Surgical treatment of recalcitrant plantar fasciitis

Twenty-six patients (35 feet) underwent partial plantar fasciectomy with neurolysis of the nerve to the abductor digiti quinti muscle. Nonsurgical treatment for plantar fasciitis had been unsuccessful in these patients. Patients were followed after surgery for an average of 37.5 months. Six patients were male and 20 patients were female; the average age was 49 years. All patients had failed to respond to nonsurgical treatment for an average of 21.5 months. In addition to routine history and physical examination patients were evaluated before and after surgery with a subjective foot rating system, and a detailed questionnaire was used to assess post-operative functional outcome. Thirty-two patients (92%) had a satisfactory functional outcome, and three patients (8%) had an unsatisfactory result (21 excellent, 11 good, 3 fair, 0 poor). The Maryland Foot Score increased from a preoperative average of 74.8/100 points to a postoperative average of 90.6/100 points. Four patients (11%) had postoperative complications, including superficial wound infection (two patients), deep venous thrombosis (one patient), and superficial phlebitis (one patient), all of which resolved uneventfully with treatment. Ten patients (28.6%) reported some degree of heel pain after surgery. All 10 patients denied limitation in activity related to postoperative pain. The average period before return to daily activity and restricted work duty was 5.6 weeks and to full work duty without restriction was 8.7 weeks. Although the length of time for partial or complete resolution of symptoms is variable, a successful treatment outcome can be expected in most patients who are treated for recalcitrant plantar fasciitis.     

Outcome of nonsurgical treatment for plantar fasciitis

Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis.     

MRI of plantar fasciitis

At present, MRI is the only imaging method that can precisely visualize lesions of the superficial plantar aponeurosis, whether they be musculoaponeurositides, enthesopathies or tears, and whether they be acute or chronic, with or without complications. By its direct visualization of the lesion, MRI enables an accurate assessment of the injury to be made and thereby better orients the therapeutic strategy.     

Diagnostic imaging of heel pain and plantar fasciitis

Heel pain or calcaneodynia is a common clinical complaint which has a myriad of causes ranging from plantar fasciitis to stress fracture. In many instances, the etiology of the heel pain is difficult to ascertain simply on the basis of history and physical examination. Therefore, the clinician may enlist various diagnostic imaging modalities to clarify the source of pain. Of all the imaging techniques, magnetic resonance imaging (MRI) has proven its worth in the diagnosis of heel pain. This article outlines the various causes of heel pain and their associated imaging findings.     

Chrysotherapy. A prospective study

A 4-year prospective clinical study of chrysotherapy was designed to reexamine old beliefs and traditions, and to test potentially new approaches to chrysotherapy. The standard weekly dosage of 50 mg was compared to that based on 1 mg/kg body weight; no significant differences were found. The rapidly absorbed aqueous thiomalate was compared to the slowly absorbed oil repository thioglucose; the latter produced significantly less side effects and an appreciably higher percentage of improvement. Almost half (43%) of nonresponders on standard regimen had a satisfactory clinical response at higher dosage levels without increase in toxicity. Some of these findings vary so much with traditional beliefs and practices that the authors urge caution in their interpretation. But generally speaking these problems are technical and do not detract from the conviction that chrysotherapy is valuable and comparatively safe in the management of rheumatoid arthritis and that it deserves more widespread application in clinical practice.     

Operative treatment of fractures of the tibial plafond. A randomized, prospective study

We performed a randomized, prospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. Surgeons were assigned to a group on the basis of the operation that they preferred (randomized-surgeon design). In the first group, which consisted of eighteen patients, open reduction and internal fixation of both the tibia and the fibula was performed through two separate incisions. An additional patient, who had an intact fibula, had fixation of the tibia only through an anteromedial incision. The second group consisted of twenty patients who were managed with external fixation with or without limited internal fixation (a fibular plate or tibial interfragmentary screws). Ten (26 per cent) of the thirty-nine fractures were open, and seventeen (44 per cent) were type III according to the classification of Rüedi and Allg?wer. There were fifteen operative complications in seven patients who had been managed with open reduction and internal fixation and four complications in four patients who had been managed with external fixation. All but four of the complications were infection or dehiscence of the wound that had developed within four months after the initial operation. The complications after open reduction and internal fixation tended to be more severe, and amputation was eventually done in three patients in this group. At a minimum of two years postoperatively (average, thirty-nine months; range, twenty-five to fifty-one months), the average clinical score was lower for the patients who had had a type-II or III fracture, regardless of the type of treatment. With the numbers available, no significant difference was found between the average clinical scores for the two groups. All of the patients, in both groups, who had had a type-II or III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up. With the numbers available, there was no significant difference between the two groups with regard to the osteoarthrotic changes. We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation.     

