Second bar syndrome. The Ten S’s Youth Lacrosse Players Must Avoid: Improving Your Game

What are the common mistakes young lacrosse players make. How can players elevate their performance by avoiding these pitfalls. Which habits should be eliminated to enhance lacrosse skills.

Second-bar Syndrome: The Importance of Proper Helmet Fitting

One of the most noticeable issues among young lacrosse players is the infamous “second-bar syndrome.” This occurs when players improperly wear their helmets, peering through the bottom two bars of the face-mask. Not only does this look awkward, but it also signifies a lack of understanding about the game’s stylistic standards.

Why is proper helmet fitting crucial in lacrosse?

• It enhances visibility on the field
• It improves overall comfort during play
• It contributes to the player’s “tilt,” which is associated with skill level

To correct this issue, players should focus on adjusting their chinstraps. Tighten the top straps and loosen the bottom ones to achieve the desired tilt. This adjustment not only improves the player’s appearance but also demonstrates a deeper understanding of lacrosse culture.

Snatching: The Pitfall of Aggressive Catching

Snatching at passes is perhaps the most common bad habit observed in youth lacrosse. This aggressive catching technique can significantly hinder a player’s performance and limit their options on the field.

What are the drawbacks of snatching?

• It slows down the player’s reaction time
• It puts the player in a vulnerable position
• It often leads to missed opportunities

Instead of snatching, players should focus on developing “soft hands.” This technique involves allowing the ball to enter the stick gently, as if catching an egg. By mastering this skill, players can quickly transition into a “triple threat” position, ready to carry, pass, or shoot as the situation demands.

Developing Soft Hands: A Key to Success

How can players improve their catching technique?

1. Practice wall-ball exercises regularly
2. Focus on absorbing the ball’s impact
3. Maintain a relaxed grip on the stick
4. Work on quick stick skills to enhance reaction time

Unnecessary Shoulder Pad Attachments: Less is More

Many young lacrosse players fall into the trap of using excessive shoulder pad attachments. While these may seem like added protection, they often prove counterproductive.

Why should players reconsider using shoulder pad attachments?

• They are largely ineffective in preventing injuries
• They can restrict movement and agility
• They may project an image contrary to the toughness associated with lacrosse

For most youth players, standard shoulder pads provide sufficient protection. The focus should be on developing skills and agility rather than relying on excessive padding. However, it’s important to note that players participating in box lacrosse may require different equipment considerations.

The Art of Ground Ball Recovery: Avoiding the Stop and Scoop

Proper ground ball technique is fundamental in lacrosse, yet many young players struggle with it. The “stop and scoop” method, also known as “raking,” is a common mistake that can lead to lost possessions and missed opportunities.

What makes the stop and scoop technique ineffective?

• It slows down the recovery process
• It often results in scrums and loose ball situations
• It gives opponents more time to contest possession

Instead of stopping and scooping, players should focus on running through ground balls. This technique involves getting low, maintaining speed, and scooping the ball in one fluid motion. At higher levels of play, advanced techniques like kicking the ball to space or “goosing” it to a teammate are also employed.

Mastering Ground Ball Recovery

How can players improve their ground ball technique?

1. Practice maintaining a low body position
2. Work on scooping while running at full speed
3. Develop peripheral vision to locate teammates
4. Learn to use body positioning to shield opponents

Goalie Equipment: Embracing Minimalism

For aspiring lacrosse goalies, there’s often a temptation to overcompensate with excessive padding. However, this approach can be counterproductive and may even signal a lack of confidence in the position.

What essential equipment do lacrosse goalies need?

• Chest protector
• Cup
• Neck guard

Contrary to popular belief, items like shin guards are unnecessary and can hinder a goalie’s mobility. The key to success in this position lies not in excessive padding but in developing quick reflexes, proper positioning, and mental toughness.

Building Confidence in the Goal

How can goalies improve their performance without relying on extra equipment?

1. Focus on footwork and agility drills
2. Practice reaction time exercises
3. Develop mental resilience through visualization techniques
4. Work on proper positioning and angles

Defensive Stick Control: The Perils of Swinging

Uncontrolled stick swinging is a common issue among defenders at various levels of play. This habit not only reduces defensive effectiveness but also increases the risk of penalties.

Why is controlled stick movement crucial for defenders?

• It maintains defensive positioning
• It reduces the risk of penalties
• It improves overall defensive effectiveness

Instead of wild swinging, defenders should focus on maintaining a two-handed grip, staying low, and using controlled pushes when necessary. In riding situations, the emphasis should be on turning the opposing player back rather than attempting risky checks.

Developing Solid Defensive Techniques

How can defenders improve their stick control?

1. Practice footwork drills to improve agility
2. Work on controlled poke and lift checks
3. Focus on body positioning to guide opponents
4. Develop communication skills with teammates

Shooting Strategies: The Power of Low Shots

Many young lacrosse players fall into the trap of consistently shooting high, believing it to be the most effective strategy. However, this approach often leads to missed opportunities and easier saves for goalkeepers.

Why are low shots often more effective in lacrosse?

• They are harder for goalies to read and react to
• They create opportunities for rebounds and second chances
• They can be more accurate, especially in close-range situations

The success of low shots is exemplified by players like Nick Schultz, who consistently scored multiple goals per game by focusing on low, accurate shots. By incorporating a mix of high-to-low shots near the crease and overhand bounce shots from the perimeter, players can significantly increase their scoring potential.

Diversifying Your Shot Selection

How can players improve their shooting accuracy and effectiveness?

1. Practice a variety of shot types, including bounce shots
2. Work on changing shot levels to keep goalies guessing
3. Develop a quick, smooth release to improve shot speed
4. Focus on accuracy over power in close-range situations

By avoiding these common pitfalls and focusing on developing proper techniques, young lacrosse players can significantly improve their game. From proper equipment use to refined stick skills and shooting strategies, these adjustments can make a substantial difference in a player’s performance and overall success on the field.

Remember, lacrosse is a sport that rewards skill, strategy, and teamwork. By eliminating these “Ten S’s” from their game, youth players can focus on developing the fundamental skills and tactics that will serve them well as they progress in the sport. Whether you’re a beginner or an experienced player looking to refine your skills, addressing these common issues can help elevate your game to the next level.

As with any sport, consistent practice and a willingness to learn and adapt are key to improvement. By focusing on these areas and working diligently to correct bad habits, young lacrosse players can set themselves up for long-term success and enjoyment of the game.

The Ten S’s Youth Lacrosse Players Must Avoid – Boathouse

Think you don’t have any bad habits in your lacrosse game? Think again. Boathouse Ambassador Jake Scott has compiled a list of the top ten bad habits he sees most frequently in youth players. Eliminate them and improve your game. Continue them and waste precious time and energy on the lacrosse field. From spinning your stick and snatching, to shooting high and standing still, here are the top ten S’s that youth lacrosse players should cut from their game.

1. Second-bar Syndrome – When you  buy your first lacrosse helmet, there are all kinds of defects you must correct. The helmet obviously isn’t broken in. The chinstrap isn’t fitted yet. And so, usually, young players end up awkwardly peering through the bottom two bars of the face-mask. Erroneous! There is an understanding amongst all knowledgeable lacrosse players that “tilt”—the lower your helmet tilts downward upon your head—accurately correlates with how talented you are at the game. It’s a style thing. True or not, the fact remains: players must fit their helmets to their head, and to acquire tilt (you’ll thank me later) tighten the top straps of the chinstrap, and lower the bottom ones. “Second-bar syndrome,” as the unfortunate appearance has been denoted, makes a player look funky, unskilled, and naiive to the stylistic standards of lacrosse.

2. Snatching – The most common bad habit I see among young players is snatching at passes. The aim for catching lacrosse balls, in general, is to do something productive with the ball once it enters your stick. Snatching takes time, puts a player in a compromising, easily-guardable position, and almost always leads to a missed opportunity. I teach my players to develop “soft hands,” and to let the ball enter their stick—as if it was an egg. They then occupy a dangerous “triple threat” position, where they can carry, pass, shoot, and read the defense effectively. Snatching is a habit eradicated by hours and hours of wall-ball.
3. Shoulder Pad Attachments – Depending on how young a player is (and whether or not he plays box lacrosse in the off-season), shoulder pad attachments are absolutely unnecessary and can be removed. They make a player look the opposite of tough, and are entirely ineffective, anyway; defensemen rarely check between the shoulder pads and the arm pads, and if they do, the ball-carrier will seldom notice, and the defender will most likely be called for a cross-check. 
4. Stopping and Scooping (otherwise known as “raking”) – This is something you learn on Day 1 as a young player. Get low and run through a groundball; don’t stop and cover it with the back of your stick. The rugby scrums that often materialize in youth lacrosse games occur because kids do not get low and run through groundballs. Instead, they us the back of their sticks as covers, and by the time they are ready to scoop, another player has dug the ball out and raked the ball himself—an infuriating cycle of bad lacrosse habits. At higher levels of lacrosse, very seldom do players rake; they run through the ball, kick it out to space, or “goose it” to a nearby teammate.
5. Shin Guards (for goalies) – This isn’t soccer. If you sign up to play goalie, you need three things only: a chest protector, cup, and neck guard. Oh—and a willingness to stand in front of a hard rubber ball humming towards your vital organs. The point is: as a goalie, you’re going to get hit by the lacrosse ball however you spin it. Shin guards and extraneous padding will only make you appear unfit for the position.
6. Swinging Your Stick – This is a big one for youth, high school, and college players, too. On defense, never swing your stick in an uncontrolled fashion. And never take a hand off of your stick, either. Those big, one-handed wrap checks are unpromising risks; the ref will rip his flag out before your check even lands. A better alternative is using two hands, getting low, shuffling your feet, and pushing off when necessary. In the ride, merely “turn your defenseman back,” and force him to get rid of the ball. Reckless swinging of the stick means you are hardly moving your feet, leaving yourself susceptible to getting run by, and most likely finding yourself at the end of the bench.
7. Shooting High – I played with a kid in youth lacrosse named Nick Schultz. Nick was a decent athlete, but no bigger or more talented than the other kids. Yet he consistently scored 5, 6, or 7 goals a game. We could never understand how. The reason for Nick’s success was this: every time he shot the ball, he shot low. Goalies couldn’t read his shot because it was strictly overhand, and he changed levels. When he was near the crease, he shot high-to-low. When he was on the perimeter, he’d score overhand bounce shots with ease. Youth goalies have such a difficult time corralling low, overhand bouncers, and although they are not as pretty and thrilling as sidearm high shots, they will result in more goals, as well as individual and team success.

