Tag: statistics

Turk Neurosurg. 2023 Mar 17. doi: 10.5137/1019-5149.JTN.43361-23.4. Online ahead of print.

ABSTRACT

AIM: To evaluate the optimal timing and outcome of fluoroscopically guided transforaminal epidural steroid injections (TFESI) for the management of radicular pain due to extruded lumbar disc herniation (LDH).

MATERIAL AND METHODS: In this clinical study, 305 individuals received fluoroscopically guided TFESI for the management of radicular pain due to extruded LDH. Preprocedural and 12-week postprocedural Visual Analog Scale (VAS) scores measuring radicular pain were statistically compared. The neurological conditions of the patients and the complications of the procedure were also recorded.

RESULTS: The intensity of radicular pain evaluated by the mean preprocedural and 12-week postprocedural VASs were 87.65 ± 5.59 and 22.81 ± 4.01, respectively. The P value was p:0.001 (p 0.05) and t value was 119.01. A correlation was noted between the short duration of symptoms before the procedure and the effectiveness of the procedure. After 12 weeks of the procedure, 32 of the 58 patients showed improvement in a neurological deficit. There was no major complication. Nine patients required lumbar disc surgery after the procedure.

CONCLUSION: This clinical research demonstrated that TFESI for the management of extruded LDH may alleviate radicular pain and may decrease the neurological deficit and that it is more effective when performed at the earliest possible time point.

PMID:36951037 | DOI:10.5137/1019-5149.JTN.43361-23.4

Turk Neurosurg. 2023 Jan 18. doi: 10.5137/1019-5149.JTN.42463-22.2. Online ahead of print.

ABSTRACT

AIM: In the surgical treatment of intracranial arachnoid cysts (IACs), microsurgical fenestration (MF), endoscopic fenestration (EF), cystoperitoneal shunt (CPS), and combinations of these techniques can be used. This study aims to compare volumetric changes of IAC in different surgical techniques.

MATERIAL AND METHODS: Sixty-six patients who underwent IAC surgery in our department between 2010 and 2020 were studied retrospectively. Based on the surgical technique, clinical and volumetric changes, postoperative complications, recurrence rates, and length of hospital stay were statistically compared.

RESULTS: MF was performed on 32 (48.5%) patients, EF on 17 patients, CPS on 11 patients, and EF + CPS in six patients. The mean IAC volume change rate was 68.54 mL, and the mean cyst volume change rate was 40.68%. The MF technique produces a significantly greater mean cyst volume change than the EF technique. The mean volume change in sylvian IAC is 4.8 times greater than in posterior fossa IAC, a significant difference. The mean cyst volume change is four times greater in patients with skull deformity than in patients with balance loss, and this difference is statistically significant. In patients with cranial deformity, the mean cyst volume change is 2.6 times greater than in patients with neurological dysfunction. This difference is also statistically significant. The volume of IAC decreased more in patients with postoperative complications, with a significant difference between the postoperative complication and the change in IAC volume.

CONCLUSION: MF can achieve better volumetric reduction in IAC, particularly in patients with sylvian arachnoid cysts. However, more volumetric reduction increases the risk of postoperative complications.

PMID:36951036 | DOI:10.5137/1019-5149.JTN.42463-22.2

Turk Neurosurg. 2023 Jan 2. doi: 10.5137/1019-5149.JTN.40154-22.3. Online ahead of print.

ABSTRACT

AIM: To determine the clinically significant association between pneumatization types of the sphenoid sinus (SS) and protrusion/dehiscence of the optic nerve (ON) and the internal carotid artery (ICA).

MATERIAL AND METHODS: This prospective cross-sectional study was conducted between November 2020 and April 2021 at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi. This study examined 300 computed tomography (CT) PNS patients aged 18-60 years. The forms of SS pneumatization, extent of pneumatization to the greater wing (GW), anterior clinoid process (ACP), and pterygoid process (PP), as well as the protrusion/dehiscence of the ON and ICA were examined. A statistical relationship was identified between pneumatization type and protrusion/dehiscence of the ON and ICA.

