The Experts below are selected from a list of 288 Experts worldwide ranked by ideXlab platform
Mansour Ali - One of the best experts on this subject based on the ideXlab platform.
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Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of Surgical Exploration.
Research and reports in urology, 2018Co-Authors: Tariq O. Abbas, Mohammed Abdelkareem, Abdelrahman Alhadi, Vishwanatha Kini, Prem Chandra, Abdulla Al-ansari, Mansour AliAbstract:Purpose Testicular torsion (TT) represents a clinical challenge that needs emergency Surgical assessment. It is common to have negative scrotal Exploration due to confounding symptoms and signs which makes it sometimes difficult to differentiate from similar Surgical emergencies that do not warrant surgery. At the same time, several occasions of misdiagnoses or late interventions occur with devastating effects. We aim at delineating the significance of the different clinical, laboratory, and radiological variables in the detection of TT. Methods We retrospectively reviewed the charts of 52 patients who were Surgically explored with a preoperative working diagnosis of suspected TT in our center over the period from 2011 to 2015. All the patients were examined by pediatric surgeons in the emergency room and had undergone ultrasound imaging of the testes. The ultrasound images were retrospectively reviewed by a pediatric radiologist who was blinded to the intraoperative findings. Univariate and multivariate and logistic regression analyses were performed. Results Of the studied group of patients, the majority (84.6%) had TT upon Surgical Exploration. The most frequently presented symptom was pain (80.8%), and only a minority (11.5%) presented with vomiting. Radiological findings with the highest sensitivity were heterogeneous echogenicity in favor of TT and enlarged epididymis indicating that TT is unlikely. However, the predictability of TT by any of the assessed clinical and imaging factors was statistically insignificant. Conclusion It is important to gather all relevant data from clinical, laboratory, and imaging sources when assessing pediatric patients with suspected TT given the inaccuracy of each single one of them if used alone. Keeping this in mind, Doppler ultrasound has a significant role to aid in the accuracy of the diagnosis and hence the appropriate decision-making thereafter. However, we found no single clinical or imaging sign that is sensitive enough to prove or rule out TT. Therefore, Surgical Exploration should take place in a timely manner. Moreover, further research is necessary to construct scoring systems where different predictors collectively have higher reliability.
Daisuke Togawa - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized study of posterolateral lumbar fusion using osteogenic protein 1 op 1 versus local autograft with ceramic bone substitute emphasis of Surgical Exploration and histologic assessment
Spine, 2006Co-Authors: Masahiro Kanayama, Tomoyuki Hashimoto, Keiichi Shigenobu, Shigeru Yamane, Thomas W Bauer, Daisuke TogawaAbstract:Study Design. A prospective, randomized and controlled study. Objectives. To evaluate the osteoinductive property of Osteogenic Protein-1 (OP-1 or BMP-7) and fusion rate in human instrumented posterolateral lumbar fusion through radiographic examination, Surgical Exploration, and histologic assessment. of Background Data. The use of osteoinductive agents is a current topic in spinal fusion. Numerous preclinical investigations have demonstrated efficacy of osteoinductive proteins in spinal fusion, but few human clinical studies have been reported. Methods. Nineteen patients with L3-L4 or L4-L5 degenerative spondylolisthesis underwent posterolateral lumbar fusion using pedicle screw instrumentation. The patients were randomized to receive either OP-1 Putty (3.5 mg OP-1/g of collagen matrix per side) alone (n = 9), or local autograft with HA-TCP granules (n = 10). Fusion status was evaluated using plain radiography and CT scan. Radiographic fusion criteria included less than 5° of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area in which the graft materials were placed following decortication. After a minimum 1-year follow-up, the patients who showed radiographic evidence of fusion underwent instrumentation removal and Surgical Exploration of the fusion site. Biopsy specimens were taken from the fusion mass and evaluated histologically. Results. Radiographic fusion rate was 7 of 9 OP-1 patients and 9 of 10 control patients. Based on Surgical Exploration of these 16 patients, new bone formation was macroscopically observed in the posterolateral lumbar region in all cases; however, solid fusion was observed in 4 of 7 OP-1 and 7 of 9 HA-TCP/autograft patients. Histologic assessment demonstrated viable bone in 6 of 7 OP-1 patients. All the control (HA-TCP/autograft) specimens contained viable bone and fibrous tissue surrounding ceramic granules, suggesting slow incorporation of the graft material. Conclusions. In a human posterolateral lumbar spine trial, OP-1 reliably induced viable amounts of new bone formation, but the fusion success rate evaluated by Surgical Exploration was only 4 of 7.