8. Standing Still – My youth coach (my dad) always told our teams, “If you’re standing still in the game of lacrosse, you’re wrong.” As a player, you should notice when you are standing flat-footed and merely watching the ball-carrier, and make an effort to move and create space. Even if your movement only involves two or three steps in one direction, a momentary flash to open space, or a curl to the ball-carrier, your motion is not in vain; it confuses the defense and clears space for your teammates. And who knows: you might find yourself wide open in front of the net.
9. Spinning Your Stick – A habitual phase we’ve all been through, this inefficient habit costs precious time on the lacrosse field. Eliminate it from your game immediately. Practice catching and throwing with no cradle. Again, hours of wall-ball is recommended. Or, have somebody lob you passes in front of a goal, and catch and shoot them without cradling. Once mindless spinning of the stick is omitted, you will become more of a threat on the field—a player who can both distribute and shoot the ball with speed and fluidity.
10. Stepping in the Crease – We’ll end with an obvious one. Know that giant white circle that surrounds the goal? Yeah, you can’t step in it. There’s this new thing called “the dive,” which we’ll discuss later, but for youth offensive players who are still learning, you must understand the importance of staying out of the crease. Due to simple lack of awareness you will cost your team a turnover. Remember this also: even if your pinky toe touches a fraction of the crease line, the ball is going the other way. Be cautious.

Related Boathouse Lacrosse Articles:

ABOUT PROJECT SOFT HANDS LACROSSE
One day when I was throwing against the wall, the concept of Project Soft Hands suddenly emerged. I created a video of myself playing wallball–throwing creative passes and making difficult catches. I showed the video to my friends and teammates. I posted it to social media. I began making more videos, and got my friends and teammates involved. I called the movement “Project Soft Hands.”

ABOUT THE FIND YOUR WALL LACROSSE CHALLENGE
The “Find Your Wall” Lacrosse Challenge is a collaboration between Project Soft Hands Lacrosse and Boathouse that encourages young lacrosse players to find “their” wall and practice wallball. The more time you play wallball, the better the lacrosse player you’ll become – which is what makes this activity a core fundamental to improving lacrosse skills of all levels. 

LACROSSE TRAINING 101
Conducted by father/son lacrosse enthusiasts, Jake and Peter Scott, the Boathouse Lacrosse Training Series is intended to educate lacrosse players of all ages in the strategic technique necessary to enhance their skills and win games. READ MORE

Guillain-Barré Syndrome | Boston Children’s Hospital

What is Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) occurs when the immune system attacks the peripheral nervous system — the system of nerves that run though the body, outside the brain, and spinal cord. It can cause muscle weakness, pain, changes in sensation (numbness or tingling), and sometimes even temporary paralysis of muscles in the legs, arms, face, and chest.

Guillain-Barré usually develops quickly, over the course of just a few days. It usually starts in the feet then moves into the upper body. In severe cases, it can cause serious breathing problems that need emergency treatment. Children with Guillain-Barré often need to be admitted to the hospital for monitoring and care, but most children recover fully and are able to go back to their regular activities in a few weeks.

People of all ages can get Guillain-Barré syndrome, but it is extremely rare: It affects only about one in 100,000 people.

Types of Guillain-Barré

There are a few types that affect children. These include:

• Acute inflammatory demyelinating polyradiculoneuropathy (AIDP). This is the most common form of Guillain-Barré. In this type, the covering around peripheral nerve cells, called myelin, is damaged.
• Acute motor axonal neuropathy (AMAN). This type of Guillain-Barré involves damage to nerve axons, rather than the myelin coverings around them. It is fairly rare in the United States, but is more common in other parts of the world including East Asia. Children with this type usually take longer to recover.
• Miller Fisher syndrome. This is a very rare form of Guillain-Barré, especially in children. It primarily affects the nerves in the face, so the major symptom is weakness in the face muscles. It also causes decreased reflexes and balance problems.
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Some children who have Guillain-Barré have a relapse months or even years later. If that happens, your child may develop CIDP.

What are the symptoms of Guillain-Barré syndrome?

Each child may have different symptoms, but some of the most common symptoms include:

• weakness or pain in the legs and arms (usually begins in the legs)
• problems walking
• pain, numbness, or tingling in the toes and fingers
• feeling lightheaded or dizzy
• weakness in the face
• breathing problems (in severe cases)

If your child is having trouble walking, call your primary care provider right away or go to an emergency room.

What are the causes of Guillain-Barré syndrome?

Doctors don’t completely understand the causes of Guillain-Barré. In some cases, it occurs after a mild viral or bacterial infection. Occasionally, it can occur after an immunization. Often, however, there is no known cause.

Experts believe that the reason why infections can trigger autoimmune conditions such as Guillain-Barré is that when the immune system attacks the invading viruses or bacteria, it can sometimes also attack healthy tissue.

Although some vaccines have been linked with Guillain-Barré in the past, this is extremely rare. If you have any concerns about vaccines, talk with your child’s pediatrician. You may also find this Q&A from the Centers for Disease Control and Prevention (CDC) helpful.

How we care for Guillain-Barré syndrome

At Boston Children’s Hospital, the specialists in our Neuromuscular Center are experienced in recognizing the signs of Guillain-Barré and providing excellent care and treatment. Our team works together with your family to help your child get back to normal life as quickly and fully as possible.

What It Is and How It’s Treated

Guillain-Barre Syndrome is a problem with your nervous system. It can cause muscle weakness, reflex loss, and numbness or tingling in parts of your body. It can lead to paralysis, which is usually temporary.

Most people recover, even those with severe cases. In fact, 85% of people with GBS make a full recovery within 6 to 12 months. Once you get better, the chance of it returning is very small.

Causes

Guillain-Barre syndrome (GBS) can happen to anyone, but it’s most common in people 50 years old or older.

No one’s sure if a germ or virus, like the Zika virus, causes GBS . It could be that some illnesses alter your nerve cells, so your immune system starts to view them as threats. Others think your immune system forgets which cells it shouldn’t attack.

It usually shows up a few days or weeks after a cold, stomach virus, or the flu. In rare cases, surgery or vaccinations can trigger it. You may hear your doctor mention “campylobacter.” That’s a type of bacteria associated with GBS.

When you have it, your immune system begins attacking your nerve cells. That weakens their ability to send signals to your brain. And your muscles then can’t respond to nerve signals. As a result, your brain gets fewer messages to your body.

Symptoms

Guillain-Barre syndrome strikes quickly. You usually feel it first in your arms and legs. You may notice muscle weakness or a “pins and needles” tingling in your hands and feet, which later moves toward your midsection. You may also feel unusually tired. Your reflexes may slow.

Some people feel only a mild weakness. Others become almost entirely paralyzed and struggle to swallow or breathe. If you feel anything more than mild weakness, you should call 911. Your symptoms can get worse quickly.

Most people are at their weakest 3 weeks after symptoms appear.

Treatment

If your doctor thinks you have GBS, they will give you a test to measure how well your muscles and nerves work. You may also get a spinal tap. A doctor inserts a needle into your lower back and takes a small amount of spinal fluid. They’ll check the protein level; it’s high in people with GBS.

If you’re diagnosed with GBS, you should begin treatment right away.

In some cases, in order to speed recovery, the doctor will take blood from your body, “clean” it, and then return it to you. This process is called plasmapheresis.

Your doctor may give you immunoglobulin, or antibodies. You’ll get high doses of healthy cells through an IV. These help lessen your immune system’s attack on your body.

Some people with GBS need to be hospitalized for a few days. Others stay for several weeks.

You’ll need support until you regain full control of your body. A nurse or loved one may need to exercise your arms or legs for you.

What to Expect

It may take a while for you to feel like yourself again. After a hospital stay, you may still feel weak and need a wheelchair or walker to get around. You may have physical therapy to build up your strength . A small number of people also have permanent nerve damage.

GBS usually lasts between 14 and 30 days. If your symptoms continue longer, you may be suffering from a chronic form of GBS called chronic inflammatory demyelinating polyneuropathy and will need more aggressive treatment.

What are the symptoms of Guillain-Barré syndrome? Should I still get the J&J vaccine?

Health officials are investigating the “small possible risk” that people getting Johnson & Johnson’s COVID-19 vaccine may develop a rare autoimmune disorder — so it’s only natural that folks would have a lot of questions. 

The Centers for Disease Control and Prevention (CDC) reported Monday that 100 people who got the J&J
JNJ,
+0.01%
Janssen shot developed Guillain-Barré syndrome, which can cause muscle weakness and occasionally paralysis. The Food and Drug Administration (FDA) also added a warning about the potential side effect to its fact sheets about the Janssen COVID-19 vaccine.

While this side effect has occurred in just a tiny fraction of the almost 13 million Americans who’ve received the single-dose COVID shot, meaning it’s extremely rare, Google searches for “guillain barre” spiked 2,700% in the U.S. on Tuesday, and “symptoms of guillain-barre syndrome” was also a breakout query on the Alphabet
GOOGL,
-0.77%
search engine. 

“
“People who received the vaccine months ago should not be concerned about this.”
”

— Dr. Leana Wen

“It’s very important that the CDC and FDA investigate these cases, but I think it’s also very important to put into perspective that those cases are rare,” Dr. Leana Wen, an emergency physician and public health professor at George Washington University, told MarketWatch. “And the FDA has determined that the benefits of the J&J vaccine still outweigh this rare but serious condition.” 

Related: Delta variant drove COVID-19 cases higher across the globe last week — including in the U.S.

“This is the FDA and CDC doing their job. Their job is to identify and present potential side effects of medicines, drugs and vaccines to make the public aware of them with a lot of scientific precision,” agreed Dr. David Putrino, director of rehabilitation innovation for Mount Sinai Health System in NYC. “Until the CDC and FDA make a recommendation to not take the vaccine, there is no cause for concern or alarm.” 

So what is Guillain-Barré syndrome (aka GBS) and what should you consider before getting the J&J jab? Here’s what we know so far. 

What is Guillain-Barré syndrome?

