Stages Of Insufficiency Research Articles

Chronic Deltoid Insufficiency in Stage IV Adult Acquired Flatfoot Deformity: Do We Have a Good Answer?

Stage IV adult acquired flatfoot deformity (AAFD) with secondary chronic deltoid ligament insufficiency is a challenging deformity to treat, with minimal consensus in the literature concerning its surgical management. Many surgical treatment options have been described, including joint-sparing techniques, fusions, osteotomies, and even arthroplasties. However, questions remain as to what, if any, treatment is optimal. This contribution reviews studies on surgical treatments for stage IV AAFD with deltoid ligament failure and provides a critical analysis regarding the quality of outcomes reported for those different treatment options. PubMed and Google Scholar databases were searched between June 1, 2022, and August15, 2022, for studies published between 1990 and 2022 that describe the treatment of stage IV AAFD with deltoid ligament insufficiency. Articles included in the study focused on subjects with stage IV AAFD and associated deltoid ligament insufficiency undergoing surgical correction. Exclusion criteria included stage I, II, and III AAFD, as well as deltoid ligament repair following acute injury/rupture. Nine studies covering five different treatment options for patients with stage IV AAFD and chronic deltoid insufficiency were included, with minimal overlap in outcome measures used to assess the efficacy of the procedure. Triple arthrodesis with deltoid ligament reconstruction resulted in a 62.5% (5/8) success rate with a residual tibiotalar (TT) angulation of 2°(success defined as <3°). Tibiotalar arthrodesis of four patients resulted in an average post-operative tibiotalar angulation of 4.8°with all patients showing progressive destabilization of the hindfoot complex at 12-18 year follow-ups. Deltoid arthroscopic laminoplasty (Brostrom) resulted in an increased American Orthopaedic Foot and Ankle Society (AOFAS) score from 49.7 pre-op to 91.9 post-op. There was no long-term follow-up of these patients. Deltoid ligament reconstruction using autografts of the peroneus longus resulted in a post-operative valgus of 2.1°in one study and <5°in another. Deltoid ligament reconstruction using an anterior tibial tendon autograft resulted in a gain of 126.4 + 40.2% in stiffness compared to an intact ligament. Twinfix suture anchors resulted in a post-operative hindfoot angle averaging 5.3°. Combined deltoid and spring ligament reconstruction resulted in a 5.1°valgus angulation. There is currently no standard of care or clinical consensus regarding surgical treatment for stage IV AAFD with deltoid insufficiency. Several studies imply that mild valgus malalignment around the tibiotalar joint can result in satisfactory outcomes. A few studies even deemed <5°of valgus tilt post-operatively successful. However, it has been described that any imbalance in tibiotalar tilt is a significant risk factor for progressive arthritis and future ligamentous failure. No treatment option was able to correct valgus tilt to an anatomical standard (i.e., to normal anatomy). These varied findings, along with the lack of consensus on post-surgical measures to assess efficacy, are worrisome and emphasize the need for better surgical options. Moreover, there is a critical need for additional research on the long-termoutcomes following stage IV AAFD and deltoid insufficiency repair, particularly, as over five million people in the United States and 10% of the geriatric population are affected by AAFD with a risk of progressing to stage IV.

Prolonged intravenous infusion therapy of lidocaine in treatment of chronic venous insufficiency in C6 and C6R stage

Chronic venous disease (CEAP stage C2 - C3) is found in approximately 25% of the population, and trophic skin changes, including leg ulcers (C4 - C6), up to 5%.The aim of the work was to develop an effective dose and concentration of lidocaine and the optimal method of its administration for the treatment of chronic venous disease in the stage of active trophic wounds and accelerate the healing process.Materials and methods. The results of treatment of 97 patients with chronic venous insufficiency in stage C6 and C6r were evaluated, which were divided into two clinical groups: retrospective (n= 50) in which classical surgical treatment was performed (Coquette veins ligation, Narat phlebectomy) and prospective (n=47) in which classical surgical intervention (crossectomy + Bebcock and / or Narat phlebectomy) was used in combination with the prolonged intravenous infusion therapy of lidocaine.Research results and their discussion. In the period of 3-6 months, complete healing of trophic wounds was observed in the prospective group. At the same time, in 25.53% of patients in this group complete healing was observed up to 7 days. Whereas, in patients of the retrospective group, this was observed between 6-9 months. In addition, the rate of decrease in the area of trophic wound for the first month in the prospective group was 23.72% higher than in the retrospective group (р˂0.05). We did not observe a recurrence of a trophic wound in the follow-up period up to 1 year in the prospective group.

