scholarly journals Using the modified Ponseti method to treat complex clubfoot: early results

2020 ◽  
Author(s):  
Celal Bozkurt ◽  
Serkan Sipahioğlu ◽  
Baran Sarıkaya ◽  
Mehmet Akif Altay ◽  
Baki Volkan Çetin
Keyword(s):  
Clinical Characteristics ◽  
Ponseti Method ◽  
Final Visit ◽  
Achilles Tenotomy ◽  
Plantar Surface ◽  
Early Results ◽  
Appropriate Treatment ◽  
The Mean ◽  
Demographic Features

Abstract Objectives In complex clubfoot, equinus, varus of the heel, forefoot adduction, and supination are more severe than in typical clubfoot. The feet are short and stubby, with deep creases above the heel and on the plantar surface. To successfully treat this subgroup of patients, orthopaedic clinicians must be able to recognise the clinical characteristics of complex clubfoot and implement the appropriate treatment effectively.Methods A total of 11 patients with 16 clubfeet were included in this study. Demographic features, clubfoot severity, number of casts, position of each foot before cast removal, ankle dorsiflexion (DF), complications, and additional procedures were noted at all clinical visits.Results The mean follow-up period was 13.3 months. All patients were initially corrected using a mean of 7 (5–8) casts and Achilles tenotomy. Relapses occurred in three patients (18.75%), but all recovered after recasting. The creases above the heels disappeared in all of the patients, whereas plantar creases persisted on two (12.5%) feet. The mean Pirani scores calculated at the first visit, after tenotomy, and at the final visit were 5.22± 0.52,, 0.72 ± 0.41and 0.41 ± 0.42, respectively. The mean DF measurements recorded before tenotomy, after tenotomy, and at the final visit were 8.31° ± 3.03°, 15.19° ± 3.75 °, and 20.19° ± 4.46°, respectively. Pirani scores and DF improved statistically significantly after treatment, and DF improved significantly between tenotomy and the final visit.Conclusions The modified Ponseti method is an effective treatment for complex clubfoot. It is crucial that orthopaedic clinicians can recognise this deformity at any stage and implement the modified Ponseti method effectively.

scholarly journals Ponseti Casting for Severe Club Foot Deformity: Are Clinical Outcomes Promising?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mohammad Hallaj-Moghaddam ◽  
Ali Moradi ◽  
Mohammad Hosein Ebrahimzadeh ◽  
Seyed Reza Habibzadeh Shojaie
Keyword(s):  
Club Foot ◽  
Ponseti Method ◽  
Foot Deformity ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Before And After ◽  
The Mean ◽  
A Prospective Study ◽  
Demographic Features

Between 2007 and 2010, a prospective study was done on 85 patients with severe idiopathic nonsyndromic clubfeet, in our center. Demographic features, severity of the deformity before and after serial casting according to Diméglio classification, and complications were assessed. The mean age of the patients was 8 days and 69% were male. The mean follow-up period was 26 months. The average number of castings used to correct the deformity was 5.7 times (range: 4 to 8). Tenotomy was performed in 76 (89.4%) of the feet. In all patients, plantigrade foot was achieved. Tenotomy occurred more in patients with higher Diméglio scores. Although patients who underwent Achilles tenotomy began to walk later than those who did not (13±7.2versus9.2±18), it was not significant (P=0.06). Relapse rate, at the end of follow-up, was 27.1%. Diméglio score before casting was16±3.4and at the end of follow-up it was1.6±6.2. The patients with bilateral clubfeet had inferior final outcome compared to those with unilateral clubfoot. Eighty percent of parents’ were completely satisfied with their child's gait and foot appearance (94.1%). Ponseti method of manipulation and casting is a valuable technique in severe club foot as well as in common types.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

scholarly journals SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1076.1-1077
Author(s):  
L. Moroni ◽  
L. Giudice ◽  
G. A. Ramirez ◽  
S. Sartorelli ◽  
A. Cariddi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Clinical Characteristics ◽  
Granulomatosis With Polyangiitis ◽  
Balloon Catheter ◽  
Subglottic Stenosis ◽  
Damage Accrual ◽  
The Mean ◽  
The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

scholarly journals Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

2021 ◽  
Vol 25 (1) ◽  
pp. 473-479
Author(s):  
Jagar Doski ◽  
Berivan Jamal
Keyword(s):  
Ponseti Method ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus ◽  
The Mean ◽  
Congenital Talipes ◽  
The Difference ◽  
Group 2 ◽  
Accelerated Protocol ◽  
Group 1

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts. Keywords: Clubfoot; Congenital talipes equinovarus; Ponseti; Accelerated; Cast.

scholarly journals Early results and medico-economic evaluation of a short daily home hemodialysis program in a Private hemodialysis center

2021 ◽  
Vol 4 (2) ◽  
pp. 105-119
Author(s):  
Hadia Hebibi ◽  
Magali Ciroldi ◽  
Laure Cornillac ◽  
Samah Saibi ◽  
Fatia El Boundri ◽  
...  
Keyword(s):  
Professional Activity ◽  
Average Volume ◽  
Training Time ◽  
Professional Integration ◽  
Daily Hemodialysis ◽  
Early Results ◽  
Average Residual ◽  
The Mean ◽  
Medico Economic

Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center. Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®). Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One patient needed anticoagulants. The mean training time was 35 days (28-35). 83% of patients were dialyzed 6 days a week with an average duration of 210 minutes (130-150) per session. The average volume of dialysate was 24.85 liters. One patient developed an allergy to the PUREMA® membrane. Pre-dialytic hemoglobin, serum creatinine, urea, phosphoremia and B2-microglobuline are stable at 9 months with improvement in metabolic acidosis. Conclusion: DHHD allowed a better socio-professional integration. One patient received a transplant and 3 patients resumed professional activity.

scholarly journals Acute Care of Older Patients with COVID-19: Clinical Characteristics and Outcomes

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 65
Author(s):  
Zara Steinmeyer ◽  
Sara Vienne-Noyes ◽  
Marc Bernard ◽  
Armand Steinmeyer ◽  
Laurent Balardy ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Final Analysis ◽  
Geriatric Syndromes ◽  
Global Pandemic ◽  
Clinical Presentations ◽  
The Mean

(1) Background: COVID-19 has become a global pandemic and older patients present higher mortality rates. However, studies on the characteristics of this population set are limited. The objective of this study is to describe clinical characteristics and outcomes of older patients hospitalized with COVID-19. (2) Methods: This retrospective cohort study was conducted from March to May 2020 and took place in three acute geriatric wards in France. Older patients hospitalized for COVID-19 infections were included. We collected clinical, radiological, and laboratory outcomes. (3) Results: Ninety-four patients were hospitalized and included in the final analysis. Mean age was 85.5 years and 55% were female. Sixty-four (68%) patients were confirmed COVID-19 cases and 30 (32%) were probable. A majority of patients were dependent (77%), 45% were malnourished, and the mean number of comorbidities was high in accordance with the CIRS-G score (12.3 ± 25.6). The leading causes of hospitalization were fever (30%), dyspnea (28%), and geriatric syndromes (falls, delirium, malaise) (18%). Upon follow-up, 32% presented acute respiratory failure and 30% a geriatric complication. Frailty and geriatric characteristics were not correlated with mortality. Acute respiratory failure (p = 0.03) and lymphopenia (p = 0.02) were significantly associated with mortality. (4) Conclusions: Among older patients hospitalized with COVID-19, clinical presentations were frequently atypical and complications occurred frequently. Frailty and geriatric characteristics were not correlated with mortality.

The Early Results of the Brunelli Procedure for Trapeziometacarpal Instability

1998 ◽  
Vol 23 (6) ◽  
pp. 758-761 ◽  
Author(s):  
S. N. J. ROBERTS ◽  
J. N. BROWN ◽  
M. G. HAYES ◽  
A. SAIES
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Joint Surface ◽  
Carpometacarpal Joint ◽  
Trapeziometacarpal Joint ◽  
Independent Observer ◽  
Abductor Pollicis Longus ◽  
Early Results ◽  
The Mean

We report the results of Brunelli’s abductor pollicis longus transfer for symptomatic instability of the trapeziometacarpal joint in 15 hands (14 patients) at a mean follow-up of 21 months. Patients were assessed subjectively, and objectively by an independent observer. All but one of the patients were very satisfied with the result of the operation, including the six patients who had significant degeneration of the carpometacarpal joint surface preoperatively. Four patients said they had no pain and the mean pain score overall on a visual analogue scale was 1.2 (out of a maximum of 10). Overall the outcome was rated good or excellent in 11 of the 15 thumbs.

scholarly journals Long-term Clinical Course of Korean Patients Diagnosed with Macular Telangiectasia Type 2

2021 ◽  
Vol 62 (8) ◽  
pp. 1098-1104
Author(s):  
Kyung Hae Kang ◽  
Ji Hyun Yoon ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim
Keyword(s):  
Visual Acuity ◽  
Final Visit ◽  
Ellipsoid Zone ◽  
Visual Deterioration ◽  
Macular Telangiectasia ◽  
Macular Telangiectasia Type 2 ◽  
The Mean

Purpose: To evaluate long-term visual prognosis and changes in the retinal microstructure in patients with macular telangiectasia type 2.Methods: Retrospective analysis of medical records were performed for 61 eyes (32 patients) diagnosed with macular telangiectasia type 2. The visual acuity at diagnosis was compared with that at the final visit. In addition, cases were classified into three grades based on optical coherence tomography (OCT) findings: grade 1, inner retinal cavities only; grade 2, outer retinal cavities with ellipsoid zone disruption; and grade 3, ellipsoid zone disruption with proliferation of retinal pigment epithelium. Change in the grade during the follow-up was verified. In addition, visual acuities were compared between eyes with and without a change in grade.Results: The mean follow-up period was 41.5 ± 33.2 months. Visual acuity had deteriorated significantly from the mean logarithm of the minimal angle of resolution 0.23 ± 0.26 at diagnosis to a mean of 0.31 ± 0.31 at the final visit (p < 0.001). When classified using OCT, 65.6%, 22.9%, and 11.5% were grades 1, 2, and 3, respectively, at diagnosis and 47.5%, 36.1%, and 16.4% at the final visit. Progression of grade was noted in 22.9%. A higher degree of visual deterioration was noted in eyes showing progression than in eyes without (p = 0.002).Conclusions: During the long-term follow-up period, visual deterioration was noted in patients with macular telangiectasia type 2. However, the degree of deterioration was not high. Progression in the disruption of the retinal microstructure was the likely cause of visual deterioration.