The CDC describes Guillain-Barré (pronounced Ghee-YAN Bah-RAY) syndrome as a rare autoimmune disorder in which a person’s own immune system damages the nerves, causing muscle weakness, and sometimes paralysis. It is not contagious. There are 3,000 to 6,000 cases of the syndrome in the U.S. per year. Symptoms can last for a few weeks, or sometimes several years. In extreme cases, some people have permanent nerve damage and paralysis. And some people have died. 

But GBS is rare, affecting only about 1 in 100,000 people. And in the case of the J&J vaccine, there have only been 100 reported cases among the almost 13 million Americans who have received the shot. While anyone can develop GBS, it is more common in men and adults older than 50. Indeed, the 100 cases being investigated in relation to the J&J vaccine mostly involve men over 50. 

What are the symptoms of Guillain-Barré syndrome?

GBS usually presents as weakness or tingling sensations (pins and needles) in both feet and legs, which often spreads to the arms and upper body. Symptoms may escalate until some muscles cannot be used at all, and the person can become paralyzed in extreme cases. The Mayo Clinic reports that symptoms often progressively worsen for about two weeks before reaching a plateau at around four weeks. Recovery can take months, or maybe even years. 

The FDA notes in its revised J&J COVID-19 vaccine fact sheet that GBS is most likely to appear within 42 days of vaccination. And in the 100 cases related to the J&J shot that the CDC is investigating, most patients developed GBS within two weeks of getting their shot. 

What if you experience Guillain-Barré symptoms?

If you start feeling a tingling or numbing sensation in your feet that quickly spreads upward, seek medical attention ASAP. “I certainly would recommend that they go and see their doctor immediately,” said Putrino, “because there are other more common conditions that it could be, such as stroke, that you would want to see your doctor about if you’re experiencing these sorts of signs or symptoms.”  

So what causes Guillain-Barré syndrome?

While the exact cause of GBS remains unknown, it is often triggered by a respiratory or gastrointestinal infection, such as the flu, Epstein Barr or Zika virus. Infection with the Campylobacter jejuni bacteria, which causes gastroenteritis (and symptoms of nausea, vomiting and diarrhea), is one of the most common risk factors for GBS. About two-thirds of people with GBS had a respiratory illness or diarrhea several weeks before developing symptoms, according to the CDC. And, very rarely, people have developed GBS in the days or weeks after receiving certain vaccines, the CDC reports. 

It is not contagious, so people don’t spread it to one another. But outbreaks of germs associated with GBS can lead to clusters of people developing GBS. 

How is Guillain-Barré syndrome treated? 

There is no known cure for GBS, but most people recover. Between 60-80% of people are able to walk independently at six months, the Mayo Clinic reports, but patients may experience lingering effects such as weakness, numbness or fatigue.

People with GBS are often hospitalized. Treatments include plasma exchange (aka plasmapheresis), which removes and replaces the liquid part of the blood (or plasma) to get rid of certain antibodies that may have been causing your immune system to attack your nerves. Patients are also given high-dose immunoglobulin therapy, aka an infusion of healthy antibodies to block the damaging antibodies that may be contributing to GBS.

What’s the connection between Guillain-Barré syndrome and vaccinations?

For reasons that are still unknown, there are rare cases of people developing GBS after getting certain vaccines. The seasonal flu vaccine is associated with roughly one to two additional cases of GBS for every million vaccines given, for example. And the 1976 swine flu vaccination campaign, which was a special flu vaccine for a potential pandemic strain of influenza, also led to a small increase in the syndrome; about one extra case of GBS for every 100,000 people vaccinated at the time. But research suggests that it is more likely a person will develop GBS after getting the flu than after receiving their flu shot. 

“All vaccines have some sort of risk of a side effect when you’re triggering the immune system the way that you are,” said Putrino. “There’s always a small risk of side effects of this nature …The numbers are still in your favor. ” But the benefits of the vaccines outweigh the risks of the serious illnesses that they are protecting you against. 

So what do we know about the J&J COVID-19 vaccine and Guillain-Barré syndrome? 

In the clinical trial for Johnson & Johnson’s COVID-19 vaccine, two patients developed GBS within two weeks of getting injected. One patient had received the placebo, however, while the other had received the vaccine. The study concluded that there wasn’t enough data to determine a cause-and-effect relationship between the vaccine and GBS. The report also noted that “many people will develop GBS by coincidence within a few weeks of vaccination.” 

“People get Guillain-Barré syndrome from other things. There are other potential triggers, like other viruses and bacteria, and so that is something else to keep in mind,” said Wen. “This is another rare but serious illness that exists in our world. ”

The CDC revealed Monday that it has received reports of 100 people among the almost 13 million Americans who received the J&J vaccine developing GBS. The health agency said it would ask its panel of outside vaccine experts to review the issue at an upcoming meeting, and the FDA also added a warning about the potential side effect to its fact sheets about the Janssen COVID-19 vaccine. Most cases of the side effect were reported in men aged 50 and up about two weeks after vaccination.

“So people who received the vaccine months ago should not be concerned about this,” said Wen. 

And the government said the Pfizer
PFE,
+0.05%
and Moderna
MRNA,
+2.30%
vaccines show no risk of the disorder after more than 320 million doses have been administered. The Pfizer and Moderna shots are mRNA vaccines, while J&J is a viral vector vaccine. The difference: the mRNA shots teach our cells how to make a protein — or even just a piece of a protein — that triggers an immune response inside our bodies to fight the coronavirus, the CDC explains on its site. The viral vector vaccine delivers a modified version of a different virus to help teach our cells how to fight the novel coronavirus.

Should you still get a COVID-19 vaccine?

Absolutely. If there’s one thing health officials agree on, it’s that the benefits of getting vaccinated against COVID far outweigh the extremely small risk of developing Guillain-Barré syndrome from the J&J vaccine. The global tally for the coronavirus-borne COVID-19 illness passed 187.8 million on Wednesday, and more than 4.04 million people around the world have died. The U.S. leads the world with a total of 33.9 million cases and 607,771 deaths and counting — and the highly infectious delta variant is spreading in states with low vaccination rates.

What’s more, millions of people have continued to suffer “long covid” symptoms for months after their initial COVID-19 infection, including extreme fatigue, shortness of breath, memory loss, brain fog, insomnia, chest pain and dizziness. One study found that 30% of COVID-19 survivors reported “persistent symptoms” nine months later. “If you think about 100 people in 13 million developing GBS, that means less than a .001% chance of getting GBS from a COVID-19 vaccine,” said Putrino. “You have a more than 10% chance of getting long covid if you catch COVID-19 while unvaccinated.” And Dr. Anthony Fauci recently reported that more than 99% of U.S. COVID-19 deaths in June were among unvaccinated people.

“
“The benefits of the vaccine far exceed the risks of the vaccine.”
”

— Dr. David Putrino

If you have experienced GBS in the past, however, you should speak with your doctor. You may want to consider one of the mRNA vaccines from Pfizer or Moderna if you haven’t been vaccinated against COVID already. But if you only have access to the J&J shot, or if you can only receive a single-dose shot, then health experts say you should feel confident that the J&J jab is safe. 

“The benefits of the vaccine far exceed the risks of the vaccine, and if people are extremely concerned about the possibility of getting GBS [from the J&J shot], they can speak to their physician and ask for a different vaccine,” said Putrino. “But not everyone has that luxury, and our recommendation, strongly, would have to be that you get the vaccine that you can get, as opposed to no vaccine at all.”  

Case reports describe ‘unusual’ Guillain-Barre variants following COVID-19 vaccination

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Two studies published in Annals of Neurology reported small clusters “of an unusual variant of Guillain-Barre syndrome” following receipt of a COVID-19 vaccine, according to a press release from the American Neurological Association.

The 11 cases of Guillain-Barre syndrome occurred among individuals who received the vaccine 10 to 22 days prior to symptom onset, the press release noted. While the rate of Guillain-Barre syndrome in these clusters was approximately four to 10 times higher than the anticipated baseline frequency, the “unusually severe” bilateral facial weakness and timing in relation to receipt of the vaccine “made these occurrences stand out.”

Two studies published in Annals of Neurology reported an atypical variant of Guillain-Barre syndrome as a “rare, but specific complication” of COVID-19 vaccines. Source: Adobe Stock

In the first report, Christopher Martin Allen, of the department of neurology at Nottingham University Hospitals NHS Trust and the University of Nottingham School of Medicine, and colleagues reported four cases of a Guillain-Barre variant presenting as bifacial weakness with paresthesias. All cases occurred after the first dose of the AstraZeneca vaccine and developed within 10 days of each other, with symptom onset 11 to 22 days after the vaccine. The cases included a white man aged 54 years with no relevant medical history; a British-Iranian man aged 20 years with a medical history of ulcerative colitis; a white man aged 57 years with a medical history of asthma and osteoarthritis, as well as bilateral knee replacements and regular use of steroid and salbutamol inhalers, loratadine, omeprazole and tamsulosin; and a white man aged 55 years with a medical history of hypertension and regular use of amlodipine and lisinopril.

All patients presented with profound bifacial weakness and normal facial sensation. All patients also tested negative for COVID-19 infection. Patients received IV immunoglobulin, oral steroids or no treatment.

Allen and colleagues noted that, while the patients described in their case report experienced neurological symptoms “temporally” associated with receipt of the vaccine, “causality cannot be assumed.” The findings demonstrate the need for “robust post-vaccination surveillance,” according to the researchers. Allen and colleagues also noted that “SARS-CoV-2 vaccines are very safe.”

In the second report, Boby Varkey Maramattom, MD, DM, FRCP, of the department of neurology at Aster Medcity in India, and colleagues reviewed seven cases of severe Guillain-Barre syndrome that developed within 2 weeks of the first COVID-19 vaccine. Researchers identified these cases during a 4-week period between mid-March and mid-April of 2021, by which point approximately 1. 5 million individuals in three regions of Kerala, India had been vaccinated against COVID-19. More than 80% of those individuals — or 1.2 million people — received the ChAdOx1-S/nCoV-19 vaccine, according to Maramattom and colleagues.

The rate of Guillain-Barre syndrome observed in this report “was 1.4- to 10-fold higher than that expected in this period for a population of this magnitude,” according to the researchers. Moreover, the rate at which bilateral facial weakness occurred, which generally develops in less than 20% of cases of Guillain-Barre syndrome, indicated “a pattern associated with the vaccination,” Maramattom and colleagues wrote.

