Complications Encountered with Circular Ring Fixation in Persons with Diabetes Mellitus

2008 ◽  
Vol 29 (10) ◽  
pp. 994-1000 ◽  
Author(s):  
Dane K. Wukich ◽  
Ronald J. Belczyk ◽  
Patrick R. Burns ◽  
Robert G. Frykberg
Keyword(s):  
Group Versus ◽  
Circular Ring ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
Duration Of Treatment ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Charcot Neuroarthropathy ◽  
Patients With Diabetes

Background: The purpose of this study was to identify and report the complications associated with the use of circular ring fixation in diabetic patients, and to compare the frequency of complications in patients without diabetes. We hypothesized that complications with circular ring fixation occurred more frequently in patients with diabetes than patients without diabetes. Materials and Methods: Institutional Review Board approval was obtained and patient charts were retrospectively reviewed from June 2004 and February 2007. Fifty six consecutive patients undergoing midfoot, hindfoot and/or ankle surgery were treated with circular ring fixation which included 33 diabetic patients in the study group and 23 non-diabetic patients in the control group. Patient demographics, the duration of treatment with the external fixator, and complications were recorded. Results: Males had a greater number of complications compared to females ( p = 0.0014). The total number of complications was statistically greater in diabetic patients (study group) versus non-diabetic patients (control group) ( p = 0.003). In multivariate logistic regression, diabetes and male sex were the only significant variables associated with wire complications (OR 7.35, 95% CI 1.93-28.04 and OR 0.22, 95% CI 0.05-8584111, respectively). Conclusion: Women are protected from wire complications with a risk reduction of 78% compared to males. Diabetics have a 7-fold risk for any wire complication compared to patients without diabetes. We found no adverse effects of BMI, obesity, age, smoking, neuropathy, or Charcot neuroarthropathy on a satisfactory recovery. Level of Evidence: IV, Retrospective Case Study

Outcomes of Prophylactic Epiglottic Petiole Suspension at the Time of Complete Laryngofissure

2019 ◽  
Vol 161 (4) ◽  
pp. 652-657 ◽  
Author(s):  
Mathieu Bergeron ◽  
Alessandro de Alarcon ◽  
Catherine K. Hart ◽  
Michael J. Rutter
Keyword(s):  
Case Series ◽  
Group Versus ◽  
Exercise Intolerance ◽  
Control Group ◽  
Study Group ◽  
Pediatric Hospital ◽  
Retrospective Case ◽  
Obstructive Sleep ◽  
Airway Reconstruction

ObjectivesTo compare the clinical outcomes of patients with prophylactic petiole suspension (PPS) at the time of laryngofissure and patients without PPS.Study DesignRetrospective case series.SettingTertiary pediatric hospital from May 2003 to August 2017.Subjects and MethodsPatients included those undergoing airway reconstruction with complete laryngofissure. Patients in the study group had PPS at the time of laryngofissure, while control group patients did not.ResultsEighty-one patients underwent complete laryngofissure (22 study patients, 59 controls) at a median age of 4.8 years (interquartile range, 2.1-9.7). Patients in the control group were younger at the time of the surgery (3.7 vs 6.5 years, P = .04). Other demographic and clinical data, including subglottic stenosis (SGS) grades, were similar. For patients with SGS, 53.8% and 46.2% in the study group had a grade 1-2 and 3-4 SGS, respectively, as compared with 46.2% and 53.8% in the control group ( P = .65). Manifestations of petiole prolapse included failure of decannulation (8.6%), exercise intolerance (16.0%), and obstructive sleep apnea (11.1%). After 4 years of follow-up, 4.5% of the study group versus 27.1% of the control group had prolapse of the petiole ( P = .04). Petiole prolapsed affected >50% of patients with no PPS after 10 years of follow-up. Patients with petiole prolapse at the first surveillance microlaryngoscopy and bronchoscopy after stent removal had an odds ratio of 10.2 (95% CI, 1.1-94.8; P = .04) of becoming symptomatic.ConclusionPatients with PPS had significantly fewer symptoms after complete laryngofissure as compared with patients without PPS. PPS should be considered when a complete laryngofissure is being performed during airway reconstruction.

scholarly journals Analysis of Health Education and Nursing Effect of Diabetic Patients Based on Clinical Path

2020 ◽  
Vol 9 (1) ◽  
pp. 6
Author(s):  
Yun Yang
Keyword(s):  
Blood Glucose ◽  
Health Education ◽  
Clinical Pathways ◽  
Study Groups ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Patients With Diabetes

