scholarly journals The influence of laterality, sex and family history on clubfoot severity

2020 ◽  
Vol 14 (2) ◽  
pp. 145-150
Author(s):  
Giada Salvatori ◽  
Camilla Bettuzzi ◽  
Caterina Novella Abati ◽  
Giuseppe Cucca ◽  
Alessandro Zanardi ◽  
...  
Keyword(s):  
Family History ◽  
Epidemiological Studies ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Degree Relative ◽  
Level Of Evidence ◽  
Female Ratio ◽  
Significant Difference ◽  
Initial Severity ◽  
The Right

Purpose Epidemiological studies on idiopathic clubfeet have shown a typical distribution consistent across ethnic groups: bilaterality in about 50% of cases and a male to female ratio of 2:1. Whether this corresponds also to differences in severity according to laterality and sex has been poorly evaluated. As well, the correlation between family history and severity has not been previously investigated. The aim of this study was to investigate how laterality, sex and family history influence severity and treatment. Methods In all, 97 infants with idiopathic clubfoot (81 male, 16 female; 55 unilateral, 42 bilateral; 19 with a first or second-degree relative affected) consecutively treated with Ponseti method were prospectively enrolled. Initial severity (according to Dimeglio and Pirani scores) and treatment (number of casts and need for tenotomy) were analyzed in the different subgroups. Results Initial severity according to Pirani (p = 0.020) and Dimeglio score (p = 0.006), number of casts (p = 0.000) and tenotomy (p = 0.045) were significantly higher in bilateral than in unilateral cases. In bilateral cases, a significant correlation was found between the right and left foot of each patient in terms of initial severity, number of casts and tenotomy performed. No statistically significant difference was found according to sex and family history. Conclusions This study has confirmed the different behaviour of bilateral cases reported by previous studies; bilateral cases are more severe and show similar features in their right and left foot. This could be the result of different pathogenic mechanisms, likely on a genetic basis. Sex and family history did not seem to influence severity. Level of Evidence Level of evidence II

scholarly journals Motor abilities in 182 children treated for idiopathic clubfoot: a comparison between the traditional and the Ponseti method and controls

2018 ◽  
Vol 12 (4) ◽  
pp. 383-389 ◽  
Author(s):  
V. S. Aulie ◽  
V. B. Halvorsen ◽  
J. I. Brox
Keyword(s):  
Traditional Method ◽  
Ponseti Method ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Extended Surgery ◽  
Motor Abilities ◽  
Significant Difference ◽  
Movement Assessment

Purpose The aim of the study was to examine motor abilities in children treated for idiopathic clubfoot with either the traditional extensive surgery method or the Ponseti method, and compare their motor skills with a control group without clubfoot. Methods A total of 89 children treated according to the traditional method (mean age 9.0 years, 7 to 10) and 93 treated ad modum Ponseti (mean age 8.8 years, 7 to 10) were recruited from a multicentre clinical study in Norway. A total of 45 age-matched children without clubfoot were recruited from a nearby school. They were all assessed with the Movement Assessment Battery for Children – Second Edition (MABC-2), which evaluates motor performance. We applied Analysis of Covariance for comparison of the two treatment methods and adjusted for gender, laterality, comorbidity, achillotomy or more extended surgery, physiotherapy and the age when the child walked independently. Results We found no significant difference in any of the various components or the total score of the MABC-2 between patients treated with the two different methods. In all, 76% of the children treated according to the traditional method and ad modum Ponseti, and 96% in the control group, respectively, were classified as having normal motor abilities. Conclusion About three-quarters of children aged nine years and treated for idiopathic clubfoot had normal motor abilities. We found similar results in patients treated with the traditional method and the Ponseti method. Level of Evidence II

scholarly journals Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus Ponseti method

2019 ◽  
Vol 13 (5) ◽  
pp. 471-477
Author(s):  
A. Zanardi ◽  
V. Fortini ◽  
C. N. Abati ◽  
C. Bettuzzi ◽  
G. Salvatori ◽  
...  
Keyword(s):  
Motor Development ◽  
Physical Therapists ◽  
Normal Population ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Gross Motor ◽  
Significant Difference ◽  
Walking Age ◽  
Independent Ambulation

Purpose A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation. The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM. Methods In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones. Results The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non-significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones. Conclusion Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age. Level of Evidence Level II – Prospective comparative therapeutic studies

scholarly journals Additional challenges in children with idiopathic clubfoot: is it just the foot?

