bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Pharmacy Computer Prescription Database to Access Hypertensive Patients for Mailed Survey Research
Authors: Beto Judith A , Listecki Robert E , Meyer Donald A , Budhy Richard J , Bansal Vinod K
Published: January 2017

OBJECTIVE:

To evaluate the use of a pharmacy computer prescription database (PCPD) to identify and sample hypertensive patients outside of their treatment setting for mailed, self-administered survey research comparing the presence and lack of participation incentives and mailed follow-up reminders.

SETTING:

Two independent, privately owned, free-standing community pharmacies.

PARTICIPANTS:

A total of 735 individuals identified from a PCPD search who had been prescribed at least 1 of 130 PCPD medications potentially used in hypertensive therapy.

METHODS:

PCPD was searched by the pharmacist/owner per protocol; participants were sent an individually addressed cover letter on pharmacy letterhead signed by the pharmacist that requested voluntary anonymous completion of an enclosed self-administered, quality-of-life opinion survey; the first search used no incentive or follow-up; die second search used an incentive and mailed a follow-up reminder. Research protocol followed published ethics guidelines.

RESULTS:

There was a mean 84% return with incentive and follow-up strategies compared with a mean 25% return without strategies (p < 0.01) for all drug groups between searches; no statistical difference in response was shown between the same drug groups (alpha1-blockers, calcium-channel blockers, and centrally acting alpha2-agonists) within searches.

CONCLUSIONS:

Acceptable response rates (74–93% return) can be obtained with traditional follow-up mailed incentives, prescription issuance within 6 months, incentives to both hypertensive and nonhypertensive responders, and sampling strategies within potential drug groups. Methodology can be adapted to other populations by alternative drug sampling strategies.
Hypersensitivity Reactions to Etoposide
Authors: Hoetelmans Richard MW , Schornagel Jan H , ten Bokkel Huinink Wim W , Beijnen Jos H
Published: January 2017

OBJECTIVE:

To report a hypersensitivity reaction to etoposide occurring in a patient after 2 months of drug therapy.

CASE SUMMARY:

a 20-year-old man with a diagnosis of testicular carcinoma was treated with bleomycin, etoposide, and cisplatin (BEP regimen). After dose 20 of etoposide, an exanthema was noted, which was attributed to etoposide. The patient had received 19 doses of etoposide during the previous 2 months without any sign of an allergic reaction. Rechallenging the patient with etoposide from another batch resulted in recurrence of the exanthema.

DISCUSSION:

Both etoposide and its excipient (polysorbate 80) are suspected of causing hypersensitivity reactions. Although the exact mechanism of the hypersensitivity reaction is not known, it is believed to be of nonimmunogenic origin.

CONCLUSIONS:

With a lower rate of infusion of etoposide and/or by premedication with antihistamines and/or corticosteroids, hypersensitivity reactions to etoposide might be prevented in patients with a history of hypersensitivity to this drug.
Aprotinin
Authors: Robert Sylvie , Wagner Bertil KJ , Boulanger Michelle , Richer Monique
Published: January 2017

OBJECTIVE:

To review the clinical pharmacology of aprotinin in patients undergoing surgical procedures involving major blood loss, namely, coronary artery bypass graft (CABG).

DATA SOURCES:

A MEDLINE search was used to identify French-and English-language publications on aprotinin using the indexing terms aprotinin, cardiothoracic surgery, and hemorrhage. The MEDLINE search was supplemented by review of article bibliographies. Data also were obtained from the approved Canadian and US product labels.

STUDY SELECTIONS:

All abstracts and uncontrolled and controlled clinical trials were reviewed.

DATA EXTRACTION:

Study design, population, results, and safety information were retained. Efficacy conclusions were drawn from controlled trials.

DATA SYNTHESIS:

Aprotinin, a serine protease inhibitor isolated from bovine lung tissue, decreases bleeding after cardiac surgery by mechanisms including antifibrinolytic activity and preservation of platelet function. Several trials have shown that aprotinin reduced blood loss and transfusion requirements in patients undergoing CABG. Its use in other surgical procedures involving major blood loss has been reported. Aprotinin is well tolerated, with minor allergic reactions being the most frequently reported adverse effect. Although unsubstantiated, the possibility that aprotinin could create a prothrombic state leading to early graft occlusion and formation of microthrombi in renal and coronary vasculatures is of concern.

CONCLUSIONS:

Aprotinin is an effective hemostatic agent in CABG. Clear definitions of indications, dosing, safety, and repeated use remain to be investigated thoroughly.
Phenytoin Protein Binding and Dosage Requirements during Acute and Convalescent Phases following Brain Injury
Authors: Markowsky Susan J , Skaar Debra J , Christie Joan M , Eyer Steven D , Ehresman David J
Published: January 2017

OBJECTIVE:

TO longitudinally evaluate unbound and total serum Phenytoin concentrations during intravenous phenytoin maintenance dosage and to determine the relationship among phenytoin protein binding, serum albumin, and unbound fatty acid concentrations in patients with head injuries during intensive care unit (ICU) and convalescent care.

DESIGN:

Serum albumin and phenytoin unbound fraction were determined twice weekly during ICU and convalescent care in 10 patients receiving phenytoin following acute brain injury. Phenytoin protein binding was also determined in 10 healthy control subjects.

