Search Results (3,738)

Background: Compressive cryotherapy, which combines cold therapy with compression, has gained attention to relieve pain and swelling after the Knee arthroscopy. However, there is still limited evidence specifically related to its use after knee arthroscopy. Objective: This study investigated the efficacy of compressive cryotherapy in decreasing postoperative pain and swelling in patients following knee arthroscopy. Methods: A quasi-experimental study was conducted at the Kasr Al-Ainy Hospital. Sixty patients scheduled for knee arthroscopy were divided into two groups. The intervention group (n = 30) received compressive cryotherapy using a cold-pack knee wrap set at 2 to 5 °C for 15 to 20 min, three times daily. The control group (n = 30) received standard postoperative care. Pain was assessed with the Numerical Rating Scale. Swelling was measured by assessing knee circumference at the mid-patella. Assessments occurred immediately after surgery (baseline), and on the first and second postoperative days. Non-parametric tests used in the analysis included the Chi-square test, the Mann–Whitney U test, the Friedman test, and the Wilcoxon signed-rank test with Bonferroni–Holm correction. Results: Patients in the compressive cryotherapy group experienced a greater reduction in pain than those in the control group. By the first postoperative day, none of the patients in the intervention group reported severe pain (p < 0.001). Knee circumference decreased significantly in the intervention group, from a median of 51.05 cm [IQR: 49.1–53.2] at baseline to 40.90 cm [39.8–42.1] by the second day. In comparison, the control group showed a smaller reduction, from 52.70 cm [50.8–54.5] to 48.55 cm [46.8–50.9]. Between-group differences in swelling were significant at the first postoperative assessment (U = 105.0, p < 0.001) and on day 2 (U = 62.5, p < 0.001). Overall, differences in both pain intensity and knee swelling between groups were statistically significant across all time points (p < 0.001). Conclusions: Compressive cryotherapy is an effective non-pharmacological intervention for reducing pain and swelling in the early postoperative period following knee arthroscopy. These results suggest that it could be a valuable addition to routine postoperative care, helping patients recover more comfortably and quickly. Full article

Background: The optimal timing and staging of anterior cruciate ligament reconstruction (ACLR) in patients with concomitant medial collateral ligament (MCL) injury remain controversial. This study aimed to compare clinical outcomes between a one-stage ACLR group and a two-stage ACLR group in patients with combined ACL and MCL injuries in which the MCL was surgically managed. Methods: This retrospective study included 68 patients with combined ACL and grade III MCL injuries treated with ACLR and MCL surgery. Patients were divided into the one-stage ACLR group (n = 42) and the two-stage ACLR group (n = 26) according to the timing and staging of ACLR relative to MCL surgery. Clinical outcomes, including knee stability, patient-reported outcomes, and range of motion (ROM), were compared between groups. Results: After a minimum 2-year follow-up, both groups demonstrated significant improvements in clinical and stability outcomes, with enhanced anterior knee stability, improved patient-reported outcomes, and better objectively assessed knee function. No significant differences were found between groups in anterior, valgus (one-stage: 1.8 ± 1.1 mm, two-stage: 2.3 ± 1.3 mm; p = 0.160), or rotational stability. Likewise, there were no significant differences in mean flexion deficits (one-stage: 2.6 ± 4.1°, two-stage: 1.0 ± 2.0°; p = 0.137), mean extension deficits (one-stage: 1.5 ± 2.5°, two-stage: 1.3 ± 2.0°; p = 0.137), flexion deficits ≥10° (one-stage: 9.5% [4/42], two-stage: 0%; p = 0.290), extension deficits ≥ 5° (one-stage: 9.5% [4/42], two-stage: 3.8% [1/26]; p = 0.642), or additional procedures for postoperative stiffness (one-stage: 16.7% [7/42], two-stage: 11.5% [3/26]; p = 0.730). Patient-reported outcomes, including the Lysholm and IKDC subjective scores, were also comparable between groups. Conclusions: Both the one-stage ACLR group and the two-stage ACLR group for surgically managed combined ACL and MCL injuries yielded comparable clinical and stability outcomes, suggesting that one-stage ACLR can be performed without an apparent increase in the risk of postoperative stiffness or ROM limitations. However, given the limited sample size, these results should be interpreted cautiously because the study may have been insufficiently powered to detect small clinically meaningful differences. Full article

