Dispelling the misconceptions of talocalcaneal interosseous ligament release in clubfoot surgery

Despite decades of experience in the topics of clubfoot considerable 1 uncertainty remains, regarding its treatment and long term results. Surgical release of talocalcaneal interosseous ligament [TCIL] possesses a controversial issue, as many thought that it has early and remote drawbacks effect as avascular necrosis of the talus and hindfoot overcorrection. This is a retrospective study of 60 idiopathic clubfeet in 43 patients were treated by posteromedial surgical approach since 14 years ago. There were 38 male patients [88.4%] and 5 were females [11.6%] . The affected side was [left =11; right= 15; bilateral = 34 feet]. The preoperative deformity was very severe in 36 feet [60%] and severe in 24 [40%] by using the Simon scale . Preoperatively the feet were divided randomly into 2 equal groups [A] and [B][30 feet each]. All the feet were treated by means of soft tissue release via posteromedial approach at mean age 9 months range [3-24 months]. In group [A] feet, the talocalcaneal interosseous ligament [TCIL] was released, where in group [B] the ligament was left intact. At mean follow-up period of 12.5 years range [11-14 years] the late follow result was satisfactory in [96.6%] in group A and [90%] in group B feet. This shows increasing of their late satisfactory percentage than their early follow up assessment. When the late total mean of both clinical and radiological scores were investigated, group [A] still graded excellent results while group [B] graded as good. The group [A] feet showed more satisfactory and statistically significant improvement of the talocalcaneal index, anteroposterior, lateral talocalcaneal and lateral calcaneus-first metatarsal angles when compared with group B elements. This was reflected clinically as it shows more better hindfoot correction with the surgical release of the TCIL .This without any evidence of significant clinical overcorrection. Magnetic resonance imaging[MRI] was performed early five months after surgery to assess talar avascular necrosis and talo-calcanio-navicular alignment .ThiV

Postermomedial surgical approach with or without selective medial release of the subtalar joint in clubfoot surgery

Congenital clubfoot is a variable three dimensional complex system of chondroosseous and joints deformity. Its treatment possess a controversial issue since dates of Hippocrates. In clubfoot surgery many complications as stiffness, overcorrection, talar avascular necrosis and subsequently poor functional results were postulated by many as a sequlae to simultaneous complete subtalar release . This is a prospective study of 33 patients with 40 idiopathic clubfeet. There were 28 males [84.8%] and 5 were female [15.2%] patients.The affected sides were [left =11; right= 15; bilateral = 14 feet]. The feet were divided randomly into 2 equal groups [A and B][20 feet each]. The initial deformity was very severe in 32 feet and severe in 8 by using the Simon scale and allocated equally in both groups. All the feet were treated at a mean age of 8 months by means of posteromedial surgical soft tissue release. In addition selective medial capsular release of the subtalar joint with release of talocalcaneal interosseous ligament was done in group [A] feet where it was left intact in group [B]. At a mean follow-up period of 26 months range [24-30], the total satisfactory results were [85%]. In both groups the result was [90%] satisfactory in group [A] and [85%] in group [B] feet . When their mean overall clinical and radiological scores were investigated and comparing their satisfactory results together, group [A] feet showed statistically significant improvement of clinical and radiological parameters than those of group [B]. This was reflected clinically on better hindfoot alignment with the release of the TCIL in group [A] feet. Neither any evidence of overcorrection nor talar avascular necrosis was detected either clinically or radiologically by conventional x-ray as well as by MRI of all the studied feet in both groups. Posteromedial surgical approach with release of TCIL proved to be a good contribution in the treatment of severe and relapsing clubfeet, which gave significantly better hindfoot alignment without aforementioned serious complication

