AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.

Adult↗

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Lethal midline granuloma starting as granuloma laryngis.

We report a case of lethal midline granuloma in a 34-year-old male patient. The patient was referred to our hospital because of long-lasting hoarseness. He was treated for granuloma laryngis. After two years nasal obstruction developed followed by ulceration of the hard palate and destruction of part of the nose and the upper lip. A biopsy demonstrated polymorphic infiltrate consisting of small lymphocytes, plasma cells, macrophages, atypical lymphoid cells and eosinophils. Radiotherapy was very effective and led to long-term remission. The different etiological aspects of this syndrome are discussed.

Adult↗

PubMedDate not supplied

CD30-positive cutaneous anaplastic large cell lymphoma with ichthyosis acquisita.

Anaplastic large cell lymphoma (ALCL) is a high-grade non-Hodgkin's lymphoma recognized by the expression of the CD30 marker and by its morphology. We report an unusual case of ALCL in a 42-year-old woman. For ten years the patient only had pruritic erythematous skin lesions, then a plaque with nodules and ulcers on the right thigh and leg developed, followed by ichthyosis acquisita. The development of ALCL in women and the association of ichthyosis acquisita with this type of lymphoma are uncommon.

Adult↗

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Family medicine training in Venezuela.

Family practice residency training in Venezuela is designed to prepare physicians to meet the health needs of the nation at a time of increasing societal concerns for the quality and cost of care. Since 1982, nine residency programs have been created throughout the country. Each two-year program is based in an ambulatory care setting. Entering physicians have completed an internship and have a minimum of two years practice experience. Graduates have been prepared to continue a socially active role to promote the new specialty. Training emphasizes community aspects of clinical practice, similar to the hopes of community-oriented primary care in the United States. Additional emphases include exposure to clinicians from other specialties, family aspects of patient care, working with a health care team, completion of a research project, and structured courses of theory in areas such as public health, behavioral medicine, and research methodology. Although hampered by economic constraints, the movement's intensely committed leaders have successfully captured political and public support.

Curriculum↗

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[Painful piezogenic pedal papules and physical activity].

Piezogenic papules are present in 10%-20% of the investigated population. They occur in all age groups, more frequently among women than men, but also among children, as shown in this case report. Herniation of fat tissue into the dermis causes their appearance. This disease may result in occupational limitations or inability to engage in certain sports.

Adipose Tissue↗

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[Radiomorphology of the caisson osteoarthropathy].

Explore the source record for details and available documents.

Adult↗