scholarly journals Fitting very short finger stumps with silicone prosthesis: A nonsurgical method

2013 ◽  
Vol 37 (5) ◽  
pp. 415-420 ◽  
Author(s):  
Michael EL Leow ◽  
Alphonsus KS Chong ◽  
Yeong-Pin Peng ◽  
Robert WH Pho
Keyword(s):  
Polyvinyl Chloride ◽  
Clinical Relevance ◽  
Short Length ◽  
Distal Stump ◽  
Silicone Prosthesis ◽  
Finger Prosthesis

Background and Aim: The fitting of short finger stumps with silicone prosthesis is a challenge because of the suboptimal finger–prosthesis contact due to length and distal tapering of digital stumps. The purpose of this report was to describe and evaluate the Micropore™–polyvinyl chloride tube technique for fitting short finger stumps. Technique: For a total of 10 patients, short finger stumps were fitted using the technique. A short length of polyvinyl chloride tube, trimmed and contoured to fit, was secured on the distal stump tip with Micropore tape. The prosthesis was worn over the polyvinyl chloride tube extension. Three different fitting methods were evaluated: fitting with and without the Micropore–polyvinyl chloride tube technique, and with the use of skin adhesive on the stump. Discussion: All patients achieved a very secure prosthetic fit with the Micropore–polyvinyl chloride tube technique. No incidences of prosthesis slippage were reported at the longest follow-up of 30 months. The Micropore–polyvinyl chloride tube technique is an effective method for fitting short finger stumps. Clinical relevance The Micropore–polyvinyl chloride tube technique presents a nonsurgical method for fitting short finger stumps. It can help avert late outcomes whereby patients, after having undergone surgery to enable fitting, found they no longer need prosthesis.

scholarly journals The Use of Anterior-Segment Optical-Coherence Tomography for the Assessment of the Iridocorneal Angle and Its Alterations: Update and Current Evidence

2021 ◽  
Vol 10 (2) ◽  
pp. 231
Author(s):  
Giacinto Triolo ◽  
Piero Barboni ◽  
Giacomo Savini ◽  
Francesco De Gaetano ◽  
Gaspare Monaco ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intraocular Pressure ◽  
Clinical Relevance ◽  
Anterior Segment ◽  
Angle Closure ◽  
Current Evidence ◽  
Optical Coherence ◽  
Iridocorneal Angle ◽  
Wide Range

The introduction of anterior-segment optical-coherence tomography (AS-OCT) has led to improved assessments of the anatomy of the iridocorneal-angle and diagnoses of several mechanisms of angle closure which often result in raised intraocular pressure (IOP). Continuous advancements in AS-OCT technology and software, along with an extensive research in the field, have resulted in a wide range of possible parameters that may be used to diagnose and follow up on patients with this spectrum of diseases. However, the clinical relevance of such variables needs to be explored thoroughly. The aim of the present review is to summarize the current evidence supporting the use of AS-OCT for the diagnosis and follow-up of several iridocorneal-angle and anterior-chamber alterations, focusing on the advantages and downsides of this technology.

scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Plantar Flexion ◽  
Clinical Results ◽  
Analog Scale ◽  
Silicone Prosthesis ◽  
Prosthesis Replacement ◽  
Freiberg Disease ◽  
Metatarsophalangeal Joints ◽  
Late Stages ◽  
Dorsal Flexion

