Development Of Contracture Research Articles

Factors Associated with Development of New Joint Contractures in Long-Term Care Residents.

Limb contractures are associated with poor outcomes and quality of life in long-term care (LTC) residents. This study examined the rate of developing new joint contracture in the LTC residents and associated risk factors to formulate effective interventions in this critical but understudied area. This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTC Residents between 2005 and 2016. Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data of the residents from 9 residential LTC facilities. Limb contractures were defined as a functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes included annual prevalence of joint contractures and factors that were associated with the development of new joint contractures. We analyzed the data for 1914 older residents (674 males, mean age 83.4 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 29.8% to 36.5%, and lower limb contractures increased from 41.5% to 57.4%. Overall, the increment of the prevalence rate of joint contractures per year ranged from 0.7% to 3.2% for the upper limbs and 0.3% to 6.0% per year for the lower limbs. Impaired mobility, presence of neurologic diseases, and older age were the leading independent risk factors for the development of new joint contractures. Joint contractures are highly prevalent among residents admitted to the LTC facilities, and many residents develop new contractures during the first 5 years of their admission. Immobility appears to be the main modifiable risk factor. Further studies are needed to identify potential strategies to prevent new contractures in this vulnerable group.

Лечение пациентов с повреждениями менисков коленного сустава

The aim: to study the results of surgical treatment of patients with injuries of the meniscus of the knee joint, in whom arthroscopic suturing of the meniscus was used according to the developed technique.Methods. In this paper, we studied the results of surgical treatment of 134 patients with chronic injuries of the meniscus of the knee joint, who were treated at the City Clinical Hospital No. 7 in Almaty for the period from 2017 to 2021. 70 (52.3%) patients made up the control group, who underwent meniscus resection using arthroscopic technique. The main group included 64 (47.7%) patients with ruptures of the meniscus of the knee joint. He performed a meniscus suture under arthroscopic control according to the method developed by us (RK patent No. 35413 dated 12/10/2021). Results. Clinical application of a new method of arthroscopic meniscus suturing in patients of the main group allowed to increase the frequency of excellent results by 7.3% (p=0.012), good treatment results by 19.7% (p<0.001) according to the Lysholm scale compared with the control group. The treatment outcomes of patients in the study groups, analyzed using the criteria of evidence-based medicine, indicate the effectiveness of a new method of arthroscopic meniscus suturing, which reduces the frequency of unsatisfactory outcomes in the long-term period of surgical treatment by 5.5% (p=0.184) compared with the control group.Сonclusions.The results of the research work support the arthroscopic repair of meniscal tears with good long-term results and a low risk of complications. Thus, a new method of arthroscopic suturing of the meniscus provides prevention of the development of contractures, gonarthrosis in the postoperative period in patients with injuries of the meniscus of the knee joint and allows for early functional treatment compared to traditional arthroscopic meniscectomy.Keywords: knee joint, menisci, meniscus injury, osteoarthritis, arthroscopy, meniscus suture, meniscus resection.

Physico-dosimetric aspects of radiotherapy treatment of breast cancer patients with an established tissue expander

According to the data for 2019, breast cancer occupies a leading position among malignant neoplasms in the female population in the Russian Federation.
 Currently, there is an increase in the number of young breast cancer patients. In this regard, the requirements for the quality of life of patients, in particular the aesthetic results of special treatment, are increasing, which contributes to the introduction of methods of reconstructive surgery in oncomammology.
 The two-stage installation of a silicone breast implant is the most common method of breast reconstruction in oncological practice, in which a tissue expander is installed in patients at the first stage after mastectomy, and at the second stage it is replaced with a permanent implant.
 At the same time, the issue of radiotherapy in patients who have undergone the surgical stage of breast cancer treatment with reconstructive plastic surgery remains relevant to date. As is known, radiotherapy plays an important role in the combined and complex treatment of breast cancer, increasing, in general, locoregional control in operated patients. On the other hand, it may increase the risk of late complications of breast reconstruction, such as the development of capsular contractures and protrusions.
 It should also be emphasized that at present, the impact of hypofractive radiotherapy regimes, which are the most promising in clinical development, primarily on endoprostheses in patients during two-stage reconstruction, remains insufficiently studied. This article presents a brief analysis of the physical and dosimetric planning of radiotherapy in patients with breast cancer after the installation of a tissue expander who were treated on the basis of the RNCRR.

