Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.

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Peripheral ostectomy with the use of Carnoy’s solution as a rational surgical approach to odontogenic keratocyst: A case report with a 5-year follow-up

Vojnosanitetski pregled ◽

10.2298/vsp1212101m ◽

2012 ◽

Vol 69 (12) ◽

pp. 1101-1105 ◽

Cited By ~ 4

Author(s):

Stevo Matijevic ◽

Zoran Damjanovic ◽

Zoran Lazic ◽

Milka Gardasevic ◽

Dobrila Radenovic-Djuric

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Third Molar ◽

Treatment Protocol ◽

Odontogenic Keratocyst ◽

Radiographic Evidence ◽

The Third ◽

Cortical Perforation ◽

Molar Region

Introduction. Odontogenic keratocyst (OKC) is a rare developmental, epithelial and benign cyst of the jaws of odontogenic origin with high recurrence rates. The third molar region, especially the angle of the mandible and the ascending ramus are involved far more frequently than the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. Different surgical treatment options like marsupialization, decompression, enucleation, enucleation with Carnoy?s solution, peripheral ostectomy with or without Carnoy?s solution, and jaw resection have been discussed in the literature with variable rates of recurrence. Case report. We presented a 52-yearold male with orthokeratinized odontogenic keratocyst. Elliptical unilocular radiolucency located in the third molar region and the ascending ramus of the mandible, 40 ? 25 mm in diameter with radiographic evidence of cortical perforation at the anterior ramus border of the mandible 20 mm in diameter, was registrated on orthopantomographic radiography. Surgical treatment included enucleation of the cyst and peripheral ostectomy with the use of Carnoy?s solution and excision of the overlying attached mucosa. Postoperatively, no paresthesia in the inervation area of the inferior alveolaris nerve was registrated. Recurrences were not registrated within 5 years post-intervention. Coclusion. Treatment of odontogenic keratocyst with enucleation and peripheral ostectomy with the use of Carnoy?s solution and excision of the overlying attached mucosa had a very low rate of recurrence. Radical and more aggressive surgical treatments as jaw resection should be reserved for multiple recurrent cysts and when OKC is associated with nevoid basal cell carcinoma syndrome (NBCCS). Following the treatment protocol in the management of OKC and systematic and long-term postsurgical follow-up are considered key elements for successful results.

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Surgical Treatment of Odontogenic Keratocyst with Application of Carnoy's Solution: Case Report

Journal of Health Sciences ◽

10.17921/2447-8938.2019v21n2p108-111 ◽

2019 ◽

Vol 21 (2) ◽

pp. 108

Author(s):

Adriano Lima Garcia ◽

Marden José Pereira Ramos Júnior ◽

Eduvaldo Campos Soares Júnior ◽

Bruno Reinoso Noronha ◽

Thiago Iafelice dos Santos ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Protocol ◽

