The role of 18F-fluorodeoxyglucose PET/computed tomography in the diagnosis and monitoring of large vessel vasculitides - a review article.

In the last two decades, advancements in positron emission tomography (PET) technology have increased the diagnostic accuracy of patients with large-vessel vasculitis (LVV). Numerous systematic reviews and meta-analyses have been conducted, and patients suspected of having LVV can be diagnosed earlier with 18F-FDG PET. Two subtypes, giant cell arteritis (GCA) and Takayasu arteritis (TA), will progress when their response to corticosteroids and enhanced immunosuppression is inadequate. In the majority of patients, disease activity cannot be monitored solely through laboratory procedures; consequently, glucose metabolism may be a source of potential biomarkers. In this article, we discuss the current state of 18F-FDG PET/CT imaging standards.

The diagnostic value of the computed tomography scan and ultrasonography in acute appendicitis.

The most prevalent cause of emergency abdominal surgery is acute appendicitis. Ultrasonography is safe and widely available, although it's operator-dependent and difficult for people with massive bodies. Computed tomography (CT) scans are more accurate than ultrasonography, with a 93 to 98% accuracy rate. The goal of this investigation is to evaluate the diagnostic value of ultrasonography and CT scanning for acute appendicitis. This is a cross-sectional study that was performed on 231 patients with suspected with acute appendicitis. The Alvarado score was initially used to diagnose acute appendicitis. A radiologist performed abdominal ultrasonography on all patients. If the results of the ultrasonography were negative or unclear, a CT scan was performed using oral contrast. Finally, all ultrasonography and CT scan data were reevaluated by an experienced radiologist and compared to the patient's final diagnosis in the case of surgery and pathology results. Comparisons between the two groups were performed. The sensitivity, specificity, and positive and negative predictive value of ultrasonography according to pathology results in patients with low clinical suspicion were 74.9%, 63.4%, 94.3%, and 67.6%, respectively. The sensitivity, specificity, positive and negative predictive value of CT scans based on pathology results were 87.9%, 81.8%, 94.7%, and 79.3%, respectively, in patients with low clinical suspicion. The CT scan results in female patients suspected of appendicitis were completely consistent with the pathology results. The CT scan demonstrated greater specificity and sensitivity in diagnosing acute appendicitis compared to abdominal ultrasonography.

Open surgery versus percutaneous nephrolithotomy for management of staghorn calculi.

BACKGROUND: For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open surgery in different populations but these results were controversial. Here, we aimed to compare and evaluate the results of open surgery and PCNL in the treatment of staghorn stones. METHODS: This retrospective descriptive study was performed to compare the results of open surgery and PCNL in the treatment of staghorn stones in 2013-2021. A total of 360 participants were studied among the population. Demographic data of patients including age, gender, and comorbidities were obtained. We assessed variables including type of stone, serum creatinine, degree of hydronephrosis, and urine culture before the operation. All participants in our study were informed of the two surgical alternatives. RESULTS: The mean length of hospital stay in PCNL patients was 3.88 ± 1.76 and in open surgery patients was 5.858 ± 2.12 (P = 0.003). In 30 patients (13.9%) in the PCNL group and 27 patients (18.8%) in the open surgery group, bleeding necessitating blood transfusion was the only intraoperative complication. 309 patients (85%) had no residual stones at the time of discharge from the hospital, which was 81.9% (177 cases) in patients treated with PCNL and 91.6% (132 patients) in the open surgery group (P > 0.05). CONCLUSION: Staghorn calculi can be managed effectively with open surgery or PCNL. Given the reduced postoperative complication rate and higher stone-free rate, we believe open surgery is better technique for complicated staghorn stones with a high burden.

Evaluation of postoperative bracing on unstable traumatic lumbar fractures after pedicle screw fixation.

BACKGROUND: Fractures of the thoracolumbar and lumbar regions are very important. There is still debate on the use of braces after surgical operations. The current study aims to evaluate and report the outcomes of postoperative bracing following pedicle screw fixation in patients with thoracolumbar and lumbar fractures in Iran. METHODS: This is a clinical trial performed from 2012 to 2022 on 144 patients diagnosed with lumbar and thoracolumbar fractures. Demographic data of patients including age and gender were obtained. Patients' fractures were classified as Frankel (A to E) in terms of clinical and neurological manifestations. Patient's quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). All patients underwent surgical fixation of the fracture. Patients were then randomized into two groups using Random Allocation Software. The first group received post-operation bracing and the second group did not receive braces. Thus, radiographic and clinical evaluation data of 1, 3, and 12 months after surgery were used to determine bone fusion. RESULTS: The most common mechanisms of trauma included falling from a height in 99 patients (68.7%), vehicle accidents in 39 patients (27.1%), and the most common fracture sites were the L1 vertebrae in 73 patients (50.7%), 111 patients (77.1%) had burst fractures, and 105 patients (72.3%) had no neurological defects (Frankel E). At the beginning of the study, there were no significant differences between the two groups regarding the mentioned data, patients' QOL, and pain severity. All patients (100%) had early mobilization. Most patients (85.4%) did not report persistent back pain 12 months after surgeries. 90.2% returned to their daily activities and all patients (100%) had full fusion based on radiologic data. The QOL and pain severity of patients improved significantly compared to baseline (P < 0.001 for both). CONCLUSION: The use or non-use of braces did not affect the treatment results. As a result, patients who have received pedicle screw fixation for unstable thoracolumbar fractures do not require braces in the postoperative period.

