European Journal of Cardiovascular Medicine

Background Tibio-talo-calcaneal (TTC) arthrodesis using retrograde intramedullary nailing is a widely accepted salvage procedure for complex hind-foot pathology. Despite its increasing utilization, functional outcomes from Indian settings using validated patient-reported outcome measures (PROMs) remain under-reported. This study evaluates radiological union, pain relief, and PROM trajectories following TTC fusion with retrograde nailing. Methods

An ambispective observational cohort was conducted at a tertiary orthopaedic center between September 2010 and April 2011. Adults (≥18 years) with post-traumatic or degenerative hind-foot arthritis, talar avascular necrosis, or paralytic deformity undergoing TTC arthrodesis with a retrograde nail were included. Patients with uncontrolled diabetes or active peripheral vascular disease were excluded. Thirty patients (mean age: 51.2 ± 10.2 years; 60% male) were analyzed. Functional outcomes were assessed preoperatively and at 1, 6, and 12 months using the Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), and Numeric Pain Scale (NPS). Fusion status, time to weight-bearing, and complications were recorded prospectively. Statistical significance was set at p < 0.05. Results At 12 months, mean FAOS improved from 30.66 to 88.31, FFI decreased from 181.11 to 118.40, and NPS declined from 7.10 to 1.47 (all p < 0.001). Radiological fusion was achieved in 96.7% at a mean of 14.5 weeks. Full weight-bearing commenced at 16.1 weeks, with functional independence by 6.8 months. Overall complication rate was 26.7%, primarily delayed wound healing (13.3%). Conclusion TTC arthrodesis with retrograde intramedullary nailing offers reliable fusion, significant pain reduction, and improved function in complex hind-foot pathology with acceptable complication rates.

Background: Anterior cruciate ligament (ACL) injuries are common in young, active individuals and often necessitate surgical reconstruction for optimal functional recovery. The five-strand hamstring autograft technique has been proposed to overcome the limitations of grafts with insufficient diameter, potentially enhancing biomechanical strength and clinical outcomes. Methods: This single-center, prospective observational study was conducted at Sree Balaji Medical College and Hospital, Tamil Nadu between January 2010 and June 2011. A total of 35 patients aged 18-45 years with isolated ACL tears underwent arthroscopic reconstruction using a five-strand hamstring autograft. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 weeks, 6 months, and 12 months. Statistical analysis was performed using the Friedman test and Wilcoxon signed-rank test for repeated measures. Results: The median IKDC score improved from 32.0 preoperatively to 84.0 at 12 months, while the KOOS overall score increased from 29.0 to 88.0 during the same period, both showing statistically significant improvements (p < 0.001). The steepest functional gains were observed between 6 weeks and 6 months postoperatively. Complications were minimal, with only one superficial surgical site infection (2.86%) and two cases of stiffness (5.71%). Conclusion: Five-strand hamstring autograft ACL reconstruction is a safe and effective technique that results in significant functional improvement as measured by IKDC and KOOS scores. It offers a reliable solution in patients with smaller tendon diameters, ensuring graft adequacy and robust recovery.

Background: Gastrostomy tube feeding is the best option for long lasting nutritional support in patients with dysphagia caused by obstructive tumours of the mouth, pharynx, larynx and oesophagus or neuromuscular diseases. However, these severely compromised patients often present severe respiratory risks, precluding the use of general anesthesia, sedation or even endoscopy. A simplified open gastrostomy (SOG) under local anesthesia has been in practice in our institution, especially for patients with severe neuromuscular diseases and continuous non-invasive ventilatory support. In this study, we try to compare the surgical outcomes of this technique, with the classical Stamm gastrostomy (SG). Material and methodsThis simplified technique uses a minimal vertical midline incision (3 cm), just below the xyphoid process, under local anesthesia. The gastrostomy tube is passed by a left lateral stab wound, inserted in a double purse-string in the gastric wall and pulled to the anterior abdominal wall. No sutures between the stomach and the peritoneum are placed. We retrospectively analyzed the clinical records of 63 consecutive gastrostomies performed upon a 3-year period, 23 of which were by SOG. Results: The SG was performed mainly in oncological patients, and SOG in patients with neuromuscular diseases (p < 0.001). In the SOG group, 95,4% (n = 22) of the patients were ASA IV, compared with 74,4% (n = 29) in SG (p = 0,03). The mean operative time was shorter in the simplified technique (37 vs 60 min; p = 0,01). All the surgeries in the SOG group were performed exclusively with local anesthesia and in the Stamm procedure, 47,5% required invasive ventilatory support (p < 0.001). There were no significant differences regarding in-hospital morbi-mortality (p = 0,18). The patients were able to receive adequate nutritional support, and the overall satisfaction of the patients and family/caregivers is very good. Conclusion: The simplified mini-laparotomy gastrostomy is a safe and effective alternative to other approaches. The association of local anesthesia with a minimal surgical offense and a short operative time render its effectiveness, even in high-risk patients.

This randomized clinical study conducted at MKCG Medical College & Hospital aimed to assess and compare the effectiveness of prophylactic infusion of ephedrine and phenylephrine in maintaining arterial pressure during lower segment caesarean section (LSCS) under sub-arachnoid block. The study included 80 full-term pregnant patients undergoing elective LSCS, with 40 patients in each group. The primary outcomes evaluated were changes in arterial pressure, heart rate, and fetal outcomes.

The results indicated that both ephedrine and phenylephrine were effective in maintaining arterial pressure within 20% of the baseline, with phenylephrine demonstrating a better blood pressure maintenance profile. Additional bolus dose requirements were significantly higher in the ephedrine group. Phenylephrine caused a reduction in heart rate, while ephedrine resulted in a significant rise. Neonatal outcomes, as measured by Apgar scores, were comparable between the two groups, but phenylephrine was associated with less fetal acidosis than ephedrine.

In conclusion, prophylactic infusion of phenylephrine at 15 micrograms/min proved more efficacious in maintaining arterial pressure during LSCS compared to ephedrine at 1.5 mg/min. The study suggests that phenylephrine may offer advantages in terms of maternal and fetal outcomes in the context of spinal anesthesia for caesarean section.