MAIN OUTCOME MEASURES:

Longitudinal serum phenytoin concentrations associated with dosage adjustments targeted to achieve unbound phenytoin serum concentrations between 1.0 and 2.0 mg/L were documented during ICU and convalescent care. Longitudinal phenytoin protein binding was correlated with serum albumin and unbound fatty acid concentrations in neurotrauma patients.

RESULTS:

ICU patients received intravenous therapy for a mean of 15.0 days. The mean ± SD initial phenytoin intravenous dosage regimen of 6.0 ± 0.7 mg/kg/d resulted in mean ± SD total and unbound phenytoin concentrations of 3.2 ± 2.3 and 0.3 ± 0.2 mg/L. Two patients had seizures associated with low phenytoin concentrations. Four patients continued to receive oral phenytoin therapy during convalescent care; phenytoin dosage requirements decreased over time in these patients. During acute and convalescent care, the phenytoin unbound fraction ranged from 6.0% to 18.3% and correlated with albumin (r2 = 0.61, p < 0.0001) but did not correlate with unbound fatty acid concentrations. The mean phenytoin unbound fraction was 10.1% and 8.9% for the ICU and convalescent patients with brain injuries, respectively, and was 7.0% for the healthy volunteers.

CONCLUSIONS:

Phenytoin protein binding was significantly correlated with albumin and was more variable in ICU and convalescent patients with brain injuries than in healthy volunteers. The high dosage requirements and subtherapeutic unbound phenytoin concentrations observed during acute care are best explained by increased metabolism. Phenytoin dosage requirements decreased during convalescence.
Serum-Sickness-Like Reaction Associated with Minocycline Therapy in Adolescents
Authors: Harel Liora , Arnir Jacob , Livni Ella , Straussberg Rachel , Varsano Itzhak
Published: January 2017

OBJECTIVE:

TO describe a serum-sickness-like reaction in five adolescents treated with minocycline.

CASE SUMMARY:

Five adolescents developed a rash and arthralgias/arthritis after taking minocycline for 10-30 days. Symptoms resolved gradually after the medication was stopped.

DISCUSSION:

Serum sickness is not described in the pharmacology literature as an adverse effect of minocycline, and in the English literature there are only two case reports. The migration inhibitory factor assay and mast cell degranulation test were positive in four of the five patients. The results of these assays were consistent with a role for minocycline in causing these reactions.

CONCLUSIONS:

Clinicians should be aware of the possibility of serum-sickness-like reaction as an adverse effect of minocycline.
Vinorelbine: A New Antineoplastic Drug for the Treatment of Non-Small-Cell Lung Cancer
Authors: Jones Suzanne Fields , Burris Howard A
Published: January 2017

OBJECTIVE:

To review the chemistry, pharmacology, pharmacokinetics, clinical activity, adverse effects, and dosage and administration guidelines for vinorelbine in the treatment of non-small-cell lung cancer (NSCLC).

DATA SOURCES:

A MEDLINE search (1989–1995) using the terms vinorelbine and Navelbine was conducted. Additional unpublished data were provided by Glaxo Wellcome Drug Information.

STUDY SELECTION AND DATA EXTRACTION:

The articles chosen for inclusion all appeared in peer-reviewed journals. Pertinent abstracts, as judged by the authors, were also included.

DATA SYNTHESIS:

Vinorelbine is a new semisynthetic vinca alkaloid approved by the Food and Drug Administration for the first-line treatment of patients with advanced NSCLC. The drug demonstrated a broad spectrum of antitumor activity in preclinical studies and produced dose-limiting neutropenia in Phase I trials. In Phase II studies, an overall response rate of approximately 30% was reported with single-agent vinorelbine. Furthermore, in large, multicenter, randomized Phase III trials, treatment with vinorelbine alone and in combination with cisplatin resulted in improved survival compared with controls. The drug was well tolerated, with granulocytopenia being the most commonly reported adverse effect. However, the incidence of fever and hospitalization associated with this granulocytopenia was exceptionally low. The recommended dose is 30 mg/m2 weekly administered by intravenous injection or infusion.

CONCLUSIONS:

As no specific chemotherapy regimen has previously been regarded as standard therapy for advanced NSCLC, vinorelbine is a promising new treatment for this patient population. It has been shown in several randomized, controlled trials to increase survival without compromising quality of life.
Cost Comparison of Recombinant Human Erythropoietin and Blood Transfusion in Cancer Chemotherapy-Induced Anemia
Authors: Sheffield Reinée E , Sullivan Sean D , Saltiel Emmanuel , Nishimura Lyn
Published: January 2017

OBJECTIVE:

To compare the cost of recombinant human erythropoietin (rHuEPO) with that of blood transfusion in the treatment of chemotherapy-induced anemia from a healthcare system perspective.

DESIGN:

A decision analytic model. Baseline estimates were obtained from a review of clinical trials data and economic evaluation studies.

SUBJECTS:

Secondary data analyses of patients with advanced malignancies, excluding hematologic malignancies and metastasized solid tumors.

INTERVENTIONS:

Patients received either leukocyte-depleted packed red blood cells (PRBCs) or rHuEPO 150 units/kg sc three times per week for 6 months (24 wk). After 6 weeks, if rHuEPO recipients did not display a response, they received rHuEPO 300 units/kg sc three times weekly for the duration of therapy. If rHuEPO recipients still exhibited no response, they were given blood transfusions.

