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The Journal of Cardiovascular Surgery Apr 2016Conventional bypass surgery is only possible when patent distal arterial outflow vessels are available. In patients with critical limb ischemia and occluded distal... (Review)
Review
Conventional bypass surgery is only possible when patent distal arterial outflow vessels are available. In patients with critical limb ischemia and occluded distal arteries, attempts have been made to establish retrograde perfusion through either deep or superficial pedal veins. Though historical results were disappointing, more recently limb salvage has been achieved after adopting a principle of 1) placing the anastomosis distally, and 2) actively destroying the distal valves. Experimental, para-clinical, and clinical data confirm that direct tissue nutrition is improved, angiogenesis stimulated, and collaterals opened. Only a limited number of cases have been reported in the literature and a number of different operative techniques have been described. The results in terms of limb salvage and wound healing vary widely. Generally, results are poorer than what would have been expected if femoro-distal arterial bypass had been possible. Recently, hybrid approaches have been developed to avoid extensive distal incisions by endovascular destruction of valves and closure of side branches. Also, a totally endovascular technique, including the position of a stent graft between the vein and artery, has been proposed and tested. These developments may in the future improve results by limiting incisional wound complications and make this treatment available to more patients who would otherwise have no other alternative than amputation.
Topics: Arterial Occlusive Diseases; Femoral Artery; Humans; Lower Extremity; Vascular Surgical Procedures; Veins
PubMed: 26683823
DOI: No ID Found -
The Angle Orthodontist Jul 2020To determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II...
OBJECTIVES
To determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II skeletal relationships.
MATERIALS AND METHODS
The sample included 59 adolescents (16 boys and 43 girls) with unilateral or bilateral Class II molar and bilateral Class II canine relationship. They were divided into group 1 with skeletal Class I (N = 27; ANB 2.90° ± 1.40°; 13.30 ± 1.53 years) and group 2 with skeletal Class II (N = 32; ANB 6.06° ± 1.64°; 13.26 ± 1.76 years). Cone beam computed tomography images were traced with Invivo software pretreatment (T1) and post-CMA usage (T2). The treatment changes in 36 measurements were calculated in each group, and the changes in 16 measurements were compared between them.
RESULTS
In group 1 and 2, maxillary first molars underwent significant distal movement (1.92 mm ± 0.80 mm and 1.67 mm ± 1.56 mm, respectively) with distal tipping and rotation, maxillary canines underwent significant distal movement (2.34 mm ± 1.07 mm and 2.24 mm ± 1.91 mm, respectively) with distal tipping and rotation, and mandibular molars underwent significant mesial movement (-1.37 mm ± 1.23 mm and -2.51 mm ± 1.51 mm, respectively) with mesial tipping. Between the groups, there were significant differences in mandibular molar mesial movement and the U1-SN changes (P < .05).
CONCLUSIONS
The CMA corrected Class II malocclusion through distal tipping and rotational movement of maxillary canines and molars and corrected mesial tipping of mandibular molars. Significantly more mandibular molar mesial movement and maxillary incisor flaring were observed in patients with skeletal Class II.
Topics: Adolescent; Cephalometry; Female; Humans; Incisor; Male; Malocclusion, Angle Class II; Maxilla; Molar; Orthodontic Appliance Design; Tooth Movement Techniques
PubMed: 33378493
DOI: 10.2319/080919-523.1 -
Operative Orthopadie Und Traumatologie Oct 2020Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited... (Review)
Review
OBJECTIVE
Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited to the radiocarpal joint.
INDICATIONS
Osteoarthritis limited to the radiocarpal joint with intact mediocarpal joint after malunited intra-articular distal radius fractures, rheumatoid osteoarthritis, scapholunate advanced collapse (SLAC) up to stage II.
CONTRAINDICATIONS
Mediocarpal osteoarthritis, poor patient compliance, SLAC from stage III, osteitis.
SURGICAL TECHNIQUE
The palmar RSL arthrodesis is performed using the palmar approach between the flexor carpi radialis tendon and the radial artery. After releasing the pronator quadratus muscle, a longitudinal capsulotomy is performed and the radiocarpal joint is inspected. After correction of a volar or dorsal intercalated segmental instability of the lunate, the lunate is temporarily fixed to the scaphoid using a K-wire. The distal quarter of the scaphoid and the palmar rim of the distal radius is resected and the cartilage between the scaphoid, lunate and distal radius is removed. The scaphoid and lunate are temporarily fixed to the distal radius using K‑wires. Under image intensifier control the angular stable low-profile plate (e.g., volar 2.5 Trilock RSL Fusion plate [Medartis® Aptus® Basel, Switzerland]) is fixed to the distal radius in the long-leg hole. The scaphoid and lunate are fixed distally with two screws each. The carpus is pushed distally using a Codeman distractor and the cancellous bone graft is impacted. Finally, the shaft is fixed with angular stable screws.
