RESUMEN
African Americans face disproportionate sexually transmitted infection including HIV (STI/HIV), with those passing through a correctional facility at heightened risk. There is a need to identify modifiable STI/HIV risk factors among incarcerated African Americans. Project DISRUPT is a cohort study of incarcerated African American men recruited from September 2011 through January 2014 from prisons in North Carolina who were in committed partnerships with women at prison entry (N = 207). During the baseline (in-prison) study visit, participants responded to a risk behavior survey and provided a urine specimen, which was tested for STIs. Substantial proportions reported multiple partnerships (42 %), concurrent partnerships (33 %), and buying sex (11 %) in the 6 months before incarceration, and 9 % tested positive for an STI at baseline (chlamydia: 5.3 %, gonorrhea: 0.5 %, trichomoniasis: 4.9 %). Poverty and depression appeared to be strongly associated with sexual risk behaviors. Substance use was linked to prevalent STI, with binge drinking the strongest independent risk factor (adjusted odds ratio: 3.79, 95 % CI 1.19-12.04). There is a continued need for improved prison-based STI testing, treatment, and prevention education as well as mental health and substance use diagnosis.
Asunto(s)
Negro o Afroamericano/psicología , Infecciones por VIH/epidemiología , Trastornos del Humor/psicología , Pobreza , Prisioneros , Enfermedades de Transmisión Sexual/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto , Estudios Transversales , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Prevalencia , Prisioneros/estadística & datos numéricos , Prisiones , Factores de Riesgo , Asunción de Riesgos , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales , Enfermedades de Transmisión Sexual/psicología , Sexo Inseguro/estadística & datos numéricosRESUMEN
The cause of intermetatarsal neuromas or intermetatarsal neuritis is unclear; however, the most likely pathogenesis is either a mechanically induced degenerative neuropathy or entrapment of the intermetatarsal nerve as it passes under the transverse intermetatarsal ligament. Treatment of intermetatarsal neuromas includes the very simple method of changing shoe styles, more complex conservative treatments with functional orthotic devices, oral anti-inflammatory medications and cortisone injections, and surgical intervention. In this study, 100 adult patients with previously untreated intermetatarsal neuromas received three to seven injections of a 4% alcohol sclerosing solution every 5-10 days. No additional treatment was provided during the visits. The use of 4% alcohol sclerosing solution showed an 89% success rate. Of the 89 patients who were improved, 82 had complete resolution of symptoms. Eleven patients showed no improvement. The results of this prospective study indicate that the alcohol sclerosis treatment of intermetatarsal neuromas is a viable alternative to serial steroid injections or surgery for persistent symptoms.
Asunto(s)
Etanol/uso terapéutico , Enfermedades del Pie/terapia , Neuroma/terapia , Soluciones Esclerosantes/uso terapéutico , Adulto , Anciano , Animales , Diagnóstico Diferencial , Femenino , Enfermedades del Pie/diagnóstico , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Neuroma/diagnóstico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The authors present several options for the surgical treatment of painful and dystrophic mycotic toenails. The procedures include total and partial nail avulsion as well as chemical and excisional matrixectomies, both partial and total. Adjunctive treatment with topical and oral antifungal agents is also discussed.
Asunto(s)
Onicomicosis/cirugía , Dermatosis del Pie/cirugía , Métodos , Uñas/cirugíaRESUMEN
A new surgical curved drill system that drills curved holes into bone is presented, along with several examples of its use in foot and ankle surgery. The technical information involving soft tissue fixation, wiring, or suturing around a bone bridge, by drilling a curved tunnel for tendon, capsule, and ligament reconstruction is also reviewed.
Asunto(s)
Tobillo/cirugía , Pie/cirugía , Instrumentos Quirúrgicos , Huesos/cirugía , Diseño de Equipo , Humanos , Ligamentos/cirugía , Complicaciones Posoperatorias/etiología , Técnicas de Sutura/instrumentación , Tendones/cirugíaRESUMEN
This article presents the clinical findings of a particular form of flatfoot described as the "symptomatic flexible juvenile pes planovalgus" condition. A review and postoperative follow-up of the results from surgical treatment of symptomatic juvenile flatfoot condition is presented for 32 children (59 feet), ranging from 7 to 15 years of age. The author describes the indications and justifications of the procedures involved and reviews the long-term results obtained with this combined surgical approach.
