Previous Methods Of Treatment Research Articles

For the prevention of postpartum diseases by autohemo-transfusion

In recent years, autohemotherapy has acquired the right of citizenship, as one of the therapeutic methods, in almost all areas of medicine and, in particular, in obstetrics and gynecology. She was the direct heir, so to speak, of the previous methods of treatment - serotherapy, vaccine therapy and protein therapy, containing the essence of the one, the other and the third. The use of autohemotransfusions is technically much easier than vaccine therapy, and especially autovaccine.

Functional and radiological outcome of osteosynthesis using proximal femoral nail antirotation II system in intertrochanteric femoral fractures

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are relatively common injuries in adults and a common source of morbidity and mortality among the elderly. Incidence of fractures is increasing because the general life expectancy of the population has increased significantly during the past few decades. Stable fixation and early mobilization is needed in these fractures to reduce the morbidity and mortality. Extra-medullary implants are biomechanically inferior in these cases. The proximal femoral nail antirotation-II (PFNA-II) is an intra-medullary nail system designed for such fractures. The purpose of this study was to assess the results and complications of PFNA-II in intertrochanteric femur fractures.</p><p class="abstract"><strong>Methods:</strong> After seeking approval from institutional Ethical committee, this study was conducted on 30 patients attending our emergency department with intertrochanteric femur fractures at SKIMS Medical College Hospital Bemina, Srinagar from February 2018 to June 2019. The patients were treated with proximal femoral nail antirotation-II. Follow up was done at 2, 6, 12 and 24 weeks. The functional outcome was assessed at 6 months follow up using the Harris Hip Score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Based on the Harris hip score, 18 (60%) patients had excellent results, 10 (33%) had good results and 2 (7%) had Fair results. None of the patients had poor result. Average time to union was 12.27 weeks.</p><p class="abstract"><strong>Conclusions:</strong> This study found the PFNA-II to be a versatile, easy to use and dependable implant for stable as well as unstable intertrochanteric fractures. PFNA II is distinct advance over the previous methods of treatment, though it has an initial learning curve.</p>

Risk factors and clinical characteristics of recurrent ectopic pregnancy: A case-control study.

ObjectiveTo compare signs and symptoms between patients with recurrent ectopic pregnancies (REP) and primary ectopic pregnancies (PEP) and to identify potential risk factors of REP.Materials and MethodsData from 2014 to 2016 were analyzed. The study included 81 women each diagnosed with REP and PEP with no recurrence of ectopic pregnancy (EP) before January 2019. Information, including historical factors and findings at presentation of both group were collected. Data were compared between the two groups. Associations between REP and the risk factors were analyzed by logistic regression.ResultsThe findings revealed that compared to the patients in the PEP group, REP patients had significantly lower education (P = 0.001), higher proportion of previous infertility (P < 0.001) and different methods of PEP treatment (P = 0.001). Clinical data of the last operation revealed significantly higher occurrences of pelvic and peritubal adhesions (P < 0.05). Further multiple regression analysis showed that lower educational background (odds ratio [OR] = 4.183 95% confidence interval [CI] 1.311–13.344 P = 0.016), nulliparity (OR = 12.312 95% CI 3.382–44.824 P < 0.001), history of salpingotomy (OR = 7.129 95% CI 1.022–49.748 P < 0.05) and abortion (OR for one abortion = 21.576, P = 0.001; OR for two abortions =36.794, P < 0.001; OR for three abortions or more = 119.013, P < 0.001) were significant risk factors for REP.ConclusionActive education on contraception is required for patients with lower educational level and history of abortion. Different plans should be formulated for patients with EP. For EP patients wanting fertility, the risk between fertility preservation and REP needs to be evaluated as reproductive function cannot be pursued blindly while ignoring the risk of recurrence.

Early Diagnosis and Treatment

Aseptic necrosis of a femoral head - severe chronic orthopedic pathology (1.2-12 %), diagnostics of which presents considerable difficulties. Problems of fast diagnostics, identical clinical symptoms, rapid development of the disease leads to disability. Risk group includes young and middle-aged men. The cause of the disease is unknown, the possibilities of conservative treatment are applied only in the early stages with doubtful efficiency, and among surgical none is the best. The research is performed in the traumatology center of Khabarovsk - clinical base of a Postgraduate Institute for Public Health Workers. During 2014-2019, retrospective analysis of treatment results was carried out on the basis of statistical data of 97 medical maps of patients diagnosed with aseptic necrosis of a femoral head, pathomorphological study of 49 preparations of the femoral head; laboratory analysis of immunological indicators of cellular immunity and thyroid hormones in the operated group of patients was carried out. Detected immunological changes indicate the systemic nature of the disease. Method of minimally invasive two-stage decompression of femoral neck is developed. Minimum injury of the developed method of treatment provides undeniable advantages in contrast to previous methods of surgical treatment. The technique has been applied in 17 cases, with positive medium-term clinical results. Aseptic necrosis of a femoral head is a pathology with a polymorphologicpicture, diagnosis of which presents considerable difficulties, associated with high risk of development atyoung age, is a current problem and demands further studying for the purpose of achievement of permanent long remission, and, perhaps, and an absolute recovery of the patient.

