FM1-2 A prospective study on surgical management of foot deformities in charcot marie tooth disease

2019 ◽  
Vol 90 (3) ◽  
pp. e21.2-e21
Author(s):  
M Laura ◽  
G Ramdharry ◽  
D Singh ◽  
D Kozyra ◽  
M Skorupinska ◽  
...  
Keyword(s):  
Surgical Management ◽  
Surgical Procedures ◽  
Ankle Instability ◽  
Evidence Base ◽  
Foot Deformities ◽  
Range Of Movement ◽  
Strength Assessment ◽  
Charcot Marie Tooth ◽  
Wide Range ◽  
Foot Alignment

ObjectivesCharcot-Marie-Tooth (CMT) Disease is the most common inherited peripheral neuropathy. Foot deformities are frequently observed in CMT patients and orthopaedic surgery is often required. Currently the evidence base on surgical management is limited. We prospectively studied surgical management of CMT patients attending our centre.SubjectsPatients were assessed at baseline and yearly after surgery.MethodsAssessment and data included: history of ankle instability, pain, skin condition, lower limb strength assessment, Charcot-Marie-Tooth Examination Score, Foot Posture Index, ankle dorsiflexion range of movement, questionnaires, details of surgical procedures.Results29 feet in 24 CMT patients (17 males, 7 females, mean age: 38.6±13) were evaluated prior to surgery. All patients but one had genetically confirmed CMT (18 CMT1A; 4 CMTX; 1 CMT4A). 17 feet in 12 pts were evaluated after 1 year; 10 feet in 9 pts were evaluated after 2 years; 8 feet in 7 pts were evaluated after 3 years. A wide range of surgical procedures were performed by one dedicated orthopaedic surgeon. There was significant improvement of foot alignment (p<0.001), callosities (p=0.002) and pain (p=0.022) after surgery. Surgery had no significant effect on strength, ankle range of movement, falls and fatigue.ConclusionsThe findings showed significant improvement of foot alignment, callosities and pain after surgery. Data acquired from this study will help developing orthopaedic intervention guidelines and identify areas for further research.

Pain pathophysiology and surgical management

2019 ◽  
pp. 895-908
Author(s):  
Richard Mannion ◽  
Rokas Tamasouskas
Keyword(s):  
Chronic Pain ◽  
Surgical Management ◽  
Surgical Procedures ◽  
Pain Mechanisms ◽  
Anatomy And Physiology ◽  
Peripheral Organs ◽  
Pain Pathways ◽  
Wide Range ◽  
Surgical Manipulation ◽  
The Brain

There can be no understanding of pain without an appreciation of its anatomical substrate from peripheral organs to the brain, but the notion of fixed pain pathways is long outdated. Plasticity, adaptive and maladaptive, has been described within each component and relay along the neuroaxis in a wide range of physiological and pathophysiological states. Clearly, this has implications for our understanding of the surgical manipulation of pain pathways and its utility (or otherwise) in patients. Here we provide an overview of the anatomy and physiology of nociception, discuss some of the pathophysiology of chronic pain states and relate this to surgical procedures that primarily aim to target pain mechanisms.

Surgical Management of Gout in the Foot and Ankle

2016 ◽  
Vol 106 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Daniel Poratt ◽  
Keith Rome
Keyword(s):  
Outcome Measures ◽  
Surgical Management ◽  
Surgical Procedures ◽  
Cochrane Library ◽  
Foot Pain ◽  
Foot And Ankle ◽  
Tophaceous Gout ◽  
Wide Range ◽  
Patient Reported

Background: The surgical management of tophaceous gout has been well documented in the literature, including its effect on foot pain and disability. To date, there have been no systematic reviews assessing the quality of the literature relating to the operative management of tophaceous gout and the outcomes in the foot and ankle. Methods: The following electronic databases were searched (1980–2014): Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Scopus, and the Cochrane Library. The articles identified were published in English and included adult participants (age ≥18 years) with diagnosed gout and surgical intervention to the foot and ankle. The Downs and Black Quality Index was modified to assess the quality of the articles being reviewed. Results: Six articles were reviewed and were of moderate quality (mean quality score of 71%). Surgical management was conducted on men (88%) with a mean age of 52 years. There was wide variation in the types of surgical procedures performed, with 28% of studies reporting surgery to the first metatarsophalangeal joint. Most studies were retrospective. A wide range of outcome measures were reported: foot pain, function, preoperative and postoperative activity levels, monitoring of uric acid levels, and patient satisfaction after surgery. Conclusions: The review demonstrated a limited number of good-quality studies. Several surgical procedures for the foot and ankle in people with chronic tophaceous gout were reported. Future studies should include prospective observational studies using validated and reliable patient-reported outcome measures.

scholarly journals Open knee dislocation with a patellar tendon rupture: Result of staged surgical repair

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882310
Author(s):  
Tsuneari Takahashi ◽  
Tomohiro Matsumura ◽  
Kazuaki Ishihara ◽  
Shuhei Hiyama ◽  
Katsushi Takeshita
Keyword(s):  
Posterior Cruciate Ligament ◽  
Surgical Management ◽  
Patellar Tendon ◽  
Tendon Rupture ◽  
Cruciate Ligament ◽  
Knee Dislocation ◽  
Patellar Tendon Rupture ◽  
Collateral Ligament ◽  
Range Of Movement ◽  
Multiligament Injury

