Common late complications of longitudinal forefoot amputations in neuropathic foot treatment

2021 ◽  
Vol 30 (6) ◽  
pp. 498-503
Author(s):  
Rodrigo Sousa Macedo ◽  
Lucas Sousa Macedo ◽  
Marcos Hideyo Sakaki ◽  
Rafael Barban Sposeto ◽  
Rafael Trevisan Ortiz ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Reoperation Rate ◽  
Late Complications ◽  
Inclusion Criteria ◽  
Patients With Diabetes ◽  
Partial Amputation ◽  
Neuropathic Foot ◽  
Foot Clinic ◽  
Ray Amputation

Objective: To describe and quantify the complications arising in consecutive neuropathic patients undergoing partial longitudinal amputations of the foot. Method: A retrospective study was conducted with data collected from the medical records of patients monitored at the Insensitive Foot Clinic of the Foot and Ankle Group of our institution who underwent partial amputation of foot rays from 2000 to 2016. Results: A total of 28 patients met the inclusion criteria, with a total of 31 amputated/partially amputated feet. Of these, 18 (58.1%) feet were amputated/partially amputated due to diabetes, seven (22.6%) due to leprosy, two (6.5%) due to alcoholic neuropathy, two (6.5%) secondary to traumatic peripheral nerve injury, and two (6.5%) due to other causes. Fifth ray amputation was the most frequent type (n=12). The cause of amputation was the presence of an infected ulcer in 93.6% of the samples. At a mean follow-up time of 60 months, 13 (41.9%) feet required new amputations—five (38.5%) transtibial, five (38.5%) transmetatarsal, two (15.4%) of the toes, and one (7.7%) at Chopart's joint. Patients with diabetes had a 50.0% reamputation rate. Patients who initially underwent amputation of the fifth ray had a 58.3% reamputation rate. Conclusion: Partial longitudinal amputation of the foot in neuropathic patients exhibited a high reoperation rate, especially in patients with diabetes or in patients with initial amputation of the peripheral rays. Declaration of interest: The authors have no conflicts of interest.

Delayed Complications after Endovascular AAA Repair in Women

2003 ◽  
Vol 10 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Murray L. Shames ◽  
Luis A. Sanchez ◽  
Brian G. Rubin ◽  
Eric T. Choi ◽  
Patrick J. Geraghty ◽  
...  
Keyword(s):  
Open Repair ◽  
Length Of Hospital Stay ◽  
Late Complications ◽  
Female Group ◽  
Inclusion Criteria ◽  
Abdominal Aortic ◽  
Secondary Procedures ◽  
Delayed Complications ◽  
Time Of Operation

Purpose: To assess whether women suffer more delayed complications or require more interventions after endovascular abdominal aortic aneurysm (AAA) repair. Methods: Over a 2-year period, 245 patients (203 men, 42 women) underwent endovascular repair with the AneuRx stent-graft at our institution. Baseline, operative, and follow-up data were reviewed and outcomes compared between men and women for complications or secondary procedures beyond the 30-day postoperative period. Results: The 42 (17.1%) women treated with the AneuRx graft experienced more technical complications (17% versus 8.3%; p<0.05) and acute conversions to open repair (6/7, 86%; p = 0.0005). At 30 days, systemic morbidity was significantly higher in women (26% versus 5.3%; p = 0.001.) However, mortality (2.3% versus 1.5%), length of hospital stay (2.6 versus 2.9 days), and major endoleaks at discharge (0% versus 1.6%) were similar. Over a mean follow-up of 11.3 months (range 1–26), graft limb occlusion occurred more frequently in female patients (12.2% versus 2.5%; p = 0.05), and secondary procedures were required in a significantly higher number of women (29% versus 9%; p<0.05). Three patients in each group (25% of women versus 17% of men) who had secondary procedures required additional interventions. Although not statistically significant, the mortality in women during follow-up was higher (9.7% versus 5%); 2 deaths were directly related to graft complications in the female group. Conclusions: Endoluminal AAA repair in women presents a technical challenge at the time of operation and may cause more frequent late complications, necessitating close post-procedural surveillance and prompt correction of complications to avoid potentially catastrophic outcomes. Reassessment of inclusion criteria for women may be necessary.

