Echocardiography revealed a left atrial tumor in a 59-year-old man with back pain that concurrently worsened with left foot drop and loss of the left ankle reflex soon after admission to our hospital. Magnetic resonance imaging of the spine revealed an epidural tumor extending from Th5 with spinal cord compression. The patient was immediately treated by emergency Th4-5 laminectomy and epidural decompression. One month later, a cardiac tumor excised via the left atrial approach was histopathologically diagnosed as myxosarcoma, and the Th5 tumor was consistent with this finding. This is the first report to describe spinal metastasis of cardiac myxosarcoma.

BACKGROUND:

Aim of this study was to evaluate prognosis of severely injured patients.

METHODS:

All severely injured patients with an Injury Severity Score (ISS) >= 50 were identified in a 6-year-period between 2000 and 2005 in German Level 1 Trauma Center Murnau. Data was evaluated from German Trauma Registry and Polytrauma Outcome Chart of the German Society for Trauma Surgery and a personal interview to assess working ability and disability and are presented as average.

RESULTS:

88 out of 1435 evaluated patients after severe polytrauma demonstrated an ISS >= 50 (6.5 %), among them 23 % women and 77 % men. 66 patients (75 %) had an ISS of 50-60, 14 (16 %) 61-70, and 8 (9 %) >= 70. In 27 % of patients trauma was caused by motor bike accidents. 3.6 body regions were involved. Patients had to be operated 5.3 times and were treated 23 days in the ICU and stayed 73 days in hospital. Mortality rate was 36 % and rate of multi-organ failure 28 %. 15 % of patients demonstrated severe senso-motoric dysfunction as well as residues of severe head injury. 25 % recovered well or at least moderately. 29 out of 56 survivors answered the POLO-chart. A personal interview was performed with 13 patients. The state of health was at least moderate in 72 % of patients. In 48 % interpersonal problems and in 41 % severe pain was observed. In 57 % of patients problems with working ability regarding duration, as well as quantitative and qualitative performance were observed. Symptoms of post-traumatic stress disorder were found in 41 %. The more distal the lesions were located (foot/ankle) the more functional disability affected daily life. In only 15 %, working ability was not impaired. 8 out of 13 interviewed patients demonstrated complete work disability.

CONCLUSIONS:

Even severely injured patients after multiple trauma have a good prognosis. The ISS is an established tool to assess severity and prognosis of trauma, whereas prediction of clinical outcome cannot be deducted from this score.

Computed tomographic (CT) scans of the ankle and foot are frequently obtained with in-patients with hind foot and ankle pain to identify fractures, arthritis, and bone lesions. Soft tissue detail is limited, however. Dual-energy CT provides additional information on soft tissue structures, including tendons, with no additional radiation dose to the patient. We present a case of an Achilles tendon tear visualized on DECT, which was subsequently confirmed with magnetic resonance imaging.

The Manchester-Oxford Foot Questionnaire (MOXFQ) is a validated 16-item, patient-reported outcome measure for evaluating outcomes of foot or ankle surgery. The original development of the instrument identified three domains. This present study examined whether the three domains could legitimately be summed to provide a single summary index score.The MOXFQ and Short-Form (SF)-36 were administered to 671 patients before surgery of the foot or ankle. Data from the three domains of the MOXFQ (pain, walking/standing and social interaction) were subjected to higher order factor analysis. Reliability and validity of the summary index score was assessed.The mean age of the participants was 52.8 years (sd 15.68; 18 to 89). Higher order principle components factor analysis produced one factor, accounting for 74.7% of the variance. The newly derived single index score was found to be internally reliable (α = 0.93) and valid, achieving at least moderate correlations (r ≥ 0.5, p < 0.001) with related (pain/function) domains of the SF-36.Analyses indicated that data from the MOXFQ can be presented in summary form. The MOXFQ summary index score (MOXFQ-Index) provides an overall indication of the outcomes of foot and ankle surgery. Furthermore, the single index reduces the number of statistical comparisons, and hence the role of chance, when exploring MOXFQ data.

Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the surgical treatment of insertional Achilles tendinosis.

OBJECTIVES:

This multicenter prospective trial was conducted to evaluate the clinical performance of a new neurostimulation system designed to treat chronic pain through the electrical neuromodulation of the dorsal root ganglia (DRG) neurophysiologically associated with painful regions of the limbs and/or trunk.

MATERIALS AND METHODS:

Thirty-two subjects were implanted with a novel neuromodulation device. Pain ratings during stimulation were followed up to six months and compared with baseline ratings. Subjects also completed two separate reversal periods in which stimulation was briefly stopped in order to establish the effects of the intervention.

RESULTS:

At all assessments, more than half of subjects reported pain relief of 50% or better. At six months postimplant, average overall pain ratings were 58% lower than baseline (p < 0.001), and the proportions of subjects experiencing 50% or more reduction in pain specific to back, leg, and foot regions were 57%, 70%, and 89%, respectively. When stimulation was discontinued for a short time, pain returned to baseline levels. Discrete coverage of hard-to-treat areas was obtained across a variety of anatomical pain distributions. Paresthesia intensity remained stable over time and there was no significant difference in the paresthesia intensity perceived during different body postures/positions (standing up vs. lying down).

CONCLUSIONS:

Results of this clinical trial demonstrate that neurostimulation of the DRG is a viable neuromodulatory technique for the treatment of chronic pain. Additionally, the capture of discrete painful areas such as the feet combined with stable paresthesia intensities across body positions suggest that this stimulation modality may allow more selective targeting of painful areas and reduce unwanted side-effects observed in traditional spinal cord stimulation (SCS).

