scholarly journals Congenital dislocation of the knee: prenatal diagnostics and treatment at an early age

2017 ◽  
Vol 5 (2) ◽  
pp. 26-35
Author(s):  
Nicolai Y. Rumyantsev ◽  
Igor Y. Kruglov ◽  
Gamzat G. Omarov ◽  
Dmitry V. Voronin ◽  
Natalia N. Rumiantceva
Keyword(s):  
Pediatric Patients ◽  
Treatment Protocol ◽  
Prenatal Ultrasound ◽  
Lower Limbs ◽  
Long Term Results ◽  
Prenatal Diagnostics ◽  
Congenital Dislocation ◽  
Ultrasound Screening ◽  
Ultrasound Diagnostics

Background. Congenital dislocation of the knee (CDK) is a rare abnormality of the musculoskeletal system, with an incidence of 1 per 100,000 liveborn infants. Timely prenatal diagnostics and treatment during the initial days of life can help avoid the development of disabilities in a child. Aim of the study. We aimed to study the possible prenatal ultrasound diagnostics and to assess the efficacy of early orthopedic alignment using conservative methods of treatment. Materials and methods. From January 1988 to February 2016, 37 newborns (50 lower limbs) with CDK were treated. The initial assessment of the affected limbs was performed immediately after birth. To determine the severity of dislocation, the Seringe and Tarek classifications were used. Conservative treatment was performed for all the patients. The age of pediatric patients at the time of treatment onset ranged from 2 hours to 5 days. Various methods were used, such as stage plaster bandages (10 lower limbs) and correction using the von Rosen splint (8 lower limbs). Since 2003, a single treatment protocol, developed by the authors of this study, has been applied. Results. The prenatal ultrasound screening enabled the detection of CDK before birth in 21% of cases. Long-term results (catamnesis from 3 to 28 years) were evaluated by the Seringe scale and were excellent in 60%, good in 32%, and satisfactory in 8% of cases. Bad results were not registered. All the pediatric patients included in the study began to walk independently at the age of 9–18 months. Conclusion. Prenatal ultrasound diagnosis enables the detection of CDK. Treatment of newborns, started in the first hours of life, according to the protocol developed by the authors, enables the alignment of the dislocated lower leg in a short time, without using prolonged stage plaster bandages. Long-term results demonstrate the efficiency of the proposed methodology.

Long-Term Results After Functional Nonoperative Treatment of Achilles Tendon Rupture

2006 ◽  
Vol 27 (3) ◽  
pp. 167-171 ◽  
Author(s):  
Tobias M. Hufner ◽  
Dirk B. Brandes ◽  
Hajo Thermann ◽  
Martinus Richter ◽  
Karsten Knobloch ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Treatment Protocol ◽  
Nonoperative Treatment ◽  
Long Term Results ◽  
Neutral Position ◽  
Return To Sports ◽  
Sports Activity ◽  
Tendon Ruptures

Background: Nonoperative treatment of complete Achilles tendon ruptures generally involves a long period of cast immobilization and is associated with frequent reruptures. Functional nonoperative treatment of complete Achilles tendon ruptures involves the use of a high-shaft boot with a 3-cm hindfoot elevation, in which physical therapy is begun after 3 weeks of wear. We reviewed our long-term results with this treatment protocol to determine its effectiveness. Methods: The indications for nonoperative treatment, defined by ultrasound, were a distance of 10 mm or less between the tendon ends with the ankle in neutral position and complete apposition of the tendon ends in 20 degrees of plantarflexion. From 1990 to 1996, 168 patients were treated; 125 (74%) were available for followup at a mean of 5.5 (2 to 12.7) years after the injury. Results: Good or excellent results were achieved in 92 (73.5%) with complete rehabilitation and return to sports activity at their pre-injury levels. Satisfactory (9%) and poor results (17.5%) were due to pain in the Achilles tendon region, a lengthened Achilles tendon, markedly reduced strength, or a marked reduction of calf size in 25 patients (76%). Eight patients (6.4%) sustained a rerupture. Conclusions: Functional nonoperative treatment achieved good results in patients who had precise sonographic evaluation and who were compliant. As a result of our study, we modified our protocol: (1) a repeat ultrasound examination is done by an experienced sonographer 2 to 5 days after the first to confirm the indications for nonoperative treatment, (2) the use of the 3-cm hindfoot elevation is extended from 6 to 8 weeks to provide a longer protection of the tendon, and (3) patients then wear shoes with 1-cm hindfoot elevation for another 3 months.

scholarly journals Treatment of adult chronic autoimmune thrombocytopenic purpura with repeated high-dose intravenous immunoglobulin

Blood ◽  
1993 ◽  
Vol 82 (5) ◽  
pp. 1415-1421 ◽  
Author(s):  
B Godeau ◽  
S Lesage ◽  
M Divine ◽  
V Wirquin ◽  
JP Farcet ◽  
...  
Keyword(s):  
Body Weight ◽  
Platelet Count ◽  
Treatment Protocol ◽  
Complete Response ◽  
Long Term Results ◽  
High Dose ◽  
Thrombocytopenic Purpura ◽  
Autoimmune Thrombocytopenic Purpura ◽  
Platelet Counts

