放散状体外冲击波疗法治疗慢性足底筋膜炎的疗效

目的：研究放散状体外冲击波治疗慢性足底筋膜炎的临床效果。方法42例慢性足底筋膜炎患者随机均分为放散状体外冲击波组（A组）和局封组（B组）,采用视觉模拟评分法（VAS ）评估两组临床疗效,并观察不良反应的发生情况。结果两组治疗后 VAS评分均较治疗前下降（P＜0．05）,且A组治疗后VAS评分低于B组（P＜0．05）。与治疗后1周相比,A组治疗后3个月时的VAS评分降低（P＜0．05）,而B组VAS 评分无明显变化（P＞0．05）。A组临床有效率高于B组（85．71％ vs ．57．14％）（P＜0．05）。两组均未发生严重不良反应。结论放散状体外冲击波疗法治疗慢性足底筋膜炎疗效显著,具有操作简单、无需麻醉、非侵入性和疗效持久可靠等优势。     

Plantar Pressure Changes and Correlating Risk Factors in Chinese Patients with Type 2 Diabetes: Preliminary 2-year Results of a Prospective Study

Background:

Plantar pressure serves as a key factor for predicting ulceration in the feet of diabetes patients. We designed this study to analyze plantar pressure changes and correlating risk factors in Chinese patients with type 2 diabetes.

Methods:

We recruited 65 patients with type 2 diabetes. They were invited to participate in the second wave 2 years later. The patients completed identical examinations at the baseline point and 2 years later. We obtained maximum force, maximum pressure, impulse, pressure-time integral, and loading rate values from 10 foot regions. We collected data on six history-based variables, six anthropometric variables, and four metabolic variables of the patients.

Results:

Over the course of the study, significant plantar pressure increases in some forefoot portions were identified (P < 0.05), especially in the second to forth metatarsal heads. Decreases in heel impulse and pressure-time integral levels were also found (P < 0.05). Plantar pressure parameters increased with body mass index (BMI) levels. Hemoglobin A1c (HbA1c) changes were positively correlated with maximum force (β = 0.364, P = 0.001) and maximum pressure (β = 0.366, P = 0.002) changes in the first metatarsal head. Cholesterol changes were positively correlated with impulse changes in the lateral portion of the heel (β = 0.179, P = 0.072) and pressure-time integral changes in the second metatarsal head (β = 0.236, P = 0.020). Ankle-brachial index (ABI) changes were positively correlated with maximum force changes in the first metatarsal head (β = 0.137, P = 0.048). Neuropathy symptom score (NSS) and common peroneal nerve sensory nerve conduction velocity (SCV) changes were positively correlated with some plantar pressure changes. In addition, plantar pressure changes had a correlation with the appearance of infections, blisters (β = 0.244, P = 0.014), and calluses over the course of the study.

Conclusions:

We should pay attention to the BMI, HbA1c, cholesterol, ABI, SCV, and NSS changes in the process of preventing high plantar pressure and ulceration. Some associated precautions may be taken with the appearance of infections, blisters, and calluses.     

Fine needle aspiration cytology of nodular fasciitis of the breast

We report a case of nodular fasciitis (NF) of the breast, which was cytologically diagnosed as a spindle cell proliferation with undetermined malignant potential. Owing to small size of the lesion (5.9 × 3.7 × 4.1 mm), only fine needle aspiration (FNA) cytology was performed under ultrasound guidance. The FNA smears were cellular, rich in single/clustered spindle cells but mammary ductal epithelial/myoepithelial cells were absent. These cytologic findings suggested spindle cell growth of mesenchymal origin. Pattern‐less arrangement of spindle cells, heterogeneous composition of the stromal matrix, lack of nuclear/cellular atypia, occasional mitosis but no aberrant mitotic figures, and lymphocyte infiltration indicated reactive rather than neoplastic nature of the lesion. Nonetheless, lumpectomy was conducted because the possibility of neoplasm was not completely ruled out. The histologic diagnosis of the resected nodule was NF. FNA specimens were reviewed thoroughly in an attempt to define the key cytomorphologic features of NF that are important for the correct diagnosis. Differential diagnoses from the lesions that show similar cytologic pictures are discussed in detail. Although NF arising from the breast is rare, cytopathologists should be aware of its clinical and cytopathologic characteristics. Knowledge of the possibility of NF in the breast and its cytologic findings may help cytopathologists to discern its reactive, not neoplastic, characteristics of the lesion. If the referring surgeon is alerted NF as a possibility along with other differential diagnoses, close observation would become a management option. In‐depth discussion of cytologic features and a review of the pertinent literature are also included. Diagn. Cytopathol. 2015;43:222–229. © 2014 Wiley Periodicals, Inc.     

Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects

The purpose of the work reported here was to describe the sonoelastographic appearance of the plantar fascia of healthy volunteers and patients with fasciitis. Twenty-three healthy subjects and 21 patients with plantar fasciitis were examined using B-mode and real-time sonoelastography (RTSR) scanning. B-Mode examination included fascia thickness and echotexture. Echogenicity and echovariation of the color histogram were analyzed. Fasciae were classified into type 1, blue (more elastic); type 2, blue/green (intermediate); or type 3, green (less elastic). RTSE revealed 72.7% of fasciae as type 2, with no significant association with fasciitis (χ² = 3.6, df = 2, p = 0.17). Quantitative analysis of the color histogram revealed a significantly greater intensity of green (mean = 77.8, 95% confidence interval [CI] = 71.9–83.6) and blue (mean = 74.2, 95% CI = 69.7–78.8) in healthy subjects. Echovariation of the color red was 33.4% higher in the fasciitis group than in the healthy group (95% CI = 16.7–50.1). Sonoelastography with quantitative analysis of echovariation can be a useful tool for evaluation of plantar fascia pathology.     

足底压力改变与2型糖尿病患者周围神经病变病情关系的研究

目的探究足底压力改变与2型糖尿病患者周围神经病变病情的关系。方法以90例2型糖尿病患者作为研究对象,根据患者的病情分为无明显周围神经病变组(DM组22例),轻度周围神经病变组(DN1,22例),中度周围神经病变组(DN2,23例),重度周围神经病变组(DN3,23例),并选取同期体检无糖尿病者(DC组,60例),比较5组足底压力随时间的变化和患者足底各区域足底压力峰值。结果 1足底压力谷值:DM组谷值(47.57±2.46 min)明显高于DC组(49.11±3.06 min)(P0.05),DN1组谷值(28.13±2.43)明显高于DC组和DM组(P0.05),DN2组谷值(45.21±3.42 min)明显高于DC组和DN1组(P0.05),DN3组明显高于其余各组(P0.05);2第一峰值和第二峰值比:DC组、DM组小(P0.05),DN3组第一峰值、第二峰值(74.52±3.86 min)和谷值均比DC组、DM组、DN1组和DN2组大(P0.05);3与DC组比较,DM组、DN1组、DN2组和DN3组第一峰值和第二峰值出现时间出现较早(P0.05),DN2组和DN3组谷值出现时间提前(P0.05);与DM组比较,DN1组第一峰值时间较晚(P0.05),DN2组和DN3组谷值出现时间提前(P0.05);与DN1组比较,DN2组和DN3组谷值出现时间提前(P0.05);与DN2组比较,DN3组谷值出现时间提前(P0.05);4与DC组左足底各区域峰值压力比较:DM组T1、M3、M4和HM区域峰值压力较大(P0.05),M2区域分值较小(P0.05);DN1组T1、M3、M5、MF足底压力较大(P0.05),M2和HM区域峰值压力较小(P0.05);DN2组M3、M4、M5足底区域峰值较大(P0.05),T1、M2、HM区域峰值较小(P0.05);DN3组M2、M3、M4、MF足底区域峰值较大(P0.05),T1和HM区域峰值较小(P0.05)。5与DC组右足底各区域峰值压力比较显示:DM组T1、M3、M4、HM区域足底峰值压力较大(P0.05),M2、HM压力较小(P0.05);DN1组T1、M3、M4、M5、MF区域足底峰值压力较大(P0.05),M2、HM足底峰值压力较小(P0.05);DN2组M3、M4、M5区域足底峰值压力较大(P0.05),T1、M2、HM区域峰值压力较小(P0.05),DN3组M2、M3、M4、M5、MF区域峰值压力较大(P0.05),T1、HM区域峰值较小(P0.05)。结论随着2型糖尿病患者并发周围神经病变病情的加重,患者前足足底压力增大,步长缩短,压力由足底后部向前部转移。     

Necrotizing fasciitis caused by perforated appendicitis: a case report

Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.     

