scholarly journals Osteochondritis Dissecans of Lateral Process of Talus Involving the Subtalar Joint: An Unusual Case

2020 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Subtalar Joint ◽  
Lateral Compartment ◽  
Lateral Part ◽  
Disability Score ◽  
Lateral Process ◽  
Subchondral Cyst ◽  
Sinus Tarsi Approach ◽  
Osteochondral Fragment ◽  
Work Up

Osteochondral dissecans (OCD)of talus is an uncommon injury is often missed initially. We reported a rare case of OCD of the lateral process of talus involving the subtalar joint in a 34-year-old male. Magnetic resonance imaging exhibited degenerative changes at the subtalar joint, with a 12 × 10 × 15-mm subchondral cystic lesion within the lateral part of talus in the posterior subtalar joint and two osseous loose bodies in the lateral compartment, which were removed through the sinus tarsi approach. A 1.2 × 1.5-cm osteochondral fragment distal to the lateral process of talus was noted intraoperatively. The subchondral cyst was excised and the fragment fixed with a 4-mm partially-threaded cannulated cancellous screw. The foot and ankle disability score improved from 26.0 preoperatively to 92.3 at the 1-year follow-up. Thus, talus OCD is an unusual condition that mandates a thorough clinical and radiological work-up and prompt management.

scholarly journals Risk Factors of Arthropathy Change of the Lateral Side of Subtalar Joint After Calcaneal Fracture Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Naohiro Hio ◽  
Atsushi Hasegawa ◽  
Satoshi Monden ◽  
Masanori Taki ◽  
Kazuhiko Tsunoda ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Subtalar Joint ◽  
Calcaneal Fracture ◽  
Joint Surface ◽  
Lateral Side ◽  
Anterolateral Approach ◽  
Sinus Tarsi Approach ◽  
Mean Width ◽  
The Mean

Category: Hindfoot, Trauma Introduction/Purpose: As a result of arthropathy change on the lateral side of subtalar joint after intra-articular calcaneal fracture, the secondary disorders such as pain or restricted range of motion occasionally occur. The purpose of this study is to examine factors that cause such arthropathy change. Methods: We divided 23 joints into two groups according to arthropathy change of the lateral side of subtalar joint: the existence of such arthropathy (O) group included 8 joints, the absence of arthropathy (N) group included 15 joints. The patients’ mean age at the time of surgery were 49.1 years and 54.9 years respectively, and the mean follow-up period were 16.1 months and 12.4 months respectively. The anterolateral approach or the sinus tarsi approach was used for both groups, and the medial approach was combined as needed. The fixing materials were a plate or screws, and in some cases, staples and Kirschner wires were used in combination. We assessed Sanders classification, postoperative clinical evaluation using Creighton-Nebraska scale, and the width, height and dislocation of subtalar joint surface of calcaneus. Results: The breakdown of the Sanders classification is as follows: N group consists of 3 joints of type 2A, 7 of type 2B, 3 of type 2C, 1 of type 3BC, 1 of type 4. O group consists of 5 joints of type 2A, 2 of type 2B, 1 of type 2C. The proportion occupied by Sanders classification type 2A in O group was larger than in N group. The average of the postoperative clinical evaluation was 94.9points in N group, 86.9points in O group. In postoperative image evaluation, the mean width in the was 106.2% in N group, 117.1% in O group, the mean dislocation of the subtalar joint surface was 0.4 mm in N group and 1.1 mm in O group. Conclusion: It was suggested that Sanders type 2A and the residual dislocation of the subtalar joint surface may be a cause of arthropathy change on the lateral side of subtalar joint.

