scholarly journals Clinical Outcomes of Single Excision Versus Kidner Procedure for Type II Accessory Navicular Associated with Flatfoot in Adults: Does accessory navicular induce flexible flatfoot?

2021 ◽  
Author(s):  
Xu Tao ◽  
Qian dong Yang ◽  
Zhenyu Wang ◽  
Wei Wang ◽  
Kang Lai Tang
Keyword(s):  
Lateral View ◽  
Radiographic Examination ◽  
Posterior Tibial Tendon ◽  
Type Ii ◽  
Flexible Flatfoot ◽  
Group A ◽  
Accessory Navicular ◽  
Medial Pain ◽  
Group B

Abstract Background Patients with type II accessory navicular (AN) originally complain of the medial pain of foot. With increasing frequency, some of them has been recognized flexible flatfoot (FFF) at the first weightbearing radiographic examination. Posterior tibial tendon (PTT) dysfunction is widely accepted as a significant contributor to FFF. However, the PTT was not affected in these patients. The relationship between AN and FFF remains controversial. The contribution of AN to FFF was designed in this study. Methods Adult patients who complained of medial pain and bone eminence between January 2014 and January 2020 were included. 61 patients were confirmed to have the AN with flatfoot and randomly divided into two operative groups. The AN was excised in Group A, and the PTT was reconstructed to the navicular region with an anchor in Group B. Preoperative and postoperative evaluations were performed, including clinical evaluations, the American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scale, a visual analog scale (VAS) and radiographic assessments of Meary’s angle, Pitch angle, talonavicular coverage, Kite’s angle and naviculocuboid overlap. PTT decline angle (PDA) and AN-Navicular joint inclination angle (ANJCA) in the lateral view were designed to evaluate the effect of AN on FFF. Results Fifty-six patients (56 feet) were included in this study because 5 patients were excluded. The mean follow-up period was 22.29 months with single excision (Group A) and 20.86 months with Kidner procedure (Group B). The AOFAS mid-foot score improved from 70.39±7.78 pre-operationally to 89.46±7.06 at the last follow-up in Group A and from 67.14±8.14 pre-operationally to 89.64±6.88 at the last follow-up in Group B. The VAS score decreased from 2.82±0.39 and 2.86±0.36 to 0.89±0.31 and 0.79±0.42, respectively. The radiographic results representing flatfoot significantly increased in the two groups. In the lateral view, PDA significantly increased after the operation, and the effect of PTT on the arch upward was induced by pull angulations and shorter distances. Conclusion The FFF with AN may be induced by AN and its synchondrosis. The weakened plantar ligament of synchondrosis was impaired under chronic tension and shear forces may be implicated as the etiologic biomechanical mechanism. AN excision or it with PTT reconstruction could release the pain and benefit the PTT pulling sufficiency.

scholarly journals Genetic Influence on Accessory Navicular Bone in the Foot: A Korean Twin and Family Study

2017 ◽  
Vol 20 (3) ◽  
pp. 236-241 ◽  
Author(s):  
In Yae Cheong ◽  
Hyo Jeong Kang ◽  
Hyeonyoung Ko ◽  
Joohon Sung ◽  
Yun-Mi Song ◽  
...  
Keyword(s):  
Family Relationships ◽  
Family Study ◽  
Family Relationship ◽  
Radiographic Examination ◽  
Posterior Tibial Tendon ◽  
Type Ii ◽  
Navicular Bone ◽  
Sibling Pairs ◽  
Accessory Navicular ◽  
Foot Disease

An accessory navicular bone (AN) is the most common accessory ossicle in the foot. The presence of an AN bone can trigger various foot problems, such as posterior tibial tendon pathology, flattening of the medial longitudinal arch, and medial foot pain. Despite the clinical influence of presence of an AN in foot disease, the research regarding its inheritance is still insufficient. A total of 135 pairs of monozygotic (MZ) twins, 25 pairs of dizygotic (DZ) twins, and 676 singletons from families were enrolled in order to estimate genetic influences on AN. After confirmation of zygosity and family relationship with a tandem repeat marker kit and questionnaires, the presence and type of the AN was classified through bilateral feet radiographic examination. The heritability of an AN was estimated using quantitative genetic analysis based on a variance decomposition model considering various types of family relationships: father–offspring pair, mother–offspring pair, and pooled DZ twin and sibling pairs. As a result, approximately 40.96% of the participants in this study had an AN in either foot, with type II being the most common type. The heritability for the presence of any type of an AN in any foot was estimated as 0.88 (95% CI [0.82, 0.94]) after adjusting for age and sex. Specifically, type II AN showed the highest heritability of 0.82 (95% CI [0.71–0.93]). The high heritability of an AN found in this large twin and family study suggests that an AN is determined by the substantial influence of genetic factor.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Renuka M. Tenahalli
Keyword(s):  
Vitamin C ◽  
Early Stage ◽  
Pathological Condition ◽  
Before And After ◽  
Group A ◽  
Phosphorus Iron ◽  
Group B ◽  
Busy Schedule ◽  
Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

scholarly journals Oral Tranexamic Acid for the Treatment of Melasma

2014 ◽  
Vol 10 (4) ◽  
pp. 40-43 ◽  
Author(s):  
D Karn ◽  
S KC ◽  
A Amatya ◽  
EA Razouria ◽  
M Timalsina
Keyword(s):  
Tranexamic Acid ◽  
Controlled Trial ◽  
Severity Index ◽  
Sustained Improvement ◽  
Treatment Measures ◽  
Group A ◽  
Group B ◽  
Novel Concept ◽  
High Treatment

Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10993 Kathmandu Univ Med J 2012;10(4):40-43

scholarly journals Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110222
Author(s):  
Ling Mo ◽  
Zixian Wu ◽  
De Liang ◽  
Linqiang Y ◽  
Zhuoyan Cai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Cement Distribution ◽  
Group A ◽  
Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

Radiofrequency ablation for markedly incompetent perforators versus compression therapy in the management of post-phelebtic venous ulcers: A randomized controlled trial

Vascular ◽  
2021 ◽  
pp. 170853812110100
Author(s):  
Mohamed Shukri Abdelgawad ◽  
Amr M El-Shafei ◽  
Hesham A Sharaf El-Din ◽  
Ehab M Saad ◽  
Tamer A Khafagy ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Radiofrequency Ablation ◽  
Controlled Trial ◽  
Compression Therapy ◽  
Randomized Controlled ◽  
Venous Ulcers ◽  
Group A ◽  
Group B ◽  
To Receive

Background Venus ulcers developed mainly due to reflux of incompetent venous valves in perforating veins. Patients and methods In this randomized controlled trial, 119 patients recruited over two years, with post-phelebtic venous leg ulcers, were randomly assigned into one of two groups: either to receive radiofrequency ablation of markedly incompetent perforators (Group A, n = 62 patients) or to receive conventional compression therapy (Group B, n = 57 patients). Follow-up duration required for ulcer healing continued for 24 months post randomization. Results Statistically significant shorter time to healing (ulcer complete healing or satisfactory clinical improvement) between both groups (56 patients, 90.3% of cases in Group A versus 44 patients 77.2% of cases in Group B) over the follow-up period of 24 months was attained ( p  = 0.001). Also, significantly different ulcer recurrence was recorded between both groups, 8 patients (12.9%) in Group A versus 19 patients (33.3%) in Group B ( p = 0.004). Conclusion In absence of deep venous obstruction, the monopolar radiofrequency ablation for incompetent perforators is a feasible and effective method that surpasses the traditional compression protocol for incompetent perforator-induced venous ulcers in terms of time required for healing even in the presence of unresolved deep venous valvular reflux.

scholarly journals Minimaly invasive mitral valve repair with Neochord system in patients with degenerative mitral disease: echocardiographic assessment and predictors for mid-term outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Drasutiene ◽  
V Janusauskas ◽  
G Speziali ◽  
D Zakarkaite ◽  
M Budra ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Beating Heart ◽  
Mean Difference ◽  
Volume Index ◽  
Term Outcome ◽  
Group A ◽  
Group B ◽  
Left Atrium Volume

Abstract Introduction Various minimally invasive mitral valve (MV) repair techniques are available to treat degenerative mitral regurgitation (MR). Transapical implantation of artificial chordae on a beating heart is performed using the NeoChord DS1000 device with real-time TEE guidance. Purpose 1)To assess preoperative and the mid-term follow-up echocardiographic data in patients after MV repair using the NeoChord DS1000 device; 2)to investigate the changes of left ventricle (LV), left atrium (LA) and mitral annulus dimensions during the follow-up period; 3)to assess the difference of baseline echocardiographic parameters between successful and not-successful (severe residual MR) MV repair groups; 4)to identify the preoperative echocardiographic variables that may be associated with recurrence of MR at mid-term follow. Methods All patients after transapical MV repair with Neochord implantation in Vilnius University hospital were prospectively entered into the study. The acquired preoperative and follow-up echocardiographic datasets were analysed. According to the residual MR at follow-up, patients were stratified to 2 groups: group A – successful durable MV repair (residual MR ≤2); group B – MV repair failure (recurrence of severe MR or reintervention). Values were expressed as Mean±SD. Univariable regression analysis was used to identify anatomical predictors of residual MR. Results 53 (70.67%) patients had a residual MR ≤2 (Group A) and 22 (29.33%) residual MR≥2+ (Group B) at 26±6 months follow-up. At baseline, Group B patients had significantly larger left ventricle end diastolic diameter (LVEDD) (mean difference 5.67±1.29mm, p&lt;0.0001) left ventricle end systolic diameter (LVESD) (mean difference 4.08±1.57mm, p=0.012), LA volume index (mean difference 21.57±5.003 p&lt;0.0001) and higher systolic pulmonary pressure values (mean difference 10.46±3.34, p&lt;0.003) compared with group A. Overall, a significant reduction in LA volume index (mean change 15.69±4.15ml/m2, p&lt;0.001), LA diameter (mean change 3.15±1.24, p=0.012), LV diameter (mean change in LVEDD 4.78±0.88mm p&lt;0.000) was observed at 24 months follow up. There was no significant changes in MV annular parameters at follow up. Left atrium volume (OR 1.018; 95% CI 1.006–1.035; p=0.009), left atrium volume index (OR 1.038; 95% CI 1.013–1.072; p=0.010), LVEDD (OR 1.201; 95% CI 1.088–1.353; p=0.0008), LVESD (OR 1.122; 95% CI 1.02–1.248); p=0.0236) and sPAP (OR 1.418; 95% CI 1.139–2.016; p=0.0014) were all significantly associated with the worse outcome (MR &gt;2) after mini-invasive MV repair in univariable regression analysis. Conclusions Minimaly invasive MV repair with Neochord system on beating heart is effective in patients with degenerative MR. Baseline echocardiographic characteristics predictive for a worse middle term outcome are mainly related to LV and LA remodeling. Reverse remodeling of LV and LA is observed during the follow-up period with no significant changes in MV annulus. Funding Acknowledgement Type of funding source: None

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

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