Hemiepiphysiodesis for the Correction of Distal Femoral Valgus in Growing Dogs

2021 ◽  
Author(s):  
Luca Vezzoni ◽  
Ida Forzisi ◽  
Antonio Ferretti ◽  
Aldo Vezzoni
Keyword(s):  
Growth Plate ◽  
Clinical Significance ◽  
Early Treatment ◽  
Reference Range ◽  
Mean Difference ◽  
Implant Removal ◽  
Skeletally Immature ◽  
Inclusion Criteria ◽  
The Mean

Abstract Objectives The aim of this study was to describe hemiepiphysiodesis for the treatment of distal femoral valgus in immature dogs and to evaluate its effect on the anatomical lateral distal femoral angle (aLDFA). Methods Skeletally immature dogs with distal femoral valgus deformities that had undergone hemiepiphysiodesis between November 2012 and March 2020 at two private veterinary practices were included. Criteria for inclusion in the study were a preoperative aLDFA below the previously published reference range (94 ± 3.3 degrees) and radiographs of the femur taken preoperatively and at growth plate closure. Results A total of 11 dogs fulfilled the inclusion criteria, and a total of 17 limbs were treated. The mean aLDFA was 82.1 ± 3.2 degrees (range: 76–87 degrees) preoperatively and 93.1 ± 5 degrees (range: 76–99 degrees) at the final re-evaluation. The mean difference between the preoperative and final aLDFA was +11 degrees, which was significant. Undercorrection occurred in 2/17 cases, whereas overcorrection was not recorded. The implants were removed in 12/17 cases, and rebound growth occurred in 3 of these. Clinical Significance Hemiepiphysiodesis for the treatment of distal femoral valgus is a technique that allows for increase in aLDFA and should be considered as an early treatment in affected immature dogs. Monitoring for possible overcorrection using serial radiography is important. Implant removal when the desired aLDFA has been achieved is recommended because the incidence of rebound growth is uncommon in dogs.

Hemiepiphysiodesis for the correction of proximal tibial valgus in growing dogs

2016 ◽  
Vol 29 (04) ◽  
pp. 330-337 ◽  
Author(s):  
Anastasia Olsen ◽  
Luca Vezzoni ◽  
Antonio Ferretti ◽  
Ross Palmer ◽  
Aldo Vezzoni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Significance ◽  
Early Treatment ◽  
Reference Range ◽  
Mean Difference ◽  
Implant Removal ◽  
Skeletally Immature ◽  
Inclusion Criteria ◽  
The Mean ◽  
Tibial Valgus

SummaryObjectives: To describe the use of hemiepiphysiodesis for the treatment of proximal tibial deformities in immature dogs and evaluate the effect on the mechanical medial proximal tibial angle (mMPTA).Methods: Skeletally immature dogs with proximal tibial deformities from three institutions treated with hemiepiphysiodesis between March 2006 and January 2015 were included. All dogs were required to have an mMPTA outside the previously published reference range (93.3 ± 1.78°) preoperatively. Dogs were required to have radiographs or computed tomography performed preoperatively and at least eight weeks postoperatively.Results: A total of 19 dogs (n = 31 limbs) fulfilled the inclusion criteria. The mean mMPTA was 102.5° ± 5.3° preoperatively and 92.4° ± 7.2° at the final re-evaluation. The mean difference in mMPTA was -10 ± 5.1° (range, -1 to -19°; p <0.001). Overcorrection was observed in 16 limbs and mMPTA remained above the reference range in nine limbs. Rebound growth was observed in eight limbs where implant removal was performed.Clinical significance: Hemiepiphysiodesis for the treatment of proximal tibial valgus is a technique that allows for reduction in mMPTA and should be considered as an early treatment for immature animals that are presented with proximal tibial deformities. Serial radiographs to monitor for overcorrection should be performed. Implant removal should be considered if overcorrection occurs, taking into consideration that rebound growth may be observed.A Supplementary Table for this paper is available online at: http://dx.doi.org/10.3415/VCOT-15-12-0204

scholarly journals Evaluating the Effect of Retinal Defocus (Blur) on Lateral Heterophoria

2021 ◽  
Vol 23 (1) ◽  
pp. 11-17
Author(s):  
George Nnamdi Atuanya ◽  
Osayimwen Osas Ero ◽  
Raphael Uchenna Enyinnaya Akpalaba
Keyword(s):  
Experimental Study ◽  
Confidence Level ◽  
Mean Difference ◽  
Inclusion Criteria ◽  
Standard Testing ◽  
Defocus Blur ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Mean ◽  
Ocular Health