More than half of the cases in India (n = 4) involved women aged between 40 and 70 years, most of whom (n = 3) required mechanical ventilation. All reported cases of Guillain-Barre syndrome in India involved bilateral facial paresis, according to Maramattom and colleagues, which generally develops in less than 20% of unselected cases. Other cranial neuropathies, including abducens palsy and trigeminal sensory nerve involvement, developed in four patients (57%), which are uncommon among reports of Guillain-Barre syndrome in India, as it occurs in less than 5% of cases, the researchers noted.

Maramattom and colleagues emphasized that a link between COVID-19 infection and Guillain-Barre syndrome has not been determined, making an increase in the rate of Guillain-Barre syndrome following COVID-19 vaccination “unlikely.” They also noted that the benefits of vaccination against COVID-19 “substantially outweigh the risk of this relatively rare outcome,” according to the case report. However, they stated that clinicians should be aware of this potential adverse event following COVID-19 vaccination, as most patients in their report required mechanical ventilatory support.

In a related editorial, the neuromuscular and statistical editors for Annals of Neurology detailed “an additional similar case” in a patient in the United States who received the Johnson & Johnson COVID-19 vaccine, according to the press release. The editors also examined cases of severe bilateral facial weakness with or without Guillain-Barre syndrome reported to the U.S.-based Vaccine Adverse Events Reporting System. More than half of the cases of Guillain-Barre syndrome with bilateral facial weakness in the United States (n = 5 of 8 cases) occurred in people who received the Johnson & Johnson vaccine, while only 3 such cases were observed in “the much larger number” of people who received the Pfizer and Moderna vaccines.

These findings indicated that, like the cases of thrombocytopenic thrombosis reported with adenovirus-based vaccines, Guillain-Barre syndrome with bilateral facial weakness represents “a rare, but specific complication,” according to the press release from the ANA. The release also noted that it is important for clinicians to be aware of this complication “so that they can identify it and promptly treat it with standard therapy,” such as IV Ig.

References:

Allen CM, et al. Ann Neurol. 2021;doi:10.1002/ana.26144.

American Neurological Association. Guillain-Barré Syndrome variant occurring after COVID-19 vaccines according to two new Annals of Neurology articles. Available at: https://myana.org/publications/news/guillain-barr%C3%A9-syndrome-variant-occurring-after-covid-19-vaccines-according-two. Accessed June 17, 2021.

Maramattom BV, et al. Ann Neurol. 2021;doi:10.1002/ana.26143.

Perspective

Back to Top

Dhanashri P. Miskin, MD

Guillain-Barré syndrome is an acute polyneuropathy that is often preceded by infection or, occasionally, vaccination. These reports both highlight a cluster of cases of a serious Guillain-Barré syndrome variant occurring within 2 to 3 weeks of the first dose of the AstraZeneca COVID-19 vaccine. Guillain-Barré syndrome, and its variants, have been previously described in association with SARS-CoV-2 infection. However, an analysis of prior post-vaccination periods, such as the years after the swine flu and h2N1, have not revealed an increased incidence of post-vaccination Guillain-Barré syndrome. Therefore, although these clusters of patients developed Guillain-Barré syndrome temporally associated with vaccination, causality cannot be assumed. The benefits of vaccination substantially outweigh the risk for this relatively rare outcome and robust post-vaccination surveillance programs remain essential to definitively establish causality.

Dhanashri P. Miskin, MD

Clinical assistant professor, neurology

Thomas Jefferson University Hospital

Jefferson Methodist Hospital

Disclosures: Healio Neurology could not confirm relevant financial disclosures for Miskin at the time of publication.

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Is Guillain-Barre syndrome (GBS) more common in certain age groups?

Guillain-Barre syndrome: A sudden paralysis of the arms and legs | Science| In-depth reporting on science and technology | DW

The US Food and Drug Administration (FDA)  warned on July 12, 2021, that the Janssen (Johnson & Johnson) COVID-19 vaccine can trigger Guillain-Barre syndrome (GBS) in very rare cases. There have been 100 preliminary reports of GBS associated with the vaccine. Ninety-five of them were severe and required hospitalization. One person has died from GBS. So far, a total of 12.5 million doses of the vaccine have already been administered in the United States. Therefore, the GBS cases are considered very rare. The Centers for Disease Control and Prevention (CDC) continue to recommend the Johnson & Johnson vaccine. 

People vaccinated with Johnson & Johnson should seek immediate medical attention if they experience any of the following symptoms: tingling sensations, especially in the legs or arms, that worsen or spread to other parts of the body; difficulty walking; difficulty with facial movements, including speaking, chewing or swallowing; double vision or an inability to move the eyes; or loss of control over bladder or bowel function. 

This is not the first time that vaccinations have been linked to GBS. In Peru, clinical trials of a COVID vaccine manufactured by Chinese company Sinopharm had been halted on December 12, 2020, after a patient developed GBS symptoms. And in the 1970s, there were 450 GBS cases after swine flu vaccinations. 

Johnson & Johnson’s vaccine has been linked to some cases of GBS in the US

Because GBS occurs so rarely, a clear causal link between the nerve disease and vaccination cannot usually be drawn. GBS occurs much more commonly after bacterial or viral infections. It can also be triggered by infection with SARS-CoV-2.  This has presented vaccine developers with difficult dilemmas.  One example: An AstraZeneca vaccine trial last year, where a similar autoimmune disease, transverse myelitis, had occurred in one case. 

In 2018, DW reported on a GBS patient who became ill after receiving a hepatitis vaccine. In light of recent events, here is the report: 

It began with a vaccine 

Carsten Kolberg is an athletic man. As a pool attendant and life guard he was until recently easily able to swim 100 meters in just over a minute. He is also a SCUBA diver, diving in ice-cold water to depths that are beyond the imagination of most other people.

In his profession, Kolberg needs to be immunized against infectious diseases. As a first responder at an open-air pool, he can easily come into contact with blood or feces.

“The company doctor found out that I needed to refresh my hepatitis B vaccination,” Kolberg recalled. “I had this done before, and never had a problem with it.” 

Kolberg before the infection: full of energy, sawing a hole into the ice for winter diving

After Kolberg got his shot, he showed symptoms of a cold: sneezing, coughing, a sore throat. One week later the symptoms had turned flulike, with fever, fatigue and a headache. Then his feet started hurting when he walked. The doctor prescribed antibiotics and told him to stay in bed.

Not a simple flu 

“The doctor said it would be over in five days. But, the very next day, I was unable to get out of bed,” Kolberg said. “That was when I got scared. Since my mobile phone wasn’t on my nightstand, I couldn’t reach it. I had to roll out of bed and crawl into the living room, where I was able to reach the phone and call my girlfriend for help.”

When he arrived at the emergency room at University Hospital Bonn, Kolberg was already in a wheelchair. He could not feel his legs and one of his arms was also paralyzed.

“The ER waiting room was packed,” he said. “I was glad to have a wheelchair. Two patients to my left and right had been in a car accident and looked really bad. Then a young doctor came in and said: ‘We have someone here who needs urgent attention.’ I looked at the others and thought: ‘They really don’t look good’. But then the doctor looked at me and said: ‘No, we mean you!’ Only then I realized how bad it really was.”

Julian Zimmerman (left) and Ullrich Wüllner are treating GBS patients

An inflammation of the nerve roots blocks the passage of impulses

The doctors diagnosed GBS. It’s an inflammation of the nervous system, or more precisely of the myelin sheath — a fatty insulation layer around the nerve cells. If the myelin sheath is inflamed, our nerves are unable to pass on electric impulses.

The doctors took Kolberg into the neurology department. That’s where Professor Ullrich Wüllner heads the section for movement disorders. He says two to three GBS Patients present each month. The inflammatory disease is rather rare.

“Such an immune system reaction can either occur following diarrhea or an infection of the upper respiratory system,” he said. “There are also several microbes that can trigger such a reaction of the immune system. Those include Campylobacter bacteria, for example.”

Only one in several hundreds of thousands of people will suffer GBS. It occurs even more rarely as a result of a vaccination.

“It is possible that ingredients in the vaccine can trigger such a reaction,” Wüllner said. “It could be aluminum ingredients or gelatin from cartilage.”

An autoimmune disease

But why is it that the immune system attacks the body’s own nerve cells all of a sudden?

“The immune system is highly specialized,” said immunologist Dr. Julian Zimmermann, a colleague of Wüllner’s. “It’s trained to detect exogenous substances, like viruses, bacteria or fungus, and then develops a specific defense against them.”

In the case of an autoimmune disease like GBS, the intruders camouflage themselves with surface structures that are similar to those of the healthy body. 

“The surface structures of the campylobacter bacteria, for example, look similar to those of the myelin sheath,” Zimmermann explained. “And all of a sudden, the immune systems starts attacking the myelin sheath and even destroying nerve cells.”

There are different ways doctors can determine someone has GBS. One involves an electrophysiological test to measure the speed in which the nerves transport electric signals. Also imaging technology can help doctors.

“An MRI of the spinal cord will show us the inflammation of the nerve roots,” Wüllner said. “And we can detect that inflammation in the cerebrospinal fluid as well.”

The fluid will be extracted from the spinal cord. If the protein content exceeds a certain concentration as compared to the defense cells, doctors know they are dealing with GBS.

After the treatment Kolberg had to work his way back from wheelchair and walker

Life threatening, but not incurable

Guillain-Barre-Syndrome can be fatal if the paralysis hits vital parts of the nervous system, like those that control breathing, blood pressure or the heart. To prevent that from happening, doctors constantly monitor the patient’s vital functions.

They furthermore support the healing process either through specialized hemodialysis or infusions of immunoglobulins. In Kolberg’s case, the doctors opted for that second option. 

“Those are pooled antibodies from blood donors,” immunologist Zimmermann explained. “We were able to show that GBS heals faster and the symptoms are milder when the patient is given immunoglobulins at a high concentration.”

Kolberg (left) still loves scuba diving, even in cold waters, and hopes to fully return to it

Excercising is of the essence

When Kolberg was released from hospital after 2 weeks, he’d lost 11 kilograms, mostly muscle. From there he went to a rehabilitation clinic. He could only walk a few meters, using a walker. And he had to re-learn almost everything else.