Asunto(s)
Pie Plano/cirugía , Tendón Calcáneo/cirugía , Adolescente , Artrodesis/métodos , Niño , Femenino , Estudios de Seguimiento , Pie/cirugía , Humanos , Masculino , Osteotomía/métodos , Podiatría/métodos , Prótesis e Implantes , Elastómeros de Silicona , Tendones/cirugíaRESUMEN
The authors present an overview of the V-Y plasty technique with a discussion of the basic underlying principles and a description of the surgical technique. The variations available and the direct application of this procedure are discussed with reference to the foot and ankle. Consideration is given for design, location, survival, and postoperative care of the V-Y plasty.
Asunto(s)
Pie/cirugía , Colgajos Quirúrgicos/métodos , Humanos , Podiatría/métodosRESUMEN
A discussion of the design and use of the Z-skin plasty to revise scars and lengthen skin contractures of the lower extremities is presented. One of the most commonly used rotational flaps to alter scar direction or relieve tension on the existing scar or skin, the Z-plasty can also be the most difficult to perform and carries a high risk of flap loss if inaccurately planned or poorly placed. Several variations of the standard procedure and examples of common usage are presented.
Asunto(s)
Cicatriz/cirugía , Contractura/cirugía , Deformidades Adquiridas del Pie/cirugía , Colgajos Quirúrgicos/métodos , HumanosRESUMEN
The basic principles of a single-lobe flap are discussed along with the description of a modified slide-swing rotational flap. This rotation flap is called the Schrudde flap, and it has many applications in the treatment of skin defects of the foot and ankle. This rotation skin flap procedure provides excellent end results with high patient acceptance.
Asunto(s)
Enfermedades del Pie/cirugía , Colgajos Quirúrgicos/métodos , HumanosRESUMEN
Scar formation is discussed along with definitions of the three most common types of scars: normal, hypertrophic, and keloid. Several current forms of therapy designed to reduce or eliminate scars are presented. The use of silicone gel sheeting is reviewed as a newer solution for the treatment of many types of lower extremity scars.
Asunto(s)
Cicatriz Hipertrófica/cirugía , Queloide/cirugía , Geles , Humanos , Siliconas/uso terapéuticoRESUMEN
An analysis of treatment options and the results of various treatments is presented for the lower extremity digital mucoid cyst. The author reviews the retrospective results of 25 consecutive Schrudde rotation flap procedures which were performed on 24 patients with digital mucoid cysts. The long-term results (greater than one year) revealed a 94% success rate with this treatment option.
Asunto(s)
Enfermedades del Pie/diagnóstico , Enfermedades del Pie/cirugía , Quiste Sinovial/diagnóstico , Quiste Sinovial/cirugía , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Estudios Retrospectivos , Dedos del PieRESUMEN
Iatrogenic and posttraumatic adhesive lesions of the ankle joint are rather common, although infrequently reported, clinical entities. Ankle arthroscopy has proved to be a valuable asset in the assessment and treatment of recalcitrant symptomatic cases of both localized adhesions and adhesive capsulitis. This article intends to broaden the reader's understanding of the clinical presentation and intra-articular derangements of these lesions.
Asunto(s)
Articulación del Tobillo , Cápsula Articular , Artrografía , Artroscopía , Humanos , Artropatías/diagnóstico , Artropatías/cirugía , Ligamentos Articulares/patología , Ligamentos Articulares/cirugía , Examen Físico , Adherencias Tisulares/diagnóstico , Adherencias Tisulares/cirugía , Tomografía Computarizada por Rayos XRESUMEN
An evaluation of the results of treatment of both fresh and long-standing hypertrophic and keloid scars on the lower extremities using topical SILASTIC Gel Sheeting was performed in 94 patients ranging in age from 11 to 73 years. In the total of 94 patients, there were 80 with true hypertrophic scars. Of this group, 74 patients (92.5%) were greatly improved with treatment, five patients (6.25%) were somewhat improved, and one patient (1.25%) was not improved. The remaining 14 patients in the study had true keloid scars, and their results were poorer with five patients (35.7%) greatly improved, five patients (35.7%) somewhat improved, and four patients (28.6%) showing no improvement. When all patients were totalled together, there were 79 patients (84%) greatly improved, 10 patients (11%) somewhat improved, and only five patients (5%) with no improvements. Overall, the success rate (somewhat improved to greatly improved) for the treatment of hypertrophic and keloid scars is high (95%).