Odontogenic Keratocyst ◽

Histopathological Diagnosis ◽

Squamous Cells ◽

Carnoy’S Solution ◽

Neoplastic Lesions ◽

Mandibular Body ◽

Teeth Development

AbstractOdontogenic cysts are benign non-neoplastic lesions that originate from epithelial cells Arachnida-Araneae) community in the process of the teeth development. Among them, the odontogenic keratocyst is a developmental cyst characterized by its epithelium of parakeratinized stratified and aggressive squamous cells as well as infiltrative behavior. Thus, the objective of this study was to describe a clinical case of surgical treatment of odontogenic keratocysts in a 52-year-old female patient, who presented for the treatment of a large lesion in a region of the left mandibular body and angle. After incisional biopsy and installation of a decompression device, the histopathological diagnosis of odontogenic keratocyst was obtained. Subsequently to a period of 9 months with the decompression device in place, a decrease of the lesion was noticed, thus allowing intervention to be performed the excision of the lesion. Thus, the patient was subjected, under general anesthesia, to enucleation of the lesion as the main treatment, with complementary maneuvers of peripheral ostectomy and application of Carnoy solution over the remaining bone bed. After an outpatient follow-up of 16 months, no signs of recurrence of the lesion were observed. The proposed treatment was efficient in removing the keratocyst with minimal surgical morbidities. In conclusion, the treatment protocol was effective and conservative in the surgical management of the lesion, allowing rapid recovery and return of the function. Keywords: Bone Cysts. Decompression. Dental Care. ResumoCistos odontogênicos são lesões benignas não-neoplásicas que tem por origem células remanescentes epiteliais do processo de formação do órgão dental. Dentre elas, o queratocisto odontogênico é um cisto de desenvolvimento caracterizado por seu epitélio de células escamosas estratificadas paraqueratinizadas, pelo comportamento agressivo e infiltrativo. Sendo assim, o objetivo desse estudo foi descrever um caso clínico de tratamento cirúrgico do queratocisto odontogênico em uma paciente do gênero feminino de 52 anos de idade, que compareceu para o tratamento de uma lesão de grande porte em região de corpo e ângulo mandibulares à esquerda. Após biópsia incisional e instalação de um dispositivo descompressivo, obteve-se o diagnóstico histopatológico de queratocisto odontogênico. Posteriormente a um período de 9 meses com o dispositivo de descompressão em posição, notou-se uma diminuição da lesão, permitindo assim a execução de intervenção para exérese da lesão. Assim, a paciente foi submetida, sob anestesia geral, à enucleação da lesão como tratamento principal, com manobras complementares de ostectomia periférica e aplicação de solução de Carnoy sobre o leito ósseo remanescente. Após um acompanhamento ambulatorial de 16 meses, não foi observado nenhum sinal de recorrência da lesão. O tratamento proposto foi eficiente em remover o queratocisto com as mínimas morbidades cirúrgicas. Concluindo, o protocolo de tratamento foi efetivo e conservador no manejo cirúrgico da lesão, permitindo rápida recuperação e retorno da função. Palavras-chave: Cistos Ósseos. Descompressão. Assistência Odontológica.

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New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

International Journal of Dentistry ◽

10.1155/2014/935657 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Simonetta Franco ◽

Simona Miccoli ◽

Luisa Limongelli ◽

Angela Tempesta ◽

Giorgio Favia ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Protocol ◽

Osteonecrosis Of The Jaw ◽

Healing Time ◽

Neoplastic Disease ◽

Stage Classification ◽

Long Term Follow Up ◽

The University

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the most serious side effect in patients receiving bisphosphonates (BPs) for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The new dimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up.

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Peri-Implantitis - Decontaminating and Regenerative Treatment Protocol

10.20944/preprints202012.0597.v1 ◽

2020 ◽

Author(s):

Fernando Duarte ◽

Leonel De Oliveira

Keyword(s):

Surgical Treatment ◽

Bone Repair ◽

Clinical Case ◽

Treatment Protocol ◽

Implant Surface ◽

Inflammatory Reactions ◽

Osseointegrated Implants ◽

Defect Area ◽

Soft Tissue Inflammation

Peri-implant diseases are defined as pathological inflammatory reactions in the tissue surrounding the osseointegrated implants. They are classified into two categories: mucositis - defined as peri-implant soft tissue inflammation and peri-implantitis - bone loss in the peri-implant region. A clinical case of a 61-years-old woman with an implant in the 46 anatomical position and a 5-year follow-up is presented. A probe depth of 5mm and a bone defect length of 35% was observed. The Implacure® Protocol was applied, with the main objective of eliminating the biofilm present on the exposed implant surface. There are multiple approaches to treat peri-implant diseases. While non-surgical treatment is essential for mucositis control, the treatment of peri-implantitis surgical treatment should be considered. Regenerative bone reconstruction promotes bone repair in the defect area and reduces bleeding during probing. To achieve that, autologous fibrin combined with Cerasorb M® was used. The proposed approach in the exposed clinical case involves the application of Implacure® Protocol, whose combination of the physical decontamination technique, together with the use of chlorhexidine and orthophosphoric acid, added with the combination Piperacillin + Tazobactam together with hyaluronic acid, provide a base that allows to regenerate bone using platelet-rich fibrin with Cerasorb M® and increase the survival time of the implant.

