Abstract 4566: Growth and Function of Hypoplastic Right Ventricles and Tricuspid Valves in Infants with Pulmonary Atresia and Intact Ventricular Septum

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
John E Foker ◽  
James M Berry ◽  
Shaun Setty ◽  
Andrew Rivard ◽  
Adriana C Gittenberger-de Groot ◽  
...  
Keyword(s):  
Pulmonary Atresia ◽  
Pulmonary Regurgitation ◽  
Complete Relief ◽  
Developmental Defect ◽  
The Mean ◽  
Catch Up ◽  
And Function ◽  
Tv Flow ◽  
Rv Function

Objectives The pulmonary atresia intact septum (PAIVS) spectrum includes very hypoplastic right ventricles (RVs) and tricuspid valves (TVs) as well as RV-coronary artery connections (RV-CACs). These abnormalities are often thought irreversible and only 30 – 40% reach a 2-ventricle repair (2VR). Our hypothesis, however, has been PAIVS is a developmental defect and catch-up growth is possible. We provide up to 10 year data on RV and TV growth and function after 2VR. Methods Follow-up echo data were sought on the 24 survivors of the 28 patients (pts) treated from 1989 –1999. Two pts with Ebstein’s anomaly and one without coronary-aorta connections were excluded. Biplane echos were required for accurately estimating RV volume, TV size, and function. Measurements were indexed (I) to determine the z-values (standard deviation of the mean from predicted). Results All patients had an RV outflow patch and ASD reduction. Growth required complete relief of RV obstruction and a mildly restrictive (3–5 mmHg) ASD to encourage TV flow. A central shunt was placed in 38%. RV-CACs (2.7 ± 1.6/pt) were uneventfully ligated off bypass in 9/28 (32%). For the 24 survivors, 19 adequate paired biplane studies were obtained and 12 approached 10 year follow-up. No central shunts remained. The other survivors were satisfactory on local follow-up visits. The TVs, despite increased flow, grew more slowly than RVs. But even very small TVs in 10 pts went from z-values of −4.6 ± 0.4 to −0.04 ± −1.5 within 5–10 years. Normal size was achieved in 9/10 and 1 went from z = −5.2 to −3.1. Valvotomies were done in 3. RV function was high normal (EF = 74.5 ± 0.1%) because of pulmonary regurgitation in 8 pts with adequate studies. Conclusions 1) Catch-up growth appears reliable in PAIVS pts even for TV z-values ≤ −4.0. 2) The consequences of PAIVS can be reversed by growth when RV obstruction is relieved and TV flow increased. 3) RV function was good and resembled well repaired TOF. 4) These results encourage pursuing 2VRs in PAIVS pts. Paired follow-up z-values and indexed sizes for the RVs and TVs

Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study

2021 ◽  
Author(s):  
Ouidade A. Tabesh ◽  
Roba Ghossan ◽  
Soha H Zebouni ◽  
Rafic Faddoul ◽  
Michel Revel ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Iliac Crest ◽  
Pain Syndrome ◽  
Clinical Findings ◽  
Complete Relief ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
The Mean

Abstract Aim. To evaluate ultrasonography findings of Thoracolumbar Fascia (TLF) enthesis in patients with low back pain (LBP) due to iliac crest pain syndrome (ICPS). Method. The ultrasonographic and clinical findings of 60 patients with LBP due to ICPS were compared to those of 30 healthy volunteers with no LBP. Thickness of the TLF was measured with ultrasound (US) at its insertion on the iliac crest. Results. Forty-eight women and 12 men with a mean age of 42.1±11.3 years were diagnosed with ICPS. In patients, the mean thickness of the TLF was 2.51±0.70mm in affected sides compared to 1.81±0.44mm in the contralateral unaffected sides. The mean thickness difference of 0.82mm between the affected and non-affected sides was statistically significant (95%CI, 0.64-0.99, P<0.0001). In volunteers, the mean thickness of the TLF was 1.6±0.2mm. The mean thickness difference of 0.89mm between the affected sides of patients and volunteers was statistically significant (95%CI, 0.73-1.06, P<0.0001). Forty-two patients who didn’t improve with conservative therapy, received injections of methylprednisolone acetate and 1% lidocaine around the TLF enthesis. All patients reported complete relief of their LBP within 20 minutes of the injections thanks to the lidocaine anesthetic effect. Fifty-six (93.3%) patients were reached by phone for a long-term follow-up. Among them, 33 (58.9%) patients experienced a sustained complete pain relief after a mean follow-up of 45±19.3 months (range, 3-74 months). Conclusion. our findings suggest that TLF enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US.

