Topical Lidocaine And Or/ Intravenous Midazolam Before Radial Coronary Angiography To Prevent Radial Artery Spasm.

Objectives: To investigate the possible advantage of topical lidocaine and intravenous midazolam in preventing spasm and pain related to the radial artery. Method: The prospective, comparative study was conducted at the catheterization laboratory of the cardiology department Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised adult patients of either gender who were due to undergo coronary angiography and/or percutaneous coronary intervention for different indications. The patients were randomised control group I which was administered a cocktail of nitroglycerine, verapamil and heparin, intervention group II which was administered the control cocktail plustopical lidocaine, group III which was administered the control cocktail plus midazolam intravenously, and group IV which was administered the control cocktail plus topical lidocaine and intravenous midazolam. The groups were compared for frequency of radial artery spasm, accesssite cross-over and the difference in occurrence as well as procedure events, including the puncture number, time and complications. Data was analysed using SPSS 25. RESULTS: Of the 120 patients, there were 30(25%) in each of the 4 groups. Overall, there were 72(60%) males and 48(40%) females. Gender and mean age were not significantly different among the groups (p>0.05). Spasm of the radial artery occurred in 22(18.3%) patients, with higher incidence in the group I 12(40%). The median visual analogue scale score was higher in patients with radial artery spasm patients (p<0.001). The groups showed no significant differences in terms of frequency related to ad hoc percutaneous coronary intervention, contrast volume and fluoroscopy time (p>0.05), while they showed a significant difference in puncture time (p<0.05). Significant differences were noted among the groups in the incidence of radial artery spasm, visual analogue scale scores, requirement of multiple punctures, and the number of indicated punctures (p<0.05). Access site cross-over was more in the group I, while age, complication rates, visual analogue scale score, incidence of multiple punctures, and puncture time were significantly higher in patients with radial artery spasm (p<0.05). CONCLUSIONS: Cutaneous analgesia and procedural sedation before transradial access for coronary interventions were found to be associated with a substantial reduction in radial artery spasm and procedure-related discomfort.

Hand-Grip Strength and Return to Heavy Manual Work at a Mean 5-Year Follow-up After Arthroscopic Release of Recalcitrant Lateral Epicondylitis.

BACKGROUND: Lateral epicondylitis of the elbow is a common degenerative disorder in middle-aged patients. Surgery is reserved for patients who do not respond to nonoperative treatment. PURPOSE: To evaluate hand-grip strength and return to heavy manual activities in patients engaged in work requiring heavy lifting after arthroscopic release of refractory lateral epicondylitis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study included consecutive patients who underwent arthroscopic release of the extensor carpi radialis brevis tendon to treat recalcitrant lateral epicondylitis of the elbow, with a minimum 48-month follow-up. Functional outcome measures included assessment of hand-grip strength, visual analog scale for pain, and Mayo elbow performance score. The recorded measurements were compared at postoperative 1 and 6 months and the final assessment. Pre- and postoperative data were compared using the paired t test, and the various postoperative assessments were compared using 1-way analysis of variance. RESULTS: A total of 22 patients (mean ± SD; age, 34.6 ± 5.9 years) with a mean follow-up of 60.5 ± 4.7 months were included in our study. There were highly significant improvements between preoperative and 1-month postoperative results regarding hand-grip strength (17.5 ± 4.1 kg to 34.4 ± 6.8 kg), visual analog scale score for pain (7.86 ± 1.2 to 1.8 ± 1.09), and Mayo score (57.1 ± 7.9 to 89.3 ± 4.9; P < .00001 for all). Significant improvements were found on all 3 functional measures between 1 and 6 months postoperatively (P ≤ .05 was statistically significant), and there were nonsignificant improvements on all measures from 6-month to final follow-up. The patients regained 96.4% of their hand strength as compared with the unaffected side and returned to their previous activities without reporting serious complications. CONCLUSION: Minimally invasive arthroscopic release of recalcitrant lateral epicondylitis of the elbow provided a satisfactory functional result, as shown by regaining of hand-grip strength in patients engaged in heavy manual occupations without significant morbidities.

Effect of Guiding Sleeve Design on Intraosseous Heat Generation During Implant Site Preparation (In Vitro Study).