MEASUREMENTS AND MAIN RESULTS:

For a treatment period of 24 weeks, approximately 64% of rHuEPO recipients responded at an average expected cost of $12 971 per patient. One hundred percent of transfusion recipients responded at a cost of $4481; this resulted in a cost savings of $8490. Variation of response rates for rHuEPO or PRBCs did not appreciably lower costs. Lower rHuEPO dosages and higher numbers of transfused units of PRBCs yielded approximately equivalent costs; however, these strategies may not be clinically prudent.

CONCLUSIONS:

From a healthcare system cost and outcome perspective, blood transfusion is the preferred strategy for chemotherapy-induced anemia. However, rHuEPO may be considered an effective blood-sparing alternative for patients with non-stem cell disorders. Future cost-effectiveness analyses are needed to assess more completely both the clinical and quality-of-life benefits rHuEPO may contribute to individual patients' lives and to society overall.
Mexiletine in the Symptomatic Treatment of Diabetic Peripheral Neuropathy
Authors: Wright Julie M , Oki Julie C , Graves Leland
Published: January 2017

OBJECTIVE:

To evaluate the efficacy and safety of mexiletine in the symptomatic treatment of diabetic peripheral neuropathy (DPN).

METHODS:

In this prospective, double-blind study, 29 patients were randomized to receive mexiletine 600 mg/d or matching placebo for 3 weeks. A four-item symptom score (FIS), which rated pain, dysesthesias, paresthesias, and nightly exacerbations of symptoms, and a 100-mm visual analog scale (VAS), which rated pain intensity, were completed by patients before and after treatment. At the end of treatment independent patient and investigator global assessments were made. Patients reported adverse effects after 1 and 3 weeks of treatment.

RESULTS:

Treatment groups were similar at baseline. The difference between the median changes in FIS scores (mexiletine = 5.5, placebo = 2) was not statistically significant. Overall symptom response was similar in both treatment groups as demonstrated by both global assessments (p = 0.19). The mean change in VAS score from baseline to posttreatment was determined for both groups and the difference between these mean scores was 16.5 mm (95% CI, −7.1 to 40.2 mm) (p = 0.16). Inadequate statistical power (1 — β = 0.40) may have resulted from small sample size, small magnitude of effect, or variability in the measured effect. Adverse effects were more common in the mexiletine group, though not statistically significant. One patient receiving mexiletine was hospitalized for palpitations.

CONCLUSIONS:

Because of conflicting reports of mexiletine's efficacy in the treatment of symptomatic DPN, this drug should be reserved for patients unresponsive or intolerant to standard therapy, without evidence of heart disease, and with sensations of burning, heat, formication, or stabbing pain.
Clinical Investigation of Topical Antimicrobials in Healthy Volunteers
Authors: Langford Jane H , Benrimoj Shalom I
Published: January 2017

OBJECTIVE:

To evaluate the antibacterial activity, onset of action, and duration of action of four topical antimicrobial gels containing cetrimide, bacitracin, polymyxin B sulfate, and a placebo gel.

DESIGN:

Multiples (1×, 2×, 4×, 8×) of minimally inhibitory in vitro drug concentrations were formulated in a gel vehicle. Antibacterial activity was evaluated using a scrub-wash methodology on artificially inoculated skin over an 8-hour study period.

SETTING AND PARTICIPANTS:

Healthy volunteers with intact forearm skin participated in the study. A standardized culture of Staphylococcus aureus NCTC 6571 was applied to four areas on each forearm, randomly assigned topical treatments were applied, and sites were sampled at predetermined time intervals using a surfactant wash fluid.

OUTCOME MEASURES:

Recovered bacteria were quantitated, allowing a comparison of antibacterial activity.

RESULTS:

Two-way and one-way ANOVA and a Scheffe test confirmed significant differences in antibacterial effect between the formulations containing 4 and 8 times the minimally inhibitory in vitro concentrations and placebo (p < 0.05). Duration of action was similar for all preparations; however, onset appeared to be faster with the formulations containing 4 and 8 times minimally inhibitory in vitro concentrations.

CONCLUSIONS:

The two topical preparations containing 4 and 8 times the minimally inhibitory in vitro concentrations of cetrimide, bacitracin, and polymyxin B sulfate demonstrated significant antibacterial activity and may have potential for further clinical investigations.
Hazards of Doubling Phenytoin Dose in the Face of an Unrecognized Interaction with Ciprofloxacin
Authors: Pollak P Timothy , Slayter Kathryn L
Published: January 2017

OBJECTIVE:

To underscore the need for caution when making dramatic changes in phenytoin dosing, and to report a possible ciprofloxacin interaction in which failure of seizure control led to inappropriately high phenytoin dosing and subsequent intoxication.

CASE SUMMARY:

A 61-year-old African-American man receiving long-term therapy with phenytoin 100 mg po tid for seizures secondary to a stroke was admitted for community-acquired pneumonia. His serum phenytoin concentration at admission was therapeutic at 12.6 μg/mL. Eight days after admission, ciprofloxacin 750 mg po bid was started for possible aspiration. Two days later he experienced a seizure; the serum phenytoin concentration was 2.5 μg/mL. In response to the 80% decline in phenytoin concentration, the dosage was gradually titrated upward to produce a serum concentration of 12.6 μg/mL. This eventually required a doubling of the original phenytoin dosage and he was discharged on 200 mg po tid. The patient subsequently developed severe ataxia and sustained a head injury for which he was seen again in the emergency department. Serum phenytoin concentration at that time was 42.8 μg/mL. Concentrations declined at a normal rate when phenytoin was withheld.

