The Role of External Banding Valvuloplasty in the Surgical Management of Chronic Deep Venous Disease

Objective: Correction of venous reflux by perivalvular banding in patients suffering from chronic venous stasis secondary to primary valvular incompetence. Design: Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to follow-up. Setting: Tertiary care teaching hospital. Patients: Twelve patients (13 extremities) with severe or moderate venous insufficiency. Interventions: Correction of valvular incompetence by narrowing a valvular ring with an external band. Twenty-seven bands were fitted to incompetent valves of 13 extremities. Main outcome measures: Abolition of reflux and improvement of muscle pump measured by clinical, plethysmographic and venographic criteria. Results: Symptomatic improvement was found in 10 extremities (77%) and complete correction of reflux on venography in eight extremities (67%). Plethysmographically measured reflux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmographic and clinical or venographic outcome. Conclusion: Perivalvular banding can correct reflux and alleviate clinical symptoms of chronic venous stasis in patients with primary valvular incompetence. Selection of patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further investigated.

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Case Report: Potential Role of Corticosteroids in the Management of Post-COVID-19 Pneumonia

Frontiers in Medicine ◽

10.3389/fmed.2021.686806 ◽

2021 ◽

Vol 8 ◽

Author(s):

Houari Aissaoui ◽

Anaïs Eskenazi ◽

Valentin Suteau ◽

Antoine Adenis ◽

Kinan Drak Alsibai

Keyword(s):

Oxygen Therapy ◽

Clinical Symptoms ◽

Severe Pneumonia ◽

Symptomatic Improvement ◽

Infectious Period ◽

Exertional Dyspnea ◽

High Flow Oxygen ◽

Pulmonary Superinfection

Certain patients who recover from severe pneumonia due to coronavirus disease 2019 (COVID-19) remain symptomatic in the post-infectious period, either clinically, radiologically, or respiratory. The post-COVID-19 period is characterized by clinical symptoms of varying duration from one subject to another and does not seem to depend on the severity of initial pneumonia. The persisting inflammatory and/or immune reactions in the post-COVID-19 period may play a role in the development of pulmonary lesions. Here, we report the case of a 61-year-old man with severe COVID-19 pneumonia, complicated by acute respiratory distress syndrome and pulmonary embolism, which required the patient's admission to the intensive care unit and high-flow oxygen therapy. The patient was hospitalized for 23 days for the management of his severe COVID-19 pneumonia. Afterwards, he was discharged home following a negative SARS-CoV-2 PCR test. The post-COVID-19 period was characterized by a complex respiratory symptomatology associating cough, resting dyspnea, and exertional dyspnea requiring oxygen therapy for several weeks. Surprisingly, the follow-up chest CT scan performed 4 weeks after discharge revealed bilateral interstitial lung lesions. After ruling out pulmonary superinfection, the patient was treated with oral corticosteroid for 3 months at a digressive dose. In our case, the use of corticosteroid therapy in the post-COVID19 phase had improved the outcome of the lung disease. These benefits are characterized by a rapid symptomatic improvement, accelerated repair of pulmonary images, rapid oxygen withdrawal, and rapid return to daily activities.

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Open Treatment of Osteochondral Lesions of the Talus With Bone Grafting and Particulated Juvenile Cartilage Allografting

Foot & Ankle Specialist ◽

10.1177/19386400211009732 ◽

2021 ◽

pp. 193864002110097

Author(s):

Suhas P. Dasari ◽

Thomas M. Langer ◽

Derek Parshall ◽

Brian Law

Keyword(s):