Rupture of Achilles tendon is the most common among those taking place in the lower extremities, being twice as common in men than in women between 30-50 years old and usually caused while doing sport. There are some risk factors such as age or chronic treatments based on corticosteroids or antibiotics when belonging to Quinolones group. Spontaneous bilateral rupture of the Achilles tendon is much more infrequent, being almost exceptional in young and healthy patients without known pathological conditions.In relation to a specific clinical case, a medical history review was developed: personal history, diagnosis, treatment and progress.Asthmatic 45 year old male occasionally undergoing medical treatment with inhaled corticosteroids. Previously asymptomatic. Training athletics in the morning and handball in the afternoon. After the first 10 min of the match notices a bilateral acute pain when starting to run, showing ruptures of both Achilles tendons confirmed by MRI scan. Treatment: surgical open-to-end suture reinforced with inverted taenia (see figure 1 below). Development: 3 weeks immobilisation without setting foot, 3 weeks Walker boot, partial setting foot and rehabilitation, medical discharge after 6 months without complications.Simultaneous and spontaneous rupture of bilateral Achilles tendons in patients without pathological factors is really unusual. 25% of the healthy population above 30 years of age has degenerative structural changes in the Achilles tendon that increase the risk of rupture depending on the patient's activity level. Both percutaneous and open surgical treatments on young and active patients provide an appropriate alternative. The open surgical treatment allows the possibility of tendon reinforcement techniques and a more complete visualisation of the damage. The postsurgical rehabilitation management is an important factor for biomechanic tendon recovery alsoallowing the restart of patient's activities as soon as possible. Figure 1Appearance of Achilles tendon before (left) and after (right) surgical repair.

The present retrospective investigation aimed to determine the factors associated with recurrence of hallux valgus deformity after scarf osteotomy in 50 feet in 43 consecutive patients. We hypothesized that hallux abductovalgus after scarf osteotomy recurs because of the presence of preoperative joint incongruity. The clinical and radiographic findings, including the weightbearing radiographic hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, first metatarsophalangeal joint congruence, American Orthopaedic Foot and Ankle Society scores, and pain measured on a visual analog scale, and logistic regression analysis were used to analyze the association of the independent variables with the recurrence of deformity. The mean age of the patients was 47.7 (range 21 to 65) years, and the mean follow-up duration was 26.2 (range 18 to 36) months. The mean American Orthopaedic Foot and Ankle Society scores improved from 50.7 ± 4.9 to 88.7 ± 7.9, and the visual analog scale pain scores improved from 7.5 ± 1.1 to 2.4 ± 1.0 (p < .05). The changes in the radiographic measurements were also statistically significant. Of the 50 feet, 5 (10%) developed recurrent hallux abductovalgus, each of which occurred in feet that had displayed a first metatarsophalangeal joint incongruity on preoperative radiographs. The incongruity was observed to be a statistically significant risk factor for recurrence according to the regression models. From our experience with the patients analyzed in the present report, we believe that first metatarsophalangeal joint congruity should be given particular attention when surgical correction of hallux abductovalgus is undertaken.

Objective.

When exploring the scientific basis of reflexology techniques, elucidation of the surface and subsurface features of reflexology areas (RAs) is crucial. In this study, the subcutaneous features of RAs related to the lumbar vertebrae were evaluated by swept source-optical coherence tomography (SS-OCT) in subjects with and without low back pain (LBP). Methods. Volunteers without LBP (n = 6 (male : female = 1 : 1)) and subjects with LBP (n = 15 (male : female = 2 : 3)) were clinically examined in terms of skin colour (visual perception), localised tenderness (visual analogue scale) and structural as well as optical attributes as per SS-OCT. From each subject, 6 optical tomograms were recorded from equidistant transverse planes along the longitudinal axis of the RAs, and from each tomogram, 25 different spatial locations were considered for recording SS-OCT image attributes. The images were analysed with respect to the optical intensity distributions and thicknesses of different skin layers by using AxioVision Rel. 4.8.2 software. The SS-OCT images could be categorised into 4 pathological grades (i.e., 0, 1, 2, and 3) according to distinctness in the visible skin layers.

Results.

Three specific grades for abnormalities in SS-OCT images were identified considering gradual loss of distinctness and increase in luminosity of skin layers. Almost 90.05% subjects were of mixed type having predominance in certain grades.

Conclusion.

The skin SS-OCT system demonstrated a definite association of the surface features of healthy/unhealthy RAs with cutaneous features and the clinical status of the lumbar vertebrae.

Purpose To examine individual and area-level socioeconomic factors that predict the onset of work restriction in employed persons with lower limb joint pain. Methods Population-based prospective cohort study. Adults were aged 50-59, reported hip, knee, foot pain or a combination and maintained employment through 3 year follow-up (n = 716). Work restriction was measured as inability to participate in work as desired. Multi-level logistic regression was used to assess the associations of work restriction onset with baseline factors: health (severity of knee pain/functional limitation, comorbidity, anxiety, depression, cognitive impairment, abnormal weight), demographic socio-economic, environment and area-level employment deprivation. Results 108 (15.1 %) reported the onset of work restriction over 3 years. Severe lower limb joint pain and functional limitation, number of affected body sites and area employment deprivation were independently associated with onset. Significant interactions indicated a greater effect of area employment deprivation on older and more depressed workers. Conclusions Results suggest that effectively preventing work disability in those with OA will require both condition-specific interventions to decrease pain and maintain function, and providing alternative employment opportunities for those with progressive functional limitations. Results in older workers are particularly concerning, as retirement ages are expected to increase in the general population.