RESULTS: The study included 171 men and 129 women with an average age of 39.28±10.9 years. The most commonly encountered pneumatization type was postsellar (63.3%), followed by sellar (27.3%), presellar (8.7%), and conchal (0.75%). The most frequent extended pneumatization was observed up to PP (44%), followed by ACP (31.33%), and GW (16.67%). The rate of dehiscence of the ON and ICA was less than that of protrusion of the same structures. The association between postsellar and sellar pneumatization types and protrusion of the ON and ICA was statistically significant (p 0.001), with the postsellar type showing more protrusions of the ON and ICA than the sellar type.

CONCLUSION: The pneumatization type of SS has a significant impact on the protrusion/dehiscence of adjacent vital neurovascular structures and should be mentioned in CT reports to alert surgeons for any disastrous intraoperative complications and outcomes.

PMID:36951035 | DOI:10.5137/1019-5149.JTN.40154-22.3

Turk Neurosurg. 2022 Nov 30. doi: 10.5137/1019-5149.JTN.42287-22.2. Online ahead of print.

ABSTRACT

AIM: The current study aims to elucidate the role of the TIR-domain-containing adaptor-inducing interferon-β (TRIF) dependent pathway in intervertebral disc degeneration (IVD).

MATERIAL AND METHODS: 88 adult male patients with low back pain (LBP) (+/- radicular pain) were further evaluated by magnetic resonance imaging (MRI) with surgical indication for microscopic lumbar disc herniation (LDH). Preoperatively, patients were classified according to Modic Changes (MC), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and the presence of radicular pain additional to the LBP.

RESULTS: The age of the 88 patients ranged from 19 to 75 years (mean: 47.3 ± 19.6 years). 28 of the patients were evaluated as MC I (31.8%), 40 as MC II (45.4%), and 20 as MC III (22.7%). The majority of patients (81.8%) had radicular LBP, while 16 patients (18.1%) had only LBP. Predominantly, 55.6% of all patients were taking NSAIDs. Levels of all adaptor molecules were highest in the MC I group and lowest in the MC III group. The levels of IRF3, TICAM1, TICAM2, NF-kB p65, TRAF6, and TLR4 were significantly increased in the MC I group compared to the MC II and MC III groups. The variations of the individual adaptor molecules showed no statistically significant difference in the use of NSAIDs and radicular LBP.

CONCLUSION: As a result of the impact assessment, the current study clearly demonstrated for the first time that the TRIF-dependent signalling pathway plays a crucial role in the degeneration process in human lumbar intervertebral disc specimens.

PMID:36951033 | DOI:10.5137/1019-5149.JTN.42287-22.2

Turk Neurosurg. 2022 Jul 27. doi: 10.5137/1019-5149.JTN.40660-22.2. Online ahead of print.

ABSTRACT

AIM: To analyze changes in the lumbosacral angle in children with tethered cord syndrome before and after spinal cord untethering surgery, and to determine the clinical value of such changes at the last follow-up.

MATERIAL AND METHODS: We retrospectively analyzed 23 children over 5 years old who were treated with spinal cord untethering in our hospital from January 2010 to January 2021 and who had complete medical data. X-rays were used to examine the child’s spine preoperatively, postoperatively, and at follow-up with frontal and lateral radiographs, and lumbosacral angle data were measured and analyzed.

RESULTS: A total of 23 children aged 5-14 years had their lumbosacral angles measured and analyzed with a postoperative followup of 12-48 months. The mean preoperative lumbosacral angle was 70.30 ± 9.04°, the mean postoperative lumbosacral angle was 63.34 ± 5.60°, and the mean lumbosacral angle at the last follow-up was 61.61 ± 9.14°. There was a statistically significant reduction in the lumbosacral angle in the children postoperatively and at the last follow-up compared to the preoperative period (p=0.002; p=0.001).

CONCLUSION: Spinal cord untethering can improve the inclination of the lumbosacral angle in children older than 5 years with tethered cord syndrome.

PMID:36951019 | DOI:10.5137/1019-5149.JTN.40660-22.2

Turk Neurosurg. 2022 Jul 27. doi: 10.5137/1019-5149.JTN.40860-22.1. Online ahead of print.

ABSTRACT

AIM: Closure of bilateral cranial defects using custom-made implants is challenging for neurosurgeons due to enlarging defect areas and challenges in developing materials or techniques such as mirror imaging. This study presents the outcomes of the simultaneous closure of bilateral cranial defects using custom-made three-dimensional (3D) titanium implants.