Therapeutic Option ◽

Symptomatic Improvement ◽

Pain Scale ◽

Osteochondral Lesions ◽

Outcome Scores ◽

Scale Scores ◽

Open Treatment ◽

Bone Autograft

Background: Large cystic osteochondral lesions of the talus (OLT) are challenging pathological conditions to treat, but particulated juvenile cartilage allografts (PJCAs) supplemented with bone grafts are a promising therapeutic option. The purpose of this project was to further elucidate the role of PJCA with concomitant bone autografts for treating large cystic OLTs with extensive subchondral bone involvement (greater than 150 mm2 in area and/or deeper than 5 mm). Methods: We identified 6 patients with a mean OLT area of 307.2 ± 252.4 mm2 and a mean lesion depth of 10.85 ± 6.10 mm who underwent DeNovo PJCA with bone autografting between 2013 and 2017. Postoperative outcomes were assessed with radiographs, Foot and Ankle Outcome Scores (FAOS), and visual pain scale scores. Results: At final follow-up (27.0 ± 12.59 weeks), all patients had symptomatic improvement and incorporation of the graft on radiographs. At an average of 62 ± 20.88 months postoperatively, no patients required a revision surgery. All patients contacted by phone in 2018 and 2020 reported they would do the procedure again in retrospect and reported an improvement in their symptoms relative to their preoperative state, especially with pain and in the FAOS activities of daily living subsection (91.93 ± 9.04 in 2018, 74.63 ± 26.86 in 2020). Conclusion: PJCA with concomitant bone autograft is a viable treatment option for patients with large cystic OLTs. Levels of Evidence: Level IV

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Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x21997198 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199719

Author(s):

Sundus Bilal ◽

Saad Muhammad Saeed ◽

Muhammad Zeeshan Siddique ◽

Muhammad Saqib ◽

Shafqat Mehmood ◽

...

Keyword(s):

Case Reports ◽

Esophageal Tumor ◽

Metallic Stent ◽

Diverse Group ◽

Expandable Metallic Stent ◽

Lost To Follow Up ◽

Expandable Metallic Stents ◽

Tamponade Effect

The role of self-expandable metallic stents is gradually evolving for a diverse group of benign and malignant gastrointestinal tract problems, with luminal obstruction being by far the most common. Although its role in refractory variceal bleeding is well established, it has rarely been tried for tumor-related bleeding, with only a few case reports in this regard. We share our experience of successfully controlling esophageal tumor–related bleeding with the use of a fully covered self-expandable metallic stent. A 58-year-old woman with irresectable distal esophageal cancer, presented with hematemesis. Esophago-gastro-duodenoscopy revealed an obstructing esophageal tumor with diffuse oozing of blood. This was unamenable to local injection of adrenaline and hemospray; therefore, a temporary self-expandable metallic stent was parked to create a tamponade effect. This successfully stopped bleeding and the patient remained asymptomatic till discharge. However, she was lost to follow-up, and therefore, the stent was removed after a period of 5 months instead of 2 weeks.

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A STUDY OF 50 CASES OF DIABETIC FOOT AT TERTIARY CARE HOSPITAL

10.36106/ijsr/4112310 ◽

2021 ◽

pp. 27-29

Author(s):

Deep N. Patel ◽

Rajnish R. Patel ◽

Hitendra K. Desai ◽

Rajesh K. Patel ◽

Haresh Memariya ◽

...

Keyword(s):

Diabetic Foot ◽

Tertiary Care ◽

Care Hospital ◽

Economic Class ◽

Control Of Diabetes ◽

Education And Awareness ◽

Careful Assessment ◽

Diabetes Melitus

BACKGROUND AND OBJECTIVES :- The present study was attempted to nd out the role of conventional and newer modalities for the treatment and rehabilitation and prevention of complication of diabetic foot patients. MATERIALAND METHOD:-. 50 patients of diabetic foot admitted in civil Hospital,ahmedabad were studied within two years from 2018 to 2020 and careful assessment of history, clinical ndings, investigation, management and follow-up of these patients done. RESULT:-According to my study, Diabetic foot is common in males & 51-60 years of age group,in smokers, in lower socio-economic class, with average duration of 8 to 10 years of diabetes melitus, most common type of lesion was abscess,most common site was forefoot, mostly was of neuropathic in nature & mostly managed by debridement. Mean hospital stay was 1 week to 1 month. CONCLUSION:- Patient education and awareness regarding good sugar control of diabetes, use of proper antibiotics, adequate debridement and proper dressing ;with eusol, betadine hydrogen peroxide along with newer dressing methods like vacuum dressing found to be effective. Amputation done only for gangrene and proper rehabilitation method carried out for these patients.

