[Femoral nerve repair with autografts for proximal retroperitoneal damage (case report and literature review)]

Femoral nerve damage, especially in proximal retroperitoneal space, is rare. Therefore, surgical strategy is still unclear for these patients. Various specialists discuss repair with autografts or neurotization by the obturator nerve or its muscular branch.

OBJECTIVE

To demonstrate the diagnostic algorithm for proximal femoral nerve injury and favorable outcomes after repair with long autografts.

MATERIAL AND METHODS

We assessed movements and sensitivity using a five-point scale, as well as ultrasound, magnetic resonance imaging and electroneuromyography data in a patient with extended iatrogenic femoral nerve damage before and after repair with long autografts (10.5 cm).

RESULTS AND DISCUSSION

The patient had complete femoral nerve interruption in proximal retroperitoneal space with 10-cm defect that required repair with five autografts from two sural nerves. Postoperative ultrasound and magnetic resonance imaging revealed signs of graft survival and no neuroma within the nerve suture lines. The first signs of motor recovery occurred after 10 months. After 14 months, strength of quadriceps femoris muscle comprised 4 points, and electroneuromyography confirmed re-innervation.

CONCLUSION

Femoral nerve repair with autografts for complete proximal anatomical interruption can provide sufficient restoration of movements and sensitivity. Therefore, this surgical option should be preferred instead of neurotization. Ultrasound, MRI and ENMG are valuable to clarify the diagnosis and state of the autografts.

FOXO3 is a potential biomarker and therapeutic target for premature ovarian insufficiency (Review)

Premature ovarian insufficiency (POI) is a common clinical disease of the reproductive system in which patients lose normal gonadal function prior to the age of 40. Common pathogenic factors include iatrogenic injury, genetics, inflammation, autoimmune, environmental and psychological factors. Patients with POI experience decreased estrogen secretion levels, ovulation disorder and infertility. POI appears frequently in clinical practice and the burden of the disease is heavy; however, the detailed pathological mechanism requires further experimental evaluation. Furthermore, there is a lack of effective treatment options. Certain causes of the pathogenesis of POI can be explained by epigenetic changes. Front fork transcription factor 3 (FOXO3) is a member of the forkhead box family of transcription factors. FOXO3 was initially considered to affect insulin/insulin growth factor signal transduction. However, the target gene range of FOXO3 includes numerous genes that affect metabolism and protein stability and are associated with aging. There is an association between decreased FOXO3 expression levels and POI. In the present review article, the role of FOXO3 in POI was evaluated, which emphasized the importance of this protein in the investigation of this disease. Moreover, the present review evaluated the evidence for the potential targets and biomarkers of FOXO3 that may be used in the treatment and diagnosis of POI.

Iatrogenic Damage to Neurovascular and Soft Tissue Structures During Lateral Release of Hallux Valgus: A Comparative Anatomical Study of Minimally Invasive Versus Open Surgical Techniques

Lateral release is often an integral step in surgical correction of hallux valgus and can be performed using open or minimally invasive techniques. We investigated whether these techniques cause iatrogenic damage to arteries, nerves, tendons, or joint capsules. In this cadaver study, lateral release was performed on 9 pairs of specimens by a specialized foot surgeon. The specimens were randomly assigned to each group. The operations were followed by anatomical preparation, data collection, photo documentation, and statistical analysis. Iatrogenic damage to arteries, nerves, tendons, or joint capsules was rare, regardless of the surgical technique used. However, with the minimally invasive technique, the tendon of the extensor hallucis longus muscle and the sensitive terminal branches of the fibular nerve were at risk due to their anatomical proximity to the access portal. The deep transverse metatarsal ligament was potentially at risk if the adductor hallucis muscle was completely detached from the lateral sesamoid. When the deep transverse metatarsal ligament was transected there was risk of damaging the underlying plantar neurovascular structures. Both surgical techniques are safe in terms of the risk of injury to neighboring neurovascular and soft tissue structures.

Is Peri-Implant Probing Causing Over-Diagnosis and Over-Treatment of Dental Implants?