“I had to re-learn my writing grip,” Kolberg said. “I was in a writing school and had to learn how to hold and move a pencil, just like in elementary school. I had to learn how to feel, how to figure out whether a surface is rough or smooth.”

In the beginning Kolberg was wondering why the water faucets in the rehabilitation clinic were marked with a warning sign, saying ‘Caution, hot!’ 

“Then I realized that one of my arms couldn’t feel the difference between hot and cold.”

Three months later, Kolberg is on the mend. He did a lot of work in rehab to rebuild his nervous system and muscles.

“It really did me well,” he said. “I’m almost as fit as I used to be before the disease. I stand at about 90 percent.”

Carsten is now back to swimming and has also been diving again. He will still continue going to a local rehabilitation clinic for another 6 months. When that is over, he’s optimistic he will once again be able to swim 100 meters in a minute.

This article from May 13, 2018, was last updated on July 13, 2021, on the occasion of the FDA’s addition of a warning label to the Johnson & Johnson COVID-19 vaccine. 

• Mysterious death of polar bear Knut solved

  A heartbreaking story

  Knut was born in 2006 in the Berlin Zoo. The cuddly pup quickly captured the hearts of thousands, drawing crowds to the zoo and becoming world famous. In 2011, when Knut was four years old, the fan community was shocked when the polar bear suffered an epileptic attack, fell into a water ditch and drowned.

• Mysterious death of polar bear Knut solved

  Two more celebrity deaths

  What made Knut’s death even more tragic was that his zookeeper Thomas Dörflein, who had nursed Knut from a puppy into polar bear adolescence, also suddenly died of a heart attack in 2008. At that time Dörflein’s fluffy foster child was two years old, and not quite so cuddly anymore. Together with Knut, Dörflein had also become a celebrity.

• Mysterious death of polar bear Knut solved

  Uncertain diagnosis

  Initially, there was much speculation as to what might have triggered the attack: Was it Knut’s mourning over the death of his foster-parent? Was he stressed out after being mobbed by other adolescent polar bears? The Leibniz Institute for the Research of Zoo and Wild Animals (IZW) investigated the circumstances and determined Knut probably contracted an infection that developed into encephalitis.

• Mysterious death of polar bear Knut solved

  Research continued

  However, researchers were not fully satisfied with their conclusion, and the real cause of the disease remained in the dark – until now. Finally, the speculations have come to an end: In an article in the journal “Scientific Reports,” published on August 27th 2015, researchers revealed Knut had an autoimmune disease.

• Mysterious death of polar bear Knut solved

  A case for biologists and neuroscientists

  The paper reveals a new discovery: A disease called “anti-NMDA-receptor encephalitis,” which until now was thought to only affect humans. This is the first proof that also animals can suffer from a version of the same disease. The research as made possible through cooperation between the IZW and the German Center for Neurodegenerative Diseases (DZNE).

• Mysterious death of polar bear Knut solved

  Overactive Defense System

  “The defense system of the body goes out of control. It starts producing antibodies which turn against the body’s own nerve cells rather than fighting infections,” DZNE scientist Harald Prüß explains. The possible symptoms of anti-NMDA-receptor encephalitis include epileptic attacks, hallucinations and dementia.

• Mysterious death of polar bear Knut solved

  Only recently discovered

  The mechanism was discovered in humans just a few years ago. That’s why IZW researcher Alex Greenwood considers these new findings “pretty remarkable.” The treatment for humans could now be adapted for zoo animals.

• Mysterious death of polar bear Knut solved

  Knut’s contribution to research

  “Autoimmune diseases of the nervous system could be more common among humans and animals than we have previously thought,” Greenwood suggests. It is possible that inflammations triggered by an autoimmune response are often overlooked when doctors are treating people with psychoses or lack of memory. In the future, routine tests could be done to get the diagnosis right.

  Author: Hannah Fuchs/fs

Bjornstad syndrome, gene BCS1L m.

Method of determination
Sequencing.

The conclusion of a geneticist is issued!

Study material
Whole Blood (with EDTA)

Investigation of mutations in the BCS1L gene.

Inheritance type.

Autosomal recessive.

Genes responsible for the development of the disease.

The BCS1L gene (BCS1, S. CEREVISIAE, HOMOLOG-LIKE) is located on chromosome 2 in region 2q33. Contains 7 exons.

Mutations in this gene also lead to the development of insufficiency of complex III of the mitochondrial respiratory chain; GRACILE syndrome and Lee syndrome (infantile subacute necrotizing encephalopathy).

Definition of the disease.

A rare disease with an autosomal recessive type of inheritance, characterized by the presence in patients of a combination of such signs as congenital sensorineural hearing loss of varying degrees and pili torti (twisted hair).

Pathogenesis and clinical picture.

The BCS1L gene product is expressed in all human tissues and participates in the assembly of complex III of the respiratory chain of the inner mitochondrial membrane. Defects in this protein lead to a decrease in the activity of the mitochondrial electron transport chain and the accumulation of reactive oxygen species. In Björnstad syndrome, there is damage to the tissues of the inner ear and hair follicle, which are especially sensitive to mitochondrial dysfunction.

Patients have a combination of signs such as congenital sensorineural hearing loss of varying degrees and pili torti (twisted hair), sometimes there is alopecia due to pili torti. With pili torti, flattened areas are revealed along the entire length of the hair shaft, twisted by 180º around the longitudinal axis, which causes increased hair fragility. Curly eyebrows and eyelashes are also noted. The disease develops in the 1st year of life.

Frequency of occurrence: not established.The disease is rare.

A list of mutations under study is available upon request.

Literature

1. KD Krasnopolskaya “Hereditary metabolic diseases. A reference book for doctors. ” M., 2005
2. Bjornstad, R. Pili torti and sensory-neural loss of hearing. (Abstract) Proc. 7th Meeting Northern Derm. Soc., Copenhagen May-29, 1965.
3. OMIM.

Surgical treatment of bone fractures in the OrthocenterSt. Petersburg

Surgical treatment of bone fractures is an extremely urgent task. 800 out of 10,000 thousand people are injured every day. Trauma always happens unexpectedly and not only brings physical suffering, but also disrupts a person’s usual way of life, sometimes depriving him of legal capacity for a long time.

Tasks of Trauma Surgeons – Your Speedy Recovery

As mentioned above, bone fractures are very common in humans. Fracture treatment is the task of traumatology, the priority goal of which is the speedy and painless recovery of the patient.Thanks to modern technologies, traumatology has reached a new level today. In modern clinics, when treating fractures, massive plaster casts, extensive incisions during operations, prolonged immobilization during the healing of the fracture, leading to a protracted and sometimes defective recovery, are a thing of the past.

In our work, we, specialists of the Orthocenter, adhere to the most modern principles of surgical treatment of fractures (osteosynthesis), developed by the Swiss Association of Traumatologists (Association osteosynthesis), the world’s most advanced organization in the development of methods for treating bone fractures.Compliance with these principles allows our patients to return to a full life as soon as possible.

For example, a severe comminuted fracture of the leg bones in the lower third, a very severe trauma for treatment, with the traditional approach, requiring extensive surgical access to insert the plate with the formation of a large postoperative scar, and a long (3-5 months) elimination of the load on the leg. It is not difficult to imagine what difficulties traditional treatment entails for the patient.

However, when using the modern approach for the surgical treatment of such fractures, constructions of the latest generation are used, in this case, a lockable intramedullary nail, which allows stepping on the leg on the 2nd day after surgery with a load of 30-50%, and after 1.5 months … with full load.

The operation was carried out through 1 cm incisions, punctures, which ensured minimal pain syndrome after the operation, the possibility of early restoration of limb function, early healing and an excellent cosmetic result.

Another similar example. The operation was performed for a severe open comminuted fracture, with traditional treatment of which the postoperative scar would have been at least 20 cm.After the operation performed with us, minimally invasive installation of the structure and plastic closure of the defect after an open fracture, a young girl achieved an excellent cosmetic result and restoration of limb function.

Basic principles of surgical treatment of fractures

• sparing reduction (matching) of bone fragments;
• stable fixation of bone fragments;
• preservation of the blood supply to bone fragments for their speedy fusion;
• early mobilization (restoration of movements) of the injured limb and the patient as a whole after surgery.

If these principles are observed, the operation is performed through small incisions for the implantation of a metal structure (rod or plate).

Modern approach to fracture treatment

Reposition (matching) of the fragments is performed closed without incision in the fracture area using a modern image intensifier in the operating room. At the same time, there is no goal, as it was in previous years, to eliminate the slightest displacement of all fragments by any means. This old approach of surgical treatment of fractures, when a large incision was made, all the fragments were isolated, separating them from the supplying tissues, and meticulously put them in place, except for a beautiful X-ray after the operation, it does not give anything good.The bone fragments separated from the feeding tissues grow together for an extremely long time (6-8 months), and sometimes they do not grow together at all, which requires a second operation.

According to modern principles of performing osteosynthesis, it is necessary to eliminate the displacement of bone fragments in length, width, rotational displacement, angle displacement, i.e. restore the normal axis of the limb, then closed (without incision, separation from the supplying tissues, without precision comparison) bring large bone fragments closer to the fracture area.Thus, the bone fragments are not additionally injured, which ensures the preservation of their blood supply and the early formation of callus (fracture union), which is 2-3 times less in time than with the old methods of surgery.

Further, remodeling (restructuring) of the callus occurs. It involves bone fragments close to the fracture site, and the callus turns into a normal, anatomically correct, bone, while the appearance of the operated limb becomes indistinguishable from a healthy one.

A small incision, in addition to the aesthetic effect (the sutures are practically invisible), gives significantly less pain after surgery and quick tissue healing.

Another example.

Implants – a unique solution in the treatment of fractures

Stability of fixation of bone fragments in the correct position is achieved by implantation of modern structures from leading world manufacturers. Stable fixation and low invasiveness of the operation allow the patient to perform movements of the injured limb almost immediately after the operation, develop joints, which improves blood circulation in the area of ​​operation and accelerates fusion.The patient may soon begin rehabilitation, return to normal life, work, drive a car, and wear normal clothes.

Clinical example. The patient was operated on for a fracture of the leg bones with an intramedullary nail with locking screws. The metal structure reliably fixes the fracture zone.