Background: Pancreatic cancer (PC) has a very poor 5-year survival and prognosis. Even when CT or MRI shows no metastasis, staging laparoscopy(SL) still detects tiny peritoneal deposits in 20–30% of patients, making them ineligible for surgery. SL is invasive, requiring general anesthesia and substantial resources. Endoscopic ultrasound (EUS) allows the observation of the bile ducts, pancreas, and abdominal cavity, and EUS-guided fine-needle aspiration (EUS-FNA) is essential for pathological diagnosis. Reports on using EUS to perform peritoneal lavage cytology are currently not available. We hypothesized that combining EUS-FNA with peritoneal lavage (EUS-lavage technique; EUS-LT) could enhance staging accuracy and avoid unnecessary surgical procedures. Methods: Ten ex vivo porcine models underwent EUS-LT. Using a 19G FNA needle, 800 mL saline was instilled into the intraperitoneal cavity and then recovered. Two refinements were introduced sequentially: an ENBD catheter with additional side holes and, subsequently, a side-hole introducer (EndoSheather) that eliminated balloon dilation. The primary endpoint was procedural success. Secondary endpoints included safety, complications, recovered volume, duration of endoscopic procedure, and time required to instill 800 mL. Nonparametric tests compared outcomes across iterations. Results: Ten-model porcine ex vivo model series were included, and all procedures were successful. No device malfunctions or unanticipated technical failures; one minor mucosal injury during saline injection resolved after re-puncture. The average procedure time was 31.1 min. Stepwise refinements shortened procedure and infusion times and increased recovered volume. Recovered volume approached the instilled amount in later cases, indicating efficient performance. Conclusions: In this ten-model ex vivo series, EUS-LT demonstrated technical feasibility and short-term safety. Full article

Background and Clinical Significance: Giant sphenoid wing meningiomas are generally viewed as skull base masses that compress frontal centers and their respective pathways gradually enough to cause a dysexecutive–apathetic syndrome, which can mimic primary neurodegenerative disease. The aim of this report is to illustrate how bedside phenotyping and multimodal imaging can disclose similar clinical presentations as surgically treatable network lesions. Case Presentation: An independent, right-handed older female developed an incremental, two-year decline of her ability to perform executive functions, extreme apathy, lack of instrumental functioning, and a frontal-based gait disturbance, culminating in a first generalized seizure and a newly acquired left-sided upper extremity pyramidal sign. Standardized neuropsychological evaluation revealed a predominant frontal-based dysexecutive profile with intact core language skills, similar to behavioral-variant frontotemporal dementia (bvFTD). MRI demonstrated a large, right fronto-temporo-basal extra-axial tumor attached to the sphenoid wing with homogeneous postcontrast enhancement, significant vasogenic edema within the frontal projection pathways, and a marked midline displacement of structures with an open venous pathway. With the use of a skull-base flattening pterional craniotomy with early devascularization followed by staged internal debulking, arachnoid preserving dissection, and conservative venous preservation, the surgeon accomplished a Simpson Grade I resection. Sequential improvements in the patient’s frontal “re-awakening” were demonstrated through postoperative improvements on standardized stroke, cognitive and functional assessment scales that correlated well with persistent decompression and symmetric ventricles on follow-up images. Conclusions: This case illustrates the possibility of a non-dominant sphenoid wing meningioma resulting in a pseudo-degenerative frontal syndrome and its potential for reversal if recognized as a network lesion and treated with tailored, venous-sparing skull-base surgery. Contrast-enhanced imaging and routine frontal testing in atypical “dementia” presentations may aid in identifying additional patients with potentially surgically remediable cases. Full article