PURPOSE: To compare the effect of different designs of guiding sleeves on heat generation during implant surgery while using different cooling fluid temperatures. MATERIAL AND METHODS: Temperature measurements were performed during guided implant site preparation in bovine rib samples using two K- type thermocouples at 2 mm and 8 mm depths. Three groups were tested according to guiding sleeve design: conventional cylindrical sleeve, open C-shaped sleeve, and modified cylindrical sleeve. Each group was irrigated with three fluid temperatures: 10°C, 15°C, and 20°C. The groups were compared using Kruskal Wallis test followed by post hoc comparisons with Bonferroni correction. The level of statistical significance was set at p = 0.05. RESULTS: Surgical guides with conventional cylindrical sleeve design showed significantly higher heat generation during implant site preparation than guides with both the open C-shaped and the modified cylindrical sleeve designs at both 2mm and 8mm depths. The difference between C-shaped and modified cylindrical sleeves was not significant in any group. Using pre-cooled irrigation fluids (10°C and 15°C) reduced the generated heat; however, the differences within the same group were not statistically significant. CONCLUSIONS: The use of a surgical guide with the conventional cylindrical sleeves led to higher heat generation than other sleeve designs, which might reach or near the critical threshold of bone thermal necrosis. Using surgical guides with open sleeves or modified cylindrical sleeves could be helpful in irrigation fluid delivery and decreasing the generated heat.

Short term results of osteotomy-sparing technique in management of moderate hallux valgus using TightRope system.

BACKGROUND: Currently, correction of the first intermetatarsal angle associated with hallux valgus is done using two main categories of surgeries either a distal or a proximal first metatarsal osteotomy. The osteotomy-sparing technique using TigthRope ®device was developed to manage hallux valgus avoiding osteotomy complications. Our hypothesis was that osteotomy sparing technique using TightRope® implant would be suitable for moderate hallux valgus in young adult patients with strong larger bones giving good results with minimal complications. METHODS: 26 male patients (30 feet) with age range 18-35 years (average 27.04 ±â€¯4.6) with moderate hallux valgus deformity were managed with osteotomy-sparing method. All patients were assessed clinically using the visual analogue scale (VAS) and American Orthopedic Foot and ankle score (AOFAS) and radiological using hallux valgus angle (HVA), first inter metatarsal angle (IMA) and sesamoids position. P value <0.05 was statistically significant. RESULTS: The mean follow up time was 19.5 ±â€¯4.1 (12-27) months. The mean IMA, HVA and AOFAS score improved from 14. 2 ±â€¯2.8°, 33.4 ±â€¯7.6° and 42.6 ±â€¯6.3 points preoperatively to 8.2 ±â€¯2.3°, 13.6 ±â€¯5.4° and 85.8 ±â€¯6.8 points postoperatively, respectively. All were statistically significant. Superficial infection occurred in one case and overcorrection in another with no other complications. CONCLUSION: Osteotomy-sparing technique using TightRope device is effective in the management of moderate hallux valgus provided that proper patient selection, adequate surgical technique, and proper postoperative protocol are followed.

Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials.

PURPOSE: since the first meniscal allograft transplantation in 1984, thousands of patients with postmeniscectomy symptoms have been treated by allograft replacement. This study aims the collection, presentation and meta-analysis of published trials reporting outcomes of meniscal allograft transplantation to establish its safety and reproducibility. METHODS: a literature search was conducted and the abstracts of all English-language trials with a more than 6 months' clinical, radiological and/or histological follow-up in human subjects were reviewed. Forty-four trials representing 1,136 grafts in 1,068 patients were analyzed. To assess the methodological quality of the collected data, original and modified Coleman methodology scores were determined for all included papers. RESULTS: the outcomes of 678 medial and 458 lateral grafts in 613 male, 265 female and 190 nondefined patients with a mean age of 34.8 years were presented. The outcome was assessed using 12 scoring systems, 4 imaging modalities, second-look arthroscopy and/or histological analysis. Whatever the follow-up period and the scoring system used, patients continuously showed clinical improvement. The average original Coleman scores were 45.9 ± 8.4 (range 25-59). The average modified Coleman scores were 43.7 ± 9.1 (range 24-62). CONCLUSIONS: all studies reported a continuously satisfactory outcome with restoration of working capacity in these active patients. The complication and failure rates are considered acceptable by all authors. Salvage procedures included osteotomy and arthroplasty without secondary difficulties. Meniscal allograft transplantation can be considered as safe and reliable for the treatment of refractory postmeniscectomy symptoms in selected patients. LEVEL OF EVIDENCE: IV.