scholarly journals Turbinoplasty of hypertrophied inferior turbinate by diode laser

1970 ◽  
Vol 16 (1) ◽  
pp. 29-34
Author(s):  
Md Rojibul Hoque ◽  
Asaduzzaman Rasel ◽  
Md Khalid Asad ◽  
Moni Lal Aich
Keyword(s):  
Diode Laser ◽  
Local Anesthesia ◽  
Operation Time ◽  
Inferior Turbinate ◽  
Complete Relief ◽  
Clinical Experiences ◽  
Short Operation Time ◽  
The Mean ◽  
Conventional Radiology

Background: Different laser types have been used for the treatment of hypertrophied inferiornasal turbinates. The clinical experiences of its treatment by means of a diode laser are presented.Methods: A total of 45 patients suffering from nasal obstruction due to hypertrophied inferiorturbinates (HIT) were treated with a continuous diode laser (14 W- 940 nm) in "contact" modeand under local anesthesia. Thirty patients (16 with allergic rhinitis and 14 with vasomotorrhinitis) were included into this clinical trial with a follow-up of 6 months. The study wasconducted by a questionnaire, photo documentation, conventional radiology of the paranasalsinuses, and histology.Results: The mean operation time took 8 min/turbinate, no nasal packing was necessary andno immediate complications (e.g., bleeding) were observed. Statistical analysis revealedsignificant subjective improvement (86%) of the nasal airflow and nasal cavity volume (photodocumentation) 6 months after laser surgery. In addition, complete relief of headache wasachieved in 32%. The remission rates of persistent rhinorrhoea and post-nasal dripping were,at about 88% and 64%, respectively. Atrophic change and synechiae had not been observed.Conclusions: Diode laser treatment of HIT is a useful procedure, which can be performed as anoutpatient surgery under local anesthesia, resulting in a controlled coagulation and ablation of thesoft tissue. The short operation time and the good results provide an excellent patient acceptance.Key words: Diode Laser; Hypertrophied Inferior Turbinate; Turbinoplasty.DOI: 10.3329/bjo.v16i1.5778Bangladesh J Otorhinolaryngol 2010; 16(1): 29-34

scholarly journals Cannulated Cancellous Screw Fixation for Capitellum Fractures in Adolescents

2011 ◽  
Vol 19 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Kee Leong Ong ◽  
Arjandas Mahadev
Keyword(s):  
Performance Index ◽  
Kirschner Wire ◽  
Excellent Outcome ◽  
Excellent Functional Outcome ◽  
Cancellous Screws ◽  
The Mean ◽  
And Function ◽  
Anterior Direction

Purpose. To review the outcome of 9 adolescents treated with 2 to 3 cannulated cancellous screws for type-1 capitellum fractures. Methods. Records of 8 boys and one girl aged 12 to 14 (mean, 14) years with type-1 capitellum fractures were reviewed. The mechanism of injury was a fall on the flexed elbow. No patient had associated injuries or neurovascular compromise. In 2 patients, the fracture was minimally displaced and treated with a cast. The remaining 7 patients with displaced fractures underwent open reduction and internal fixation using 4.0-mm cannulated partially threaded cancellous screws inserted in a posterior-to-anterior direction. In one patient, a Kirschner wire was added to fix a small comminuted fragment. Elbow pain, range of motion, stability, and function were evaluated using the Mayo Elbow Performance Index. Results. The mean follow-up period was 7 (range, 2–18) months. The mean Mayo Elbow Performance Index score was 100, indicating excellent outcome. No patient developed avascular necrosis or heterotrophic ossification. All patients achieved anatomic bone union. All implants were removed after a mean of 4.7 (range, 2–7) months. Conclusion. The fixation of type-1 capitellum fractures with 2 to 3 cannulated cancellous screws inserted posteroanteriorly achieved excellent functional outcome.

scholarly journals Effect of thyroxine on initial catch-up growth in children with hypothyroidism

