Lateral Knee Osteoarthritis

Background: gonarthrosis is a common entity characterized by involvement of one or more compartments, of which the lateral one is the one with the lowest incidence in isolation. Aim: the aims of this research are too updated on the most important features on lateral knee osteoarthritis and look for updated bibliography on the subject. Methods: PubMed, Hinari, SciELO and Medline databases were searched for citations from August 1st 2021 to September 30th 2021 using the EndNote search manager and reference manager. Out of 312 articles, 44 selected citations were used in this review, being 42 of the last five years. Results: the main causes of lateral knee osteoarthritis are mentioned, especially the secondary ones. Reference is made to the main clinical and imaging elements for diagnosis based on plain radiography and magnetic resonance imaging. Both conservative and surgical treatment modalities are exposed, in the latter the main indications and complications are described, among which osteotomies and arthroplasties stand out. Conclusions: lateral gonarthrosis is the least common of the unicompartmental gonarthrosis that affect the knee joint. Clinical and imaging diagnosis provides the essential elements for both conservative and surgical therapeutic behaviour, the latter modality includes techniques that preserve the joint such as osteotomies and others that do not, such as arthroplasties.

Hydrated Nucleus Pulposus Extrusion in Dogs: Thoracolumbar Compared to Cervical Cases

Objective The aim of this study was to review and describe cases of thoracolumbar (TL) hydrated nucleus pulposus extrusion (HNPE) diagnosed with magnetic resonance imaging and surgery, and compare them to cases of cervical (C) HNPE. Study Design Retrospective, single-center study. Results Thirty-six dogs met the inclusion criteria. Fifteen cases were C and 21 TL. Thirteen dogs were chondrodystrophic breeds, mean body weight was 13 kg, median age was 7.5 years, and 30/36 were male. Fewer dogs were chondrodystrophic in the C group compared with the TL group (p = 0.022). More than 90% had an acute onset, and strong activity was more often reported in the TL group. TL HNPE was more often painful, and extruded disc material more often lateralized (p = 0.017). Median Modified Frankel Score at presentation was 3 and 72.2% were non-ambulatory. More TL HNPE (11/21) were treated surgically compared with C HNPE (4/15). Treatment choice was correlated with spinal cord compression (p = 0.0075). Median Modified Frankel Score improved during hospitalization (p = 0.002) and there was no difference in outcome between C and TL HNPE or conservative and surgical treatment. Mean follow-up time was 33 days. All patients were ambulatory at follow-up. Conclusion This study suggests that the HNPE is not limited to the C vertebral column of dogs and can occur in the TL vertebral column as well. Dogs with TL HNPE show spinal hyperesthesia more often and extruded nucleus material is more often lateralized. Outcome is similar to what has previously been described for C HNPE.

Inter-rater agreement among shoulder surgeons on treatment options for proximal humeral fractures among shoulder surgeons

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures.Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomograms of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed.Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity.Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

Possibilities of conservative treatment of patients with lymphedema of the extremities (literature review)

The literature review describes various methods for treating patients with lymphedema of the extremities. Statistics show an increase in the incidence and disability of patients with this pathology. However, the possibilities of therapeutic measures in lymphedema are far from perfect.The analysis of literature data showed that the basis of treatment for lymphedema of the extremities is comprehensive conservative therapy with the use of pathogenetically grounded physical, mechanical, and medical methods. In complex schemes of conservative treatment for lymphedema, physiotherapy methods occupy a prominent place. The most common technique among them is regular combined decongestive therapy. This method is recognized by leading experts as the main one in treating patients with lower extremity lymphedema. Commitment of patients to treatment and their social and psychological counseling are of great importance. The choice of the volume and method of surgical intervention requires a difficult and individual assessment of pathological changes developing throughout the course of the disease.Despite certain improvements in treatment methods, lower extremity lymphedema is still an unsolved issue. The experience of most specialists involved in lymphedema treatment demonstrates a reasonable balance between basic conservative and surgical treatment methods. Undoubtedly, results of evaluation of these methods will improve the choice of an optimal technique for treating patients with lymphedema of the extremities.