Pocket probing depth (PPD) and bleeding on probing (BOP) measurements are useful indices for the assessment of periodontal conditions. The same periodontal indices are commonly recommended to evaluate the dental implant/tissue interface to identify sites with mucositis and peri-implantitis, which, if not treated, are anticipated to lead to implant failure. The aim of the present narrative review is to discuss the available literature on the effectiveness of probing at dental implants for identification of peri-implant pathology. There is substantial clinical evidence that PPD and BOP measurements are very poor indices of peri-implant tissue conditions and are questionable surrogate endpoints for implant failure. On the contrary, the literature suggests that frequent disturbance of the soft tissue barrier at implants may instead induce inflammation and bone resorption. Moreover, over-diagnosis and subsequent unnecessary treatment may lead to iatrogenic damage to the implant-tissue interface. Despite this, the recommendations from recent consensus meetings are still promoting the use of probing at dental implants. For evaluation of implants, for instance at annual check-ups, the present authors recommend a clinical examination that includes (i) a visual inspection of the peri-implant tissues for the assessment of oral hygiene and the detection of potential redness, swelling, (ii) palpation of the peri-implant tissues for assessment of the potential presence of swelling, bleeding, suppuration. In addition, (iii) radiography is recommended for the assessment of crestal bone level for comparison with previous radiographs to evaluate potential progressive bone loss even if there is a need for more scientific evidence of the true value of the first two clinical testing modes.

[Occurrence of a lethal outcome due to iatrogenic damage of an intercostal vessel during a pleural puncture procedure]

A rare case of a lethal outcome due to iatrogenic damage to the intercostal vessel, a collateral branch of the posterior intercostal artery, is described. The little-known features of the topography of this vessel (location on the upper edge of the underlying rib), which requires further study in the context of variable anatomy, are given. The risks associated with deviations from the traditionally recommended sites of pleural puncture (below the eighth intercostal space to the scapular line) are substantiated. An analysis of the characteristics of bleeding arising from the intercostal vessels (from two ends, under high pressure, etc.) is given, which implies the extreme importance of a timely diagnosis. Differing points of view on the legal assessment of malpractice when care is delivered by a series of doctors, and the legal necessity of determining the 'point of no return' (the latest moment after the onset of bleeding, in which medical aid can still prevent an unfavorable outcome), are considered. An opinion is expressed on the need for the active participation (initiative) of an expert in the provision of expertise.

Iatrogenic Damage to the Periodontium Caused by Implants and Implant Treatment Procedures

A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor.Well planned, comprehensive treatment plans lead to successful implant treatment and patient satisfaction, which are the eventual long-term objectives. Probability of implant success can be put at jeopardy by absolute and relative risk factors.

Iatrogenic Damage to the Periodontium Caused by Endodontic Treatment Procedures: An Overview

The tooth, the pulp tissue within it and its supporting structures should be viewed as one biologic unit. The interrelationship of these structures influences each other during health, function and disease. The interrelationship between periodontal and endodontic diseases has aroused much speculation, confusion and controversy. The endodontium and periodontiumare closely related and disease or damage of one tissue may lead to the involvement of the other.

Iatrogenic Factors Affecting the Periodontium: An Overview

The principal reason of gingival inflammation is bacterial plaque, along with other predisposing factors. These predisposing factors are calculus, malocclusion, faulty restorations, complications associated with orthodontic therapy, self- inflicted injuries, use of tobacco & radiation therapy. The contributing factors to gingival inflammation & periodontal destruction are deficient dental restorations and prosthesis. Inadequate dental procedures that add to the weakening of the periodontal tissues are referred to as iatrogenic factors.

Iatrogenic Damage to the Periodontium Caused by Laser: An Overview

Lasers have been used in dentistry since 1994 to treat a number of dental problems. A variety of lasers are now available for use in dentistry. Once stated as an intricate technology with restricted usage in clinical dentistry, there is a growing awareness of the usefulness of lasers in the armamentarium of the modern dental practice, where they can be used as an adjunct or alternative to various long-standing approaches.