scholarly journals Results of treatment of congenital clubfoot after soft tissue release in children

2020 ◽  
pp. 81-85
Author(s):  
O. Holubenko ◽  
◽  
A. Levytskyi ◽  
O. Karabenyuk ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Cuboid Bone ◽  
Long Term Treatment ◽  
Plaster Casts

Topicality. Widespread use of the method of I. Ponseti allows to significantly reduce the number of reconstructive surgeries and/or reduce their volume. However, if presence the rigid, severe deformities that cannot be corrected with staged plaster casts, or recurrences, surgical treatment is advisable. The literature describes many surgical techniques, the main purpose of which is to reduce the frequency of postoperative complications. And at the same time find the most convenient access to eliminate contractures, further wound healing by primary tension with minimal formation of connective tissue elements. Objective: to reduce the incidences of complications in the surgical treatment of congenital clubfoot by using a modified surgical approach. Materials and methods. In the Department of Orthopedics and Traumatology of NCSH «OKHMATDYT» 57 children (72 feet) with a diagnosis of congenital clubfoot underwent surgical treatment using a modified Carroll approach for the period from January 2014 to September 2018. The mean age of patients was 3±0.4 years. 41 of them boys and 16 girls. Bilateral deformity was observed in 12 patients. 48 patients (58 feet) were underwent surgical treatment after initial treatment with staged plaster casts according to the method of I. Ponseti. Recurrences of deformity after surgery was observed in 9 patients (14 feet). Results. When assessing the immediate results during surgery in all patients, complete correction of foot deformity was achieved. No postoperative complications were noted. Long-term treatment results 2 years after surgery showed that good results were in 12 patients (21±9.53%), satisfactory in 39 (68.4±27.14%) and unsatisfactory in 6 (7±2.18%). Four patients with unsatisfactory results and residual manifestations of deformity in the form of passively corrected isolated adduction of the anterior foot, subsequently underwent surgery to transplant the anterior tibialis tendon to the lateral cuneiform bone. And 2 patients – wedge-shaped resection of the cuboid bone. Indication of which was not the possibility of passive correction of deformity. Conclusions. The comparative analysis of the obtained results and literature data testifies to the effectiveness of the proposed method of treatment of idiopathic clubfoot in children (using three approaches), as well as in the presence of residual deformity after conservative and surgical treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: clubfoot, children, posteromedial release, surgical treatment.

scholarly journals APPLICATION OF I.PONSETI TECHNIQUE IN SURGICAL TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN

2019 ◽  
Vol 111 (3) ◽  
pp. 6-10
Author(s):  
Oleksii Holubenko ◽  
Anatolii Levytskyi ◽  
Oleksandr Karabeniuk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Preoperative Preparation ◽  
Congenital Clubfoot ◽  
High Relapse Rate ◽  
Group I ◽  
Initial Correction ◽  
Prevention Of Recurrence

Summary. One of the most common malformation of the musculoskeletal system in children is congenital clubfoot, which occurs from 2 to 5 cases per 1000 newborns. Treatment of idiopathic clubfoot by the Ponseti method is now standard, and most feet can achieve satisfactory initial correction using this technique. But the high relapse rate (from 20 to 40%) and the existing postoperative complications necessitate the search for approaches to reduce them. One of such approaches is the application of the I.Ponseti technique at the stages of preoperative preparation. The aim of our work is to reduce the incidence of complications in the surgical treatment of congenital clubfoot by applying the I.Ponseti technique. Materials and methods. An analysis was made of the treatment of 62 children (74 feet) with idiopathic congenital clubfoot, who were inpatient and outpatient treatment at the NSH «Ohmatdet» from september 2015 to august 2018. Of these, 39 were patients with recurrence of congenital clubfoot after the initial treatment according to method I.Ponseti and 23 patients with relapsed deformity after initial surgical treatment. Of these, 35 boys and 27 girls. All patients were separated into two groups. Group I – 27 patients (32 feet) who did not use casting according to the I.Ponseti technique before surgical treatment. Group II – 35 patients (42 feet) who underwent staging casting according to I.Ponseti technique at the stages of preoperative planning. The average age of the patients is 4 ± 0.85 years. Result. Use of the I.Ponseti technique at the stages of preoperative preparation in the treatment of congenital clubfoot can significantly reduce the incidence of postoperative complications. The result of which is the possibility of early rehabilitation of patients and prevention of recurrence of deformity.