Knee dislocation with concomitant multiligament injury is a rare and devastating injury. We report the successful repair of a rare case of open knee dislocation with concomitant multiligament injury and patellar tendon rupture of an 18-year-old male due to a motorcycle accident. The patient presented with an open wound running parallel to the knee joint line and patellar tendon rupture with full exposure of the cartilage of the distal femur. Staged surgical management including the application of a ring-type external fixator with a hinged joint, lateral collateral ligament repair, medial collateral ligament reconstruction using autogenous hamstring tendon, and joint release was performed. Range of movement was recovered to 0 degrees of knee extension and 80 degrees of knee flexion, and extension lag was negative. The Lysholm score of the patient was recovered to 92. The patient was able to return to work in the construction field 2 years after sustaining the injury. The patient had no complaint of pain and was able to resume construction work, even though reconstruction of the anterior cruciate ligament and posterior cruciate ligament was not performed. The application of a hinged ring-type external fixation device might play a key role in early range of movement restoration and to maintain the reduced position and acceptable recovery of the posterior cruciate ligament injury without the need for reconstructive surgery. This report is the first to describe the safety and effectiveness of staged surgical management for the repair of open knee dislocation with concomitant multiligament injury and patellar tendon rupture. However, further studies with longer follow-up periods will be needed to observe the development of osteoarthritis or weakness of the knee. Staged surgical management is a safe and effective procedure for repairing an open knee dislocation with concomitant multiligament injury and patellar tendon rupture.

scholarly journals Ostomy-Related Complications

2019 ◽  
Vol 32 (03) ◽  
pp. 176-182 ◽  
Author(s):  
Douglas Murken ◽  
Joshua Bleier
Keyword(s):  
Gastrointestinal Tract ◽  
Surgical Procedures ◽  
Parastomal Hernia ◽  
Significant Morbidity ◽  
Stoma Formation ◽  
Wide Range ◽  
Peristomal Skin ◽  
Stomal Stenosis

AbstractIleostomy or colostomy formation is an important component of many surgical procedures performed for a wide range of disorders of the gastrointestinal tract. Despite the frequency with which intestinal stomas are created, stoma-related complications remain common and are associated with significant morbidity as well as cost. Some of the most prevalent complications of stoma formation which will be detailed in this article include peristomal skin complications, retraction, stomal necrosis, stomal stenosis, prolapse, bleeding, dehydration from high ostomy output, and parastomal hernia. The authors will review these common complications, detail means to avoid or prevent them, and outline recommendations for management.

scholarly journals Surgery at Cranio-vertebral (CV) Junction: Our Experience of 32 Cases

1970 ◽  
Vol 29 (2) ◽  
pp. 78-84
Author(s):  
FH Chowdhury ◽  
MR Haque ◽  
NKSM Chowdhury ◽  
MS Islam ◽  
Z Raihan ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Surgical Techniques ◽  
Clinical Findings ◽  
Type I ◽  
College Hospital ◽  
Chiari Malformation Type I ◽  
Female Ratio ◽  
Medical College ◽  
Neoplastic Lesion ◽  
Wide Range

Cranio vertebral (CV) junction is one of the critical sites for surgery. It's anatomy, physiological aspects and pathological involvement varies in a wide range of margins. Common problems are developmental anomalies, traumatic involvement, inflammatory, infective and neoplastic lesion. Management of these problems varies a lot from each other. Aim of the article is to overview the pathologies in this area and to study presentations, investigations, surgical procedures and results of these pathologies. We prospectively analyzed 32 cases of Cranio-vertebral (CV) region surgery in the Department of Neurosurgery Dhaka Medical College Hospital and Mitford Hospital, Dhaka, from 2000 to 2008. In our series, male and female ratio was 7.2:1. Pathologies were atlanto- axial dislocation (AAD), Chiari malformation type –I, schwannoma, meningioma, hydatid cyst and tuberculosis. Common clinical findings were- neck pain, quadriparesis, quadriplegia, hand atrophy, autonomic dysfunction and hypertension. Various types of surgical procedures were done in this series according to the pathology. Death was in 01 case, neurological deterioration seen in one case, 2 cases were neurologically stable and 28 cases (87.5%) improved neurologically where one was non useful improvement (Frankel grade-C). Complete pre operative radiological study is a very important adjunct for a successful surgical result. Proper evaluation of patients with selection of appropriate surgical procedures along with safe surgical techniques are the necessary things for successful surgery in this area. DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7952 (J Bangladesh Coll Phys Surg 2011; 29: 78-84)

scholarly journals Questionable safety of thyroid surgery with same day discharge

2012 ◽  
Vol 94 (8) ◽  
pp. 543-547 ◽  
Author(s):  
HE Doran ◽  
J England ◽  
F Palazzo
Keyword(s):  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Evidence Base ◽  
Day Surgery ◽  
Hospital Environment ◽  
British Association ◽  
Outpatient Basis ◽  
Day Case ◽  
Increased Risk ◽  
Same Day Discharge

INTRODUCTION Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. METHODS The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed. RESULTS There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. CONCLUSIONS Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.

scholarly journals Agenesis of Isthmus of the Thyroid Gland in a Patient with Graves-Basedow Disease and a Solitary Nodule

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Omer Faruk Ozkan ◽  
Mehmet Asık ◽  
Huseyin Toman ◽  
Faruk Ozkul ◽  
Oztekin Cıkman ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Thyroid Gland ◽  
Surgical Procedures ◽  
Congenital Anomalies ◽  
Clinical Symptoms ◽  
Endocrine Gland ◽  
Solitary Nodule ◽  
Rare Congenital Anomaly ◽  
Wide Range

The thyroid is a vascular endocrine gland with two lateral lobes connected by a narrow, median isthmus. Although a wide range of congenital anomalies of the thyroid gland has been reported in the literature, agenesis of the thyroid isthmus is a very rare congenital anomaly. Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. We describe a patient with no isthmus of the thyroid, associated with Graves-Basedow disease. Thyroid isthmus agenesis should be kept in mind in order for surgical procedures involving thyroid pathologies to be carried out safely.

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