MATERIAL AND METHODS: Demographic data of 26 patients with bilateral cranial defects who underwent cranioplasty using the 3D custom-made titanium implants in our clinic between 2017 and 2022 were retrospectively reviewed. Data on the area of cranium defect, the time interval between last cranial surgery and cranioplasty, postoperative complications, etiology of the cranium defect, and hospitalization of the patient were statistically evaluated.

RESULTS: The incidence of bilateral cranioplasty was 19.11%. The gender distribution of patients was 4 (15.4%) female and 22 (84.6%) male, with a mean age of 29.08 ± 14.65 years. The mean defect area was 35.0 ± 19.03 and 29.24 ± 22.51 cm2 on the right and left sides, respectively. The etiology of the cranium defect was gunshot wounds in 12 patients, and 14 patients had a history of trauma-related injuries such as falls and vehicle accidents. Eight patients had a history of failed cranioplasty with autologous bone. Postoperative complications were wound dehiscence in two patients and diffuse cerebral edema in one patient. No mortality was recorded.

CONCLUSION: The custom-made cranioplasty is feasible for simultaneous closure of bilateral cranial defects. Many complications can be prevented by careful preoperative evaluation before surgery and an appropriate implant selection for the patient.

PMID:36951018 | DOI:10.5137/1019-5149.JTN.40860-22.1

Minerva Dent Oral Sci. 2023 Mar 23. doi: 10.23736/S2724-6329.23.04764-2. Online ahead of print.

ABSTRACT

BACKGROUND: Several types of suture materials are available for oral surgery. However, the most used non-resorbable suture in oral surgery is 3/0 silk. The aim of the present study was to compare the effectiveness of knotless/barbed sutures with silk sutures during the postoperative period after the third molar surgery in terms of clinical and microbiological parameters.

METHODS: The study comprised 38 patients who underwent surgical extraction of a mandibular impacted third molar. The patients were divided into two groups. The mucoperiosteal flap was closed using 3/0 knotless/barbed sutures for the test group and 3/0 silk sutures for the control group. The duration of suturing was recorded during surgery. Pain level, postoperative edema, and trismus were measured at 3 and 7 days after surgery. The status of plaque formation on the sutures was scored using the Plaque Index at 3 and 7 days after the surgery. At 7 days, the suture materials were removed and submitted to the laboratory for microbiological analysis. The level of pain during suture removal was also recorded by a Visual Analog Scale.

RESULTS: The duration of suturing in the barbed sutures group was found significantly lower than in silk sutures (P<0.05). There was no significant difference between the suture types in terms of trismus and edema at 3 and 7 days after surgery (P>0.05). On the third day after surgery and during suture, removal pain scores were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). The Plaque Index values of the barbed sutures were statistically significantly lower than that of the silk sutures at 3 and 7 days after surgery (P<0.05). Aerobic, anaerobic, and aerobic/anaerobic mean colony forming units (CFUs) were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05).

CONCLUSIONS: Barbed sutures increase the ease of operation and patient comfort with less postoperative pain than silk sutures. Additionally, less plaque accumulation and lower bacterial colonization were found on the barbed/knotless sutures than on the silk sutures.

PMID:36951010 | DOI:10.23736/S2724-6329.23.04764-2

J Eur Acad Dermatol Venereol. 2023 Mar 23. doi: 10.1111/jdv.19060. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence for the association between psoriasis and uveitis according to the severity of psoriasis including psoriatic arthritis (PsA) and type of uveitis is lacking, and there are no data on the frequency or timing of recurrence of uveitis in patients with psoriasis.

OBJECTIVES: We aimed to evaluate the risk of first-occurrence and recurrence of uveitis in patients with psoriasis in the Korean population. We further evaluated the risk of uveitis according to the severity of psoriasis, comorbidity of PsA, and location of uveitis.

METHODS: In a nationwide retrospective cohort study, we compared 317,940 adult patients who had psoriasis with 635,880 matched controls. Incidence rates (IRs) and estimated IR ratios of the first occurrence and recurrence of uveitis were calculated using survival analysis and Poisson regression, respectively.

