instrumentation and helped in avoiding revision surgery for malpositioned screws.

Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation

Study DesignRetrospective review.PurposeTo determine the accuracy of thoracolumbar pedicle screw insertion with the routine use of three-dimensional (3D) intraoperative imaging and navigation over a large series of screws in an Asian population.Overview of LiteratureThe use of 3D intraoperative imaging and navigation in spinal surgery is aimed at improving the accuracy of pedicle screw insertion. This study analyzed 2,240 pedicle screws inserted with the routine use of intraoperative navigation. It is one of very few studies done on an Asian population with a large series of screws.MethodsPatients who had undergone thoracolumbar pedicle screws insertion using intraoperative imaging and navigation between 2009 and 2017 were retrospectively analyzed. Computed tomography (CT) images acquired after the insertion of pedicle screws were analyzed for breach of the pedicle wall. The pedicle screw breaches were graded according to the Gertzbein classification. The breach rate and revision rate were subsequently calculated.ResultsA total of 2,240 thoracolumbar pedicle screws inserted under the guidance of intraoperative navigation were analyzed, and the accuracy of the insertion was 97.41%. The overall breach rate was 2.59%, the major breach rate was 0.94%, and the intraoperative screw revision rate was 0.7%. There was no incidence of return to the operating theater for revision of screws.ConclusionsThe routine use of 3D navigation and intraoperative CT imaging resulted in consistently accurate pedicle screw placement. This improved the safety of spinal instrumentation and helped in avoiding revision surgery for malpositioned screws.

Cemented Total Knee Arthroplasty- A Short Term Clinical, Functional Assessment and Outcome Analysis.

Total Knee Arthroplasty (TKA) has become a standard operative procedure to relieve pain, and to restore alignment and function of patients with advanced arthritis of knees.1,2,3 Total knee arthroplasty has evolved into a very reliable surgical treatment for advanced arthritis of knee. TKA provides pain relief and improves function for patients with advanced osteoarthritis of the knee. The aim of this study is to prospectively evaluate the clinical and functional outcomes of total knee arthroplasty in arthritic knees in terms of pain relief, range of motion and stability.METHODSWe prospectively reviewed a series of 65 primary Total Knee Arthroplasties performed in 40 patients at our institute from November 2014 to November 2017. Of these patients, 12 underwent bilateral TKA in the same sitting, 13 underwent staged bilateral TKA and 15 patients underwent TKA on one side. Patients were followed up to 3 years post-operatively with an average follow up of 24 months and were evaluated with Knee Society Clinical Ratings and radiographic analysis.RESULTSPre-operative mean of clinical score (pain, ROM and stability) and functional score (walking distance and stair climbing) of patients improved from 48.33 to 92.82 and 49.65 to 88.43 respectively.CONCLUSIONSIn this short-term analysis of this prospective observational study, satisfactory results were obtained in a good percentage of arthritic knee patients

A Clinical Assessment And Evaluation Of Mantha Sann (autism Spectrum Disorder) With Siddha Therapeutic Management In Children

Autism is most common mental disabilities in childhood with unknown aetiology nowadays. In our Siddha paediatric text, the symptoms of Mantha sanni are nearly correlated with Autism Spectrum Disorder (ASD). Objectives: The Main objectives of the study is to evaluate the Siddha therapeutic management and to analyse the clinical assessment of Mantha sanni (Autism Spectrum Disorder) with Experimental formulations and procedures and the secondary objectives are to calibrate the resemblance and the equivalence of Mantha Sanni with Autism Spectrum Disorder and to explore the Siddha therapeutic management in Autism children. Methods: In preclinical studies of Physicochemical, Phytochemical activities and Pharmacological activities were done. In clinical studies, among 30 children were included in inclusion criteria and received Kuruver kudineer as internal twice a day and Sambrani thuvalai and Mysatchi pugai as external once in a day. The Experimental period was 90 days and the activities of ASD children were recorded 0th day followed by every 30th day. Results and Discussion: In this clinical study indicating that both internal and external medicine had superior action as far as improvement in ASD is considered. Since Kuruver Kudineer use is to enhance cognitive skills, enhance nerve impulse transmission, research has been focused on the mechanism behind this activity. Thuvalai with Sambrani ennai use to enhance the Sitting tolerance, invigorating feeling and can give comfort. Fumigation with Mysatchi pugai is one of the methods of treatment in ancient period. It has to enhancing the mind calming activity, reduced hyperactivity, induced sound sleep, reduced screaming and irritable cry. In Statistical analysis, there is significant difference between before and after treatment on clinical assessment parameter score i.e. 86% improvement in this score after treatment. Based on the results of this clinical study, it can be conclude that Kuruver kudineer as internal and Sambrani thuvalai and Mysatchi pugai as external. It has a definite action as well as clinical efficacy on symptoms in ASD children seen in regular OPD and IPD. The effects of Internal and external therapies may be due individual drugs multipronged action. Further study is required for scientific validation to prove its clinical efficacy in multicentre clinical study.