Purpose: This study was conducted to ascertain the effect of retinal defocusing or retinal blur on lateral heterophoria at far and near.Methods: This was a quasi-experimental study involving 57 participants aged 5 to 35 years, who were selected based on the inclusion criteria of being myopes and emmetropes who had a normal general and ocular health. The Von Graefe technique was used for measuring phoria under standard testing conditions.Results: The mean baseline lateral phoria for emmetropes were 0.53 ± 1.14∆ exophoria and 2.47 ± 2.08∆ exophoria at far and near respectively, while after defocusing, it was 2.80 ± 0.88∆ exophoria and 4.34 ± 1.70∆ exophoria at far and near respectively. For myopes, the baseline lateral phoria was 1.52 ± 1.09∆ exophoria and 4.76 ± 1.13∆ exophoria at far and near respectively while after defocussing, it was 3.39 ± 0.92∆ exophoria at far and 7.60 ± 1.00∆ exophoria at near. The mean difference in lateral phoria was found to be significant at the 95% confidence level (P = 0.000). There was no statistically significant difference in lateral phoria change at far (P = 0.072), while the near phoria difference was significant (P = 0.002).Conclusion: Gas Retinal defocusing with +2.50D resulted in a shift towards exophoria at both far and near, with myopes experiencing more exophoric shift. This is because they are less sensitive to the presence of blur. This will enable practitioners to be cautious of the inhibition of accommodation due to higher exophoria at near when prescribing lenses. Keywords: Retinal Defocus, Myopia, Emmetropia, Near lateral phoria, Distance lateral phoria.

Effect of Syndesmotic Implant Removal on Dorsiflexion

2019 ◽  
Vol 40 (5) ◽  
pp. 499-505 ◽  
Author(s):  
Jorge Briceno ◽  
Timilien Wusu ◽  
Philip Kaiser ◽  
Patrick Cronin ◽  
Alyssa Leblanc ◽  
...  
Keyword(s):  
Final Analysis ◽  
Ankle Dorsiflexion ◽  
Implant Removal ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Level Ii ◽  
Significant Difference ◽  
Before And After ◽  
The Mean

Background: There is limited evidence that syndesmotic implant removal (SIR) is beneficial. However, many surgeons advocate removal based on studies suggesting improved motion. Methodologic difficulties make the validity and applicability of previous works questionable. The purpose of this study was to examine the effect of ankle dorsiflexion after SIR using radiographically measured motion before and after screw removal utilizing a standardized load. Methods: All patients undergoing isolated SIR were candidates for inclusion. Dorsiflexion was measured radiographically: (1) immediately before implant removal intraoperatively, (2) immediately after removal intraoperatively, and (3) 3 months after removal. A standardized torque force was applied to the ankle and a perfect lateral radiograph of the ankle was obtained. Four reviewers independently measured dorsiflexion on randomized, deidentified images. A total of 29 patients met inclusion criteria. All syndesmotic injuries were associated with rotational ankle fractures. There were 11 men (38%) and 18 women (62%). The mean, and standard deviation, age was 50.3 ± 16.9 years (range 19-80). Results: The mean ankle dorsiflexion pre-operatively, post-operatively, and at a 3-month follow-up was 13.7 ± 6.6 degrees, 13.3 ± 7.3 degrees and 11.8 ± 11.3 degrees, respectively ( P = .466). For subsequent analysis, 5 patients were excluded because of the potential confounding effect of retained suture button devices. Analysis of the remaining 24 patients (and final analysis of 21 patients who had complete 3-month follow-up) demonstrated similar results with no statistically significant difference in ankle dorsiflexion at all 3 time points. Conclusion: Removal of syndesmotic screws may not improve ankle dorsiflexion motion and should not be used as the sole indication for screw removal. Level of Evidence: Level II, prospective cohort study.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

Effect of Surgical Versus Pharmacological Decompression of Ludwig’s Angina on Airway Compromise among Nigerian Patients

2020 ◽  
Author(s):  
Ekaniyere EB
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Decompression ◽  
Airway Compromise ◽  
Inclusion Criteria ◽  
Hospital Stays ◽  
Ludwig’S Angina ◽  
The Mean ◽  
The University ◽  
Ludwig's Angina ◽  
Gender Type

