Pes Anserinus Syndrome Caused by Osteochondroma in Paediatrics: A Case Series Study

Introduction: Osteochondroma is a common benign bone tumor, protruding from the underlying normal bone. Osteochondromas can cause pain depending on their location and size. The pes anserinus is located at the proximal medial side of the tibia, where the tendinous insertions of the sartorius, gracilis and semitendinosus muscles collectively attach. Pes anserinus syndrome, or anserine bursitis, is a painful condition of the pes anserinus, and is more common in adults typically with overweight females. The occurrence of pes anserinus syndrome is rare in the paediatric population. Results: In the current case series, five patients with pes anserinus syndrome due to proximal tibial osteochondroma are reported. Pain was present in all cases, with snapping in one case. The average age of the patients was 13 ± 1.2 years, ranging from 12 to 15 years. Three patients had a single osteochondroma, and two patients had hereditary multiple exostoses. The sizes of the osteochondromas on plain radiographs varied from 0.5 to 2.5 cm, with an average of 1.46 ± 0.83 cm. All lesions characteristically were located at the medial-posterior edge of the proximal tibia. The symptoms resolved in four cases with surgical resection, and persisted in one non-resected patient. Conclusion: The characteristic location of the osteochondroma causes pes anserinus syndrome, even though the lesion is small. The diagnosis of osteochondroma or pes anserinus syndrome may be overlooked when it occurs in a paediatric population. The symptoms seem to be consistent, and resection of the osteochondroma is necessary for treatment.

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Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01795-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Carlos Ramírez-Paesano ◽

Albert Juanola Galceran ◽

Claudia Rodiera Clarens ◽

Vicenҫ Gilete García ◽

Bartolomé Oliver Abadal ◽

...

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Hospital Discharge ◽

Case Series ◽

Ehlers Danlos Syndrome ◽

Painful Condition ◽

Discharge Data ◽

Gastrointestinal Complications ◽

Case Series Study ◽

Series Study

Abstract Background Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic. Methods A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values < 0.05. Results Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54–5.37) vs. OP 6.39 (6.07–6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

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Pertussis Vaccination Failure in the New Zealand Pediatric Population: Study Protocol

Vaccines ◽

10.3390/vaccines7030065 ◽

2019 ◽

Vol 7 (3) ◽

pp. 65

Author(s):

Chisholm ◽

Howe ◽

Best ◽

Petousis-Harris

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Pediatric Population ◽

Case Series ◽

Risk Groups ◽

Paediatric Population ◽

Investigate Risk Factor ◽

Case Series Study ◽

Study Results ◽

Series Study

Pertussis vaccines have been effective at reducing pertussis-associated morbidity and mortality. However, they have a complex array of limitations, particularly associated with the duration of protection against clinical disease and imperfect immunity (carriage and transmission). Little is known about risk factors for pertussis vaccination failure. Understanding pertussis vaccination failure risk is most important in the paediatric population. This study aims to investigate risk factors for pertussis vaccination failure in (1) infants between birth and six weeks of age born to mothers who received pertussis booster vaccinations during pregnancy and (2) infants after the completion of the primary series (approximately five months old) to four years old. This will be achieved in a two-step process for each study group. Pertussis vaccination failure cases will first be described using a case series study design, relevant case characteristics will be sourced from six national administrative datasets. The case series study results will help select candidate risk factors (hypothesis generating step) to be tested in the retrospective cohort study (hypothesis testing step. Pattern analysis will be used to investigate risk factor patterns in the cohort study. The identification of higher risk groups enables targeting strategies, such as additional doses, to better prevent pertussis disease.

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Change to win - flapless external dacryocystorhinostomy (DCR)

Tropical Journal of Ophthalmology and Otolaryngology ◽

10.17511/jooo.2020.i08.04 ◽

2020 ◽

Vol 5 (8) ◽

pp. 224-230

Author(s):

Dr. Ravi Ranjan ◽

◽

Dr. Kumari Rupam ◽

Dr. Sudhir Kumar ◽

◽

...

