Integrated approach to treatment of inoperable patients with critical lower limb ischemia and diabetes mellitus: results and prospects

INTRODUCTION: The question of the optimal methods of conservative treatment of patients with critical lower limb ischemia (CLLI) and diabetes mellitus (DM) is still open. AIM: To evaluate the long-term results of therapeutic treatment of patients with CLLI and DM whose peripheral vascular bed is unsuitable for reconstruction, or who refused surgical treatment for different reasons, and to determine effectiveness of additional angiogenesis in this group of patients. MATERIALS AND METHODS: The work involved 65 patients with CLLI and DM who were divided to 2 groups. The control group of patients (40 individuals) received a course of conventional therapy. In the study group (25 individuals), additional exogenous stimulation of angiogenesis was used with angiogenic vascular endothelial growth factor. Subsequently, instrumental parameters of limb perfusion were assessed within 6 months, and in the long-term period (5 years), limb preservation and mortality in this group. RESULTS: Exogenous stimulation of angiogenesis permits to improve the following 6-month treatment results (8% of deaths and 20% of amputations in the study group versus 15% of deaths and 42.5% of amputations in the same period in the control group), and permits to maintain this trend within 5 years of follow-up (64% of deaths and 72% of amputations in the study group versus 80% of deaths and 87.5% of amputations in the control group). Reliable differences between the groups in the frequency of amputations were observed on visits in 6 months (p = 0.041) and in 1 year of follow-up (p = 0.048). According to instrumental data, the best parameters in terms of the painless walking distance (p = 0.032) and transcutaneous oxygen tension were obtained in the study group by 6 months of follow-up (p = 0.028). CONCLUSIONS: Therapeutic angiogenesis improves the results of treatment of patients with CLLI and diabetes mellitus, especially in 6 months — 2 years interval, however, conservative therapy still demonstrates unsatisfactory results of treatment in the near and in the long terms.

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Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

Journal of Neurosurgery ◽

10.3171/2019.5.jns19227 ◽

2020 ◽

Vol 133 (3) ◽

pp. 830-838 ◽

Cited By ~ 1

Author(s):

Andrea Franzini ◽

Giuseppe Messina ◽

Vincenzo Levi ◽

Antonio D’Ammando ◽

Roberto Cordella ◽

...

Keyword(s):

Neuropathic Pain ◽

Lower Limb ◽

Internal Capsule ◽

Posterior Limb ◽

Vas Score ◽

The Mean ◽

Deep Brain ◽

Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients—one-year follow-up study

Scientific Reports ◽

10.1038/s41598-021-94549-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Michał Waszczykowski ◽

Bożena Dziankowska-Bartkowiak ◽

Michał Podgórski ◽

Jarosław Fabiś ◽

Arleta Waszczykowska

Keyword(s):

Systemic Sclerosis ◽

Hand Function ◽

Exercise Program ◽

Rehabilitation Program ◽

Long Term Results ◽

Home Exercise ◽

Control Group ◽

Study Group

AbstractThe aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. The regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

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Evaluation of the effectiveness of spinal cord stimulation in patients with critical lower limb ischemia using the WIQ Questionnaire

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2019-2-50-58 ◽

2019 ◽

Vol 23 (2) ◽

pp. 50

Author(s):

O. V. Kamenskaya ◽

A. S. Klinkova ◽

I. Yu. Loginova ◽

A. V. Ashurkov ◽

V. V. Lomivorotov ◽

...

Keyword(s):

