Background: Arthroscopic hip-preservation surgery is commonly performed to address nonarthritic sources of hip pain in young, active individuals. However, there is little evidence to support postoperative rehabilitation protocols, including the most appropriate frequency and length of individual formal physical therapy sessions. There is also a lack of information to look at patients’ perceived value of their home program/self-practice in relation to outcomes. Purpose: To investigate postoperative rehabilitation factors after hip arthroscopy related to formal physical therapy and home program/self-practice and their correlation with patient outcomes and satisfaction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 125 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and a labral tear (75 men) were included. The mean age was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL) scores, overall satisfaction scores, and factors related to supervised physical therapy and home program/self-practice were collected. Correlations between continuous variables and differences in the length of individual formal physical therapy and patients’ rating of the importance of their home program/self-practice between those who would and those who would not undergo surgery again were assessed. Results: The frequency and length of individual formal physical therapy sessions were significantly correlated with postoperative HOS-ADL scores ( r = 0.22, P = .014; and r = 0.24, P = .007, respectively) and level of satisfaction ( r = 0.24, P = .007; and r = 0.21, P = .02, respectively). The length of individual formal physical therapy sessions was significantly greater in those who noted they would undergo surgery again (35.3 vs 26.3; P = .033). A significant correlation was identified between the rating of the importance of their home program/self-practice and postoperative HOS-ADL scores ( r = 0.29; P = .001) and their level of satisfaction ( r = 0.23; P = .009). There was a significant difference in the rating of the importance of their home program/self-practice between those who would undergo surgery again and those who would not (8.9 vs 7.8; P = .007). Conclusion: Surgeons and physical therapists should emphasize the value of home program/self-practice when it comes to outcomes and may want to encourage their patients to participate in more frequent, longer, formal physical therapy sessions.
Surgery associated with lymphadenectomy may sometimes result in a lymphorrhagia, which usually resolves spontaneously within a few days, sometimes becoming a refractory complication to the treatment. In the case of large flows, particular attention should be paid to hydro-electrolytic and protein losses. We present the case of a patient with persistent lymphorrhagia after a cephalic duodenopancreatectomy for a pancreatic head tumor. From the 5th postoperative day, the patient had a milky-like secretion on the subhepatic drainage tube. The discharge rate was variable, between 500 and 1500 ml per day, requiring parenteral administration of amino acids, plasma and electrolyte solutions. The postoperative progression was slowly favorable, with the patient discharge on the 25th day following surgery. There are several treatment options for a lymphorrhagia following an extended lymphadenectomy, from intensive parenteral therapy to peritoneal-venous shunt or ligation of the lymphatic vessel responsible for the production of lymphorrhagia. In this case the conservative treatment had a favorable result.
Atypical hepatocellular neoplasm (AHN) is an adenoma-like hepatic tumor that even occurs in noncirrhotic liver of males (any age) or females ≥50 years old, or associates focal atypical features.In this article, 2 unusual cases diagnosed in elderly cirrhotic patients, unrelated to steroids, are presented.The first case was incidentally diagnosed in an 83-year-old female. During laparoscopic surgery for cholecystectomy, hemoperitoneum was installed and laparotomy was necessary to remove a 70-mm nodular encapsulated hepatic tumor that was microscopically composed by hepatocyte-like cells with clear cytoplasm, arranged in 1- to 2-cell-thick plates and intermingled with areas of peliosis, negative for alpha fetoprotein (αFP), p53, and keratin 7, with low Ki67 index and intact reticulin framework. The second case was incidentally diagnosed at ultrasound examination in a 66-year-old male. The surgical specimen was a 50-mm solid multinodular tumor that microscopically consisted of 3-cell-thick plates of hepatocyte-like cells with acinar, pseudoglandular, and trabecular architecture, intermingled with peliotic areas, without nuclear atypia and disintegrated reticulin framework. Both of the cases occurred in cirrhotic liver. The tumor cells were marked by AE1/AE3 keratin, displayed a Ki67 index < 5% and were negative for αFP, p53, and keratin 7. No recurrences or any other disorder occurred 6 months after surgery.In cirrhotic liver, adenomas with peliosis that do not satisfy all the diagnosis criteria synthesized in the article should be considered AHNs and differential diagnosis includes hepatocellular carcinoma but also focal nodular hyperplasia, regenerative nodules, and dysplastic nodules. This histological entity is not yet included in the WHO Classification list.
This is the first time since the pandemic began with isolated cases in the early fall of 2019 in the city of Wuhan (CCP-China) that health authorities have completely lost control of the pandemic’s development without having any tool to counteract this evolving event. Sars-CoV-2 Omicron is unstoppable.
Hydatid cyst involving the spleen is a rare clinical condition (0.5-4%). We report a case of multi-parasitic infection in a 62 year old female (hydatid cyst and ascaris lumbricoides infestation), confirmed during surgery. The purpose of the paper is to emphasize on the rare association of the two parasitic infections, affecting two different organs (spleen and jejunum). The combined symptomatology of the two parasites could mimic an acute surgical abdomen.
Oncological resection and articular reconstruction through modular tumor prosthesis is a challenge for the surgeon, but at the same time gives the patient the certainty of keeping the function and hope for healing. Due to technical evolution, the recovery of osteoarticular post-resection tumor is today much more versatile and permissive, providing the comfort of the orthopedic oncologist surgeon during reconstruction and at the same time the patient satisfaction. Purpose of the paper. Short-term and medium-term evaluation of surgical treatment outcome of bone oncological pathogenesis of the knee with modular tumor prosthesis. Material and method. Recording based on the unique tumor registry of the Clinic in a monocentric, retrospective continuously study between 2009 and 2017, of all orthopedic oncology patients with malignant/ borderline tumors with metaphyso-epiphyseal knee periarticular involvement, beneficiaries of the resection-reconstruction with prosthesis modular tumor - a total of 21 cases. Case analysis included details of histopathological types of tumors, followed by Enneking staging, which was performed, alongside classical demographics. The Malaware oncological resection technique was followed and the learning curve and results of the prostatic modular prosthetic reconstruction were registered, considering failure for any of the following reasons: revision, necessity exhaustion of the prosthesis - infection, relapse, or amputation. The functional evaluation was based on the revised Muscular-skeletal Tumor Society Score (rMSTS). Results and discussions. Only one case of failure was registered - a periprosthetic infection. The overall rate of apparently postoperative complications followed the literature data for this type of intervention - 40-50%. Compared to amputation, the lower limb salvage process in the knee malignant tumors has proven to be cost-effective and has contributed to improving the quality of life, becoming one of the sustainable options for onco-surgical management in good cases selected. The limits of the study are determined by the relatively short duration of follow-up, and the apparently large number of complications is nevertheless included in the international statistics related to such interventions.
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