Progressive pseudo-rheumatoid dysplasia -a rare genetic disorder: Case Report

Progressive pseudorheumatoid dysplasia (PPRD), also known as spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA), is an autosomal recessive disorder, resulting from mutations in the WNT1-inducible signaling pathway protein 3 (WISP3) gene involving the axial skeleton as well as small peripheral joints. Because of rarity here we present a case of 14-year-old boy, 1st issue of consanguineous parents who was presented with pain & gradual development of contracture in 3rd distal interphalangeal joint of right hand when he was 4-year-old, then gradual involvement of other interphalangeal joints of hands, bilateral wrists, elbows, shoulder, knees &ankles occurred over years with the development of contractures and restricted movement. For last few years, he developed difficulty in walking. Clinically spinal scoliosis and coxa vara was present. Mobility of spines and multiple joints including proximal & distal interphalangeal joints of hands, wrists, elbows, shoulders, knees, ankles were restricted with flexion contractures. The gait of the patient was limping. Radiological evaluation showed osteopenia in X-ray of pelvis with both hip joints and both knee joints. Generalized osteopenia, fusiform swelling in distal interphalangeal joint, flexion deformity in distal interphalangeal joint of middle and ring fingers of both hand was shown in X-ray of both hands. MRI of lumbosacral spine showed dorso-lumbar vertebral bodies dysplastic with anterior wedging producing bullet nose. Superior epiphyseal deformity was also noted in lower dorsal bodies suggestive of spondyloepiphyseal dysplasia of dorso-lumbar spine. Genetic study showed homozygous nonsense variation in exon 5 of the WISP3 gene suggestive pathogenic variant. Finally, he was diagnosed as a case of PPRD and treated with physiotherapy, family counseling, and anti-inflammatory medications.
 AKMMC J 2022; 13(1) : 52-55

Analysis of the Structure of Contractures of the Upper Limb Joints

Summary. Analysis of the restrictions in the amplitude of movements in the joints is traditionally considered from the standpoint of individual nosologies that cause them, but the systemic results of the inverse syndromological approach to the study of contractures are published only sporadically.
 Objective: to determine the structure, causes, nature, and severity of contractures of the upper extremity joints.
 Materials and Methods. The structure of contractures of the upper extremity joints as the consequences of injuries and diseases was analyzed on a large array of patients (16,710 patients). Distribution by location, etiology, severity of contracture, gender and age, and relationships between type and localization of contracture were assessed. The dynamics of the development of contractures and the number of necessary surgical interventions was traced.
 Results. Restriction of movements in the upper extremity joints was registered in 5,450 out of 16,710 (32.6%) patients; among them there were 3,485 male (63.9%) and 1,965 (36.1%) female patients. During reconstructive treatment, 7,892 surgeries were performed. Most often these were contractures of the finger joints (42.5%), then shoulder (26.9%), elbow (13.4%), carpal joint (13.3%), less often – radioulnar contractures (3.9%). The elbow, radioulnar and carpal joint contractures most often are caused by osteo-cartilaginous lesions; a polyetiological component is typical for the finger joints. The shoulder joint contractures may be caused evenly by desmogenic, myogenic, or osteo-cartilaginous lesions. Most of the joint contractures are of moderate severity. Contractures of the fingers require multi-stage surgical treatment (1.91±1.35 surgeries); one-stage treatment is used for contractures of the shoulder joint (1.34±0.81 surgeries). The most polystructural lesions were combat wounds, ischemic, and finger contractures (2.53±1.22; 2.52±1.34 and 2.5±1.24 structures, respectively), and the least – radioulnar contractures (1.59±1.34 structures). Radioulnar contractures in 37.3% of cases are accompanied by contractures of the fingers, but vice versa only in 1.2%. It was noted that contractures of the radioulnar joints are often accompanied by restriction of movements in the elbow and wrist joints – in 34.9 and 56.6% of cases, respectively. At the same time, the inverse dependence of the combination of contractures in the wrist and elbow joints with radioulnar joints is not very high – 4.2% and 6% of cases, respectively.
 Conclusions. In patients who are hospitalized for highly specialized surgical treatment of pathology of the upper extremity, contractures of its joints are moderate and severe, characterized by polyetiology, and, in most cases, caused by disorders of osteo-cartilaginous structures and their combination with desmogenic, tenogenic, and myogenic lesions. Specific relationships are traced in localization and mutual burden of contractures, rapidity of their progression. As a rule, upper limb contractures are chronic ones and require multi-stage surgical treatment.

