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In this review, we outline the limitations, challenges and current status of endovascular technology to treat pathologies of the AA.Aortic arch aneurysms are a challenging clinical problem especially in high-risk patients. Open aortic arch replacement, even in the best of centers, carries significant risk of stroke or death in this high-risk population. Many high-risk patients are deemed inoperable and not offered repair. Branched and fenestrated thoracic endografts are currently undergoing clinical trials in the United States but are not yet commercially available. Many elderly and frail patients have significant brachiocephalic occlusive disease or anatomy excluding them for consideration for such clinical trials. These patients also present with acute aortic syndromes requiring urgent or emergent repair and are unable to participate in clinical trials due to the time required to have such devices available. Alternative endovascular therapies, including parallel stent grafts (including Chimneys, Snorkels and Periscopes) and physician modified thoracic endografts, have been used to treat such high-risk patients combined with commercially available thoracic endovascular aneurysm repair (TEVAR) devices. This paper aims to review the techniques and current reported outcomes from parallel stent grafts and physician modified devices used to treat high risk patients undergoing repair for aortic arch pathologies.

At present, the optimal management strategy for chronic type B aortic dissection (CTBAD) remains unknown, as equipoise remains regarding medical management versus endovascular treatment versus open surgery. However, the results over recent years of thoracic endovascular aortic repair (TEVAR) in CTBAD appear promising. The aim of this systematic review was to provide a comprehensive analysis of the available data reporting outcomes and survival rates for TEVAR in CTBAD.

Electronic searches of six databases were performed from inception to April 2021. All studies reporting outcomes, specifically 30-day mortality rates, for endovascular repair of CTBAD were identified. Relevant data were extracted, and a random-effects meta-analysis of proportions or means was performed to aggregate the data. Survival data were pooled using data derived from original Kaplan-Meier curves, which allows reconstruction of individual patient data.

Forty-eight studies with 2,641 patients were identified. Early (<30 days) all-to address these challenges.

The significant heterogeneity in the available evidence and absence of consensus reporting standards are important considerations and concern when interpreting the data. Evaluation of the evidence suggests that TEVAR for CTBAD is a safe procedure with low rates of complications. However, the optimal treatment strategy for CTBAD remains debatable and requires further research. selleck compound Evidence from high-quality registries and clinical trials are required to address these challenges.For patients with fulminant liver failure and end-stage liver disease, liver transplantation remains the only effective treatment. Over the years, as a result of the ageing population, the average age of liver transplant donors and recipients has increased and currently about one quarter of patients receiving transplantation in the United States are above the age of 65. Recently, a study reported that patients aged 65 years or older had lower one-year survival compared to a younger cohort. Herein, we express our opinion about this interesting publication.Patients with inflammatory bowel disease (IBD) can develop extra-renal complications and as a result, suffer from end stage renal failure requiring kidney transplantation (KT). A brief review of available literature revealed that IBD patients undergoing KT have shorter overall survival rates compared to their controls. Literature reporting steroid regimens and survival outcomes specific to IBD and post kidney transplant are scarce and these studies have small sample sizes thus making it difficult to draw accurate conclusions. Further research is required in the form of a randomized controlled study to clarify the effect and mechanism of steroid immunosuppression on the prognosis of renal transplant recipients and explore new treatment schemes.

Genu Valgum usually originates from distal femur and many open and closed wedge osteotomies of distal femur have been reported but none has proved to be the best. Distal femur V osteotomy is a wedgeless osteotomy and is a rarely reported osteotomy with only a few case series and 167 cases of isolated distal femur V osteotomy for genus valgum in young patients (<25 years) in literature but with a tendency to have an excellent outcomes.

To determine correction and clinical outcome following V osteotomy for genu valgum in adolescents and young adults (10-25 years).

A systematic research was conducted of PubMed, MEDLINE and Google Scholar to identify studies reporting the correction and clinical outcome following V osteotomy in adolescents and young adults (10-25 years) for genu valgum by 2 different authors according to PRISMA guidelines.

5 studies with 167 patients and 263 knees were identified meeting the inclusion criteria for review. The follow-up period ranged from 3 months to 36 months. Overall complication rate was 12.3%, the most common being plaster sore, 4.2% (11/263) followed by superficial infection, 2.7% (7/263). The mean correction was 19.1° and a mean post-operative valgus was 5.7°. In those compared with Bostman score (157/167), 94.3% had excellent (148/157) and remaining 5.7% (9/157) had good scores (20-27/30) with none showing poor score (<20/30).