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A Prospective Randomized Study of Posterolateral Lumbar Fusion Using Osteogenic Protein-1 (OP-1) Versus Local Autograft With Ceramic Bone Substitute : Emphasis of Surgical Exploration and Histologic Assessment
Spine, 2006Co-Authors: Masahiro Kanayama, Tomoyuki Hashimoto, Keiichi Shigenobu, Shigeru Yamane, Thomas W Bauer, Daisuke TogawaAbstract:STUDY DESIGN A prospective, randomized and controlled study. OBJECTIVES To evaluate the osteoinductive property of Osteogenic Protein-1 (OP-1 or BMP-7) and fusion rate in human instrumented posterolateral lumbar fusion through radiographic examination, Surgical Exploration, and histologic assessment. SUMMARY OF BACKGROUND DATA The use of osteoinductive agents is a current topic in spinal fusion. Numerous preclinical investigations have demonstrated efficacy of osteoinductive proteins in spinal fusion, but few human clinical studies have been reported. METHODS Nineteen patients with L3-L4 or L4-L5 degenerative spondylolisthesis underwent posterolateral lumbar fusion using pedicle screw instrumentation. The patients were randomized to receive either OP-1 Putty (3.5 mg OP-1/g of collagen matrix per side) alone (n = 9), or local autograft with HA-TCP granules (n = 10). Fusion status was evaluated using plain radiography and CT scan. Radiographic fusion criteria included less than 5 degrees of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area in which the graft materials were placed following decortication. After a minimum 1-year follow-up, the patients who showed radiographic evidence of fusion underwent instrumentation removal and Surgical Exploration of the fusion site. Biopsy specimens were taken from the fusion mass and evaluated histologically. RESULTS Radiographic fusion rate was 7 of 9 OP-1 patients and 9 of 10 control patients. Based on Surgical Exploration of these 16 patients, new bone formation was macroscopically observed in the posterolateral lumbar region in all cases; however, solid fusion was observed in 4 of 7OP-1 and 7 of 9 HA-TCP/autograft patients. Histologic assessment demonstrated viable bone in 6 of 7 OP-1 patients. All the control (HA-TCP/autograft) specimens contained viable bone and fibrous tissue surrounding ceramic granules, suggesting slow incorporation of the graft material. CONCLUSIONS In a human posterolateral lumbar spine trial, OP-1 reliably induced viable amounts of new bone formation, but the fusion success rate evaluated by Surgical Exploration was only 4 of 7.
Tariq O. Abbas - One of the best experts on this subject based on the ideXlab platform.
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Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of Surgical Exploration.