Diabetes Mellitus ◽

Spinal Cord ◽

Coronary Heart Disease ◽

Conflict Of Interest ◽

Lower Limb ◽

Walking Speed ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

One Year

Aim. To evaluate various parameters of walking using the Walking Impairment Questionnaire (WIQ) in patients with critical lower limb ischemia (CLLI) before and one year after spinal cord stimulation (SCS). Methods. In 46 patients with CLLI aged 64.5 (54.9–72.6) years, the following parameters were assessed before and one year after SCS using the WIQ questionnaire: pain, distance, speed, stairs, where 100% no restrictions when walking. Results. In patients with CLLI, low WIQ values were initially identified for the scales of distance, speed, and stairs, less than 10%, and about 30% for the pain scale. One year after SCS, the values of pain, distance, and speed increased to 83.3% (68.4%–100%), 39.5% (17.9%–55.2%), and 24.4% (17.3%–35.8%), respectively, with significance at p < 0.001, p = 0.004, and p = 0.005, respectively. The lowest rates were on the scale of stairs: 6.2% (3.4%–7.3%), p = 0.06. Before the SCS, the factor adversely affecting the indicators of the distance scale was diabetes mellitus (β = –0.417; p = 0.002), and the age factor adversely affected the walking speed (β = –0.544; p = 0.005). After SCS, age exerted a negative effect on the walking speed (β = –0.497; p = 0.002). The scale for stairs was negatively affected by the presence of coronary heart disease (β = –0.421; p = 0.001) or diabetes mellitus (β = –0.325; p = 0.032). Conclusion. The use of SCS in patients with CLLI improves the parameters of walking in the long-term follow up after treatment, except for the ability to climb stairs. Age and the presence of diabetes mellitus or coronary heart disease are adverse factors that affect the walking parameters, both before and in the long-term period after SCS.Received 14 March 2019. Accepted 25 July 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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Is initial success of thrombolytic therapy with rt-PA in patients with lower limb ischemia durable? A long-term follow-up series

VASA ◽

10.1024/0301-1526.36.2.114 ◽

2007 ◽

Vol 36 (2) ◽

pp. 114-120 ◽

Cited By ~ 7

Author(s):

Geier ◽

Mumme ◽

Köster ◽

Marpe ◽

Hummel ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Success Rate ◽

Lower Limb ◽

Limb Ischemia ◽

Long Term Results ◽

Bleeding Complications ◽

Acute Ischemia ◽

Lower Limb Ischemia

Background: Catheter-directed intraarterial thrombolytic therapy with rt-PA has been established as an alternative to surgery in selected patients with lower limb ischemia. The purpose of this study is to evaluate its long-term results and to try to identify patient variables influencing outcome. Patients and methods: The results of thrombolytic treatment for acute or subacute lower limb ischemia in 82 patients (51 male, 31 female) were retrospectively analysed. Clinical data (time of symptoms onset, clinical stage, type of affected vessel, anatomical localisation) as well as comorbidities were recorded. The success rate of thrombolysis as well as the incidence of adverse events was evaluated. Patients with initial success were followed up after a median of 52,5 months. Results: Thrombolytic therapy was successful in 67 cases (82%). An additional endovascular or surgical procedure was necessary in 39 of these patients (48%). The overall bleeding rate was 18% and the mortality and major amputation rate was 1%. 42 patients with early clinical success were available for follow-up. 34 of them (81%) were free of ischemic symptoms and the overall limb salvage rate was 96%. We could not identify factors significantly influencing early or long-term results, although there was a trend towards better results in patients with acute ischemia and in patients with occluded native arteries. Conclusions: Intraarterial local thrombolytic therapy has a relatively high initial success rate in selected patients with lower limb ischemia, but is associated with a significant number of bleeding complications. Furthermore, additional procedures are required in almost half the patients. Initial success is durable at the long-term in the majority of cases. Better selection of patients and refinements of the thrombolytic therapy might help to further improve results and lower the bleeding complications.

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Outcomes of Prophylactic Epiglottic Petiole Suspension at the Time of Complete Laryngofissure

Otolaryngology ◽

10.1177/0194599819852619 ◽

2019 ◽

Vol 161 (4) ◽

pp. 652-657 ◽

Cited By ~ 2

Author(s):

Mathieu Bergeron ◽

Alessandro de Alarcon ◽

Catherine K. Hart ◽

Michael J. Rutter

Keyword(s):