Background: Even though the decompression of the cellulitis phase of Ludwig’s angina (LA) by surgical or pharmacological approach is well documented, it is unclear which approach is more effective. Objective: We aim to compare the outcome of treatment between surgical versus pharmacological decompression in patients with LA. Subjects and Methods: A retrospective cohort study was designed. Data were collected from the case notes of patients that met the inclusion criteria from 2004 to 2018 at the University of Benin Teaching Hospital, Nigeria.The data were age, gender, type of decompression approach, length of hospital stay (LOS) and airway compromise. Result: A total of 62 patients comprising 37(59.7%) surgical decompression group and 25(40.3%) pharmacological decompression group were studied. Thirty-six (58.1%) males and 26 (41.9%) females were studied. Their mean age and standard deviation were 40.6 years and 11.9 years respectively. The mean length of hospital stays between the pharmacological and surgical decompression groups were 8.05 days and 13.8 days respectively. The incidence of airway compromise in the surgical decompression group was 19.9% lower than that of the pharmacological decompression group (P=0.47), which was not significant. The type of decompression approach also failed to influence the incidence of airway compromise (P = 0.41). Conclusion: The use of surgical versus pharmacological decompression does not significantly alter the incidence of airway compromise in the management of LA. The Patients that had surgical decompression had a shorter stay in the hospital as compared to those who had pharmacological decompression. This was not statistically significant.

One-year real-life results on effect of intravitreal aflibercept in patients with diabetic macular oedema switched from ranibizumab

2020 ◽  
pp. 112067212092727
Author(s):  
Marko Lukic ◽  
Gwyn Williams ◽  
Zaid Shalchi ◽  
Praveen J Patel ◽  
Philip G Hykin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Early Treatment ◽  
Macular Oedema ◽  
Real Life ◽  
Diabetic Macular Oedema ◽  
Foveal Thickness ◽  
Macular Volume ◽  
Central Foveal Thickness ◽  
The Mean

Purpose To assess visual and optical coherence tomography–derived anatomical outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in patients switched from intravitreal ranibizumab (Lucentis®). Design Retrospective, cohort study. Participants Ninety eyes (of 67 patients) receiving intravitreal anti–vascular endothelial growth factor therapy were included. Methods This is a retrospective, real-life, cohort study. Each patient had visual acuity measurements and optical coherence tomography scans performed at baseline and 12 months after the first injection of aflibercept was given. Main Outcome Measures We measured visual acuities in Early Treatment Diabetic Retinopathy Study letters, central foveal thickness and macular volume at baseline and at 12 months after the first aflibercept injection was given. Results Ninety switched eyes were included in this study. The mean (standard deviation) visual acuity was 63 (15.78) Early Treatment Diabetic Retinopathy Study letters. At baseline, the mean (standard deviation) central foveal thickness was 417.7 (158.4) μm and the mean macular volume was 9.96 (2.44) mm3. Mean change in visual acuity was +4 Early Treatment Diabetic Retinopathy Study letters (p = 0.0053). The mean change in macular volume was −1.53 mm 3 in SW group (p = 0.21), while the change in central foveal thickness was −136.8 μm (p = 0.69). Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in the switched group at 12 months after commencing treatment with aflibercept for diabetic macular oedema.

scholarly journals Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment

2021 ◽  
Vol 7 (1) ◽  
pp. e000920
Author(s):  
Dimitris Challoumas ◽  
Neal L Millar
Keyword(s):  
Systematic Reviews ◽  
Assessment Tool ◽  
Data Extraction ◽  
Cochrane Collaboration ◽  
Mean Difference ◽  
Strength Of Evidence ◽  
The Mean ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Cochrane Collaboration

ObjectiveTo critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment.Data sourcesMedline from inception to June 2020.Study eligibilityAll SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy.Data extraction and synthesisIncluded SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication.ResultsA total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately.ConclusionsIn light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.

scholarly journals The Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study—Defining a Threshold for Non-Cycloplegic Myopia Prevalence in Children

2021 ◽  
Vol 10 (6) ◽  
pp. 1215
Author(s):  
Aparna Gopalakrishnan ◽  
Jameel Rizwana Hussaindeen ◽  
Viswanathan Sivaraman ◽  
Meenakshi Swaminathan ◽  
Yee Ling Wong ◽  
...  
Keyword(s):  
Open Field ◽  
Tamil Nadu ◽  
Mean Difference ◽  
School Vision ◽  
Elite School ◽  
Prevalence Estimates ◽  
The Mean ◽  
Clinically Significant ◽  
Set Up ◽  
Definition Of

