scholarly journals Humeral lengthening by Ilizarov technique in patients with post septic shortening

2020 ◽  
Vol 12 (4) ◽  
pp. 86-88
Author(s):  
Bari MM ◽  
Islam Shahidul ◽  
Bari AM Shayan R
Keyword(s):  
Deformity Correction ◽  
Radial Nerve Palsy ◽  
Efficacy And Safety ◽  
Humeral Lengthening ◽  
Original Length ◽  
Age At Surgery ◽  
Epiphyseal Injury ◽  
Ilizarov Fixator ◽  
Pin Track

Purpose: Humeral lengthening in patients with post septic shortening is a challenging procedure for Orthopaedic surgeon. The aim of this study was to evaluate the efficacy and safety of humeral lengthening using Ilizarov fixator. We reviewed the literature on humeral lengthening using different fixators with regard to indications, operative technique, results and complications. We also retrospectively reviewed 12 patients treated with humeral lengthening using Ilizarov external fixation. The etiology was epiphyseal injury (7 cases), infection (5 cases). The average age at surgery was 14,5 years (range 12,5-23,5) with post septic humeral shortening. The patients were assessed clinically and radio-graphically. Follow up ranged from 1-10-years.The magnitude of lengthening achieved ranged from 5-15cm with an average of 7, 5cm. Functionally all the patients returned to their preoperative jobs and daily activities including sports. Complications included pin track infection in 8 patients, radial nerve palsy which recovered completely in one patient. Conclusion; Humeral lengthening is a valid method that improves the outcome following arm shortening and deformity correction including angulation and rotation. Extensive lengthening up to 100% of the original length could be achieved without increasing the risk of complications.

Bilateral use of the vertical expandable prosthetic titanium rib attached to the pelvis: a novel treatment for scoliosis in the growing spine

2009 ◽  
Vol 10 (4) ◽  
pp. 287-292 ◽  
Author(s):  
Amer F. Samdani ◽  
Ashish Ranade ◽  
Henry J. Dolch ◽  
Reed Williams ◽  
Tricia St. Hilaire ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Deformity Correction ◽  
Early Onset Scoliosis ◽  
Spine Deformity ◽  
Complication Rates ◽  
Novel Device ◽  
Age At Surgery ◽  
Growing Spine

Object Few options exist for the treatment of severe, early onset scoliosis. Goals of treatment include stabilizing curve progression while allowing for normal spine, chest, and lung growth. The vertical expandable prosthetic titanium rib (VEPTR) is a novel device designed to control the spine deformity while permitting lung and spine growth. In this paper the authors report their experience with using bilateral VEPTRs from the ribs to the pelvis for children with severe, early onset scoliosis. Methods Eleven children were identified who had been treated with bilateral VEPTRs from the ribs to the pelvis. The authors conducted a retrospective review and collected the following data: clinical diagnosis, age at surgery, number of lengthening procedures, and complications. In addition, pre- and postoperative radiographs were reviewed to measure maximum Cobb angle (both thoracic and lumbar), thoracic height, total spine height as measured from T-1 to S-1, thoracic kyphosis (T2–12), and lumbar lordosis (L1–S1). Results The average patient age at surgery was 71 months; the mean preoperative thoracic Cobb angle was 81.7°. This angle was corrected to 50.6° immediately postoperatively, and this correction was maintained; at the most recent follow-up the curves averaged 58°. Similarly, the preoperative kyphosis (T2–12) angle measured 43° preoperatively, 23° immediately postoperatively, and 37° at the most recent follow-up evaluation. The patients underwent a total of 41 lengthening procedures (average 3.7 lengthening procedures per patient), and overall spine length increased from 23.1 cm preoperatively, to 27.3 cm immediately postoperatively, to 29.4 cm at the final follow-up (an average of 25 months). Four (36.4%) of the 11 patients experienced complications. Conclusions The VEPTR offers a viable treatment option for children with severe, early onset scoliosis. It achieves and maintains spinal deformity correction, while allowing for continued spine and chest-wall growth. Complication rates are similar to those reported for other growing systems.

scholarly journals Quality of life after surgery for neuromuscular scoliosis

2013 ◽  
Vol 5 (1) ◽  
pp. 1 ◽  
Author(s):  
Peter Obid ◽  
Andrea Bevot ◽  
Almut Goll ◽  
Corinna Leichtle ◽  
Nikolaus Wülker ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deformity Correction ◽  
Neuromuscular Scoliosis ◽  
Approval Rate ◽  
Age At Surgery ◽  
The Mean ◽  
Clinical Outcome Study ◽  
Main Curve

