Predicting Late Follow-up and Understanding Its Consequences in Growth Modulation for Pediatric Lower Limb Deformities

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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Internal valvuloplasty combined with sleeve wrapping in the treatment of severe deep venous incompetence: A case report

Vascular ◽

10.1177/1708538121990121 ◽

2021 ◽

pp. 170853812199012

Author(s):

Yingfeng Wu ◽

Libing Wei ◽

Xixiang Gao ◽

Yixia Qi ◽

Zhu Tong ◽

...

Keyword(s):

Lower Limb ◽

Venous Insufficiency ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Vein Wall ◽

Polyester Urethane ◽

Left Lower Limb ◽

Deep Vein ◽

Color Duplex Ultrasound

Background The main cause of severe chronic venous insufficiency is deep venous incompetence. Deep venous reconstructive surgeries are reserved for cases that do not show a good response to conservative therapies. Method We present the case of a 68-year-old man presenting with swelling, pain, and pigmentation in his left lower limb for 14 years and ulcers for 10 years. Descending venography identified a Kistner’s grade IV reflux in the deep vein of the left lower limb. Internal valvuloplasty was performed following Kistner’s method. Meanwhile, external wrapping with a 1-cm-wide polyester-urethane vascular patch was performed to strengthen the vein wall in the venospasm condition. Results Symptoms were immediately relieved postoperatively. Refractory ulcers healed five months after the procedure. At the six-month follow-up, color duplex ultrasound of the deep vein of the left lower limb showed no reflux in the proximal segment of the femoral vein. Conclusion Internal valvuloplasty combined with sleeve wrapping is feasible in the treatment of severe deep venous incompetence with good short-term results.

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Leg Varices Originating from the Pelvis: Diagnosis and Treatment

Vascular ◽

10.2310/6670.2006.00030 ◽

2007 ◽

Vol 15 (2) ◽

pp. 70-78 ◽

Cited By ~ 25

Author(s):

Milka Greiner ◽

Geoffrey L. Gilling-Smith

Keyword(s):

Effective Treatment ◽

Lower Limb ◽

Varicose Veins ◽

Diagnosis And Treatment ◽

Repeat Surgery ◽

Recurrent Reflux ◽

Venous Circulation ◽

Platinum Coils

This article reports the investigation and treatment of 24 women presenting with recurrent lower limb varicosities secondary to reflux within the pelvic venous circulation. Diagnosis based on selective retrograde pelvic phlebography enabled precise identification and classification of sites of incompetence. A total of 74 veins were treated by embolization with platinum coils and glue prior to repeat surgery to the lower limb veins. At 4-year follow-up, signs of stasis had disappeared in all patients. Repeat phlebography revealed no evidence of recurrent reflux at the sites of treatment. One patient developed recurrent varices due to incomplete embolization of incompetent pelvic veins. Endovascular occlusion of incompetent pelvic veins is an effective treatment for varicose veins secondary to pelvic venous incompetence.

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Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00474-8 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Masanori Kaneko ◽

Kazuya Fujihara ◽

Mayuko Yamada Harada ◽

Taeko Osawa ◽

Masahiko Yamamoto ◽

...

Keyword(s):

Lower Limb ◽

Cox Regression ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Historical Cohort ◽

Cox Regression Analysis ◽

Claims Database ◽

Younger Age

Abstract Background The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y). Methods We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. Results The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%. Conclusions Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.

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