The effectiveness of skin allografts in survival rate of patients with major burns.

BACKGROUND: Burns are still one of the most prevalent injuries in the world. Allograft is in high demand as a biological dressing for any superficial open wounds, not just burn victims. Skin allograft is the gold standard for treating burns in people who do not have enough skin to cover all of the injured areas of their bodies. Studies have shown that skin allografts are superior to topical antimicrobial dressings in partial thickness burns and can reduce complications and length of hospital stay in burn patients. However, to the best of our knowledge very few studies have investigated these results in our country. The aim of the current study is to evaluate and report the outcomes of skin allograft on burn patient survival in Iran. METHOD: This prospective clinical trial study was performed on patients admitted to the burn center of Imam Khomeini Hospital in Tehran between July 15, 2017 and April 27, 2021. The control group consisted of patients admitted to the burn ward who were not undergoing skin allografts. This group was matched with the case group in terms of sex, age, and percentage of burns. We compared the outcome of the study was the duration of hospitalization, and status of patients at discharge. The study protocol was approved by Iranian Registry of Clinical Trials (IRCT) under the code of IRCT2016112431074N1 (https://fa.irct.ir/trial/24517). RESULT: Overall, 112 patients in the case group and 224 patients in the control group were studied. The length of hospital stay in the case group (41.13±11.7) was considerably longer than the control group (24.6±12.1) (P<0.001), but the mortality rate in the two groups was not statistically different (P=0.633). The average survival time of case group (53 days, 95% CI=45-56) was higher than the control group (49 days, 95% CI=39-58) (P=0.012). Number of allograft usage (OR=0.038, 95% CI=0.142-0.945) and also Age (OR=1.03, 95% CI=1.005-1.070) were predictors of death. CONCLUSION: Although the use of skin allografts in large burns (more than 50%) reduced mortality in burn patients, their use in burns less than 50% has not been effective in reducing patient mortality. Due to the limited access to this valuable product, its use in burns less than 50% should be done with caution and, due to the limited access to skin allografts in most burn centers in Iran, patients with extensive burns (more than 50%) should be used as a priority.

Predictive value of number and volume of demyelinating plaques in treatment response in patients with multiple sclerosis treated with INF-B.

BACKGROUND: Multiple Sclerosis (MS) is an autoimmune, inflammatory disease of the central nervous system. Magnetic resonance imaging (MRI) findings are associated with disease clinical activity and response to treatment. This study aimed to evaluate the future value of plaque number and volume in MRI as radiological criteria in determining the treatment response to INF-B in patients with MS. METHODS: This is a cross-sectional study performed in 2016-2021 in Iran on patients with the newly diagnosed (less than one year) relapsing-remitting MS. Brain MRI was taken for all patients. The number and volumes of the MS plaques were evaluated from FLAIR images by the two radiologists. Patients were treated with INF-B1a with a dosage of 12 million units equal to 44 micrograms subcutaneously, three times per week. Patients were visited monthly by neurologists to examine their clinical status. After one year, the brain MRI was conducted with the similar characteristics to the beginning of the study, and the number and volume of MS plaques were measured again. RESULTS: The study population consisted of 33 males and 90 females with a mean age of 28.37 ± 6.29 years. The mean Expanded Disability Status Scale (EDSS) of the patients was 3.16 ± 0.23 at the beginning of the study. The specificity for a 50% reduction in the number and volume of plaques as two separate criteria was the same and equal to 100%. The sensitivity of the number and volume of plaques were 65.5% and 90.6%, respectively. In addition, considering 10% as the cut-off point of the number of plaques, the sensitivity of the number of plaques as a criterion was equal to the sensitivity of the plaque volume. CONCLUSION: The results of this study showed that imaging criteria provide a more objective tool for evaluating the effectiveness of treatment. These findings indicate that the number and volume of plaques could be two reliable MRI imaging criteria for assessing therapy response. The number of plaques was less accurate than the volume of plaques.

Comparison of surgical complications following hip hemiarthroplasty between the posterolateral and lateral approaches.

INTRODUCTION: Femur neck fractures are common fractures among the elderly. Hemiarthroplasty is a surgical choice for femur neck fractures in patients older than 70 years. This surgery is performed using two main methods: Posterolateral and Direct lateral. Here in this study, we aimed to evaluate and compare surgical and post-surgical complications of these two methods. MATERIALS AND METHODS: This retrospective study was performed on 154 patients with femur neck fractures between 2017-2021. All patients with femur neck fractures who had been under hemiarthroplasty entered this study. Data regarding complications such as dislocation, mortality, cause of mortality, repeated surgery and incidence of deep vein thrombosis (DVT) in both Posterolateral and Direct lateral surgical approaches were collected and analyzed. RESULTS: We indicated that there is no significant difference between the two surgical approaches regarding dislocation (P=0.06), mortality (P=0.598) and repeated operation (P=0.550). CONCLUSION: Taken together there are no significant differences between the two surgical approaches and we suggest that clinicians could decide based on their experiences and the clinical condition of patients.