Keyword(s):

Subcutaneous Tissue ◽

Symptomatic Relief ◽

Case Series ◽

Nasolacrimal Duct ◽

Medial Side ◽

Case Series Study ◽

Lacrimal Bone ◽

External Dacryocystorhinostomy ◽

One Year ◽

Series Study

Introduction: Nasolacrimal Duct obstruction (NLDO) is a common ophthalmic problem and theusual Treatment is Dacryocystorhinostomy (DCR), either external or endonasal. This study aims toevaluate the success of external DCR with neither anterior nor posterior flaps with Mitomycin c(MMC) syringing on the 5th post-operative day (early proliferative phase of wound healing). It wasshown in the present study that a comparable good result can be achieved without tedious flapsmaking and anastomosis. Material and Methods: It is a retrospective, non-comparativeobservational Case series study done from March 2011 to August 2019. A total of 2165 patientswere included in this study qualifying inclusion criterion. 8 to 10 mm Arruga’s bone trephine wasused to make osteum in lacrimal bone and passage in the nasal mucosa. The anterior margin of thelateral side of the remaining sac was sutured to the subcutaneous tissue of the medial side adjacentto the nasal osteotomy. Syringing with 1 ml of 0.4 mg/ ml MMC was done in the newly formedpassage on the 5th post-operative day. These patients were followed up for one year. The successcriteria were symptomatic relief from epiphora subjectively. Objectively a patent nasolacrimal ductupon syringing and Nasal endoscopy. Results: 2136 (out of 2165) patients' eyes treated with thisprocedure showed resolution of epiphora with a success rate of 98.66%. Conclusion: The currentstudy suggest that DCR without flap making is an effective and easy procedure in the managementof NLDO obstruction and flap making is a futile step in the procedure as it has no impact on theoutcome.

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Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon: a case series

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2018-000462 ◽

2018 ◽

Vol 4 (1) ◽

pp. e000462 ◽

Cited By ~ 1

Author(s):

Håkan Alfredson ◽

Lorenzo Masci ◽

Christoph Spang

Keyword(s):

Achilles Tendon ◽

Case Series ◽

Achilles Tendinopathy ◽

Activity Level ◽

Secondary Outcome ◽

Surgical Removal ◽

Return To Sports ◽

Medial Side ◽

Plantaris Tendon ◽

Case Series Study

ObjectivesSurgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.Design and settingProspective case series study at one centre.ParticipantsTen consecutive patients (9 men and one woman, mean age 35 years, range 19–67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon.InterventionsOperative treatment consisting of ultrasound-guided excision of the plantaris tendon.Primary and secondary outcome measuresScores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.ResultsThe VISA-A scores increased from 61 (range 45–81) preoperatively to 97 (range 94–100) postoperatively (p<0.01). Follow-up results at 10 months (range 7–72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activityConclusionThe plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.

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Systemic Minoxidil Accidental Exposure in a Paediatric Population: A Case Series Study of Cutaneous and Systemic Side Effects

Journal of Clinical Medicine ◽

10.3390/jcm10184257 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4257

Author(s):

Manuel Sánchez-Díaz ◽

David López-Delgado ◽

Trinidad Montero-Vílchez ◽

Luis Salvador-Rodríguez ◽

Alejandro Molina-Leyva ◽

...

Keyword(s):

Side Effects ◽

Treatment Time ◽

Case Series ◽

Paediatric Population ◽

High Dose ◽

Retrospective Case ◽

Case Series Study ◽

High Doses ◽

Initial Zone ◽

Series Study

Oral minoxidil is an approved treatment for high blood pressure which is also used as an off-label drug for alopecia. Knowledge about the effects of systemic minoxidil in the paediatric population is limited. A retrospective case series study of paediatric patients with history of systemic minoxidil intake due to contaminated sets of omeprazole was performed to describe side effects of high dose oral minoxidil intake in children. Twenty patients aged between 2 months and 13 years joined the study. They had received high doses of oral minoxidil (mean dose 0.90 mg/kg/day) during a mean time of 38.3 days. Hypertrichosis appeared in 65%, with a mean latency time of 24.31 days. Treatment time was associated with the appearance of hypertrichosis (p < 0.05). Most common initial zone of hypertrichosis was the face. Systemic effects developed in 15%, with no cases of severe disorders. The present study shows a novel insight into the side effects of high doses of oral minoxidil in children.

