scholarly journals TREATMENT OPTIONS FOR NEGLECTED ACHILLES TENDON RUPTURED: WETHER SPONTANEOUS HEALING IS POSSIBLE?

2018 ◽  
Vol 24 (2) ◽  
pp. 59-69
Author(s):  
A. P. Sereda
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendon ◽  
Treatment Outcomes ◽  
Plantar Flexion ◽  
Treatment Options ◽  
Tendon Healing ◽  
Spontaneous Healing ◽  
Minimal Incision ◽  
Better Than

The paper considers cases of spontaneous healing of achilles tendon with elongation. In such condition the tendon defect is not palpable, active plantar flexion is preserved and patients are complaining for strength diminution.Purpose— to study features of spontaneous achilles tendon healing with elongation and to analyze the shortening tenoplasty option as a procedure primarily aimed at restoration of strength for gastrocnemius-soleus complex.Material and Methods.The paper presents features and outcomes of surgical treatment of 25 patients who underwent a shortening tenoplasty of various types: crimping (3 patients), Z-type (2 patients), oblique (1 patient) and transverse (19 patients).Results.No re-ruptures or other serious complications were observed in the patients of the present study. Treatment outcomes were evaluated by j. leppilahti scale in 304,7±8,9 days after the procedure. postoperative leppilahti scores were statistically significantly better than prior to surgery — 82,4±5,6 and 62,2±7,7, respectively, (p<0,0001). Conclusion. Shortening tenoplasty can be indicated in cases of spontaneous achilles tendon healing with elongation. at relatively early stages of the injury with rather elastic scars the crimping tenoplasty can be applied.  At later stages a resection shortening tenoplasty is recommended through a minimal incision with transverse resection of tendon and removal of scar block. 

Case Report: The TRTMI Procedure, a Novel Surgical Technique for Gynecomastia

2020 ◽  
pp. 074880682094169
Author(s):  
Beshoy Nashed ◽  
Rhys Branman
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Glandular Tissue ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
Minimal Incision ◽  
Surgical Methods ◽  
Aesthetic Results

Gynecomastia presents the most common breast issue in men. It is defined as benign proliferation and enlargement of male breast glandular tissue that distributes most prevalently among neonates, adolescents, and elderly men. With a prevalence of over 60% in the male population, various classifications and treatment options have emerged to address male gynecomastia. Surgical treatment presents challenges and is used when gynecomastia has been present for several years or if medical therapy has been unsuccessful. We attempt to address some of these surgical challenges as they relate to aesthetic goals by presenting our surgical technique. Our surgical technique, the Tissue Resection Through Minimal Incision method, is described with illustrations included. Surgical candidates are selected after a review of the patient’s history, a thorough physical evaluation, obtaining any necessary imaging, and a detailed discussion with the patient. A hybrid, minimally invasive, and direct excision technique is used, including both standard VASER liposuction and direct glandular tissue resection via only a single 3-mm, well-hidden incision using simple instruments readily available with reproducible outcomes. We stress the idea of tissue inversion being key to make this feasible. Several case examples are presented with before and after comparisons, demonstrating good aesthetic results and skin retraction. In the more than 80 cases performed, one patient presented with dusky nipple areolar complex in the recovery room, which resolved with topical nitroglycerin. No nipple areolar complex necrosis occurred, nor hospitalizations were required for the cases performed. A few cases of tissue edema and swelling occurred correlating with inadequate compression or strenuous activity. Incisions were well hidden and aesthetically pleasing to patients. We briefly review gynecomastia classification and treatment options focused on surgical approaches. Of the various surgical methods available to treat gynecomastia, limitations and challenges include unfavorable scar and risk profiles, as well as inadequacy of tissue resection with the minimally invasive techniques. To meet this unmet need, our patented Tissue Resection Through Minimal Incision technique offers a novel minimally invasive approach that includes adequate tissue excision while maximizing aesthetic results and with nominal scarring. There is great need in surgical treatment of gynecomastia to minimize incisions and improve outcomes. Glandular tissue excision is a challenge to the cosmetic profile because of incisions used. Our novel technique and benefits involved address those concerns. However, our procedure does not address gynecomastia cases with excessive skin redundancy that requires excision. Further studies are still needed to address such challenges regarding aesthetic profile goals.

scholarly journals AB1345-HPR THE MULTIDISCIPLINARY FOOT CLINIC: A SERVICE EVALUATION PROJECT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1960.1-1961
Author(s):  
G. Jevons ◽  
H. Edginton ◽  
G. Mccall ◽  
A. Pillai ◽  
S. Haque
Keyword(s):  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Treatment Options ◽  
Full Range ◽  
Service Evaluation ◽  
General Anaesthetic ◽  
Clinical Issue ◽  
Foot Disease ◽  
Operative Medicine ◽  
Evaluation Project

