STUDY OF COMPARISON OF THE RECURRENCE PATTERNS IN CTEV PATIENTS WITH ADHERENCE TO BRACE PROTOCOLAND THOSE WITHOUT ADHERENCE TO BRACE PROTOCOL IN CHILDREN UP TO 5 YEARS.

Mapping Intimacies ◽

10.36106/ijsr/8914451 ◽

2020 ◽

pp. 78-80

Author(s):

Ravi Kumar ◽

Shailendra Kumar Singh

Keyword(s):

Ponseti Method ◽

Recurrence Pattern ◽

Newly Diagnosed ◽

Correction Rate ◽

Normal Functional ◽

Recurrence Patterns ◽

Application Methods ◽

Congenital Talipes ◽

Initial Correction

BACKGROUND: The purpose of the study was to evaluate the comparative outcome of the recurrence pattern in congenital talipes equino varus (CTEV) patient’s upto 5 years old following Ponseti correction and brace application. METHODS: A study of prospectively collected cohort data of 94 newly diagnosed idiopathic CTEV patients who were managed conservatively with Ponseti correction followed by tendoachilles (TA) tenotomy in 90 % of patients and brace application. Patients were evaluated with Pirani scoring prior to commencing Ponseti correction and during follow up and the parents were asked regarding the compliance and acceptance of the brace by the child and the difficulties faced while the child was on brace. RESULT: Out of 94 patients in our study, recurrence of deformity was noticed in 13 patients, while 81 patients had totally normal functional foot. CONCLUSION: We conclude that the Ponseti method enables us to correct most clubfeet with gentle manipulation, casting and foot abduction brace. Experience with the Ponseti method and great attention to the details of manipulation and moulding of the cast are necessary to achieve initial correction rate of over 98%.

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Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

Zanco Journal of Medical Sciences ◽

10.15218/zjms.2021.009 ◽

2021 ◽

Vol 25 (1) ◽

pp. 473-479

Author(s):

Jagar Doski ◽

Berivan Jamal

Keyword(s):

Ponseti Method ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

The Mean ◽

Congenital Talipes ◽

The Difference ◽

Group 2 ◽

Accelerated Protocol ◽

Group 1

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts. Keywords: Clubfoot; Congenital talipes equinovarus; Ponseti; Accelerated; Cast.

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Management of congenital talipes equino varus using Ponseti method: 3 year follow up in 166 club feet

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172890 ◽

2017 ◽

Vol 3 (4) ◽

pp. 775

Author(s):

Rahul Bansal ◽

Angad Jolly ◽

P. B. Mohammed Farook ◽

Idris Kamran ◽

Syed Wahaj ◽

...

Keyword(s):

Club Foot ◽

Ponseti Method ◽

Foot Deformities ◽

Non Invasive ◽

Bilateral Involvement ◽

The Past ◽

Pirani Score ◽

Congenital Talipes

Background: Our aim was to study the effectiveness of Ponseti method using Pirani score in children with club foot treated over the past three years at our hospital.Methods: We studied 111 children with 166 idiopathic club feet who were treated at our teaching hospital between period of January 2012 and January 2017.The foot deformities were assessed using Pirani score at the time of first visit and the scores were recorded with each subsequent visit, with each casting and manipulation until correction of deformity. Tenotomy was performed on all the idiopathic club feet and continued with Steenbeek foot abduction brace (FAB) and the scores were recorded with every follow up and the progress was noted. All the relevant data in terms of treatment and demographics were recorded with dates and maintained.Results: Total of 166 feet of 111 children was treated out of which 72 were males and 39 were females. 55 children had bilateral involvement remaining were unilateral. Mean Pirani score was 5.5 (range 4-6) when the treatment was started. On an average 5.7 casts (range 3-9) were required before preforming a tenotomy. Tenotomy was performed on all the feet (100%) with idiopathic club foot. Foot abduction orthosis was given to all the patients and 108 patients (97.3%) were compliant. Mean Pirani score after three years of treatment was 0.26. Skin complications like blister formation were seen in three children during the course of the treatment. Four patients did not follow up and defaulted. Three patients had relapse or worsening of Pirani score. The recurrence or worsening of scores is thought to be due to poor compliance while using the foot abduction brace.Conclusions: Ponseti method of treatment for CTEV is very effective, simple, non-invasive and convenient with excellent outcomes over long term with no significant complications.

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Recurrence Pattern After Temozolomide Concomitant With and Adjuvant to Radiotherapy in Newly Diagnosed Patients With Glioblastoma: Correlation With MGMT Promoter Methylation Status

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.4969 ◽

2009 ◽

Vol 27 (8) ◽

pp. 1275-1279 ◽

Cited By ~ 205

Author(s):

Alba A. Brandes ◽

Alicia Tosoni ◽

Enrico Franceschi ◽

Guido Sotti ◽

Giampiero Frezza ◽

...