Pleurodesis: A Comparision of Two Sclerosing Agents for Pleural Effusion

Introduction: Pleural effusion is one of the most frequentlyencountered pathology in our hospital. Thoracocentesis,thoracostomy, pleurodesis is the most commonly usedtreatment options for recurrent and persistent pleural effusion.Sterile talc powder is most commonly used as an sclerosingagent. In our study we have used sodium tetradecyl sulfateas a newer sclerosing agent and we have compared thecomplication rate, clinical response and success rate inboth sodium tetradecyl sulfate and talc sclerosing agent forpleurodesis. Study aimed to compare the safety and efficacyof the sodium tetradecyl sulfate and talc as a pleurodesis agentin pleural effusion cases.Material and methods: Pleural effusion cases (both malignantand non-malignant cases) were randomly allocated into groupA or group B. Group A patients were treated with 60mg of3% sodium tetradecyl sulfate, Group B patients were treatedwith 2 grams of sterile talc powder. Clinical data regardinggeneral complications, the rate of success, reduction in ICDdrainage and lung expansion were noted for every patient whounderwent pleurodesis.Results: 25 patients were allocated in each group. Patientscharacteristics were balanced between the two groups withthe majority of pleural effusion malignant in etiology. There isa statistically significant difference between the use of sodiumtetradecyl sulfate and talc in clinical response, ICD drainageand lung re-expansion. Sodium tetradecyl sulfate patient hasbetter lung reexpansion and clinical response in comparison totalc powder. The general complication was observed to be lowwith sodium tetradecyl sulfate than talc pleurodesis.Conclusion: Sodium tetradecyl sulfate pleurodesis appearsto have better pleurodesis effect than talc pleurodesis in ourstudy

Antitumor activity of ethanol extract of Gracilaria edulis (Gmelin) Silva on Ehrlich ascites carcinoma-bearing mice / 中西医结合学报

To evaluate antitumor activity of Gracilaria edulis in Swiss albino mice with Ehrlich ascites carcinoma (EAC).

Recombinant factor VIIa in a case of pontine hemorrhage.

A 59-year-old lady presented with hypertensive hemorrhage involving the pons. Since she presented within 3 hours of onset of the stroke, recombinant factor VIIa was administered. From a state of altered sensorium there was a rapid recovery of consciousness followed by gradual improvement in limb weakness. Serial CT scans of the brain revealed no further expansion of the hematoma. The hematoma progressively resolved. Recombinant factor VIIa could be an attractive therapeutic option in treating hemorrhages at critical sites like brainstem where expansion of hematoma could be fatal.

Recurrent venous thrombosis with factor V Leiden mutation.

A patient who presented with recurrent venous thrombosis is reported. Following an episode of spontaneous deep vein thrombosis of the lower limb he was started on oral anticoagulant therapy, which he discontinued. He presented with cerebral venous thrombosis and improved partially with anticoagulant therapy. Evaluation for hypercoagulable states revealed factor V Leiden mutation by polymerized chain reaction method. Long-term anticoagulation has been planned. Evaluation for factor V Leiden mutation is always warranted in patients presenting with spontaneous thrombosis, especially if there is recurrent thrombosis.

Lobster-claw syndrome.

Lobster-Claw syndrome is a rare autosomal dominant, hand-foot malformation with Oro-dental features. This is a rare condition and from the available reports so far, cases being reported are less than 1%. Most reports have focused on the hand-foot deformity of this syndrome. This paper highlights the typical Oro-dental features associated with this syndrome such as retained deciduous teeth, hypodontia and variation in crown size, arch length and arch width.

Cardiac involvement in Wilson's disease--an electrocardiographic observation.

BACKGROUND: Wilson's disease is known for its protean manifestations; however electrocardiographic abnormalities have not received much attention. AIM: To evaluate the various electrocardiographic (ECG) changes in patients with Wilson's disease. METHOD: The resting ECGs of 50 patients with Wilson's disease were systematically analyzed independently by three observers after excluding other causes that could induce ECG abnormalities. RESULT: Fifteen patients had at least one abnormality in the ECG. Sinus tachycardia was seen in eight and sinus bradycardia in six. Other abnormalities included: bifid P wave (1), ST elevation (2), ST depression (2), T inversion (4), ventricular premature contraction - VPC (1) and prominent U waves (1). QRS axis, PR interval, QRS complex, R/S amplitude ratio and QT interval were normal in all. Ventricular premature beats were not recorded in any. None had features of ventricular hypertrophy. There was no statistically significant difference in ECG abnormalities with reference to age, gender, duration of illness or treatment, serum copper or ceruloplasmin, and severity of neurological impairment. CONCLUSION: ECG abnormalities are not uncommon in Wilson's disease and are presumably related to an underlying cardiomyopathy due to deposition of copper in heart.