The Role of Arthroscopy in the Treatment of Gouty Arthritis of the Knee Case presentation

2018 ◽  
Vol 69 (8) ◽  
pp. 2236-2239
Author(s):  
Marius Moga ◽  
Mark Edward Pogarasteanu ◽  
Dumitru Ferechide ◽  
Antoine Edu ◽  
Chen Feng Ifrim
Keyword(s):  
Gouty Arthritis ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Clinical Aspects ◽  
Associated Lesions ◽  
Number Of Patients ◽  
Long Term Treatment ◽  
Functional Scores ◽  
Urate Crystals

Gout is a metabolic disease involving the impregnation of joints and other tissues with urate crystals. The onset is often brutal, and it manifests itself with pain and inflammation in the affected joint. The treatment usually involves rest, ice, NSAIDs and anti-gout medication. The long-term treatment involves medication and dietary changes. In the joint, urate crystals are deposited in the synovial, in the cartilage and in the menisci. In the arthroscopic practice, the gouty knee is a rare occurrence. We present a relevant case, that of a 57 years old patient without a prior gout diagnosis where we found urate crystal deposits covering the synovium, cartilage and meniscus, and we discuss the current and recent year Pub Med indexed literature in order to evaluate the possibilities for arthroscopic treatment of this pathology. We looked at the number of patients involved, their characteristics, and the surgical techniques used. We also looked at the temporal relation of the arthroscopic intervention to the recent gout attacks, and at the described lesions that were found. Also, we evaluated the papers for joint liquid analysis, gout drug treatment, and description of clinical aspects involved and associated lesions. Finally, we looked at the follow-up, at the functional scores used to monitor the patient�s evolution, at the associated medication and at the long-term outcomes, if described. We have found opinions to vary. In the end, we draw conclusions pertaining to the practical short-term and long-term use of knee arthroscopy in the treatment of gout.

scholarly journals Cirurgia no Aspergiloma Pulmonar: Experiência Mono-Institucional

2014 ◽  
Vol 27 (4) ◽  
pp. 417
Author(s):  
Silvia Da Silva Correia ◽  
Carlos Pinto ◽  
João Bernardo
Keyword(s):  
Postoperative Complications ◽  
Surgical Resection ◽  
Surgical Procedure ◽  
Lung Resection ◽  
Previous History ◽  
Term Treatment ◽  
High Rate ◽  
Long Term Treatment ◽  
Immunosuppressed Patients ◽  
Pulmonary Aspergilloma

<strong>Introduction:</strong> Pulmonary aspergiloma or mycetoma is a saprophytic colonization of a preexisting cavity by aspergilloma. Surgical resection is the only effective long-term treatment, but remains controversial because of the high rate of complications in the perioperative and postoperative time.<br /><strong>Objectives:</strong> Analysis of the experience of a Cardiothoracic Surgery Center for the treatment of pulmonary aspergilloma and evaluation of the prognostic factors after surgery.<br /><strong>Material and Methods:</strong> Retrospective analysis including all the patients with a diagnosis of pulmonary aspergilloma submitted to surgery for a 10 years period, in a single institution (June 2001-June 2011).<br /><strong>Results:</strong> The study included 22 patients (18 men) with a mean age of 51.0 + 17.4 years. Of them, 46% were smokers, 41% were alcoholic and 50% had a previous history of tuberculosis. Most of the patients had a complex aspergilloma (73%) and 17% a simple aspergilloma. The most common presentation was hemoptysis (50%). The common surgical procedure performed was atypical lung resection in 55%, lobectomy in 27% and pneumectomy in 9%. Two patients were submitted to thoracoplasty. There was one operative death (5%). Postoperative complications occurred in 36% and the most frequent were pneumothorax (18%) and empyema (18%). The mean follow-up period was 52 months (3 - 116) and the 5 years mortality rate of 35%. Of them, 4 patients died because of non- related causes and 3 were immunosuppressed patients. The mortality was 40% in the group of complex aspergilloma and 33% in the group of complex aspergilloma.<br /><strong>Discussion:</strong> The most common surgical procedure performed was atypical lung resection. The postoperative complications rate was similar to previous studies.<br /><strong>Conclusion:</strong> Surgical resection of aspergilloma presents a low morbidity and mortality. Therefore, for patients with lung function preserved, it is the preferred treatment.<br /><strong>Keywords:</strong> Aspergillus; Pulmonary Aspergillosis/surgery.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