Compulsory treatment in psychiatry from the viewpoint of the patient. A prospective study

During a 6-month period all patients who had been treated involuntarily in a state-funded mental mental health unit were studied prospectively. They were interviewed after the first compulsory measure and at the end of treatment. A control group of patients (not experiencing involuntary treatment) were interviewed as well. The aim of the study was to establish whether the groups differed with respect to judgement of subjective well-being and satisfaction with treatment. The stability of these judgements over time and especially changes in perception and acceptance of involuntary treatment during the course of treatment were also monitored. the 36 patients in the study group perceived themselves as being far less ill at both time points and were less satisfied with treatment than the 29 control patients. At the end of treatment, all patients judged themselves to be significantly more ill retrospectively and patients of the study group were more satisfied with treatment than at the beginning. When questioned in the days after an involuntary measure, 25% of the patients concerned denied that any measure had taken place against their will; at the end of the hospital stay this figure had increased to 42%. In contrast, four control patients complained that they had been involuntarily subjected to treatment. In discordance with the previously published literature, the acceptance of involuntary treatment declined over time.     

A prospective study of youth gambling behaviors.

Little is known about the course and outcomes of adolescent gambling. This prospective study describes findings from a 3-wave (Time 1 [T1], Time 2 [T2], and Time 3 [T31]) assessment of gambling behaviors among youth (N = 305). Stable rates of any gambling and regular gambling (weekly or daily) were observed across T1, T2, and T3. The rate of at-risk gambling significantly increased at T3 (young adulthood), whereas the rate of problem gambling remained stable over time. Several adolescent risk factors were associated with either T3 at-risk or problem gambling, many of which are risk factors for adolescent substance abuse. Findings suggest that important to the origins of young adult gambling problems are risk factors associated with the problem behavior syndrome of adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology, treatment completion and 5 years outcome. A prospective study of drug abusers

The strategy of isolating the band-specific expression fragments from a probe pool generated by human chromosome microdissection was reported. A chromosome 14q24.3 band-specific single copy DNA pool was constructed based on this probe pool. Using total DNA of the pool as probe to hybridize the human marrow cDNA library, 68 primary positive clones were selected from 5 x 10(5) cDNA clones. Among these primary clones, 32 secondary clones were obtained after second-round screening and designed as cFD14-1-32. Finally, 24 band-specific expression fragments were identified from these 32 positive clones by DNA hybridization. Those band-specific clones can hybridize to both 14q24.3 DNA and human genomic DNA but can't hybridize to 17q11-12 DNA. Partial sequences of 13 fragments of them were sequenced and identified as novel cDNA sequences, and these sequences were proved to have some homology with known genes in NCBI database. Analysis of expression spectrum of cFD14-1 suggested that the cDNA fragments thus obtained should be used to isolate the genes can not been cloned in 14q24.3 region.     