The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to −0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to −0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ −0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ −0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤−0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ −0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ −0.50 D.

scholarly journals Estimates of the mean difference in orthopaedic randomized trials: obligatory yet obscure

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lauri Raittio ◽  
Antti Launonen ◽  
Ville M. Mattila ◽  
Aleksi Reito
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Ceiling Effect ◽  
Mean Difference ◽  
Discussion Section ◽  
Power Calculations ◽  
Randomized Controlled ◽  
Patient Reported ◽  
The Mean

Abstract Background Randomized controlled trials in orthopaedics are powered to mainly find large effect sizes. A possible discrepancy between the estimated and the real mean difference is a challenge for statistical inference based on p-values. We explored the justifications of the mean difference estimates used in power calculations. The assessment of distribution of observations in the primary outcome and the possibility of ceiling effects were also assessed. Methods Systematic review of the randomized controlled trials with power calculations in eight clinical orthopaedic journals published between 2016 and 2019. Trials with one continuous primary outcome and 1:1 allocation were eligible. Rationales and references for the mean difference estimate were recorded from the Methods sections. The possibility of ceiling effect was addressed by the assessment of the weighted mean and standard deviation of the primary outcome and its elaboration in the Discussion section of each RCT where available. Results 264 trials were included in this study. Of these, 108 (41 %) trials provided some rationale or reference for the mean difference estimate. The most common rationales or references for the estimate of mean difference were minimal clinical important difference (16 %), observational studies on the same subject (8 %) and the ‘clinical relevance’ of the authors (6 %). In a third of the trials, the weighted mean plus 1 standard deviation of the primary outcome reached over the best value in the patient-reported outcome measure scale, indicating the possibility of ceiling effect in the outcome. Conclusions The chosen mean difference estimates in power calculations are rarely properly justified in orthopaedic trials. In general, trials with a patient-reported outcome measure as the primary outcome do not assess or report the possibility of the ceiling effect in the primary outcome or elaborate further in the Discussion section.

scholarly journals Comparing the Tibial Tuberosity–Trochlear Groove Distance Between CT and MRI in Skeletally Immature Patients With and Without Patellar Instability

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097366
Author(s):  
Zhen-Zhen Dai ◽  
Lin Sha ◽  
Zi-Ming Zhang ◽  
Zhen-Peng Liang ◽  
Hao Li ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Intraclass Correlation ◽  
Mean Difference ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Skeletally Immature ◽  
Bony Landmarks ◽  
The Difference ◽  
Ct And Mri

Background: The tibial tubercle–trochlear groove (TT-TG) distance was originally described for computed tomography (CT), but it has been measured on magnetic resonance imaging (MRI) in patients with patellar instability (PI). Whether the TT-TG measured on CT versus MRI can be considered equivalent in skeletally immature children remains unclear. Purpose: To investigate in skeletally immature patients (1) the effects of CT versus MRI imaging modality and cartilage versus bony landmarks on consistency of TT-TG measurement, (2) the difference between CT and MRI measurements of the TT-TG, and (3) the difference in TT-TG between patients with and without PI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively identified 24 skeletally immature patients with PI and 24 patients with other knee disorders or injury but without PI. The bony and cartilaginous TT-TG distances on CT and MRI were measured by 2 researchers, and related clinical data were collected. The interrater, interperiod (bony vs cartilaginous), and intermethod (CT vs MRI) reliabilities of TT-TG measurement were assessed with intraclass correlation coefficients. Results: The 48 study patients (19 boys, 29 girls) had a mean age of 11.3 years (range, 7-14 years). TT-TG measurements had excellent interrater reliability and good or excellent interperiod reliability but fair or poor intermethod reliability. TT-TG distance was greater on CT versus MRI (mean difference, 4.07 mm; 95% CI, 2.6-5.5 mm), and cartilaginous distance was greater than bony distance (mean difference, 2.3 mm; 95% CI, 0.79-3.8 mm). The TT-TG measured on CT was found to increase with the femoral width. Patients in the PI group had increased TT-TG distance compared with those in the control group, regardless of landmarks or modality used ( P > .05 for all). Conclusion: For skeletally immature patients, the TT-TG distance could be evaluated on MRI, regardless of whether cartilage or bony landmarks were used. Its value could not be interchanged with CT according to our results; however, further research on this topic is needed.

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