Relief of symptoms and quality of life after conservative versus surgical treatment of benign liver tumors (CONSULT): a retrospective propensity score matched study.

BACKGROUND: Surgery can be considered for selected patients with benign liver tumours (BLT). The aim of this study was to compare symptoms and quality of life (QoL) after conservative and surgical management of BLT. METHODS: In this dual-site cross-sectional retrospective study, adult patients with BLT diagnosed between 2000 and 2019 completed EORTC QLQ-C30 questionnaires on current symptoms and symptoms at diagnosis. Summary scores (SumScores) and QoL scores at follow-up were compared between surgically and conservatively treated patients by matched t-tests. Propensity score matching attempted to reduce confounding. Higher scores indicate less symptoms and higher QoL. RESULTS: Fifty surgically (22.6%) and 171 (77.4%) conservatively treated patients were included at median 95 (IQR:66-120) and 91 (IQR:52-129) months, respectively. Most surgically treated patients reported stable, improved or disappeared symptoms (87%) and would undergo surgery again (94%). After propensity score matching, surgical patients had higher SumScores (mean difference 9.2, 95%CI:1.0-17.4, p = 0.028) but not higher QoL scores (p = 0.331) at follow-up than conservatively treated counterparts (31 patients in both groups). DISCUSSION: Patients who had undergone surgery often reported they would undergo surgery again. Moreover, they had less symptoms than conservatively managed patients while they were propensity score matched on relevant variables, including baseline symptoms.

Revision in Ceramic-on-Ceramic and Ceramic-on-Polyethylene Bearing in Primary Total Hip Arthroplasty with Press-fit Cups: A Systematic Review and Meta-analysis of Different Methodological Study Designs.

Background: The influence of bearing on revision, especially in press-fit modular cup total hip arthroplasty (THA), remains underexposed. Methods: A systematic literature review was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov in line with the PRISMA guidelines. The primary outcome was overall revision between ceramic-on-ceramic (CoC) and all sorts of ceramic-on-polyethylene (CoPE) bearings. As secondary outcomes complications and reasons for revision were compared between bearings. Outcomes were presented in subgroups based on study design (randomized controlled trials (RCT), non-randomized comparative, and registry studies). The quality of evidence was assessed using the GRADE. The risk of bias was assessed using the Cochrane collaboration's tool and the MINORS criteria. Results: This meta-analysis included twelve RCTs, three non-randomized comparative studies and two registry studies, including 38,772 THAs (10,909 CoPE and 27,863 CoC). Overall revision showed a lower risk in CoPE compared to CoC in the two registry studies (HR 0.71 (95%CI 0.53; 0.99)) (very low-quality GRADE evidence). In RCTs and non-randomized comparative studies, no difference was observed (low-quality GRADE evidence). Loosening, dislocation, infection, and postoperative periprosthetic fracture showed no significant differences in risk ratio for all designs. Conclusion: The lower risk of overall revision in registry studies of primary THA with a press-fit modular cup using CoPE bearing compared to CoC should be considered preliminary since this outcome was just slightly significant, based on very low-quality GRADE evidence and based on only two studies with several limitations. Since no difference was observed in the other methodological designs and the separate reasons for revision showed no significant difference in all designs either, no preference for CoC or CoPE can be expressed, and therefore both seem suitable options based on the available literature. More comparative long-term studies are needed to confirm the potential advantages of wear-reduction of both bearings since the currently available literature is limited.

Systematic review on percutaneous aspiration and sclerotherapy versus surgery in symptomatic simple hepatic cysts.

BACKGROUND: Simple hepatic cysts (SHC) may cause pain and bloating and thus impair quality of life. Whereas current guidelines recommend laparoscopic cyst deroofing, percutaneous aspiration and sclerotherapy (PAS) may be used as a less invasive alternative. This review aimed to assess the efficacy of PAS and surgical management in patients with symptomatic SHC. METHODS: A systematic search in PubMed and Embase was performed according to PRISMA-guidelines. Studies reporting symptoms were included. Methodological quality was assessed by the MINORS-tool. Primary outcomes were symptom relief, symptomatic recurrence and quality of life, for which a meta-analysis of proportions was performed. RESULTS: In total, 736 patients from 34 studies were included of whom 265 (36%) underwent PAS, 348 (47%) laparoscopic cyst deroofing, and 123 (17%) open surgical management. During weighted mean follow-up of 26.1, 38.2 and 21.3 months, symptoms persisted in 3.5%, 2.1%, 4.2%, for PAS, laparoscopic and open surgical management, respectively. Major complication rates were 0.8%, 1.7%, and 2.4% and cyst recurrence rates were 0.0%, 5.6%, and 7.7%, respectively. CONCLUSION: Outcomes of PAS for symptomatic SHC appear to be excellent. Studies including a step-up approach which reserves laparoscopic cyst deroofing for symptomatic recurrence after one or two PAS procedures are needed.