Impact of radiotherapy on long-term treatment outcomes in patients with breast cancer who have undergone simultaneous one-stage and two-stage reconstructive surgeries. Literature review

The evolution in reconstructive breast surgery in the form of widespread use of implants allows you to abandon the “simple” mastectomy in most patients, provide faster rehabilitation and minimize the psychological trauma due to the absence of a breast. However, in most cases, radiation therapy and/or drug treatment are necessary, as they reduce the risk of relapse, disease progression and mortality. The combined or complex treatment increases the frequency of postoperative complications, such as prolonged wound healing, infection, protrusion/extrusion of the endoprosthesis, the development of capsular contracture, seroma, hematoma, etc. The greatest negative impact on the aesthetic result, both in the early and in the long-term period, is provided by remote radiation therapy. On the other hand, performing reconstructive plastic surgery may complicate radiation therapy. The issues of how long it is necessary to conduct radiation therapy, what type of reconstruction and how to conduct radiation therapy, how to minimize the frequency of complications without compromising the oncological and aesthetic results of treatment of breast cancer patients remain controversial.

Clinical trials of 3D printing splints to avoid contracture development in burned children

Background/aimWe evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study.Materials and methodsAfter approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials’ significances and financial impact were evaluated statistically.ResultsSeventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant.Conclusion The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.

Экспериментальное исследование механических свойств ахиллова сухожилия кроликов в процессе его восстановления после травмы

Актуальность. Проблема лечения больных с повреждениями сухожилий остается нерешенной. Неудовлетворительные результаты после хирургического лечения, по данным разных авторов, составляют от 15 до 62 %. Функциональный результат после хирургического восстановления поврежденных сухожилий трудно прогнозировать из-за высокого риска образования рубцового блока, препятствующего их свободному скольжению. Спайки нарушают растяжимость сухожилий, что, в свою очередь, сказывается на их прочности. Цель: исследовать в эксперименте прочностные свойства ахилловых сухожилий после их хирургического восстановления с дальнейшим использованием различных медикаментозных препаратов. Материалы и методы. Проведены исследования механических свойств ахилловых сухожилий кроликов, на которых была создана модель их частичного повреждения путем пересечения на 1/2 диаметра. Травмированное сухожилие ушивалось сухожильным швом. В ходе эксперимента изучали 5 групп препаратов ахилловых сухожилий кроликов с пяточной костью по 3 препарата в каждой группе. 1-я группа — контрольная. После выполнения сухожильного шва рану ушивали. Во 2-й группе животным вокруг сухожильного шва вводили препарат нолтрекс. В 3-й группе вводили препарат гиалуроновой кислоты, в 4-й — препарат лидазы. 5-я группа — норма, препараты неоперированных ахилловых сухожилий интактных животных. Все животные были выведены из эксперимента на 60-е сутки. По результатам испытаний рассчитывали величину модуля упругости и предел прочности препарата. Результаты. Наибольшее удлинение под действием растягивающей нагрузки величиной 30 Н было достигнуто на препаратах неоперированных ахилловых сухожилий кроликов — 2,96 ± 0,22 мм. Наименьшая величина удлинения была получена на препаратах контрольной группы — 0,83 ± 0,37 мм. Остальные группы препаратов показали промежуточные значения. Наибольшим значением модуля упругости обладают препараты ахиллова сухожилия кроликов контрольной группы — 0,216 ± 0,123 МПа. Наименьшее значение модуля упругости выявлено при изучении нетравмированных препаратов ахиллова сухожилия — 0,051 ± 0,004 МПа. Наибольшей прочностью обладали препараты контрольной группы (величина предельно допустимой нагрузки 81,81 ± 0,34 Н). Наименьшую прочность продемонстрировали препараты нетравмированных ахилловых сухожилий кроликов (величина предельно допустимой нагрузки 69,72 ± 0,18 Н). Выводы. В процессе восстановления ахиллова сухожилия кроликов после травмы наблюдается увеличение значений показателей, характеризующих прочностные свойства тканей, — модуля упругости, предельно допустимой нагрузки и предела прочности. Величина показателей, характеризующих пластические свойства тканей, уменьшается, что может стать одной из причин развития посттравматических контрактур. Наилучшие показатели с точки зрения пластичности тканей наблюдались в группе препаратов ахиллова сухожилия кроликов, леченных с помощью гиалуроновой кислоты. Наихудшие — в контрольной группе.