Intravenous (i.v.) infusions of Ig concentrates are an effective but expensive treatment for patients with autoimmune thrombocytopenic purpura (AITP). The optimal treatment protocol and the long-term results are uncertain, and the precise mechanism by which the platelet count increases is poorly understood. Twenty adult patients with chronic AITP were enrolled in a prospective study to compare the respective efficacy of two high-dose IVIgG induction regimens (1 g v 2 g/kg body weight) and the long-term effect of six 1 g/kg body weight i.v. IgG reinfusions. An initial response was observed in all 18 evaluable patients: the platelet count increased to a mean value of 251 x 10(9)/L (range 72 to 836 x 10(9)/L) and the mean pretreatment platelet count was multiplied by 14.6. No difference in efficiency was observed between the two i.v. IgG dosages. The degree of the platelet count increment correlated in both groups with the increase in the clearance of antibody-coated red blood cells, measured by an isotopic method, but not with the serum IgG elevation. Treatment was considered to have failed in 11 patients, 90 days after the last i.v. IgG reinfusion (D90), because the platelet counts were comparable with pretreatment values. In contrast, a complete response was observed at D90 in five patients (mean platelet count: 184 x 10(9)/L; range: 150 to 250 x 10(9)/L) and a partial response at D90 was obtained in the remaining two patients (platelet counts: 70 and 104 x 10(9)/L). Five of the 7 responders at D90 kept a platelet count above 50 x 10(9)/L during the entire follow-up period (mean 33 months; range: 5 to 66) with no further treatment; unfortunately, no clinical or biologic criteria were found to be predictive of the long-term response. This study shows that an i.v. IgG infusion regimen of 1 g/kg body weight could safely replace the classical 2 g/kg body weight dosage, at least in patients who do not have life-threatening thrombocytopenia. Moreover, repeated i.v. IgG reinfusion could be an alternative for AITP patients in whom splenectomy is contraindicated.

scholarly journals ENDOVENOUS LAZER COAGULATION: LONG-TERM RESULT - CRITERION OF TRUTH

2018 ◽  
Vol 3 (4) ◽  
pp. 27-30
Author(s):  
A G Shalashov ◽  
A V Kazantsev
Keyword(s):  
Varicose Veins ◽  
Intraoperative Complications ◽  
Lower Limbs ◽  
Long Term Results ◽  
Laser Coagulation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Result ◽  
Varicose Disease

Objectives - to study the long-term results of endovenous laser coagulation in patients with varicose veins of the lower extremities. Material and methods. The study included 241 patients with varicose disease of the lower limbs veins, who underwent surgical treatment using the method of endovenous laser coagulation. Results. The technical success of the operation was achieved in all cases, which was confirmed by color duplex scanning. There were no intraoperative complications. Long-term outcome was studied in 174 (72.2%) patients in the period up to 5 years. During the follow-up period the GSV occlusion signs were detected in 168 (96.4%) patients, partial recanalization of the GSV was registered in 6 (3.5%) patients.

scholarly journals Treatment of adult chronic autoimmune thrombocytopenic purpura with repeated high-dose intravenous immunoglobulin

Blood ◽  
1993 ◽  
Vol 82 (5) ◽  
pp. 1415-1421 ◽  
Author(s):  
B Godeau ◽  
S Lesage ◽  
M Divine ◽  
V Wirquin ◽  
JP Farcet ◽  
...  
Keyword(s):  
Body Weight ◽  
Platelet Count ◽  
Treatment Protocol ◽  
Complete Response ◽  
Long Term Results ◽  
High Dose ◽  
Thrombocytopenic Purpura ◽  
Autoimmune Thrombocytopenic Purpura ◽  
Platelet Counts

Abstract Intravenous (i.v.) infusions of Ig concentrates are an effective but expensive treatment for patients with autoimmune thrombocytopenic purpura (AITP). The optimal treatment protocol and the long-term results are uncertain, and the precise mechanism by which the platelet count increases is poorly understood. Twenty adult patients with chronic AITP were enrolled in a prospective study to compare the respective efficacy of two high-dose IVIgG induction regimens (1 g v 2 g/kg body weight) and the long-term effect of six 1 g/kg body weight i.v. IgG reinfusions. An initial response was observed in all 18 evaluable patients: the platelet count increased to a mean value of 251 x 10(9)/L (range 72 to 836 x 10(9)/L) and the mean pretreatment platelet count was multiplied by 14.6. No difference in efficiency was observed between the two i.v. IgG dosages. The degree of the platelet count increment correlated in both groups with the increase in the clearance of antibody-coated red blood cells, measured by an isotopic method, but not with the serum IgG elevation. Treatment was considered to have failed in 11 patients, 90 days after the last i.v. IgG reinfusion (D90), because the platelet counts were comparable with pretreatment values. In contrast, a complete response was observed at D90 in five patients (mean platelet count: 184 x 10(9)/L; range: 150 to 250 x 10(9)/L) and a partial response at D90 was obtained in the remaining two patients (platelet counts: 70 and 104 x 10(9)/L). Five of the 7 responders at D90 kept a platelet count above 50 x 10(9)/L during the entire follow-up period (mean 33 months; range: 5 to 66) with no further treatment; unfortunately, no clinical or biologic criteria were found to be predictive of the long-term response. This study shows that an i.v. IgG infusion regimen of 1 g/kg body weight could safely replace the classical 2 g/kg body weight dosage, at least in patients who do not have life-threatening thrombocytopenia. Moreover, repeated i.v. IgG reinfusion could be an alternative for AITP patients in whom splenectomy is contraindicated.