Do we publish what we present? The publication rate of a national arthroscopy society and a review of the literature.

The publication rate (PR) of full-text articles after presentation at medical society meetings varies widely. The purpose of this study is (1) to determine the PR of abstracts presented at the Dutch Arthroscopy Society's (NVA) annual meeting from 2006 until 2016, (2) to determine the time between presentation and publication, and (3) to review the known literature on the PR of orthopaedic scientific meetings. We retrospectively reviewed the programs of the NVA annual meetings from 2006 to 2016. All podium presentations reported were included. The search for subsequent journal publication was performed using PubMed, EMBASE, and Google Scholar databases. A systematic literature search was performed in PubMed. All studies regarding the publication rates of orthopaedic scientific meetings were included. From 2006 to 2016 a total of 131 papers were presented at the NVA annual meetings, of which 83 were published as full text articles (63%). The mean time to publication was 16.5 months. The overall PR at orthopaedic scientific meetings ranges from 21% to 71%.

Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review.

BACKGROUND: The value of open and minimally invasive liver resection for symptomatic solid benign liver tumours (BLT) such as hepatocellular adenoma, focal nodular hyperplasia and haemangioma is being debated. A systematic review on symptom relief, quality of life (QoL) and surgical outcome after both open and minimally invasive surgery for solid BLT is currently lacking. METHODS: A systematic search in PubMed and EMBASE was performed according to the PRISMA guidelines (January 1985-April 2018). Articles reporting pre-and postoperative symptoms or QoL in patients undergoing open or minimally surgery for BLT were evaluated. Methodological quality was assessed using the MINORS tool. RESULTS: Forty-two studies were included with 4061 patients undergoing surgery for BLT, 3536 (87%) open and 525 (13%) laparoscopic resections. Randomized and propensity-matched studies were lacking. Symptoms were the indication for resection in 56% of the patients. After a weighted mean of 28.5 months follow-up after surgery, symptoms were relieved in 82% of symptomatic patients. Validated QoL tools were used in eight studies, of which two found significant better QoL scores following laparoscopic compared to open surgery. DISCUSSION: Resection of symptomatic BLT seems safe and relieves symptoms in the vast majority of selected patients. Comparative studies are needed before more firm conclusions can be drawn.

Closed reduction of congenital dislocation of the hip: prediction factors and results.

From 2009 to 2015, 15 infants with a congenital dislocation of the hip were treated with closed reduction under anaesthesia, after first being treated with Pavlik bandaging. A retrospective study was carried out with a minimum follow-up of 1 year to assess the success rate of the procedure and predictive factors. Twelve out of 15 (80%) patients achieved successful reduction. In the successful cases, the Barlow test was positive and the safe zone was 20° or more. In the unsuccessful cases, there was a negative Barlow present in the outpatient clinic and the safe zone was less than 20°. These three cases all had teratologic comorbidity, and required additional surgery in the form of open reduction. Avascular necrosis was noted in one out of 15 (6.7%) patients. In nonteratologic hips, a positive Barlow test with a safe zone of 20° is predictive of a successful closed reduction. In these patients, anaesthesia and arthrography might not be necessary.

Prognostic Factors for Failure of Antibiotic Treatment in Patients With Osteomyelitis of the Spine.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to identify factors independently associated with antibiotic treatment failure in patients with spinal osteomyelitis. SUMMARY OF BACKGROUND DATA: There are few studies that have identified risk factors for antibiotic treatment failure in medically managed spinal osteomyelitis. Identifying such factors could help to identify patients who can be treated solely with antibiotics. METHODS: All patients who underwent antibiotic treatment for spinal osteomyelitis in one of our institutions between January 1, 2001 and January 1, 2015 were identified. Patients who underwent surgery before the start of the antibiotic treatment were excluded. RESULTS: We included 215 patients with a mean age of 58 years; 63 (29%) patients had failure of antibiotic treatment. Diabetes (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.03-2.79, P = 0.037), fever (HR 1.61, 95% CI 0.93-2.79, P = 0.088), osteomyelitis at an additional site (HR 5.17, 95% CI 2.63-27.9, P = 0.001), and the presence of an epidural abscess (HR 1.91, 95% CI 1.05-3.45, P = 0.033) were associated with failure of antibiotic treatment. In the multivariate Cox regression analysis, diabetes (HR 1.69, 95% CI 1.03-2.79, P = 0.019), osteomyelitis at an additional site (HR 8.26, 95% CI 2.51-27.2, P = 0.001), fever (HR 1.77, 95% CI 1.00-3.12, P = 0.050), and the presence of an epidural abscess (HR 1.82, 95% CI 1.06-3.13, P = 0.030) were independently associated with failure of antibiotic treatment. CONCLUSION: Antibiotic treatment failed in 29% of patients; diabetes, current other osteomyelitis, and having an epidural abscess were independently associated with failure of antibiotic treatment. LEVEL OF EVIDENCE: 3.