Research and reports in urology, 2018Co-Authors: Tariq O. Abbas, Mohammed Abdelkareem, Abdelrahman Alhadi, Vishwanatha Kini, Prem Chandra, Abdulla Al-ansari, Mansour AliAbstract:Purpose Testicular torsion (TT) represents a clinical challenge that needs emergency Surgical assessment. It is common to have negative scrotal Exploration due to confounding symptoms and signs which makes it sometimes difficult to differentiate from similar Surgical emergencies that do not warrant surgery. At the same time, several occasions of misdiagnoses or late interventions occur with devastating effects. We aim at delineating the significance of the different clinical, laboratory, and radiological variables in the detection of TT. Methods We retrospectively reviewed the charts of 52 patients who were Surgically explored with a preoperative working diagnosis of suspected TT in our center over the period from 2011 to 2015. All the patients were examined by pediatric surgeons in the emergency room and had undergone ultrasound imaging of the testes. The ultrasound images were retrospectively reviewed by a pediatric radiologist who was blinded to the intraoperative findings. Univariate and multivariate and logistic regression analyses were performed. Results Of the studied group of patients, the majority (84.6%) had TT upon Surgical Exploration. The most frequently presented symptom was pain (80.8%), and only a minority (11.5%) presented with vomiting. Radiological findings with the highest sensitivity were heterogeneous echogenicity in favor of TT and enlarged epididymis indicating that TT is unlikely. However, the predictability of TT by any of the assessed clinical and imaging factors was statistically insignificant. Conclusion It is important to gather all relevant data from clinical, laboratory, and imaging sources when assessing pediatric patients with suspected TT given the inaccuracy of each single one of them if used alone. Keeping this in mind, Doppler ultrasound has a significant role to aid in the accuracy of the diagnosis and hence the appropriate decision-making thereafter. However, we found no single clinical or imaging sign that is sensitive enough to prove or rule out TT. Therefore, Surgical Exploration should take place in a timely manner. Moreover, further research is necessary to construct scoring systems where different predictors collectively have higher reliability.
Hugh D Flood - One of the best experts on this subject based on the ideXlab platform.
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blunt testicular trauma is Surgical Exploration necessary
Irish Journal of Medical Science, 2018Co-Authors: E J Redmond, F Mac T Namara, Subhasis K Giri, Hugh D FloodAbstract:Objectives EAU and AUA guidelines recommend urgent Surgical Exploration in cases of suspected testicular rupture. However, the management of rupture to other encapsulated organs (e.g. kidney) is primarily non-operative. The aim of this study was to evaluate the conservative management of blunt scrotal trauma.
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Blunt testicular trauma - is Surgical Exploration necessary?
Irish journal of medical science, 2018Co-Authors: E J Redmond, F Mac T Namara, Subhasis K Giri, Hugh D FloodAbstract:EAU and AUA guidelines recommend urgent Surgical Exploration in cases of suspected testicular rupture. However, the management of rupture to other encapsulated organs (e.g. kidney) is primarily non-operative. The aim of this study was to evaluate the conservative management of blunt scrotal trauma. Standard practice in our Level II trauma centre is to manage all blunt scrotal injuries conservatively with analgesia, antibiotics and scrotal support. Ultrasonography is performed where testicular injury or haematocoele is suspected clinically. All patients are offered a 3 month follow-up appointment. A retrospective chart review was performed on all patients who underwent ultrasonography for blunt scrotal trauma between 1998 and 2014. Each patient was contacted by telephone to assess for testicular atrophy. Thirty-seven consecutive patients were identified for inclusion in the study. Twenty-three patients (62%) were diagnosed with significant testicular injury (rupture of tunica albuginea or large haematocele). All were managed conservatively regardless of ultrasound findings. Four patients had evidence of testicular atrophy at their three month follow up appointment. None reported chronic pain or required delayed orchidectomy. Four patients later underwent repair of an asymptomatic post-traumatic hydrocoele. Our experience shows that blunt scrotal trauma can be safely managed conservatively and may reduce the risk of atrophy compared to case series where the testis was Surgically explored.