Postural stabilization and balance assessment in Charcot–Marie–Tooth 1A subjects

The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot–Marie–Tooth disease (CMT) type 1A. For this purpose ground reaction force (GRF) was measured by means of a piezoelectric force platform during the sit-to-stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Centre of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects.The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Y_inf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres.Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.     

体感交互技术训练对帕金森病患者平衡功能、足底压力及跌倒发生率的影响

目的 分析体感交互技术训练对帕金森病患者平衡功能、足底压力及跌倒发生率的影响。方法 选取2020年2月-2022年4月三二〇一医院收治的115例帕金森患者,按不同训练方案分为常规组（n=56）与体感交互组（n=59）。常规药物治疗期间,常规组实施传统平衡训练,体感交互组接受体感交互技术训练。比较两组训练4周后Berg平衡量表（Berg Balance Scale,BBS）评分,动、静态足底压力分布,跌倒发生率。结果 训练后体感交互组BBS评分高于常规组（P＜0.05）;训练前后比较,常规组BBS评分无统计学意义（P＞0.05）,体感交互组BBS评分有所提升,具有统计学意义（P＜0.05）。训练前两组静态、动态足底压力分布无统计学意义（P＞0.05）,两组静态站立时双脚压力由低到高排序为：2区＜1区＜3区＜6区＜5区＜4区＜7区＜8区;行走时左足：2区＜6区＜1区＜3区＜5区＜4区＜7区＜8区,右足：2区＜6区＜1区＜3区＜5区＜7区＜8区＜4区。训练后两组站立时双足的3区压力上升,双足压力：2区＜1区＜6区＜5区＜3区＜4区＜7区＜8区;行走时左足：2区＜6区＜1区＜5区＜3区＜4区＜7区＜8区,右足压力分区未变。训练后两组静态跌倒风险指数评分上升,动态跌倒风险指数评分下降,且体感交互组评分优于常规组（P＜0.05）。1个月随访期间,常规组发生11例跌倒,体感交互组发生2例,体感交互组跌倒发生率3.39%低于常规组19.64%（P＜0.05）。结论 体感交互技术训练能有效改善帕金森患者平衡功能康复情况,有助于更好调整动、静态足底压力分布,降低跌倒风险,减少跌倒发生情况。     

Effectiveness of extra-corporeal shock wave therapy (ESWT) vs methylprednisolone injections in plantar fasciitis

IntroductionIn Plantar Fasciitis, the main concern of the patients is the pain that disturbs their day to day activities. Different modalities of treatments are being used for its pain management. This study seeks to investigate and compare decrease in level of pain following treatment with Methylprednisolone injections (DMP) Vs Extra-Corporeal Shock Wave Therapy (ESWT) in plantar fasciitis.MethodsThis prospective comparative non randomized study was conducted in 60 patients of any age presenting with Plantar Fasciitis at B&B Hospital, Kathmandu. Patients were divided into 2 groups (30 each) based on patients preference. Methylprednisolone injection was given to one group and another group received ESWT. Follow up of both groups were carried out at 6 weeks, 3 months and 6 months and the outcome was measured with Visual Analogue Pain Scale (VAS). Statistical analysis wasdone using SPSS software, version 13. Chi-square and Independent t-test were applied to look for significant variations in outcome.ResultsFollow-up at 6 weeks revealed 26 (86.7%) patients attaining VAS < 5 in ESWT group in comparison to 16 (53.3%) patients of DMP group (p = 0.005). At the end of 6 months, 5 patients in DPM group still had significant pain (VAS ≥ 5) compared to 2 patients in ESWT group (p = 0.02). However 11 patients of DMP group and 23 of ESWT group received single episode of treatment only and had persistent symptomatic pain relief (VAS < 5) during all follow ups at 6 weeks, 3 months and 6 months (p = 0.004).ConclusionsPlantar fasciitis was more prevalent in overweight population and females. Significant improvement in pain was observed with both ESWT and DMP Injections. However, ESWT was found to be more effective than DMP Injections for treatment of Plantar Fasciitis.