scholarly journals Insertional Achilles tendinopathy

2020 ◽  
Vol 14 (1) ◽  
pp. 68-73
Author(s):  
Lucas Candido Honório ◽  
Mariana Alcantara Roldi de Azeredo ◽  
Joaquim Maluf Neto
Keyword(s):  
Functional Performance ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Calcaneal Tendon ◽  
Functional Quality ◽  
Case Series Study ◽  
Therapeutic Study ◽  
The Impact

Objective: Retrospectively analyze surgical procedures performed on patients with insertional Achilles (calcaneal tendon) tendinopathy, focusing on outcomes and the impact on the patients’ functional quality. Methods: A descriptive, retrospective, case series study drawn up by collecting data directly from the patients’ medical records. For the functional analysis of patients, we used the questionnaire of the adapted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). An assessment was carried out on each of the patients who underwent surgery at our hospital from 2010 to 2019, using the surgical technique described in this article, i.e., resection of the affected portion of the tendon with its subsequent reinsertion. Results: All surgical patients achieved an improvement in their AOFAS score and in pain levels, with good functional performance only three months into the postoperative period, from 50.1 to 83.75 (p<0.001). Conclusion: The use of the technique proved very effective, particularly in terms of the maintenance of foot function and important improvement in pain levels, thus producing a relevant increase in function among patients. Level of Evidence IV; Therapeutic Study; Case Series.

Review of Pharmacist Driven Penicillin Allergy Assessments and Skin Testing: A Multi-Center Case-Series

2021 ◽  
pp. 001857872110468
Author(s):  
Hanna M. Harper ◽  
Michael Sanchez
Keyword(s):  
Skin Testing ◽  
Case Series ◽  
Cost Savings ◽  
Penicillin Allergy ◽  
Teaching Hospitals ◽  
Beta Lactam ◽  
Retrospective Case ◽  
Beta Lactam Antibiotics ◽  
Case Series Study ◽  
The Impact

Objective: To describe the impact of pharmacy driven penicillin allergy assessments on de-labeling penicillin allergies and antibiotic streamlining opportunities for hospitalized patients. Design: Multi-center, retrospective case-series study. Setting: A health system of 4 non-teaching hospitals. Participants: Patients aged 18 years and older with a physician order for a pharmacist penicillin allergy assessment. Exclusion criteria consisted of patients with anaphylaxis or a type II penicillin allergy, anaphylaxis of any cause within 4 weeks, refusal of penicillin allergy skin test (PAST), antihistamine use within 24 hours, penicillin intolerance, immunosuppression or immunosuppressive medications, or skin conditions that could interfere with PAST. Interventions: The primary endpoint evaluated the number of de-labeled penicillin allergies after pharmacists provided penicillin allergy assessments. Secondary endpoints evaluated the percent of patients with antibiotics deescalated to beta-lactam antibiotics and classification of notable interventions made by pharmacists. Measurements and Main Results: There were 35 patients who met inclusion criteria. Twenty-four patients underwent both penicillin allergy skin testing and oral (PO) amoxicillin challenge. Five patients had allergies de-labeled only after a pharmacist interview. Four patients received only the PO amoxicillin challenge and 2 patients received only PAST. Penicillin allergies were de-labeled from the electronic health record (EHR) in 31 (89%) patients despite all testing negative for a penicillin allergy from PAST or a PO amoxicillin challenge. Four patients had the allergy re-added to the chart on subsequent admissions. No patients experienced a reaction from PAST, PO amoxicillin challenge, or subsequent beta-lactam antibiotics. Twenty-eight (80%) patients had their antibiotic therapy changed as a result of the allergy assessment. Seventeen patients were de-escalated onto beta-lactam antibiotics and aztreonam was stopped in 6 patients. Conclusion: Results from this study suggests that pharmacists expanding their scope of practice with PAST is a safe and effective allergy de-labeling tool. Pharmacist-driven penicillin allergy assessments could provide antibiotic cost savings and avoid aztreonam use. The study supports the need to emphasize education for patients and caretakers regarding allergy testing results to avoid relabeling in future hospital visits.

scholarly journals The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study

2019 ◽  
Vol 48 (1) ◽  
Author(s):  
Ahmed Mourad ◽  
Hussein Jaffal ◽  
Ismaeel El-Hakim ◽  
Hamdy El-Hakim
Keyword(s):  
Quality Of Life ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Case Series Study ◽  
The Impact ◽  
Series Study

Abstract Background Inferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad. Methods A retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children’s center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children’s Benefit Inventory (GCBI) was administered by phone to assess QOL improvement. Results One hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication. Conclusions This study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.