scholarly journals Clinical Characteristics of Intermittent Esotropia

2021 ◽  
Vol 62 (12) ◽  
pp. 1650-1656
Author(s):  
Young Chae Yoon ◽  
Nam Yeo Kang
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Age At Onset ◽  
Clinical Findings ◽  
Main Symptom ◽  
Angle Of Deviation ◽  
The Mean ◽  
Onset Angle ◽  
Dissociated Vertical Deviation

Purpose: To evaluate clinical findings and surgical outcomes of intermittent esotropia.Methods: We retrospectively reviewed the medical records of 23 patients (aged 9-42 years) who presented with intermittent esotropia between January 2007 and December 2020. We analyzed the age at onset, angle of deviation, presence of symptomatic diplopia, fusional state, near stereoacuity, and surgical results.Results: The mean age at onset was 19.9 ± 8.0 years and mean duration of esodeviation was 23.4 ± 27.1 months. Mean follow-up time was 13.0 ± 15.6 months. All patients except three had symptomatic diplopia, and 78.3% showed intermittent diplopia. Mean angles of deviation were 21.6 ± 10.3 prism diopters (PD) at distance and 20.2 ± 10.4 PD at near. Twenty-one patients (91.3%) were myopia. No patients had amblyopia and one had dissociated vertical deviation. On Worth’s four-dot test, five patients (21.7%) showed diplopia and four showed suppression at both distance and near. The other patients showed fusion at near or distance. Eleven patients underwent surgical correction. At the final examination, all patients achieved successful motor alignment and fusion with resolution of diplopia. Only two patients (18.2%) achieved normal 60 arcsec stereopsis, and six attained subnormal stereopsis.Conclusions: The main symptom of intermittent esotropia was diplopia. Surgical treatment was effective in achieving good postoperative motor alignment and fusion. However, successful motor alignment did not guarantee recovery of fine stereopsis.

scholarly journals Effectiveness of achillotomy in children with arthrogryposis

2019 ◽  
Vol 7 (2) ◽  
pp. 51-60
Author(s):  
Svetlana I. Trofimova ◽  
Denis V. Derevianko ◽  
Evgeniia A. Kochenova ◽  
Ekaterina V. Petrova
Keyword(s):  
Open Surgery ◽  
Ponseti Method ◽  
Lateral View ◽  
Neutral Position ◽  
X Ray ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Equinus Contracture ◽  
The Mean ◽  
Equinus Deformity

Introduction. Ponseti method is a widespread treatment for clubfoot in children with arthrogryposis. Closed subcutaneous achillotomy in these patients could not completely rectify the equinus deformity due to tissue rigidity which often leads to reconsideration of the tenotomy principles. Aim. This study aimed to formulate the anticipating criteria to assess the effectiveness of achillotomy in order to develop a different achillotomy approach for children with arthrogryposis. Materials and methods. This study retrospectively analyzed closed subcutaneous achillotomy in 28 patients (56 feet) with arthrogryposis. The mean age of the patients was 5.4 months (range 2–8 months). The children were subdivided into two groups according to the residual equinus deformity after the completion of Ponseti serial casting. All patients were physically and radiographically examined. Results and discussion. The first group included 12 patients (24 feet), which achieved foot neutral position or dorsiflexion ≥5° after achillotomy. The second group consisted of 16 patients (32 feet) with residual equinus after achillotomy who required surgery. X-ray images showed that the patients in the second group had significantly wider tibiocalcaneal angle and smaller talocalcaneal angle in lateral view (р < 0.01). The correction values of the equinus deformity after achillotomy in the children with arthrogryposis were greatly limited: 27° (20°–30°) and 19° (10°–30°) in the first and second groups, respectively. Conclusion. Closed subcutaneous achillotomy for effective equinus elimination during clubfoot treatment by Ponseti method should be performed only after complete correction at the level of tarsal joints. X-ray examination of the feet is recommended for the children with arthrogryposis in order to evaluate the talocalcaneal divergence and heel position more comprehensively. Furthermore, the values of tibiocalcaneal and talocalcaneal angles in lateral view prior to achillotomy are essential prognostic factors of its effectiveness. Moreover, the severity of equinus contracture should be considered prior to achillotomy. Achilles tenotomy is inappropriate if equinus deformity exceeds 30°. In such cases, open surgery should be considered.

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