<p>Objective: To explore the nursing effect of health education based on clinical pathways on patients with diabetes. Methods: 80 patients with diabetes participated in the study, and the consultation period was from February 2019 to February 2020. In this study, patients were first divided into control and study groups, and then different health education methods were implemented. The control group was routine health education and nursing, and the patients in the study group were based on clinical pathways for health education and nursing. Observation indicators for statistics of two groups of patients include: Blood glucose levels before and after nursing, and satisfaction with nursing to achieve the purpose of analyzing the effects of health education nursing measures. Results: The differences in blood glucose levels between the groups before nursing were small (P＞0.05), and all improved after the nursing, and the improvement degree of the research group was better than that of the control group (P＜0.05); the satisfaction of the control group and the study group on nursing were 75% (30/40) and 97.5% (39/40), respectively, and the study group was significantly higher (P &lt; 0.05). Conclusion: For the health education and nursing of diabetic patients, the implementation based on the clinical path has ideal value, so it can be applied.</p>

scholarly journals Risk factors for third- and fourth-degree perineal tears during vaginal delivery

2011 ◽  
Vol 25 (1) ◽  
pp. 2
Author(s):  
Leonard Juul ◽  
Gerhard B. Theron
Keyword(s):  
Risk Factors ◽  
Shoulder Dystocia ◽  
Control Group ◽  
Study Group ◽  
Tertiary Referral Hospital ◽  
Retrospective Case ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Vaginal Deliveries ◽  
Hiv Negative

<strong>Objective</strong>. To identify risk factors for thirdand fourth-degree perineal tears, so as to anticipate and intervene in order to prevent this complication that can severely affect a woman’s quality of life. The study design was a retrospective case control study. <strong>Method</strong>. Ninety-three cases of third- and fourth-degree perineal tears were identified from the birth register of a tertiary referral hospital (Tygerberg Hospital). One hundred and nine patients with normal vaginal deliveries in the same time period were used as control group. <strong>Results</strong>. An analysis of the results revealed that there were no significant differences between cases and controls with regards to age, body mass index (BMI), gestation at delivery, duration of second stage, episiotomy and birth weight. However, there were significantly more primigravidas, assisted deliveries (forceps and vacuum), occipitoposterior positions, HIV negative patients and shoulder dystocia in the study group. <strong>Conclusions</strong>. Antenatal risk factors for thirdand fourth-degree tears are difficult to identify. However, intrapartum occipitoposterior and assisted deliveries, especially in the primigravid patient, should warn the obstetrician/ midwife about the risk of a severe tear. A restrictive episiotomy policy should be practiced. Shoulder dystocia was invariably associated with third- and fourth-degree tears in this study. The higher incidence of HIV negative patients in the study group requires further research.

scholarly journals THE EFFECT OF RECTAL PROGESTERONE ON DOPPLER PARAMETERS OF THE UTERINE ARTERIES FOR THE PREVENTION OF PRETERM DELIVERY IN IRAQI POPULATION

2018 ◽  
Vol 11 (10) ◽  
pp. 545
Author(s):  
Fatin Shallal Farhan ◽  
Ban Hadi Hameed ◽  
Muna Abdulghani Zghair
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Resistance Index ◽  
Control Group ◽  
Study Group ◽  
Duration Of Treatment ◽  
Uterine Arteries ◽  
Doppler Study ◽  
Threatened Preterm Labor ◽  
Doppler Indices

Objective: The effectiveness of progesterone in the prevention of threatened preterm labor has been established for many years, but the preferable route, dose, and duration of treatment are until now under the evaluation of researches. The aim of this study was to determine the effect of rectal progesterone on Doppler indices of the uterine arteries in pregnant women with threatened preterm delivery.Methods: A prospective case–control study was conducted at the obstetric ward and the Outpatients Department of Al-Yarmouk Teaching Hospital in Baghdad for the period of 1 year from April 1, 2017, to April 1, 2018. 100 women were enrolled in the study, 50 of them were pregnant women with a diagnosis of preterm labor assigned as a study group and the other 50 were apparently healthy pregnant women of the same gestational age assigned as a control group. Doppler study of uterine arteries was done to all participants, and the results were compared for both groups. The patients with preterm labor received nifedipine tocolysis initially until contractions subsided and Doppler study had been repeated for those women after 1 week of rectal progesterone therapy.Results: The study group had a significantly higher resistance index (RI) than the control group (0.58 vs. 0.52) as p<0.05, in spite of the pulsatility index (PI) being higher for the study group compared to the control group (0.78 vs. 0.77) but this difference was not statistically significant. The RI before the therapy (0.58) was significantly higher than the index after therapy (0.52), and the PI was again significantly higher before therapy (0.78) than after therapy (0.71) as p<0.05. During the follow-up period, 3 (6.5%), 4 (8.7), and 39 (84.8%) patients delivered within 1 week, after 1 week, and at term, respectively.Conclusion: Rectal progesterone can arrest threatened preterm labor, and this effect is possible in part explained by its action on uterine arteries.