Prospects of using cilostazol in combined treatment of patients with obliterating atherosclerosis of lower limb arteries

Despite intensive study of pathophysiology, of molecular and cell mechanisms of progression of atherosclerosis, development and introduction of a wide range of new conservative and surgical treatment methods, until now the diseases of lower limb arteries (DLLA) are one of the most urgent problems of the modern vascular surgery and medicine in general. Intensive development of roentgen-endovascular methods of treatment for the diseases of lower limb arteries has led to a considerable revision of the tactics of management of this category of patients in the recent years. Despite the achievements of roentgen-endovascular surgery, frequency of obstructions after surgical revascularization of limbs remains high, both in early and late postoperative periods. It should also be noted that despite the intensive development of methods of therapy of patients with DLLA, frequency of limbs amputation in this category of patients remains high. One of the urgent problems of management of patients with DLLA after endovascular treatment is the problem of restenosis. In the recent years, new efficient methods of pharmacotherapy of DLLA have been developed and introduced into clinical practice, which allows significant improvement of medical prognosis in this category of patients and improvement of the outcomes. It should be noted that standard approaches to antithrombotic therapy in patients after endovascular surgeries based on use of antiaggregant drugs, can only decrease the rate of thrombotic complications, but not of restenosis, which, from the point of view of pathophysiology, is mainly hyperproliferative condition. Among promising approaches to treatment of restenosis, there is use of cilostazol, efficiency of which after endovascular surgeries on coronary and peripheral arteries has been proven in a number of studies.

CROHN’S DISEASE IN CHILDREN: THE CURRENT STATE OF THE PROBLEM

Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

Comparison of Conservative and Surgical Treatment of Grade III Acromio-Clavicular Dislocation

Objectives: To compare the mean of constant score between conservative and surgical treatment in patients with Grade-III acromio-clavicular dislocation. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from July 2020 to June 2021. Study Procedure: This study involved 94 both male and female patients aged between 18-60 years presenting in orthopedic emergency with Grade-III AC dislocation. These patients were assigned into two treatment groups randomly. Patients in Group-A were managed conservatively while those in Group-B were managed surgically with hook plate. Outcome variable was functional shoulder outcome which was assessed after 6 weeks of treatment using constant score. An informed written consent was gained from every patient. Results: The mean age of the patients was 29.9±9.5 years. Majority (n=44, 46.8%) of the patients were young and were aged between 18-30 years followed by 31-40 years (36.2%) and 41-50 years (17.0%). There were 89 (94.7%) male and 5 (5.3%) female patients in the study group with a male to female ratio of 17.8:1. The mean BMI of these patients was 25.2±2.2 Kg/m2. Right side was more frequently involved (54.3%) as compared to the left side (45.7%). Upon follow-up, the mean constant score was significantly higher in patients treated surgically as compared to conservative treatment (86.72±6.75 vs. 67.43±8.93; p-value<0.001). Similar substantial difference was observed through different subgroups based on patient’s age, gender, BMI and side involved. Conclusion: Surgical treatment of patients with Grade-III acromioclavicular dislocation was associated with better functional shoulder outcome as compared to conservative treatment and should be preferred in future practice if there is no contraindication to surgery. Keywords: Grade-III AC Dislocation, Conservative Treatment, Surgical Treatment, Shoulder Function