Characteristic of the hemostasis indices in chronic venous insufficiency in stage of decompensation

Objective. To compare the hemostasis indices in patients, suffering chronic venous insufficiency (CHVI) in decompensation stage, owing or not the thrombotic complications.&#x0D; Маterials and methods. The indices of hemostasis were studied up in 47 patients, suffering CHVI in decompensation stage, in whom the blood was obtained from central and regional blood flow. To Group I 27 patients were included, suffering CHVI in decompensation stage and complicated by an acute varicothrombophlebitis. To Group II (control) were included 20 patients, suffering CHVI in a decompensation stage without thrombotic complications.&#x0D; Results. The indices of hemostasis of the regional blood flow of Group I and Group II differ significantly more, than the hemostasis indices of the central blood flow.&#x0D; Conclusion. The changes in hemostasis in patients, suffering an acute varicothrombophlebitis, are predominantly of a local character.

Osteoarthritis of Lateral Lisfranc Joint After Lateral Column Lengthening in Flatfoot

Category: Lesser Toes Introduction/Purpose: Lateral column lengthening (LCL) procedure is commonly optional treatment as one of reconstruction surgery for the adult acquired flatfoot deformity (AAFD) due to posterior tibial tendon insufficiency in stage II. However, it had been confirmed that lateral forefoot pressures increase after LCL in previous studies. We may occasionally encounter some cases who have pain in the lateral aspect of the foot associated with osteoarthritis of Lisfranc joint after the surgery (Fig.). In this study, we retrospectively assessed lateral Lisfranc arthritis as postoperative complications after LCL. Methods: 17 feet in 15 patients who underwent operation including LCL for AAFD due to posterior tibial tendon insufficiency in stage II (two patients male and 13 were female). The mean age at the time of surgery was 64.2 years (52-80). All cases had LCL by calcaneocuboid distraction arthrodesis. The amounts of LCL achieved were 12.7 mm on average (8.0-15.0). The average duration of follow-up after the surgery was 21.8 months (4-97). We divided the subjects up into two groups: (1) pain group (n=7), were experiencing pain in the plantar-lateral aspect of the foot and/or tenderness at fourth and/or fifth tarsometatarsal (TMT) joint postoperatively; and (2) no-pain group (n=10), did not have that pain nor tenderness until the latest follow-up. Two groups were compared in age, body mass index (BMI), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the amounts of LCL and several parameters on the radiograph. Results: In the pain group, all cases had osteoarthritic changes of the lateral Lisfranc joint (41.2%) on radiographs (grade II or more on the Kellgren-Lawrence grading scale). In overall subjects, 11 feet (65%) were revealed lateral Lisfranc arthritis. There were no significant differences in age, BMI, AOFAS scale, the LCL amounts between both groups. The medial column height was lower than lateral preoperatively, it became higher postoperatively by the reconstruction. In the pain group, the postoperative differences between medial and lateral tend to be greater than in no-pain group (P = 0.17). Patients with pain had significantly lower postoperative first talometatarsal angle (p &lt; 0.05). However, no significant differences were found in terms of the other radiographic parameters such as calcaneal pitch angle, talonavicular coverage angle and hindfoot alignment by Cobey’s view. Conclusion: This study indicated a high possibility of Lisfranc arthritis in patients who have pain of the lateral aspect of the foot after LCL. We suggest that this osteoarthritic change is one of the causes of such pain, and attribute the arthritis to increased lateral column pressures by excess calcaneocuboid distraction. As a preventive measure had reported previously, we may have to keep LCL within less than 10 mm, and may have to add the stabilization of medial column such as the first TMT fusion or Cotton osteotomy.

Prevention Of Chronic Renal Diseases

It is easier to prevent a disease than to cure it. This postulate is a foundation stone of the contemporary medicine, furthermore its mission. The Chronic Kidney Diseases (CKD), amongst them the Chronic Pyelonephrites (CP) and the mass kidney reduction take an important place in human pathologies in general, and in particular in renal ones. The Chronic Pyelonephrites are chronic renal pathologies, which on one side are of various causes and on the other side are multi systemic. At the same time they tend, earlier or later, depending on their course, to bring the patient towards the Chronic Kidney Insufficiency in stage of uremia, consequently in need of substitution therapies e.g. dialysis, peritoneum dialysis or transplant. It is worthy to emphasize that from the prevention and correct cure of CP make profit the patients, the family, the state and in the last analyses the entire society, because in that way the budget expense destined for the fore going substitution cures, dialysis, peritoneum dialysis or transplant, is considerably reduced. The same should be mentioned in relation to the CP and the mass kidney reduction, speaking about our country, which are still at the first place as the very cause of Chronic Kidney Insufficiencies (CRI), later on advancing toward uremia and terminal uremia along with its grave consequences. In general the very foundation of the CP is on the infections of urinary roads, in particular on the complicated ones, among them it should be mentioned-congenital kidney anomalies, renal calculosis so much present in our country, and pathologies of segment or vesical-ureteral reflux, and rarely the pathologies of prostate.