CONCLUSIONS:

It appears that a rapid decline in phenytoin concentration during the first admission was related to coadministration of ciprofloxacin, either through inhibition of absorption or induction of metabolism. In a conscientious effort to titrate phenytoin concentrations back to therapeutic values, the issue as to why this required such a dramatic change in dosage was ignored. Thus, in trying to prevent further seizures, the patient was unknowingly placed in jeopardy a second time when his usual dosage of phenytoin was doubled. As a result, phenytoin intoxication ensued after discharge when the ciprofloxacin was discontinued. This case illustrates a potentially dangerous interaction between ciprofloxacin and phenytoin, and it underscores the need to maintain a high index of clinical suspicion for drug interactions in any patient requiring a substantial change in drug dosage.
The Biomechanical Relationship Between The Tendoachilles, Plantar Fascia and Metatarsophalangeal Joint Dorsiflexion Angle
Authors: Carlson Robert E. , Fleming Lamar L. , Hutton William C.
Published: January 2017

We carried out an experiment to measure the relationship between tensile force in the tendoachilles and plantar fascia strain, and how this relationship is affected by the metatarsophalangeal joint dorsiflexion angle. Eight cadaver lower extremity specimens underwent biomechanical testing. Using a servo-hydraulic testing machine, a tensile force up to 500 N was applied to the tendoachilles while the strain on the plantar fascia was measured using an extensometer. The experiment was repeated at four different metatarsophalangeal joint dorsiflexion angles (0°, 5°, 30°, and 45°). Measurements and calculations showed that dorsiflexion of the toes tightens the plantar fascia (the windlass effect) and increases the effect that a tensile force in the tendoachilles has on the tensile strain and tensile force in the plantar fascia.
Haglund's Syndrome: Disappointing Results Following Surgery-A Clinical And Radiographic Analysis
Authors: Schneider Wolfgang , Niehus Wolfgang , Knahr Karl
Published: January 2017

Clinical and radiographic data were analyzed for 49 surgical interventions of painful heel syndrome with a mean follow-up of 4 years and 7 months. In all patients the surgical procedure consisted of a triangular shaped resection of the posterosuperior portion of the calcaneus. The clinical evaluation showed disappointing results with complete relief of complaints in only 34 procedures (69.4%), and 7 patients (14.3%) with even a worsening of their symptoms. The time course of rehabilitation was long with an average of 6 months of functionally significant pain after surgery, reducing the willingness to undergo this operation again. Formerly published angular thresholds of radiographic calcaneal angles could not be confirmed to be predictors for the preoperative symptoms or the postoperative outcome. There was no accumulation of pathologic clinical foot shapes, only a slight increased calcaneal pitch in patients with isolated pain on the posterosuperior lateral part of the calcaneus. According to Haglund's description of painful heel syndrome, the clinical picture of our patients included affections of bone, tendon, peritendon, bursae, soft tissue and skin in different combinations.

Based on this evaluation, we advise to be cautious to indicate the operation. All possibilities of conservative treatment should be performed prior to surgery.
Chronic Recurrent Subluxation of the Peroneal Tendons in a Pediatric Patient. Surgical Recommendations
Authors: Forman Edward S. , Micheli Lyle J. , Backe Lizanne M.
Published: January 2017

Numerous surgical and non-operative approaches have been used to treat chronic recurrent subluxation of the peroneal tendons in adult athletes. There have been no published reports of surgical repair in children. In this report on a skeletally immature patient a modification of the Chrisman-Snook 3 procedure (previously described for lateral ligament reconstruction) is described to correct recurrent subluxation of the peroneal tendons. KEYWORDS
Transarticular Stabilization for Malunited Fracture of the Distal Tibia in Diabetics With Loss of Protective Sensation
Authors: Pinzur Michael S.
Published: January 2017

Five diabetic patients who require insulin developed symptomatic malunited stress fracture of the distal tibia and fibula. All were treated with intramedullary fixation crossing the ankle joint. All progressed to stable union without evidence of infection. Two patients treated with antegrade intramedullary nailing required nail exchange for subsidence at the fracture site. One patient sustained a fracture at the proximal tip of a short retrograde nail, requiring replacement with a longer nail. Transarticular intramedullary fixation is an effective method of achieving stabilization for malunited fracture of the distal tibia in individuals with diabetes who are insensate. Due to the risk of fracture at the proximal tip of a standard short intramedullary nail, it is recommended to use a nail that extends to the proximal tibial metaphysis.
Prognostic Value of 99m Tc Leukocyte Scintigraphy in Diabetic Pedal Osteomyelitis
Authors: Van der Wall Hans , Lunz David , Stanton David , Bruce Warwick
Published: January 2017

While leukocyte scintigraphy is accurate in detection of pedal osteomyelitis, there has been little data relating the technique to outcomes. We designed a trial to examine the prognostic value of sequential 99m Tc labeled leukocyte scans to establish the diagnosis of osteomyelitis and after three to four weeks of culture-guided antibiotic therapy.

Twenty-three diabetic patients with proven pedal osteomyelitis (21/23) or persistent uptake (2/23) on the sequence of scans were studied. Five additional episodes of osteomyelitis developed in the group over the period of the study.

