scholarly journals The Operative Management of Patella Malalignment

2012 ◽  
Vol 6 (1) ◽  
pp. 327-339 ◽  
Author(s):  
Alexios Dimitrios Iliadis ◽  
Parag Kumar Jaiswal ◽  
Wasim Khan ◽  
David Johnstone
Keyword(s):  
Primary Care Physicians ◽  
Correct Diagnosis ◽  
Operative Management ◽  
Evidence Base ◽  
Accurate Identification ◽  
Orthopedic Surgeons ◽  
Dynamic Factors ◽  
Joint Pathology ◽  
Complex Organization ◽  
Cartilage Wear

Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment. Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness. A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.

Delayed diagnosis of cervical spondylotic myelopathy by primary care physicians

2013 ◽  
Vol 35 (1) ◽  
pp. E1 ◽  
Author(s):  
Eyal Behrbalk ◽  
Khalil Salame ◽  
Gilad J. Regev ◽  
Ory Keynan ◽  
Bronek Boszczyk ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Primary Care Physicians ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Diagnostic Process ◽  
Published Data ◽  
Family Practitioner ◽  
Community Based ◽  
Orthopedic Surgeons ◽  
Initial Care

Object A retrospective study analyzing medical files of patients who had undergone surgical management for cervical spondylotic myelopathy (CSM) at a single tertiary hospital was performed to determine the time needed by community care physicians to reach a diagnosis of CSM in patients presenting with typical myelopathic signs and symptoms, and to establish the reasons for the delayed diagnosis when present. Previous studies have documented that early diagnosis and surgical treatment of CSM may improve patients' neurological as well as general outcome. However, patients complaining of symptoms compatible with CSM may undergo lengthy medical investigations and treatments by community-based physicians before a correct diagnosis is made. The authors have found no published data on the process and time frame involved in attaining a diagnosis of CSM in the community setting. Methods The medical records of 42 patients were retrospectively reviewed for demographic data, symptoms, time to diagnosis, physician specialty, number of visits involved in the diagnostic process, and neurological status prior to surgery. Results The mean time delay from initiation of symptoms to diagnosis of CSM was 2.2 ± 2.3 years. The majority of symptomatic patients (90.4%) initially presented to a family practitioner (69%) or an orthopedic surgeon (21.4%), with fewer patients (9.6%) referring to other disciplines (for example, the emergency department) for initial care. In contrast, the diagnosis of CSM was most often made by neurosurgeons (38.1%) and neurologists (28.6%), and less frequently by orthopedic surgeons (19%) or family physicians (4.8%). Conclusions The diagnosis of CSM in the community is frequently delayed, leading to late referral for surgery. A higher index of suspicion for this debilitating entity is required from family practitioners and community-based orthopedic surgeons to prevent neurological sequelae.

scholarly journals Mitral commissural prolapse

2020 ◽  
Author(s):  
EVA PAPADIMITRAKI ◽  
Alexandros Patrianakos ◽  
Antonis Pitsis ◽  
Maria Marketou ◽  
Aggeliki Zacharaki ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Planning ◽  
3D Imaging ◽  
Correct Diagnosis ◽  
Surgical Techniques ◽  
Valve Repair ◽  
Accurate Identification ◽  
2D Echocardiography ◽  
2D And 3D ◽  
Echocardiographic Findings

Mitral commissural prolapse or flail, either isolated or combined with more extensive degenerative valve disease imposes several challenges both on its diagnosis and management whilst being a risk factor for valve reoperation after mitral valve repair. Accurate identification of the prolapsing segment is often not feasible with transthoracic 2D echocardiography, with transesophageal 3D imaging then required for correct diagnosis and surgical planning. Various surgical techniques employed alone or in combination, have yielded good results in the repair of commissural prolapse. Herein, we analyze the specific characteristics of commissural disease focusing our attention on 2D and 3D echocardiographic findings and we briefly comment on techniques employed for surgical correction of the disease.

Acute Cardiac Events in Patients With Severe Limb Infection

2018 ◽  
Vol 17 (4) ◽  
pp. 261-267
Author(s):  
Mohita Singh ◽  
Khurrum Khan ◽  
Evan Fisch ◽  
Christopher Frey ◽  
Kristen Mathias ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Primary Care Physicians ◽  
Myocardial Infarctions ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Orthopedic Surgeons ◽  
Tertiary Center ◽  
High Index Of Suspicion ◽  
Acute Cardiac Event

