scholarly journals Recurrence of Dupuytren’s disease following surgery – an analysis of the causes and incidence

2020 ◽  
Vol 66 (4) ◽  
pp. 6-8
Author(s):  
Andrzej Żyluk
Keyword(s):  
Significant Risk ◽  
Significant Risk Factor ◽  
Dupuytren’S Disease ◽  
Time Interval ◽  
Disease Treatment ◽  
Dupuytren's Disease ◽  
True Recurrence ◽  
The Mean ◽  
Mean Time

AbstractThe incidence of recurrence Dupuytren’s disease after surgery is estimated up to 50% in relation to progression of the disease, treatment modality and time of the follow-up. The objective of this study was an analysis of the causes and frequency of recurrences among 67 patients following surgery for recurrent Dupuytren’s disease in the author’s institution in the years 2016–2018. The 67 patients comprised 56 men (83%) and 11 women (17%) at a mean age of 59 years (range 40–81), of which 27 patients (40%) had undergone a 2nd operation to the same hand, 22 patients (33%) had undergone a 3rd operation, 14 (21%) had undergone a 4th operation, and the remaining 4 patients had each undergone more than 5 operations on the same hand. The defined rate of recurrence in the analysed period was 20%. The mean time interval from the last operation and the appearance of signs of a relapse was 14 months; in 42 patients (63%) it was less than 1 year (3–12 months) and in the remaining 25 (37%) 1–4 years. Progressing contracture of the previously operated finger and contracture of the adjacent finger which was not involved at the 1st operation, was the most frequently observed pattern of recurrence, found in 29 patients; it was a combination of true recurrence and extension of the disease. The number of operations performed in a given patient was found to be a statistically significant risk factor of recurrence.

scholarly journals Problems in diabetic retinopathy treatment and management during the COVID-19 pandemic

2020 ◽  
Author(s):  
Hasan Öncül ◽  
Mehmet Fuat Alakuş
Keyword(s):  
Diabetic Retinopathy ◽  
Glycated Haemoglobin ◽  
Time Interval ◽  
Ophthalmological Examination ◽  
Treatment Practices ◽  
The Mean ◽  
Hospital Visits ◽  
New Treatments ◽  
Mean Time

Purpose: The aim of this study is to determine the problems occurring during the COVID-19 pandemic period in patients treated with intravitreal (IV) injection for diabetic retinopathy, and to provide recommendations for treatment management in these patients. Methods: Twenty-nine eyes of 17 patients were included in this prospective, observational study. The frequency of hospital visits, treatments performed, and detailed ophthalmological examination findings, including optical coherence tomography findings and glycated haemoglobin (HbA1c) values, were recorded in the period before the COVID-19 pandemic. During the COVID-19 pandemic period, the detailed ophthalmological examination findings and HbA1c values were noted after the patients who had delayed their routine control time (>90 days) applied to the hospital. New treatments were planned according to the current situation. Results: Seventeen patients who were diagnosed with diabetic macular edema were included in the study; 10 were female (58.8%) and seven were male (41.2%). The mean time interval between following visits was 45.52±5.85 days during the pre-pandemic period, but it increased to 110.41±13.47 days during the COVID-19 pandemic period (p<.001). Visual acuity (LogMAR) was 0.44±0.36 in the pre-pandemic period and 0.76±0.48 during the COVID-19 pandemic period (p=.003). Central macular thickness was 300.10±85.56 µm in the pre-pandemic period and it increased to 387.10±144.48 µm during the COVID-19 pandemic period (p=.007). In three patients, complications of diabetic retinopathy that could not be cured by medical treatment developed and surgical treatment was recommended. Conclusions: Delays in the treatment of diabetic retinopathy may cause permanent impairment in visual functions. The COVID-19 pandemic has caused an increase in the hospital visit intervals of patients, and this situation has resulted in disruptions in the follow-up and treatment of patients with diabetic retinopathy. Alternative diagnosis and treatment practices are needed in order to manage these and similar processes smoothly.

Reliable outcomes and survivorship of unicompartmental knee arthroplasty for isolated compartment osteonecrosis

2018 ◽  
Vol 100-B (4) ◽  
pp. 450-454 ◽  
Author(s):  
B. P. Chalmers ◽  
K. G. Mehrotra ◽  
R. J. Sierra ◽  
M. W. Pagnano ◽  
M. J. Taunton ◽  
...  
Keyword(s):  
Significant Risk ◽  
Significant Risk Factor ◽  
Lateral Compartment ◽  
Unicompartmental Knee ◽  
Unicompartmental Knee Arthroplasties ◽  
Implant Survivorship ◽  
Total Knee ◽  
The Mean ◽  
Bearing Design