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AB1053 EFFECTIVENESS OF METHOTREXATE IN IDIOPATHIC GRANULOMATOUS MASTITIS TREATMENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.679 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1816.1-1817

Author(s):

D. Yalcin Kehribar ◽

T. Izci Duran ◽

A. Kamali Polat ◽

M. Ozgen

Keyword(s):

Surgical Treatment ◽

Nipple Discharge ◽

Treatment Protocol ◽

Post Treatment ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Clin Pathol ◽

Methotrexate Treatment

Background:Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast [1], for which there is a lack of consensus on the treatment protocol [2, 3]; it requires long-term follow-up and is associated with a high rate of relapse after surgical treatment. In this study, we report on the largest single-center cohort of idiopathic granulomatous mastitis treated with steroids + methotrexate.Objectives:We present this study believing that our experience with patients with IGM and use of steroid + methotrexate treatment in them will contribute to the literature.Methods:We retrospectively examined the data of 33 patients histopathologically diagnosed with idiopathic granulomatous mastitis who were evaluated by our Rheumatology or General Surgery Clinics between 2013 and 2016.Results:Of the 33 female patients (age: 38.64 ± 6.9 years), 24 were admitted with an initial diagnosis of Idiopathic granulomatous mastitis, whereas 9 were admitted after surgical treatment. The breast symptoms and laboratory values of the patients before and after the steroid and methotrexate treatment are shown in Table 1. Remission was achieved in 87.9% patients with steroid + methotrexate treatment, and there were no relapses during the 24-month follow-up.Table 2.Pre- and post-treatment laboratuary and clinical findings.Pre-treatmentPost-treatmentP valueESR (mm/h)42.45±28.8817.24±11.31<0.001*CRP (mg/L)24.72±35.325.37±6.50.004*Mass Size (mm)36.94±16.4010.79±15.01<0.001*Fistula (n)15/33 (45%)2/33(6%)<0.001**Nipple discharge(n)17/33(52%)1/33(3%)<0.001**ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; *Paired T Test;**Chi-Square test.Conclusion:Methotrexate has so far been added to IGM treatment in order to decrease steroid dosage or to treat relapses, and it has been reported to be effective in case study and a limited number of studies with few patients [2, 4, 5]. Steroid + methotrexate treatment used by us in patients with IGM, which is a rare disease and for which no consensus exists regarding the treatment protocol, is effective and reliable in providing clinical improvement and long-term remission. Therefore, this treatment appears to be successful owing to long-term remission outcomes and very low relapse rates, without the patients having to undergo a surgical procedure and experience the associated anxiety and complications.References:[1]Kessler, E. and Y. Wolloch, Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972. 58(6): p. 642-6.[2]Schmajuk, G. and M.C. Genovese, First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol, 2009. 36(7): p. 1559-60.[3]Patel, R.A., et al., Idiopathic granulomatous mastitis: case reports and review of literature. J Gen Intern Med, 2010. 25(3): p. 270-3.[4]Sheybani, F., et al., Treatment for and clinical characteristics of granulomatous mastitis. Obstet Gynecol, 2015. 125(4): p. 801-7.[5]Aghajanzadeh, M., et al., Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast, 2015. 24(4): p. 456-60.Disclosure of Interests:None declared

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Revascularization of an Immature Tooth with Apical Periodontitis Using Calcium Hydroxide: A 3-year Follow-up

The Open Dentistry Journal ◽

10.2174/1874210601509010482 ◽

2015 ◽

Vol 9 (1) ◽

pp. 482-485 ◽

Cited By ~ 4

Author(s):