Asunto(s)
Cicatriz Hipertrófica/terapia , Dimetilpolisiloxanos/uso terapéutico , Queloide/terapia , Apósitos Oclusivos , Elastómeros de Silicona/uso terapéutico , Adolescente , Adulto , Anciano , Niño , Femenino , Pie/cirugía , Traumatismos de los Pies , Humanos , Masculino , Persona de Mediana Edad , Mallas QuirúrgicasRESUMEN
KA develops from a rapidly growing, firm, smooth nodule into a mature dome-shaped lesion with a central core filled with keratin that usually degenerates into an involuting keratinous mass. KAs must be differentiated from squamous cell carcinoma. Classically, KA is a benign tumor that is self-limiting. However, there is controversy concerning the aggressiveness of the tumor. Some authors believe there is no way to determine the aggressiveness of the tumors and they should be classified as low grade squamous cell carcinomas (3). Others feel that the risk of malignant transformation is not a serious consideration but misdiagnosis is, due to the histopathologic similarities (31, 33). Overall, the literature shows that solitary and giant lesions should be excised. Excisional biopsy yields a more cosmetic scar and increases the chance for an accurate biopsy diagnosis. Multiple and multinodular lesions should be excised if they have the potential for causing a mutilating deformity but are otherwise treated systematically. If a solitary or multiple lesion which is left to spontaneously resolve shows signs of aggressiveness, even with a biopsy indicating that it is a KA, it should be immediately excised. Solitary and giant KA are usually not considered to be located on the palms and soles. However, with the cases presented here, there are now a total of 4 cases in the literature. Therefore, KA should be included in the differential diagnosis when dealing with rapidly growing tumors on the plantar aspect of the foot.
Asunto(s)
Enfermedades del Pie , Queratoacantoma , Anciano , Enfermedades del Pie/diagnóstico , Enfermedades del Pie/etiología , Enfermedades del Pie/fisiopatología , Enfermedades del Pie/terapia , Humanos , Queratoacantoma/diagnóstico , Queratoacantoma/etiología , Queratoacantoma/fisiopatología , Queratoacantoma/terapia , MasculinoRESUMEN
This is a combined research study including use of a reproducible technique for ankle stress x-ray examinations (both preoperatively and postoperatively) and the use of the bovine bioprosthesis tendon implant for stabilization and augmentation of the lateral ankle ligaments. The surgical technique is fully described and the follow-up results indicate that there is long-term ankle stability, and that patient acceptance is very high.
Asunto(s)
Articulación del Tobillo/cirugía , Bioprótesis , Inestabilidad de la Articulación/cirugía , Prótesis Articulares , Esguinces y Distensiones/cirugía , Tendones/cirugía , Adolescente , Adulto , Animales , Traumatismos del Tobillo , Bovinos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Diseño de PrótesisRESUMEN
A recent advancement in the surgical treatment of chronic lateral ankle instability is presented. The authors have collected data from 401 surgical stabilizations of the lateral ankle performed at the Waldo Podiatric Residency Program. A data summary is presented to provide the reader an appreciation of the evolution in treatment of ankle instability at this institution. The free tendon graft method of lateral ankle ligament reconstruction is also presented as performed on 37 patients with chronic unstable ankles.
Asunto(s)
Traumatismos del Tobillo , Trastornos de Traumas Acumulados/cirugía , Inestabilidad de la Articulación/cirugía , Tendones/trasplante , Trasplante Autólogo , Enfermedad Aguda , Articulación del Tobillo/fisiología , Articulación del Tobillo/cirugía , HumanosRESUMEN
The authors describe use of a Silastic plug to limit subtalar joint motion in symptomatic pediatric flatfeet. Three patients sustained postoperative injury resulting in pedal complications. Successful resolution of these cases is discussed.
Asunto(s)
Artrodesis/instrumentación , Pie Plano/cirugía , Traumatismos de los Pies , Plásticos , Polipropilenos , Complicaciones Posoperatorias/etiología , Prótesis e Implantes , Articulación Talocalcánea/cirugía , Adolescente , Niño , Femenino , Humanos , MasculinoAsunto(s)
Mortalidad Infantil , Mortalidad , Preescolar , Femenino , Humanos , Lactante , Masculino , Papúa Nueva GuineaAsunto(s)
Pie Plano/terapia , Preescolar , Pie Plano/diagnóstico por imagen , Humanos , Masculino , RadiografíaRESUMEN
A surgical technique utilizing a bovine xenograft bioprosthesis has been developed for stabilizing a chronically unstable lateral ankle. With this new technique, minimal dissection of adjacent soft tissue is required, and the method allows for tissue ingrowth for strength and anastomosis to bone. However, a longer period of non-weightbearing is required to prevent inadequate incorporation of the graft.