Correction results of atypical clubfeet managed with modified Ponseti technique: A meta-analysis of 354 feet

Background/purposeAtypical clubfeet are distinct from idiopathic clubfeet. It is resistant to correction by conventional casting methods and often requires a modification of Ponseti's casting technique. Although the initial correction rates are reasonable, relapse and complications are frequent. There is limited literature on the results of modified Ponseti casting of these feet. We conducted this meta-analysis to study a few important aspects of atypical/complex clubfeet treatment by the modified Ponseti technique.Research questionWhat are the results of atypical or complex clubfeet after treatment by the modified Ponseti technique?MethodologyFive electronic databases (PubMed, Embase, Scopus, Ovid, and Cochrane Library) were searched for articles reporting on the results of atypical/complex clubfeet treated by the modified Ponseti technique. Details of the number of casts required for correction, rate of percutaneous Achilles tenotomy (PAT), other soft tissue procedures required, complications, and relapse rates were extracted into spreadsheets, and meta-analysis was carried out using OpenMeta Analyst software.ResultsTen studies were included for analysis with a total of 240 patients with 354 clubfeet. The initial correction was achieved in all feet. A pooled analysis of the data showed that a mean of six casts was required for the initial correction. The rate of PAT was 98.3%. The overall complication rate was 16.8%. 7.2% required an additional soft tissue procedure apart from the PAT, and relapse of the deformity was observed in a mean of 19.8% cases.ConclusionModified Ponseti technique is effective in the initial management of atypical/complex clubfeet. Although the PAT rate is slightly higher in the Modified Ponseti technique, the remaining result parameters are comparable with the results of idiopathic clubfoot managed with the Ponseti method of casting. However, these children should be kept under follow-up for a longer duration to find the exact relapse rates.     

Hallux length and deep medial crease in complex clubfeet: Do they recover?

ObjectiveThe shortened hallux and deep medial crease are a significant cosmetic deformity in complex clubfeet. We quantitatively determined the correction of hallux length and deep medial crease following treatment of complex clubfeet.MethodsA chart review of 11 patients (17 feet) with complex clubfeet treated with modified Ponseti method was undertaken. Pretreatment clinical photographs and Pirani scores were compared with those obtained at a recent follow-up to analyze outcomes. Hallux length was matched with 2nd toe and graded similar to Pirani score.ResultsMean patient age at enrollment was 26.8 weeks. Average follow up was 22.6 months. Pre treatment and follow up Pirani score averaged 5.8 and 0.2 respectively. The average number of cast utilized was 7. Incomplete/non correction of hallux was observed in 6 feet (35%), of which 4 suffered an equinus relapse. Deep medial crease corrected in all.ConclusionsThe study describes a clinical method of hallux length quantification in complex clubfeet. Medial crease recovered in all feet. The recovery of hallux length was delayed in some patients and might indicate persistent posteromedial soft tissue contracture/fibrosis in these feet.     

Tumor teratoide/rabdoide atípico con diferenciación tipo ganglioglioma: reporte de caso

BackgroundAtypical teratoide/rhabdoid tumor is a very rare and aggressive disease that primarily presents in pediatric patients. To the best of our knowledge, the initial presentation of this type of tumor with ganglioglioma-like differentiation is rare in the literature.Case reportWe present the case of a 9-month-old patient with left facial paralysis. An MRI revealed a lesion at the left cerebellopontine angle. Complete macroscopic surgical resection was performed. Histopathology and immunohistochemistry testing revealed an atypical teratoid/rhabdoid tumor with ganglioglioma-like differentiation.ConclusionsThis case report presents an atypical teratoid/rhabdoid tumor with initial gangligioma-like differentiation. This study adds to the data in the literature and promotes the study of this type of histogenesis. It lays a foundation for encouraging further studies to determine whether changes should be made to existing management protocols and, at the same time, determine whether there would be any variation with regard to disease prognosis.     

心电图诊断不典型心肌梗死的临床价值

〔摘 要〕 目的：探究心电图诊断不典型心肌梗死的临床价值。方法：纳入南阳市第二人民医院 2019 年 1 月至 2020 年 12 月收治的 65 例不典型心肌梗死患者作为观察组，以及同期收治的 65 例典型心肌梗死患者作为对照组，均进行心电图检查， 比较两组患者首发症状（无痛、不典型疼痛、典型胸背部＋上腹部疼痛），以冠状动脉造影为金标准，计算心电图诊断符合率。 结果：观察组 8 例无痛，占 12.31 %；50 例不典型疼痛，占 76.92 %，其中 29 例剑突下痛、15 例不规则胸闷隐痛、10 例下颌痛、 7 例肩痛、4 例腹部不适、2 例典型胸背部＋上腹部疼痛、58 例心电图不典型。对照组 65 例均为典型胸背部＋上腹部疼痛、 5 例心电图不典型。两组患者无痛、不典型疼痛、典型胸背部＋上腹部疼痛、心电图不典型比较，差异均具有统计学意义 （P ＜ 0.05）。观察组均经冠状动脉造影检查确诊，心电图确诊 63 例，占 96.92 %。经冠状动脉造影与心电图检查结果比较， 差异无统计学意义（P ＞ 0.05）。结论：心电图在诊断不典型心梗中的准确性较高，且操作方便。     

The changing face of central chondrosarcoma of bone. One UK-based orthopaedic oncology unit’s experience of 33 years referrals

AimTo ascertain the changing incidence over time of the three commonest primary sarcomas of bone. Data obtained with particular reference to central chondrosarcoma from the annual referral rate to a large UK-based specialist orthopaedic oncology unit. To discuss how the “barnyard pen” analogy of cancers previously applied to certain commoner cancers can also be applicable to central chondrosarcoma (CS) of bone.Materials and methodsA retrospective review was conducted of a computerised database identifying all central cartilage tumours (CCT) of bone, including enchondroma and CS subtypes, between 1985 and 2018. These were compared with the referrals of the other two commonest primary sarcomas of bone, osteosarcoma and Ewing sarcoma.ResultsThere was a total of 1507 CS showing a 68% overall increase in annual referral rate/incidence over the study period. 68% cases were the borderline malignant lesions now known as atypical cartilaginous tumour (ACT). The annual referral rate/incidence of this entity increased by 194% over the 30 years. Whereas, the annual referral rate/incidence for osteosarcoma and Ewing sarcoma was static for the past 20 years.ConclusionThe annual incidence of central CS of bone showed a marked increase over the 33-year period as compared with both osteosarcoma and Ewing sarcoma. This is especially in the ACT category and is thought to be due to the increased provision of MRI scanning flagging up a rise in incidental findings. The spectrum of CCTs from benign to highly malignant elegantly fits the “barn yard” pen analogy and could prove useful as an explanatory tool for patients and clinicians unfamiliar with these diseases.