Dynadesis for Treatment of Dynamic Scaphoid Instability with 20-Year Results

Background Even though the scapholunate interosseous ligament is the most common wrist ligament injury, its treatment remains a challenge for hand surgeons. We report on a surgical treatment (Dynadesis) for dynamic scaphoid instability (DSI) with a 20-year follow-up period. Description of Technique Dynadesis utilizes antagonist forearm muscles in order to synergistically provide dynamic stabilization to the scaphoid when the wrist is loaded. It is a tendon-to-tendon transfer with the following two components: 1) Dorsal—The extensor carpi radialis longus (ECRL) is passed through a hole in the reduced, distal scaphoid, providing the scaphoid with an independent extension force. 2) Volar—A dynamic checkrein is created by tension-locking the ECRL tendon around the flexor carpi radialis (FCR) tendon. The portion of the FCR distal to the scaphoid tethers and tightens with contracture of the ECRL and FCR muscles. Patients and Methods Twenty patients (21 wrists) were treated with Dynadesis and reevaluated 20 years later (range: 20–27 years). Results Average grip strength improved by 8 kg. The average wrist flexion-extension arc decreased by 3°. Wrist X-rays showed no radiocarpal arthritis. On the Mayo wrist score, 81% reported excellent to good results (average: 89). Pain levels improved by 90%, with 76% of patients reporting no pain. All patients (100%) were satisfied with their results and would recommend the procedure. Conclusions Dynadesis is specifically designed for the treatment of DSI. It avoids the eventual complication of osteoarthritis and does not sacrifice wrist motion. A predictable and satisfactory long-term result is obtainable with correct patient selection based on clinical staging and arthroscopic findings.

Long-term Result of Surgical Correction of Ischemic Mitral Insufficiency in a Patient With Posterior Basal Post-Infarction Left Ventricular Aneurysm

The article presents a long-term result of surgical correction of ischemic mitral valve insufficiency, left ventricle inferior wall reconstruction.

A Brief Review on Importance of Mental Health First Aid Kit for Depressed Adolescents

Adolescent mental wellbeing is a serious and un-recognized public health concern. Adolescent depression is widespread, but many may not have convenient accessibility to mental health resources. If they are diagnosed and handled early on, there is a greater likelihood of a good long-term result. Early identification and effective assistance-seeking can only arise if young adults and their "associates" (e.g., families, peers, and friends) are informed of the early differences affected by behavioral illness, as well as the best forms of help available and how to achieve it. The aim of a mental first aid kit is to offer advice and instruction to parents and peers about how to recognize and support people who are struggling from mental illnesses. Since this is a popular issue among teenagers, a Juvenile MHFA curriculum must be initiated in schools and colleges to include instruction on how to utilize the MHFA. This review focuses on understanding the seriousness of mental disorders in adolescents and use of MHFA to recognize it.

Conservative treatment of the longitudinal flatfeet in children

Introduction. A significant percentage of the musculoskeletal system pathology in children is currently fall on the foot pathology – longitudinal flatfeet, which is not only a medical, but also a social problem. The incidence of this pathology is up to 58% of the total orthopedic foot pathology. Traditional methods of treatment and prevention of mild (I– II severity) longitudinal flatfeet (LF), which are known today (massage, physiotherapy exercises, the use of orthopedic devices, electromyostimulation) do not give a significant effect and a stable, long-term result. This makes us look for more effective methods of conservative treatment of LF of the I– II severity degree, which have a pathogenic orientation and physiological effect. Purpose of the work: to develop the most effective algorithm for the complex conservative treatment of LF, depending on the severity, hemodynamic disorders, deformity options, foot rigidity. Materials and methods. Conservative treatment was carried out in 62 patients aged 10– 18 years with LF of the I– II severity degree. Depending on the clinical manifestations and examination results, the treatment was carried out in two stages. At the first stage, serial casting was used (in the presence of concomitant deformations – silicone pelottes were used). Results. The results of the two-stage conservative treatment of LF demonstrate the effectiveness of serial casting in combination with the use of silicone pelottes and biostimulators in comparison with traditional methods of foot correction. Conclusions. Algorithms for conservative treatment of LF were developed, depending on the severity, nature of the deformity, hemodynamic disorders and muscle tone of the lower leg and foot.

Minimally Invasive Method of Treatment of Biliary Tract Strictures

The article presents a minimally invasive method for treating strictures of a biliodigestive anastomosis, which consists in creating access to the intestinal lumen without entering the abdominal cavity. A guideline in this is the scar on the anterior abdominal wall, which remained after the removal of the circular drainage or Volker's drainage. In this way, in our clinic, 10 patients were operated on after an operation to form a biliodigestive anastomosis on a disconnected RF loop. A clinical case with a follow-up period of more than 10 years is presented. There was no recurrence of strictures, and according to the data of clinical, echographic and biochemical examinations, all of them had a good long-term result.