Despite the solidity of the metal structure, which can carry the entire body weight even before the fracture is healed, it was installed through a puncture incision up to 1.0 cm.Scars are practically invisible, an injured limb with a severe fracture is indistinguishable from a healthy one (see photos)

The patient can fully step on the leg even before the bone is healed.

OrthoCentre’s specialists are proficient in all types of minimally invasive osteosynthesis of bones in limb segments. Treatment is carried out in the shortest possible time, in conditions corresponding to the level of leading Russian and foreign orthopedic centers.

90,000 The situation at the Fukushima NPP is not like Chernobyl

Thousands of people in Japan are missing, entire settlements are completely destroyed, fires are raging in gas and oil storage facilities. Meanwhile, in the center of the news picture is the fate of nuclear reactors located in the area of ​​the disaster.

US Congressman Ed Markey, a longtime opponent of nuclear power, announced a “new Chernobyl” and predicted that the same could happen in the United States. In particular, he called for the suspension of the licensing process for the Westinghouse AP1000 third-generation reactor, which has been undergoing review by the Nuclear Energy Regulatory Commission for seven years.

Before succumbing to panic, it is worthwhile to understand and understand what exactly is happening in Japan and what we really need to fear.

The temperature in the reactor core is about 288 degrees, which is lower than the temperature of a coal stove and only slightly higher than the temperature in a home oven. If something unexpected happens, the control rods of the reactor power are lowered, stopping the nuclear reaction. A reactor cannot be completely out of control and cannot explode like an atomic bomb.A commercial nuclear reactor and a bomb are related in much the same way as petroleum jelly and napalm. Both substances are produced from the same raw materials, but only one of them is explosive.

After the reactor is shut down, the heat of radioactive decay remains, which can take more than a week to neutralize. In this case, it is necessary to continue cooling the rods with water.

In all the reactors of the second generation – those that are in operation now – the circulation of water is maintained by means of electric pumps.New reactors, as a rule, are equipped with a simpler “passive” cooling system, in which the water circulation is natural.

If a pump fails in a second generation reactor – as happened at the Fukushima Dai-Ichi station – the water in the cooling system can start to overheat and evaporate. The steam increases the internal pressure, which must be relieved by releasing the steam. In 1979, during the accident at the Three Mile Island nuclear power plant in Pennsylvania, USA, radioactive steam was released, the same as now at the Fukushima station.The radiation level of this vapor roughly corresponds to the background when taking an X-ray. In addition, it is a short-lived waste that decays quickly.

If evaporation continues in the cooling system, the water level may drop and expose the fuel rods. This will lead to their melting, that is, the fuel will melt and reach the bottom of the containment.

Many believe that the fuel will then continue to melt and pass through the metal shell, and then through the concrete containment.This is the so-called “China syndrome” – the fear that radioactive fuel will reach China itself. The accident at the Three Mile Island station showed that nothing of the kind was happening. The molten rods will not have enough heat to melt metal and concrete.

But the residual heat, of course, must be removed, and the last resort in such a situation is to fill the entire containment with water. This causes significant damage to the reactor, but prevents further steam emissions. Using seawater, Japanese specialists have performed this operation several times in at least two of the three damaged reactors.These reactors will never be started up again.

None of this looks like a “new Chernobyl”. The Chernobyl reactor had two key systemic problems. Firstly, graphite was used there as a neutron moderator, which is necessary for the reaction. The graphite caught fire during the accident and continued to burn for four days. As you know, water does not burn.

Secondly, the Chernobyl nuclear power plant had no concrete containment. When the graphite caught fire, it gave off a cloud of radioactive smoke that spread to the entire planet.A concrete shell would suppress fire and contain the spread of radioactive material.

If fuel melt does occur in Japan, it will be a disaster for the Tokyo Electricity Company, but not for the general population. Steam emissions that can occur will not have serious consequences. Researchers have studied the health effects of steam emissions from the Three Mile Island nuclear power plant for many years and have not found them.

Now, when there are so many dead in Japan, so much destruction and threats to the spread of diseases dangerous for tens of thousands of people, it seems to me not appropriate to worry about the fate of a nuclear reactor.

The tragedy in Japan proved that even outdated containments can withstand one of the worst earthquakes in history. A failure has occurred in the electrical pumps of the cooling system. It would be wrong to stop developing third-generation reactors, in which this particular systemic deficiency has been eliminated.

Lebgok Health LLC. New generation medicine. Stary Oskol

As a topic for today’s conversation, I have chosen the problem that we, neurologists, most often encounter in our daily practice.The urgency of back pain is high – every year it is registered in 15-25% of the adult population of the country. Between the ages of 30 and 45, back pain is one of the most common causes of disability. Moreover, only 40% of patients seek medical help. It is also known that in one third of patients, acute pain subsequently turns into chronic pain, which persists for more than 12 weeks.

Why does my back hurt?

As soon as the first man got up from all fours and proudly raised his head, he condemned all his descendants to sufferings associated with the spine.The spine in four-legged animals is horizontal and serves to balance all parts of the body. Such a spine remains in perfect condition for a long time, it can withstand any stress, tension and exposure to adverse factors. In humans, the spine began to play the role of a rod, or column, and turned into that part of the body that is very easy to disable. Numerous modern studies have shown that pathological changes in the spine are inherent not in individual people or groups of people, but in all of humanity as a biological species.These changes lead to the fact that by the age of fifty, about 80% of men and 60% of women suffer from spinal diseases, and the onset of clinical manifestations of the disease falls on the most able-bodied period of life, on average 35 years. The most common cause of back pain is dorsopathies.

Dorsopathy – what is it? Causes and mechanism of its development

Dorsopathies – a group of diseases of the musculoskeletal system and connective tissue, the leading symptom complex of which is pain in the back and extremities of non-visceral etiology.

The term dorsopathy is translated from Latin as back disease. The spine is a complex structure that can withstand significant loads associated with the vertical position of the human body. Until the age of 30, the processes of anabolism (synthesis and restoration of tissues) prevail in the body, then the process of involution and degenerative changes in the tissues of the ridge, primarily the cartilage of the intervertebral discs, takes place. This leads to deformation of the vertebrae, infringement of the spinal roots, inflammation of the paravertebral muscles and tissues.

What factors contribute to the onset of dorsopathy?

• Heredity – a high probability of developing this pathology in children whose parents suffered from diseases of the spine.
• Increased static load on the spinal column – persons of certain professions associated with prolonged standing (surgeons, hairdressers). In these cases, the process develops in the lumbar spine.
• Severe simultaneous load on the spine associated with heavy lifting
• Congenital curvature of the spine
• Metabolic disorders in the body
• Alcohol and tobacco abuse
• Chronic infections
• Insufficient and unbalanced nutrition
• Sedentary lifestyle

All causal factors lead to a change in the height of the intervertebral discs, a change in the shape of the vertebral bodies and inflammation of the paravertebral tissues with spasm of the striated muscles and entrapment of the nerve fibers of the spinal cord.As a consequence, these processes become irreversible

Dorsopathy symptoms

The main symptoms of dorsopathy are:

• Constant aching back pain, tension and soreness on the side of the lesion in the muscles of the neck, shoulder girdle, back and limbs;
• increased pain with sudden movements, physical exertion, lifting weights, coughing and sneezing;
• feeling of numbness and aches in the limbs, paresis (impaired sensitivity), muscle weakness (up to paralysis), with decreased reflexes and muscle hypotrophy of the arms and / or legs;
• muscle spasms, limitation of mobility, decreased range of motion;
• Local changes in soft tissues: vascular, dystrophic changes, neuromyo- and neuroosteofibrosis.

Depending on the location of the dorsopathy, the following symptoms are possible:

• with cervical spine dorsopathy : pain, feeling of numbness in the arms, shoulders; headaches. There may also be complaints of noise in the head, dizziness, flashing “flies”, colored spots before the eyes. In combination with a throbbing headache, this suggests the so-called “vertebral artery syndrome” (one of the complications of cervical dorsopathy).
• with dorsopathy thoracic spine : pain in the chest, in the region of the heart and other internal organs;
• with dorsopathy of the lumbosacral spine : back pain radiating to the sacrum, lower extremities, sometimes to the pelvic organs;
• with lesions of the nerve roots (herniated intervertebral discs, osteochondrosis, spondylolisthesis, spondyloarthrosis): shooting pain and impaired sensitivity, a feeling of “creeping” in the lower extremities, hypotrophy, hypotension, weakness in the innervated muscles, decreased reflexes.

Diagnosis for dorsopathy

Diagnosis of dorsopathy is not particularly difficult. The disease is determined by a neuropathologist based on patient complaints and neurological tests. To clarify the diagnosis, an X-ray examination of the spine is prescribed. More detailed information is provided by the ultrasound method (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI). Doctors of other specialties often face this problem. In this situation, the doctor will definitely refer the patient for consultation or treatment to a neurologist.

Treatment of dorsopathy

Consider the treatment of three main types of dorsopathies: cervical, thoracic and dorsal spine:

In the treatment of acute dorsopathy, significant pain regression should be expected within 1-2 weeks. For a long time, the existing installation of limiting physical activity, up to strict bed rest, has now been somewhat revised: with moderate pain, partial restriction is recommended, and with intense pain, the period of bed rest is reduced to 1-3 days.This is necessary in order to completely relieve the load on the spine;

• To eliminate pain and relieve muscle tension, non-steroidal anti-inflammatory drugs are prescribed. Emergency pain relief and relieving muscle spasms is also achieved by prescribing analgesics and muscle relaxants;
• anti-inflammatory and warming ointments help relieve inflammation in the affected areas.
• to eliminate edema of the nerve roots in the treatment of dorsopathy, blockade is prescribed using Lidocaine, Novocaine, Dexamethasone and other medicines
• to eliminate metabolic disorders in tissues, their insufficient blood supply in compression syndrome, anti-ischemic drugs are prescribed

A special place in the therapy of dorsopathies, mainly with stenosis and arthrosis of the facet joints, is occupied by drugs of the chondroprotective series, they help to inhibit the degenerative process and reduce the likelihood of chronic pain.In neurological practice, preference is given to drugs for parenteral administration.

Thus, drug treatment of dorsopathies is a complex task that requires deep knowledge of the pathogenesis and clinical manifestations of the disease. The physician should also adhere to algorithms designed for the stage of the process.

