Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis.

Background: An anterior cruciate ligament (ACL) tear is a risk factor for early osteoarthritis (OA) onset. Generally, ACL reconstruction (ACLR) is associated with better outcomes. However, there is a lack of evidence regarding the effect of operative versus nonoperative treatment for preventing premature knee OA in isolated ACL tears while achieving good functional outcomes. Purpose/Hypothesis: The purpose of the study was to compare the outcomes of ACLR to primarily nonoperative management of isolated ACL tears. It was hypothesized that the outcomes between treatment types would be similar. Study Design: Systematic review; Level of evidence, 3. Methods: This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registration No. CRD42021285901) and was conducted according to the Cochrane Handbook guidelines. We systematically searched for randomized and nonrandomized studies that compared ACLR with nonoperative treatments in isolated ACL tears in 3 databases until October 25, 2021. The risk of bias and quality of evidence of the included studies was assessed in accordance with the Cochrane guidelines. The primary outcome was radiologic signs of OA, and the secondary outcomes were functional parameters. Using the common effects model, we calculated pooled mean differences (MDs) and odds ratios (ORs) with 95% CIs. Results: Five studies-2 randomized controlled trials (RCTs) and 3 retrospective non-RCTs-were included. There was a moderate risk of bias in 2 studies and a serious risk of bias in 1 study. The quality of evidence was rated low because of the higher risk of bias and inconsistency. Nonoperatively treated knees showed a trend toward lower odds of developing radiological signs of OA (OR, 1.84 [95% CI, 0.90 to 3.75]); however, surgically reconstructed knees had significantly better stability (MD, -2.44 [95% CI, -3.21 to -1.66 ]) and a trend toward better but clinically not meaningful Lysholm scores (MD, 2.88 [95% CI, -1.09 to 6.85]). The qualitative synthesis showed that surgical reconstruction was protective against subsequent injuries but not superior when returning to previous activity levels or various functional tests. Conclusion: Findings indicated that there is no certain evidence that ACLR for an isolated ACL tear is superior to nonoperative treatment. Clinicians should consider nonoperative treatments with a well-designed rehabilitative program as a primary option. However, these findings must be interpreted with caution because of low study quality and high risk of bias.

Effects of Temperature, Axial Ligand, and Photoexcitation on the Structure and Spin-State of Nickel(II) Complexes with Water-Soluble 5,10,15,20-Tetrakis(1-methylpyridinium-4-yl)porphyrin.

Water-soluble metalloporphyrins, depending on the metal center, possess special spectral, coordination, and photochemical features. In nickel(II) porphyrins, the Ni(II) center can occur with low-spin or high-spin electronic configuration. In aqueous solution, the cationic nickel(II) complex (Ni(II)TMPyP4+, where H2TMPyP4+ = 5,10,15,20-tetrakis(1-methylpyridinium-4-yl)porphyrin), exists in both forms in equilibrium. In this study, an equilibrium system involving the low-spin and high-spin forms of Ni(II)TMPyP4+ was investigated via application of irradiation, temperature change, and various potential axial ligands. Soret band excitation of this aqueous system, in the absence of additional axial ligands, resulted in a shift in the equilibrium toward the low-spin species due to the removal of axial solvent ligands. The kinetics and the thermodynamics of the processes were also studied via determination of the rate and equilibrium constants, as well as the ΔS, ΔH, and ΔG values. Temperature increase had a similar effect. The equilibrium of the spin isomers was also shifted by decreasing the solvent polarity (using n-propanol) as well as by the addition of a stronger coordinating axial ligand (such as ammonia). Since triethanolamine is an efficient electron donor in Ni(II)TMPyP4+-based photocatalytic systems, its interaction with this metalloporphyin was also studied. The results promote the development of efficient photocatalytic systems based on this complex.

A successfully operated case of a rare type of incarcerated diaphragmatic hernia / Bochdalek-hernia egy felnottben

The authors present a successfully operated case of a Bochdalek hernia in an adult. This type of diaphragmatic hernia mostly occurs in infants, it is a rarity in adults. A 41-year-old woman was admitted with emergency because of right upper abdominal and dorsal pain. In her previous history, there was not any trauma or known congenital diaphragmatic defect. Her laboratory tests were normal except for anaemia. Chest X-ray was negative, abdominal X-ray showed dilated bowels between the liver and the diaphragm with suspicion of free abdominal air. Chest and abdominal computed tomography scan revealed a right dorsal diaphragmatic hernia with an incarcerated part of small intestine. Physical examination revealed no abdominal tenderness, but she had severe dorsal and upper abdominal pain. She underwent an urgent operation. An abdominal approach (upper horizontal laparotomy) was performed. No hernia sac was present. Approximately 40 cm incarcerated ileum was removed from the thoracic cavity. Due to the immediate expansion of the lungs, thoracostomy tube was not inserted. The diaphragm was sutured, the necrotised small bowel was resected and an end-to-end anastomosis was performed. During the post-operative period, small pneumothorax occurred, but no intervention was needed, it healed spontaneously. The patient was discharged on the 10th day after operation.