Recent studies have shown an association between infections, such as influenza, pneumonia, or bacteremia, and acute cardiac events. We studied the association between foot infection and myocardial infarction, arrhythmia, and/or congestive heart failure. We analyzed the records of 318 consecutive episodes of deep soft tissue infection, gangrene, and/or osteomyelitis in 274 patients referred to a vascular surgery service at a tertiary center. We identified 24 acute cardiac events in 21 of 318 (6.6%) episodes of foot infection or foot gangrene. These 24 events included 11 new myocardial infarctions (3.5%), 8 episodes of new onset or worsening congestive heart failure (2.5%), and 5 new arrhythmias (1.6%). Tachycardia and systemic inflammatory response syndrome were associated with acute cardiac events ( P < .05 for each). The 1-year survival of patients with acute cardiac events was 50.4%, significantly lower than the 91.7% 1-year survival of patients without acute cardiac events ( P < .0015). Acute cardiac complications are not uncommon among patients presenting with severe foot infection and are associated with a high 1-year mortality. Primary care physicians, cardiologists, and vascular and orthopedic surgeons must keep a high index of suspicion for the occurrence of an acute cardiac event.

scholarly journals Controversies in Cervical Discectomy and Fusion: Practice Patterns Among Canadian Surgeons

2004 ◽  
Vol 31 (4) ◽  
pp. 478-483 ◽  
Author(s):  
Gwynedd E. Pickett ◽  
Jessica Van Soelen ◽  
Neil Duggal
Keyword(s):  
Practice Patterns ◽  
Operative Management ◽  
Anterior Cervical Discectomy ◽  
Disc Disease ◽  
Fusion Technique ◽  
Cervical Discectomy ◽  
Single Level ◽  
Orthopedic Surgeons ◽  
Cervical Orthosis ◽  
Training Background

Objective:Optimal fusion technique and peri-operative management of patients undergoing anterior cervical discectomy (ACD) is unclear.We document current practice patterns among Canadian spinal surgeons regarding the surgical management of single level degenerative cervical spondylosis.Methods:We conducted a web-based survey of neurosurgeons and spinal orthopedic surgeons in Canada. We asked questions pertaining to the management of single level cervical degenerative disc disease causing radiculopathy and/or myelopathy, including frequency of fusion following single-level discectomy, preferred fusion technique, indications and frequency of use of anterior plating, and use of an external cervical orthosis following surgery. Demographic factors assessed included training background, type and length of practice.Results:Sixty respondents indicated that their practice involved at least 5% spine surgery and were included in further analysis. Neurosurgeons comprised 59% of respondents, and orthopedic surgeons 41%. Fusion was employed 93% of the time following ACD; autologous bone was the preferred fusion material, used in 76% of cases. Neurosurgeons employed anterior cervical plates in 42% of anterior cervical discectomy and fusion cases, whereas orthopedic surgeons used them 70% of the time. External cervical orthoses were recommended for 92% of patients without plates and 61% of patients with plates. Surgeons who had been in practice for less than five years were most likely to be performing spinal surgery, using anterior cervical plates, and recommending the postoperative use of cervical orthoses.Conclusion:Practice patterns vary among Canadian surgeons, although nearly all employ fusion and many use instrumentation for single-level ACD. Training background, and type and length of practice influence practice habits.

scholarly journals Radiological study of Os trigonum and its clinical significance

2021 ◽  
Vol 12 (12) ◽  
pp. 173-176
Author(s):  
Mallikarjun Adibatti ◽  
Muthiah Pitchandi ◽  
V Bhuvaneswari
Keyword(s):  
Correct Diagnosis ◽  
Distal Tibia ◽  
Causative Factor ◽  
Ossification Center ◽  
Flexor Hallucis Longus ◽  
Ankle Pain ◽  
Posterior Aspect ◽  
Os Trigonum ◽  
Orthopedic Surgeons ◽  
Secondary Ossification Center

Background: Os trigonum (OST) is commonly located on the posterior aspect of the talus. It occurs as a result of secondary ossification center failing to fuse with the lateral tubercle of the posterior process of the talus; its incidence varies between 2 and 25%, and is more often bilateral. It occurs as an intra-articular Os, which is most often securely rooted to the lateral tubercle of the talus by a fibrocartilaginous synchondrosis. Aims and Objective: To determine the incidence, morphology, and distribution of Os Trigonum (OST). Materials and Methods: Retrospective 500 lateral foot radiographs view were studied to determine the incidence, morphology, and distribution of OST. Results: Incidence of OST in the present study was 6.6%, with predominantly round or ovoid in shape. OST was located on the posterolateral aspect of the talus. Conclusion: OST can be one of the causative factor responsible for Flexor hallucis longus tendonitis, OST syndrome, which occur in plantarflexion of the ankle, leading to compression of the OST between the distal tibia and the calcaneus. Hence, knowledge regarding the incidence, morphology, and distribution of OST is important for the radiologist, orthopedic surgeons to arrive at a correct diagnosis, which aids in the management of cases presenting with complaints of posterior ankle pain.