Differential DNA methylation and transcriptional signatures characterize impairment of muscle stem cells in pediatric human muscle contractures after brain injury.

Limb contractures are a debilitating and progressive consequence of a wide range of upper motor neuron injuries that affect skeletal muscle function. One type of perinatal brain injury causes cerebral palsy (CP), which affects a child's ability to move and is often painful. While several rehabilitation therapies are used to treat contractures, their long-term effectiveness is marginal since such therapies do not change muscle biological properties. Therefore, new therapies based on a biological understanding of contracture development are needed. Here, we show that myoblast progenitors from contractured muscle in children with CP are hyperproliferative. This phenotype is associated with DNA hypermethylation and specific gene expression patterns that favor cell proliferation over quiescence. Treatment of CP myoblasts with 5-azacytidine, a DNA hypomethylating agent, reduced this epigenetic imprint to TD levels, promoting exit from mitosis and molecular mechanisms of cellular quiescence. Together with previous studies demonstrating reduction in myoblast differentiation, this suggests a mechanism of contracture formation that is due to epigenetic modifications that alter the myogenic program of muscle-generating stem cells. We suggest that normalization of DNA methylation levels could rescue myogenesis and promote regulated muscle growth in muscle contracture and thus may represent a new nonsurgical approach to treating this devastating neuromuscular condition.

Обґрунтування ранньої нейрореабілітації в дітей неонатального віку

На підставі катамнестичного спостереження 25 новонароджених із вадами розвитку спинного мозку та постгеморагічною гідроцефалією, яким проводилось шунтування шлуночкової системи головного мозку, обґрунтована необхідність ранньої нейрореабілітації вже в перші дні життя, ще на етапі відділення реанімації та інтенсивної терапії. Вивчена ефективність розробленого комплексу заходів первинної реабілітації новонароджених на етапі виходжування після проведення інтенсивної терапії, з подальшою оцінкою її ефективності за шкалою Alberta Infant Motor Scale (AIMS) протягом першого року життя. Запропонована індивідуальна програма реабілітації з комплексом вправ залежно від потреб дитини та її можливостей дає значний позитивний результат щодо становлення моторних і сенсорних навичок дитини та профілактики їх згасання.

MP09-11 GREENLIGHT LASER PROSTATECTOMY: ARE OUTCOMES SUSTAINABLE AFTER A DECADE OF SURGERY? A SINGLE CENTER EXPERIENCE WITH UP TO 15 YEARS' FOLLOW-UP

