Neglected and Relapsed Clubfoot in Adults, the Functional Outcome of Acute Surgical Correction

Background: Neglected clubfoot in this series is defined as untreated equino-cavo-adducto-varus in older children or adults. Relapsed clubfoot is the residual deformity that remains after single or multiple surgical interventions. Severely neglected clubfoot rarely exists today in developed countries, except in some emigrants from low- and middle-income countries. Acute surgical management with corrective mid-foot osteotomy and elongation of the Achilles tendon has an excellent functional outcome. Objective: To assess the functional outcome of acute correction of neglected Talipes-quinoa-varus deformity in adults. Methods: This is a cross-sectional, hospital–based multi-centric study. Forty patients were included in this study. Midfoot osteotomy and elongation of the Achilles tendon were performed on all patients. Data was collected using a questionnaire and the functional outcome has been assessed using the American Orthopedic Foot and Ankle Society Score (AOFAS). This score was measured before surgery and one year after surgery. Results: the mean age was 19.9 ± 4.7 years. Males were 25 (62.5%) and females were 15 (37.5%). The mean preoperative AOFAS score was 37.7 ± 7.1 (poor). This score improved to 80.7 ± 13.7 (good to excellent), two years after surgery. However, this indicates a significant change in the functional outcome after the operation (p value Conclusion: acute correction of neglected and relapsed TEV with elongation of the Achilles tendon and single midfoot osteotomy has excellent functional outcome as assessed by AOFAS Score. The satisfaction with this procedure is impressive. The younger age population showed better outcomes with this procedure.

Reawakened Sexual Interest: The Result of Surgical Correction of Concealed Penis

Concealed penis (CP) is a developmental anomaly in which the penis is hidden in the skin of the abdomen, thigh or scrotum. As a result of this, the penis appears shortened in length. It was first described by Keyes Jr. E.L. in 1919. It can be associated with voiding problem and in adults, sexual issues, among others. Objective: To show that surgery can reverse celibacy induced by CP and highlight the need for an interdisciplinary approach to correction of this anomaly. Patient and Method: A thirty-one-year male patient who had a surgical release of his buried penis by two surgeons in 2019 in a private hospital. The case note was reviewed, the data obtained analyzed and the results including photographs, were presented. The patient was followed up. Result: A 10 cm length of penis and a hundred percent (100%) take of sheet of split skin graft used to resurface the denuded penis were achieved using combined spinal and epidural anesthesia. The patient, his mother and the surgeons were satisfied with the outcome. Consequently, he resolved to marry a wife after all. Conclusion: Concealed penis can now be regarded as a known cause of celibacy and surgical correction can reverse the celibate state.

Laubry-Pezzi Syndrome in an Adult Male Patient and Its Surgical Correction: A Case Report and Literature Review

This Laubry-Pezzi syndrome is rarely seen in patients with ventricular septal defect (VSD) combined with aortic regurgitation. A 20-year-old male patient presented to the Cardiothoracic and vascular surgery department with a large VSD with severe aortic regurgitation (AR). However, he was first symptomatic at 12 years of age and initially treated by medical management with the suggestion of surgical correction. Nevertheless, he was delayed getting surgical management due to his financial problem. This article reported on an adult patient with Laubry-Pezzi syndrome and his surgical correction and outcome. The association of congenital defects VSD and AR needs to be identified and corrected in early life for better outcomes.

Development of pulmonary hypertension remains a major hurdle to corrective surgery in Down syndrome

Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down syndrome.Down syndrome patients,especially with large shunts are particularly predisposed to early development of severe pulmonary hypertension(PH)compared with shunt lesions in general population.This necessitates timely surgical correction which remains the only viable option to prevent long term morbidity and mortality.However,despite clear recommendations,there is wide gap between actual practice and fear of underlying PH which often leads to surgical refusals in Down syndrome even when the shunt is reversible.Another peculiarity is that Down syndrome patients can develop PH even after successful correction of shunt.It is not uncommon to come across Down syndrome patients with uncorrected shunts in adulthood with irreversible PH at which stage intracardiac repair is contraindicated and the only option available is a combined heartlung transplant.However,despite the guidelines laid by authorities,the rates of cardiac transplant in adult Down syndrome remain dismal largely attributable to the high prevalence of intellectual disability in them.The index case presents a real-world scenario highlighting the impact of severe PH on treatment strategies and discrimination driven by the fear of worse outcomes in these patients.