scholarly journals Clinical efficacy of oxidative stress correction by actovegin in diabetic polyneuropathy at type 2 diabetic patients with arterial hypertension

2010 ◽  
Vol 13 (2) ◽  
pp. 84-89
Author(s):  
Ivan Petrovich Gorshkov ◽  
Vladimir Ivanovich Zoloedov ◽  
Anna Petrovna Volynkina
Keyword(s):  
Oxidative Stress ◽  
Arterial Hypertension ◽  
Diabetic Polyneuropathy ◽  
Oxidative Capacity ◽  
Control Group ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Patients With Diabetes ◽  
Total Antioxidant

Aim. To study Actovegin efficacy in oxidative stress (OS) correction at diabetic polyneuropathy (DPN) in patients with diabetes mellitus type 2 (DM2)and arterial hypertension (AH).Materials and Methods. 51 patients (24 women and 27 men) aged 53.4?0.7 with the average duration of DM2 5.6?0.2 years, DPN - 4.9?0.2years and AH - 6.0?0.2 years were examined. Daily albuminuria, glomerular filtration rate (GRF) were evaluated, standard methods for diagnosisof DPN were used. 26 patients took Actovegin therapy during 6-8 weeks, the rest 25 patients were in the control group. Parameters of the OS werestudied. Results. The increase of total oxidative capacity, the decrease of total antioxidant capacity and the rise of levels of antibodies to oxidated LDL wererevealed in patients with DM2, DPN and AH. Antioxidant and anti-hypoxic effects of 400 mg/day of Actovegin were established in this group of patients.Conclusions. Actovegin impacts oxidative stress parameters and improves the clinical manifestation of diabetic polyneuropathy.

scholarly journals Volume rendered 3D OCTA assessment of macular ischemia in patients with type 1 diabetes and without diabetic retinopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Enrico Borrelli ◽  
Domenico Grosso ◽  
Mariacristina Parravano ◽  
Eliana Costanzo ◽  
Maria Brambati ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Healthy Subjects ◽  
Diabetic Group ◽  
Control Group ◽  
Diabetic Patients ◽  
Vascular Volume ◽  
Patients With Diabetes ◽  
Perfusion Density

AbstractThe aim of this study was to measure macular perfusion in patients with type 1 diabetes and no signs of diabetic retinopathy (DR) using volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). We collected data from 35 patients with diabetes and no DR who had OCTA obtained. An additional control group of 35 eyes from 35 healthy subjects was included for comparison. OCTA volume data were processed with a previously presented algorithm in order to obtain the 3D vascular volume and 3D perfusion density. In order to weigh the contribution of different plexuses’ impairment to volume rendered vascular perfusion, OCTA en face images were binarized in order to obtain two-dimensional (2D) perfusion density metrics. Mean ± SD age was 27.2 ± 10.2 years [range 19–64 years] in the diabetic group and 31.0 ± 11.4 years [range 19–61 years] in the control group (p = 0.145). The 3D vascular volume was 0.27 ± 0.05 mm3 in the diabetic group and 0.29 ± 0.04 mm3 in the control group (p = 0.020). The 3D perfusion density was 9.3 ± 1.6% and 10.3 ± 1.6% in diabetic patients and controls, respectively (p = 0.005). Using a 2D visualization, the perfusion density was lower in diabetic patients, but only at the deep vascular complex (DVC) level (38.9 ± 3.7% in diabetes and 41.0 ± 3.1% in controls, p = 0.001), while no differences were detected at the superficial capillary plexus (SCP) level (34.4 ± 3.1% and 34.3 ± 3.8% in the diabetic and healthy subjects, respectively, p = 0.899). In conclusion, eyes without signs of DR of patients with diabetes have a reduced volume rendered macular perfusion compared to control healthy eyes.

scholarly journals Early Detection of Microvascular Changes in Patients with Diabetes Mellitus without and with Diabetic Retinopathy: Comparison between Different Swept-Source OCT-A Instruments

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Stela Vujosevic ◽  
Caterina Toma ◽  
Edoardo Villani ◽  
Valentina Gatti ◽  
Marco Brambilla ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Group Versus ◽  
Retinal Disease ◽  
Control Group ◽  
Microvascular Damage ◽  
Swept Source ◽  
Microvascular Changes ◽  
Circularity Index ◽  
Patients With Diabetes ◽  
Perfusion Density