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-11 GREENLIGHT LASER PROSTATECTOMY: ARE OUTCOMES SUSTAINABLE AFTER A DECADE OF SURGERY? A SINGLE CENTER EXPERIENCE WITH UP TO 15 YEARS' FOLLOW-UP Ahmed Ibrahim, Nawar Touma, Ahmad M. AlShammari, Serge Carrier, and Mélanie Aubé-Peterkin Ahmed IbrahimAhmed Ibrahim More articles by this author , Nawar ToumaNawar Touma More articles by this author , Ahmad M. AlShammariAhmad M. AlShammari More articles by this author , Serge CarrierSerge Carrier More articles by this author , and Mélanie Aubé-PeterkinMélanie Aubé-Peterkin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since its introduction in 2005, GreenLight laser has been widely adopted as a convenient source of energy for surgical treatment of benign prostatic hyperplasia (BPH). However, there is paucity in the literature quantifying long-term outcomes (>10 years) of GreenLight laser prostatectomy. Herein, we report our single-center experience with long-term outcomes over a period of 15 years. METHODS: Between 2005 and 2020, a prospectively maintained database for patients undergoing GreenLight photovaporization of the prostate (PVP) for symptomatic BPH was reviewed. Three Generations of Green Light Laser were used over this time period. Patients with ≥10-years follow-up were included. Demographic and perioperative data were collected together with the International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), and PSA changes. In addition, perioperative and late adverse events were recorded. RESULTS: After a mean follow-up of 12.1 years (10-15 years), 124 patients were included with a mean age of 73.9 (range: 54- 85) years and a mean preoperative prostate size of 72.4±15.3mL. Demographic and perioperative data are presented in Table 1. Blood transfusion rate was 2.4%. Development of bladder neck contracture and urethral stricture were encountered in 7 (5.6%) and 9 (4.3%) of patients. 6 (4.8%) patients required repeat surgery for adenoma regrowth. Additionally, there were significant reductions in mean IPSS, QoL and PVR (60.4% and 65%, and 72.6%, respectively) (p <0.001). Likewise, there was a significant increase in Qmax (8.2 to 17.7 ml/s, p <0.001) with PSA reduction by 64.2 % compared to its baseline value. CONCLUSIONS: Our long-term functional outcomes support the durability of the GreenLight laser prostatectomy with acceptable long-term adverse events after a decade of surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e163-e164 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ibrahim More articles by this author Nawar Touma More articles by this author Ahmad M. AlShammari More articles by this author Serge Carrier More articles by this author Mélanie Aubé-Peterkin More articles by this author Expand All Advertisement Loading ...

Musculoskeletal and skin considerations in children with medical complexity: Common themes and approaches to management

The term "children with medical complexity" (CMC) describes a population of heterogeneous genetic and metabolic disorders with multi-system involvement, with shared common abnormalities within the musculoskeletal system. Disorders that affect the central nervous system (CNS) result in abnormal muscular tone, ranging from dystonia and spasticity, to hypotonia, to combinations of both (axial hypotonia with appendicular hypertonia). Abnormal tone can impair movement and function and contribute to development of contractures, progressive scoliosis and hip dislocation. Impaired mobility, chronic illness and polypharmacy can result in fragile bones and increased risk of fracture, which can be difficult to diagnose and associated with pain. Additionally, CMC with impaired ability to communicate, total dependence on caregivers and frequent use of support devices can develop unintended skin injuries. There are a variety of treatments available for CMC with musculoskeletal disorders ranging from physical supports to pharmacologic treatments to surgeries. Medical and surgical treatments can promote changes in tone and support bone health to improve comfort, hygiene and proper positioning. These therapies may also carry significant risk in medically fragile patients. It is important for CMC to have a care team with a good understanding of the patient's overall health and goals of care and that can advocate for the patient to balance optimization of function and reduction of pain while also minimizing risk.

Sleep Pattern and Night-Time Muscle Activity in Children With Cerebral Palsy Compared to Typically Developing Peers

Objectives: To compare night-time muscle activity in children with cerebral palsy (CP) with that in typical developing peers. Methods: Polysomnography with electroencephalography (EEG), electrocardiogram, electromyography (EMG), respiration, and electrooculography movements recorded during one night were used to characterize sleep stages in a group of children with CP (Gross Motor Function Classification Scale I–III) and a group of typically developing (TD) children (aged 3–13 years). Periods of EMG activity for the tibialis anterior and soleus (SOL) muscles were identified, and the coherence between EEG and EMG was measured to assess corticomuscular drive during sleep. Results: There were no significant differences between the groups in total sleep time, average time spent awake, or rapid eye movement, N1, and N3 sleep. Children with CP spent significantly less time in N2 than their healthy peers (43% vs. 51%, p=0.03). There was only a significant difference between TD and CP in SOL muscle activity during the wake stage. Otherwise, there were no differences between groups in coherence in EEG and EMG signals for any sleep stage. Conclusion: Mildly affected children with CP do not show altered night sleep or muscle activity patterns as compared to TD peers. Abnormal muscle activity is unlikely to contribute to sleep disturbance, development of contractures, joint deformation, pain, or general discomfort in this group of children with CP.