Management of oral anticoagulation in a population of children with cardiac disease using a computerised system to support decision-making

2006 ◽  
Vol 16 (3) ◽  
pp. 256-260 ◽  
Author(s):  
Juliet Soper ◽  
George T.C. Chan ◽  
Jonathan R. Skinner ◽  
Heather D. Spinetto ◽  
Thomas L. Gentles
Keyword(s):  
Decision Making ◽  
Care Service ◽  
Case Series ◽  
Target Range ◽  
Prescribing Practices ◽  
Retrospective Case ◽  
Case Series Study ◽  
The Stability ◽  
The Impact ◽  
Support Decision Making

Objective:To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation.Design:Retrospective case series study comparing manual and computerised records of prescribing.Setting:A tertiary paediatric cardiology department in a teaching hospital.Participants:The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making.Interventions:A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians.Main outcomes:We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department.Results:We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p = 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p = 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines.Conclusion:The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.

Isolated Shear Fracture of the Metatarsal Head in Lesser Toes Treated With ORIF: Case Series

2020 ◽  
pp. 107110072095279
Author(s):  
Ying Li ◽  
Wenjing Li ◽  
Shaoliang Li ◽  
Yan Wang ◽  
Shengsheng Guan ◽  
...  
Keyword(s):  
Shear Fracture ◽  
Case Series ◽  
Metatarsal Head ◽  
Ct Scans ◽  
Activity Levels ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Imaging Characteristics ◽  
Case Series Study

Background: Isolated shear fractures of a metatarsal head in the lesser toes are rare in clinical practice. We report the clinical and imaging characteristics, and treatment results, of these fractures. Methods: A retrospective consecutive case-series study was performed on 7 patients with symptomatic isolated shear fracture of a metatarsal head in the lesser toes who were operatively treated using open reduction and internal fixation (ORIF). Radiographs and computed tomographic (CT) scans of the patients were analyzed. The American Orthopaedic Foot & Ankle Society–lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS) score, and passive dorsiflexion range of motion (ROM) of the metatarsophalangeal (MTP) joint were determined preoperatively and at final follow-up. Postoperative complications were also recorded. Results: There were 5 males and 2 females, with a mean age of 21 years (range, 16-36) at the time of surgery. Four fractures occurred at the fourth metatarsal. There were 3 chronic cases, 1 was not diagnosed initially; the other 2 failed conservative treatment. The main symptom of the chronic fractures was limited dorsiflexion at the MTP joint. Preoperative radiographs and CT scans revealed dorsal displacement of the fragment without dislocation of the MTP joint. At the final follow-up (mean, 17.4 months; range 9-27), the AOFAS-LMI scores had improved from 70.6 (range, 59-79) preoperatively to 93.3 (range, 92-100) ( P = .001). VAS scores showed a decrease in pain from 4.0 to 0.0 ( P = .016). Mean passive dorsiflexion ROM of the MTP joint improved significantly from 8.6 degrees preoperatively to 35.7 degrees at final follow-up ( P < .001). All patients returned to their respective preinjury activity levels. Conclusion: Patients with an acute or chronic isolated shear fracture of a metatarsal head in the lesser toes treated by ORIF achieved good short-term clinical and radiologic outcomes. Level of Evidence: Level IV, retrospective case series.

First Metatarsal Head Osteochondral Defect Treatment With Particulated Juvenile Cartilage Allograft Transplantation: A Case Series

2017 ◽  
Vol 39 (2) ◽  
pp. 236-241 ◽  
Author(s):  
Bryan Van Dyke ◽  
Gregory C. Berlet ◽  
Justin L. Daigre ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin
Keyword(s):  
Articular Cartilage ◽  
Osteochondral Defect ◽  
Case Series ◽  
Metatarsal Head ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Allograft Transplantation ◽  
Case Series Study