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Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

Ambulatornaya khirurgiya = Ambulatory Surgery (Russia) ◽

10.21518/1995-1477-2021-18-2-151-153 ◽

2021 ◽

Vol 18 (2) ◽

pp. 151-153

Author(s):

F. Kh. Nizamov

Keyword(s):

Chronic Diseases ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Clinical Symptoms ◽

Varicose Veins ◽

Clinical Manifestations ◽

Pain Syndrome ◽

Venous Stasis ◽

Vein Wall ◽

Vas Scores

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

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Retrospective analysis of paediatric tracheostomy in Indian tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200630 ◽

2020 ◽

Vol 6 (3) ◽

pp. 533

Author(s):

Digant Patni ◽

Vishal R. Munjal

Keyword(s):

Retrospective Analysis ◽

Tertiary Care ◽

Care Facility ◽

Tertiary Care Centre ◽

Prolonged Intubation ◽

Changing Trend ◽

Lost To Follow Up ◽

Neurological Infection ◽

Related Mortality

Background: Tracheostomy is frequently performed surgical procedure. The present study was carried out to assess data on various indications, surgical issues if any, complications and outcomes of paediatric tracheostomy.Methods: This study is a retrospective analysis of 32 paediatric patients between 1 to 12 years of age, who underwent tracheostomy at SAIMS, Indore between June 2015 to June 2019. Data was analysed in terms of patient age, sex, emergency or planned procedure, any surgical challenge, complications and post-operative follow up. Results: Majority of patients were of prolonged intubation due to respiratory and laryngotracheobronchitis (15.6%) each, neuromuscular disease (15.6%), seizure disorder (9.4%), metabolic disease (9.4%) and neurological infection (6.3%). Obstructive causes included head injury (9.4%), sub-glottic stenosis (6.3%), malignancy (6.3%) and craniofacial anomaly (3.1%). Common complication encountered were partial blockage of tube, peri-stomal granulation and accidental decannulation. There was no tracheostomy related mortality in this study. Out of 32 patients, 16 were successfully decannulated, 6 were lost to follow up, 6 could not be decannulated and 4 expired due to worsening of primary disease.Conclusions: There is a changing trend in indications of tracheostomy and overall complications have reduced due to trained team and better care facility.

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Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

Acta Médica Portuguesa ◽

10.20344/amp.9811 ◽

2018 ◽

Vol 31 (3) ◽

pp. 146 ◽

Cited By ~ 3

Author(s):

Luís Ramos dos Santos ◽

Magna Alves-Correia ◽

Margarida Câmara ◽

Manuela Lélis ◽

Carmo Caldeira ◽

...

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Clinical Symptoms ◽

Carbon Monoxide Poisoning ◽

Case Series ◽

Neurological Syndrome ◽

High Flow Oxygen ◽

Lost To Follow Up ◽

Mean Time

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

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Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420953963 ◽

2020 ◽

pp. 247412642095396

Author(s):

Cason B. Robbins ◽

Henry L. Feng ◽

Divakar Gupta ◽

Sharon Fekrat

Keyword(s):

Initial Treatment ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Light Perception ◽

Initial Management ◽

Pars Plana ◽

Line Loss

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

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Cryoablation of Small Renal Tumors in Patients with Solitary Kidneys: Initial Experience

Advances in Urology ◽

10.1155/2008/197324 ◽

2008 ◽

Vol 2008 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Ravi Munver ◽

Grant I. S. Disick ◽

Salvatore A. Lombardo ◽

Vladislav G. Bargman ◽

Ihor S. Sawczuk

Keyword(s):