Background: Acute coronary syndrome (ACS) continues to be a major contributor to morbidity and mortality worldwide. While percutaneous coronary interventions (PCIs) have significantly evolved, coronary artery bypass grafting (CABG) has retained a role in emergency revascularization. Nevertheless, ongoing debate persists about how to select candidates for surgery, when to operate, and which surgical techniques offer the greatest safety and efficacy. Methods: A comprehensive literature search was conducted, yielding 2302 records, of which 25 studies met predefined screening criteria and were included for detailed analysis. Given that timing remains one of the most controversial issues in the management of ACS, our primary aim was to determine the optimal timing for CABG in this patient population. Additionally, we examined how preoperative antiplatelet therapy and the presence of cardiogenic shock influence clinical outcomes, and what revascularization strategy may be most appropriate for these patients. Results: Of the 2302 initially identified studies, 25 were selected for a detailed analysis, supplemented by 28 additional key references. Among the included studies, 17 focused primarily on the effects of surgical timing and 8 on comparisons between the outcomes of CABG and PCI. The analysis comprised 15 database or multicentre retrospective cohort studies, 8 single-centre retrospective studies, and 2 prospective investigations. Conclusion and limitations: Although the topic of non-elective coronary surgery has been with us for several decades, a number of inherent biases hinder thorough statistical investigation in this complex population. Although a number of contradictory findings hinder drawing simple conclusions, being reluctant to perform early surgery solely based on poorer unfiltered outcomes might miss a point. Full article

Gallstone ileus is a rare but serious complication of gallstone disease, often requiring surgical intervention. While enterolithotomy remains the standard treatment, the role of additional biliary surgery, particularly subtotal cholecystectomy, remains controversial. This study examines the management of gallstone ileus in a rural setting, where limited surgical resources and access to specialized biliary interventions pose unique challenges. We present a case series of four patients diagnosed with gallstone ileus in a rural healthcare facility. All patients underwent initial enterolithotomy for bowel obstruction relief. Surgical outcomes, complications, and the necessity for a second intervention, including subtotal cholecystectomy, were evaluated. Ever patient had a successful recovery. Of the four cases, two patients underwent a subtotal cholecystectomy. No perioperative mortality was observed, but limited access to advanced imaging and specialized biliary surgery influenced clinical decision-making. The rural setting in which these series occurred comes with its unique challenges regarding resource management and technological demands. Full article

Background: Achieving breast symmetry is an important aesthetic goal following reconstruction post-mastectomy; however, little is known about women’s awareness, attitudes, and barriers regarding Contralateral Breast Symmetry Procedures (CBSP) in Jordan. Objectives: To assess awareness, perceptions, and barriers toward contralateral breast symmetry procedures among breast cancer survivors who underwent reconstruction at King Hussein Cancer Center. Methods: A cross-sectional study was conducted from July to Oct 2025 at KHCC, among 314 women diagnosed with breast cancer who had post-breast reconstruction. Data were collected using a structured Arabic questionnaire, which was developed based on existing literature, validated by an expert panel, and piloted on 10 women for clarity and reliability. The final tool demonstrated acceptable internal-consistency (Cronbach’s α = 0.712). The questionnaire captured sociodemographic and clinical data and detailed knowledge, attitudes, and barriers related to CBSP. Descriptive statistics summarized the data. Results: Participants’ mean age was 45.8 years; the majority were married (83.8%) and held university degrees (65.6%). Most reconstructions used silicone implants (94.6%). Only 6.4% had undergone CBSP, primarily delayed breast augmentation or mastopexy, with 75% reporting satisfaction. Awareness of CBSP was limited (37.9%), and less than one-third had discussed CBSP options with their surgeon or knew about insurance coverage. While 82.5% valued symmetry for body image, 31.5% viewed it as unnecessary after cancer recovery. Main barriers included satisfaction with current appearance (48.1%), fear of additional surgery (32.2%), financial constraints (37.3%), and lack of physician counseling (27.1%). Trust in medical team recommendations was high (89.2%). Conclusions: Contralateral breast symmetry procedures are under-recognized and infrequently pursued, primarily due to limited awareness, financial concerns, and insufficient counseling. Focused education and enhanced surgeon–patient communication are essential to support women’s aesthetic and psychological needs after reconstruction in Jordan. Full article