Ultrasonographic examination of skeletal muscles in traumatic ischemia (experimental study)

Post-traumatic muscles ischemia of the extremities is the result of severe trauma and leads to permanent dysfunction. The tactics of management and treatment of patients are decisive at all stages, so the latest methods of treatment using cellular technologies are being developed to prevent the development of complications and improve long-term results. Aim: to determine the correlation between histological and ultrasonographic parameters (qualitative and quantitative) in the muscles after traumatic ischemia and to compare the results. Material and methods. The study was performed on rabbits breed Chinchilla. The animals were placed on a tourniquet on the lower limb from the middle third of the thigh to the ankle joint, after 6 hours it was removed. Developed software to determine the texture of the sonographic image (δ-entropy) allowed to assess the qualitative and quantitative changes in the damaged muscles. Correlation analysis was performed between sonographic and histological changes in the muscles. Results. The relative amount of structurally altered tissue was morphometrically estimated and compared with entropy. A high correlation between muscle damage and vertical δ-entropy has been found, indicating that high-probability sonography can detect areas of necrosis and, to a lesser extent, fibrosis in the development of ischemic limb contracture. Conclusions. The obtained high positive correlation between the histological index of muscle tissue damage (especially atrophy of muscle fibers and fibrosis) and the results of sonographic data processing, namely vertical δ-entropy, have clinical importance in terms of establishing the severity of necrotic lesions segments of the extremities and the prediction of fibrous changes, formation of limb contracture. Key words: traumatic ischemia, necrosis, histological changes in the muscles.

Impact of Customized and Sustained Physiotherapy in Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth (CMT) disease is the most inherited form of peripheral neuropathy. This condition is also known as hereditary motor and sensory neuropathy (HMSN), which is a slowly progressive neuropathy affecting peripheral nerves and causes sensory loss, weakness and muscle wasting. This primarily involves distal muscles of feet, lower legs, hands and forearm. CMT is the most frequently inherited peripheral neuropathy known to affect 1 in 2500 individuals. There are four types: CMT1, CMT2, CMT3 and CMT4, depending upon the involvement of specific gene deficit, inheritance pattern, age of onset and whether the primary defect results in an abnormality of the myelin or axon of the nerve. Diagnosis of CMT is done based on physical examination, genetic testing, and electromyography (EMG) and nerve conduction velocity (NCV) test results. Symptoms of weakness progress from distal to proximal, i.e., it begins from feet and ankles. CMT is a known length dependent neuropathy which results in foot drop and later weakness of hands and forearm becomes evident. Due to the involvement of sensory nerve fibres, sensations like heat, touch, pain and most prominently vibration is also present distally. Long standing effects of CMT leads to the development of deformity and/or contractures which may involve forefoot, hindfoot, toes and/or long finger flexors. As physiotherapy is a means to maintain and/or gain maximum possible functional independence, consistency of the treatment becomes the most important factor. This case report intends to show that consistency in performing physiotherapeutic exercises helps in gaining maximum possible functional independence. This case report is a discussion of a 25-year-old male patient referred to the physiotherapy department with the polyneuropathy type symptoms with his history and investigation reports being consistent with that of Charcot-Marie-Tooth disease.

Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review.

Capsular contracture is a severe complication to breast surgery with implants. Previous studies suggest multiple risk factors are associated with capsular contracture, but the etiology is still unknown. We performed a literature review to investigate existing studies on histological analyses of breast implant capsules and how clinical risk factors impact the capsule morphology. The literature search was conducted in PubMed. Studies that performed histological analyses of breast implant capsules were included. Animal studies or studies with a study population of less than five patients were excluded. Fifty-two studies were included. The histological analyses showed that the breast implant capsules were organized in multiple layers with an inner layer of synovial-like metaplasia which was reported to diminish in capsules with capsular contracture. The remaining layers of the capsule mostly consisted of collagen. The alignment of the collagen fibers differed between contracted and non-contracted capsules, and capsules with higher Baker grade were generally thickest and contained more tissue inflammation. Studies investigating capsules affected by radiotherapy found a more pronounced inflammatory response and the capsules were generally thicker and fibrotic compared with nonirradiated capsules. The included studies offer valuable insights into the histological changes caused by capsular contracture and their relation to clinical risk factors. Further studies with larger sample sizes and more strict inclusion criteria are needed to further investigate implant capsules and the role of the synovial-like metaplasia for the development of capsular contracture. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Aesthetic outcomes and complications following post-mastectomy radiation therapy in patients undergoing immediate extended latissimus dorsi flap reconstruction and implant insertion.