Background:Patients with rheumatological foot disease are an overlooked population, and it was noted locally that these patients received a fragmented service; attending multiple appointments for the management of one clinical issue. This led to delays in treatment; significant inter-departmental correspondence and variations in the peri-operative management of disease modifying anti-rheumatic drug (DMARD) and biologic therapies. To remedy this a foot multidisciplinary (MDT) clinic was established, including input from rheumatology, orthopaedic surgery, specialist rheumatology podiatry and physiotherapy. The outcomes from the foot MDT clinic have been analysed in this service evaluation project.Objectives:To evaluate the outcomes of the multidisciplinary foot MDT clinic, with particular reference to concordance to the British Rheumatology Society (BSR) guidelines on peri-operative medicine guidelines.Methods:Data was collected retrospectively across all clinics from January 2017 to February 2019. Clinic letters were obtained, and data was collected using a standardised data collection sheet. Data was collected on patient demographics, rheumatological diagnoses, treatment outcomes from the foot MDT, appropriateness of peri-operative plan and post-operative complications. No data was available on these outcomes prior to the advent of the foot MDT clinic.Results:Data from 12 clinics was analysed (n=40). Patients had a median age of 66 years (IQR 27.5 years); 65% of patients were female and 35% of patients were male. The commonest rheumatological foot disease seen was rheumatoid arthritis (67%), followed by psoriatic arthritis (15%). All patients were treated with biologic or non-biologic DMARDs. Treatment outcomes were as follows: 27.5% were offered surgical treatment; 10% were offered intra-articular (IA) injections under ultrasound guidance; 10% were offered IA injections under general anaesthetic; 25% underwent specialist rheumatology podiatry, and the remaining 30% elected for a conservative approach after careful consideration of treatment options. Of those who were offered surgical treatment, 72% of patients were provided with a peri-operative plan which accorded with British Rheumatology Society (BSR) guidelines. Of those whom underwent surgery, one patient’s surgical treatment was complicated by a post-operative infection; however, the peri-operative DMARD/biologic plan was not felt to be contributing factor.Conclusion:The foot MDT clinic provides a comprehensive review of rheumatological foot conditions, with readily available access to a full range of treatment options. Co-location of all relevant professionals allows for real-time interdepartmental communication; shared decision making between clinicians and patients; avoids multiple appointments; reduces uncertainty with peri-operative planning as well as providing a cost-effective and efficacious service. Discrepancies in the peri-operative plan for medicines arose when the treating orthopaedic surgeon was not present in clinic. In these cases, the plan for surgical treatment was made outside of this clinic, without input from the treating rheumatologist. To improve concordance with BSR peri-operative medicine guidelines, it is recommended that all treatment decisions are made during the clinic, allowing input from all relevant partners. Informal feedback from patients commended the foot MDT, this shall be formalised through further qualitative data.Disclosure of Interests:None declared

scholarly journals Tactics of Surgical Treatment of Instability of the Long Head of Biceps Tendon

2018 ◽  
pp. 60-66
Author(s):  
O. A. Danilenko ◽  
E. R. Makarevich
Keyword(s):  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Conservative Therapy ◽  
Biceps Tendon ◽  
Clinical Results ◽  
Long Head Of Biceps ◽  
Long Head ◽  
Type 3

Objective: assess effectiveness of the tactics and methods developed by the authors for surgical treatment of instability of the long biceps head tendon. Material and methods. The results of the treatment of 66 patients with instability of the long head of biceps tendon over 2004-2017 have been studied. Depending on the diagnosed type of instability of the long head of biceps tendon, the subjects were divided into 5 groups by Bennet classification (2003). Patients with type 1 and type 2 of damage were prescribed a course of conservative therapy, patients with type 3-5 were recommended surgical treatment using arthroscopy and the methods developed by the authors. Results and discussion. According to the OSS, 66 patients, who had undergone treatment, revealed 38 (57.6 %) excellent, 13 (19.7 %) good, 14 (21.2 %) satisfactory and 1 (1.5 %) unsatisfactory treatment outcomes. The result of the assessment is presented in the form of Me [Q25; Q75] and made up 56 points before the treatment [46; 56], and 14 [12; 32] after it. The tactics and methods of surgical treatment developed by the authors aimed at eliminating damage to the rotator-bicipital complex have confirmed their effectiveness. Conclusion. The tactical approaches aimed at correcting damage to the rotator-bicipital complex is a promising way to improve the clinical results of the treatment.