2019 ◽  
Vol 7 (1) ◽  
pp. 159
Author(s):  
Ami H. Patel ◽  
Pinakin P. Trivedi
Keyword(s):  
Growth Parameters ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Height Velocity ◽  
Total Serum ◽  
P Value ◽  
Adequate Treatment ◽  
The Mean ◽  
Catch Up

Background: Hypothyroidism is a common endocrinal cause of growth retardation in children. Following adequate treatment with thyroxine, growth resumes at an accelerated rate which is known as catch-up growth. There are few observational studies from India on the growth parameters following treatment with thyroxine in children with hypothyroidism.Methods: A retrospective study was done in children aged 2-10 years who were newly diagnosed cases of primary hypothyroidism [Total serum Thyroxine (T4) levels <5 µg/dl and serum Thyroid Stimulating Hormone (TSH) levels ˃15 µU/ml] and treated with oral thyroxine to attain euthyroid state. Height measured before starting treatment and at the time of follow up visits was noted, the Height Standard Deviation Scores (HSDS) were calculated. The effect of thyroxine on linear growth was studied.Results: There were 23 children who were diagnosed as having primary hypothyroidism of whom 16(69.6%) were females and 7(30.4%) were males. The mean age of the children studied was 7.3±2.3 years. The mean dose of thyroxine required to maintain euthyroid status was 4.6±2.2 µg/kg/day. Mean duration of follow up was 13.7±2.4 months. The initial HSDS was - 2.31±0.9 which improved to a final value of - 1.7±0.76 (ΔHSDS0.61, p value <0.0001). Mean height velocity was 8.1 cms/year.Conclusions: Following adequate thyroxine replacement therapy catch-up growth occurs and increased growth velocity leads to partial regain of height deficit in the first couple of years of treatment.

scholarly journals Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901876857 ◽  
Author(s):  
Eduard Alentorn-Geli ◽  
Nathan R Wanderman ◽  
Andrew T Assenmacher ◽  
John W Sperling ◽  
Robert H Cofield ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Simple Shoulder Test ◽  
Posterior Subluxation ◽  
The Mean ◽  
Group 2 ◽  
And Function ◽  
Group 1

Purpose: To compare the outcomes of total shoulder arthroplasty (TSA) with posterior capsule plication (PCP) and reverse shoulder arthroplasty (RSA) in patients with primary osteoarthritis, posterior subluxation, and bone loss (Walch B2). Patients and methods: All shoulders undergoing anatomic TSA with PCP were retrospectively identified (group 1, G1) and compared to shoulders undergoing RSA (group 2, G2) for Walch B2 osteoarthritis. There were 15 patients in G1 (mean (SD) age and follow-up of 70.5 (7.5) years and 42.8 (18.4) months, respectively) and 16 patients in G2 (mean (SD) age and follow-up of 72.6 (5.4) years and 35.1 (14.2) months, respectively). Results: Both groups had substantial improvements in pain and function. In G1, results were excellent in 80% and satisfactory in 20%, compared to 81% and 6% in G2, respectively ( p = 0.2). The mean (SD) American Shoulder and Elbow Surgeons score was 91.2 (6.7) and 80.3 (14.3) in G1 and G2, respectively ( p = 0.08). The mean Simple Shoulder Test score was 10.6 in G1 and 8.5 in G2 ( p = 0.01). There were no reoperations in either group, but G1 had seven postoperative complications. Conclusions: The outcomes of TSA with PCP are comparable to RSA in patients with osteoarthritis and biconcave glenoids. However, TSA leads to more complications while RSA leads to lower functional outcomes.

scholarly journals Staged Correction of Pulmonary Atresia, Ventricular Septal Defect and Collateral Arteries

2021 ◽  
Author(s):  
Pieter van de Woestijne ◽  
M. Mokhles ◽  
Ingrid van Beynum ◽  
Peter de Jong ◽  
Jeroen Wilschut ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Pulmonary Vasculature ◽  
Collateral Arteries ◽  
Staged Approach ◽  
The Right ◽  
Rv Function