Complications of radiotherapy after implant-based reconstruction include capsular contracture development, seroma formation, and reoperation for implant removal or replacement. However, there is a lack of studies regarding aesthetic outcomes and complication rates following radiation therapy among patients undergoing latissimus dorsi (LD) flap-based reconstruction with implant insertion for volume shortage. The present study aimed to evaluate clinical and aesthetic outcomes of post-mastectomy radiation therapy (PMRT) among patients receiving both LD flap reconstruction and implant insertion. This study comprised 66 patients who underwent mastectomy and breast reconstruction between March 2014 and July 2019. Patient demographics and outcomes were compared among patients who did and did not receive PMRT. Aesthetic outcomes were compared using gross photographs. The incidence of complications, including seroma formation, flap necrosis, nipple-areola complex necrosis, hematoma development, and capsular contractures, was compared between groups. No differences in aesthetic outcomes using gross photos during outpatient follow-up were observed between the radiation and control groups. No significant difference in the frequency of complications was observed between groups. The use of implants and LD reconstruction are inevitable in a proportion of patients due to a lack of LD flap volume. For these patients, PMRT could be safe treatment option if the necessary precautions are implemented.

RESIDUAL PHENOMENA OF THE TRANSFERRED COVID-19 IN THE MAXILLOFACIAL REGION OR ITS COMPLICATIONS

Today, the issues of the incidence of the Covid-19 virus and its complications are extremely relevant. Much attention in the scientific literature is paid to possible complications such as sufferings of the lungs, heart. Along with this, it became known that the coronavirus can affect the brain, nasopharynx, eyes, blood vessels, liver, kidneys and intestines. Interesting data from clinicians and morphologists has been received. Those who have had Covid-19 note the long-term effects of scarring of the lung tissue and kidney failure, inflammation of the heart muscle, arrhythmias, liver damage, cognitive impairment, psychosis, accompanied by a sharp change in mood. Interesting observations from the Department of Systems Biology at George Mason University were seen: 70% of patients who have had Covid-19 rarely observe pathology of internal organs.&#x0D; The purpose of our work was to highlight the complications from the large salivary glands in the patients who suffered from Covid-19.&#x0D; Objects and research methods. Our observations were carried out at the Poltava Center for Salivary Gland Pathology. There were only 17 patients. Three or four weeks ago, they reliably suffered from the disease. The function of the parotid salivary glands was studied using metal catheters, which were introduced into the mouth of the gland ducts for 10 minutes. The cellular composition of the secretion of the parotid glands was investigated according to the method generally accepted in cytology. 8 patients underwent ultrasound examination of salivary glands.&#x0D; Results. The antiviral and symptomatic treatment given to the patients eliminated the leading symptoms of the disease. At the time of completion of treatment, general somatic symptoms were eliminated and they were discharged healthy. 3 patients complained of dryness in the mouth, especially at night and in the morning. 4 patients complained of dry mouth, burning sensation in the eye area. In 5 patients, along with dryness in the mouth and nose, there was a complete lack of sense food taste. 5 patients complained of disorders of appearance. The parotid-masticatory areas were enlarged, we could observe dryness of the mucous membranes of the mouth and eyes. All patients had short-term or long-term headaches. Before the viral disease, none of the patients and their relatives had diseases of the salivary glands. Physical examination in 8 patients did not reveal any facial asymmetry. Palpation revealed slightly enlarged parotid salivary glands, slightly compacted, and slightly painful. The submandibular salivary glands were of normal consistency and were painless. These patients had a moderate amount of oral fluid in the mouth. Saliva of normal viscosity was released from the ducts of the parotid and submandibular glands. With sialometry of the parotid glands, there was a slight drop in secretion to 1.5 + 0.3 ml. Cytological examination of the secretion of the parotid glands determined a small number of cells of the columnar epithelium. Some of these cells had a tendency to necrosis; single squamous epithelial cells were found in the preparation.&#x0D; Conclusions. We evaluated the results of clinical examination data of 17 patients who had a viral Covid-19 infection and they were examined by us. In 3 - 4 weeks after recovery, there were complaints: dryness of the mucous membranes of the mouth, nose, conjunctiva of the eyes, loss food taste, enlargement of the parotid and submandibular salivary glands. It is possible to reliably state that patients have clinical phenomena of sialopathy. The results of additional studies of the secretion of the parotid glands, data of the cytology of their secretion and ultrasound examination confirm the secretory process in the glands of various degrees. The presence of elements of an inflammatory nature in the secret clearly defines the sialectatic process. The presence of headaches in the examined patients determines their probable vascular disorders in the components of the brain. Such changes can indirectly affect the vascular complex of the salivary glands and be the cause of the development of duct contractures and leads to sialadenosis.&#x0D; Perspectives. In order to examine this category of patients, the study of the features of blood circulation in the vessels of the brain and salivary glands should be considered to clarify the pathogenesis of sialadenosis.