Eleven patients demonstrated persistent uptake in the sequential scans. Nine progressed to amputation. The remaining two patients were biopsy-negative for infection, did not have cutaneous ulceration and were thought to have rapidly progressive arthropathy. Sequential leukocyte scintigraphy accurately predicts the need for amputation and can circumvent ineffective prolonged antibiotic therapy.
Foot Care Practices, Services and Perceptions of Risk among Medicare Beneficiaries with Diabetes at High and Low Risk for Future Foot Complications
Authors: Harwell Todd S. , Helgerson Steven D. , Gohdes Dorothy , McInerney Michael J. , Roumagoux Louise P. , Smilie Jane G.
Published: January 2017

A cohort of Medicare beneficiaries with diabetes was identified from inpatient and outpatient claims data and their risk for foot complications was estimated based on claims reflecting services for recent foot problems. A telephone survey of a random sample from this cohort was conducted to assess their foot care practices, barriers, and perceptions of risk. Eight percent of respondents reported a history of foot ulcers and 7% a history of lower extremity amputation. Based on claims data, 30% of respondents were at high risk for future foot complications. Compared to those at low risk, those at high risk were more likely to report having an annual foot exam, using protective footwear, and perceiving themselves to be high risk for future foot complications. However, 50% of those with claims indicating a high risk perceived themselves to be at low risk for future foot complications. Overall, 20% of respondents seldom checked their feet daily for sores or irritations. Among this group, 60% felt that it was unimportant and 9% reported they were limited by poor vision or physical problems. Our findings suggest that strategies are needed to improve the delivery of preventive foot care services to older persons with diabetes. Additionally, emphasis is needed to help individuals understand their risk and seek and perform appropriate preventive foot care.
Chevron (Austin) Distal Metatarsal Osteotomy for Hallux Valgus: Comparison of Pre- and Post-Surgical Characteristics
Authors: Kernozek Thomas W. , Sterriker Steven A.
Published: January 2017

The purpose of the study was to compare the range of motion, perceived pain and plantar loading characteristics of the Chevron (Austin) corrective procedures in treating hallux valgus (HV) 12 months postsurgically. Twenty-five female participants with the diagnosis of mild to moderate HV deformity were studied. All participants had a distal metatarsal osteotomy (Chevron (Austin)) to correct their deformity. First metatarsophalangeal and talocrural joint range of motion (ROM) and a 10-point analog pain scale were measured presurgically and 12 months post-surgically on each participant. Radiographic measures of hallux valgus and intermetatarsal (IM) angles were taken preoperatively and six weeks postoperatively for comparison. Five pressure distribution measurements were recorded of barefoot walking using the EMED-SF presurgically and 12 months postsurgically. Statistical analyses revealed that plantar loading is still altered 12 months postsurgically despite a decrease in perceived pain and adequate first metatarsophalangeal joint ROM. Greater loading occurred in the central forefoot (CFF) region with decreases in some of the loading parameters in the medial toe (MT) region postsurgically. Loading parameters in the lateral forefoot (LFF), heel (HL), midfoot (MF), and lateral toe (LT) were unchanged 12 months postsurgery compared to presurgery.
The Ludloff Metatarsal Osteotomy: Guidelines for Optimal Correction Based on a Geometric Analysis Conducted on a Sawbone Model
Authors: Trnka Hans-Jörg , Parks Brent G. , Myerson Mark S.
Published: January 2017

Ideally, osteotomy for hallux valgus deformities corrects varus angle and pronation, while minimizing elevation, depression, and shortening. We used a serial linkage tracking device to evaluate five variations of the Ludloff osteotomy, a stable proximal metatarsal osteotomy that incorporates an oblique dorsal to plantar cut and a lateral swing or pivoting correction of the dorsal fragment. A neutral osteotomy (perpendicular to the sagittal plane) yielded the greatest correction (14°) but with shortening (average, 2.85 mm), elevation (average, 1.36 mm), and additional pronation (average, 1.88°). The same osteotomy angled 10° plantarly with 8° of correction produced an average of 1.57° of supination, 1.22 mm of depression and, 0.54 mm of shortening. Additional plantar inclination (20°) and angular correction (16°) yielded increased depression, supination, and shortening. The current findings provide guidelines to achieve the desired correction and rotation and suggest that optimal results can be obtained by performing this osteotomy angled 10° plantarly with a correction of 8° to 16°.
Rheumatoid Nodules and Postoperative Complications
Authors: Bibbo Christopher , Anderson Robert B. , Davis W. Hodges , Norton Jim
Published: January 2017

The records of 104 patients who underwent reconstructive foot and ankle surgery for deformities secondary to rheumatoid arthritis were reviewed. The use of rheumatoid chemotherapeutic agents, age, sex, rheumatoid nodule status, and the number of concurrent surgical procedures performed was analyzed to determine any association with the postoperative outcome for wound healing and infectious complications. The 104 patients, ranging in age from 23 to 83 years, underwent 725 operative procedures. An overall 32% complication rate was recorded. Analysis of five specific rheumatoid chemotherapeutic agents (NSAIDs, steroids, methotrexate, hydroxychloroquine, gold), age, sex, number of operative procedures performed, and presence of rheumatoid nodules, either alone or in combination, failed to prove a statistical association with either a healing or infectious postoperative complication.
The Problem with Measuring Patient Perceptions of Outcome with Existing Outcome Measures in Foot and Ankle Surgery
Authors: Parker Jan , Nester Christopher J. , Long Andrew F. , Barrie Jim
Published: January 2017