Snowboarder's Talus Fracture

2005 ◽  
Vol 33 (6) ◽  
pp. 871-880 ◽  
Author(s):  
Victor Valderrabano ◽  
Thomas Perren ◽  
Christian Ryf ◽  
Paavo Rillmann ◽  
Beat Hintermann
Keyword(s):  
Surgical Treatment ◽  
Subtalar Joint ◽  
External Rotation ◽  
Sport Activity ◽  
Treatment Algorithm ◽  
Activity Level ◽  
Talus Fracture ◽  
Level Of Evidence ◽  
Lateral Process

Background Fracture of the lateral process of the talus is a typical snowboarding injury. Basic data are limited, particularly with respect to treatment and outcome. Hypothesis As the axial-loaded dorsiflexed foot becomes externally rotated and/or everted, fracture of the lateral process of the talus occurs. Primary surgical treatment may improve the outcome of this injury, reducing the risk of secondary subtalar joint osteoarthritis. Study Design Cohort study; Level of evidence, 2. Methods We recorded details of the treatment and evaluation of 20 patients (8 female and 12 male; age at trauma, 29 years [range, 17-48 years]) who sustained a lateral process of the talus fracture while snowboarding. The injury pathomechanism was documented. The patients were treated either nonsurgically or surgically based on a fracture-type treatment algorithm. The evaluation at most recent follow-up (mean, 42 months [range, 26-53 months]) included clinical and functional examination, follow-up of sport activity, and radiological assessment (radiograph, computed tomography scan). Results The injury mechanism included axial impact (100%), dorsiflexion (95%), external rotation (80%), and eversion (45%). Using the American Orthopaedic Foot and Ankle Society hindfoot score, the patients obtained a mean of 93 points; the surgically treated group (n = 14) scored higher (97 points) than did the nonoperative group (n = 6; 85 points) (P <. 05). Degenerative disease of the subtalar joint was found in 3 patients (15%; operative, 1 patient; nonoperative, 2 patients). All but 4 (20%, all after nonsurgical treatment) patients reached the same sport activity level as before injury. Conclusion The snowboarding-related lateral process of the talus fracture represents a complex hindfoot injury. In type II fractures, primary surgical treatment has led to achieving better outcomes, reducing sequelae, and allowing patients to regain the same sports activity level as before injury.

Guideline for radioimmunotherapy of rituximab relapsed or refractory CD20+ follicular B-cell nonHodgkin´s lymphoma

2004 ◽  
Vol 43 (05) ◽  
pp. 171-176 ◽  
Author(s):  
T. Behr ◽  
F. Grünwald ◽  
W. H. Knapp ◽  
L. Trümper ◽  
C. von Schilling ◽  
...  
Keyword(s):  
Quality Control ◽  
Quality Management ◽  
Medical Physics ◽  
Essential Elements ◽  
Background Information ◽  
After Care ◽  
Complete Treatment ◽  
Close Cooperation ◽  
Work Up

Summary:This guideline is a prerequisite for the quality management in the treatment of non-Hodgkin-lymphomas using radioimmunotherapy. It is based on an interdisciplinary consensus and contains background information and definitions as well as specified indications and detailed contraindications of treatment. Essential topics are the requirements for institutions performing the therapy. For instance, presence of an expert for medical physics, intense cooperation with all colleagues committed to treatment of lymphomas, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how the treatment has to be carried out technically. Here, quality control and documentation of labelling are of greatest importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with those colleagues (haematology-oncology) who propose, in general, radioimmunotherapy under consideration of the development of the disease.

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (2) ◽  
pp. V7
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Cleavage Plane ◽  
Foramen Magnum ◽  
Senior Author ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Sitting Position ◽  
Brainstem Cavernoma ◽  
Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

scholarly journals The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

2021 ◽  
Author(s):  
C. J. Koppel ◽  
B. W. Driesen ◽  
R. J. de Winter ◽  
A. E. van den Bosch ◽  
R. van Kimmenade ◽  
...  
Keyword(s):  
Coronary Artery ◽  
The Netherlands ◽  
Multicentre Study ◽  
Ct Angiography ◽  
Patient Group ◽  
Care Pathway ◽  
Coronary Anomalies ◽  
Work Up ◽  
Ischaemia Detection

Abstract Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.