Case Series ◽

Group Versus ◽

Exercise Intolerance ◽

Control Group ◽

Study Group ◽

Pediatric Hospital ◽

Retrospective Case ◽

Obstructive Sleep ◽

Airway Reconstruction

ObjectivesTo compare the clinical outcomes of patients with prophylactic petiole suspension (PPS) at the time of laryngofissure and patients without PPS.Study DesignRetrospective case series.SettingTertiary pediatric hospital from May 2003 to August 2017.Subjects and MethodsPatients included those undergoing airway reconstruction with complete laryngofissure. Patients in the study group had PPS at the time of laryngofissure, while control group patients did not.ResultsEighty-one patients underwent complete laryngofissure (22 study patients, 59 controls) at a median age of 4.8 years (interquartile range, 2.1-9.7). Patients in the control group were younger at the time of the surgery (3.7 vs 6.5 years, P = .04). Other demographic and clinical data, including subglottic stenosis (SGS) grades, were similar. For patients with SGS, 53.8% and 46.2% in the study group had a grade 1-2 and 3-4 SGS, respectively, as compared with 46.2% and 53.8% in the control group ( P = .65). Manifestations of petiole prolapse included failure of decannulation (8.6%), exercise intolerance (16.0%), and obstructive sleep apnea (11.1%). After 4 years of follow-up, 4.5% of the study group versus 27.1% of the control group had prolapse of the petiole ( P = .04). Petiole prolapsed affected >50% of patients with no PPS after 10 years of follow-up. Patients with petiole prolapse at the first surveillance microlaryngoscopy and bronchoscopy after stent removal had an odds ratio of 10.2 (95% CI, 1.1-94.8; P = .04) of becoming symptomatic.ConclusionPatients with PPS had significantly fewer symptoms after complete laryngofissure as compared with patients without PPS. PPS should be considered when a complete laryngofissure is being performed during airway reconstruction.

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A Prospective 30-Year Follow-Up of ADHD Associated With Perinatal Risks

Journal of Attention Disorders ◽

10.1177/1087054714548036 ◽

2014 ◽

Vol 21 (10) ◽

pp. 799-810 ◽

Cited By ~ 4

Author(s):

Timo Tervo ◽

Katarina Michelsson ◽

Jyrki Launes ◽

Laura Hokkanen

Keyword(s):

Control Group ◽

Study Group ◽

Adhd Symptoms ◽

Learning Impairments ◽

Adult Outcome ◽

Psychiatric Problems ◽

Motor Perception ◽

Perinatal Risks

Objective: Longitudinal follow-up of ADHD suggests a poorer outcome in those affected. Studies extending to 30 years however are rare. We investigated the adult outcome of ADHD associated with perinatal risks (PRs), treated non-pharmacologically. Method: A study group of 122 participants (86 men, 36 women) with PR-associated ADHD was followed-up from birth and compared with a control group also prospectively studied. Results: The study group showed more cognitive, motor perception, and learning impairments as well as psychiatric problems at ages 5, 9, and 16. At age 30, the study group reported less education, more involuntary job dismissals and more alcohol abuse. Self-reported ADHD symptoms were still prevalent in adulthood. Conclusion: ADHD symptoms persist and impair the long-term educational, occupational, and psychiatric outcome. ADHD in participants with PR appears to follow a course seen in studies of unselected ADHD.

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Trabeculectomy with Healaflow versus Trabeculectomy for the Treatment of Glaucoma: A Case-Control Study

Journal of Ophthalmology ◽

10.1155/2015/836269 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Dimitris Papaconstantinou ◽

Andreas Diagourtas ◽

Petros Petrou ◽

Alexandros Rouvas ◽

Athanasios Vergados ◽

...

Keyword(s):

Case Control Study ◽

Group Versus ◽

Study Groups ◽

Case Control ◽

Control Group ◽

Study Group ◽

Safe Procedure ◽

Mean Values ◽

Control Study

Purpose. To compare the outcomes of trabeculectomy with and without Healaflow (Anteis S.A, Geneva, Switzerland), a high molecular weight viscoelastic gel, in patients requiring glaucoma surgery.Methods. This was a retrospective, comparative, interventional case-control study. Forty patients formed two matched study groups and were analyzed (trabeculectomy alone (control) versus trabeculectomy with Healaflow (study)).Results. The postoperative levels of mean IOP were statistically significantly lowerP<0.05than preoperatively in both groups, for all time intervals. There was no statistical difference, at the end of the follow-up period, between the two groups in the mean values of the IOP (14.9 ± 3.2 mmHg for the study group versus 14.8 ± 3.3 mmHg for the control group). The number of antiglaucoma drugs used in the study group was reduced from a preoperative mean of 3.4 ± 0.75 to a 6-month postoperative mean of 0.6 ± 0.8P<0.001and in the control group from 3.6 ± 0.59 to 0.55 ± 0.9P<0.001.Conclusions. Although trabeculectomy with Healaflow appears to be a safe procedure, we failed to identify any significant advantages in the use of Healaflow when compared with trabeculectomy alone, at the end of the 6-month follow-up period.