Outcome of Splenectomy On Adult Idiopathic Thrombocytopenic Purpura (ITP)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4690-4690
Author(s):  
Tarun K. Dutta ◽  
Vishnu Vy ◽  
Debdatta Basu
Keyword(s):  
Complete Remission ◽  
Drug Treatment ◽  
Conflicts Of Interest ◽  
Line Treatment ◽  
Inclusion Criteria ◽  
Thrombocytopenic Purpura ◽  
Prospective Group ◽  
Secondary Failure ◽  
Fair Chance

Abstract Abstract 4690 Aim: To study outcome of splenectomy on adult ITP patients (both in prospective and retrospective groups) Patient and Methods: Two groups of ITP patients were studied. They were as follows: (i) Retrospective group – Twenty two patients who underwent splenectomy during last twenty one years (ii) Prospective group – All patients admitted during last three years with a minimum follow-up of six months (29 patients) Result: Retrospective group: Twenty two patients had undergone splenectomy during last twenty one years. Median time from diagnosis to splenectomy was 32 months. Median platelet count was 28,000/μl with some form of drug treatment (before undergoing splenectomy). Median post-splenectomy follow-up was 54 months (maximum 252 months). Eleven (50%) patients had either primary failure or relapse following splenectomy during subsequent years. The cumulative break-up figure was as follows: Primary failure – 3 (13.6%) At 24 months – 7 (31.8%) At 5 years – 9 (40.9%) At 10 years – 11(50%) Prospective group: Out of 29 patients of ITP enrolled according to inclusion criteria of minimum six months’ follow-up, 20 had complete remission with steroids; nine had primary failure. Out of 20 patients with complete remission, two had relapse within six months of remission. Out of total 11 patients with failure to response to steroids (nine primary failure and two secondary failure), six patients agreed to undergo splenectomy. Three patients had complete remission till last follow-up (maximum follow-up was for 23 months). Two had primary failure following splenectomy and one had relapse. Five patients who did not agree for splenectomy are in complete or partial remission with azathioprine. Conclusion: At the end of two years in retrospective group, almost one-third of 22 patients who underwent splenectomy had either primary failure or relapse. Similarly in prospective group, though small in number, at the end of 23 months itself, three of six patients who underwent splenectomy had either no response or had relapsed. Thus this study questions the utility of splenectomy as second-line treatment after steroid failure. Rather, patient may be given a choice to opt for other form of drug treatment after steroid failure and advised splenectomy as and when unavoidable. Nevertheless, any patient opting for splenectomy should be cautioned that there is a fair chance of relapse later in life. Furthermore, it appears incidence of relapse following splenectomy is higher in Indian patients as compared to that in the Western patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Management of Foreign Body Displacement into the Maxillary Sinus as a Complication of Maxillofacial Interventions: Systematic Review

2020 ◽  
Author(s):  
Bartosz Wojtera ◽  
Angelika Woźna ◽  
Oskar Komisarek
Keyword(s):  
Systematic Review ◽  
Foreign Body ◽  
Maxillary Sinus ◽  
Randomized Trials ◽  
Foreign Bodies ◽  
Late Complications ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Inclusion Criteria

Abstract Displacement of foreign bodies into the maxillary sinus shows an increasing tendency, especially in regard to raising amount of dental implant installation procedures. The purpose of our study was to compare the efficiency and the rate of late complications among the methods of removal of foreign bodies from maxillary sinus. We performed a systematic review following PRISMA Checklist, searching Pubmed and Google Scholar databases for studies investigating the methods of removal of foreign bodies from maxillary sinus. The inclusion criteria embraced the examined group of at least 10 cases and the follow up period of minimum 3 months. We qualified 7 papers from 531 identified in primary search. Among qualified studies functional endoscopic sinus surgery used in order to remove foreign body from maxillary sinus had no late complications, whereas they occurred in 0–5% cases of using replaceable or pedicled bone approaches and in 15–18% cases of Caldwell-Luc approach. FESS probably should become a gold standard in retrieving foreign bodies from maxillary sinus, however poor evidence requires further investigation, especially in prospective, randomized trials.