scholarly journals Acute and long-term treatment of mania

2008 ◽  
Vol 10 (2) ◽  
pp. 165-179 ◽  
Keyword(s):  
Correct Diagnosis ◽  
Evidence Base ◽  
Term Treatment ◽  
Acute Mania ◽  
Compulsory Admission ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment ◽  
Treatment Refractory

The treatment of mania starts with a correct diagnosis and elementary measures to prevent risks for the patient, relatives, and others. Sometimes, compulsory admission and treatment may be required for a few days. Patients with psychotic or mixed mania may be more difficult to treat. At the present time, there is solid evidence supporting the use of lithium, the anticonvulsants valproate and carbamazepine, and the antipsychotics chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in acute mania, and some evidence supporting the use of clozapine or electroconvulsive therapy in treatment-refractory cases. However, in clinical practice, combination therapy is the rule rather than the exception. The treatment of acute mania deserves a long-term view, and the evidence base for some treatments may be stronger than for others. When taking decisions about treatment, tolerability should also be a major concern, as differences in safety and tolerability may exceed differences in efficacy for most compounds. Psychoeducation of patients and caregivers is a powerful tool that should be used in combination with medication for optimal long-term outcome. Functional recovery should be the ultimate goal.

scholarly journals Meningococcal infection in children: factors influencing outcome

2019 ◽  
Vol 11 (3) ◽  
pp. 13-19 ◽  
Author(s):  
O. V. Samodova ◽  
E. A. Krieger ◽  
L. V. Titova ◽  
O. Yu. Leonteva
Keyword(s):  
Primary Care Physicians ◽  
Cox Regression ◽  
Correct Diagnosis ◽  
Fatal Outcome ◽  
Clinical Signs ◽  
Immunization Coverage ◽  
Outpatient Department ◽  
Meningococcal Infection ◽  
Factors Influencing ◽  
Mandatory Vaccination

Generalized forms of meningococcal infection are characterized by high risk of complication and fatal outcomes. In Russian Federation, 2016, meningococcal infection was the second most common cause of pediatric deaths (25%) due to infectious diseases after community associated-pneumonia. Mandatory vaccination against meninococcal infection is not regulated, and immunization coverage according to epidemic indications is insufficient. During first 6–8 hours of illness clinical signs of this infection may be non-specific, because of that it is difficult to make correct diagnosis at outpatient department. Aim of the study was to analyze mistakes of diagnostics of meningococcal infection and to assess factors influencing the disease outcome. Material and methods. Retrospective cohort study was performed including 113 pediatric cases of generalized meningococcal infection occurred in Arkhangelsk region (46 cases with fatal outcome and 67 patients, who recovered). Factors influencing the outcome were recognized using Cox regression. Results. Median age of patients was 11 months. Clinical forms were meningitis (13,3%), meningococcemia (40,7%), mixed form (46%). The diagnosis of meningococcal infection was made at outpatient department in 36,9% of cases. The main causes of diagnostic mistakes were the lack of experience among primary care physicians and non-specificic symptoms during the first hours of the disease. Age younger 2 years, septic shock and time between onset of the diseases and admission to the hospital were associated with fatal outcome. Conclusion. To manage meningococcal disease we need to have good compliance with clinical guidelines for outpatient departments and hospitals; to optimize medical students education for prevention of diagnostic mistakes. Vaccination is the most effective method of prevention of deaths associated with meningococcal infection.

scholarly journals AN INTEGRATIVE TAXONOMY OF MOLECULAR AND TRADITIONAL APPROACHES FOR IDENTIFICATION OF A STORAGE MITE, ALEUROGLYPHUS OVATUS (ACARI: ASTIGMATA: ACARIDAE) IN MALAYSIA

2016 ◽  
Vol 6 (2) ◽  
pp. 882-889
Author(s):  
Ernieenor Faraliana Che Lah
Keyword(s):  
Molecular Identification ◽  
Dna Sequences ◽  
Correct Diagnosis ◽  
Morphological Characters ◽  
Integrative Taxonomy ◽  
Its2 Region ◽  
Morphological Identification ◽  
Taxonomic Identification ◽  
Internal Transcribed Spacer Region ◽  
Accurate Identification