V osteotomy is a reliable method of distal femoral osteotomy to attain a good correction with an excellent clinical outcome even with variations of fixation however longer follow-up period are required for better evaluation of recurrence.

V osteotomy is a reliable method of distal femoral osteotomy to attain a good correction with an excellent clinical outcome even with variations of fixation however longer follow-up period are required for better evaluation of recurrence.

Extraction of a well-fixed femoral stem during revision total hip arthroplasty presents a technical challenge to the operating surgeon. The option of several stem designs during implantation necessitates the availability of extraction tools to be utilised intra-operatively. This study aims to compare the amount of axial force generated from using a threaded-coupled extraction device, loop extraction device, and vice-grip universal extraction set on a potted total hip arthroplasty stem construct.

A size 7 Stryker Accolade® II femoral stem (Stryker, Mahwah, NJ) was potted within a 5.20cm inner diameter polyvinyl chloride pipe using a potting medium with tensile strength and lap shear of 1000psi. This construct was coupled to a material testing system whose force transducer was calibrated to a recording speed of 1000 frames per second. The extractors were coupled to the potted stem, and a force of 1.32J was applied ten times sequentially to each construct. Force was recorded in Newtons.

The maximum average force for the threaded, loop, and Shukla extractors was 111.46±1.77N, 90.22±0.87N, and 64.70±9.03N (p<0.01). Loss of coupling was not experienced with any extractor.

Within our study, the forces observed per constant load when utilising a threaded-coupled extraction device that attaches to the shoulder of the implant were significantly higher than those seen when using an extraction device that couples to the neck of the femoral stem.

Within our study, the forces observed per constant load when utilising a threaded-coupled extraction device that attaches to the shoulder of the implant were significantly higher than those seen when using an extraction device that couples to the neck of the femoral stem.

The advanced stage of vertebral involvement in spinal tuberculosis (STB) can cause vertebral body collapse, which leads to kyphotic deformity and paraplegia in severe cases. Surgery is indicated in patients having disabling back pain, progressive neurological deficit, and instability in spine despite conservative management. The derangement of lumbar parameters, especially the loss of lumbar lordosis has been found to cause functional deterioration in patients. With the current evidences in place, this study was done to evaluate the correlation between the restoration of lumbar lordosis, pelvic parameters, and functional outcome when posterior only approach was used to manage the lumbar STB.

Active Tuberculosis of lumbar vertebra (L1-S1) confirmed by radiology (X-ray, MRI) and histopathological examination were included. All the cases scheduled for surgery underwent radiographs, CT scan, and MRI scans. Lumbar lordosis and other pelvic parameters were calculated on X-rays. VAS scores and ODI scores were dos. But the correlation needs to be further studied and evaluated by a well-constructed study especially with a control group treated conservatively.

Recent studies show increasing mortality rates of geriatric femoral neck fracture patients with delays in operative treatment greater than 48hours from injury. A less extensively studied area in this population is the effect of length of inpatient hospital stay (LOS) on outcomes. The purpose of this study was to determine the association of LOS after arthroplasty for geriatric femoral neck fractures with 30-day mortality risk.

This study is a retrospective review using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a nationally validated, outcomes-based database incorporating data from over 700 geographically diverse medical centers. It included 9005 patients, 65 years of age or older, who underwent either hemiarthroplasty or total hip arthroplasty for a femoral neck fracture between 2011 and 2018. Using multivariate analysis, risk of 30-day mortality based on surgery-to-discharge time was determined, expressed as odds ratios (OR) with 95% confidence intervals (CI).

After controlling for sex, BMI, age, surgical procedure, American Society of Anesthesiologists (ASA) classification, and discharge location, the risk of mortality after discharge was increased with longer post-surgical length of stay [OR 2.5, P<.001].

Prolonged LOS after arthroplasty for geriatric femoral neck fractures is associated with increased 30-day mortality risk. Efforts made to target and mitigate modifiable risk factors responsible for delaying discharge may improve early outcomes in this population.

Prolonged LOS after arthroplasty for geriatric femoral neck fractures is associated with increased 30-day mortality risk. Efforts made to target and mitigate modifiable risk factors responsible for delaying discharge may improve early outcomes in this population.

Strain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy.

To assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE.

A prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years.