Quality outcome measures are the cornerstone of clinical research. A review of outcome measures used in foot and ankle surgery research reveals that the issues of validity, reliability and responsiveness of outcome measures have not been addressed. Most reports in the literature have attempted to evaluate patient perceptions of outcome following foot surgery. Underlying the many difficulties with these outcome measures is a lack of understanding of what patients perceive to be important in terms of outcome. Consequently none of the existing outcome measures can claim to be valid measures of patient perceptions of outcome, as there has been no research uncovering these perceptions. In addition, measures of general health status and quality of life in relation to outcome of foot and ankle surgery have been largely ignored to date.
Hallux Valgus in Men Part II: First Ray Mobility after Bunionectomy and Factors Associated with Hallux Valgus Deformity
Authors: Coughlin Michael J. , Shurnas Paul S.
Published: January 2017

Methods:

A retrospective study of 30 men (35 feet) was performed. First ray mobility, ankle dorsiflexion, pes planus, and metatarsus adductus were evaluated at the final follow-up. All internal fixation was routinely removed at six to eight weeks postoperatively. Standard radiographs were evaluated and angular measurements were calculated on all feet.

Conclusion:

Hallux valgus in this group of male patients was not associated with limited ankle dorsiflexion or pes planus. Men with toe pronation and a positive family history had a greater hallux valgus deformity than those without after a distal soft tissue repair with proximal first metatarsal osteotomy. There was no evidence of first ray hypermobility after a DSTP-PMO.
Stress Fractures of the Medial Great Toe Sesamoids in Athletes
Authors: Biedert Roland , Hintermann Beat
Published: January 2017

The purpose of this study was to determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a long jumper. Some swelling to the forefoot and activity-related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plain X-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occur more often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended.
Three-Dimensional Starch Model for Simulation of Corrective Osteotomy for a Complex Bone Deformity: A Case Report
Authors: Shimizu Tominaga , Fujioka Fumio , Gomyo Hiroki , Isobe Kenichi , Takaoka Kunio
Published: January 2017

The complex valgus deformity of the right ankle of a 24-year-old Maffucci syndrome man was corrected by three-dimensional osteotomy followed by limb lengthening. Before surgical correction of the deformity, we used computed tomography data to make a life-size three-dimensional plastic model of the deformed ankle for an accurate understanding of the anatomical deformity. We then used this model to perform a simulated osteotomy. The real osteotomy was performed immediately afterwards and valgus and recurvatum deformities were corrected accurately. We recommend simulated surgery using a three-dimensional plastic model which will improve the pre-operative planning technique and the accuracy of the end results.
Ankle Stabilization with Hamstring Autograft: A New Technique Using Interference Screws
Authors: Lee Jeys Marcus , Harris Nicholas John
Published: January 2017

Many techniques have been advocated for the late surgical reconstruction of the lateral ankle ligament complex, including the use of hamstring tendon autografts. A new technique is described which attempts to restore anatomically the anterior talofibular ligament using hamstring autograft. The distal end of the graft is secured in a blind-ended tunnel in the talus without the need for transosseous tensioning. This is achieved with the use of the Bio-Tenodesis Screw System.
Fourth Brachymetatarsia Treated with Distraction Osteogenesis
Authors: Song Hae-Ryong , Oh Chang-Wug , Kyung Hee-Soo , Kim Sung-Jung , Guille James T. , Lee Sung-Man , Kim Poong-Taek
Published: January 2017

Background:

This study investigated metatarsal lengthening by distraction osteogenesis for fourth brachymetatarsia in 22 metatarsals (16 patients).

Methods:

From May 1997 to May 2000, lengthening was performed with a monoexternal fixator, and distraction was started at a rate of 0.5 mm per day after a latency period of approximately 7–10 days.

Results:

The average gain in length was 16.5 mm (range, 13–21 mm), equivalent to an increase of 39% (range, 28–51%), and the average healing index was 72.9 days/cm (range, 51.7–95.7 days/cm). The American Orthopaedic Foot and Ankle Society (AOFAS) average score for lesser toe was 86.3 (range, 47–100). The most common residual complication was subluxation of metatarsophalangeal (MTP) joint in five cases, with partial or total stiffness of the MTP joint. These complications happened in the group of metatarsals excessively lengthened more than 40% and made the AOFAS score poorer. The other complications were three cases of angular deformity in the lengthened bone, and two cases of pin-tract infection.