MANAGEMENT OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS

2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Hospital Stay ◽  
Treatment Outcomes ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Diagnostic Approach ◽  
Early Activation ◽  
Intracranial Hematomas

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury

TYPE 2 DIABETES MELLITUS REMISSION AND ITS PREDICTION AFTER TWO-STAGE SURGICAL TREATMENT OF PATIENTS WITH MORBID OBESITY

2019 ◽  
Vol 72 (5) ◽  
pp. 739-743
Author(s):  
Oleksandr Yu. Ioffe ◽  
Mykola S. Kryvopustov ◽  
Yuri A. Dibrova ◽  
Yuri P. Tsiura
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Surgical Treatment ◽  
Two Stage ◽  
C Peptide ◽  
Peptide Level

Introduction: Morbid obesity (MO) has a significant impact on mortality, health and quality of life of patients. Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with MO. The aim is to study T2DM remission and to develop a prediction model for T2DM remission after two-stage surgical treatment of patients with MO. Materials and methods: The study included 97 patients with MO. The mean BMI was 68.08 (95% CI: 66.45 - 69.71) kg/m2. 70 (72,2%) patients with MO were diagnosed with T2DM. The first stage of treatment for the main group (n=60) included the IGB placement, for the control group (n=37) - conservative therapy. In the second stage of treatment the patients underwent bariatric surgery. The study addresses such indicators as BMI, percentage of weight loss, percentage of excess weight loss, ASA physical status class, fasting glucose level, HbA1c, C-peptide. Results: Two-stage treatment of morbidly obese patients with T2DM promotes complete T2DM remission in 68.1% of patients. The risk prediction model for failure to achieve complete T2DM remission 12 months after LRYGB based on a baseline C-peptide level has a high predictive value, AUC = 0.84 (95% CI: 0.69-0.93), OR = 0.23 ( 95% CI: 0.08-0.67). Conclusions: Two-stage treatment of patients with MO promotes improvement of carbohydrate metabolism indicators. With a C-peptide level > 3.7 ng/ml, prediction of complete T2DM remission 12 months after Laparoscopic Roux-en-Y Gastric Bypass is favorable.

A Randomized controlled trial of SMS Intervention in Inner Mongolia with Type 2 Diabetes (Preprint)

2018 ◽  
Author(s):  
Xue Mei Wang ◽  
Dan Liu ◽  
Mao Lin Du ◽  
Rui Qi Hao ◽  
Hui Qiu Zheng ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Weight Control ◽  
Controlled Trial ◽  
Average Score ◽  
Randomized Controlled ◽  
Sms Intervention ◽  
Better Than

BACKGROUND Nonadherence to self-management is common among patients with type 2 diabetes (T2D) and often leads to severe complications. Short messages service (SMS) technology provides a practical medium for delivering content to address patients’ barriers to adherence. OBJECTIVE The aim of this study was to design a series of SMS intervention templates, and to evaluate the feasibility of the SMS through a short message quality evaluation questionnaire and to explore the intervention effect. METHODS 1. The SMS evaluation was assessed through the 10-point scale SMS Quality Assessment Questionnaire. 2. A randomized controlled trial was conducted. The patients in SMS intervention were randomly divided into intervention group (IG) and control group (CG), which received evaluated messages education and regular education, respectively. The intervention was divided into four phases, a telephone interview was conducted to evaluate the effectiveness of the intervention after each phase. The main outcome were changes in blood glucose and blood pressure (BP) and their control rates, and secondary outcomes were changes in diet, physical activity, weight control and other health-related behaviors. RESULTS 1. SMS design: 42 SMS text messages were designed to promote healthy behaviors in different stages of behavior change, covering four key domains: healthy knowledge, diet, physical activity, living habits and weight control. 2. SMS evaluation: The average score for healthy knowledge, diet, physical activity, living habits, weight control were 8.0 (SD 0.7), 8.5 (SD 0.6), 7.9 (SD 1.0), 8.0 (SD 0.7), and 8.4 (SD 0.9), respectively. 3. SMS intervention: A total of 146 people completed the four-phase intervention, including 72 in the CG and 74 in the IG. At the end of the intervention period, in the IG, the decrease in fasting blood glucose (FBG, mean 1.5mg/l [SD 3.0] vs 0.4 mg/l [SD 2.8], P=0.011), postprandial blood glucose (PBG, mean 5.8mg/l [SD 5.1] vs 4.2 mg/l [SD 4.7], P=0.028), systolic blood pressure (SBP, mean 9.1mmHg [SD 15.8] vs 2.2mmHg [SD 13.3], P=0.025), FBG control rate (45.9% vs 31.0%, P=0.046) and PBG control rate (57.8% vs 33.7%, P=0.002) were better than the CG. In self-behavior management, the changes of the weight control, diet and physical activity in the IG were better than those in the CG, and the average score of the IG was greater than that of the CG (1.1 vs [-0.3] ), P0.001). CONCLUSIONS The overall quality of SMS content is higher to meet the needs of patients; Diet, physical activity and weight control message need to be focused on push. SMS interventions contribute to the management of blood glucose and BP, and help to promote a series of healthy-related behaviors.

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