AimsPrimary (or spontaneous) and secondary osteonecrosis of the knee can lead to severe joint degeneration, for which either total or unicompartmental arthroplasty may be considered. However, there are limited studies analyzing outcomes of unicompartmental knee arthroplasties (UKAs) for osteonecrosis involving an isolated compartment of the knee. The aims of this study were to analyze outcomes of UKAs for osteonecrosis with specific focus on 1) survivorship free of any revision or reoperation, 2) risk factors for failure, 3) clinical outcomes, and 4) complications.Patients and MethodsA total of 45 patients underwent 46 UKAs for knee osteonecrosis between 2002 and 2014 at our institution (The Mayo Clinic, Rochester, Minnesota). Twenty patients (44%) were female; the mean age of the patients was 66 years, and mean body mass index (BMI) was 31 kg/m2. Of the 46 UKAs, 44 (96%) were medial UKAs, and 35 (76%) were fixed-bearing design. Mean mechanical axis postoperatively was 1.5° varus (0° to 5° varus); 41 UKAs (89%) were performed for primary osteonecrosis. Mean follow-up was five years (2 to 12)ResultsSurvivorship free of any revision in the cohort was 89% (95% CI 77 to 99) and 76% (95% CI 53 to 99) at five and ten years, respectively. In patients undergoing UKA for primary osteonecrosis survivorship free of any revision was 93% (95% CI 83 to 100)at both five and ten years. Secondary osteonecrosis was a significant risk factor for poorer survivorship free of any revision or reoperation (hazard ratio 7.7, p = 0.03). Three medial UKAs (6.5%) were converted to total knee arthroplasties (TKAs): two for lateral compartment degeneration and one for development of lateral osteonecrosis. No implants were revised for loosening, fracture, or wear. Knee Society scores improved from a mean of 60 (44 to 72) preoperatively to a mean of 94 postoperatively (82 to 100) (p < 0.001). There were no surgical complications.ConclusionWhen done for primary osteonecrosis of the knee, UKA resulted in reliable clinical improvement, minimal complications, and durable estimated implant survivorship free of revision at ten years. UKA done for secondary osteonecrosis was substantially less durable at mid-term follow-up. Progression of knee degeneration, rather than implant failure or loosening, was most common indication for conversion to TKA. Cite this article: Bone Joint J 2018;100-B:450–4.

Dupuytren’s Disease Risk Factors

2004 ◽  
Vol 29 (5) ◽  
pp. 423-426 ◽  
Author(s):  
J.M. GEOGHEGAN ◽  
J. FORBES ◽  
D.I. CLARK ◽  
C. SMITH ◽  
R. HUBBARD
Keyword(s):  
Risk Factors ◽  
Disease Risk ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Increased Risk ◽  
Antiepileptic Medications ◽  
Control Study ◽  
Large Case

Dupuytren’s is a common problem, but little is known about its a etiology. We have undertaken a large case-control study to assess and quantify the relative contributions of diabetes and epilepsy as risk factors for Dupuytren’s in the community. Cases were patients with a diagnosis of Dupuytren’s disease and, for each, two controls were individually matched by age, sex, and general practice. Our dataset included 821 cases and 1,642 controls. Five hundred and eighty-eight (72%) of the cases were men. The mean age at diagnosis was 62 (range 24–97) years. Diabetes was a significant risk factor for Dupuytren’s disease (OR = 1.75) and there was an increased risk for medicinally treated diabetes (metformin – R = 3.56; sulphonylureas – OR = 1.75) and particularly insulin controlled (OR = 4.39) rather than diet-controlled diabetes. Epilepsy (OR = 1.12) and antiepileptic medications were not associated with Dupuytren’s disease. Ascertainment bias in previous studies may explain the reported association with epilepsy.

A Cohort Study Of 15,912 Patients On The Long-Term Quality Of Vka Therapy After Extreme Overanticoagulation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2384-2384
Author(s):  
Hilde A.M. Kooistra ◽  
Nakisa Khorsand ◽  
Hanneke C. Kluin-Nelemans ◽  
Nic J.G.M. Veeger ◽  
Margriet Piersma ◽  
...  
Keyword(s):  
Vitamin K ◽  
Therapeutic Range ◽  
Time Interval ◽  
Thrombotic Risk ◽  
Total Group ◽  
The Mean ◽  
The Individual ◽  
Mean Time