Background: Computer-guided static implant surgery (CGSIS) is widely adopted to enhance the precision of dental implant placement. However, significant heterogeneity in reported accuracy values complicates evidence-based clinical decision-making. This variance is likely attributable to a fundamental lack of standardization in the methodologies used to assess dimensional accuracy. Objective: This scoping review aimed to systematically map, synthesize, and analyze the clinical methodologies used to quantify the dimensional accuracy of CGSIS. Methods: The review was conducted in accordance with the PRISMA-ScR guidelines. A systematic search of PubMed/MEDLINE, Scopus, and Embase was performed from inception to October 2025. Clinical studies quantitatively comparing planned versus achieved implant positions in human patients were included. Data were charted on study design, guide support type, data acquisition methods, reference systems for superimposition, measurement software, and accuracy metrics. Results: The analysis of 21 included studies revealed extensive methodological heterogeneity. Key findings included the predominant use of two distinct reference systems: post-operative CBCT (n = 12) and intraoral scanning with scan bodies (n = 6). A variety of proprietary and third-party software packages (e.g., coDiagnostiX, Geomagic, Mimics) were employed for superimposition, utilizing different alignment algorithms. Critically, this heterogeneity in measurement approach directly manifests in widely varying reported values for core accuracy metrics. In addition, the definitions and reporting of core accuracy metrics—specifically global coronal deviation (range of reported means: 0.55–1.70 mm), global apical deviation (0.76–2.50 mm), and angular deviation (2.11–7.14°)—were inconsistent. For example, these metrics were also reported using different statistical summaries (e.g., means with standard deviations or medians with interquartile ranges). Conclusions: The comparability and synthesis of evidence on CGSIS accuracy are significantly limited by non-standardized measurement approaches. The reported ranges of deviation values are a direct consequence of this methodological heterogeneity, not a comparison of implant system performance. Our findings highlight an urgent need for a consensus-based minimum reporting standard for future clinical research in this field to ensure reliable and translatable evidence. Full article

Background: Vertebral compression fractures are prevalent in elderly patients with osteoporosis. While the vertebral augmentation procedure is often used for symptom control and improving life quality, cement leakage is still a significant complication of vertebral augmentation procedures. This case report describes a 92-year-old man with a T8 compression fracture who underwent kyphoplasty with low-viscosity bone cement after failed conservative treatment. Methods: A previously developed decompressed kyphoplasty technique using dual portals was employed to reduce intravertebral pressure; however, fluoroscopy revealed posterior leakage toward the spinal canal. A case-specific intraoperative modification of this established technique was then applied, converting the injection portal into a suction channel to aspirate extravasated cement before it hardened. Results: This approach averted spinal cord compromise, obviated the need for additional decompression surgery, and preserved neurological function. The patient achieved rapid pain relief and early mobilization. Conclusions: This case demonstrates how a suction-assisted intraoperative maneuver may be used to manage posterior cement leakage during decompressed kyphoplasty. Full article

Background: Although diabetes mellitus is traditionally viewed as a systemic metabolic disorder, growing evidence indicates that it also affects the upper airways through vascular, inflammatory, and neuro-sensory mechanisms. The sinonasal mucosa, highly vascularized and immunologically active, may represent an early target of diabetic microangiopathy and immune–metabolic imbalance. Objectives: Our objectives are to synthesize current evidence on the rhinologic manifestations of DM, with a focus on chronic rhinosinusitis, olfactory dysfunction, and other nasal disorders, and to identify the main pathophysiologic and clinical patterns linking diabetes to sinonasal disease. Results: Evidence suggests that DM, particularly type 2 DM, increases susceptibility to CRSwNP and modulates the sinonasal microbiome toward Gram-negative predominance. Surgical outcomes after endoscopic sinus surgery are generally comparable between diabetics and non-diabetics when perioperative care is optimized. Olfactory dysfunction occurs more frequently and severely in diabetic patients, likely reflecting the combined effects of chronic inflammation, vascular compromise, and insulin resistance. Additional manifestations include recurrent epistaxis, delayed mucociliary clearance, and chronic cough. Allergic rhinitis appears to not be increased, and maybe even inversely related, especially among users of DPP-4 inhibitors. Conclusions: Diabetes intersects with rhinologic health through immune–metabolic, vascular, and epithelial pathways that may shape susceptibility, disease phenotype, and neurosensory decline. Future research should focus on disentangling type-specific mechanisms, metabolic biomarkers, and longitudinal outcomes, with the aim of developing precision-based approaches to rhinologic assessment and management in diabetic patients. Full article

Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex in which trigeminal stimulation precipitates abrupt vagally mediated cardiovascular changes, ranging from bradycardia to asystole. While classically described during down-fracture or pterygomaxillary disjunction in Le Fort I osteotomy, rhinocardiac events from lateral nasal wall manipulation are less emphasized in orthognathic surgery. Case presentation: A 32-year-old man undergoing Le Fort I osteotomy developed ventricular asystole during lateral nasal osteotomy. The maneuver was stopped immediately; chest compressions and a single dose of epinephrine were administered, with return of spontaneous circulation within approximately one minute. Surgery was aborted and the patient was transferred to the surgical ICU. Clinical discussion: The temporal association with lateral nasal wall manipulation, in the setting of controlled hypotension and multimodal anesthesia, is most compatible with a peripheral (V2) TCR-type event, although drug-related and hemodynamic contributors cannot be excluded. A mini review of orthognathic TCR reports underscores recurring high-risk steps (down-fracture, pterygomaxillary disjunction, mandibular maneuvers) and highlights lateral nasal osteotomy as a potential additional trigger. Management principles remain the immediate cessation of the stimulus, optimization of oxygenation and ventilation, anticholinergics for bradycardia, and epinephrine/advanced cardiac life support for instability or arrest. Conclusion: Lateral nasal osteotomy may trigger a TCR-like event with severe bradyarrhythmia or asystole during Le Fort I osteotomy, particularly in hemodynamically vulnerable patients. Anticipation, swift recognition, and prompt, protocolized management are essential for favorable outcomes. Full article

Objectives: The choice between endovascular treatment and microsurgery for unruptured intracranial aneurysm (UIA) is influenced by aneurysm location, with middle cerebral artery (MCA) UIAs traditionally requiring surgery. This study compares these treatment modalities using propensity score matching (PSM). Methods: This single-center analysis included adults with saccular MCA UIAs who underwent treatment. PSM incorporated patient and aneurysm characteristics to create comparable groups. Results: Before matching, 124 patients underwent microsurgery and 28 underwent endovascular treatment. With a median follow-up of 76.5 months, 93.4% achieved good functional outcome (modified Rankin Scale [mRS] 0–2), including 117 (93.4%) in the surgical group and 25 (89.3%) in the endovascular group. Complications occurred in 15.3% of surgical and 10.7% of endovascular patients (p > 0.05). Three patients developed subarachnoid hemorrhage post-treatment: two from other aneurysms and one from an endovascularly treated MCA UIA. Proximal location predicted worse outcomes (p = 0.04), whereas distal location was associated with better outcomes (p < 0.01). Ordinal logistic regression revealed no additional associations. After PSM, we did not observe significant between-group differences in complications or mRS at follow-up, and ordinal logistic regression predicting mRS at follow-up revealed no differences. Distal MCA remained associated with better outcomes (p < 0.01). No differences in survival were found between groups before or after PSM (log-rank test p = 0.34 and p = 0.49, respectively). Conclusions: No differences in long-term outcomes or complications were observed in this cohort after endovascular treatment vs. microsurgery. Distal location was the only factor associated with favorable outcomes. At a median follow-up of 6.4 years, most patients achieved good functional outcomes. These results likely reflect individualized treatment selection within an experienced team and should be considered exploratory given limited statistical power and generalizability. Full article