Factors Associated With Successful Chopart Amputation in Patients With Diabetes

2010 ◽  
Vol 3 (5) ◽  
pp. 278-284 ◽  
Author(s):  
Valerie L. Schade ◽  
Thomas S. Roukis ◽  
Joyce L. Yan
Keyword(s):  
Inclusion Criteria ◽  
Prosthetic Device ◽  
Viable Option ◽  
Factors Associated ◽  
High Profile ◽  
Ambulatory Patients ◽  
Residual Functional ◽  
Patients With Diabetes ◽  
Functional Limb

Chopart amputations were first performed for treatment of a non-salvageable distal foot but became unfavorable because of the development of equinovarus contractures and ulcerations. The majority of below-knee amputations today occur in ambulatory patients with diabetes in which a Chopart amputation may be a viable option; however, the durability of the residual limb is questionable. The authors undertook a systematic review of electronic databases and other relevant sources to identify material relating to the factors associated with a successful Chopart amputation in ambulatory patients with diabetes. Studies were eligible for inclusion only if they consecutively enrolled ambulatory patients with diabetes who underwent a Chopart amputation, regardless of etiology, with or without any tendinous or osseous balancing performed and had a mean follow-up of ≥ 12 months duration. Four studies involving 74 patients/feet were identified that met the inclusion criteria with a weighted mean follow-up of 21.1 months. The efficacy of tendinous and/or osseous balancing could not be assessed because of the lack of comparable techniques. However, review of the included studies supports that a residual functional limb can be maintained for ≥ 12 months with the use of a properly fitting high-profile prosthetic device for lifelong ambulation.

PS01.062: REFLUX ASPIRATION SURGICAL OUTCOMES: DOES LAPAROSCOPIC FUNDOPLICATION SIGNIFICANTLY DECREASE QUANTITATIVE AND SYMPTOMATIC PULMONARY ASPIRATION?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 67-67
Author(s):  
Oleksandr Khoma ◽  
Susanna Falk ◽  
Leticia Burton ◽  
Hans Van Der Wall ◽  
Gregory Falk
Keyword(s):  
Laparoscopic Fundoplication ◽  
Conflicts Of Interest ◽  
Pulmonary Aspiration ◽  
Objective Data ◽  
Inclusion Criteria ◽  
Short Term ◽  
Life Data ◽  
Oesophageal Dysmotility

Abstract Background Pulmonary aspiration of gastric refluxate is one of the indications for anti-reflux surgery. Effectiveness of surgery in preventing pulmonary aspiration post-operatively has not been previously tested. Methods Retrospective analysis of prospectively populated database of patients with confirmed aspiration of gastric refluxate on scintigraphy. Patients that have undergone anti-reflux surgery between 01/01/2014 and 31/12/2015 and had scintigraphy post-operatively were included. Objective data such as resolution of aspiration, degree of proximal aero-digestive contamination, surgical complications and oesophageal dysmotility as well as patient quality of life data was analysed. Results Inclusion criteria were satisfied by 39 patients (11 male and 28 female). Pulmonary aspiration was prevented in 24 out of 39 patients (61.5%) post operatively. Significant reduction of isotope contamination of upper oesophagus supine and upright (P = 0.002) and pharynx supine and upright (P = 0.027) was confirmed on scintigraphy post operatively. Severe oesophageal dysmotility was strongly associated with continued aspiration post-operatively OR 15.3 (95% CI 2.459–95.194; P = 0.02). Majority (24/31, 77%) of patients were satisfied or very satisfied with surgery, whilst 7/31 (23%) were dissatisfied. Pre-operative GIQLI scores were low (mean 90.5, SD 18.8), modest improvements at 6 months (mean 92.8, SD 23.9) and 12 months (mean 92.2, SD 27), were not significant (P = 0.07). Conclusion Surgery is partially effective in reversing pulmonary aspiration of gastric refluxate on short-term follow up. Severe oesophageal dysmotility is a predictor of inferior control of aspiration with surgery. Overall satisfaction with surgery in patients with pulmonary aspiration is inferior compared to other patients undergoing anti-reflux surgery. Disclosure All authors have declared no conflicts of interest.

Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

2021 ◽  
Vol 34 (1) ◽  
pp. 83-88
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Minghao Wang ◽  
Andrew K. Chan ◽  
Bo Li ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Single Level ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

Fractionated Stereotactic Radiotherapy For the Treatment of Large Arteriovenous Malformations with or without Previous Partial Embolization

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. 519-531 ◽  
Author(s):  
Erol Veznedaroglu ◽  
David W. Andrews ◽  
Ronald P. Benitez ◽  
M. Beverly Downes ◽  
Maria Werner-Wasik ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Arteriovenous Malformations ◽  
Three Dimensional ◽  
Late Complications ◽  
Fractionated Stereotactic Radiotherapy ◽  
Medical Systems ◽  
Significant Treatment ◽  
Lost To Follow Up

Abstract OBJECTIVE: Despite the success of stereotactic radiosurgery, large inoperable arteriovenous malformations (AVMs) of 14 cm3 or more have remained largely refractory to stereotactic radiosurgery, with much lower obliteration rates. We review treatment of large AVMs either previously untreated or partially obliterated by embolization with fractionated stereotactic radiotherapy (FSR) regimens using a dedicated linear accelerator (LINAC). METHODS: Before treatment, all patients were discussed at a multidisciplinary radiosurgery board and found to be suitable for FSR. All patients were evaluated for pre-embolization. Those who had feeding pedicles amenable to glue embolization were treated. LINAC technique involved acquisition of a stereotactic angiogram in a relocatable frame that was also used for head localization during treatment. The FSR technique involved the use of six 7-Gy fractions delivered on alternate days over a 2-week period, and this was subsequently dropped to 5-Gy fractions after late complications in one of seven patients treated with 7-Gy fractions. Treatments were based exclusively on digitized biplanar stereotactic angiographic data. We used a Varian 600SR LINAC (Varian Medical Systems, Inc., Palo Alto, CA) and XKnife treatment planning software (Radionics, Inc., Burlington, MA). In most cases, one isocenter was used, and conformality was established by non-coplanar arc beam shaping and differential beam weighting. RESULTS: Thirty patients with large AVMs were treated between January 1995 and August 1998. Seven patients were treated with 42-Gy/7-Gy fractions, with one patient lost to follow-up and the remaining six with previous partial embolization. Twenty-three patients were treated with 30-Gy/5-Gy fractions, with two patients lost to follow-up and three who died as a result of unrelated causes. Of 18 evaluable patients, 8 had previous partial embolization. Mean AVM volumes at FSR treatment were 23.8 and 14.5 cm3, respectively, for the 42-Gy/7-Gy fraction and 30-Gy/5-Gy fraction groups. After embolization, 18 patients still had AVM niduses of 14 cm3 or more: 6 in the 7-Gy cohort and 12 in the 5-Gy cohort. For patients with at least 5-year follow-up, angiographically documented AVM obliteration rates were 83% for the 42-Gy/7-Gy fraction group, with a mean latency of 108 weeks (5 of 6 evaluable patients), and 22% for the 30-Gy/5-Gy fraction group, with an average latency of 191 weeks (4 of 18 evaluable patients) (P = 0.018). For AVMs that remained at 14 cm3 or more after embolization (5 of 6 patients), the obliteration rate remained 80% (4 of 5 patients) for the 7-Gy cohort and dropped to 9% for the 5-Gy cohort. A cumulative hazard plot revealed a 7.2-fold greater likelihood of obliteration with the 42-Gy/7-Gy fraction protocol (P = 0.0001), which increased to a 17-fold greater likelihood for postembolization AVMs of 14 cm3 or more (P = 0.003). CONCLUSION: FSR achieves obliteration for AVMs at a threshold dose, including large residual niduses after embolization. With significant treatment-related morbidities, further investigation warrants a need for better three-dimensional target definition with higher dose conformality.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

Sign in / Sign up

Export Citation Format

Share Document