Surgery in patients with neuromuscular scoliosis is associated with a higher rate of complications. It is still controversially discussed whether the patients truly benefit from deformity correction. The purpose of this study is to investigate if the quality of life has been improved and if the patients and their caregivers are satisfied with the results of surgery. This is a retrospective clinical outcome study of 46 patients with neuromuscular scoliosis which were treated with primary stable posterior pedicle screw instrumentation and correction. To achieve fusion only autologous bone was used. Follow up was minimum 2 years and maximum 5 years with an average of 36 months. The patients and/or their caregivers received a questionnaire based on the PEDI (pediatric disability inventory) and the GMFS (gross motor function score). The patients (and their caregivers) were also asked if the quality of life has improved after surgery. Only 32 of 46 patients answered the questionnaire. The answers showed a high approval-rate regarding the patients satisfaction with the surgery and the improvement of quality of life. The questionnaire could be answered from 1 (I do not agree) to 4 (I completely agree). The average agreement to the following statements was: i) the quality of life has improved: 3.35; ii) I am satisfied with surgery: 3.95; iii) the operation has fulfilled my expectations: 3.76. The average age at surgery was 12.7 years. The mean pre-operative cobb-angle of the main curve was 83.1° with a correction post-operatively to a mean of 36.9° and 42.6° at final follow-up. That is an average correction of 56.9%. Although spinal fusion in neuromuscular scoliosis is associated with a higher rate of complications our results show that the patients and their caregivers are satisfied with the operation and the quality of life has improved after surgery.

scholarly journals Uso del Método de Ilizarov en Pie Bot Pediátrico

10.15417/110 ◽  
2013 ◽  
Vol 78 (2) ◽  
pp. 21
Author(s):  
Silvana Fiscina ◽  
Rodolfo Goyeneche ◽  
Horacio Miscione ◽  
Claudio Primomo
Keyword(s):  
Prognostic Factors ◽  
High Rate ◽  
Soft Tissue Release ◽  
Ilizarov Method ◽  
Factores Pronósticos ◽  
Palabras Clave ◽  
Age At Surgery ◽  
Ilizarov Fixator ◽  
Initial Results

<p><strong><em>Introducción:</em></strong><strong> </strong>El objetivo de tratamiento del pie Bot está enfocado en lograr un pie plantígrado, indoloro y  que permita el uso del calzado habitual.</p><p>El objetivo del trabajo fue medir la incidencia de recidiva luego de obtenida la corrección de la deformidad en pacientes con pie bot tratados con tutor de Ilizarov, y  analizar los factores pronósticos asociados.</p><p><strong><em>Material y Método: </em></strong>Cohorte retrospectiva de factores pronóstico. Se trató con este método a 48 pacientes (70 pies) desde 1988. Se excluyeron los pacientes con falta de corrección de la deformidad en el momento de retirar el tutor (deformidad residual o corrección incompleta). La variable de estudio fue la recidiva.</p><p><strong><em>Resultados:</em></strong></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>El 77% de los 70 pies eran idiopáticos. Solo 18 pies no habían sido tratados. Todos eran pacien- tes pediátricos. El promedio de edad en el momento de la cirugía era de 7,9 años. Se incluyeron tres grupos de pacientes: tratados con Ilizarov solo (40,2%), en combi- nación con cirugía de partes blandas (38,5%) y asociado con osteotomías (21,3%). El seguimiento promedio posoperatorio fue de 10,6 años (de 5,5 a 22). En el 71% de los pies, los resultados fueron pobres, la deformidad recidivó en un promedio de 38 meses, y fueron necesarias cirugías complementarias para lograr un pie plantígrado.</span></p></div></div></div><p><strong><em>Conclusi</em></strong><strong><em>ó</em></strong><strong><em>n:</em></strong> Presentamos una importante casuística con seguimiento alejado de pie bot recidivado o inveterado, con una alta recidiva de la deformidad (71%). No encontramos diferencias estadísticamente significativas entre los subgrupos estudiados (edad, diagnóstico, trata- mientos previos y procedimientos asociados).</p><p>Actualmente no consideramos a esta técnica de primera elección, pues nuestros resultados fueron poco alentadores.</p><p> </p><p><strong><em>Palabras clave: Pie Bot Recidivado, Inveterado, Ilizarov.</em></strong></p><p> </p><p> </p><p> </p><p> </p><p><strong>Abstract:</strong></p><p><strong><em>Introduction:</em></strong> The goal of treatment for clubfoot is to achieve a pain-free, plantigrade foot that allows walking comfortably with normal shoes.</p><p>The aim of the study was to assess the relapse rate after having achieved correction of the deformity in patients with clubfoot treated with the Ilizarov method and to analyze associated prognostic factors.</p><p><strong><em>Material and method:</em></strong> In a retrospective cohort study of prognostic factors we evaluated 48 patients, 70 feet, treated with the Ilizarov method between 1988 and 2006.</p><p>Patients in whom correction of the deformity with the external fixator failed (residual deformity or incomplete correction) were excluded from the study. The study variable was relapse.</p><p><strong><em>Results:</em></strong> Etiology was idiopathic in 77% of 70 feet. Only 18 feet had not been treated previously. All patients were children. Mean age at surgery was 7.9 years. The patients were divided into three groups according to the treatment with the Ilizarov fixator alone (40%), in combination with soft-tissue release (38%), or associated with osteotomies (21%).</p><p>Mean post-operative follow-up was 10.6 years (range: 5.5-22 years).</p><p>Outcome was poor in 71% of the feet, which relapsed after a mean of 38 months, requiring additional surgeries to achieve a plantigrade foot.</p><p><strong><em>Summary:</em></strong> The present is a large series of neglected or relapsed clubfeet treated with the Ilizarov method with good initial results, but a high rate of recurrence of the deformity after a long follow-up period (71%). We did not find statistically significant differences among the subgroups comparing age, diagnosis, previous treatments, and associated procedures and no prognostic factors for relapse could be identified.</p><p>Currently, we do not consider the Ilizarov method the technique of choice for the treatment of neglected or relapsed clubfoot as our results were not very promising.</p><p> </p><p><strong><em>Key Words: Ilizarov; Treatment; Recurrence; Neglected Clubfoot.</em></strong></p>