2019 ◽  
Vol 13 (3) ◽  
pp. 245-251 ◽  
Author(s):  
E. Lööf
Keyword(s):  
Motor Skills ◽  
Developmental Disorders ◽  
Ponseti Method ◽  
Control Group ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Gross Motor ◽  
Assessment Protocol ◽  
Related Quality ◽  
Health Related

Purpose Treatment of idiopathic clubfoot (IC) has improved since the introduction of the Ponseti method. However, relapses are still common and primarily related to non-adherence to the brace regime. Our hypothesis was that IC might be more than just a structural deformity. Based on three studies, the aim of this paper was to provide an overview of findings regarding additional challenges within IC. Methods In total, 153 children with IC and 137 control children participated in the studies. The first study assessed gross motor skills in six motor tasks using the Clubfoot Assessment Protocol. The second and third studies surveyed neurodevelopmental difficulties (NDDs) using the Five to Fifteen (FTF) questionnaire and health-related quality of life (HRQoL) using the EuroQol-5D youth. Results A high percentage of gross motor deviations were found in children with IC compared with controls, and those correlated poorly with clubfoot severity and foot movement. Children with IC had a higher prevalence of NDDs on the FTF compared with the control group, including the domains: motor skills, perception and language. One-third of children with IC were defined as at risk of developmental disorders. In this subgroup, parents were less satisfied with the outcome of clubfoot treatment and the children reported worse HRQoL than those without NDDs. Conclusion The findings suggest additional challenges in children with IC, such as NDDs, apparently affecting both clubfoot treatment outcome and HRQoL. Thus, awareness of these challenges could be vital to further optimize treatment and support, for example, with regards to brace adherence. Level of Evidence II - Prognostic study

Multivariate analysis of factors affecting overall survival in minority-based population of young colorectal cancer patients: A single-institution experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14186-e14186
Author(s):  
Shivi Jain ◽  
Kireet Agrawal ◽  
Shinoj Pattali ◽  
Abhijai Singh ◽  
Kamal Agrawal ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Family History ◽  
Cancer Patients ◽  
Stage Iv ◽  
Female Ratio ◽  
Stage Iv Colorectal Cancer ◽  
Significant Difference ◽  
Colorectal Cancer Patients

e14186 Background: Overall survival in colorectal cancer is influenced by obesity, age, gender and stage at diagnosis. However, in minority based populations, effect of the above factors on overall survival has not been studied in any detail. Hence, we undertook this retrospective study to evaluate effect of above factors on overall survival in young colorectal cancer patients. Methods: 1,195 subjects with colorectal cancer treated at John H. Stroger Hospital of Cook County between 2000 and 2008 were retrospectively analyzed. 179 subjects with age 50 years and younger were identified. 146 of 179 subjects with available Body Mass Index (BMI) in kg/m2 were included in the study. Effect of BMI, age, sex, race, LDH and CEA levels, stage, site of tumor, smoking and family history on overall survival was evaluated using standard statistical multivariate analysis. Results: In our population, 22 of 146(15%) were underweight (BMI<20), 56 of 146(38.4%) were normal weight (BMI 20-24.9), 46 of 146(31.5%) were overweight (BMI 25-29.9) and 22 of 146(15%) were obese (BMI >30). Male: female ratio was 1.4:1. 75 of 146(51.7%) were African American, 23 of 146(15.9%) were Caucasians. 50 of 146(34.2%) were stage IV colorectal cancer at diagnosis. On univariate analysis, BMI<20(p=0.031, HR 2.1, 95% CI 1.15-3.82), CEA >4ng/ml (p=0.005, HR 1.93, 95% CI 1.21-3.08) and stage IV colorectal cancer (p<0.001, HR 6.1, 95% CI 2.42-15.53) were significantly associated with decreased overall survival. LDH<200 U/L was significantly associated with improved overall survival (p 0.029, HR 0.6, 95% CI 0.391-0.950). On multivariate analysis, stage IV colorectal cancer was a single significant independent predictor of overall survival (p=0.001, 95% CI 2.47-27.78). CEA>4ng/ml was marginally significant for decreased overall survival (p=0.06, 95% CI 0.978-3.015). On the contrary, no statistically significant difference was found on overall survival with age, BMI>20, gender, race, tumor location, smoking and family history. Conclusions: Advanced stage and CEA >4ng/ml are independent prognostic variables for decreased overall survival in minority based population of young colorectal cancer.