Tumor Location ◽

Renal Tumors ◽

Minimal Risk ◽

Contralateral Kidney ◽

Nephron Sparing ◽

Feasible Alternative ◽

Lost To Follow Up

Introduction. The purpose of this study was to evaluate the role of renal cryoablation in patients with solitary kidneys with the goals of tumor destruction and maximal renal parenchymal preservation.Methods. Eleven patients with single tumors were treated with cryoablation, of which 10 patients had solitary kidneys and 1 had a nonfunctioning contralateral kidney. All procedures were performed via an open extraperitoneal approach; ten tumors were treated with in-situ cryoablation and 1 tumor was treated with cryo-assisted partial nephrectomy.Results. Cryoablation was successfully performed without any preoperative complications. Mean patient age was 62.4 years (range 49–79), tumor location included: 6 (upper pole), 2 (mid-kidney), 3 (lower pole). The mean and median tumor size was 2.6 cm and 2.8 cm (range 1.2–4.3 cm), mean operative time 205 minutes (range 180–270 minutes), blood loss 98.5 ml (range 40–250 ml), and hospitalization 4.6 days (range 3–8 days). Creatinine values included: preoperative 1.43 mg/dL (range 1.2–1.9), postoperative 1.67 mg/dL (range 1.5–2.5), and nadir 1.57 mg/dL (range 1.3–2.1). All patients were followed postoperatively with magnetic resonance imaging for surveillance. At a median follow-up of 43 months, 9 patients had no evidence of recurrence, 1 patient has an enhancing indeterminate area, and 1 patient was lost to follow-up.Conclusion. Intermediate-term results suggest that renal cryoablation offers a feasible alternative for patients that require a maximal nephron-sparing effort with preservation of renal function and minimal risk of tumor recurrence.

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Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.11.peds12251 ◽

2013 ◽

Vol 11 (3) ◽

pp. 307-312 ◽

Cited By ~ 14

Author(s):

Charles G. Kulwin ◽

Neal B. Patel ◽

Laurie L. Ackerman ◽

Jodi L. Smith ◽

Joel C. Boaz ◽

...

Keyword(s):

Clinical Symptoms ◽

Incidental Finding ◽

Tethered Cord ◽

Symptomatic Improvement ◽

Tethered Cord Syndrome ◽

High Rate ◽

Leg Pain ◽

Postoperative Mri ◽

Urodynamic Studies

Object The surgical management of patients with symptoms of tethered cord syndrome (TCS) who lack significant radiographic abnormalities is controversial. One potential MRI marker for TCS is a spinal cord syrinx or syringomyelia. Alternatively, a syrinx may be a benign and incidental finding. In this report the authors evaluated a highly selected cohort of patients with symptoms of TCS with minimal radiographic abnormalities other than syringomyelia. They analyzed clinical and radiographic outcomes after tethered cord release (TCR). Methods A retrospective review of data from 16 children who met the study inclusion criteria was performed. All patients had been surgically treated at Riley Hospital for Children in Indianapolis, Indiana, between 2006 and 2011. All children had clinical symptoms of TCS as well as available pre- and postoperative MRI data. Results The most common presentation (12 [75%] of 16 patients) was urinary dysfunction, defined as symptoms of urgency or incontinence with abnormal urodynamic studies. Clinical follow-up data were available in 11 of these 12 patients. All 11 had improvement in symptoms at an average follow-up of 17 months. Seven (87.5%) of 8 patients presenting with back or leg pain had improvement. Three patients had progressive scoliosis; 2 had stabilization of the curve or mild improvement, and 1 patient had worsening deformity. Radiographic follow-up data were obtained an average of 14.5 months after surgery. Twelve patients (75%) had stable syringomyelia after TCR. Four patients showed improvement, with 2 having complete radiographic resolution. Conclusions Highly selected patients with symptoms of TCS did very well clinically. Patients with abnormal urodynamic studies, pain, and gait disturbances showed a high rate of symptomatic improvement. However, a smaller percentage of patients had radiographic improvement of the syrinx. Therefore, the authors suggest that the decision to perform TCR should be based on clinical symptoms in this population. Symptomatic improvement was not necessarily related to radiographic resolution of the syrinx.

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