scholarly journals Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up

2019 ◽  
Vol 10 (4) ◽  
pp. 406-411
Author(s):  
Maroun Rizkallah ◽  
Amer Sebaaly ◽  
Khalil Kharrat ◽  
Gaby Kreichati
Keyword(s):  
Cobb Angle ◽  
Subgroup Analysis ◽  
Deformity Correction ◽  
Congenital Scoliosis ◽  
Angle Correction ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
Vertebral Resection

Study Design: Retrospective cohort. Objectives: To evaluate the long-term effect of convex growth arrest (CGA) on coronal deformity correction in congenital scoliosis. Methods: Twenty-two patients with congenital scoliosis operated by 1-staged double approach hemiephysiodesis by bone grafting of the convex side without instrumentation are included. Eighteen curves had an isolated hemivertebra while 4 curves had congenital bar. Subgroup analysis was performed according to age at surgery (3 years cutoff), type of malformation (hemivertebra vs congenital bar), and severity of curve (35° cutoff). Results: Patients’ mean age at surgery was 3 years (range 0.5-8 years), with a mean frontal Cobb angle of 40.59°. Mean follow-up is 10.7 years (range 5.5-25 years). Overall results showed mean frontal Cobb angle reduction of 35.47% (40.59° to 27.41°). Detailed analysis showed that 15 curves had a mean correction of 51.8%, 5 stabilized and 2 had a mean aggravation of 25.11%. Subgroup analysis revealed that patients operated ≤3 years of age had mean cobb angle correction of 43.1% versus 21.49% in patients operated >3 years ( P = .140). Mean correction of 44.5% was gained in curves with isolated hemivertebra compared with 1.3% in curves with congenital bar ( P = .004). A 58.17% mean correction was reached in curves ≤35° versus 23.68% in curves >35° ( P = .032). Conclusions: A limited convex hemiepiphysiodesis still has a place in congenital scoliosis care when it is performed in patients ≤3 years old, with curves ≤35°, and with isolated hemivertebra. It spares patients the risks of vertebral resection and instrumentation, while fusing the same number of levels.

scholarly journals Clinical efficacy and safety of ultra-short-course chemotherapy in treatment of spinal tuberculosis after complete debridement: an observational study

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052096761
Author(s):  
Guangwei Sun ◽  
Qian Wang ◽  
Qiang Liang ◽  
Xiangwei Song ◽  
Jian Chen ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Clinical Manifestations ◽  
Deformity Correction ◽  
Postoperative Chemotherapy ◽  
Efficacy And Safety ◽  
Short Course ◽  
Short Course Chemotherapy