Masahiro Kanayama - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized study of posterolateral lumbar fusion using osteogenic protein 1 op 1 versus local autograft with ceramic bone substitute emphasis of Surgical Exploration and histologic assessment
Spine, 2006Co-Authors: Masahiro Kanayama, Tomoyuki Hashimoto, Keiichi Shigenobu, Shigeru Yamane, Thomas W Bauer, Daisuke TogawaAbstract:Study Design. A prospective, randomized and controlled study. Objectives. To evaluate the osteoinductive property of Osteogenic Protein-1 (OP-1 or BMP-7) and fusion rate in human instrumented posterolateral lumbar fusion through radiographic examination, Surgical Exploration, and histologic assessment. of Background Data. The use of osteoinductive agents is a current topic in spinal fusion. Numerous preclinical investigations have demonstrated efficacy of osteoinductive proteins in spinal fusion, but few human clinical studies have been reported. Methods. Nineteen patients with L3-L4 or L4-L5 degenerative spondylolisthesis underwent posterolateral lumbar fusion using pedicle screw instrumentation. The patients were randomized to receive either OP-1 Putty (3.5 mg OP-1/g of collagen matrix per side) alone (n = 9), or local autograft with HA-TCP granules (n = 10). Fusion status was evaluated using plain radiography and CT scan. Radiographic fusion criteria included less than 5° of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area in which the graft materials were placed following decortication. After a minimum 1-year follow-up, the patients who showed radiographic evidence of fusion underwent instrumentation removal and Surgical Exploration of the fusion site. Biopsy specimens were taken from the fusion mass and evaluated histologically. Results. Radiographic fusion rate was 7 of 9 OP-1 patients and 9 of 10 control patients. Based on Surgical Exploration of these 16 patients, new bone formation was macroscopically observed in the posterolateral lumbar region in all cases; however, solid fusion was observed in 4 of 7 OP-1 and 7 of 9 HA-TCP/autograft patients. Histologic assessment demonstrated viable bone in 6 of 7 OP-1 patients. All the control (HA-TCP/autograft) specimens contained viable bone and fibrous tissue surrounding ceramic granules, suggesting slow incorporation of the graft material. Conclusions. In a human posterolateral lumbar spine trial, OP-1 reliably induced viable amounts of new bone formation, but the fusion success rate evaluated by Surgical Exploration was only 4 of 7.
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A Prospective Randomized Study of Posterolateral Lumbar Fusion Using Osteogenic Protein-1 (OP-1) Versus Local Autograft With Ceramic Bone Substitute : Emphasis of Surgical Exploration and Histologic Assessment
Spine, 2006Co-Authors: Masahiro Kanayama, Tomoyuki Hashimoto, Keiichi Shigenobu, Shigeru Yamane, Thomas W Bauer, Daisuke TogawaAbstract:STUDY DESIGN A prospective, randomized and controlled study. OBJECTIVES To evaluate the osteoinductive property of Osteogenic Protein-1 (OP-1 or BMP-7) and fusion rate in human instrumented posterolateral lumbar fusion through radiographic examination, Surgical Exploration, and histologic assessment. SUMMARY OF BACKGROUND DATA The use of osteoinductive agents is a current topic in spinal fusion. Numerous preclinical investigations have demonstrated efficacy of osteoinductive proteins in spinal fusion, but few human clinical studies have been reported. METHODS Nineteen patients with L3-L4 or L4-L5 degenerative spondylolisthesis underwent posterolateral lumbar fusion using pedicle screw instrumentation. The patients were randomized to receive either OP-1 Putty (3.5 mg OP-1/g of collagen matrix per side) alone (n = 9), or local autograft with HA-TCP granules (n = 10). Fusion status was evaluated using plain radiography and CT scan. Radiographic fusion criteria included less than 5 degrees of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area in which the graft materials were placed following decortication. After a minimum 1-year follow-up, the patients who showed radiographic evidence of fusion underwent instrumentation removal and Surgical Exploration of the fusion site. Biopsy specimens were taken from the fusion mass and evaluated histologically. RESULTS Radiographic fusion rate was 7 of 9 OP-1 patients and 9 of 10 control patients. Based on Surgical Exploration of these 16 patients, new bone formation was macroscopically observed in the posterolateral lumbar region in all cases; however, solid fusion was observed in 4 of 7OP-1 and 7 of 9 HA-TCP/autograft patients. Histologic assessment demonstrated viable bone in 6 of 7 OP-1 patients. All the control (HA-TCP/autograft) specimens contained viable bone and fibrous tissue surrounding ceramic granules, suggesting slow incorporation of the graft material. CONCLUSIONS In a human posterolateral lumbar spine trial, OP-1 reliably induced viable amounts of new bone formation, but the fusion success rate evaluated by Surgical Exploration was only 4 of 7.