Keyword(s):

Standard Treatment ◽

Methylation Status ◽

Time Interval ◽

Recurrence Pattern ◽

Newly Diagnosed ◽

Mgmt Methylation ◽

Resonance Imaging ◽

Time To Recurrence ◽

Newly Diagnosed Glioblastoma

Purpose The aim of the present study was to evaluate factors predicting the recurrence pattern after the administration of temozolomide (TMZ), initially concurrent with radiotherapy (RT) and subsequently as maintenance therapy, which has become standard treatment for patients with newly diagnosed glioblastoma (GBM). Patients and Methods Ninety-five patients with newly diagnosed GBM were treated with RT plus TMZ (75 mg/m2/d) followed by maintenance TMZ cycles (150 to 200 mg/m2 for 5 days every 28 days). Assessable MGMT methylation status and magnetic resonance imaging follow-up were mandatory in all cases. Results After a median follow-up of 18.9 months (range, 6.6 to 44.8 months), 79 patients (83%) had recurrence: inside the RT field in 57 patients (72.2%), outside in 17 patients (21.5%), and at RT margin in five patients (6.3%). MGMT status was correlated with the site of recurrence, which occurred inside, or at the margin of, the RT field in 51 patients (85%) with MGMT unmethylated status and in 11 patients (57.9%) with MGMT methylated status (P = .01). Recurrences outside the RT field occurred after a longer time interval than those inside the RT field (14.9 v 9.2 months, P = .02). Conclusion After the administration of TMZ concomitant with and adjuvant to RT in patients with GBM, the pattern of, and time to, recurrence are strictly correlated with MGMT methylation status.

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Functional outcome of idiopathic congenital talipes equinovarus treated by Ponseti method: a midterm study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180683 ◽

2018 ◽

Vol 4 (2) ◽

pp. 296

Author(s):

Madhuchandra P. ◽

Raju K. P. ◽

Pawankumar K. M. ◽

Shrinidhi I. S.

Keyword(s):

Functional Outcome ◽

Skeletal Maturity ◽

Ponseti Method ◽

Final Outcome ◽

Indian Children ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Long Term Follow Up ◽

Congenital Talipes

Background: Idiopathic congenital talipes equinovarus is a characterized by deformities with lot of ambiguity regarding the forces maintaining the deformity and preventing its correction. The aim of our midterm study is to analyze the functional outcome of idiopathic congenital talipes equinovarus using Ponseti’s technique in Indian children presenting to us within the first three months of life without any prior treatment.Methods: 87 patients with 132 feet were treated for correction of idiopathic congenital talipes equino varus using the Ponseti technique from September 2009 to January 2013 at our Institute. These patients were followed up in a prospective manner for a period ranging from twelve months to fifty seven months (mean period of follow up was thirty two months). Children were evaluated before casting and at the end of casting, then at monthly intervals for another two months. Further follow up was done every six weeks till three years of age and then at six monthly intervals.Results: Our overall good to fair result was seen in 87.6% of cases. Rest of them had poor functional outcome. Long term follow up of all patients till skeletal maturity is required to know the final outcome of our treatment. Conclusions: Severity of the deformity and the compliance of the parents and infants with orthotic devices for maintenance of the correction were the factors which ultimately determine the final outcome.

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Recurrence patterns of Chinese patients with gastric cancer after complete resection

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15667 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15667-e15667

Author(s):

M. Lu ◽

L. Shen

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Locoregional Recurrence ◽

Distant Recurrence ◽

R0 Resection ◽

Recurrence Pattern ◽

Node Dissection ◽

Recurrence Patterns

e15667 Background: Recurrence after radical resection was the most important factor that influence the prognosis of patients with gastric adenocarcinoma. Focusing on the clinicopathologic features and recurrence patterns, this study aims to find the characteristics of recurrence pattern and the predictive factors of gastric cancer patients in China. Methods: This is a retrospective analysis of the gastric adenocarcinoma patients who accepted adjuvant treatment and follow up in our medical department after R0 resection. From June 1995 through June 2007, among 845 patients with R0 resection, 773 cases with detailed information of follow-up enrolled in this study. The location of first recurrence were reviewed. Recurrences location were categorized as locoregional, peritoneal, or distant. Locoregional recurrence was defined as dominant masses in the gastric bed, regional nodes or anastomotic recurrence. Peritoneal recurrence was documented by positive cytology in ascitic fluid, peritoneal nodules or ovaries with tumors involved. Distant metastases were defined as the specific organ or distant lymph nodes involved. Univariate and multivariate analyses were performed to identify predictive factors of recurrence patterns. Results: Till the last follow-up date in November 2008, 426 patients (55.1%) recurred, and 303(71.1%) recurred within 2 years after resection. The pattern of recurrence was locoregional in 240 patients (31%), distant in 261 patients (33.8%) and peritoneal in 88 patients (11.4%). On multivariate analysis, proximal location, the rate of positive lymph node > 0.33, number of lymph node dissetion<15 and operated in general hospital increase the risk of locoregional recurrence. Distant recurrence was significant associated with male gender, advanced T-stage, positive lymph nodes and number of lymph node dissection<15; female gender, poor differentiation and advanced T-stage were high risk factors of peritoneal recurrence. Conclusions: Different recurrence pattern has remarkable relationship with various clinicopathologic factors. It is noteworthy that both locoregional recurrence and distant recurrence are associated with the number of lymph node dissection, confirming the importantace of lymph node dissection. No significant financial relationships to disclose.