Mauro Henrique Chagas Silva ◽

Celso Neiva Campos ◽

Marcelo Santos Coelho

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Vascular Tissue ◽

Treatment Protocol ◽

Maxillary Central Incisor ◽

Regenerative Endodontics ◽

Immature Development ◽

New Treatment ◽

Revascularization Procedures

Root canal treatment of teeth presenting immature development is a great challenge for both the patient and the professional. The thinness of the root canal walls of immature teeth may lead to root fracture and thus the outcomes of such treatments are uncertain. Revascularization is based on root canal decontamination followed by the induction of blood migration from the periapical tissues and the development of new vascular tissue in the canal space. The principle of disinfection in regenerative endodontics is that it should be achieved with minimum root canal instrumentation; an intracanal medication is used to inhibit bacterial growth and appropriate sealing of the coronal portion is performed. The American Association of Endodontists (AAE) considerations for regenerative endodontics include calcium hydroxide as an alternative intracanal dressing. This material has also been claimed to diminish the possibility of dental staining during revascularization procedures. The relatively new treatment protocol has been widely reported in the last few years; however it should be performed only when other alternatives are not reasonable. This case report presents a 3-year follow-up of a case of revascularization of a maxillary central incisor using calcium hydroxide as a root canal disinfection dressing.

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Tratamiento ambulatorio de la diverticulitis aguda no complicada

Acta gastroenterológica latinoamericana ◽

10.52787/atse6386 ◽

2020 ◽

Vol 50 (4) ◽

Author(s):

Ana Sánchez Gollarte ◽

Ricardo Alvarado Hurtado ◽

Cristina Vera Mansilla ◽

Fernando Mendoza Moreno ◽

Manuel Díez Alonso ◽

...

Keyword(s):

Surgical Treatment ◽

Antibiotic Therapy ◽

Diverticular Disease ◽

Outpatient Treatment ◽

Acute Diverticulitis ◽

Treatment Protocol ◽

Major Complication ◽

Current Evidence ◽

Number Of Patients

Introduction. Acute diverticulitis is a major complication of diverticular disease. Antibiotic therapy has classically been considered the mainstay of treatment for these patients. The aim of this study is to present the results of the outpatient treatment protocol for mild acute diverticulitis in our centre, assess its results and understand if it is needed to modify said protocol based on the current evidence. Material and methods. Retrospective analysis of the patients included in the outpatient treatment protocol for uncomplicated acute diverticulitis in our centre in the period between the 1st of January and the 31 of December of 2018. The presence of complications in the same episode, the need for admission and recurrence rate until December 2019. Finally, the reports of the colonoscopies performed after the resolution of the process and the need or not for surgical treatment were studied. Results. A total of 64 patients were included in the outpatient protocol, representing 68% of the total of diverticulitis treated. During follow-up 6 patients required admission (9.3%) in the following days. Of the total number of patients studied, 5 (7.8%) presented recurrence throughout the years 2018-2019, only one of them was a severe recurrence and required surgical treatment. The data from our study indicate that the outpatient treatment of mild acute diverticulitis in our setting is safe with the current protocol, since 90.7% were treated successfully.

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Painful Heel Syndrome: Results of Nonoperative Treatment

Foot & Ankle International ◽

10.1177/107110079401501002 ◽

1994 ◽

Vol 15 (10) ◽

pp. 531-535 ◽

Cited By ~ 151

Author(s):

Pamela F. Davis ◽

Erik Severud ◽

Donald E. Baxter

Keyword(s):

Treatment Outcome ◽

Surgical Treatment ◽

Surgical Intervention ◽

Treatment Protocol ◽

Nonoperative Treatment ◽

Heel Pain ◽

Heel Spur ◽

Stretching Exercises ◽

Painful Heel

One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients.

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Hip-Spine Syndrome in Patients With Spinal Cord Injuries: Hyperlordosis Associated With Severe Hip Flexion Contracture

Frontiers in Pediatrics ◽

10.3389/fped.2021.646107 ◽

2021 ◽

Vol 9 ◽

Author(s):

Isaac Rhee ◽

Woo Sung Do ◽

Kun-Bo Park ◽

Byoung Kyu Park ◽

Hyun Woo Kim

Keyword(s):

Spinal Cord ◽

Lumbar Lordosis ◽

Spinal Cord Injuries ◽

Flexion Contracture ◽

Functional Score ◽

Cord Injury ◽

Lumbar Hyperlordosis ◽

The Mean ◽

Hip Flexion

Aim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries.Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs.Results: Improvements were seen in the mean hip flexion contracture (p < 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Mean lumbar lordosis decreased (p = 0.029) while the mean Cobb angle increased (p = 0.001) at the latest follow up. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up.Conclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.

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