scholarly journals ELASTOGRAPHIC ANALYSIS OF THE SUPRASPINATUS TENDON IN DIFFERENT AGE GROUPS

2020 ◽  
Vol 28 (4) ◽  
pp. 190-194
Author(s):  
César Rubens da Costa Fontenelle ◽  
Márcio Schiefer ◽  
Pietro Mannarino ◽  
Isac Borges Lacerda ◽  
Francisco José Thomé Machado ◽  
...  
Keyword(s):  
Shear Modulus ◽  
Age Groups ◽  
Supraspinatus Tendon ◽  
Level Of Evidence ◽  
Mean Values ◽  
Age Progression ◽  
Normality Test ◽  
Significant Difference ◽  
Student’S T ◽  
The Right

ABSTRACT Objective: To compare the mechanical properties of the supraspinatus tendon in different age groups using Supersonic Shearwave Imaging (SSI) elastography. Methods: We evaluated 38 healthy individuals of both genders, 20 being in the range of 20 to 35 years and 18 being over 60 years. The shear modulus of the supraspinatus tendon was measured by SSI elastography, always on the right side. Means between age groups were compared and statistically analyzed using the Shapiro-Wilk normality test followed by the student’s t-test and were established as a statistically significant value of p ≤ 0.05. Results: A statistically significant difference was observed when the mean values of the shear modulus of the supraspinatus tendon of young adults (23.98 ± 9.94 KpA) were compared with those of older adults (17.92 ± 6.17 KpA). Conclusion: We found a difference between the means of the shear modulus measured by the SSI elastography, showing a significant decrease of the shear modulus with the chronological age progression. Level of Evidence III, Diagnostic Studies - Investigating a Diagnostic Test.

scholarly journals Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

2021 ◽  
Vol 87 (1) ◽  
pp. 175-179
Author(s):  
Thibault Dewilde ◽  
Sebastiaan Schelfaut ◽  
Sven Bamps ◽  
Matthias Papen ◽  
Pierre Moens
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Technical Note ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Coronal Balance ◽  
Scoliotic Deformity ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

scholarly journals Comparative study of the FAOS and FAAM questionnaires as functional assessment instruments for patients with hallux valgus

2020 ◽  
Vol 14 (2) ◽  
pp. 144-147
Author(s):  
Alesson Filipi Bernini ◽  
Silvia Iovine Kobata ◽  
Alexandre Cassini de Oliveira ◽  
Rubens Trabbold Aguiar ◽  
Antônio César Mezêncio da Silveira
Keyword(s):  
Hallux Valgus ◽  
Functional Assessment ◽  
Case Series ◽  
Assessment Instruments ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Right ◽  
Relationship Of

Objective: To compare the Portuguese translations of the Foot and Ankle Activity Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) questionnaires as functional assessment instruments for patients with hallux valgus and assess correlations between scores and severity of deformity. Methods: A total of 28 patients were assessed and the functional scores provided by the FAAM and FAOS questionnaires were compared and their correlations with clinical and radiological severity were analyzed. Results: Mean age was 46.88 years (range: 18 to 64). Laterality was distributed as follows: 57.1% had the deformity on the right foot (16 cases) and 42.9% on the left (12 cases). The deformities identified were graded as follows: 26.1% of patients had mild deformity (6 cases), 45.3% had moderate deformity (14 cases), and 28.6% had severe deformity (8 cases). It was observed that the distribution of scores for the different grades of deformity was the same for both questionnaires. Conclusion: There was no significant difference between the results obtained using the FAAM or the FAOS questionnaire or in the relationship of proportionality between radiological deformity grade and the functional scores obtained using the two tests. Level of Evidence IV; Therapeutic Studies; Case Series.