A case of spontaneous non-penetrating keratoprosthesis during multi-stage implantation of a Fedorov — Zuyev prosthesis in a patient with a severe chemical eye burn

Purpose: to evaluate the results of spontaneous non-penetrating keratoprosthesis with a Fedorov — Zuev prosthesis in a patient with severe chemical burns in both eyes. Material and methods.Patient K., 38, who had sustained a severe burn injury in the past and numerous reconstructive plastic operations on both eyes (amniotic tissue implantation, allolymbal transplantation, layer-by-layer and penetrative keratoplasty, cataract extraction with IOL implantation, total auto-conjunctival corneal plastic surgery) with no functional effect, was subjected to a multi-stage keratoprosthesis of the left eye according to the method practiced by the Helmholtz National Medical Research Center of Eye Diseases. Results.After one of the stages (implantation of the haptic part of the keratoprosthesis with a temporary cylindrical plug), an aseptic necrosis of the tissue above the cylinder occurred. As a result, an unexpected functional effect was revealed: visual acuity of the operated eye 0.02 sph -20.0 D = 0.2. During a dynamic follow-up that lasts 2.5 years, visual acuity remains stable, and the corneallayers behind the cylinder retain transparency. During this time, all stages of keratoprosthesis were performed on the fellow eye with a functional result of 1.0. Conclusion. The long-term result of spontaneous non-penetrating keratoprosthesis indicates the need to study the prospects and develop a method of non-penetrating keratoprosthesis with a Fedorov — Zuyev prosthesis.

Migration characteristics of the Corail hydroxyapatite-coated femoral stem—a retrospective clinical evaluation and migration measurement with EBRA

Purpose Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analysis) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless press-fit stem after two years follow-up. Stem type and postoperative gap between collar and femur were evaluated as a risk factor. Methods Applying a retrospective study design, we reviewed all consecutive patients who between 2013 and 2017 received a cementless press-fit Corail stem (DePuy Orthopaedics Inc., Warsaw, IN, USA) at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. Results A total of 109 stems in 105 patients (female: 60; male: 45) fulfilled our inclusion criteria. Mean age at surgery was 67.8 (range, 21.6–90.5) years. EBRA migration analysis showed a mean subsidence of 1.8 mm (range, 0.0–12.1) at final follow-up. At 18 months mean subsidence of collared stems was significantly lower than in the collarless group [1.3 mm (range, 0.0–7.6) vs. 3.2 mm (range, 0.5–10.7), p = 0.0104]. Collared stems resting on the femoral cut presented a tendency to less subsidence than did collared stems showing a postoperative gap between collar and femur (1.3 vs. 2.0 mm) without finding statistical significance (p > 0.05). Conclusions Low subsidence and the migration pattern of the cementless press-fit stem may predict a good long-term result. Collared stems investigated in our study provide good stability and are able to prevent significant subsidence. Trial registration number and date of registration: Number: 20181024-1875; Date: 2018-10-24

Long term clinical result of implant induced injury on the adjacent tooth

The purpose of the retrospective study was to investigate the long-term result of implant-induced injury on the adjacent tooth. The subjects of this retrospective study were patients who had received implants and had tooth injury; direct invasion of root (group I), root surface contact (group II), or < 1 mm distance of the implant from the root (group III). Clinical and pathological changes were periodically examined using radiographs and intra-oral examinations. Paired t-tests and chi-square tests were used to evaluate the implant stability quotient (ISQ) of implant and tooth complications, respectively (α = 0.05). A total of 32 implants and teeth in 28 patients were observed for average 122.7 (± 31.7, minimum 86) months. Seven teeth, three of which were subsequently extracted, needed root canal treatment. Finally, 90.6% of the injured teeth remained functional. Complications were significant and varied according to the group, with group I showing higher events than the others. The ISQs increased significantly. One implant in group I resulted in osseointegration failure. The implant survival rate was 96.9%. In conclusion, it was found even when a tooth is injured by an implant, immediate extraction is unnecessary, and the osseointegration of the invading implant is also predictable.

Off-pump direct hepatic veins-to-hemiazygos vein anastomosis after primary Kawashima operation: long-term result

Direct hepatic veins-to-hemiazygos connection offers the balanced distribution of hepatic venous blood to both lungs, not requiring anticoagulation. We report a 13-year follow-up after this type of off-pump Fontan completion. Patient’s hepatic veins-to-hemiazygos confluence increased with growth to allow for unobstructed flow. This unique technique can be recommended in heterotaxy patients, if atrial hepatic venous drainage and hemiazygos vein are in close proximity.