POSTOPERATIVE MANAGEMENT
Immobilization using a plaster cast or thermoplastic short-arm orthosis for 5 weeks. After 2 weeks, the orthosis can be removed during hand therapy with active wrist and finger exercises. Normal activities permitted after 12 weeks.
RESULTS
Palmar RSL arthrodesis and distal scaphoidectomy using angular stable plate fixation shows a high union rate and pain relief while maintaining good residual mobility of the wrist.
Topics: Arthrodesis; Humans; Lunate Bone; Scaphoid Bone; Treatment Outcome; Wrist Joint
PubMed: 32100069
DOI: 10.1007/s00064-020-00651-1 -
Journal of Clinical Orthodontics : JCO Mar 2016
Review
Topics: Humans; Malocclusion, Angle Class II; Maxilla; Molar; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Tooth Movement Techniques
PubMed: 27117735
DOI: No ID Found -
International Journal of Sports... Apr 2019Distal biceps rupture is less common than injury to the proximal biceps; however, injury distally has profound functional implications on activities which rely on power...
BACKGROUND AND PURPOSE
Distal biceps rupture is less common than injury to the proximal biceps; however, injury distally has profound functional implications on activities which rely on power during elbow flexion and forearm supination. The majority of distal biceps ruptures can be treated with surgical repair of the distal biceps utilizing either a single or two-incision technique; both of which achieve comparable improved outcomes and reported minimal pain and disability at two years. Safe and effective rehabilitation following distal biceps repair is accomplished through a phased progression, with avoidance of premature stress to the healing soft tissue repair.The purpose of this clinical commentary is to provide a concise review of distal biceps tendon injury, including relevant anatomy, etiology, diagnosis, and operative intervention as well as post-operative factors influencing the pursuit of a criterion based, progressive rehabilitation program after distal biceps tendon repair. This commentary seeks to provide an update on current treatment strategies used in distal biceps rehabilitation with accompanying scientific rationale.
LEVEL OF EVIDENCE
5.
PubMed: 30997282
DOI: No ID Found -
Clinics in Sports Medicine Jan 2022Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has... (Review)
Review
Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.
Topics: Humans; Joint Instability; Osteotomy; Patella; Patellofemoral Joint; Tibia
PubMed: 34782071
DOI: 10.1016/j.csm.2021.07.008 -
American Journal of Orthopedics (Belle... 2017We systematically reviewed patella alta with respect to type of measurements, reported cutoff values, cutoff values for surgical correction, and proposed surgical... (Review)
Review
We systematically reviewed patella alta with respect to type of measurements, reported cutoff values, cutoff values for surgical correction, and proposed surgical techniques. Using the term patella alta, we performed a systematic literature search on PubMed. Inclusion criteria were original study or review articles, publication in peer-reviewed English-language journals between 2000 and 2017, and narrative description or measurement of human patellar height on plain radiographs or magnetic resonance imaging (MRI). All evidence levels were included. Of 211 articles identified, 92 met the inclusion criteria for original study, and 28 for review. The 92 original study articles defined patella alta mostly with imaging-based measurements (81.5%) and more rarely by description only (18.5%). Eighteen types of measurement methods with 27 different cutoff values were used to assess patella alta; these methods included lateral radiographs, sagittal MRI, radiographic ratios measured on MRI, and patellar tendon length. The Insall-Salvati index (ISI) was used more than the Caton-Deschamps index (CDI); cutoff values for patella alta varied from >1.2 to >1.5 for ISI and from >1.2 to >1.3 for CDI. Both indices were seldom used on MRI; cutoff values were similar to those for conventional radiographs. On sagittal MRI, the patellotrochlear index was used most; cutoff values ranged from <0.125 to 0.28. Eleven studies used patellar tendon length and found it was increased (>52 mm to >56 mm). The 28 reviews described patella alta mostly with ISI (75%) or CDI (64%). However, 12 (57%) of the 21 review studies that used ISI and 7 (39%) of the 18 review studies that used CDI did not report cutoff values. Only 2 review studies suggested an ideal patellar height after surgery. Different procedures were used to treat patella alta: tibial tubercle distalization with and without patellar tendon tenodesis, tibial tubercle distalization and medialization, and distal advancement of the patellar tendon. Only 11 original studies proposed a critical patellar height as an indication for surgery; however, these studies mainly used CDI, and only 4 mentioned a desired postoperative patellar height after correction. Our review revealed many variations in patella alta definitions and descriptions, measurement methods, cutoff values, and treatment options. Presence of patella alta depends on the measurement method used. Unfortunately, there is no generally accepted consensus on patella alta. Given its influence on patellofemoral loading/stress and patellar stability, however, we must strive to establish a consensus in the near future.