Gamma nail in the management of intertrochanteric fractures of femur in adults

Background: Intertrochanteric fracture is an extracapsular fracture of the proximal femur. Gamma nail is a cephalomedullary nail that is emerging as the treatment of choice for intertrochanteric fractures. For intertrochanteric fractures, the use of cephalomedullary devices has increased dramatically to 67% among surgeons over the years. Aims of this study was to observe the results of operative treatment of intertrochanteric fractures with Gamma 3 trochanteric nail.Methods: This prospective study was conducted in the Post Graduate Department of Orthopaedics of Government Medical College, Srinagar. This study included 30 cases of intertrochanteric fractures who attended hospital for bone and joint surgery.Results: Excellent results were obtained in 80% patients and good results were obtained in rest 20% with an average Harris hip score of 93.8. Average time to union was 11.6 weeks. There were no non-unions, screw cut outs or peri-implant fractures. The most common complication was varus malunion occurring in 20% patients. However, significant malunion (greater than 10 degrees) was present in only one patient among them.Conclusions: This study finds Gamma 3 nail to be a versatile, easy to use and dependable implant in intertrochanteric fractures. Gamma 3 nail is an ideal implant for stable as well as unstable intertrochanteric fractures and is a distinct advance over the previous methods of treatment, though it has an initial learning curve.

Outcome analysis of intercondylar humerus fractures treated by locking compression plates

Background: Distal humeral fractures are uncommon fractures. They occur in both younger as well as older patients. The complex shape of the elbow joint, the adjacent neurovascular structures, the sparse soft tissue cover combine to make treatment difficult. Previous methods of conservative treatment have caused significant functional impairment. Thus the consensus has shifted towards treatment with open reduction and internal fixation so as to provide stability and early mobilization. Different modalities like 1/3 rd tubular plate, reconstruction plate, K wires, double tension band wiring have been tried. The quality of elbow function following the treatment is related to the degree to which the normal anatomic relationships are restored. Materials and Methods: 27 patients of Intercondylar Humerus fractures classified by Riseborough & Radin system and treated by ORIF by pre-contoured AO Locking compression plates. Clinical and radiological follow-up performed and patients assessed for pain, range of motion, and Mayo elbow performance score. Results: Average follow up was of 6 months. Average age was 37.5 years (18-62 years). Fracture consolidation observed at an average of 12.8 weeks (10-14 weeks). The outcome was excellent or good in 17 patients. 3 patients had infection, 1 case each of ulnar neuropathy, mal-union and myositis ossificans. There were no cases of implant migration, secondary displacement or implant failure. Conclusion: Anatomically pre-shaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising.

Monogenic diabetes – an unappreciated problem among physicians

Monogenic diabetes results from one or more mutations in a single gene. It is a relatively rare genetic condition, therefore, it was frequently unappreciated among clinicians. Consequently, monogenic diabetes is misdiagnosed as type 1 diabetes or type 2 diabetes. Such misclassification leads to an inappropriate treatment, often inconvenient for the patients, such as insulin injections with their permanent glycemic control. The correct diagnosis may completely change previous methods of treatment. Patients diagnosed with GCK mutations may be completely treated with adequate diet. HNF1A/HNF4A affected patients are extremely sensitive to low dose sulphonylureas. Moreover, the exact diagnosis has an impact on patients’ relatives. Mostly, misdiagnosing of monogenic diabetes is caused by its rare occurrence and insufficient training in this area among physicians. According to different studies it may comprise 1–4% of all cases of diabetes. The aim of this article is to emphasize that despite the fact that monogenic diabetes is an uncommon disease, it should always be considered in cases of diabetes with unusual course.

Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

BackgroundIf a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect.MethodsFrom 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction.ResultsUpon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery.ConclusionsUsing a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.

4. Contemporary research in contact lens care

As our understanding of the eye and how it works evolves, we must re-evaluate previous findings, beliefs, and methods of diagnosis and treatment. The eye has proven to be naturally adept at protecting itself from pathogenic intruders, but contact lens wear and lens cleaning products can adversely impact this innate ability. Keeping up to date on the latest information is challenging, and becomes more complex when trying to incorporate the new scientific data into clinical practice. Several factors prevent drawing a straight line from study findings to real-world results, such as patient compliance and potentially flawed diagnostic tools. In this section, we review the latest research findings and opinions related to contact lens care and further explore compliance and its effect on ocular health.

