scholarly journals Treatment of Varus Deformities of the Lower Limbs in Patients with Achondroplasia and Hypochondroplasia

2013 ◽  
Vol 7 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Ali Al Kaissi ◽  
Sebastian Farr ◽  
Rudolf Ganger ◽  
Jochen G Hofstaetter ◽  
Klaus Klaushofer ◽  
...  
Keyword(s):  
Limb Lengthening ◽  
Varus Deformity ◽  
Clinical Problem ◽  
Valgus Deformity ◽  
Lower Limbs ◽  
Phenotypic Characterization ◽  
Complex Patients ◽  
Limb Deformities ◽  
Common Clinical Problem ◽  
Angular Deformities

Angular deformities of the lower limbs are a common clinical problem encountered in pediatric orthopaedic practices particularly in patients with osteochondrodysplasias. The varus deformity is more common than the valgus deformity in achondroplasia and hypochondroplasia patients because of the unusual growth of the fibulae than that of the tibiae. We retrospectively reviewed six patients (four patients with achondroplasia and two patients with hypochondroplsia) with relevant limb deformities due to the above-mentioned entities. All patients manifested significant varus deformity of the lower limbs. Detailed phenotypic characterization, radiologic and genetic testing was carried out as baseline diagnostic tool. We described the re-alignment procedures, which have been applied accordingly. Therefore, bilateral multi-level procedures, multi-apical planning and limb lengthening have been successfully applied. While recognition of the underlying syndromic association in patients who are manifesting angular deformities is the baseline for proper orthopaedic management, this paper demonstrates how to evaluate and treat these complex patients.

scholarly journals Growth modulation in idiopathic angular knee deformities: is it predictable?

2019 ◽  
Vol 13 (3) ◽  
pp. 318-323 ◽  
Author(s):  
B Danino ◽  
R. Rödl ◽  
J. E. Herzenberg ◽  
L. Shabtai ◽  
F. Grill ◽  
...  
Keyword(s):  
Average Rate ◽  
Skeletal Maturity ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
First Year ◽  
Growth Modulation ◽  
Level Of Evidence ◽  
Sequence Of Events ◽  
One Year ◽  
Angular Deformities

Purpose To evaluate the temporal and spatial sequence of events following temporal hemiepiphysiodesis in idiopathic knee varus/valgus. Methods This is a retrospective multicentre study on 372 physes in 206 patients. The average rate of correction (ROC) was calculated; univariate and multivariate analysis were performed. Results In all, 92% of the femoral physes were followed for more than one year/reached skeletal maturity. Of those, 93% were corrected to a mechanical lateral distal femoral angle (mLDFA) of 85° to 89°; 2% did not, while 5% were over-corrected. A total of 92% of the tibial physes were followed for more than one year/reached skeletal maturity. Of those, 92% were corrected to a mechanical medial proximal tibial angle (mMPTA) of 85° to 89°; 2% did not, while 6% were over-corrected. Factors significantly influencing success and ROC were age, direction and magnitude of deformity. Femoral ROC was significantly faster than tibial ROC: 0.85° versus 0.78°/month, respectively (p = 0.05). Femoral valgus ROC was significantly faster than varus ROC: 0.90° versus 0.77°/month, respectively (p = 0.04). A constant was derived to calculate the amount of correction. Significant correlation was found between calculated and actual mLDFA in valgus deformity during the first year (r = 0.58 to 0.87, p < 0.01). Calculated mLDFA of varus deformity did not correlate with actual mLDFA. Significant correlation was found when calculating mMPTA correction in all deformities. Conclusions Femur corrects faster than tibia; valgus femoral deformities are corrected faster than varus. Valgus correction in the distal femur/proximal tibia as well as varus correction in the tibia in idiopathic patients is highly predictable. The constant derived is the first tool which enables predicting and monitoring amount of correction in hemiepiphysiodesis when correcting angular deformities around the knee. Level of Evidence IV

scholarly journals A Rare Case of Hypokalemia Induced Rhabdomyolysis Secondary to Gitelman Syndrome: An Easily Overlooked Inherited Tubulopathy

2020 ◽  
Vol 21 (2) ◽  
pp. 105-108
Author(s):  
Richmond Ronald Gomes ◽  
Diapankar Kumar Basak ◽  
Akmat Ali
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Alkalosis ◽  
Rare Case ◽  
Kidney Injury ◽  
Clinical Problem ◽  
Short Review ◽  
Gitelman Syndrome ◽  
Lower Limbs ◽  
Life Threatening ◽  
Common Clinical Problem