Cyclosporine A in the treatment of early rheumatoid arthritis. A prospective, randomized 24-month study

OBJECTIVE: To investigate the efficacy, tolerability and safety of cyclosporine A (CSA) in early rheumatoid arthritis (RA) patients. METHODS: Patients with an early diagnosis of RA, a disease duration of less than 3 years, and without prior disease modifying antirheumatic drug (DMARD) treatment were studied. They randomly received oral CSA (3 mg/kg/day) or oral methotrexate (MTX) (0.15 mg/kg/week). In addition, all patients in both groups received oral prednisone (7.5 mg/day). RESULTS: Fifty-two patients were assigned to the CSA group and 51 to the MTX group. After 24 months of treatment, 48 patients from the CSA group and 48 from the MTX group showed significant clinical improvement. This was evaluated by the duration of morning stiffness, grip strength, the total joint count, joint swelling, and joint tenderness and pain, compared to pre-treatment values. The clinical improvement was also associated with a significant decrease in ESR and CRP values in both groups. No significant radiological deterioration was observed in the CSA patients compared to those treated with MTX after 24 months. Four patients from the CSA group dropped out of the study, two because of a synovitis flare, one because of severe hypertrichosis and one because of severe gingival hyperplasia. Three patients from the MTX group withdrew, one because of disease flare-up and two because of gastrointestinal disturbances. CONCLUSION: Early immunointervention in RA patients appears to be crucial to limit the development of joint damage. Cyclosporine A appears to be effective, well tolerated and safe in the long-term treatment of RA and can therefore be used as a first immunomodulatory drug in the armamentarium for the treatment of RA.     

Sudden infant death syndrome. A prospective study

One hundred twenty-five sudden infant death syndrome (SIDS) victims followed up since birth from a large prospective study were compared with matched controls. Some of the future SIDS victims showed evidences of neonatal brain dysfunction including abnormalities in respiration, feeding, temperature regulation, and specific neurologic tests. These abnormalities could not be ralated to events in labor or delivery. A greater proportion of the future victims were mildly underweight for gestational age. The gestations that produced the SIDS victims were characterized by a greater frequency of mothers who smoked cigarettes and had anemia. The demographic profile of SIDS families proved to be indentical to the profile for families with excessive perinatal mortality. Many of the SIDS victims showed a retardation in postnatal growth prior to death.     

Hardiness and health: A prospective study.

Hypothesized that hardiness—commitment, control, and challenge—functions to decrease the effect of stressful life events to producing illness symptoms. 259 upper- and middle-level male managers (mean age 48 yrs) were administered a battery of tests (including Rotter's Internal–External Locus of Control Scale, the Schedule of Life Events, and the Seriousness of Illness Survey) covering a 5-yr period. Results support the hypothesis by showing main effects on illness for both stressful life events and hardiness and an interaction effect for these independent variables. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pregnancy and multiple sclerosis. A prospective study

OBJECTIVE: To conduct a prospective assessment of pregnancy on women with multiple sclerosis (MS), focusing on pregnancy outcome and relapses during gestation and up to 6 months after delivery. DESIGN: Expected numbers of relapses were based on data for (1) "self-controls": the mothers ("cases") themselves prior to becoming pregnant and (2) "matched controls": female patients with MS "matched" to the mothers for year of birth, age of MS onset, MS type, MS course, and initial MS symptom(s). SETTING: Cases and controls were identified from an ambulatory care MS clinic that serves the province of British Columbia, Canada. PATIENTS OR OTHER PARTICIPANTS: Women with a diagnosis of MS who attended the MS clinic during 1982 through 1986 and subsequently became pregnant during 1982 through 1989 inclusive were included in this study as cases. Matched controls were women with MS who attended the MS clinic during the same period but did not become pregnant. RESULTS: No significant increase in relapse rate was found for cases during the first two trimesters of gestation. The number of relapses was significantly less than expected during the third trimester compared with matched controls (chi 2 = 6.80, df = 1, P < .02), but not compared with self-controls (chi 2 = 3.39, df = 1, P > .05). The observed number of relapses for the 6 months after delivery did not differ significantly from expected (self-controls: chi 2 = 2.84, df = 2, P > .05; matched controls: chi 2 = 1.76, df = 2, P > .05). CONCLUSION: These data suggest that neither pregnancy nor the 6-month period after delivery is a risk factor for relapse in MS. They are consistent with previous observations that, in the long term, pregnancy does not influence subsequent MS disability.     

Time of first intercourse: A prospective study.

