The role of rehabilitation in the management of diabetic foot wounds.

Diabetes is one of the most common health problems worldwide. Diabetic foot wounds (DFWs) are hazardous complications of the disease. Patients are often referred to rehabilitation facilities at later stages of the diabetic complications, particularly after amputation surgery. There are potential benefits of rehabilitation practices in preventing and managing DFWs. Therefore, rehabilitation needs to be more involved in the management of DFWs and should be in all stages of diabetic care. In this review, we discuss literature data to bring rehabilitation perspective to the multidisciplinary management of DFWs.

Prosthetic management of cleft lip and palate

Cleft lip and palate is the most frequent congenital oral dysmophosis (1/600 births). They can be associated with polyformative syndromes. The aetiology is most often unknown, but heredity is still a predominant factor. These clefts result from an absence or insufficient fusion of the different facial buds occurring from the fifth to the 7th week of intrauterine life. They can have several forms. The treatment of cleft lip and palate requires multidisciplinary management. When orthodontics is lacking, the prosthesis takes over. Combined with maxillofacial surgery, the results are spectacular.

Multidisciplinary management to optimize outcome of ultrasound-guided high-intensity focused ultrasound (HIFU) in patients with uterine fibroids

Little is known about the specific anaesthesiological and multidisciplinary management of high-intensity focused ultrasound (HIFU) in uterine fibroids. This observational single-center study is the first reporting on an interdisciplinary approach to optimize outcome following ultrasound (US)-guided HIFU in German-speaking countries. A sample of forty patients with symptomatic uterine fibroids was treated by HIFU. Relevant treatment parameters such as total treatment time for intervention, anaesthesia, and sonication time as well as total energy, body temperature, peri-interventional medication and complications were analyzed. Interventional variables did not correlate significantly either with opioid dose or with body temperature. The average fibroid volume reduction rate was 37.8% ± 23.5%, 48.5% ± 22.0% and 70.2% ± 25.5% after 3, 6 and 12 months, respectively. No major anaesthesiological complications occurred apart from an epileptic seizure prior to HIFU treatment in one patient. Peri-procedural hyperthermia (> 37.5 °C) occurred in two patients. Post-procedural two patients experienced a sciatic nerve irritation up to one year; one patient with very large treated fibroid experienced strong short-lasting post-procedural pain. There were two complication-free pregnancies of HIFU-treated patients. Multidisciplinary management is crucial to optimize safety and outcome of US-guided HIFU for uterine fibroids. Peri-procedural pain and temperature management are critical points where an adequate collaboration between anesthesiologist and interventionalist is mandatory.

Endoscopic retrograde cholangiopancreatography in giant lithiasis of the bile tract: case report and literature review

In Mexico, the prevalence of biliary disease is 8.5% in men and 20.5% in women. Choledocholithiasis is a frequent clinical entity, predominantly in females and with well-defined risk factors. Obstruction of the bile duct due to stones is called giant choledocholithiasis when the largest diameter of the stone is greater than 15 mm. Endoscopic treatment fails in up to 88% of cases of giant choledocholithiasis. The authors presented the case of a patient suffering from giant choledocholithiasis, of 9 years of evolution, with an endoprosthesis, successfully treated by ERCP (endoscopic retrograde cholangiopancreatography). The selection of patients who will undergo this type of procedure must be careful, multidisciplinary management is essential to maintain the optimal conditions possible for each case, since the risks are usually high, it is a fact that the diameter of the distal bile duct it is the most important predictive factor when selecting the diameter of the balloon to use, since excessive dilation increases the risk of perforation.