scholarly journals Outcome Analysis of Lipomeningomyelocele Repair in Children in a Tertiary Care Center in Nepal

2019 ◽  
Vol 41 (2) ◽  
pp. 30-34
Author(s):  
Puspa R Koirala ◽  
Amit B Pradhanang ◽  
Gopal Sedain ◽  
Mohan R Sharma
Keyword(s):  
Urinary Incontinence ◽  
Low Income ◽  
Tertiary Care ◽  
Lower Limbs ◽  
Long Term Results ◽  
Filum Terminale ◽  
Total Excision ◽  
Satisfactory Outcome ◽  
Care Surgery

Introduction: Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, pediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods: Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminable could be donein 8 patients. Follow up varied from 6 months to 2 years. Results: This study included 8 (61.5 %) patients of lumbosacral LMM, 3 (23%) patients of sacral LMM and 2 (15.38%) patients of thoracolumbar LMM. About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of post operative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion: Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual diploma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration.

scholarly journals Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus which will develop severe long‐term sequelae

2021 ◽  
Vol 57 (1) ◽  
pp. 97-104 ◽  
Author(s):  
M. Leruez‐Ville ◽  
S. Ren ◽  
J.‐F. Magny ◽  
F. Jacquemard ◽  
S. Couderc ◽  
...  
Keyword(s):  
Prenatal Ultrasound ◽  
Ultrasound Screening

LONG-TERM RESULTS OF TREATMENT OF PATIENTS WITH SUBUNGUAL MELANOMA

2017 ◽  
Vol 63 (3) ◽  
pp. 479-485
Author(s):  
Georgiy Gafton ◽  
Valentin Anisimov ◽  
Dmitriy Matsko ◽  
Aleksandr Ivantsov ◽  
Ivan Gafton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Lower Limbs ◽  
Long Term Results ◽  
Skin Melanoma ◽  
Results Of Treatment ◽  
Upper And Lower Extremities ◽  
Probability Of Death ◽  
Subungual Melanoma

At the N.N. Petrov Research Institute of Oncology from 1986 to 2015 there were performed 445 radical operations for skin melanoma of upper and lower extremities in patients aged 18 to 87 years. The present study analyzed data of 40 patients with morphologically confirmed diagnosis of “subungual melanoma” (SM). Long-term results and causes of death were evaluated in all operated patients. A 1-year survival rate of SM patients, whatever stage of disease was 90%, a 5-year overall survival rate - 47%, while only 20% of patients have survived a 10-year line. Overall survival median was 55 ± 9.4 months (95% CI, 36.4-73.5). The probability of death of radically operated SM patients in the next 5 years after surgical treatment from co-morbidities did not exceed 10%. SM patients had the worst prognosis as compared with patients with skin melanoma of upper and lower limbs (p = 0,0001).

scholarly journals Microabrasion: An Effective Method for Improvement of Esthetics in Dentistry

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Biji Balan ◽  
Chengappa Madanda Uthaiah ◽  
Sreejesh Narayanan ◽  
Priyadarshini Mookalamada Monnappa
Keyword(s):  
Hydrochloric Acid ◽  
Male Patient ◽  
Efficient Method ◽  
Clinical Case ◽  
Treatment Protocol ◽  
Enamel Surface ◽  
Long Term Results ◽  
Clinical Implications ◽  
Results Of Treatment

Enamel microabrasion can eliminate enamel irregularities and discoloration defects, thus improving the appearance of teeth. This paper presents the latest treatment protocol of enamel microabrasion to remove stains on the enamel surface. It has been verified that teeth submitted to microabrasion acquire a yellowish colour because of the thinness of the remaining enamel, revealing the colour of dentinal tissue to a greater degree. Enamel microabrasion is a technique that can be used to correct discoloured enamel. Enamel microabrasion was developed in the mid-1980s as a method of eliminating enamel discolouration defects and improving the appearance of teeth. Several years after the method was developed, much has been learned about this technique, long-term results of treatment, and microscopic changes to the enamel surface that have distinguishable clinical implications. In addition, certain patients can benefit from enamel microabrasion to yield attractive cosmetic results. The aim of this study was to report the clinical case of a male patient of 25 years with moderate fluorosis, whose smile was re-established by the use of an enamel microabrasion technique, with 18% hydrochloric acid and pumice slurry shown to be a safe and efficient method for removing fluorosis stains.

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