Abstract Introduction Many patients are on long-term vitamin K antagonists (VKA) for atrial fibrillation (AF) or recurrent venous thromboembolism (VTE). This therapy proved highly effective for the prevention of stroke and recurrence of venous thrombosis. However, due to intra-individual variations in the dose-response relationship it can be difficult to keep the International Normalized Ratio (INR) within the therapeutic range. As underanticoagulation increases the thrombotic risk and overanticoagulation the bleeding risk, the efficacy and safety of VKA depend on the individual time in the therapeutic range (iTTR). Although patients on stable VKA therapy tend to stay stable over time, a proportion develops extreme overanticoagulation. It is well known that the iTTR is lowered directly after overanticoagulation. However, it is unclear whether such patients will subsequently restabilize. For that reason, we analyzed in a large cohort of AF and VTE patients the course of VKA therapy during the 3 months after extreme overanticoagualation. Material and Methods We selected from a consecutive cohort of 15,912 AF and VTE patients all patients who were on ‘stable VKA therapy’ during the 3 months ‘screening period’. The screening period started for the individual patient at the first INR between January 2009 and January 2012 that was measured ≥3 month after treatment initiation. Stable VKA therapy was defined by a maximum interval of 56 days between INR-measurements and the absence of extreme overanticoagulation (INR≥ 8.0 or unscheduled supplementation of vitamin K). End of follow-up was June 2012. In patients with extreme overanticoagulation (EO), we compared the 3 months before with the 3 months after EO. Patients with EO were also compared with the total group of selected patients. The primary outcome was inadequate iTTR (iTTR <65%), as we know from previous studies that the majority of major bleeds and thrombo-embolic events occurs in this relatively small group. Secondary outcomes were: time under and above the therapeutic range, iTTR (linear), and frequency of INR-measurements. Target INR was 2.0-3.5 according to Dutch guidelines. The iTTR was calculated for each individual patient using linear interpolation. INRs within 7 days before or after EO were not taken into account. Results We selected 14,417 stable patients: 11,194 AF and 3,223 VTE patients. During a total follow-up of 25,848 patient-years, 885 patients (3.4/100 patient-years) experienced EO. After EO, 731 (83%) patients continued VKA treatment. In the 3 months before EO, 50.0% of patients had an iTTR<65%. This increased with 16.6% (95% CI 14.3 – 19.2) to 66.7 % after EO. In patients who continued VKA treatment, the mean iTTR decreased with 7.1% (95%CI 4.6 – 9.6) from 64.2 to 57.2 after EO. The mean time above the therapeutic range only slightly decreased (3.9%, 95%CI 1.5 – 6.3) from 22.4% to 18.5%. Interestingly, the time below the therapeutic range almost doubled as it increased with 11.0% (95%CI 8.7 – 13.3) to 24.3%. The frequency of INR-measurements increased from a mean time interval of 18.4 to 14.0 days. In the total cohort of 14,417 patients, 18% of patients had an iTTR<65%. The mean time below, within and above the therapeutic range was 10.4%, 77.3% and 12.3%, respectively. Therefore, the RR risk of inadequate VKA therapy was 2.8 (95%CI 2,6 – 3.0) before and 3.7 (95%CI 3.5 – 4.0) after EO, compared to the total group. Conclusion Patients with EO had a significantly higher risk of inadequate VKA therapy compared to the total group of patients already in the 3 months before EO. After EO, the time below the therapeutic range increased, which could be caused by a counter reaction. This resulted in further deterioration of the iTTR. Thus, even with more frequent INR-measurements, adequate VKA therapy was not achieved for most of these patients. Although an episode of EO does alert staff, this does not lead to better control. These patients might be better candidates for one of the new oral anticoagulants. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Surgical treatment results for dupuytren's disease

2017 ◽  
Vol 25 (3) ◽  
pp. 71-73 ◽  
Author(s):  
Serkan Aykut ◽  
Mehmet Baydar ◽  
Abdul Fettah Büyük ◽  
İbrahim Avşin Öztürk ◽  
Erdem Özden ◽  
...  
Keyword(s):  
Gold Standard ◽  
Case Series ◽  
Dupuytren’S Disease ◽  
Treatment Results ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Study Results ◽  
Standard Level ◽  
The Mean

ABSTRACT OBJECTIVE: To present the results of our cases of Dupuytren's disease treated with regional selective fasciectomy in light of the literature. METHODS: Patients diagnosed with Dupuytren's contracture and surgically treated with regional selective fasciectomy at our institution with adequate follow-up data were included in the study. All patients were routinely followed after surgery to assess results and complications. QuickDASH scoring was used to evaluate the patients and recurrences and complications were recorded. RESULTS: Twenty-one hands of 19 patients (13 males, 6 females) who underwent surgery and received adequate follow-up were retrospectively evaluated. Mean patient age was 65.8 (range: 41 to 86) and the mean follow-up period was 48.2 months (range: 24 to 86). Fourteen (66.6%) hands had excellent results, five (23%) hands had good results and two (9.4%) had fair results. The mean QuickDASH score for the patients at the final follow-up was 6.58 (range: 0 to 20.4). CONCLUSION: Our study results demonstrated that regional selective fasciectomy is a reliable and efficient method to treat Dupuytren's disease with low rates of complications and recurrence and the technique can be considered the gold standard. Level of Evidence IV, Case Series.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

External Ventricular Drain Infection

2007 ◽  
Vol 107 (1) ◽  
pp. 248 ◽  
Author(s):  
George K. C. Wong ◽  
Wayne W. S. Poon
Keyword(s):  
Major Trauma ◽  
Independent Predictor ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
The Mean ◽  
The Relationship ◽  
Shed Light

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ±0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

scholarly journals Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110108
Author(s):  
Andrea Bardos ◽  
Sanjeeve Sabhrawal ◽  
Graham Tytherleigh-Strong
Keyword(s):  
Ct Scan ◽  
Constant Score ◽  
Case Series ◽  
Sternal Fracture ◽  
Elite Level ◽  
The Mean ◽  
Mean Time ◽  
Time From Injury ◽  
Sternal Fractures

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

Sign in / Sign up

Export Citation Format

Share Document