Characteristics of Familial CLL Evaluated in the CLL Research Consortium Cohort

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3125-3125 ◽  
Author(s):  
Jennifer R Brown ◽  
Laura Rassenti ◽  
Donna Neuberg ◽  
Andrew Greaves ◽  
John C. Byrd ◽  
...  
Keyword(s):  
Family History ◽  
Tissue Bank ◽  
Age At Diagnosis ◽  
Degree Relative ◽  
Family History Information ◽  
Mutational Status ◽  
Significant Difference ◽  
Gene Usage ◽  
Research Consortium ◽  
Beta 2 Microglobulin

Abstract Approximately 10–15% of patients with CLL report a family history (FH) of CLL or a related lymphoproliferative disorder. Whether the biologic features of CLL that occurs within families differ from those that occur sporadically is unknown. A recent study addressing this question has reported that mutated IgVH is significantly more common among familial than sporadic CLL, 68% vs 47%, although the distribution of VH genes used was similar (Blood111:5691, 2008). Therefore we compared IgVH mutational status and gene usage, as well as other biologic features, between familial and sporadic CLL derived from patients enrolled on the CLL Research Consortium (CRC) Tissue Core. Of 4533 patients enrolled in the CRC database and tissue bank, 3328 had adequate family history information, and these were subdivided into 4 groups: FH of CLL (n=468), FH of other heme cancer but not CLL (n=421), FH of non-heme cancer (n=1444), and sporadic cases (no FH of any cancer) (n=995). Of those patients reporting a FH of CLL, 63% had at least one affected 1st degree relative, 20% at least one affected 2nd or greater degree relative, and 17% unknown. 68% of those reporting a FH of CLL also had other cancers in their family. Patients reporting a FH of CLL or non-CLL heme cancers were more frequently white (91%), compared to 87% of those with FH non-heme cancer and 84% of sporadic CLL patients (p=0.005). The proportion of CLL cases that were female was similar among groups, at 37.6% of patients with FH CLL, as compared to 32.5% of sporadic patients (p=0.12). The age at diagnosis of CLL also did not differ among the four groups, although a trend toward a difference was observed between the FH CLL patients, whose mean age at diagnosis was 54.9 (range 30, 93), and the sporadic patients, whose mean age at diagnosis was 56.1 (range 30, 84) (p=0.08). No significant difference was observed among groups in the frequency of IgVH mutation (defined as &lt;98% homology to the most similar germline VH gene), which was present in 50.3% (95% CI 44.5–56.2) of patients with FH CLL, 56.3% (95% CI 49.7–62.7) of patients with FH other heme cancer, 51.9% (95% CI 48.5–55.3) of patients with FH non-heme cancer, and 51.3% (95% CI 47.0–55.5) of sporadic patients (p=0.53). The pattern of IgVH family gene usage also did not differ among the groups; the VH3 subgroup was most commonly used, at 45%, 52%, 46% and 47% of patients with FH CLL, FH other heme cancer, FH non-heme cancer and sporadic, respectively. The VH1 subgroup was next most common in all 4 groups, at 28%, 24%, 26% and 25%, respectively, followed by the VH4 subgroup, at 19%, 17%, 21% and 21%. In addition, no significant difference was observed in the distribution of ZAP-70 expression amongst the four family history subgroups (mean %ZAP-70 expression, 22.8% for FH CLL patients and 24.4% for sporadic patients, p=0.31), or in the fraction considered ZAP-70 positive (&gt;20% expression), which was 40% for FH CLL patients and 45% for sporadic patients (p=0.16). The relative expression of CD23 and CD38 did not differ among groups, nor did levels of beta-2-microglobulin or IgG determined at time of CRC enrollment. Time from diagnosis to initial treatment for each of the subgroups is currently being analyzed. These data on patterns of biologic risk factors in this large group of familial CLLs compared to sporadic CLLs suggest that familial and sporadic CLL are biologically similar and therefore likely to have similar pathogenetic mechanisms, including perhaps an underlying genetic susceptibility.

