BACKGROUND: Diabetic foot ulcers (DFUs) are a challenging complication of diabetes mellitus, often leading to poor clinical outcomes and significant socioeconomic burdens. We evaluated the effectiveness of a definitive single-stage protocolized surgical management pathway, including the use of local antibiotic bone graft substitute, for the treatment of infected DFUs with associated osteomyelitis.
METHODS: A retrospective cohort study was conducted. Medical records were extracted (from January 2017 to December 2020) to establish a database consisting of patients who underwent surgical intervention for the treatment of an infected DFU with osteomyelitis. Patients were divided into conventional (control) and protocolized (intervention) surgical groups depending on the treatment received. Clinical outcomes were assessed over a 12-month follow-up period.
RESULTS: A total of 136 consecutive patients were included (conventional = 33, protocolized = 103). The protocolized group demonstrated a statistically significant reduction in the mean number of operations performed per patient (1.2 vs. 3.5) (P < 0.001) and a shorter accumulative hospital length of stay (12.6 vs. 25.1 days) (P < 0.001) compared to the conventional group. Major amputation rates were significantly lower in the protocolized group (2% vs. 18%) (P < 0.001). Within 12 months of surgical intervention, the protocolized group exhibited an ulcer healing rate of 89%, with a low rate of recurrence (3%).
CONCLUSIONS: The protocolized surgical pathway, including local antibiotic bone graft substitute use, demonstrated superior outcomes compared to conventional management for the treatment of infected DFUs with osteomyelitis. Further research is needed to evaluate the cost-effectiveness and generalizability of this approach.

Dental implants are designed to ensure natural tooth replacement based on improved design, simplified placement, and long-term survival. This study aimed to compare one-piece implant (OPI) and two-piece implant (TPI) to determine the success rate over the TPI. This study conducted on 15 patients selected with the age range of 20-60 years to place OPI and TPI. The surgical consent form duly signed by the patients was procured. The implants used were of Adin Implant System, and a follow-up examination was done at 3, 6, and 9 months after implant loading and various clinical and radiographic parameters were noted for both OPI and TPI. The clinical parameters measured were Silness, and Loe gingival index and probing depth and the radiographic parameters included crestal marginal bone loss. Independent Sample t-test and ANOVA were used for statistical analysis. The statistical analysis showed no significant difference between the OPI and TPI based on the gingival index, probing depth, and crestal bone loss. On the contrary, there was a statistical significance in comparing the same parameters during the follow-up period of 3, 6, and 9 months. Over a protracted period, OPIs are better than TPIs by the design and placement procedure. Further research with a higher sample size shall possibly establish esoteric results on a large scale.

UNASSIGNED: Retrospective study.
UNASSIGNED: To evaluate and compare the outcomes of single stage surgery for Tandem Spinal Stenosis (TSS) in elderly (Age ≥65 years) and younger patients (Age <65 years).
UNASSIGNED: Tandem spinal stenosis among elderly is common and often missed diagnosed with delayed presentation. Literature evaluating efficacy and safety of single staged surgery for TSS in elderly patients is scanty.
UNASSIGNED: Analysis of 74 patients with TSS managed with single stage posterior surgery from 2007 to 2016 was done. A total of 62 patients who satisfied our inclusion criteria were evaluated and subdivided into two groups based on age; Study group (age ≥65years)] (n = 32) and control group (age <65years) (n = 30). Perioperative, clinical/radiological parameters and postoperative complications and recovery rate were noted.
UNASSIGNED: The Mean ODI and mJOA showed significant improvement post-operatively in both groups however there was no significant difference between the two groups at final follow-up. There was no statistical difference in operative time, blood loss and hospital stay between the groups. As per Odom\'s criteria, 78.1% had excellent to good results in study group, while 83.3% had excellent to good results in control group. Postoperative complications were more in elderly group however, there was no significant difference among neurological or cardiopulmonary complications between both groups.
UNASSIGNED: Single stage surgery is safe & efficacious modality with less morbidity and optimal results in elderly patients with proper preoperative risk assessment. Our study showed that increased age does not proved to be deterrent in the outcome of single staged surgery in tandem spinal stenosis.

Most of the case reports on hydatid cyst have documented its diagnosis and treatment involving either lungs or liver. This case report is unique as it documents the standard diagnostic and treatment approach followed for curing concurrent multiple hydatid cysts involving liver and right lung simultaneously via single stage surgery. A 52-year-old male presented with symptoms of simple pneumonia along with mild pain in the right upper quadrant. Hydatid cyst was considered as the differential diagnosis after physical examination. Both CT scan and MRI confirmed the presence of multiple cysts both in the liver as well as right lung. A single stage radical removal of cysts from both the organs was performed. The patient was hemodynamically stable, and no complications were reported postoperatively. This case report highlights the importance of considering hydatid cyst as a differential diagnosis in the light of vague presenting symptoms. Also, it emphasizes on the benefits of single stage surgery for removing cysts from both the organs simultaneously.

OBJECTIVE: Hirschsprung\'s disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung\'s disease. In this study, we present our early experience with single stage transanal pull through in neonates.
METHODS: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung\'s disease in our institute from January 2011 to January 2013.
METHODS: Five newborn boys who presented with Hirschsprung\'s disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years.
RESULTS: Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range - 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range - 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series.
CONCLUSIONS: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.

Complex dumb-bell spinal tumors are challenging surgical lesions. Combined antero-posterior exposures have traditionally been used in their management. This combined exposure has the disadvantage of a two-stage operation with transthoracic or retroperitoneal dissection. With better understanding of biomechanics of spine and evolution of microsurgical technique, there has been resurgence of single stage surgeries, among which the transparaspinal exposure provides the simplest and the most direct route for resection of dumb-bell tumors. A 16-year-old male was admitted with history of back pain with radiation to left lower limb for 6 months, progressive weakness of both lower limbs for two months, and hesitancy of micturition for 1 month. A clinical diagnosis of cauda-conus lesion was made. Radiological investigations revealed a complex dumb-bell spinal tumor extending from lower part of L2-L4 vertebra, with large paraspinal extension through left L3 intervertebral foramina. Tumor was successfully removed in one step using a transparaspinal approach. We discuss technical details of this novel approach along with limitations and possible complications.