At the same time, additional techniques are successfully used, such as acupuncture , which is used to treat dorsopathies, as well as a huge number of other diseases; various types of manual therapy ; physiotherapy techniques – electro-, magneto-, light-, mud therapy.

In conclusion, it should be emphasized that effective therapy of lesions of the spinal column involves a combination of drugs from different groups, as well as the use of various medicinal and non-medicinal effects.

Surgical intervention is required for hernia and disc protrusion (bulging without rupture of the annulus fibrosus). The decision on surgical treatment is made by the doctor and the patient together. There are absolute and relative indications for surgery.

The decision on surgical intervention is made in the following cases:

• Compression of the cauda equina (the so-called bundle of lumbar, sacral and coccygeal roots of the spinal nerves) with lower paraparesis and pelvic (that is, urination and defecation disorders) disorders
• Increasing paresis (progressive decrease in strength in the limb)
• Severe pain syndrome that does not respond to conservative treatment within three to six months

In conclusion, I must say that the effectiveness of back pain treatment depends to a large extent on the patient himself, because the leading way to slow down the processes that take place in the spine over time is exercise therapy.The patient needs to be patient, persistent, have a great desire to get better and act in this direction with all his might.

For my part, I congratulate everyone on the coming New Year and wish prosperity, harmony, happiness in families, but most importantly – be healthy!

The author of the article is Marina Petrovna Protsenko: doctor – neurologist of the highest category. Work experience – 15 years. From 2011 to 2015, she was engaged in medical activities in large medical institutions in Moscow, including the Dikul V.And is engaged in the treatment and diagnosis of vertebrogenic, orthopedic and neurological medical problems, diseases of the nervous system of adults and children. Author of publications on the treatment of pain in the lower back, depressive conditions. He is fluent in reflexology techniques. He constantly improves his professional level by attending medical and scientific conferences.

Features, types and stages of classical dental implantation in our clinic

Restoration of the dentition can be performed according to the classical or express method.In the first case, implantation occurs in four stages, in the second – in one visit.

Classical prosthetics are more reliable, durable and allow you to install the rods even with insufficient bone tissue. Express implantation takes place directly on the day of removal. It is less traumatic for the mucous membrane, but requires good oral health.

How classical implantation works

Complete restoration of the dentition according to the classical technique takes from 4 to 7 months.The whole process of implantation can be conditionally divided into several stages:

1. examination, diagnosis and preparation of the oral cavity;
2. installation of the implant;
3. installation of the healing abutment;
4. prosthetics (abutment and crown).

Examination, diagnostics and preparation of the oral cavity

At this stage, the doctor carefully examines the oral cavity, identifies the anatomical features of the jaw, performs X-rays, CT scans, assesses the general health and quality of the patient’s bone tissue.In addition, during the initial examination, the dentist-surgeon:

• examines the relationship between the alveolar ridges and the teeth;
• analyzes the bite;
• checks the dentition for pathological mobility;
• marks the area most suitable for implantation;
• selects the shape and size of the implant.

Based on the information collected, the doctor gives recommendations on the preparation and implementation of the implantation procedure, determines how long the dental procedure will take and whether it takes time for additional treatment of concomitant health problems in which the implantation is impossible.
Before surgery, sanitation is required – caries is eliminated, diseases of the mucous membrane and gums are treated. At the time of implantation, there should be no inflammatory processes in the oral cavity.

The reorganization procedure includes:

• diagnostics of such diseases as: gingivitis, pulpitis, periodontitis, caries;
• complex treatment of the oral cavity, including tooth extraction, if therapy is not possible;
• professional oral hygiene.

Important! Installation of the implant should not be carried out during the period of exacerbation of chronic diseases, with infectious ailments, during pregnancy and with weakened immunity. In this state, the probability of the rod being rejected by the body increases many times over.

Implant placement

This is the immediate surgical stage, at which a hole is prepared in the bone tissue and the implant itself with plugs is installed, sutures are applied, which are removed on days 7-14. The procedure is performed under local anesthesia and is absolutely painless for the patient.The duration of such an operation is about 40-50 minutes.

Bone bed formation
The creation of a landing hole for the implant is carried out using special cutters. The depth and diameter of the bone bed are formed on the basis of the sizes selected at the preparatory stage of the pins. Before drilling, the specialist exposes the bone tissue by making an incision in the mucosa.

Insertion of the implant and plug
A titanium rod (implant) is screwed into the formed hole.The plug is installed over it. It prevents the penetration of pathogenic microflora into the structure. Then a tight suture is applied to the mucosal incision site, which completely covers the implant. The installation process itself takes no more than 15-20 minutes.

Important. For the implant to take root in the lower jaw, an average of 2-3 months is needed, in the upper dentition the process can take up to six months. As a rule, after the implantation of a tooth, the gum hurts for about 5-6 days – this is normal. If after this time the pain syndrome does not go away, but only intensifies, you do not need to endure it – consult a doctor.

Additional surgical procedures
Before implantation, some patients require additional surgical procedures:

• augmentation, restoration of the structure of bone tissue;
• expansion of the gum surface.

The growth and restoration of bone tissue is necessary if it atrophies, becomes thinner, has lost its structure due to lack of load. This situation usually occurs if the patient has been missing a tooth for a long time.However, the problem may be congenital. In any case, it requires a solution, because such a base will not hold any prosthesis. In order to restore the density and structure of the damaged “cement”, the doctor performs bone grafting.
The second most common problem is the lack of sufficient space for the implant due to misaligned teeth. Nature abhors a vacuum, and if there are not enough teeth in the oral cavity, their place is gradually “occupied” by nearby healthy teeth. Faced with such a problem, orthodontic treatment is carried out.

Installing the healing abutment

After complete healing of the mucous membrane and integration of the implant with the bone tissue, a special gum shaper is installed on the prosthesis. It rises slightly above its surface and helps the gums to take the desired anatomical shape. At this stage, if the patient wishes, it is possible to install the first temporary prosthesis.

Procedure steps for installing the healing abutment:
• the operation site is anesthetized;
• the gum is incised, exposing the upper part of the implant;
• plugs are pulled out;
• mucosal formers are inserted in their place.

The patient goes home. The next visit to the implantologist is scheduled 7-14 days after the manipulation. As a rule, this time is enough for the gums to completely heal and take the desired shape.

Placement of abutment and crown

In the last step, the healing abutments are replaced with abutments, over which the crowns are placed. It takes an average of 6-7 days to create individual prostheses. When it comes to anterior teeth, then, as a rule, the patient wears temporary crowns before making permanent dentures.Such a measure helps to solve the aesthetic question that is exciting for many.

After implantation – dentist’s recommendation
Immediately after dental implantation, you must not eat or smoke. The first snack is possible no earlier than 2 hours after the operation. It is advisable to give up smoking for at least a day. Also, it is imperative to adhere to all the recommendations of the attending physician.

Restrictions after surgical implantation:

• eat only soft, unheated and pureed food for the first 2-3 days;
• be sure to rinse your mouth with a solution prescribed by your doctor;
• do not take a hot bath, do not take a steam bath and a sauna for 14 days;
• during the first 2 days when brushing your mouth, avoid touching the implantation area;
• in the future, you can clean the entire oral cavity, but be careful not to damage the seams;
• do not go in for active sports – 2 weeks;
If 7 days after the operation, the pain in the gums does not go away, and the mucous membrane begins to swell, be sure to consult a doctor.You should also consult a doctor in a situation if you have a high fever or the implant has erupted through the gingival mucosa.

Memo – Dental care after final prosthetics
All patients who have undergone classical implantation, after the implant has taken root and the installation of a permanent crown, should remember that artificial teeth require no less care than real ones. They should not be overloaded – gnaw nuts, bones and other hard objects. If even a slight mobility of the implants appears, you should immediately consult a doctor.Implants, like “live” teeth, need daily hygiene, cleaning and rinsing after meals.
In addition, it is advisable to use dental floss and a special brush with brushes in the care.
Remember that the lifespan of implants that have taken root depends largely on you. When used correctly, prostheses perform their function and retain their excellent appearance even after 25-30 years of use.

How is express implantation

Express implantation is performed immediately after tooth extraction.Such prosthetics is less traumatic, does not require cutting the gums and subsequent suturing.

Stages:

1. consultation with a doctor, examination, preparation of the oral cavity;
2. tooth extraction;
3. preparation of the hole for implantation, drilling of bone tissue;
4. installation of an implant into an open hole;
5. placement of an abutment and a temporary crown, if necessary;
6. permanent prosthetics.

The first five stages of express prosthetics are carried out on the first day of the visit in one session.A permanent crown is placed within 2-4 months after the implantation of the nail.

Conditions for simultaneous implantation

Express implantation is possible only if the bone tissue is in good condition and in the absence of foci of inflammation in the oral cavity: diseases of the gums, mucous membranes, caries.

3.4 Surgical treatment / ConsultantPlus

3.4 Surgical treatment.

Criteria for starting surgical treatment:

1. Signed consent of the patient for treatment.

2. Absence of chronic diseases in the stage of decompensation, severe organ dysfunctions.

– All patients with 3 – 4 stages of chronic hemorrhoids with pronounced external hemorrhoids, with ineffectiveness or impossibility of using minimally invasive surgical methods, it is recommended to perform hemorrhoidectomy (removal of hemorrhoids) or stapler hemorrhoidopexy to increase the effectiveness of treatment and reduce the risk of complications [1 – 5, 25 , 61 – 89].

Strength of recommendation – A (level of evidence – 2)

Comment: Hemorrhoidectomy remains one of the most effective treatments for hemorrhoids.At the same time, after the operation, a long period of rehabilitation is required and there is a rather high frequency of complications that are practically not encountered after other methods. The most commonly used are open and closed hemorrhoidectomy, which can be performed with a surgical scalpel, diathermocoagulation, laser, or ultrasonic scissors. Neither type of hemorrhoidectomy has a significant advantage over others. The main disadvantages of hemoroidectomy are a long rehabilitation period (up to 40 days) and a high percentage of postoperative complications: dysuria – 15-24%; severe pain syndrome – 34 – 41%; bleeding – 2 – 3%; purulent-inflammatory complications – 2 – 3%; stricture – 1 – 2%; insufficiency of the anal sphincter – 1.8 – 4%.Submucosal hemorrhoidectomy is recommended as a separate method in a limited contingent of patients with chronic hemorrhoids of stages 3-4, accompanied by technical difficulties. Hemorrhoidopexy (Longo’s operation), despite the intact structures of the anal canal, is not a minimally invasive surgical intervention, which is associated with high-grade surgical risks: severe pain syndrome – up to 60%; leakage of the anastomosis – up to 6%; severe bleeding up to 48%. Also described are such complications as: rectvaginal fistulas; Fournier’s gangrene; extensive hematomas of the pelvic cavity; rectal stricture, acute intestinal obstruction, etc.p.