Biomechanical Comparison of Achilles Tenotomy and Achilloplasty Techniques in Young Rats

2009 ◽  
Vol 99 (3) ◽  
pp. 216-222 ◽  
Author(s):  
Ali Dogan ◽  
Mahmut Korkmaz ◽  
Nurettin Cengiz ◽  
A. Murat Kalender ◽  
M. Ata Gokalp
Keyword(s):  
Randomized Study ◽  
Tendon Healing ◽  
Maximum Load ◽  
Ponseti Method ◽  
Sprague Dawley ◽  
Achilles Tenotomy ◽  
Tendon Lengthening ◽  
Significant Difference ◽  
The Right ◽  
Tendo Achillis

Background: Tendo Achillis lengthening is performed by means of Z-plasty in the classic treatment of clubfoot. In the Ponseti method for treating clubfoot, Achilles tenotomy is performed percutaneously for residual equine deformity. A randomized study was designed to compare tendon healing after tenotomy versus Z-plasty. Methods: Thirty-six Sprague-Dawley rats were divided randomly into two groups. On the first day, while the right tendo Achillis of group 1 rats underwent tenotomy, those of group 2 rats underwent Z-plasty. Nine rats from each group were humanely killed on days 21 and 45 postoperatively. The two groups were compared with each other biomechanically and histologically. The Achilles tendons of eight rats in each group were evaluated biomechanically, and the remaining rat in each group underwent histologic evaluation. Results: Mean ± SD maximum load at rupture of the treated tendons on days 21 and 45 in the tenotomy group was 26.38 ± 7.31 N and 47.16 ± 15.36 N, respectively, and in the Z-plasty group was 27.37 ± 5.20 N and 45.27 ± 9.59 N, respectively. The biomechanical evaluation revealed no significant difference in terms of breaking forces between the two groups. The difference between breaking forces on days 21 and 45 was statistically significant for both groups. Conclusions: Tendons in the tenotomy group healed as well as those in the Z-plasty group, and Achilles tenotomy in the rat was similar to Z-plasty for Achilles tendon lengthening. Human correlation may or may not exist, but this study suggests that it should be considered and investigated. (J Am Podiatr Med Assoc 99(3): 216–222, 2009)

scholarly journals Simple , safe and fast Ponseti cast removal procedure in pes equina varus patients

2021 ◽  
Vol 8 (2) ◽  
pp. 64-67
Author(s):  
Ferdi Dırvar ◽  
Ömer Cengiz
Keyword(s):  
Cutting Tool ◽  
Classical Group ◽  
Cutting Tools ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Chi Square ◽  
Removal Time ◽  
Significant Difference ◽  
The Mean ◽  
Mean Time

Objective: In our study, it is aimed to remove the cast more easily and safely without using the cutting tools by leaving the cast ends marked by folding in the idiopathic clubfoot patients treated with Ponseti method. Material and Methods: Forty feet of 29 patients treated for Pes Equinovarus were included in the study. Patients were followed up in two groups. The group treated with Ponseti method by cast marking were named as “modified group” and cast wrapped group without marking were named as “classical group”. Neurological, teratologic and syndromic clubfoot patients were not included in the study. During the six series of casting, cast removal times for each extremity are recorded in minutes and it is noted that whether any additional cutting tool is used during cast removal or not. A summary of the data was presented as mean, standard deviation and percentage. Comparisons of the categorical characteristics were analysed by using the Chi-square test and the Mann-Whitney test. IBM-SPSS 20 program was used for analysis. In all tests, the level of significance was adjusted to 0.05. Results: Thirteen (44.8%) of the 29 patients were male and 16 (55.2%) were female. While the mean time to start treatment for the 15 patients in the modified group was 3.46 (2-7) days, mean time for the 14 patients in the classical group was 3.78 (2-10) days. While the mean cast removal time of the 20 extremities of 15 patients in the modifying group was 10.9 minutes (8-14.3 min);it was 22.2 minutes (17.1-29.5 min) for the 20 extremities of 14 patients in the classical group. While no additional cutting tool was used during cast removal in the modified group, additional cutting tools were used during removal of cast in 75% (15/20) of the patients in the classical group and statistically significant difference was found between two groups in terms of the use of cutting tools (p<0.001). Conclusion: We found that the cast ends’ being marked by folding during plastering in idiopathic clubfoot patients treated with Ponseti technique is costless, easy to apply, significantly shortens cast removal time, does not require the use of cutting tools, and thus is a notably safe method for these patients.

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