Conclusion:

Although distraction osteogenesis is an effective method to address fourth brachymetatarsia, stiffness or subluxation of the MTP joint was not uncommon. To avoid complications that can happen as a result of excessive lengthening, careful preoperative radiographic measurement to calculate the optimal amount of lengthening may help us to avoid over-lengthening and the complications that accompany it.
Acute Surgical Management of Jones' Fractures
Authors: Portland Greg , Kelikian Armen , Kodros Steven
Published: January 2017

The purpose of this study was to evaluate the effectiveness of surgical management for acute Jones' fractures and Torg types I and II proximal diaphyseal stress fractures presenting acutely in both athletes and nonathletes. Twenty-two patients underwent intramedullary screw fixation between 1994 and 1999. Immediate intramedullary screw fixation of acute Jones' fractures and type I stress fractures resulted in a 100% union rate with an average time to union of 6.2 weeks. Fixation of type II stress fractures had a union rate of 100% with a mean time to union of 8.3 weeks. The overall complication rate was 9%. Surgical intervention allowed an earlier return to weightbearing with a more rapid and predictable union rate. The authors recommend intramedullary fixation as a treatment of choice for the management of fifth metatarsal fractures distal to the tuberosity in nonathletes as well as athletes.
Primary Synovial Chondromatosis of the Subtalar Joint Affecting Two Brothers
Authors: Hocking Richard , Negrine John
Published: January 2017

Primary synovial chondromatosis is a rare benign condition characterized by the formation of multiple cartilaginous nodules in the synovium of joints and on occasions tendon sheaths or bursae. A case of primary synovial chondromatosis affecting the subtalar joint is reported. The patient's brother developed the same condition affecting the same joint 2 years later. The proposed etiologies are discussed including the presence of the proto-oncogene C-erb B-2.
Kinematic Changes After Fusion and Total Replacement of the Ankle Part 3: Talar Movement
Authors: Valderrabano Victor , Hintermann Beat , Nigg Benno M. , Stefanyshyn Darren , Stergiou Pro
Published: January 2017

Introduction: The purpose of this study was to determine talar movement (e.g., talar rotation and talar shift during (dorsiflexion/plantarflexion) with respect to the tibia in the normal ankle, in the fused ankle, and in the replaced ankle by currently used prosthetic designs. Methods: A 6-df device with an axial load of 200 N and a four-camera high-speed video system were used for the measurement of the range of motion in six fresh-frozen cadaveri leg specimens. While moving the foot through the whole range of motion for plantarflexion/dorsiflexion, segmental motion of the marked bones of the foot and shank were measured dynamically. Rotation and medial-lateral shift of the talus were then calculated with regard to flexion position of the foot. Results: In the normal ankle, plantarflexion movement was coupled with talar inversion of 3.5°, and dorsiflexion movement with talar eversion of 1.0°, in totally accounting for 4.5° of talar rotation. While both the HINTEGRA and the S.T.A.R. prostheses did not show changes to the normal condition during the dorsiflexion/plantarflexion cycle ( p <.05), talar rotation had a 60% decrease ( p <.05) for the AGILITY prosthesis. In the normal ankle joint, a lateral talar shift of 1.4 mm was found to occur during dorsiflexion, and a lateral talar shift of 5.2 mm during plantarflexion. In both, the HINTEGRA and S.T.A.R. ankles, talar shift was converted into medial direction during dorsiflexion of the foot (difference to normal: p <.05), whereas talar shift in the lateral direction was found to occur during plantarflexion of the foot which was comparable to the normal ankle. The AGILITY ankle evidenced an 80% decrease of talar shift ( p < .05) during the whole dorsiflexion/plantarflexion cycle. Discussion: The two-component ankle (AGILITY) obviously tends to restrict tremendously talar motion within the ankle mortise, whereas the three-component ankles (HINTEGRA, S.T.A.R.) seem to allow talar range of motion comparable to that in the normal ankle. It is suggested that such a restriction of talar motion results in an increase of stress forces within and around the prosthesis, leading to polyethylene wear and potential loosening at the bone–implant interfaces. Therefore, a successful prosthetic design for the ankle should consist of three components that are shaped as anatomically as possible to provide a normal range of motion and to allow the full transmission of movement transfer between foot and shank and unconstrained movement of the talus within the ankle mortise.
Recall of the Risks of Forefoot Surgery After Informed Consent
Authors: Shurnas Paul S. , Coughlin Michael J.
Published: January 2017

Purpose: To determine the number of risks a patient can recall from the informed consent process prior to surgery and if recall can be improved with a visual aid and to assess patient satisfaction with the informed consent process utilized. Methods: Randomly selected patients, from all patients requiring forefoot surgery, were randomly assigned into two groups from August 2001 through October 2001. All patients were asked to recall the risks of surgery and to rate their satisfaction with the informed consent process at their final routine postoperative visit. Results: There were 19 patients in each group. All patients uniformly expressed their satisfaction with the preoperative informed consent discussion at their final visit. The mean number of the 11 risks recalled per patient was 1.0 for group A (range, 0–3) and 0.94 for group B (range, 0–4). Conclusion: At the final routine postoperative visit, patients in both groups had poor or no recall of the risks of surgery. The visual aid had no effect on improving recall.
Lateral Shifting of the First Metatarsal Head in Hallux Valgus Surgery: Effect on Sesamoid Reduction
Authors: Esemenli Tanil , Yildirim Yakup , Bezer Murat
Published: January 2017

Thirty feet with hallux valgus (HV) having grade 2 and 3 sesamoid stations on AP radiographs were examined after Lindgren-Turan oblique distal metatarsal osteotomy with a minimum follow-up of 12 months. Adductor tendon release from the lateral sesamoid was not performed to determine the isolated effect of distal metatarsal osteotomy on metatarsosesamoidal reduction. Of the 30 feet, 20 (67%) had reduced and 10 (33%) unreduced sesamoids at the follow-up. Ultimately, distal metatarsal osteotomy (DMO) with lateral shifting of the first metatarsal head more than 7.2 mm was found to reduce the sesamoids in the great majority of the cases (95% CI 7.243–9.757). Sesamoid release is redundant for metatarsosesamoidal reduction if sufficient lateral shift of the first metatarsal head over the sesamoids is accomplished.
Effect of Extracorporeal Shock Waves on Calcaneal Bone Spurs
Authors: Lee Gregory P. , Ogden John A. , Cross G. Lee
Published: January 2017

