The Akron midtarsal dome osteotomy in the treatment of rigid pes cavus: a preliminary review

This study reviews the preliminary results of a previously unreported midtarsal "dome" osteotomy, all operations being performed by a single surgeon. The procedure is centered at the apex of the deformity and allows for extensive angular and rotational correction of the midfoot. The initial review has demonstrated 67% satisfactory results in 22 patients representing 35 feet. Satisfactory results were obtained in 15 of 16 feet (94%) in patients greater than 8 years of age. Careful short-term analysis suggests that the midtarsal "dome" osteotomy is best indicated for the child greater than 8 years of age with a rigid cavus or cavovarus foot.     

Primary care delivery in the United States and four northwest European countries: comparing the "corporatized" with the "socialized"

Primary care--often considered the weak link in the United States health care delivery system--is the focal point of several European systems. Thoughtful analysis of structural and service differences and similarities among these approaches--whether "corporatized" or "socialized"--reveals areas for helpful innovation in the United States. Matters of access to and continuity of services, preventive care for children, long-term care, and accountability are especially relevant for primary care in an American context.     

Minimizing Therapeutic Differences Between Bilateral and Unilateral Nondominant ECT

Conflicting results continue to be reported for studies contrasting the therapeutic efficacy of bilateral and unilateral nondominant electroconvulsive therapy (ECT). At least in part, the therapeutic advantage for bilateral ECT observed by some investigators may be related to the use of nonoptimum unilateral ECT technique. Consideration of technique-related factors, such as stimulus electrode location, contact at the electrode-scalp interface, stimulus dosing, and seizure monitoring, will allow unilateral ECT to be carried out with maximal therapeutic potency.     

Amphetamine does not affect the partial punishment effect (PPE)

The effects of amphetamine on the partial punishment effect (PPE) at one trial per day, were examined. Two groups of animals were trained to run in a straight alley. The continuously reinforced (CRF) group received food reward on every trial. The partially punished (PP) group received food reward on every trial but in addition, received footshocks of a gradually increasing intensity in the goal box on a random 50% of the trials. In the test stage, all animals received both food and footshock on each trial. dl-Amphetamine 1.5 mg/kg was administered in a 2 × 2 design, i.e. drug-no drug in training and drug-no drug in test. The partially punished animals exhibited increased persitence in running to the goal box during test, and this partial punishment effect was unaffected by amphetamine.     

Cervical tissue uptake of all-trans-retinoic acid delivered via a collagen sponge-cervical cap delivery device in patients with cervical dysplasia

The present study was undertaken to evaluate the systemic absorption and cervical tissue uptake of all-transretinoic acid (TRA), delivered via a collagen spongecervical cap delivery device in patients with intraepithelial cervical dysplasia. Ten patients with histologically proven mild or moderate cervical dysplasia were included in this pharmacologic study. The two TRA concentrations (0.05% and 0.372%) selected for study represent the starting and maximally tolerated doses used in phase I clinical trial. All-trans-retinoic-11-³H acid (³H-TRA, 500 Ci) was used to facilitate cervical tissue uptake studies. Cervical biopsies and post-treatment blood samples were obtained from each patient after TRA exposure. The uptake of TRA into cervical tissues four hours after drug administration was significantly increased at the maximally tolerated TRA dose. There was a rapid decrease in cervical tissue concentration of TRA at the 0.372% dose between 4 and 24 h after drug exposure, suggesting a relatively short elimination half-life of TRA in cervical tissues. HPLC analysis of post-treatment blood samples indicate that there was no systemic absorption of TRA after local cervical administration.     

The effect of lengthening the gastrocnemius muscle in chronic therapy resistant plantar fasciitis

BackgroundThe aetiology of chronic therapy resistant plantar fasciitis (CTRPF) is multifactorial with more focus in recent times on the gastroc-soleus complex. This study evaluates the effect of lengthening the gastrocnemius muscle in CTRPF.MethodsAll patients with CRTPF complaints for at least one year underwent the same standard conservative treatment prior to surgery. 32 patients failed this treatment and underwent gastrocnemius recession. Silfverskiöld test, questionnaires and plantar pressure measurements were obtained at 5 visits.ResultsOne year follow up showed a significantly increase in dorsiflexion of the ankle (16 degrees), a decrease in VAS; 78 (SD: 19) to 20 (SD: 24) and significant improved functional scores. Plantar pressure measurements showed an increase of pressure under the medial proximal part of the midfoot and the 1 st metatarsal and a decrease under the hallux.ConclusionsA gastrocnemius recession results in a significant gain in dorsiflexion, altered loading of the foot and good clinical outcome in patients with CTRPF.Level of EvidenceLevel 2     

Reversal to normal anatomy after one-anastomosis/mini gastric bypass,indications and results: a systematic review and meta-analysis

This review evaluates the indications and outcomes of one-anastomosis/mini gastric bypass (OAGB/MGB) reversal to normal anatomy. A systematic literature search and meta-analysis was performed in PubMed, Web of Science, and Scopus for articles published by October 1, 2020, including the keywords “one anastomosis gastric bypass,” “OAGB,” “mini gastric bypass,” “MGB,” “reversal,” “reverse,” “malnutrition,” and “reversal bariatric surgery”. After examining 182 papers involving 11,578 patients, 14 studies were included. A reversal was performed in 119 patients on average 23.6 months after the primary OAGB/MGB surgery. The mean body mass index (BMI) was 22.92 ± 3.47 kg/m² and the mean albumin level was 25.17 ± 4.21 g/L at reversal. The mean length of the common channel (CC) was 383.57 ± 159.35 cm, with a mean biliopancreatic limb (BPL) length of 214.21 ± 48.45 cm. Pooled estimation of the meta-analysis of prevalence studies reported a prevalence of 1% for reversal. The major signs and symptoms of protein-energy malnutrition were the leading causes of the reversal of OAGB/MGB. Bleeding, leakage, and death due to severe liver failure were the most reported complications after reversal, with an overall incidence of 10.9%. In conclusion, OAGB/MGB reversal has a prevalence of 1% and has a complication rate of 10.9%. Protein-energy malnutrition with hypoalbuminemia was the most common etiology. The mean lengths of BPL and CC were reported as 215 cm and 380 cm, respectively, in the cases. Therefore, special attention should be paid to malnutrition in all OAGB/MGB patients during follow-up to prevent severe malnutrition and subsequent increase in reversal procedures.