The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results?

Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures. Our purpose was to assess this implant as a panacea for subtrochanteric fractures. All cases of AO type A and B were anatomically fixed, whereas type C was biologically plated. The idea was to assess the applicability and adaptability of the DCS. Fractures in 29 cases united, with one patient suffering from an implant failure. There were 17 excellent, 5 good, 5 fair and 3 poor results. The DCS is a definite advance over previous methods of treatment; when combined with the utilization of biological fixation techniques for comminuted fractures, can be relied upon to treat all types of subtrochanteric fractures.

Stress Fracture Of The Supracondylar Region Of The Femur Induced By The Weight Of The Tibial Ring Fixator

Since its introduction the Ilizarov method has been applied to various orthopaedic pathologies including infected non unions, limb lengthening, deformity correction, filling of defects, arthrosis, arthrodesis, osteomyelitis, occlusive vascular disease and achondroplasia.[4]. The biology of bone and soft tissue regeneration under the conditions of tension stress have virtually solved the healing problems of bone.[8]. In infected non union of long bones, the previous methods of treatment were associated with disuse osteoporosis, soft tissue dystrophy and persistent infection.[9]. In comparison the stable fixation afforded by the Ilizarov apparatus avoids joint immobilization, positively influences osteogenesis, improves circulation while avoiding stiffness.[8,11]. Inherent to the success of this method is the emphasis on early weight bearing, range of motion and gait training.[11] Significant complications with Ilizarov procedures have been shown to be rare and less severe.[11,14]. Paley has described and classified these complications in terms of problems, obstacles and true complications.[14]. We report two cases of stress induced supracondylar fractures of the femur due to the weight of the tibial ring fixator applied for infected non union in the paediatric age group. Complications due to the inherent weight of the fixator construct have never been documented in literature before.

EARLY ACTIVE MOBILIZATION OF PRIMARY REPAIRS OF THE FLEXOR POLLICIS LONGUS TENDON

This study reports the treatment of divided flexor pollicis longus (FPL) tendons from 1989 to 1998. The first 30 patients, in whom the tendon was repaired with a Kessler suture and simple epitendinous suture and mobilized using early active motion with only the thumb splinted, achieved 70/73% (White/Buck-Gramcko assessments respectively), excellent or good results and a rupture rate of 17%. The next 39 patients underwent the same treatment but in a splint with the thumb position altered and the fingers also splinted, with 67/72% excellent or good results and a rupture rate of 15%. The next 49 patients underwent repair with a Kessler suture and a reinforced epitendinous suture and the same mobilization as group 2, with 76/80% excellent or good results and a rupture rate of 8%. The final combination of repair and early active mobilization for primary repair of FPL tendons compares favourably with previous methods of treatment.

Use of Interlocking Intramedullary Nail in Treatment of Delayed Union or Nonunion of the Long Bone Fractures

Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offers the effect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, K.. untscher nail in 2 and interlocking nail in 7 among 24 cases of closed fracture and external fixator in 8 and interlocking nail in 2 among 대한골절학회지 제11권, 제4호, 1 9 98년 1 0월 The Journal of the Korean Society of Fractures Vol.11, No.4, October, 1998

Treatment strategies in traumatic cervical spinal cord injuries with tetraplegia

In our unit between 1984 and January 1988 we have operatively reduced the hospital treatment time in 21 cases of cervical injuries including spinal cord lesions. An initial reposition was carried out according to the principles of Lorenz Böhler and the fixation achieved using a Smith-Robinson H-plate widge spondylodesis. Further conservative management was carried out as advocated by the late Sir Ludwig Guttmann. Early use of operative techniques meant that we were able to shorten significantly the period of medical rehabilitation as compared with previous conservative methods of treatment.