Longitudinal psychosocial data were used to predict the transition from virginity to nonvirginity among 430 7th–9th graders, all of whom were virgins at the initial testing in 1970. By the most recent follow-up in 1979, 93% reported having had sexual intercourse. Variation in time of onset of initial intercourse was categorized into 6 time periods and served as the main criterion variable in the study. Bivariate and multivariate analyses showed that antecedent measures of personality, the perceived environment, and behavior were predictive of variation in time of onset and, taken together, accounted for approximately 30% of the criterion variance. Results support the utility of the problem-behavior-theory framework and show onset of sexual intercourse to be a systematic aspect of psychosocial development in adolescence. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Port-site metastases. A prospective study of 131 cases

Laparoscopic staging and laparoscopic treatment of gastrointestinal malignancy is still controversial because some studies report port-site metastases. BACKGROUND: The aim of the study is to determine in 131 patients, with prospective follow-up, after laparoscopic staging or laparoscopic treatment the incidence of port-site metastases. METHODS: 131 patients, with gastro intestinal malignancy, proved or with peritoneal carcinomatis or liver metastases, were included. In 57 cases only laparoscopic staging is performed in 49 cases laparotomic treatment is performed a after laparoscopic staging; in 57 cases (43.5 per cent) tumor invaded serosa. RESULTS: The median follow-up was 17.7 months (3 to 62 months). 502 port-sites were controlled. One patient (0.7%) has presented one port site metastasis 3 months after right colectomy for carcinoma with local carcinomatis. CONCLUSION: The study affirm that port-site metastases are rare. They are favorised by serosa invasion. The low rate indulge in laparoscopic staging to recognize occults lesions which are not detected by conventionals examinations in 44.2 per cent in this study.     

HDR and MDR intracavitary treatment for carcinoma of the uterine cervix. A prospective randomized study

The multiple goals theory of conflict management (Ohbuchi & Tedeschi, in press) postulated that participants in a conflict pursue to achieve resource goals (economic and personal resources) and social goals (relationship, identity, justice, and power-hostility). The hypotheses based on this theory were examined by the episode method, in which 207 university students were asked to rate their recent experiences of interpersonal conflicts in terms of participants' attributes, goals, and tactics. More than 80% of the subjects answered that they were motivated to achieve multiple goals in their attempts to resolve the conflicts. Social goals were found to be more strongly activated, and economic resource goals were least strongly activated. Regression analyses revealed that the effects of participants' attributes on tactical preference were mediated by goals.     

Group A streptococcal bacteremia. A 10-year prospective study

In this paper we present a prospective evaluation of 100 patients with Group A Streptococcal (GAS) bacteremia evaluated in our hospital over a 10-year period. Sixty-two patients were intravenous drug users (IVDU); all but 1 of these had an obvious cutaneous portal of entry related to the injection of illicit drugs. Twenty-seven patients had infectious metastasis, and the presence of septic pulmonary embolism was associated with suppurative phlebitis. Four of these patients had endocarditis. In the non-IVDU group, 24 patients had an underlying disease, and 12 were immunosuppressed. In 14 cases the infection was of hospital acquisition; in 35% infection was related to medical manipulations. Comparing the IVDU and non-IVDU groups, GAS bacteremia in IVDU patients is associated with a more benign outcome, a longer time of evolution before diagnosis, and a lower frequency of septic shock and mortality than in non-IVDU patients. Although in the univariate analysis GAS bacteremia was associated with several variables, in the multivariate analysis only the presence of shock and nosocomial acquisition of the infection were independently associated with a fatal outcome. Fifty-two patients were infected with human immunodeficiency virus (HIV); 5 of these were in the non-IVDU group. During the last 5 years of study, GAS bacteremia in our hospital was 39 times more frequent in HIV-infected patients than in patients without HIV. Nine patients presented clinical criteria corresponding to Streptococcal toxic shock syndrome (STSS), although its incidence was lower in the IVDU group. In the non-IVDU group, STSS was more frequent in patients with a necrotizing portal of entry, an age between 20 and 40 years, women, and when the origin of the infection was the skin or soft tissue. Six patients with STSS died, and death was associated with the presence of necrotizing lesions and lower counts of white cells, platelets, or hemoglobin.