scholarly journals Living Kidney Donation: Practical Considerations on Setting Up a Program

2021 ◽  
Vol 2 (1) ◽  
pp. 75-86
Author(s):  
Maria Irene Bellini ◽  
Vito Cantisani ◽  
Augusto Lauro ◽  
Vito D’Andrea
Keyword(s):  
Good Practice ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Exchange Programs ◽  
Paired Exchange ◽  
Stage Renal Disease ◽  
End Stage ◽  
Additional Value ◽  
Work Up

Living kidney donation represents the best treatment for end stage renal disease patients, with the potentiality to pre-emptively address kidney failure and significantly expand the organ pool. Unfortunately, there is still limited knowledge about this underutilized resource. The present review aims to describe the general principles for the establishment, organization, and oversight of a successful living kidney transplantation program, highlighting recommendation for good practice and the work up of donor selection, in view of potential short- and long-terms risks, as well as the additional value of kidney paired exchange programs. The need for donor registries is also discussed, as well as the importance of lifelong follow up.

MR imaging of ventriculus terminalis of the conus medullaris: A report of two operated patients and review of the literature

2003 ◽  
Vol 44 (4) ◽  
pp. 444-446
Author(s):  
R. Dullerud ◽  
A. Server ◽  
J. Berg-Johnsen
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Signal Intensity ◽  
Incidental Finding ◽  
Conus Medullaris ◽  
Review Of The Literature ◽  
Per Se ◽  
Specific Symptoms ◽  
Work Up

We report on 2 patients in whom a cystic dilation of the conus medullaris was incidentally found at MR imaging carried out in the work-up for sciatica. The cysts were well circumscribed and had signal intensity identical to the CSF on both T1- and T2-weighted images. There was no evidence of contrast enhancement. None of the patients had specific symptoms related to the spinal cord. At surgery, no evidence of malignancy was seen in any of the patients. A benign cystic dilation, also called dilated ventriculus terminalis, occasionally can be seen in the conus medullaris as an incidental finding at thoracolumbar MR imaging. Unless the expansion per se indicates cyst drainage, these patients may be monitored by clinical and MR follow-up, avoiding surgery in a substantial number of cases.

Solitary Ovarian Plasmocytoma: A Rare localization of Extramedullary Plasmocytoma. A Case Report

2021 ◽  
Vol 4 (5) ◽  
pp. 01-04
Author(s):  
Salma Fares ◽  
Adil Taoufik ◽  
Aissam Maataoui ◽  
Kaoutar Sokori ◽  
Ouadie Qamouss
Keyword(s):  
Plasma Cells ◽  
Female Genital Tract ◽  
Malignant Neoplasm ◽  
Solitary Plasmacytoma ◽  
Adequate Treatment ◽  
Complete Surgical Resection ◽  
Plasma Cell Dyscrasias ◽  
Extramedullary Plasmocytoma ◽  
Work Up

Background: Solitary plasmacytoma is a rare malignant neoplasm of plasma cells accounting 5-10% of all plasma cell dyscrasias with extramedullary plasmocytoma in 3- 5%. Their localization in the female genital tract is quite rare, either as solitary plasmacytomas or as part of a disseminated MM. Solitary ovarian plasmocytoma is extremely rare. Case: A 52-year-old woman, presented presented postmenopausal recurring episodes of metrorrhagia with left ovarian mass. She was diagnosed with solitary ovarianplasmocytoma without systemicdisease. The patient underwent complete surgery resection and a full work up to rule out multiple myeloma that objectived a small serum monoclonal protein that had resolved postoperatively. At 17 months of follow-up, the patient is still alive and doing well with no signs of recurrence or progression to mutliple myeloma. Although rare, solitary plasmacytoma of the ovary can occur without any overt symptoms or laboratory abnormalities tests and require prompt and adequate treatment and rigorous monitoring due to their ability to relapse or progress to MM. Complete surgical resection followed by activesurveillance is appropriate.

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