– Stapler hemorrhoidopexy is recommended for all patients with chronic hemorrhoids 2-4 stages, as well as with a combination of hemorrhoids with prolapse of the mucous membrane of the lower ampullar rectum to improve treatment results and shorten the rehabilitation period [1-5, 25, 40, 44, 48 , 49, 54, 61 – 75].

The level of persuasiveness of the recommendations – A (the level of evidence is 2)

Comment: the purpose of the operation is to fix and lift the internal hemorrhoidal plexus by circular resection of the mucous-submucosal layer of the lower ampullary rectum with a stapler with the formation of a mechanical suture, which further prevents the internal hemorrhoids.Internal and external plexuses, as a result of stapler hemorrhoidopexy, are not removed. Among the complications after this operation, the literature describes cases of the development of rectovaginal fistula, rectal fistula, rectal stricture, bleeding, phlegmon of the retroperitoneal tissue, rectal perforation. With stapler hemorrhoidopexy, there is a decrease in postoperative pain syndrome and a shorter period of patient rehabilitation in comparison with traditional hemorrhoidectomy. However, the incidence of postoperative complications in both stapler hemorrhoidopexy and traditional hemorrhoidectomy (open and closed) is approximately the same.

Methodology. This intervention is performed using a special kit. The operation begins with the introduction of a transparent anoscope into the anal canal, with which it is possible to control the location of the dentate line. The jagged line serves as a guide when choosing the height of the purse-string suture formation. A purse-string suture is applied through the anoscope, at a distance of 4 – 5 cm from the dentate line. The suture begins at a projection of 3 o’clock and is applied with the capture of the mucous membrane and the submucosa of the intestinal wall.Rotating the anoscope, a continuous purse-string suture is applied along the entire circumference of the lower ampullar rectum, with the distance between the stitches from 0.5 to 1.0 cm.After removing the anoscope, the head of the circular stapler is inserted above the applied purse-string suture, followed by tightening the purse on the rod of the apparatus … In this case, the mucous membrane should close tightly around the rod of the apparatus. The ends of the threads are pulled through the lateral holes located at the base of the circular apparatus and are fixed from the outside.The head approaches the base of the apparatus and resection of the circular section of the mucous-submucosal layer of the lower ampullar rectum is performed with the formation of a two-row staple suture.

– Closed hemorrhoidectomy (with restoration of the anal mucosa) is recommended for all patients with stages 3 – 4 of chronic hemorrhoids in the absence of clear boundaries between the external and internal hemorrhoids to improve treatment results and reduce the risk of complications [1 – 5, 25, 77 – 79 , 81, 82].

The level of persuasiveness of the recommendations – A (the level of evidence is 1)

Comment: suturing of wounds in the anal canal causes faster healing of postoperative wounds, however, after closed hemorrhoidectomy, a more pronounced pain syndrome is noted in the early postoperative period.

Technique: On the base of the internal hemorrhoid, above the dentate line, a Billroth forceps is applied. The hemorrhoid is cut off to the vascular pedicle, followed by its stitching and ligation.The node is cut off distal to the vascular pedicle ligation site. The wound is sutured by grasping the edges and bottom with separate interrupted sutures or a continuous suture with an absorbable suture. The external hemorrhoidal node is excised as a single block with the internal node or separately. The wound is also sutured with separate sutures with an absorbable suture.

– Open hemorrhoidectomy (Milligan-Morgan hemorrhoidectomy) is recommended for all patients with stages 3-4 of chronic hemorrhoids, as well as in cases of combination of hemorrhoids with inflammatory diseases of the anal canal (anal fissure, rectal fistula) to improve treatment results and reduce the risk of complications [1 – 5, 25, 56 – 58, 60, 66 – 69, 78, 84, 88].

The level of persuasiveness of the recommendations – A (the level of evidence is 1)

Comments: for open hemorrhoidectomy, the longest rehabilitation is characteristic, which is associated with the period of healing of postoperative wounds.

Methodology. The internal hemorrhoid is cut off to the vascular pedicle, followed by stitching and ligation. The node is cut off distal to the vascular pedicle ligation site. A thorough hemostasis is achieved. The wound is not closed. The external hemorrhoidal node is excised as a single block with the internal node or separately.

– Electrosurgical hemorrhoidectomy with dosed energy supply depending on the properties of coagulated tissue (tissue impedance) and hemorrhoidectomy with an ultrasonic scalpel are recommended for all patients with chronic hemorrhoids of stages 3–4 to improve treatment results and reduce the risk of complications [1–5, 25, 47, 52 , 79 – 89].

The level of persuasiveness of the recommendations – A (the level of evidence is 2)

Comment: the use of these techniques for hemorrhoids 3 – 4 stages can significantly reduce the time of surgery, reduce the intensity and duration of pain syndrome, shorten the rehabilitation of patients, significantly reduce the frequency of dysuric disorders …Good results can be achieved in 96.4% of the operated patients.

Technique of electrosurgical hemorrhoidectomy with dosed energy supply depending on the properties of the tissue to be coagulated (tissue impedance): the internal hemorrhoid is grasped with a Luer clamp, followed by suturing of the vascular pedicle. The branches of the LigaSure coagulation forceps are applied to the base of the node from outside to inside, with further coagulation. Along the outer edge of the coagulation layer, the node is cut off with scissors to the vascular pedicle.Coagulation of the vascular pedicle by the apparatus is performed twice with the movement of the branch of the apparatus without leaving a gap between the coagulated areas. Then, along the outer edge of the coagulation layer, the vascular pedicle is crossed with scissors, the node is removed.

Technique of hemorrhoidectomy with an ultrasonic scalpel: dissection of tissues in the area of ​​the base of the external hemorrhoidal node is performed with ultrasonic scissors in cutting mode. Then, in stages, the outer and inner components are removed in a single block until they intersect completely.Treatment of the vascular pedicle is performed in coagulation mode.

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Genetic, chromosomal or developmental disorders affecting the skin

15 Skin diseases

This subheading encodes genetic and chromosomal diseases as well as intrauterine developmental disorders affecting the skin.

EC10 Genetic syndromes with poikiloderma

Genetic syndromes affecting the cutaneous vasculature

LD27.0 Syndrome of ectodermal dysplasia

Synthesis of LD2B with premature aging as the main function

EC1Y Other specified genetic syndromes affecting the skin

EC20 Genetic disorders of keratinization

EC20.0 Non-syndromic ichthyosis

EC20.00 Ichthyosis vulgaris

EC20.01 X-linked ichthyosis

EC20.02 Autosomal recessive congenital ichthyosis

EC20.03 Keratinopathic ichthyosis

EC20.0Y Other specified or unclassified non-syndromic ichthyosis

EC20.1 Hereditary skin peeling

EC20.2 Hereditary acantholytic dermatoses

EC20.3 Hereditary keratoderms of palmoplastar

EC20.30 Diffuse keratoderms of palmoplastar

LD27.03 Hydrodynamic ectoderm dysfunction, Clouston type

EC20.31 Focal palmoplantar keratodermas

5C50.12 Tyrosinemia type 2

EC20.32 Papal palmoplantar keratoderms

EC20.3Z. Hereditary keratoderm of palmar type, unspecified type

LD27.2 Synchronous ichthyosis

ED56 Keratosis pilaris

EC20.Y Other specified genetic disorders of keratinization

EC21 Genetic defects in hair or hair growth

EC21.0 Genetic defects of the hair shaft

EC21.1 Genetic syndromes with hair shaft abnormalities

EC21.2 Hereditary alopecia or hypotrichosis

EC21.3. Genetic syndromes with alopecia or hypotrichosis

5C50.A0 Argininosuccinic acid

LD27.03 Hydrodynamic ectoderm dysfunction, Clouston type

EC21.4. Genetically determined hypertrichosis

LD27.3 Genetic syndromes with hypertrichosis

EC21.Y Other specified genetic defects in hair or hair growth

EC22 Genetic defects in nail or nail growth

EC22.0 Inherited nail deformities

LD27.4 Genetic syndromes affecting nails

EC23 Genetic disorders of skin pigmentation

EC23.0 Non-syndromic genetically determined hypermelanosis or lentiginosis

EC23.1 Syndromic genetically determined hypermelanosis or lentiginosis

LD2D.0 Pitz-Jagers syndrome

LD27.00 Incontinentia pigmenti

LD2D.1 Neurofibromatosis

EC23.2 Albinism or other specific genetically determined hypomelanotic disorders

EC23.20 Oculocutaneous albinism

EC23.2Y Other specified genetically defined hypomelanotic disorders

EC23.Y Other specified genetic disorders of skin pigmentation

Genetically determined epidermolysis buffer

EC30 Epidermolysis bullosa simplex

EC31 Epidermolysis brilliant

EC32 Epidermolysis buffalo dystrophic

EC33 Syndromic buffalo epidermolysis

EC3Z Epidermolysis bullosa

Genetic disorders affecting cutaneous, elastin or other matrix proteins

EC40 Pseudoxanthoma elasticum

LD28.1 Ehlers-Danlos syndrome

LD28.01 Marfan syndrome

LD28.2 Genetically determined cutis laxa

EC4Y Other specified genetic disorders affecting dermal matrix proteins

Certain developmental anomalies affecting the skin

EC50 Anomalies of the umbilical cord

LB03.0 Remains of Altai ducts or cysts

LA14.0 Structural malformations of the eyelids

LA31 Structural malformations of the mouth or tongue

LA51 Face slits

LA21 Minor Pinna Anomalies

EC5Y Other indicated developmental anomalies affecting the skin

Chromosomal disorders affecting the skin

DNA instability syndromes affecting the skin

Genetic disorders of adipose tissue or lipid metabolism affecting the skin

Genetic disorders of amino acid metabolism or transport affecting the skin

Sphingolipidosis with skin manifestations

LD27.