A reliable and rapid taxonomic identification of a mite is the basis for a correct diagnosis of important mite associated allergies as they produce species-specific allergens. A double approach (molecular and morphological) to the taxonomic identification of Aleuroglyphus ovatus was presented. Molecular identification was performed with amplification of the internal transcribed spacer region (ITS2), whilst morphological characters were examined under light microscope. The BLAST results obtained from molecular analysis of A. ovatus was shown to be in concordance with the morphological identification with 97% genetic similarity. Thus, the molecular identification based on the ITS2 region can be applied as a reliable and efficient tool for species identification of Aleuroglyphus and probably any other astigmatid mites. Our findings suggest the need for a broad taxonomic sampling especially from closely related species for an accurate identification of local mites using both DNA sequences and morphology.

scholarly journals Adipocyte differentiation impairment as well as lipid metabolism and transport problems – major causes of genetic lipodystrophies

2019 ◽  
Vol 73 ◽  
pp. 741-761
Author(s):  
Agnieszka Dettlaff-Pokora
Keyword(s):  
Adipose Tissue ◽  
Primary Care Physicians ◽  
Adipocyte Differentiation ◽  
Plasma Cholesterol ◽  
Correct Diagnosis ◽  
Hdl Cholesterol ◽  
Diagnostic Methods ◽  
Tissue Loss ◽  
Ectopic Fat ◽  
Fat Accumulation

Lipodystrophies are heterogenic group of adipose tissue disorders with its general or partial atrophy. In case of congenital lipodystrophies disturbances of adipogenesis or/and alterations of adipocyte differentiation often occur leading to thermogenic adipocytes formation. Basic adipocyte functions can be perturbed, including improper synthesis of triacylglycerols and phospholipids of lipid droplet, but also impaired fatty acids release and intracellular lipid traffic. Lipodystrophy can result from weakening of adipose tissue structure, but also from improper function of both cytoskeleton and nuclear lamina leading to cell dysfunction. Lack of adipose tissue leads to a) increased plasma triacylglycerols level and ectopic fat accumulation in other tissues; b) total plasma cholesterol increase; c) plasma HDL-cholesterol decrease. Ectopic fat accumulation in liver can cause fatty liver and with time can lead to hepatomegaly and liver cirrhosis. Dysfunctions are proportional to the extent of fat tissue loss with generalized lipodystrophies patients developing complications at early ages. Diabetes and insulin resistance are common comorbidities. Improvement of diagnostic methods of medical genetics allows precise determination of their genotypes and correct diagnosis of patients suffering from lipodystrophy. For that reason number of described cases increased in recent years, also in Poland. New lipodystrophy types were described. Therefore there is a need to bring lipodystrophy syndromes for the attention of primary care physicians, pediatricians and endocrinologists.

scholarly journals Physician treatment preferences in non-displaced distal fibula fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Steven Neufeld ◽  
Dan Merenstein
Keyword(s):  
Operative Treatment ◽  
Practice Guidelines ◽  
Evidence Based Practice ◽  
Operative Management ◽  
The United States ◽  
Nonoperative Treatment ◽  
Treatment Preferences ◽  
Evidence Based ◽  
Foot And Ankle ◽  
Orthopedic Surgeons

Category: Trauma Introduction/Purpose: Background: Several studies have demonstrated equivocal long-term functional outcomes for both operative and nonoperative treatment of Weber-B fractures, however there are currently no evidence-based practice guidelines. The purpose of this study was to determine which treatment modality was preferred by orthopedic surgeons in the United States and Internationally, despite the lack of accepted guidelines. Methods: Methods: A survey of 428 practicing orthopedic surgeons was conducted to evaluate physician treatment preferences for non-displaced Weber-B fractures. Analyses were performed to determine physician preference for operative versus nonoperative fracture treatment, as well as to determine group differences between U.S, international and foot and ankle orthopedic surgeons compared to all other orthopedic surgeons. A cost effective analysis was conducted to compare differences among nonoperative and operative preferences. Results: Nonoperative treatment of non-displaced Weber-B fractures was preferred by 90.4% of orthopedic surgeons compared to operative treatment (9.6%; P<0.0001). Internationally-based orthopedic surgeons chose operative management at a higher rate (30/129) than U.S.-based surgeons (11/299; P<0.0001). General orthopedic surgeons were not more likely than subspecialty orthopedic surgeons to choose operative management, but foot and ankle subspecialists chose operative treatment at a higher rate compared to all other orthopedic surgeons (11/61 versus 29/362; P=0.0185). The direct medical costs and the indirect societal costs are likely to be 249 percent greater if managed operatively. Conclusion: Our findings suggest that while the vast majority of practicing surgeons choose to non-operatively manage non-displaced Weber-B fractures, there still exist a significant percentage of physicians who prefer to operate on these fractures. Given the existing literature suggesting equivalent outcomes for operatively and non-operatively treated Weber-B fractures, the current data suggests the need for further research into the reasons behind such differences in treatment preferences, as well as the evolution of evidence-based practice guidelines to guide the management of this very common fracture.

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