Post-traumatic coccygodynia: current issues. Review of foreign literature

There are no clear clinical recommendations for the diagnosis and treatment of patients with coccygodynia, and there are still debates about the choice of the best method of diagnosis, the effectiveness of blockades, the indications for surgical treatment and the most appropriate method of surgical treatment, and the need for antibiotics. The aim of the study is to evaluate the current state of the problem of diagnosis, conservative and surgical treatment of patients with post-traumatic coccygodynia based on the analysis of scientific publications. Materials and methods. A review of the literature data published on the problem of diagnosis and treatment of patients with post-traumatic coccigodenia is presented. The features of the anatomical structure of the coccyx are considered. Radiation methods for the diagnosis of coccygodynia, publication materials on the evaluation of the effectiveness of conservative and surgical treatment, and methods of surgical treatment of patients with coccygodynia are presented. The indications for surgical treatment and the results of surgical treatment of patients with coccygodenia are considered. Results. In coccygodynia, surgical treatment is indicated only in patients in whom comprehensive conservative treatment, the combined repeated blockades or radiofrequency ablation of the unpaired sympathetic ganglion are ineffective. Surgical treatment should only be carried out after the diagnosis has been precisely established, including the use of modern radiological diagnostic methods such as CT, MRI. The best method of coccyx resection is subperiosteal total proximal coccygectomy according to Key, with antibiotic therapy. The effectiveness of surgical treatment in patients with idiopathic coccygodynia is lower than in post-traumatic coccygodynia. Conclusion. Complex conservative treatment of patients with coccygodynia in most cases leads to recovery. Steroid blockades or radiofrequency ablation of the impair ganglion prove to be effective. Surgical treatment of post-traumatic coccygodynia is indicated only in cases of resistance to complex conservative treatment and ineffectiveness of blockades. The most optimal method of surgical treatment is subperiosteal proximal complete resection of the coccyx against the background of antibiotics.

Rehabilitation of women after conservative and surgical treatment

The relevance of the study is due to the increase in the volume of conservative and surgical care for women who need mandatory rehabilitation measures in the postoperative period. Until relatively recently, there were very few rehabilitation facilities in the country where women could recover under the supervision of a nurse. Therefore, rehabilitation could drag on for many months and it was very difficult to fully return to normal life. In the modern world, it has become possible to undergo all the necessary analyzes and conduct treatment using the latest scientific methods on high-precision equipment, and then perform a full course of postoperative regeneration. After all, medical centers have great technological capabilities today and control the healing process as soon as possible. The nature of the measures for the recovery of women depends on the changes in the body, which are due to the individual background at the time of treatment. It is important to understand the dependence of a woman's position at the time of recovery: the duration of taking medications, the presence of psychological trauma, the development of chronic diseases, the frequency of repeated interventions. The aim of the study is a step-by-step volumetric study of the implementation of various measures aimed at the rehabilitation of women after conservative and surgical treatment. Modern approaches require responsibility, high qualifications of medical personnel and the direct participation of the patient himself in this process. Timely start of rehabilitation ensures productive restoration of lost functions. The main principle of success is the use of standardized methods, informing the patient at all stages of treatment, using techniques with minimal consequences and maximum impact, and analyzing the course of the postoperative period. The need for an in-depth study of the features of providing medical care to patients with gynecological diseases, including after surgical interventions, is confirmed. The practical significance of the material lies in the high-quality and effective organization of medical rehabilitation, which is of key importance for the full restoration of the functions of the woman's reproductive system.

Left coronary button aneurysm presenting with progressive enlargement after aortic root replacement

Background Aneurysmal degeneration of the coronary button after aortic root replacement using the button technique is a rare but potentially life-threatening complication. However, the appropriate management of this complication, including the indications for conservative and surgical treatment, is still unknown. Case presentation Here we present a 38-year-old woman who successfully underwent surgical repair of a left coronary button aneurysm using the graft interposition technique 24 years after aortic root replacement. Because follow-up computed tomography after aortic root replacement showed a progressively enlarging left coronary button aneurysm, the patient was judged an acceptable candidate for surgical treatment, considering the potential risk of aneurysmal rupture and subsequent myocardial infarction. The postoperative recovery was uneventful. The patient is doing well 1 year after the surgery. Conclusions We believe that serial follow-up using computed tomography is mandatory for coronary button aneurysms, and surgical intervention may be considered if progressive enlargement of the aneurysm is observed, especially in younger patients.