Surgical decompression of posterior tibial nerve entrapment in the tarsal tunnel

Tarsal tunnel syndrome is entrapment neuropathy of the posterior tibial nerve or any of its branches at the posteromedial aspect of the ankle and foot. Its treatment possesses a controversial issue, when non operative means fail to resolve the problem, its surgical decompression with neurolysis of the nerve and its branches is mandatory. This is a prospective study of 26 patients with 36 Tarsal tunnel syndromes, at a mean age of 40 years range [23-57 years] . There were 6 male patients [23%] and 20 [77%] were females. The affected sides were [right = 12; left= 4; bilateral = 20 feet]. All the patients were presented after having been subjected to conservative treatment for varying periods of time which range from [12-36] months. Preoperatively the affection was clinically severe in 16 feet [44.4%] and moderate in 20[55.6%] as assessed clinically by the author and confirmed by electro-diagnostic studies using the modified pointing scoring system which proposed by Dellon et al. All the feet were treated by surgical decompression of tarsal tunnel with neuro lysis of the posterior tibial nerve and its branches . At mean follow-up period of 20 months which ranges from [15-30 months] the result was satisfactory in 33feet [91.6%] and 3[8.4%] were unsatisfactory. When the follow up overall mean scores of clinical and electrodiagnostic studies were investigated showed that there are significant positive linear improvement than those of the preoperative scores of clinical and nerve conduction studies.This was reflected clinically to the improvement of the patients daily activity to normal or nearly normal life style. This study suggests that early decompression of the posterior tibial nerve and neurolysis of its branches is mandatory when non operative means fail to resolve the problem

Effects of obesity smoking and hypertension on plasma endothelin

Endothelins belong to a family of vasoactive peptides implicated in several disorders of the microvasculature. Endothelin-1 is a potent vasoconstrictive peptide with divers physiologic actions and has been considered to be involved in pathogenesis of hypertension. Several investigators had reported multiple vascular complications related to the high circulatory level of endothelin-[1]. The study comprised 80 male subjects allocated in 4 study groups: Group 1 contained 20 normal men. Group 11 contained 20 obese men. Group 111: contained 20 hypertensive men. Group IV contained 20 smokers. All of study participants were assigned for estimation of plasma levels of endothelin-1 .insulin and blood lipid profile. The obtained results showed a significantly higher fasting plasma ET-[1] levels in all study groups compared to the control. furthermore, there was a significant increase of fasting plasma insulin levels in all study groups, except the smokers, hypertensive as compared to the control levels. The mean value of serum cholesterol and LDL was significantly increased in obese group as compared to controls, but did not differ significantly in hypertensive and smokers compared to controls. The mean value of serum TGS was significantly increased in all study group compared to controls, On the other hand, serum HDL was significantly decreased in all study groups compared with controls. Analysis of the obtained results showed the presence of a positive significant correation between fasting plasma ET-[1] and the mean BMI of obese subjects. Furthermore, fasting plasma ET-[1] showed a positive significant correlation with fasting plasma of insulin in all study groups except the smokers, such correlation suggested a synergistic or additive effect of both peptides in the pathogenesis of obesity, hypertension. Moreover, there was a positive significant correlation between fasting plasma level of ET-[1] with cholesterol, TGs and LDL and a negative significant correlation with serum levels of HDL in all study group. These results signify the presence of a relationship between dyslipidemia occuring in obese, hypertensive and smokers and these peptides. This relation may be causal or concomitant Conclusion, Increased fasting plasma levels of ET-[1] increases the risk of occurrence of cardiovascular complications in either obese, hypertensive, or smoker subjects. The concomitant increase of fasting plasma insulin levels leads to a more pronounced damaging effect and despite being a causal or result, the concomitant dyslipidemia will sign a danger signal for these high risk subjects of being at an increased risk of cardiovascular complications

Effect of calcium antagonists on kidney function in rats

Calcium antagonists is cardiovascular protective drugs and used in treatment of hypertension in addition to its nephroprotective effect. The present work was carried out on thirty male albino rats which divided into three equal groups. Group I: it included 10 normal rats used as control. Group II: it included 10 induced acute uraemic rats by dehydration for 24 hours then intramuscular injection 10 mg/kg glycerol. Group III: it included 10 induced uraemic rats received diltiazem 9 mg/kg twice daily orally 7 days before dehydration. Our results showed that the biochemical parameters [urea, creatinine, sodium, potassium] was significantly increased in group II as compared to normal rats as a result of dehydration and glycerol injection in this group. On other hand the mean value of biochemical parameters of kidney function in group III that received diltiazem was significantly decreased in comparison to group II but there is no significant difference in the parameters of kidney function between group III and group I. Calcium antagonists showed nephroprotective effect. The above results suggest the possiblity of using diltiazem in treatment of acute renal failure or as a prophylactic when acute renal failure is predicted