The association of equinus and primary genu recurvatum gait in cerebral palsy

Primary genu recurvatum (GR) is less investigated and data presenting the prevalence among patients with bilateral spastic cerebral palsy (BSCP) is lacking in the literature. Equinus is mentioned as one of the main underlying factors in GR, but its influence on the severity and onset type of GR is mainly unanswered, yet. Hence, the purpose of this retrospective study was to assess the prevalence of GR in a large sample size in children with BSCP and to investigate sagittal plane kinematics to evaluate the influence of equinus on different GR types using data of three-dimensional gait analysis. GR was defined as a knee hyperextension of more than one standard deviation of an age matched control group during stance phase in either one or both of the limbs. Primary GR was defined as a GR without having previous surgery regarding the lower extremity, no selective dorsal rhizotomy and/or interventions like botulinum toxin injection, shock wave therapy or serial casting during the last 6 months in the patient history. In a retrospective study 463 patients with BSCP (GMFCS Level I–III) received three-dimensional gait analysis and were scanned for the presence of primary GR. Finally, 37 patients (23 males, 14 females) matched the determined inclusion criteria and were therefore included for further analysis in this study. Out of those patients seven walked with orthoses or a walker and were excluded from further statistical comparison: Kinematics of the lower limbs were compared between patients having severe (knee hyperextension > 15°) and moderate (knee hyperextension 5–15°) GR and between patients showing an early (first half of stance phase) and a late (second half of stance phase) GR. Primary GR was present in 37 patients/52 limbs (prevalence 8.0/5.6%). Severe GR was associated with a decreased ankle dorsiflexion compared with moderate GR. Early GR showed an increased knee hyperextension compared to late GR. In conclusion GR is less frequent compared with crouch or stiff gait. Our findings support the importance of equinus as a major underlying factor in primary GR. In this context the influence of equinus seems to be more important in early GR.     

Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument

The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6–48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24–72 mths) were used.Four items were excluded before analysis due to zero variance. Principal Components Analysis showed one factor with 8 items. Internal consistency was >0.70 (Chronbach's alpha) for both food consistencies and for both groups of children. Inter-observer reliability varied from 0.51 to 0.98 (weighted Gwet's agreement coefficient). The total MOE scores for both groups showed normal distribution for the population. There were no floor or ceiling effects.The revised MOE now contains 8 items that (a) have a consistent concept for mastication and can be scored on a 4-point scale with sufficient reliability and (b) are sensitive to stages of chewing development in young children. The removed items are retained as part of a criterion referenced list within the MOE.     

Validation of Surveillance,Epidemiology, and End Results TNM staging for testicular germ cell tumor

ObjectivesTo evaluate the accuracy of testicular germ cell tumor category in the Surveillance, Epidemiology, and End Results (SEER) database following the 2010 American Joint Committee of Cancer revision of the TNM staging criteria.MethodsWe performed a retrospective review of our testicular cancer database from January 2010 to July 2011. Registrar extracted data on 76 patients were entered into the Cancer Surveillance Program database from 2 hospitals. We reviewed the SEER coding for each patient, including T, N, M, and S and overall stage group, as well as the range and S value given for tumor markers (lactate dehydrogenase, beta-human chorionic gonadotropin, and α-fetoprotein) both preorchiectomy and postorchiectomy. We then compared these values with the actual staging and tumor markers determined by patient medical record review by a single urologist.ResultsA high proportion of registry records were found to have inaccurate values of category: 71% of S category entries and 34% of N category entries, leading to an overall group stage inaccuracy of 77% in SEER data. Accuracy of overall combined stage group was significantly different between hospitals, with a higher percentage of errors at Hospital A (P< 0.05).ConclusionDespite improvements made to the SEER criteria for extracting data used to code testicular germ cell tumor TNM stage, considerable errors were identified, most notably in tumor marker and nodal status, resulting in an overwhelming number of errors in overall stage. Our findings suggest caution when utilizing SEER data for review of patients with testicular cancer and their staging.     

Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology

Background

Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis.

Methods

One hundred and eighty-two suspected benign soft tissue tumors of the upper extremity with a preoperative diagnosis other than ganglion cyst were excised by one of three surgeons over a 10-year period. A preoperative diagnosis was applied for 125 tumors. No preoperative imaging was used.

Results

Only 26 of the 125 tumors (21 %) with a preoperative diagnosis were discrepant. The tumors that were most likely to have a discrepant diagnosis were vascular tumors (32 %) and other less common benign tumors (33 %). Among the entire cohort of 182 tumors, lipomas (19 %), giant cell tumors of tendon sheath (GCTTS; 19 %), and vascular tumors (16 %) were the most frequent pathological diagnoses. Among the 57 tumors that did not have a preoperative diagnosis, most were vascular tumors (23 %), fibromas (14 %), and GCTTS (11 %). One tumor without a preoperative diagnosis was a malignant tumor, but we consider this unusual and possibly spurious.

Conclusions

A hand surgeon’s preoperative diagnosis without imaging is usually correct prior to excision of a mass in the hand. Discrepant diagnoses are usually benign and do not alter treatment. Level of evidence: Prognostic II     

微波透热治疗恶性肿瘤210例观察

应用微波透热治疗恶性肿瘤２１０例，近期疗效：原发癌９５例，临控１０例，显效３０例，临控显效率４２％；转移癌１１５例，临控１５例，显效３９例，临控显效率４７％。微波透热综合治疗可提高对放、化疗不敏感，常规治疗无效的难治愈恶性肿瘤的治疗效果。     

Angular malalignment as cause of limitation of forearm rotation: An analysis of prospectively collected data of both-bone forearm fractures in children

Introduction

Although limitation of pronation/supination following both-bone forearm fractures in children is often attributed to an angular malunion, no clinical study has compared pronation/supination and angular malalignment of the same child by analysis of prospectively collected clinical data.

Aim

The purpose of this trial is to explore whether limitation of pronation/supination can be predicted by the degree of angular malalignment in children who sustained a both-bone forearm fracture.

Methods

In four Dutch hospitals, children aged ≤16 years with a both-bone forearm fracture were prospectively followed up consecutive children for 6–9 months. At the final follow-up, pronation/supination and angular malunion on radiographs were determined.

Results

Between January 2006 and August 2010, a total of 410 children were prospectively followed up, of which 393 children were included for analysis in this study. The mean age of the children was 8.0 (±3.5) years, of which 63% were male and 40% fractured their dominant arm. The mean time to final examination was 219 (±51) days. Children with a metaphyseal both-bone fracture of the distal forearm with an angular malalignment of ≤15° had a 9–13% chance of developing a clinically relevant limitation (i.e., <50° of pronation and/or supination), while children with an angular malalignment of ≥16° had a 60% chance. Children with diaphyseal both-bone forearm fractures with ≤5° of angular malalignment had a 13% chance of developing a clinically relevant limitation, which showed no significant increase with a further increase of angular malalignment.

Conclusions

Children who sustained a both-bone forearm fracture localised in the distal metaphysis have a higher chance of developing a clinically relevant limitation of forearm rotation in case of a more severe angular malalignment, while children with a diaphyseal both-bone forearm fracture had a moderate chance of limitation, irrespective of the severity of the angular malalignment.     

State of the art in oncology: High risk neuroblastoma,alveolar rhabdomyosarcoma,desmoplastic small round cell tumor,and POST-TEXT 3 and 4 hepatoblastoma

Despite advances in the treatment of pediatric cancers during the past few decades, high-risk neuroblastoma, alveolar rhabdomyosarcoma, desmoplastic small round cell tumor, and hepatoblastomas with 3 or 4 sector involvement after chemotherapy continue to present significant challenges. This review summarizes recent research on the management of these diseases, with a special focus on the use of surgical debulking, genetic analysis, immunotherapy, and chemotherapy in improving outcomes of patients with these solid tumors.