Topics: Humans; Magnetic Resonance Imaging; Orthopedic Procedures; Patella; Patellar Ligament; Tibia
PubMed: 29309446
DOI: No ID Found -
Developmental Biology Sep 2017Vertebrate limb development relies on the activity of signaling centers that promote growth and control patterning along three orthogonal axes of the limb bud. The... (Review)
Review
Vertebrate limb development relies on the activity of signaling centers that promote growth and control patterning along three orthogonal axes of the limb bud. The apical ectodermal ridge, at the distal rim of the limb bud ectoderm, produces WNT and FGF signals, which promote limb bud growth and progressive distalization. The zone of polarizing activity, a discrete postero-distal mesenchymal domain, produces SHH, which stimulates growth and organizes patterning along the antero-posterior axis. The dorsal and ventral ectoderms produce, respectively, WNT7A and BMPs, which induce dorso-ventral limb fates. Interestingly, these signaling centers and the mechanisms they instruct interact with each other to coordinate events along the three axes. We review here the main interactions described between the three axial systems of the developing limb and discuss their relevance to proper limb growth and patterning.
Topics: Animals; Body Patterning; Extremities; Models, Biological; Signal Transduction
PubMed: 28283405
DOI: 10.1016/j.ydbio.2017.03.006 -
Progress in Orthodontics Dec 2023The aim of this study was to evaluate the distal movement, vertical movement, distal tipping and crown buccal torque of maxillary molars after the completion of...
BACKGROUND
The aim of this study was to evaluate the distal movement, vertical movement, distal tipping and crown buccal torque of maxillary molars after the completion of distalization by comparing the predicted movement with the achieved movement using palatal rugae registration.
METHODS
The study included 22 clear aligner patients (7 males and 15 females), and 79 molars were measured. Two digital models were generated before treatment and after molar distalization and were superimposed after selecting the palatal rugae area for registration in GOM inspect suite software 2022 (GOM; Braunschweig, Germany). The predicted and achieved movements of molar distalization, intrusion, distal tip and crown buccal torque were measured and compared.
RESULT
The achieved distalization (1.25 ± 0.79 mm vs. 2.17 ± 1.03 mm, P < 0.001; 1.41 ± 1.00 mm vs. 2.66 ± 1.15 mm, P < 0.001), intrusion (0.47 ± 0.41 mm vs. 0.18 ± 0.54 mm, P < 0.01; 0.58 ± 0.65 mm vs. 0.10 ± 1.12 mm, P < 0.01), distal tip (5.30 ± 4.56° vs. 1.53 ± 2.55°, P < 0.001; 4.87 ± 4.50° vs. - 1.95 ± 4.32°, P < 0.001) and crown buccal torque (1.95 ± 4.18° vs. - 1.15 ± 4.75°, P < 0.001; 0.43 ± 4.39° vs. - 4.27 ± 6.42°, P < 0.001) were significantly different from the predicted values in the two groups (first molar, second molar). Significant regression relationships were found between the achieved distal movement and deviational intrusion (R = 0.203, P < 0.0001), distal tip (R = 0.133, P < 0.001) and crown buccal torque (R = 0.067, P < 0.05). There was a significant correlation between the deviational movements of intrusion and the distal tip (R = 0.555, P < 0.0001).
CONCLUSION
Approximately 2 mm maxillary molar distalization was achieved in this study. Deviational movement of intrusion, distal tip and crown buccal torque beyond the clear aligner virtual design appeared to a certain degree after distalization. Thus, more attention should be given to molar intrusion and distal tip and crown buccal torque as the designed distalization increases.
Topics: Male; Female; Humans; Torque; Malocclusion, Angle Class II; Maxilla; Molar; Crowns; Orthodontic Appliances, Removable; Tooth Movement Techniques
PubMed: 38151662
DOI: 10.1186/s40510-023-00500-4