SPLATT Combined with Tendo Achilles Lengthening for Spastic Equinovarus in Adults: Results and Predictors of Surgical Outcome

Foot & Ankle ◽  
1993 ◽  
Vol 14 (6) ◽  
pp. 335-338 ◽  
Author(s):  
Peter Edwards ◽  
John Hsu
Keyword(s):  
Surgical Outcomes ◽  
Postoperative Management ◽  
Ambulatory Status ◽  
Brain Injured ◽  
Anterior Tibial ◽  
Ambulatory Patients ◽  
And Function ◽  
Injured Patients ◽  
Spastic Quadriparesis

During a 4-year period, split anterior tibial tendon transfer (SPLATT) was performed on 42 adults with cerebrospastic equinovarus deformity. Twenty-one patients (24 feet) had a minimum 1-year follow-up, which included detailed documentation of foot appearance position and function as well as ambulatory status. Thirteen patients were male and 8 were female. Average age of the patients was 41 years. Seventeen patients were independent ambulators with orthoses, one was a maximally assisted ambulator. Three patients with spastic quadriparesis were nonambulatory. All patients had uniform surgical technique and postoperative management. This paper presents the results of SPLATT and identifies risk factors for poor surgical outcomes. After an average follow-up of 39 months, 83% of the feet were rated as having good or excellent results. All ambulatory patients had improved gait and 35% of them were able to discontinue their orthoses. Poor surgical outcomes were associated with nonambulatory status in brain injured patients ( P = .018). Salvage of failed SPLATT is discussed.

scholarly journals Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

2018 ◽  
Vol 29 (03) ◽  
pp. 243-246 ◽  
Author(s):  
Dhanya Mullassery ◽  
Sumita Chhabra ◽  
Ashik Babu ◽  
Roberta Iacona ◽  
Simon Blackburn ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Surgical Outcomes ◽  
Anorectal Malformations ◽  
Postoperative Management ◽  
Posterior Sagittal Anorectoplasty ◽  
Anorectal Reconstruction ◽  
Definitive Surgery ◽  
The Uk

Aim Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers. Materials and Methods This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups. Results From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18–48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B (p = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B (p = 0.48). Conclusion The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.

scholarly journals Residual Pituitary Function after Brain Injury-Induced Hypopituitarism: A Prospective 12-Month Study

2005 ◽  
Vol 90 (11) ◽  
pp. 6085-6092 ◽  
Author(s):  
Gianluca Aimaretti ◽  
Maria Rosaria Ambrosio ◽  
Carolina Di Somma ◽  
Maurizio Gasperi ◽  
Salvatore Cannavò ◽  
...  
Keyword(s):  
Brain Injury ◽  
High Risk ◽  
Gh Deficiency ◽  
Pituitary Function ◽  
Brain Injured ◽  
Injured Patients ◽  
The Brain ◽  
Over Time

Abstract Context: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism. Objective: The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury. Design and Patients: Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32). Results: In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency. Conclusion: There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.

scholarly journals Selegiline in Patients With Disorder of Consciousness: An Open Pilot Study

2018 ◽  
Vol 45 (6) ◽  
pp. 688-691
Author(s):  
Orsola Masotta ◽  
Luigi Trojano ◽  
Vincenzo Loreto ◽  
Pasquale Moretta ◽  
Anna Estraneo
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Clinical Effects ◽  
Disorder Of Consciousness ◽  
Brain Injured ◽  
Minimally Conscious ◽  
Injured Patients ◽  
Open Pilot

AbstractThis open study investigated the clinical effects of 10-week selegiline administration in six patients in vegetative state and in four patients in a minimally conscious state, at least 6 months after onset. Clinical outcome was assessed by Coma Recovery Scale-Revised once a week during selegiline administration and 1 month later. Three patients stopped treatment because of possible side effects. After treatment and at 1 month of follow-up, four patients showed improvements in clinical diagnosis, and three patients showed an increase in arousal level only. Selegiline might represent a relatively safe option to enhance arousal and promote recovery in brain-injured patients with disorders of consciousness.

scholarly journals ‘ROSE concept’ of fluid management: Relevance in neuroanaesthesia and neurocritical care

2017 ◽  
Vol 04 (01) ◽  
pp. 010-016 ◽  
Author(s):  
Joseph Monteiro ◽  
Shwetal Goraksha
Keyword(s):  
Neurocritical Care ◽  
Brain Injuries ◽  
Fluid Management ◽  
Tissue Perfusion ◽  
Neurosurgical Patients ◽  
Brain Injured ◽  
Randomised Controlled ◽  
And Function ◽  
Injured Patients ◽  
The Rose