Category: Lesser Toes Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease in their late stages. They underwent double stemmed flexible silicone prosthesis replacement for metatarsophalangeal joints. The average age was 63.8 (range 30~88) years. The average follow up period was 26 (range 18–42) months. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), AOFAS and Maryland metatarsophalangeal joints scale before surgery and at the latest follow-up. Results: The average ROM of dorsal flexion improved from 39.3±6.1° before surgery to 75.4±8.6° at latest follow-up (p<0.001). The average ROM of plantar flexion improved from 19.0±11.4° before surgery to 20.2±9.3° at latest follow-up (p=0.14). The average VAS significantly improved from 8.1±0.5 before surgery to 2.6±0.2 at latest follow-up (p<0.001). The average Maryland metatarsophalangeal joints score significantly improved from 65.3±9.3 points before surgery to 90.3±4.1 points at the latest follow-up (p<0.001). The average AOFAS was 89.4±8.5 after surgery compared 56.3±6.4 preoperatively (p<0.005). Conclusion: A flexible silicone prosthesis replacement was carried out to treat Freiberg disease in its late stages. The function was observed in all cases with improved clinical results. The silicone prosthesis was considered to be useful in certain cases.

Effects of altitude and recombinant human erythropoietin on iron metabolism: a randomized controlled trial

2021 ◽  
Author(s):  
Andreas Breenfeldt Andersen ◽  
Thomas Christian Bonne ◽  
Jacob Bejder ◽  
Grace Jung ◽  
Tomas Ganz ◽  
...  
Keyword(s):  
Sea Level ◽  
Clinical Relevance ◽  
Recombinant Human Erythropoietin ◽  
Controlled Trial ◽  
Venous Blood ◽  
Early Assessment ◽  
Stress Erythropoiesis ◽  
Human Erythropoietin ◽  
The Impact

Current markers of iron deficiency (ID) such as ferritin and hemoglobin have shortcomings, and hepcidin and erythroferrone (ERFE) could be of clinical relevance in relation to early assessment of ID. Here, we evaluate whether exposure to altitude-induced hypoxia (2,320 m) alone, or in combination with recombinant human erythropoietin (rHuEPO) treatment, affects hepcidin and ERFE levels before alterations in routine ID biomarkers and stress erythropoiesis manifest. Two interventions were completed, each comprising a four-week baseline, a four-week intervention at either sea level or altitude, and a four-week follow-up. Participants (n=39) were randomly assigned to 20 IU·kg bw-1 rHuEPO or placebo injections every second day for three weeks during the two intervention periods. Venous blood was collected weekly. Altitude increased ERFE (P≤0.001) with no changes in hepcidin or routine iron biomarkers, making ERFE of clinical relevance as an early marker of moderate hypoxia. rHuEPO treatment at sea level induced a similar pattern of changes in ERFE (P<0.05) and hepcidin levels (P<0.05), demonstrating the impact of accelerated erythropoiesis and not of other hypoxia-induced mechanisms. Compared to altitude alone, concurrent rHuEPO treatment and altitude exposure induced additive changes in hepcidin (P<0.05) and ERFE (P≤0.001) parallel with increases in hematocrit (P<0.001), demonstrating a relevant range of both hepcidin and ERFE. A poor but significant correlation between hepcidin and ERFE was found (R2=0.13, P<0.001). The findings demonstrate that hepcidin and ERFE are more rapid biomarkers of changes in iron demands than routine iron markers. Finally, ERFE and hepcidin may be sensitive markers in an anti-doping context.

Validating the clinical relevance of alternative stimulant use treatment outcome measures by examining their association with 3-month follow-up outcomes.

2021 ◽  
Vol 29 (3) ◽  
pp. 288-293
Author(s):  
André Q. C. Miguel ◽  
Crystal L. Smith ◽  
Ekaterina Burduli ◽  
John M. Roll ◽  
Sterling M. McPherson
Keyword(s):  
Treatment Outcome ◽  
Outcome Measures ◽  
Clinical Relevance ◽  
Stimulant Use

Combined Hemimandibular Hyperplasia and Elongation: the Orthodontic-Surgical Management

2020 ◽  
Vol 13 (3) ◽  
pp. 134-140
Author(s):  
Ciarán Devine ◽  
Anna Sayan ◽  
Velupillai Ilankovan
Keyword(s):  
Primary Care ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Clinical Relevance ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnostic Techniques ◽  
Mandibular Asymmetry ◽  
Contemporary Management