In a prospective study of 435 patients with chronic proximal plantar fasciitis, 283 (65%) had an inferior calcaneal bone spur of variable size evident prior to treatment with electrohydraulic high-energy extracorporeal shock waves (ESW). This included 308 patients who received extracorporeal shock wave treatments and 127 placebo (sham control) patients. At both initial (3 months) and final (12 months) evaluations after receiving ESW, no patient who received shock wave applications had significant disappearance or change in the radiographic appearance of the heel spur. Clinical outcome after ESW was satisfactory in 168 patients (82%) with a radiographically demonstrable inferior heel spur and in 81 patients (79%) without such a heel spur. The results showed no correlation between the presence or absence of the heel spur and the eventual treatment outcome.
Corrective-Elongation Osteotomy Without Bone Graft for Old Ankle Fracture With Residual Diastasis
Authors: Chao Kuo-Hua , Wu Chia-Chun , Lee Chian-Her , Chu Cheng-Mien , Wu Shing-Shen
Published: January 2017

The main principle for treatment of ankle fractures is anatomic reduction until bony union is achieved. Old fractures of the ankle with residual diastasis, however, may cause persistent pain, joint effusion, and range-of-motion limitation, and make eventual ankle arthrodesis inevitable. Restoration of the integrity of the ankle mortise is the determining factor for successful repair of this type of ankle fracture. Old ankle fracture, where malunion has already occurred, is a great challenge for the orthopedic surgeon. Twelve such patients were treated by means of reconstructive corrective-elongation osteotomy without bone graft at the authors’ institution from 1997 to 1999. These patients had persistent symptoms and radiographic evidence of a fibula that had healed in a shortened, rotated position, resulting in widening of the ankle mortise. The average time interval between injury and reconstructive operation was 18 months. At follow-up, which averaged 34 months, greatly improved ambulation and level of joint function was noted for all patients, and follow-up x-ray confirmed good ankle mortise geometry. The short-term results for these patients were good, with further follow-up planned to determine efficacy long term. In conclusion, reconstructive corrective-elongation osteotomy is a worthwhile procedure for old ankle fracture with malunion, and it can also postpone degenerative change in the ankle joint.
The Avascular Talus: Revascularization in an Animal Model
Authors: Weber Martin , Bellwald Dominik , Wingenfeld Carsten , Hempfing Axel , Leunig Michael
Published: January 2017

Avascular necrosis of bone such as the talus can lead to collapse and loss of function. To avoid this, early revascularization has been proposed as an important event. Revascularization can occur either by vessel growth directly through the bony surface, or by vessel growth into the periosteum or ligaments with secondary reconnection to the bone. The ability to attract new vessels (angiogenesis) of the bony surface and the connective tissue was compared in an animal model. A talus isograft (all cortical surface, periosteum, and ligaments remaining; n = 11) or a sector of a femoral head isograft (cancellous surface, no connective tissue; n = 12) of adult mice was implanted into dorsal skinfold chambers of mice of the same strain. The implants were observed by intravital microscopy every 12 hours. First indicators of angiogenesis were hemorrhages around the implants (tali: 11 of 11, 72 ± 12 hours; femoral heads: 6 of 12, 84 ± 24 hours). Next, a sudden redness of the transplant indicated marrow hemorrhage (tali: 9 of 11 after 84 ± 36 hours; femoral heads: 10 of 12 after 96 ± 36 hours). Histology showed clear growth of capillaries into the cancellous surface of the femoral heads and possible growth of capillaries into the ligament stumps (tali). However, there was widespread necrosis of the marrow cells indicating failure of recirculation. A cancellous bony surface as well as the soft tissues attached to the bone provided a stimulus to rapid revascularization of the grafts. This model was able to evaluate differing rates of early partial revascularization for various bone surfaces, which may have implications for studying treatment options for certain fracture dislocations (e.g., in the talus).
Arthrodesis of the Toe Joints with an Intramedullary Cannulated Screw for Correction of Hammertoe Deformity
Authors: Caterini R. , Farsetti P. , Tarantino U. , Potenza V. , Ippolito E.
Published: January 2017

Twenty-four patients (37 feet, 51 toes) affected by hammertoe deformity of the lesser toes and treated surgically by arthrodesis of the proximal interphalangeal joint, stabilized with an intramedullary titanium cannulated screw, were reviewed 1–4 years after the operation. At follow-up, the arthrodesis was fused in 48 toes; three toes showed an asymptomatic radiographic nonunion, and in one of them the screw was broken. In seven toes, the cannulated screw was removed because of persistent pain at the tip of the toe where the head of the screw was located. In one case only, there was a late infection, with toe malalignment. All the patients were able to use street shoes 2 weeks after surgery. The average AOFAS score at follow-up was 86.54 points. Compared to the conventional temporary stabilization with an intramedullary Kirschner wire, the stabilization with a cannulated screw decreases the risk of infection, of radiographic nonunion, and of mallet toe deformity.