Petersen hernia, a rare type of hernia in our department / Petersen-hernia, egy ritka sérvtípus megjelenése osztályunkon

61 years old female with previous surgical history of Roux-en-Y gastric bypass (3 years ago) and earlier hysterectomy admitted to our surgical department with clinical and radiological signs of small intestinal obstruction. Urgent intervention had been performed with following findings: Petersen herniation of alimentary tract including the ­ biliopancreatic tract and the small bowel extending to the midpart of the terminal ileum. Viability of herniated intestinal tract had been confirmed, and reposition of herniated parts through the Petersen hernia had been done. Closure with non-absorbable running suture of the gap between the transverse colon and the mesenteriun of the alimentary limb had been performed. Patient was fit for discharge on the fifth postoperative day.

Colon cancer during the coronavirus pandemic ­ recovery from COVID-19 pneumonia of an elderly woman with multiple co-morbidities / Vastagbéldaganat a koronavírusjárvány idején - idos, multimorbid nobeteg COVID-19-tüdogyulladásának gyógyulása: (A COVID­19-pandémia orvosszakmai kérdései)

COVID-19, caused by the new coronavirus, can lead to acute respiratory failure or even sepsis. Patients with multiple co-morbidities are more likely to develop these severe forms of the disease. The aim of this report is to highlight cases the analysis of which might help discover factors that influence the course and mortality of COVID-19 pneumonia. The past medical history of our elderly patient (75-year-old female) includes rectum resection with intraoperative cardiac arrest and successful resuscitation. In January 2020, the patient was diagnosed with adenocarcinoma of the ascending colon and concomittant pulmonary embolism. Following 6 weeks of therapeutic dose low-molecular-weight heparin (LMWH) treatment, the cancerous colonic section was resected. The patient arrested intraoperatively but was successfully resuscitated. On post-operative day 15, the patient developed arterial anastomosis bleed, which necessitated acute right-sided hemicolectomy. Post-operatively she became pyrexial and COVID-19 was confirmed, but later became apyrexial with symptomatic treatment. Subsequently, the patient developed partial anastomosis insufficiency, which resolved with conservative management. Following three negative SARS-CoV-2 tests, she was successfully discharged from hospital. It is worthy of note that due to the active anastomosis bleed the angiotensin-converting enzyme (ACE)-inhibitor treatment was stopped, and later the patient got infected with SARS-CoV-2. A long-lasting LMWH therapy was performed. The timely management of colorectal carcinoms remains important even during an epidemic. The appropriate treatment of these patients during the pandemic presents a great challenge for all doctors, but, as shown in our case report, surgical treatment of even those with multiple co-morbidities can be successful. Orv Hetil. 2020; 161(25): 1059-1062.

[Rare lymphoma causing acute abdomen - Case study]. / Akut hasi panaszokat okozó ritka limfóma ­ Esettanulmány.

Introduction: Lymphomas are rare entities in the gastrointestinal tract. The so-called Burkitt-like lymphoma belongs to the non-Hodgkin lymphoma group, and it is quite an aggressive, rapid-growing, but potentially curable disease. Surgeons mostly encounter with this tumor as a solid mass which causes abdominal pain, or as a cause of bowel obstruction or perforation. Our aim was to present a case, when Burkitt-like lymphoma caused acute abdominal symptoms without alarming complaints, obstruction or perforation. Furthermore we review and summarize the relevant literature data on this topic. Regarding our case we can claim that histological investigation and multidisciplinary approach are essential to make the diagnosis and to start the treatment as early as possible.

A relation between cell cycle and intestinal metaplasia in oesophageal biopsies using optical and digital microscopy.

Protein expression changes in relation to cell cycles provide important information, and it may represent a new method for an early diagnosis of metaplasia - dysplasia - adenocarcinoma sequence. We investigated potential changes in cell cycle genes such as protooncogenes (PCNA, EGFR), tumour suppressor gene (p53), apoptotic TUNNEL (Tdt mediated dUTP nick and labelling) gene, as well as small intestinal mucus antigen (SIMA) and large intestinal mucus antigen (LIMA), which accumulates in metaplastic epithelium due to the inflammatory process in routine oesophageal biopsies using immunohistochemistry. Oesophageal biopsies were taken from patients with Barrett's oesophagus (n = 30), reflux oesophagitis (n = 30), healthy oesophagus (n = 30) and healthy cardia (n = 10). Immunohistochemical signalling was carried out by Streptavidin-Biotin-AEC (aminoetil-carbazol). Expression of PCNA was statistically significantly lower in healthy oesophagus (p < 0.05) versus reflux oesophagitis and Barrett's oesophagus. However, no significant change was detected in the expression of SIMA and LIMA in intestinal metaplasia. Further, EGFR, p53 and TUNNEL levels were significantly different in healthy versus Barrett's oesophagus. Manual counting using virtual microscopy was comparable with the result using conventional light microscopy, but the former is significantly quicker. There was no difference between manual and automated cell counting (p > 0.05).