scholarly journals Advances in the management of craniopharyngioma

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1632 ◽  
Author(s):  
Lillie O'steen ◽  
Daniel J. Indelicato
Keyword(s):  
Benign Tumor ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Subtotal Resection ◽  
Temporal Lobes ◽  
Long Term Treatment ◽  
Central Brain ◽  
Treatment Morbidity ◽  
Intracranial Vasculature

Craniopharyngioma is a curable benign tumor, but owing to its intimate relationship to critical structures in the central brain—such as the optic apparatus, pituitary, hypothalamus, intracranial vasculature, brain stem, and temporal lobes—its management introduces the risk of long-term treatment morbidity. Today, the most common treatment approach is conservative subtotal resection followed by radiotherapy, and the goal is to limit long-term toxicity. Many recent advances in the treatment of craniopharyngioma are attributable to improved surgical techniques and radiotherapy technologies.

scholarly journals Outcomes Following Surgical Treatment of Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Hallux Valgus ◽  
Surgical Techniques ◽  
Weighted Average ◽  
Secondary Surgery ◽  
Weighting Method ◽  
Hallux Varus ◽  
Hallux Valgus Deformity ◽  
Inverse Variance

Category: Bunion Introduction/Purpose: Hallux valgus (HV) deformity is one of the most common chronic disorders. Surgical correction plays a central role in the treatment of painful HV deformity with over 100 different surgical techniques described in the current literature. In this report we performed a systematic literature review on studies that addressed clinical outcomes following surgical treatment of hallux valgus. The objectives of our study were to (1) describe available study characteristics on surgical HV deformity treatment; (2) determine patients’ postoperative satisfaction including postoperative pain and recurrence of HV deformity; (3) determine rate of postoperative complications by surgery type; and (4) analyze the relationship between radiographic HV deformity parameters and postoperative complication rate. Methods: We reviewed the literature using common data bases. All searches were unlimited. Study demographics were collected and analyzed. Gender distribution was estimated using an inverse-variance weighting method and patient age and follow-up time were summarized using a simple weighted average due to an absence of reporting variance in the majority of studies. A chi- squared Q test, or heterogeneity test, was used to test for differences across surgery types for patient dissatisfaction, deformity recurrence, removal of hardware, reoperation, nonunion, hallux varus, nerve injury, infection, metatarsalgia, and VAS>5. Outcome estimates and 95% confidence intervals (CIs) for each surgery type were pooled across studies using the inverse-variance weighting method. A random effects model was used when study variance was estimated using the DerSimonian-Laird method. Results: In total, 269 studies with 13,112 patients and 16,594 feet were included. Patients treated by simple buniectomy had the highest dissatisfaction rate with 25.5% (95%CI 17.5-35.6). Deformity recurrence was highest in patients treated by proximal osteotomy with 10.5% (95%CI 5.6-18.7). The highest rate of secondary surgery was in patients treated by simple buniectomy with 6.1% (95%CI 2.4-14.7). In the same patient group the highest rate of hallux varus deformity was observed with 9.1% (95%CI 2.9- 24.9). Patients treated by hemi-joint resection had the highest rate of postoperative metatarsalgia with 16.2% (95%CI 11.3-22.8) and persisting pain VAS>5 with 6.5% (95%CI 3.3-12.3). Conclusion: Patients with buniectomy and hemi-joint resection demonstrated the highest rates of postoperative complications including dissatisfaction, need for secondary surgery, postoperative metatarsalgia, and persisting pain.

scholarly journals A method of reconstruction of female genitalia in girls with virilization

2014 ◽  
Vol 95 (3) ◽  
pp. 450-454 ◽  
Author(s):  
N R Akramov ◽  
A K Zakirov
Keyword(s):  
Surgical Treatment ◽  
Ambiguous Genitalia ◽  
Term Treatment ◽  
Urogenital Sinus ◽  
Basic Knowledge ◽  
Treatment Quality ◽  
Step Method ◽  
Self Identity ◽  
Long Term Treatment ◽  
One Step