Evaluation of femoral malrotation after intramedullary nailing.

BACKGROUND: Intramedullary nailing and closed reduction are one of the most important treatment strategies for femoral shaft fractures. Malrotation in the femoral shaft is a complication that requires exact investigations. Here we aimed to evaluate and report the outcomes of malrotation of femur in patients with femoral shaft fractures following antegrade intramedullary nailing. METHODS: In this cross-sectional study, 140 patients who had referred to Shahid-Beheshti Hospital in Abadan, Iran and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during a 6-year period from 2015 to 2021 were enrolled. Demographic information and disease-related information were collected. During operation, the patients were assessed clinically for malrotation of femur with 90° of the knee flection and with the hip in 0° flexion and then in the postoperative follow-up period, the patient was examined again and a computed tomography scan requested to identify the degree of malrotation of femur and the observers were unaware of the CT scan result at the time of the clinical examination. We also measured the amount of internal and external rotation while the patient in the lying supine position with 90° flexion in the knee and hip joint and lying prone position with hip extension. In CT imaging to determine the amount of malrotation of femur, the angle between a line drawn across the two femoral condyles in the posterior aspect and the femoral neck shows the amount of rotation. RESULTS: Degree of rotational deformity, less than 5°, 5 to 10° and 10 to 15° was less than 8.6%, 75.7% and 15.7% respectively and did not relate to age, sex, fracture location and activity of the patients (P>0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity (r=0.333 and P=0.005), which was stronger in women than men (r=0.336 in men and r=0.659 in women) (P<0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity was observed only in external malrotation of femur (r=0.541 and P=0.001). A poor inverse linear relationship was observed between clinically detected and CT detected torsional deformity with the age of the patients which the correlation of clinically detected was more than the CT detected (r in clinical examination =-0.285 and r in CT measurement =-0.246) (P<0.05). CONCLUSION: In this study, there was no femoral malrotation over 15° that was associated with clinical symptoms. However, a CT scan should be performed for accurate diagnosis and necessary measures but it does not seem necessary to perform in all patients.

One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration.

BACKGROUND: Tranexamic acid (TXA) in orthopedics has recently been gaining favor due to its efficacy and ease of use, both in intravenous (IV) and intraarticular (IA) usage. However, because of safety concerns with IV administration, there has been a growing interest in the IA use of TXA to prevent bleeding. MATERIALS AND METHODS: This study conducted a systematic review and meta-analysis that included 31 randomized, controlled trials in which the effect of systemic and topical TXA on total blood loss (TBL), rates of transfusion, and thromboembolic events was investigated. RESULTS: Compared to the control, the IA administration of TXA led to the significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and reduction of rate of thromboembolic events (p = 0.29). Compared to the control group, the IV administration of TXA resulted in significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and rate of thromboembolic events (p = 0.66). Although no significant differences in efficacy and safety between the IA and IV administration of TXA were found, the IA method was safer than the IV method in that it reduced rate of transfusion and thromboembolic events. CONCLUSION: This study showed that TXA leads to significant reductions in TBL and the rate of allogeneic transfusions. Generally, no significant difference was detected between IA and IV administration of TXA; however, more studies with focus on safety and efficacy are warranted.

What is the source of low back pain?

AIMS: Determining the source of low back pain (LBP) is still controversial. This study was designed to determine the source of LBP and its relations with age and gender. SETTINGS AND DESIGN: A retrospective chart review at Isfahan University of Medical Sciences, Isfahan, Iran. MATERIALS AND METHODS: A total of 1,125 patients were evaluated to determine the sources of their LBP with physical examinations, imaging, injections, and other laboratory examinations, if needed. The patients were divided into five groups based on their ages. Frequencies of the sources of pain were assessed in the five age groups, and the assessments were done separately by gender. STATISTICAL ANALYSIS USED: Independent t-test, analysis of variance (ANOVA), chi-square test. RESULTS: The patients enrolled in this study consisted of 527 males (46.8%) and 598 females (53.2%). The frequencies of the sources of pain were, in descending order, spine (689, 61.2%), no cause found (163, 14.5%), spine with sacroiliac joint (SIJ) (72, 6.4%), spine with hip (65, 5.8%), SIJ (60, 5.3%), hip (44, 3.9%), spine along with hip and SIJ (20, 1.8%), hip with SIJ (8, 0.7%), and other diseases (4, 0.4%). There were significant statistical differences between the genders and mean ages for different sources (P = 0.03 and 0.000, respectively). CONCLUSIONS: This study showed that the spine was the main source of LBP in all age groups. Physicians should always be alert for other sources in middle-aged and older patients. Future studies with long-term follow-up for determining the benefits of treatments are warranted.