Anterior cricoid split for subglottic stenosis

Subglottic stenosis is a common problem that often results from ventilatory support necessary in the premature infant. Previous methods of treatment include tracheostomy with dilatation of the stenosis, steroid injections, and procedures to stent the trachea. Results of these methods have been unsatisfactory because of the multiple procedures needed to obtain an adequate airway as well as the high mortality from long-term tracheostomy in infants. In the past 2 years, seven infants have undergone an anterior cricoid split for tight subglottic stenosis and airway obstruction. Of the seven patients, six were premature, five of whom required ventilatory support ranging from 4 to 30+ days. Each child presented in respiratory distress with symptoms present in five children from 1 to 11 months (mean 3.8) after birth. Bronchoscopy identified the site of obstruction in each case as subglottic, with a narrow lumen, usually less than 2.5 mm in diameter. Anterior cricoid split was performed at ages ranging from 2 to 11 months (mean 5.0). All children were extubated at 10 to 14 days and subsequently discharged home asymptomatic; none required postoperative tracheostomy. Complications developed in five children, including atelectasis, otitis media, phlebitis, and tracheocutaneous fistula in two, one of whom required operative closure. One child was rebronchoscoped at 3 weeks postoperatively for bronchospasm, which resolved on aminophylline. The subglottic trachea was normal. At follow-up ranging from 2 to 21 months (mean 8.3), no child has symptoms referrable to the subglottic region. In one patient, a brief period of respiratory distress recurred 3 months postoperatively due to tracheomalacia.(ABSTRACT TRUNCATED AT 250 WORDS)

Craniofacial resection for tumors of the nasal cavity and paranasal sinuses

The craniofacial approach for resection of tumors of the nose and paranasal sinuses is well established, as are its advantages over previous methods of treatment. The technique has been considerably modified, resulting in an operation that combines excellent access, a sound oncologic resection with excellent cosmesis, and low postoperative morbidity for conditions associated hitherto with an extremely poor prognosis. The 7-yr experience of 60 patients is presented. Results suggest improved survival in a group of patients who are potentially curable by this procedure, while in those with extensive disease good palliation is achieved. In addition, large benign tumors that would previously have been considered inaccessible can be resected. Its many advantages recommend it as the treatment of choice for tumors of the nose and paranasal sinuses.

Venous malformations in the face and neck. Radiologic diagnosis and treatment with absolute ethanol.

Venous malformations in the face and neck have a characteristic clinical picture. They consist of a cluster of venous cavities with a very slow blood flow and are normally not demonstrated at conventional external carotid angiography. Previous methods of treatment have been of limited value but recently good results have been reported with instillation of fibrosing agents as Ethibloc and ethanol. Five patients with facial venous malformations were referred for therapy. External carotid angiography was performed and was almost normal in all patients. Superselective catheterization demonstrated the malformation clearly in 2 patients only. Direct puncture phlebography confirmed the diagnosis by demonstrating the venous cavities in all the patients. This procedure was concluded by instillation of absolute ethanol into the cavities. There was a marked reduction in size of the malformation but it was not permanently completely occluded. The treatment was repeated in 4 patients with further reduction of the size, but small remnants are still left. Serious complications with extensive soft tissue necrosis occurred in one patient probably as a result of extravasation of ethanol. The necrosis later healed well after surgical treatment. Instillation of ethanol under radiologic control seems to be a promising way of treatment of venous malformations.

Avascular necrosis of the femoral head: a review of the indications and results of Sugioka's transtrochanteric rotational osteotomy.

The results of Sugioka's trans-trochanteric anterior rotational osteotomy are reported. Seventeen cases of idiopathic avascular necrosis of the femoral head have been operated upon and followed-up for between 10 to 48 months, with an average of 25.2 months. Since 1975 the operative technique and complications are described and the clinical results were assessed according to Patterson's criteria. These results are compared with previous methods of treatment. The short term results of Sugioka's method are favorable in cases with a small to medium sized necrosis. This new method of re-orientation of the head provides an intact part of the femoral head for weight bearing and therefore would seem to be appropriate in cases without established osteo-arthritis.

External Fixation in Pelvic Fractures

The treatment of unstable pelvic ring fractures, markedly comminuted and displaced acetabular fractures, and combinations of these insults to the pelvis has been an unsolved problem in orthopedics up to the present time. Of the previous methods of treatment, external fixation has appeared to hold the most promise for certain major pelvic insults, especially those accompanied by instability of the pelvic ring. Many of the previously used external fixation devices, however, have not provided adequate stability. Recently we have modified the Hoffmann external frame to provide a simple method of treatment for unstable pelvic ring fractures that permits the patient to undergo immediate mobilization from bed to chair. Certain other complex central acetabular fractures and combined insults involving the pelvic ring, central acetabulum, and proximal femur have been treated by extensive external frames. The results of these methods are described. Although such external devices appear to be superior to previously available methods, nevertheless, in view of their inherent limitations, we have begun to explore possible methods of internal fixation of the posterior portion of the disrupted pelvic ring combined with internal or external fixation of the anterior segment of the pelvis.

INJECTION TREATMENT FOR VASCULAR FLARES

Small or minor varicosities pose a considerable cosmetic problem to women afflicted with them. Previous methods of treatment have been either painful, or ineffective, or both. A simplified method of injection of these varices is described.