Objectives Pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic-pulmonary collateral arteries (SPCA’s) has a variable anatomy with regard to the pulmonary vasculature, asking for an individualized surgical treatment. A protocol was applied consisting of staged unifocalization and correction. Methods Since 1989 39 consecutive patients were included (median age at first operation 13 months). In selected cases a central aorto-pulmonary shunt was performed as first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Postoperatively and at follow up echocardiographic data were obtained. Results In 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, four of them died. One patient is awaiting further correction. Correction was done successfully in 28 patients. Operative mortality was 3% and late mortality 11%. Median follow-up after correction was 19 years. Eleven patients needed homograft replacement. Freedom from conduit replacement was 88%, 73% and 60% at 5, 10 and 15 years respectively. Right ventricular function was reasonable or good in 75 % of the patients. Conclusions After complete unifocalization 30/37 patients (81%) were considered correctable. The main reasons for palliative treatment without correction were pulmonary hypertension and/or inadequate outgrowth of pulmonary arteries. Staged approach of PA, VSD and SPCA’s results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients.

scholarly journals Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

2019 ◽  
Vol 47 (5) ◽  
pp. 1998-2010 ◽  
Author(s):  
Liang Sun ◽  
Zhong Li ◽  
Teng Ma ◽  
Han-Zhong Xue ◽  
Qian Wang ◽  
...  
Keyword(s):  
Bone Healing ◽  
Case Series ◽  
Lower Limbs ◽  
Structural Environment ◽  
Tibial Nonunion ◽  
The Mean ◽  
And Function ◽  
Atrophic Nonunion ◽  
Humeral Nonunion

Objective To investigate the efficacy of the treatment of atrophic nonunion using structural autogenous ilium bone grafting in combination with vertical fixation of double plates. Methods This retrospective study analysed the clinical data from consecutive patients with atrophic nonunion who underwent autogenous ilium grafting in combination with double-plate vertical fixation. The injury type and the bone affected by nonunion, the duration of nonunion and the outcomes following surgery were recorded for all patients. Results The study enrolled 43 patients with atrophic nonunion of the upper and lower limbs: 17 patients with tibial nonunion, 21 with femoral nonunion, four with humeral nonunion and one with radial shaft nonunion. The mean duration of postoperative follow-up was 14.5 months (range, 8–28 months). A total of 43 of 43 patients (100%) achieved a healed nonunion fracture without the occurrence of complications such as infection, fracture of internal fixation or pain in the harvesting site. Comprehensive postoperative assessments of bone healing and function were observed to be good and/or excellent in all 43 patients. Conclusion Structural autogenous ilium grafting used in combination with double-plate vertical fixation can provide a stable structural environment for near optimal bone healing in patients with atrophic nonunion.

Abstract 3126: Pulmonary Valve Replacement In Chronic Pulmonary Regurgitation In Adults With Congenital Heart Disease: Influence Of Preoperative QRS-duration On Postoperative Right Ventricular Function

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mechthild Westhoff-Bleck ◽  
Girke Stefan ◽  
Thomas Breymann ◽  
Joachim Lotz ◽  
Stafanie Pertsch ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Cardiorespiratory Function ◽  
Qrs Duration ◽  
Rv Function

Background: Chronic pulmonary regurgitation (PR) causes progressive right ventricular (RV) dysfunction and heart failure. Parameters defining the optimal time point for surgery of chronic PR are lacking. The present study prospectively evaluated the impact of clinical parameters, cardiorespiratory function and neurohumoral activation on post operative RV function and volumes assessed with magnetic resonance imaging (MRI) after pulmonary valve replacement in patients with severe PR. Methods and Results: MRI was performed preoperatively and at follow-up 5.2±3.5months after surgery in 27 patients (23.6±2.9 years, 15 women) with severe PR. Underlying cardiac disease was repaired Tetralogy of Fallot (n=22), Double outlet right ventricle (n=3) and PR after pulmonary valvulotomy (n=2). Postoperatively, RV endsystolic (RVESVI) and enddiastolic volume indices (RVEDVI) decreased significantly (RVESVI pre 78,2±20,4 ml/m 2 BSA vs. RVESVI post 52,2±16,8 ml/m 2 BSA, p<0,001; RVEDVI pre 150,7±27,7 ml/m 2 BSA vs. RVEDVI post 105,7±26,7 ml/m 2 BSA; p<0,001). Mean RV ejection fraction (RVEF) remained unchanged in the study cohort (47.6 ± 8.7% vs. 49.7 ±7.0%, n.s.). Preoperative volumes did not correlate with postoperative ejection fraction. With increasing preoperative QRS-duration, postoperative RVEF decreased significantly (r=−0.57; p<0,005). A preoperative QRS-duration smaller than the median (156ms) predicted an improved RVEF as compared to a QRS-duration ≤ 156ms (54.9% vs. 46.8%, p<0.05). Neither elevated NT-proBNP levels nor reduced cardiorespiratory function were able to predict postoperative RVEF. Conclusion: Valve replacement in severe pulmonary regurgitation causes significant reduction of RV volumes. Prolonged preoperative QRS-duration was associated with a worse outcome with respect to postoperative RVEF. During follow-up an increase in QRS-duration in patients with chronic PR might indicate deterioration in RV function reflecting a risk of impaired RV function postoperatively.