Objective To evaluate the clinical efficacy and safety of ultra-short-course chemotherapy (<4 months) in treating spinal tuberculosis following complete debridement. Methods Clinical data of patients diagnosed with spinal tuberculosis, who underwent surgery with postoperative chemotherapy for < 4 months at the General Hospital of Ningxia Medical University between January 2005 and March 2015, were retrospectively analysed. Clinical manifestations, American Spinal Injury Association grades, states of bone fusion and lesion healing, deformity correction, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and adverse drug reactions, observed before and after surgery and at the final follow-up, were assessed. Results Sixty patients were included, comprising 26 male and 34 female patients aged 16–78 years (mean, 40.85 years). Patients received postoperative chemotherapy for 3–4 months (mean, 3.61 months) and were followed for 25–129 months (mean, 70.61 months). Spinal tuberculosis recurred after surgery in one patient, who was cured by subsequent surgery. At the final follow-up, no symptoms of tuberculosis, local pain, abscess or sinus were observed. Daily life and working abilities were almost recovered in all patients. ESR and CRP levels were restored to normal, bone grafts fused, lesions healed and neurological functions were recovered. Postoperative chemotherapy-induced complications occurred in 10 patients (16.67%). Conclusions Complete debridement plus ultra-short-course chemotherapy for 3–4 months may be safe and efficacious in treating spinal tuberculosis, and requires further investigation.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

Efficacy and safety of long-acting pasireotide in acromegalic patients in the real life: The reappraisal of the first-dose follow-up visit

2020 ◽  
Author(s):  
Claudio Urbani ◽  
Francesca Dassie ◽  
Benedetta Zampetti ◽  
Di Certo Agostino Maria ◽  
Renato Cozzi ◽  
...  
Keyword(s):  
Real Life ◽  
Efficacy And Safety ◽  
The Real ◽  
Long Acting

scholarly journals Pregnancy and neonatal outcomes in fresh and frozen cycles using blastocysts derived from ovarian stimulation with follitropin delta

2021 ◽  
Author(s):  
Jon Havelock ◽  
Anna-Karina Aaris Henningsen ◽  
Bernadette Mannaerts ◽  
Joan-Carles Arce ◽  
Keyword(s):  
Ovarian Stimulation ◽  
Implantation Rate ◽  
Neonatal Outcomes ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Relative Contribution ◽  
Follitropin Alfa ◽  
Start Up ◽  
Comparative Trials

Abstract Purpose To describe the pregnancy and neonatal outcomes using fresh and vitrified/warmed blastocysts obtained from ovarian stimulation with follitropin delta in controlled trials versus follitropin alfa. Methods This investigation evaluated the outcome from 2719 fresh and frozen cycles performed in 1326 IVF/ICSI patients who could start up to three ovarian stimulations in the ESTHER-1 (NCT01956110) and ESTHER-2 (NCT01956123) trials, covering 1012 fresh cycles and 341 frozen cycles with follitropin delta and 1015 fresh cycles and 351 frozen cycles with follitropin alfa. Of the 1326 first cycle patients, 513 continued to cycle 2 and 188 to cycle 3, and 441 patients started frozen cycles after the fresh cycles. Pregnancy follow-up was continued until 4 weeks after birth. Results The overall cumulative take-home baby rate after up to three stimulation cycles was 60.3% with follitropin delta and 60.7% with follitropin alfa (−0.2% [95% CI: −5.4%; 5.0%]), of which the relative contribution was 72.8% from fresh cycles and 27.2% from frozen cycles in each treatment group. Across the fresh cycles, the ongoing implantation rate was 32.1% for follitropin delta and 32.1% for follitropin alfa, while it was 27.6% and 27.8%, respectively, for the frozen cycles. Major congenital anomalies among the live-born neonates up until 4 weeks were reported at an incidence of 1.6% with follitropin delta and 1.8% with follitropin alfa (−0.2% [95% CI: −1.9%; 1.5%]). Conclusions Based on comparative trials, the pregnancy and neonatal outcomes from fresh and frozen cycles provide reassuring data on the efficacy and safety of follitropin delta. Trial registration ClinicalTrials.gov Identifier: NCT01956110 registered on 8 October 2013; NCT01956123 registered on 8 October 2013.

OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France

2020 ◽  
Vol 36 (S1) ◽  
pp. 4-4
Author(s):  
Jean-Charles Lafarge ◽  
Denis-Jean David ◽  
Cédric Carbonneil
Keyword(s):  
Esophageal Cancer ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Severe Obesity ◽  
One Anastomosis Gastric Bypass ◽  
Close Monitoring ◽  
Efficacy And Safety ◽  
Multicenter Rct ◽  
Nutritional Complications

IntroductionOne anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.MethodsA systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.ResultsThe three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.ConclusionsHAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.

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