Background: Interscalene brachial plexus block (ISB) remains the gold standard anesthesia method in shoulder surgery. However, risk of diaphragm paralysis is a major concern among anesthesiologists. Recent studies on anterior suprascapular nerve block (ASB) and costoclavicular brachial plexus block (CCB) have given promising results for preventing diaphragm paralysis and providing sufficient analgesia. Methods: Forty-six patients who underwent arthroscopic shoulder surgery under one of three regional anesthesia techniques, including ISB (n = 15), ASB (n = 15), and CCB (n = 16), were included in the study. Diaphragmatic excursion was measured by ultrasonography 30 min after the block. Postoperative pain was assessed with a numerical rating scale. The groups were compared in terms of diaphragm paralysis and postoperative pain status. Results: The groups were similar in basic patient and surgical characteristics as well as motor and sensory block scores. There was no difference in analgesic use between the groups. Diaphragm measurements in the ISB group were found to be significantly lower compared to the ASB and CCB groups (p < 0.001). In addition, diaphragm measurements in the ASB group were found to be lower than in the CCB group (p = 0.036). When comparing diaphragm measurements between the initial and 30th min of block, significant decreases were observed in the ISB and ASB groups (p < 0.001), whereas no difference was found in the CCB group. Conclusions: Postoperative pain scores and analgesic use were similar between the three blocks. In terms of diaphragm paralysis, the best blocks appeared to be CCB followed by ASB. CCB and ASB can be considered as safe and effective alternative blocks in arthroscopic shoulder surgery, particularly for patients without serious obstructive or restrictive pulmonary disease. Full article

A promising application of smart materials based on natural polymers is the potential to solve problems related to hemostasis in cases of severe bleeding caused by injury or surgery. This can be a life-threatening situation. Cellulose and its modified derivatives represent one of the most promising sources for creating effective hemostatic systems, as well as for various sensing applications related to disease detection, infection diagnosis, chronic condition monitoring, and blood analysis. The aim of this review was to identify key criteria for the efficiency of cellulose-based gels with hemostatic activity. Experimental studies aimed at evaluating new hemostatic devices were analyzed based on international sources using the PRISMA methodology. A total of 111 publications were identified. Following the identification and screening stages, 20 articles were selected for the final qualitative synthesis. The analyzed publications include experimental studies focused on the development and analysis of highly porous cellulose-based scaffolds in the form of aerogels and cryogels. The type and origin of cellulose, as well as the influence of additional components and synthesis conditions on gel formation, were investigated. Three major groups of key criteria that should be considered when developing new cellulose-based highly porous scaffolds with hemostatic functionality were identified: (I) physicochemical and mechanical properties (pore size distribution, compressive strength, and presence of functional groups); (II) in vitro tests (blood clotting index, red blood cell adhesion rate, hemolysis, cytocompatibility, and antibacterial activity); (III) in vivo hemostatic efficiency (hemostasis time and blood loss) in compliance with the 3Rs policy (replacement, reduction, refinement). The prospects for the development of highly porous cellulose-based scaffolds are not only focused on their hemostatic properties, but also on the development of smart platforms. Full article

Background/Objectives: Achieving gross total resection is crucial in the surgical management of pituitary neuroendocrine tumors (PitNETs). However, PitNETs with anterosuperior extension remain challenging to completely remove using the conventional transsellar approach (TSA) due to limited access to the anterior suprasellar region. This study evaluated the efficacy and safety of a modified TSA (mTSA) that involves additional removal of the tuberculum sellae and planum sphenoidale (PS) bones without expanding the dural incision. Methods: We retrospectively reviewed 104 patients with nonfunctioning PitNETs who underwent endoscopic transsphenoidal surgery between 2017 and 2022. Seventy-seven patients were treated with the conventional TSA and 27 with the mTSA. Tumor configuration and accessible area were measured on pre- and postoperative MR imaging and CT. The ratio of the accessible to total tumor area was calculated on mid-sagittal images. Surgical outcomes and postoperative complications were compared between groups. Results: Gross total resection was achieved in all patients. Tumors treated with mTSA were larger (median height, 32 mm vs. 25 mm; p < 0.001) and showed greater anterosuperior extension. The mTSA increased the median accessible tumor area from 70% to 88%, with a median PS removal distance of 4.4 mm. Postoperative complications were minimal: cerebrospinal fluid leakage (3%), meningitis (3%), transient ocular movement disturbance (2%), and transient visual worsening (1%). No hemorrhage or anosmia occurred. Conclusions: The mTSA safely expands the surgical corridor to the anterior suprasellar region, enhancing accessibility and enabling complete resection without dural incision. This approach balances surgical radicality and safety in PitNETs with anterosuperior extension. Full article