BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a def...BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up.Randomized clinical trials with larger samples,as well as long-term outcome assessments,are needed in the future.展开更多
AIM:To evaluate the clinical usefulness of 18F-fluorodeoxyglucose positron emission and computed tomography(18F-FDG PET/CT)in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS:Between J...AIM:To evaluate the clinical usefulness of 18F-fluorodeoxyglucose positron emission and computed tomography(18F-FDG PET/CT)in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS:Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans(three patients had two scans and one patient had three scans)for restaging after surgical resection and radiotherapy.The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after 18F-FDG PET/CT examinations. RESULTS:Tumor recurrence was confirmed histopathologically in seven of the 20 patients(35%) and by clinical and radiological follow-up in 13(65%). 18F-FDG PET/CT was positive in 14 patients(68.4%) and negative in six(31.6%).18F-FDG PET/CT was true positive in 11 patients,false positive in three and true negative in six.Overall,the accuracy of 18F-FDG PET/CT was 85%,negative predictive value(NPV)was 100%,and positive predictive value(PPV)was 78.6%.The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes(n =2)and anastomosis inflammation(n=1).PET/ CT demonstrated distant metastasis in 10 patients. 18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed.Treatment regimens were changed in 12(60%)patients after introducing 18F-FDG PET/CT into their conventional post-treatment follow-up program.CONCLUSION:Whole body 18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy.It could also have important clinical impact on the management of esophageal cancer,influencing both clinical restaging and salvage treatment of patients.展开更多
文摘BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up.Randomized clinical trials with larger samples,as well as long-term outcome assessments,are needed in the future.
文摘AIM:To evaluate the clinical usefulness of 18F-fluorodeoxyglucose positron emission and computed tomography(18F-FDG PET/CT)in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS:Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans(three patients had two scans and one patient had three scans)for restaging after surgical resection and radiotherapy.The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after 18F-FDG PET/CT examinations. RESULTS:Tumor recurrence was confirmed histopathologically in seven of the 20 patients(35%) and by clinical and radiological follow-up in 13(65%). 18F-FDG PET/CT was positive in 14 patients(68.4%) and negative in six(31.6%).18F-FDG PET/CT was true positive in 11 patients,false positive in three and true negative in six.Overall,the accuracy of 18F-FDG PET/CT was 85%,negative predictive value(NPV)was 100%,and positive predictive value(PPV)was 78.6%.The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes(n =2)and anastomosis inflammation(n=1).PET/ CT demonstrated distant metastasis in 10 patients. 18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed.Treatment regimens were changed in 12(60%)patients after introducing 18F-FDG PET/CT into their conventional post-treatment follow-up program.CONCLUSION:Whole body 18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy.It could also have important clinical impact on the management of esophageal cancer,influencing both clinical restaging and salvage treatment of patients.