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Correlation of Pirani Scoring with the Outcome of Treatment in Idiopathic Congenital Talipes Equinovarus Treated with Ponseti Method: A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49976.15437 ◽

2021 ◽

Author(s):

Karnakar Kolla ◽

BD Athani ◽

Shweta Jain ◽

Vikas Gupta

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Ponseti Method ◽

Achilles Tenotomy ◽

Pirani Score ◽

Satisfactory Outcome ◽

Talipes Equinovarus ◽

Congenital Talipes

Introduction: Congenital Talipes Equino Varus (CTEV) is the most common congenital musculoskeletal malformation and Ponseti method of correction is most commonly used technique. Pirani score is the simplest, reliable and quick to use tool designed to assess the severity of deformity. Aim: To evaluate the results of Ponseti method in children with idiopathic CTEV using modified Pirani score. Materials and Methods: A prospective cohort study was conducted over a period of 18 months from September 2015 to February 2017 in the Departments of Physical Medicine and Rehabilitation (PMR) and Orthopaedics of Safdarjung hospital, New Delhi. Thirty cases representing 47 feet were recruited for the study. They were divided (15 in each) into 0-6 months (younger) and 6-12 months (older) group and were evaluated pre and post Ponseti correction using modified Pirani score in terms of number of casts required, necessity of Percutaneous Tendo-Achilles Tenotomy (PTAT) and the outcome after 12 months of follow-up. Spearman rank correlation coefficient was used for correlation. Results: There was preponderance of bilateral CTEV, 17 (56.6%) and 38 severe cases (80.85%) had mean Pirani score higher (5.52) in older group than in younger group (5.38). Number of casts required to correct the deformity with Pirani score 0 at the end of the treatment was related to severity (p=0.001) and not age (p=0.591). Present study showed 43 feet (91.48%) required PTAT to correct the equinus deformity (p=0.041). Satisfactory outcome was noted in 41 feet (87.23%) of cases at 12 months of follow-up out of which more were in younger age group. Conclusion: Requirement of number of casts and tenotomy was related with severity of CTEV.

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Treatment of non-idiopathic clubfeet with the Ponseti method: a systematic review

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180066 ◽

2018 ◽

Vol 12 (6) ◽

pp. 575-581 ◽

Cited By ~ 4

Author(s):

T. De Mulder ◽

S. Prinsen ◽

A. Van Campenhout

Keyword(s):

Systematic Review ◽

Successful Treatment ◽

Primary Treatment ◽

Ponseti Method ◽

Current Evidence ◽

Level Of Evidence ◽

Long Term Effect ◽

Initial Correction ◽

Meta Analyses

Purpose Although non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method. Methods PubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Data on average number of casts, Achilles tendon tenotomy (ATT), initial correction, recurrence, successful treatment at final follow-up and complications were pooled. The Methodological Index for Non-Randomized Studies was used to assess the methodological quality of the selected studies. Results In all, 11 studies were included, yielding a total of 374 non-idiopathic and 801 idiopathic clubfeet. Non-idiopathic clubfeet required more casts (7.2 versus 5.4) and had a higher rate of ATT (89.4% versus 75.7%). Furthermore, these feet had a higher recurrence rate (43.3% versus 11.5%) and a lower rate of successful treatment at final follow-up (69.3% versus 95.0%). Complications were found in 20.3% of the non-idiopathic cohort. When comparing results between clubfeet associated with myelomeningocele and arthrogryposis, the first group presented with a lower number of casts (5.4 versus 7.2) and a higher rate of successful treatment at final follow-up (81.8% versus 58.2%). Conclusion The Ponseti method is a valuable and non-invasive option in the primary treatment of non-idiopathic clubfeet in young children. Studies with longer follow-up are necessary to evaluate its long-term effect. Level of Evidence Level III – systematic review of Level-III studies. This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

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