Patients commonly present to orthodontists with complaints of facial and/or mandibular asymmetry. It is important that all asymmetry complaints are taken seriously and further investigated. Orthodontists play an important role in the diagnosis, management and follow-up of these conditions. For condylar hyperactivity, management is generally in a multidisciplinary setting. Clinicians who practice orthodontics in a primary care setting need to be aware of the correct terminology and the appropriate investigations required for diagnosis and the management of this condition. This paper aims to describe the contemporary management of condylar hyperactivity and presents a case of combined orthodontic-surgical treatment. CPD/Clinical Relevance: Condylar hyperactivity can lead to severe orofacial deformities and severe malocclusions. The orthodontist must understand the terminology, diagnostic techniques and treatment of this condition in order to offer the most appropriate management. The entire dental team may be involved in cases of condylar hyperactivity from diagnosis through to follow-up. Increased awareness may therefore improve diagnosis and ensure appropriate early referrals are made, thus potentially improving outcomes.

Clinical Relevance of Bone Marrow Biopsy in Staging and Follow-Up of Breast Cancer

1983 ◽  
Vol 69 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Giorgio Cruciani ◽  
Gian Maria Fiorentini ◽  
Giovanni Rosti ◽  
Amelia Tienghi ◽  
Daniele Bardella ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Bone Metastases ◽  
Bone Marrow Biopsy ◽  
Clinical Relevance ◽  
Bone Biopsy ◽  
Bone Marrow Biopsies ◽  
Female Patients

Bone marrow biopsies by Jamshidi needle were performed in 106 breast cancer female patients. Sixty-four of them were in follow-up after mastectomy, and neoplastic involvement of marrow was found in 21 patients (32.8%). Among the 42 women undergoing staging before mastectomy, the incidence of marrow involvement was 11.9% (5 women, all with radiographic positivity). Of the 37 women, either in follow-up or in the staging phase, with bone metastases detected by roentgenographic and isotopic examination, the bone biopsy was positive in 23 (62.1%), and 7 histologically had micrometastases. Three women, without any radiographic or isotopic sign of metastases, had positive biopsies. A good correlation was found between the hydroxyproline:creatinine ratio and neoplastic involvement of bone marrow.

scholarly journals Glioblastoma: Is There Any Blood Biomarker with True Clinical Relevance?

2020 ◽  
Vol 21 (16) ◽  
pp. 5809
Author(s):  
Paulo Linhares ◽  
Bruno Carvalho ◽  
Rui Vaz ◽  
Bruno M. Costa
Keyword(s):  
Clinical Relevance ◽  
De Novo ◽  
Primary Brain Tumor ◽  
Serum Biomarkers ◽  
Easy Access ◽  
Disease Evolution ◽  
The Central Nervous System ◽  
Cancer Types ◽  
Low Incidence

Glioblastoma (GBM) is the most frequent malignant primary brain tumor in adults, characterized by a highly aggressive, inflammatory and angiogenic phenotype. It is a remarkably heterogeneous tumor at several levels, including histopathologically, radiographically and genetically. The 2016 update of the WHO Classification of Tumours of the Central Nervous System highlighted molecular parameters as paramount features for the diagnosis, namely IDH1/2 mutations that distinguish primary and secondary GBM. An ideal biomarker is a molecule that can be detected/quantified through simple non- or minimally invasive methods with the potential to assess cancer risk; promote early diagnosis; increase grading accuracy; and monitor disease evolution and treatment response, as well as fundamentally being restricted to one aspect. Blood-based biomarkers are particularly attractive due to their easy access and have been widely used for various cancer types. A number of serum biomarkers with multiple utilities for glioma have been reported that could classify glioma grades more precisely and provide prognostic value among these patients. At present, screening for gliomas has no clinical relevance. This is because of the low incidence, the lack of sensitive biomarkers in plasma, and the observation that gliomas may develop apparently de novo within few weeks or months. To the best of our knowledge, there is no routine use of a serum biomarker for clinical follow-up. The purpose of this paper is to review the serum biomarkers described in the literature related to glioblastoma and their possible relationship with clinical features.