The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

BackgroundIndications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP).MethodsInclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively.ResultsSixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months.Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively.Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001.There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D.ConclusionsRelative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

AB0855 FIBROUS ARTHROPATHY AS THE KEY FEATURE OF JUVENILE SCLERODERMA - CASE REPORT

Background:Systemic sclerosis (SSc) is an autoimmune disease characterized by endothelial dysfunction, immunological disorders, and excessive synthesis of collagen and its deposition in various tissues and organs. The juvenile onset SSc before the age of 16 is very rare, with annual incidence of 0.27-0.5 cases per million children according to English and Finnish authors [1,2].Objectives:To present a clinical case of juvenile onset SSc, manifesting from the childhood predominantly with fibrous contractures.Methods:Patient K., 30 yo. Clinical presentation on admission to the Institute of Rheumatology in September 2020: thickening of the trunk and limbs skin (mRSS 10 scores), pronounced induration of subcutaneous tissues and muscles; contractures of the elbow, shoulder, hip and knee joints, short stature (height 142 cm) with proportional shortening of the limbs. ANA (HEp-2) 1/320, a-Scl-70, a-RNP-70 and ACA tests were negative. Ultrasonography revealed left-sided coxitis, esophagogastroduodenoscopy - Barrett’s esophagus. Chest CT, echocardiography, electrocardiography and capillaroscopy yielded no specific findings.The patient has been ill since the age of 3, when SSc manifested with skin thickening, “dry” arthritis and rapid development of contractures of the large joints. Thorough diagnostic elaboration ruled out such potential causes as phenylketonuria, glycogenosis, mucopolysaccharidoses, primary amyloidosis, and porphyria. Histological findings (2007) of a biopsied skin specimen containing subcutaneous fat and muscle tissue included focal vacuolization of keratinocytes, poor perivascular lymphocytic and histiocytic infiltration, fibrosis and hyalinosis of collagen fibers of varying intensity in the in mid- and deep dermis, infiltration of collagen fibers by fibroblasts, skin appendages atrophy – all of them representing a pattern of morphological changes characteristic of SSc. Therapeutic regimens including prednisone at 5-15 mg/day and D-penicillamine were ineffective.Results:In this case, in view of fibrotic arthropathy, a differential diagnosis was made with deep morphea and stiff skin syndrome. Visceral involvement, immunological disorders and biopsy findings substantiated a diagnosis of juvenile onset SSc. Oral MTX was initiated at 15 mg to target skin lesion and osteoarticular symptoms.Conclusion:Predominance of fibrotic arthropathy in presented case caused difficulties in establishing SSc diagnosis, as this patient did not have such inherent features as the Raynaud’s phenomenon, interstitial lung disease or pulmonary hypertension. Juvenile onset SSc manifesting before the age of 16 has its own clinical features, usually persisting through the adulthood, and therefore, such one-of-a-kind appearances of juvenile onset SSc should not be missed or misinterpreted.