RESULTS: The rate of uveitis incidence and uveitis recurrence in patients with psoriasis were 1.18 and 2.31 per 1,000 person-years, respectively. Compared with the controls, the IR ratios of development and recurrence of uveitis in patients with psoriasis were 1.14 (95% CI 1.08, 1.2) and 1.16 (95% CI 1.12, 1.21), respectively. The recurrence rate of uveitis was highest within 3 years after the onset of psoriasis. The corresponding IR ratios for uveitis recurrence in patients with mild psoriasis, severe psoriasis, and PsA were 1.11 (1.06, 1.16), 1.24 (1.16, 1.33), and 1.49 (1.31, 1.7), respectively. Patients with psoriasis had an increased risk of recurrence of anterior uveitis, and patients with both psoriasis and PsA had an increased risk of recurrence of both anterior and pan-uveitis.

CONCLUSIONS: Patients with psoriasis had a higher risk of both development and recurrence of uveitis, especially with severe psoriasis and PsA. The timing of uveitis recurrence was related to the onset of psoriasis, and patients who had psoriasis with PsA had an increased risk of vision-threatening pan-uveitis.

PMID:36950978 | DOI:10.1111/jdv.19060

Rev Esp Salud Publica. 2023 Mar 22;97:e202303022.

ABSTRACT

OBJECTIVE: One in one hundred minors has some mental health problem. Symptomatology varies according to gender. Most research has been conducted with the general population. The objective of this paper was to analyze the moderating role of sex in the presence of internalizing (emotional disorders, anxiety and depression) and externalizing symptomatology (behavioral disorders and hyperactivity) in childhood, as well as to compare the general population with the clinical population.

METHODS: A descriptive cross-sectional study was conducted with 552 boys and girls between ten and twelve years of age, 94 mental health patients and 458 schoolchildren. Participants completed self-report measures: Strengths and Difficulties Questionnaire (SDQ-Cas), Modified Depression Scale (MDS) and a sociodemographic information questionnaire. For data analysis, descriptive statistics and multivariate and univariate mean comparisons were performed by parametric and re-sampling procedures.

RESULTS: Statistically significant differences were observed between clinical and school population groups in externalizing, internalizing and depressive symptomatology (p<0.001). No sex differences were found in externalizing and depressive symptomatology. Sex differences were found in internalizing symptoms (p<0.001, p_boot<0.001) as well as group interaction effects (p=0.016), girls had higher scores than boys, with greater differences in the clinical group (p<0.001, p_boot=0.003).

CONCLUSIONS: Research with mental health patients is essential to verify the existence or not of differences with the general population as well as differences by sex, which will allow adapting preventive and intervention strategies to each case.

PMID:36950951

Surg Innov. 2023 Mar 22:15533506231164895. doi: 10.1177/15533506231164895. Online ahead of print.

ABSTRACT

Background. Single anastomotic surgeries can increase the risk of reflux, marginal ulceration, and gastrointestinal complications. Braun anastomosis prevents bile reflux after gastric resection and gastrojejunal anastomosis surgeries. The present pilot study evaluated Braun’s efficacy in a single anastomosis sleeve ileal (SASI) bypass surgery.Methods. 28 patients with a history of SASI bypass surgery from October 2017 to September 2021 were included in the study. Patients were divided into 2 groups based on having Braun anastomosis to this surgical procedure; group A: underwent SASI bypass without Braun anastomosis; group B: underwent SASI bypass with Braun anastomosis. The surgical complications in terms of bile reflux, marginal ulcer, reflux esophagitis, and gastritis were evaluated and compared between the groups. Results. Bile reflux and reflux esophagitis were seen more in group A than in group B (37.5% vs 8.3% and 18.8% vs 8.3%, respectively). In contrast, 2 patients (16.7%) in group B had marginal ulcers compared to 1 (6.3%) in group A. Also, gastritis was seen in 1 patient in each group (6.3% in group A vs 8.3% in group B). However, the differences were not statistically different. Conclusions. Braun anastomosis is probably an effective procedure to reduce bile reflux, a concern of SASI bypass. Besides, further studies with a larger study population are needed.

PMID:36949026 | DOI:10.1177/15533506231164895