AbstractFluid therapy in neurosurgical patients aims to restore intravascular volume, optimise haemodynamic parameters and maintain tissue perfusion, integrity and function. The goal is to minimise the risk of inadequate cerebral perfusion pressure and to maintain good neurosurgical conditions. However, fluid management in brain-injured patients has several distinctive features compared with non-brain-injured critically ill patients. The ROSE concept advocates the restriction of fluids, which is consistent with the prevention of a ‘tight brain’ in neurosurgery. Whether this imbalance in fluid management studies between different types of brain injuries is a reflection of differences in clinical relevance of fluid management is not clear. Further randomised controlled trials in the future are essential in subarachnoid haemorrhage and traumatic brain injury patients who are critical and need long-term Intensive Care Unit stay to elucidate and define the role and relevance of the ROSE concept in neuroanaesthesia and neurocritical care.

scholarly journals Management of Patients with Brain Injury Using Noninvasive Methods

2020 ◽  
Author(s):  
Gustavo Frigieri ◽  
Nicollas Nunes Rabelo ◽  
Ricardo de Carvalho Nogueira ◽  
Sérgio Brasil
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Brain Injury ◽  
Intensive Care Units ◽  
Clinical Parameters ◽  
Noninvasive Methods ◽  
Brain Injured ◽  
Medical Teams ◽  
Injured Patients

In the last decades, the development of new noninvasive technologies in critical care allowed physicians to continuously monitor clinical parameters, aggregating important information that has been previously inaccessible or restricted due to the invasiveness of the existing techniques. The aim of this chapter is to present noninvasive methods in use on intensive care units (ICU) for brain injured patients monitoring, collaborating to the diagnosis and follow-up, aiding medical teams to achieve better outcomes.

Partial or Total Calcanectomy as an Alternative to Below-the-Knee Amputation for Limb Salvage

2012 ◽  
Vol 102 (5) ◽  
pp. 396-405 ◽  
Author(s):  
Valerie L. Schade
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Free Tissue Transfer ◽  
Definitive Treatment ◽  
Ambulatory Status ◽  
Below The Knee ◽  
Major Complications ◽  
Ambulatory Patients

Background: Below-the-knee amputations are regarded as definitive treatment for calcaneal osteomyelitis. They may be less than desirable in patients with a viable midfoot and forefoot. Partial and total calcanectomies have been reported as an alternative for limb salvage. However, the durability of the residual limb is questionable. Methods: A systematic review was undertaken to identify material relating to the potential for limb salvage with partial or total calcanectomy in ambulatory patients with calcaneal osteomyelitis. Studies eligible for inclusion consecutively enrolled ambulatory patients older than 18 years who underwent partial or total calcanectomy without adjunctive free tissue transfer for the treatment of calcaneal osteomyelitis and had a mean follow-up of 12 months or longer. Results: Sixteen studies involving 100 patients (76 partial and 28 total calcanectomies) met all of the inclusion criteria. Weighted mean follow-up was 33 months. Minor complications with subsequent healing occurred in less than 24% of patients. Most major complications were related to residual soft-tissue infection and osteomyelitis. Approximately 10% of patients required a major lower-extremity amputation. Major complications and major lower-extremity amputations occurred more frequently after total calcanectomy and in patients with a diagnosis of diabetes. Eighty-five percent of patients maintained or improved their ambulatory status postoperatively. Only 3% of patients decreased their ambulatory status postoperatively, becoming unlimited household ambulators. Conclusions: This systematic review provides evidence that partial or total calcanectomy is a viable option for limb salvage in ambulatory patients with calcaneal osteomyelitis. (J Am Podiatr Med Assoc 102(5): 396–405, 2012)

Specific Computerized Attention Training in Stroke and Traumatic Brain-Injured Patients

2003 ◽  
Vol 14 (4) ◽  
pp. 283-292 ◽  
Author(s):  
W. Sturm ◽  
B. Fimm ◽  
A. Cantagallo ◽  
N. Cremel ◽  
P. North ◽  
...  
Keyword(s):  
Divided Attention ◽  
Single Case ◽  
Baseline Period ◽  
Specific Training ◽  
Attention Task ◽  
Baseline Phase ◽  
Computerized Training ◽  
Brain Injured ◽  
Divided Attention Task ◽  
Injured Patients

Abstract: In a multicenter European approach, the efficacy of the AIXTENT computerized training programs for intensity aspects (alertness and vigilance) and selectivity aspects (selective and divided attention) of attention was studied in 33 patients with brain damage of vascular and traumatic etiology. Each patient received training in one of two most impaired of the four attention domains. Control tests were performed by means of a standardized computerized attention test battery (TAP) comprising tests for the four attention functions. Assessment was carried out at the beginning and at the end of a four week baseline period and after the training period of 14 one-hour sessions. At the end of the baseline phase, there was only slight but significant improvement for the most complex attention function, divided attention (number of omissions). After the training, there were significant specific training effects for both intensity aspects (alertness and vigilance) and also for the number of omissions in the divided attention task. The application of inferential single case procedures revealed a high number of significant improvements in individual cases after specific training of alertness and vigilance problems. On the other hand, a non specific training addressing selectivity aspects of attention lead either to improvement or deterioration of alertness and vigilance performance. The results corroborate the findings of former studies with the same training instrument but in patients with different lesion etiologies.

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