Optical coherence tomography angiography (OCT-A) has recently improved the ability to detect subclinical and early clinically visible microvascular changes occurring in patients with diabetes mellitus (DM). The aim of the present study is to evaluate and compare early quantitative changes of macular perfusion parameters in patients with DM without DR and with mild nonproliferative DR (NPDR) evaluated by two different swept-source (SS) OCT-A instruments using two scan protocols (3×3 mm and 6×6 mm). One hundred eleven subjects/eyes were prospectively evaluated: 18 healthy controls (control group), 73 eyes with DM but no DR (no-DR group), and 20 eyes with mild NPDR (DR group). All quantitative analyses were performed using ImageJ and included vessel and perfusion density, area and circularity index of the FAZ, and vascular complexity parameters. The agreement between methods was assessed according to the method of Bland-Altman. A significant decrease in the majority of the considered parameters was found in the DR group versus the controls with both instruments. The results of Bland-Altman analysis showed the presence of a systemic bias between the two instruments with PLEX Elite providing higher values for the majority of the tested parameters when considering 6×6 mm angiocubes and a less definite difference in 3×3 mm angiocubes. In conclusion, this study documents early microvascular changes occurring in the macular region of patients at initial stages of DR, confirmed with both SS OCT-A instruments. The fact that early microvascular alterations could not be detected with one instrument does not necessarily mean that these alterations are not actually present, but this could be an intrinsic limitation of the device itself. Further, larger longitudinal studies are needed to better understand microvascular damage at very early stages of diabetic retinal disease and to define the strengths and weaknesses of different OCT-A devices.

Negative Interaction between Lithium and Electroconvulsive Therapy – A Case-Control Study

1996 ◽  
Vol 168 (2) ◽  
pp. 241-243 ◽  
Author(s):  
A. K. Jha ◽  
G. S. Stein ◽  
P. Fenwick
Keyword(s):  
Adverse Effects ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Study Group ◽  
Negative Interaction ◽  
Retrospective Case ◽  
Concurrent Use ◽  
Control Study ◽  
Age And Sex

BackgroundConcurrent use of lithium and ECT is suspected to increase neurotoxicity.MethodA retrospective case-control study over an eight-year period was conducted to investigate the adverse effects of a combined lithium/ECT treatment Thirty-one subjects with combined lithium/ECT treatment were compared with a control group (ECT only) of 135 cases matched for age and sex.ResultsMost cases in both groups had no adverse effects. Three (10%) study group subjects and 15 (11 %) controls experienced brief delirium. Three controls and none of the subjects developed a prolonged confusion. There were no significant differences in the profile of other adverse effects between the two groups.ConclusionPrescription of lithium together with ECT was not associated with higher frequency of adverse effects.

Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy

2020 ◽  
Vol 134 (4) ◽  
pp. 350-353
Author(s):  
M Narayan ◽  
S Limbachiya ◽  
D Balasubramanian ◽  
N Subramaniam ◽  
K Thankappan ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Small Volume ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Study Group ◽  
Retrospective Case ◽  
Control Study ◽  
Pharyngocutaneous Fistulae

AbstractObjectivesPharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.MethodsA retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.ResultsIn the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.ConclusionSmall-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.

Tibiocalcaneal Arthrodesis Using the Ilizarov Technique in the Presence of Bone Loss and Infection of the Talus

2008 ◽  
Vol 29 (10) ◽  
pp. 1001-1008 ◽  
Author(s):  
Robert Rochman ◽  
James Jackson Hutson ◽  
Oladapo Alade
Keyword(s):  
Bone Loss ◽  
Circular Ring ◽  
Successful Outcome ◽  
Ilizarov Technique ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ring Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
Final Followup ◽  
Retrospective Case Study

Background: Infected nonunions and extrusions of the talus can often lead to below-knee amputation. Limb-salvage procedures have goals of eradicating infection and creating a painless, stable limb. Often, a tibiocalcaneal fusion is the best option; however, in the presence of infection and bone loss, it can be difficult to achieve a successful outcome using internal fixation. We review the results of circular ring external fixation to obtain a tibiocalcaneal arthrodesis despite these obstacles. Methods: A retrospective review of 11 patients who underwent tibiocalcaneal arthodesis using an Ilizarov external fixator for infected talar nonunions or extrusions was performed. Each patient had a debridement of all nonviable talus. The bony surfaces were prepared for the fusion followed by application of a circular ring fixator. Clinical outcomes were measured using the AOFAS ankle-hindfoot scale. There was a mean followup of 35 months. Results: Nine of the 11 patients had successful fusions. One fused successfully after a revision and the other developed a stable pseudoarthrosis. Eight patients underwent concomitant lengthening with the Ilizarov fixator. Mean AOFAS score at final followup was 65. This was out of a maximum of 86 since the tibiotalar and subtalar joint motion were removed. There were no recurrent deep infections or amputations. Conclusions: Tibiocalcaneal arthrodesis using the Ilizarov technique is a viable alternative to amputation in patients with infected nonunions or large bone loss of the talus. Level of Evidence: IV, Retrospective Case Study

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