Background: Focal damage to articular cartilage, also called an osteochondral defect (OCD), can be a cause of pain and decreased range of motion. Recent advancements have led to transplantation techniques using particulated juvenile articular cartilage allograft. This technique has been applied to the first metatarsal head to a very limited degree, with no published results to our knowledge. The aim of this study was to review the clinical results of patients who underwent particulated juvenile cartilage allograft implantation for first metatarsal head OCDs. Methods: We performed a retrospective consecutive case series study. Nine patients, at an average age of 41 years, were treated for symptomatic focal osteochondral defects of the first metatarsal head with particulate cartilage grafting from 2010 to 2016. Patients were contacted by phone to assess interest in returning to the office for follow-up, where weightbearing radiographs of the foot were obtained and a foot examination was performed. Results: At an average follow-up of 3.3 years, 7 of 9 patients reported no pain with recreational activities and no patient required further operations. This patient cohort was physically active, with 6 of 9 listing running as a regular activity. The average overall American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire score was 85 (maximum 100), AOFAS pain 35.6 (maximum 40), and AOFAS function 40.1 (maximum 45). Patient satisfaction surveys correlated with the AOFAS scores and revealed that 7 of 9 patients were very satisfied with their results, 1 was satisfied, and 1 patient was very dissatisfied. Conclusion: Particulated juvenile cartilage allograft transplantation is a promising treatment option for symptomatic first metatarsophalangeal focal articular cartilage lesions. Further study is needed to demonstrate which lesions respond better to this type of cartilage graft versus traditional marrow-stimulating procedures. Level of Evidence: Level IV, retrospective case series.

scholarly journals Hallux rigidus

2019 ◽  
Vol 13 (3) ◽  
pp. 191-7
Author(s):  
Mariana Alcântara Roldi de Azeredo ◽  
Joaquim Maluf Neto
Keyword(s):  
Functional Performance ◽  
Case Series ◽  
Cross Sectional Study ◽  
Hallux Rigidus ◽  
Resection Arthroplasty ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Cross Sectional ◽  
Before And After ◽  
Therapeutic Study

Objective: This study evaluated the postoperative outcomes of patients with hallux rigidus who underwent cheilectomy combined with modified Lelièvre resection arthroplasty. Methods: This retrospective cross-sectional study applied the adapted American Orthopedic Foot and Ankle Society (AOFAS) forefoot questionnaire. A total of 28 patients (31 feet with hallux rigidus) were evaluated and treated following the same clinical and surgical protocol between February 2010 and June 2018. We evaluated pain, footwear use, sports activity, surgical complications, and the AOFAS score before and after surgery. Results: All patients who underwent surgery showed improved AOFAS scores and reduced pain with satisfactory functional performance. Conclusions: The use of cheilectomy combined with modified Lelièvre resection arthroplasty was effective, especially with regard to maintaining foot function, significantly improving pain and gait performance, and providing the possibility of wearing ordinary footwear, thereby increasing patient quality of life. This result was consistent with the extant literature on the topic. Level of Evidence IV; Therapeutic Study; Case Series.

scholarly journals Ketogenic Dietary Interventions in Autosomal-Dominant Polycystic Kidney Disease (ADPKD)– A Retrospective Case Series Study: First insights into Feasibility, Safety and Effects

2021 ◽  
Author(s):  
Sebastian Strubl ◽  
Simon Oehm ◽  
Jacob A Torres ◽  
Franziska Grundmann ◽  
Jazmine Haratani ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Real Life ◽  
Case Series ◽  
Dietary Interventions ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Case Series Study ◽  
Autosomal Dominant Polycystic Kidney ◽  
The Impact ◽  
Series Study

Abstract Background Our laboratory published the first evidence that nutritional ketosis, induced by ketogenic diet (KD) or time-restricted diet (TRD), ameliorates disease progression in PKD animal models. We reasoned that, due to their frequent use for numerous health benefits, some ADPKD patients may already have had experience with ketogenic dietary interventions (KDIs). This retrospective case series study is designed to collect first real-life observations of ADPKD patients about safety, feasibility, and possible benefits of KDIs in ADPKD as part of a translational project pipeline. Methods Patients with ADPKD who had already used KDIs were recruited to retrospectively collect observational and medical data about beneficial or adverse effects, the feasibility and safety of KDIs in questionnaire-based interviews. Results 131 ADPKD patients took part in this study. 74 executed a KD and 52 TRD, for 6 months on average. 86% of participants reported that KDIs had improved their overall health. 67% described improvements in ADPKD-associated health issues. 90% observed significant weight loss. 64% of participants with hypertension reported improvements in blood pressure. 66% noticed adverse effects that are frequently observed with KDIs. 22 participants reported safety concerns like hyperlipidemia. 45 participants reported slight improvements in eGFR. 92% experienced KDIs as feasible while 53% reported breaks during their diet. Discussion Our preliminary data indicate that KDIs may be safe, feasible, and potentially beneficial for ADPKD patients highlighting that prospective clinical trials are warranted to confirm these results in a controlled setting and elucidate the impact of KDIs specifically on kidney function and cyst progression.

scholarly journals Femoral and Dega osteotomies in the treatment of habitual hip dislocation in Down syndrome patients - is it efficient or not?