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A GHASTLY RISING RATE OF PREVENTABLE PEDIATRIC BURNS: WE NEED TO ACT

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70i6.4308 ◽

2020 ◽

Vol 70 (6) ◽

pp. 1622-28

Author(s):

Muhammad Rizwan Aslam ◽

Taokeer Ahmed Rizvi ◽

Muhammad Tariq Munawar ◽

Asad Maqbool ◽

Shahid Naqvi

Keyword(s):

Tertiary Care ◽

Case Series ◽

Care Facility ◽

Paediatric Population ◽

First Aid ◽

Incident Type ◽

Tertiary Care Facility ◽

Case Series Study ◽

Pediatric Burns ◽

Electric Burns

ABSTRACT Objective: To ascertain the increase in paediatric burn admissions in our tertiary care facility. Find various causes of this trend and assess the morbidity and mortality in paediatric population, and suggest remedies. Study Design: This is a “descriptive case series study” Place of Study: This Study was conducted during September 2017 to August 2019 at Department of Burns & Plastic surgery. Materials and Methods: Total number of acute burn admissions under 12 years were recorded. Subdivided this group into 0 to 2 years and 2 to 12 years. We assessed epidemiology, sex, cause of burn, mode of admission, location of incident, type of first aid given, mortality, and compared results during two equal halves of this period. We used SPSS 20 for data analysis. Results: 504 (49.85%) were pediatric acute burn admissions. Their age ranged from 25 days to 12 years (mean 5 ±1.2 years). 152 were infants/toddlers aged 0-2 years. 270 male and 234 females. 316 were direct admissions. There were 72.43% more pediatric burn admissions. 381 were scalds, 91 flame burns, 21 electric burns and 11 chemical burns. There was 11.94% improved survival among burn patients. Two temporal peaks, largest in summer from May to Jul and second in Dec to Feb. Conclusion: There is an increasing trend in acute pediatric burn admissions. Majority of victims did not receive proper first aid. We need to start a very aggressive campaign on print and electronic media for public education.

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Force Plate Analysis of Dogs with Bilateral Hip Dysplasia Treated with a Unilateral Triple Pelvic Osteotomy: A Long-term Review of Cases

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632616 ◽

1998 ◽

Vol 11 (02) ◽

pp. 85-93 ◽

Cited By ~ 10

Author(s):

Joanne R. Cockshutt ◽

H. Dobson ◽

C. W. Miller ◽

D. L. Holmberg ◽

Connie L. Taves ◽

...

Keyword(s):

Gait Analysis ◽

Hip Dysplasia ◽

Weight Bearing ◽

Force Plate ◽

Case Series ◽

Pelvic Osteotomy ◽

Vertical Force ◽

Long Term Outcome ◽

Case Series Study

SummaryA retrospective case series study was done to determine the long-term outcome of operations upon dogs treated for canine hip dysplasia by means of a triple pelvic osteotomy (TPO). Twentyfour dogs with bilateral hip dysplasia, that received a unilateral TPO between January 1988 and June 1995, were re-examined at the Ontario Veterinary College. The assessment included physical, orthopedic and lameness examinations, standard blood work, pelvic radiographs and force plate gait analysis. They were compared to bilaterally dysplastic dogs that had not been treated, and also to normal dogs. Force plate data analysis demonstrated a significant increase in peak vertical force (PVF) and mean vertical force over stance (MVF) in the limb that underwent surgical correction by means of a TPO, when compared to the unoperated hip. It was determined that performing a unilateral TPO on a young dysplastic dog resulted in greater forces and weight bearing being projected through the TPO corrected limb when compared to the unoperated limb.Dogs with bilateral hip dysplasia treated with a unilateral triple pelvic osteotomy (TPO) were assessed by force plate gait analysis, radiographs and orthopedic examination. There was a significant increase in hip Norberg angles over time, although degenerative changes did progress. Limbs that had been operated upon had significantly greater peak and mean ground reaction forces than limbs that had not received an operation.

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Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

The Journal of Knee Surgery ◽

10.1055/s-0040-1713898 ◽

2020 ◽

Author(s):

Jae Ik Lee ◽

Mohd Shahrul Azuan Jaffar ◽

Han Gyeol Choi ◽

Tae Woo Kim ◽

Yong Seuk Lee

Keyword(s):

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Case Series ◽

Patellofemoral Instability ◽

International Knee Documentation Committee ◽

Predisposing Factors ◽

Mpfl Reconstruction ◽

Patellar Tilt ◽

Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

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