Ankle arthroscopy versus conservative modalities in management of ankle impingement syndrome: a systematic review of literature

Background: it has been well established that chronic ankle pain negatively affects the lives of patients. Surgical techniques for ankle pain have evolved dramatically over the past decade, as arthroscopic equipment has improved to allow excellent exposure to the ankle joint and surrounding anatomic areas. Soft-tissue and osseous impingement syndromes are now increasingly recognized as a significant cause of chronic ankle pain, The exact cause of this condition is debated but seems to involve osteophyte formation due to either repetitive microtrauma or macrotrauma associated with major injuries. Careful analyses of patient history and signs and symptoms at physical examination can suggest a specific diagnosis in most patients

Aim of the work: this systematic review aimed to assess the outcome of ankle arthroscopy versus conservative modalities in management of ankle impingement syndrome

Methods: a systematic literature search of the PubMed, Embase [classic], and Chochrane library databases, for articles that published from January 1990 to June 2017 was performed using the following inclusion criteria English language puplications, human clinical trials, studies that reported on at least one of the chosen outcome measures which are patient satisfaction, time to return to full activity, AOFAS score, visual analog scale [VAS] score for pain, and complications, we found 9 studies met our inclusion criteria, data extraction was done which is consisted of population characteristics, in addition to the outcome measures

Results: nine articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with ankle impingement syndrome, patient satisfaction rates was reported in 5 studies, we reported high percentages of good to excellent satisfaction rates, ranging 74% to 94%, especially in patients treated with arthroscopy, Complication rates were 14.1%, as regard to patients treated with arthroscopy the rate was 13.2%, on the other hand the rate was 17.6% in those patients treated with injection therapy technique, conventional conservative modalities reported to be ineffective in treating ankle impingement except injection therapy technique in case of ankle soft tissue impingement

Conclusion: our systematic review showed that Patients may respond to conservative treatment modalities, especially ultra-sound guided injection mainly in soft tissue impingement type, arthroscopic debridement is the treatment of choice for patients of ankle impingement syndrome of both osseous and soft tissue nature with least morbidity and early return to function, and also it is noted to be superior to conservative modalities

prevalence of vitamin d deficiency in ancient egyptian population from baharia oasis, the greco roman period

Vitamin D deficiency is considered to be the most common nutritional deficiency andalso one of the most common undiagnosed medical conditions in the world. Vitamin D is naturallypresent only in minor amounts in most foods; the great majority is synthesized by the action ofultraviolet light on chemical precursors in the skin.The manifestation of vitamin D deficiency in sub adults is referred to as rickets, and in adults,osteomalacia . Rickets and osteomalacia are the sub adult and adult expressions of a disease in whichthe underlying problem is a failure to mineralize bone protein [osteoid]. The most common cause ofthis disease is a physiological deficiency in vitamin D. The associated problems include deformedbones. This study aimed to investigate the skeletal remains of ancient Egyptiansfrom Baharia Oasis population for lesions indicative of vitamin D deficiency [rickets andosteomalacia]. The material consisted of 1075 commingled bones [38 sub adults and 1037 adults]. They were recovered from Baharia oasis. The results showed that, there was no evidence of rickets in sub adult group. The prevalenceof osteomalacia in adult Baharia populations was 7.4% ; all were adult males.This result could indicate that this population was subjected to sunlight all over the year and their dietwas rich of calcium and phosphorus. These few cases that were found may be due to mechanical stress during wine andtextile production

Fundus changes in liver cirrhosis

Introduction: vitamin A deficiency-related ophthalmopathy, Xerophthamia and colour blindness may be documented in liver cirrhosis due to various etiologies. Retinopathy is an obscure feature of cirrhosis. Our aim is to evaluate ophthalmic disorders with special attention to funuds changes in cirrhotic patients

Methods: this study included 26 cirrhotic patients [18 male and 8 female] with the mean of age was 50.4 +/- 7.4 years and 26 healthy-volunteers as control group with the mean of age was · 46 +/- 9.l years. Patient with systemic diseases such as diabetes mellitus and hypertension were excluded. All participants had ophthalmic examination

Results: four [15.4%] of the cirrhotic patients had soft exudates in the retina. None of the control subjects had retinopathy [P= 0.01]. As regard to other ophthalmic pathologies, there were no statistically significant differences between the two groups. Fundus changes did not show any differences according to etiology of cirrhosis

Conclusion: fundus examination reveals soft exudates, ·which probably due to impaired synthetic function of the liver and hemodynamic effect of portal hypertension. Retinopathy in liver cirrhosis, must be sought and followed-up because of its sever morbidity

Evaluation of primary inferior oblique muscle surgery inv-pattern strabismus

Purpose: to study effectiveness of accurate evaluation and surgery of the inferior oblique muscle in cases of V-pattern strabismus with primary inferior oblique over-action

Material and Methods: Twenty eyes of ten patients with V-Pattern strabismus and primary inferior oblique over-action were examined and operated upon in Minya University Hospital, from September 2003 to April 2004. Operative technique used in this study was combined recession-resection for horizontal deviation, with transposition of the medial rectus downwards in two cases and graded recession-anteriorizaion of the inferior oblique

Results: Orthotropia in nine diagnostic positions of gaze occurred in four cases [two of them with recession-resection and MR. trans-position]. Under-correction of horizontal deviation occurred in four cases and residual inferior oblique over-action with horizontal deviation occurred in two cases

Conclusion: The effect of inferior oblique weakening procedures on horizontal alignment needs to be thoroughly studied and calculated added to the role of abnormal muscle insertion as a cause of V-pattern should be kept in mind during medial rectus muscle surgery