2018 ◽  
Vol 12 (3) ◽  
pp. 227-231 ◽  
Author(s):  
Ahmad S. Aly ◽  
Mohamed A. Al-kersh
Keyword(s):  
Down Syndrome ◽  
Case Series ◽  
Hip Dislocation ◽  
Lateral Wall ◽  
Acetabular Coverage ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Hip Instability ◽  
Case Series Study ◽  
Derotational Osteotomy

Purpose The purpose of this case series study is to report on the intermediate-term outcomes following a femoral varus derotational osteotomy (FVDO) performed in conjunction with a Dega osteotomy (DO) in management of hip ­instability in Down syndrome (DS) patients. Methods Ten hips in seven children with DS suffering from hip dislocation were included. All patients included in this study had hip dislocation in the habitual phase and painless mobile hip to full abduction. All patients were firstly subjected to FVDO. An additional DO was added if intraoperative assessment demonstrated posterior instability. The mean age at time of surgery was 5.6 years (3 to 7). There were three male and four female patients. All patients were followed up after two years with a mean follow-up of 3.27 years (2 to 5). All operations were performed by the first author. Results There was improvement of neck shaft angles (130° to 175°, median = 160° preoperatively, to 120° to 140°, median =130° postoperatively). The Shenton line was restored in all our cases. There was also improved percentage of the femoral head uncovered by the lateral wall of the acetabulum (25° to 100° with median = 45° preoperatively, to 0° to 15° with median = 5° postoperatively) and improved posterior acetabular coverage, which was assessed by CT. Conclusion FVDO combined with DO without ­capsulorrhaphy is efficient in the management of hip instability in DS, as it corrects hip biomechanics and increases posterior acetabular coverage. Level of Evidence IV - retrospective case series

scholarly journals TRAUMATIC ATLANTOAXIAL ROTATORY DISLOCATION IN THE PEDIATRIC POPULATION

2021 ◽  
Vol 20 (2) ◽  
pp. 144-148
Author(s):  
Cristian Illanes
Keyword(s):  
Pediatric Population ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Skeletal Traction ◽  
Rotatory Dislocation ◽  
Case Series Study ◽  
The Stability ◽  
And Function ◽  
Type Of Injury

ABSTRACT Objective: The treatment of C1-C2 rotatory dislocation remains controversial and surgery is rare. Surgical treatment is indicated when the injury satisfies the instability criteria or when it cannot be reduced. The objective of this study is to analyze the principles and the adaptations necessary for treating these injuries in the pediatric population. Methods: A retrospective case series study. Three cases of patients diagnosed with traumatic C1-C2 rotatory dislocation and treated surgically in our hospital were studied. Through critical analysis of the available literature, a practical guide was proposed to establish the principles and competencies for the treatment of these injuries. Results: The operated cases were female patients between 8 and 16 years of age, with a diagnosis of traumatic atlantoaxial dislocation. Two patients required preoperative skeletal traction with halo. All patients underwent posterior instrumented arthrodesis, two with a transarticular screw technique and one with mass and C2 isthmic (Göel-Harms) screws. Conclusion:. It is essential to determine if the injury is stable and reducible. We recommend treating this type of injury keeping the criteria and competencies related to the stability, alignment, biology and function of the spine in mind. Level of evidence IV; Case series.

First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

2021 ◽  
pp. 107110072110345
Author(s):  
Chien-Shun Wang ◽  
Yun-Hsuan Tzeng ◽  
Tzu-Cheng Yang ◽  
Chun-Cheng Lin ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hallux Valgus ◽  
Reconstructive Surgery ◽  
Case Series ◽  
Deformity Correction ◽  
Level Of Evidence ◽  
Factors Affecting ◽  
Radiographic Parameters ◽  
Case Series Study ◽  
Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

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