Hypokalemia is a common clinical problem in endocrinologists’ and nephrologists’ practice. There are many obvious causes of hypokalemia such as diarrhea, vomiting or diuretics abuse. Other causes such as tubulopathies are rarely observed and their diagnosis is more challenging. There are many inherited and acquired tubulopathies causing hypokalemia, sometimes severe and life-threatening. We report a case of a middle aged female patient who presented with weakness of upper and lower limbs, muscle pain and oliguria. On evaluation, she had hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria and diagnosis of Gitelman syndrome was established. In addition, she had acute kidney injury (AKI ) due to rhabdomyolysis secondary to hypokalemia. A short review on the etiology, pathogenesis and management of Gitelman syndrome is presented. J MEDICINE JUL 2020; 21 (2) : 105-108

scholarly journals Biomechanical Changes in Gait Patterns of Patients with Grade II Medial Gonarthritis

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1242
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Alexey Prizov ◽  
Aljona Altukhova ◽  
Alexander Troitskiy ◽  
...  
Keyword(s):  
Inertial Sensor ◽  
Varus Deformity ◽  
Functional Condition ◽  
Lower Limbs ◽  
Knee Oa ◽  
Affected Side ◽  
Hip Function ◽  
Healthy Control ◽  
Grade Ii ◽  
Single Support Phase

Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject’s functional condition over time and during the treatment.

Chronic pain following elective inguinal hernia repair—is it a common clinical problem?

2007 ◽  
Vol 32 (Suppl. 1) ◽  
pp. 174
Author(s):  
Z. M. Kirkor ◽  
T. N. Evans ◽  
H. Mathew ◽  
C. Swart ◽  
C. Morris ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Clinical Problem ◽  
Common Clinical Problem

scholarly journals The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xin You Li ◽  
Ming Tian ◽  
Ai Zhi Li ◽  
Chun Lei Han ◽  
Ke Zhong Li
Keyword(s):  
Laparoscopic Surgery ◽  
Shoulder Pain ◽  
Prospective Observational Study ◽  
Conditional Logistic Regression ◽  
Specific Treatment ◽  
Clinical Problem ◽  
Pain Visual Analogue Scale ◽  
Risk Patients ◽  
Treatment Plans ◽  
Common Clinical Problem

AbstractPostlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

Monomelic Maffucci syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. e239619
Author(s):  
Gopalkrishna G Verma ◽  
Vijay Kumar Jain ◽  
Karthikeyan P Iyengar
Keyword(s):  
Lower Limb ◽  
Corrective Osteotomy ◽  
Valgus Deformity ◽  
Left Knee ◽  
Leg Length ◽  
Maffucci Syndrome ◽  
Successful Clinical Outcome ◽  
Genu Valgus Deformity ◽  
Angular Deformities

Maffucci syndrome is a rare congenital, non-hereditary condition characterised by presence of multiple enchondromas and haemangiomas. Enchondromatous lesions affecting epiphysial growth plates can lead to angular deformities and leg-length discrepancy in the lower limb. We describe a 12-year-old girl with monomelic Maffucci syndrome affecting her left lower limb. She presented with progressive genu valgus deformity of her left knee. This caused her to limp during her gait and was a cosmetic dissatisfaction. The deformity affected her quality of life. She underwent a supracondylar distal femoral corrective osteotomy with a successful clinical outcome and restoration of her gait and cosmetic deformity.

Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽  
2021 ◽  
Author(s):  
Luiz Carlos Esteves Grelle ◽  
Luiz Antonio Bastos Camacho
Keyword(s):  
Subclinical Hypothyroidism ◽  
Clinical Importance ◽  
Clinical Problem ◽  
Thyroid Stimulating Hormone ◽  
Exclusion Criteria ◽  
The Mean ◽  
Common Clinical Problem ◽  
Prompt Diagnosis ◽  
Serum Tsh ◽  
Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

Evaluation of the patient with a bleeding tendency

2010 ◽  
pp. 4498-4506
Author(s):  
Trevor Baglin
Keyword(s):  
Clinical Problem ◽  
Bleeding Tendency ◽  
Common Clinical Problem

An apparent bleeding tendency is a common clinical problem, with presentation varying from acute unexpected bleeding during or immediately after surgery, to spontaneous unusual or excessive bruising, purpura, epistaxis, or a chronic haemorrhagic tendency. The following are important aspects of the assessment of the patient....

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