scholarly journals Intradialytic resistance training: an effective and easy-to-execute strategy

2019 ◽  
Vol 41 (2) ◽  
pp. 215-223
Author(s):  
Antônio Paulo André de Castro ◽  
Sergio Ribeiro Barbosa ◽  
Henrique Novais Mansur ◽  
Danielle Guedes Andrade Ezequiel ◽  
Mônica Barros Costa ◽  
...  
Keyword(s):  
Resistance Training ◽  
Adverse Events ◽  
Skeletal Muscles ◽  
Low Cost ◽  
Nephrology Care ◽  
The Mean ◽  
Muscle Groups ◽  
And Function

Abstract Chronic kidney disease (CKD) alters the morphology and function of skeletal muscles, thereby decreasing patient physical capacity (PC) and quality of life (QoL). Intradialytic resistance training (IRT) is a pragmatic tool used to attenuate these complications. However, IRT has not been strongly adopted in nephrology care centers. This study aimed to assess the efficacy and safety of a low-cost, easy-to-use IRT protocol. Methods: The study enrolled 43 patients (52.8 ± 13.85 years) on HD for five to 300 months followed from April 2014 to July 2017. The efficacy of IRT was assessed based on PC - derived from muscle strength (MS) and preferred walking speed (PWS) - and QoL. The occurrence of adverse events was used as a measure of safety. The IRT protocol consisted of exercises of moderate to high intensity for the main muscle groups performed three times a week. Results: The mean follow-up time was 9.3 ± 3.24 months, for a total of 4,374 sessions of IRT. Compliance to the protocol was 96.5 ± 2.90%, and patients presented significant improvements in MS (from 27.3 ± 11.58 Kgf to 34.8 ± 10.77 Kgf) and PWS (from 0.99 ± 0.29 m/s to 1.26 ± 0.22 m/s). Physical and emotional components of QoL also increased significantly. Conclusion: IRT led to significant increases in PC and higher scores in all domains of QoL. Important adverse events were not observed during intradialytic resistance training.

Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors

2002 ◽  
Vol 96 (1) ◽  
pp. 131-134 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Chang Hun Rhee ◽  
Seung Hoon Lee
Keyword(s):  
Vertebral Column ◽  
Screw Fixation ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Complete Relief ◽  
Content Type ◽  
Vertebral Bodies ◽  
The Mean ◽  
Fine Print

✓ Screw fixation augmented with polymethylmethacrylate (PMMA) or some other biocompatible bone cement has been used in patients with osteoporosis requiring spinal fusion. No clinical studies have been conducted on PMMA-augmented screw fixation for stabilization of the vertebral column in patients with metastatic spinal tumors. The purpose of this study was to determine whether screw fixation augmented with PMMA might be suitable in patients treated for multilevel metastatic spinal tumors. Ten patients with metastatic spinal tumors involving multiple vertebral levels underwent stabilization procedures in which PMMA was used to augment screw fixation after decompression of the spinal cord. Within 15 days, partial or complete relief from pain was obtained in all patients postoperatively. Two of four patients in whom neurological deficits caused them to be nonambulatory before surgery were able to ambulate postoperatively. Neither collapse of the injected vertebral bodies nor failure of the screw fixation was observed during the mean follow-up period of 6.7 months. Screw fixation augmented with PMMA may offer stronger stabilization and facilitate the instrumentation across short segments in the treatment of multilevel metastatic spinal tumors.

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