The most common cause for female virilization is congenital adrenal hyperplasia. For anticipating the serious psychological distress related to ambiguous genitalia, these patients require plastic surgery. At present, two-step methods are preferred as more reliable. However, the surgical treatment in this case extends over several years, and can greatly affect patient’s psychosocial status. Based on the analysis of known surgical treatments, we proposed a one-step method of feminizing genitoplasty. The advantages of the proposed method allows one-step surgical treatment of girls with virilized genitalia at an earlier age, before the child reaches the period of sexual self-identity. This approach provides less psychosocial distress and reduces the number of interventions, maintaining the adequate sensitivity of the clitoris, providing moist and age-appropriate vaginal opening by using the preputium of the penis homolog and urogenital sinus mucosa at genitoplasty. The abovementioned advantages increases the surgical treatment quality and quality of life in girls with virilized genitalia. The method is reproducible by pediatric surgeons with basic knowledge of children’s anatomy. Yet, a lengthy follow-up is needed to assess the long-term treatment results.

scholarly journals Pneumonectomy in the treatment of tuberculosis relapse in a previously resected lung

2020 ◽  
Vol 179 (2) ◽  
pp. 11-19
Author(s):  
D. B. Giller ◽  
A. A. Glotov ◽  
O. Sh. Kesaev ◽  
E. M. Glotov ◽  
Ya. G. Imagogev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Clinical Effect ◽  
High Efficiency ◽  
Radical Surgery ◽  
Surgical Techniques ◽  
Results Of Treatment ◽  
Completion Pneumonectomy ◽  
Medical Indications ◽  
Tuberculosis Relapse

THE OBJECTIVE of our study was to increase the efficiency of treatment of tuberculosis postoperative reactivations in a previously operated lung, by clarifying the medical indications, improving surgical techniques and tactics when removing a previously resected lung.METHODS AND MATERIALS. We analyzed the results of treatment of 220 patients who, in the 2004–2017 timeframe in our institution, had pneumonectomies (76 cases) and pleuropneumonectomies (144 cases) for tuberculosis relapse in a previously operated lung. For more objective planning of surgical treatment and evaluation of its results, we identified three degrees of treatment radicalism: radical, conditionally radical, and palliative.RESULTS. 32 patients, who had carried a radical surgery, were diagnosed as having a complete clinical effect at the time of discharge (absence of destruction cavities in a single lung, bacterial excretion and illiquid complications) in 100 % of cases; in the group of patients operated conditionally radical, there were diagnosed 161 out of 168 (95.8 %) and in the group of patients operated palliative, there were distinguished only 3 cases out of 20 (15.0 %).CONCLUSION. The implementation of the completion pneumonectomy and pleurapneumonectomy is accompanied by high technical complexity and more frequent development of intraoperative and postoperative complications. At the same time, the high efficiency of treatment of tuberculosis relapses in a previously operated lung can be achieved using the recommended tactics and techniques of surgical treatment when performing radical and conditionally radical interventions.

Surgical treatment of diffuse toxic goiter in children. A review of the literature

2013 ◽  
Vol 4 (4) ◽  
pp. 69-76
Author(s):  
Alexander Vadimovich Gostimsky ◽  
Sergey Sergeevich Peredereev
Keyword(s):  
Surgical Treatment ◽  
Radioactive Iodine ◽  
Term Treatment ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Review Of The Literature ◽  
Large Size ◽  
Long Term Treatment ◽  
Toxic Goiter

Diffuse toxic goiter (DTG) is an autoimmune disease, to which there is a genetic predisposition. In children DTG is less common than in adults. Manifestation of graves‘ disease in childhood has a number of peculiarities. During the DTG in children is usually manifested thyrotoxicosis, requiring long-term treatment to achieve euthyroid, tendency to relapse and more frequently than adults, accompanied by ophthalmopathy and the large size of goiter. Diagnosis of graves‘ disease is based on the clinical picture of thyrotoxicosis, the existence of which is confirmed by the level of thyroid hormones and TSH in the blood. There are three types of treatment of patients DTG: medical, radioactive iodine therapy and surgery. There is no а single glance at the choice of the volume of operations in children.

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