A Sialolith and a Megalith: a Report of Two Cases

Dental Update ◽  
2020 ◽  
Vol 47 (1) ◽  
pp. 71-74
Author(s):  
Jawaad Ahmed Asif ◽  
Paras Ahmad ◽  
Tahir Yusuf Noorani
Keyword(s):  
Early Diagnosis ◽  
Salivary Glands ◽  
Submandibular Gland ◽  
Male Patient ◽  
Clinical Relevance ◽  
Diagnosis And Treatment ◽  
Normal Functioning ◽  
First Case ◽  
Free Swelling

Sialolithiasis is considered as one of the most frequently encountered diseases of the salivary glands. The most susceptible site is the submandibular gland and its duct. However, megaliths have been sparsely reported in the literature. This article portrays management of a sialolith and a megalith in a 26-year-old and a 59-year-old male patient, respectively. The sialolith in the first case case was 4 mm long, whereas the second case demonstrated a megalith measuring 46 mm at its greatest size. Follow-up revealed normal functioning and a painless gland in the first case, while the second case showed no eventful complications. It is interesting to know that both patients remained relatively pain-free, despite having such longstanding sialolith/megaliths. After removal of the small sialolith, the gland regained its normal functioning swiftly, whereas in the case of the megalith, the gland removal was mandatory because such a longstanding megalith led to irreversible functional injury to the gland. CPD/Clinical Relevance: A giant sialolith can be easily misdiagnosed as a submandibular infection or neoplasm, especially when the patient presents with a longstanding pain-free swelling. Hence, early and appropriate referral and investigation is necessary for early diagnosis and treatment.

scholarly journals Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian D. Steginsky ◽  
Mallory Suhling ◽  
Eric Giza ◽  
Christopher D. Kreulen ◽  
B. Dale Sharpe ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Distal Stump ◽  
Achilles Tendon Repair ◽  
Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

RESULTS OF END-TO-SIDE NERVE COAPTATION IN SEVERE OBSTETRIC BRACHIAL PLEXUS LESIONS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 656-663 ◽  
Author(s):  
Willem Pondaag ◽  
Alain Gilbert
Keyword(s):  
Brachial Plexus ◽  
Nerve Repair ◽  
Multiple Root ◽  
Axonal Outgrowth ◽  
Distal Stump ◽  
Nerve Grafts ◽  
Small Series ◽  
Obstetric Brachial Plexus ◽  
Plexus Lesion

Abstract OBJECTIVE Options for nerve repair are limited in brachial plexus lesions with multiple root avulsions because an insufficient number of proximal nerve stumps are available to serve as lead-out for nerve grafts. End-to-side nerve repair might be an alternative surgical technique for repair of such severe lesions. In this technique, an epineurial window is created in a healthy nerve, and the distal stump of the injured nerve is coapted to this site. Inconsistent results of end-to-side nerve repairs in traumatic nerve lesions in adults have been reported in small series. This article evaluates the results of end-to-side nerve repair in obstetric brachial plexus lesions and reviews the literature. METHODS A retrospective analysis was performed of 20 end-to-side repairs in 12 infants. Evaluation of functional recovery of the target muscle was performed after at least 2 years of follow up (mean, 33 mo). RESULTS Five repairs failed (25%). Seven times (35%) good function (Medical Research Council at least 3) of the target muscle occurred in addition to eight partial recoveries (40%). In the majority of patients, however, the observed recovery cannot be exclusively attributed to the end-to-side repair. The reinnervation may be based on axonal outgrowth through grafted or neurolyzed adjacent nerves. It seems likely that recovery was solely based on the end-to-side repair in only two patients. No deficits occurred in donor nerve function. CONCLUSION This study does not convincingly show that the end-to-side nerve repair in infants with an obstetric brachial plexus lesion is effective. Its use cannot be recommended as standard therapy.

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