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Long-Term Follow-Up of Intraarterial Infusion of Streptokinase in Acute Lower Limb Ischemia

Vascular Surgery ◽

10.1177/153857448702100506 ◽

1987 ◽

Vol 21 (5) ◽

pp. 339-343

Author(s):

C. Delcour ◽

B. Bellens ◽

G. Vandenbosch ◽

J.P. Dereume ◽

J. Struyven

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Intraarterial Infusion ◽

Lower Limb Ischemia ◽

Long Term Follow Up

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Features of manifestation and progression for critical lower limb ischemia in subjects with abdominal aortic calcification: a pilot study

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-3-58-64 ◽

2017 ◽

Vol 21 (3) ◽

pp. 58

Author(s):

V. A. Zelinskiy ◽

M. V. Melynikov

Keyword(s):

Conflict Of Interest ◽

Lower Limb ◽

Limb Ischemia ◽

Aortic Calcification ◽

Control Group ◽

Study Cohort ◽

Study Group ◽

Abdominal Aortic Calcification ◽

Lower Limb Ischemia ◽

Abdominal Aortic

Aim. The study was designed to assess the specific features of manifestation and progression for critical low limb ischemia in patients with abdominal aortic calcification. Methods. The total of 151 patients with low limb critical ischemia due to peripheral arterial disease were enrolled to the study cohort: 79 patients (study group) with abdominal aortic calcification and 72 patients (control group) without any signs of abdominal aortic wall calcification. Abdominal aortic calcification was detected by CT-imaging. The patients with diabetes mellitus and with chronic renal insufficiency were excluded from the study cohort. Results. Critical lower limb ischemia in subjects with abdominal aortic calcification manifested itself in the following features: predominant localization of lesions in the aorto-iliac position (68.4% vs. 33.3% in patients without abdominal aortic calcification; р<0.05), rapid progression of lower limb ischemia (its prevalence in the study group was 77.7% vs. 37.3% in the control group; р<0.01), expressed hypercoagulation combined with a decrease in the level of natural anticoagulants concentration (mean activity of antithrombin III in individuals with abdominal aortic calcification was 56.5±10.4% vs. 98.7±16.4% in patients without abdominal aortic calcification; р<0.001). Conclusion. The study findings have shown that critical lower limb ischemia in subjects with abdominal aortic calcification has specific futures of manifestation and clinical course that need to be considered when choosing the best treatment strategy.Received 24 April 2017. Revised 7 June 2017. Accepted 19 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

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Long-term attitude towards follow-up colposcopy in women of reproductive age after excisional treatment for cervical dysplasia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh180704014s ◽

2019 ◽

Vol 147 (5-6) ◽

pp. 321-326

Author(s):

Radmila Sparic ◽

Dimitrios Papoutsis ◽

Svetlana Spremovic-Radjenovic ◽

Sasa Kadija ◽

Zoran Bukumiric ◽

...

Keyword(s):

Condom Use ◽

Cervical Dysplasia ◽

Reproductive Age ◽

Living Alone ◽

Anxiety And Depression ◽

Control Group ◽

Study Group ◽

Women Of Reproductive Age

Introduction/Objective. Very little is known about the factors influencing women?s attitude towards colposcopy follow-up after cervical treatment. The aim of the study was to investigate the long-term attitude to follow-up colposcopy in women of reproductive age after cervical excision and to evaluate if their attitude was related to their anxiety and depression levels. Methods. Women treated with cervical excision were interviewed after a follow-up colposcopy visit. Their socio-demographic and clinical characteristics were recorded. All women filled in the Beck?s anxiety and depression inventory. Results. A total of 160 women were divided into the study group of 42 (26.3%) women who felt discomfort during follow-up colposcopy and the control group of 118 (73.7%) women who did not report such feelings. The mean age of the total sample was 35.3 ? 5.4 years with median time after treatment being five years (range: 2?18). Women in the study group had a significantly lower BMI values, had higher rates of nulliparity and nulligravidity, were more often single or living alone, and had significantly changed their attitude towards condom use after treatment. Beck?s anxiety and depression scores were significantly higher in the study group. Multivariate analysis showed that independent predictors of discomfort during follow-up colposcopy were anxiety levels (OR: 1.06; 95% CI: 1?1.12), living alone or without a partner (OR: 2.65; 95% CI: 1.08?6.55), and the change in their practice of condom use after treatment (OR: 2.69; 95% CI: 1.02?7.07). Conclusion. Almost one third of women after excisional treatment reported discomfort during their follow-up colposcopy. These women exhibited higher levels of anxiety.

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