ABSTRACT
PURPOSE: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. MATERIALS AND METHODS: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. RESULTS: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. CONCLUSION: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.
Subject(s)
Animals , Humans , Ankle , Arthritis, Rheumatoid , Congenital Abnormalities , Follow-Up Studies , Foot , Hallux , Hallux Valgus , Hammer Toe Syndrome , Hoof and Claw , Joints , Metatarsal Bones , Metatarsophalangeal Joint , Orthopedics , Osteotomy , Range of Motion, Articular , ToesABSTRACT
Blood-borne metastatic involvement of the gastric mucosa as a result of cancer is a rare occurrence. The tumors which were most commonly reported to metastasize to the stomach include melanoma, breast carcinoma, and lung carcinoma. Some reports document that large cell carcinoma and squamous cell carcinoma of the lungs have a higher pre- dilection for gastrointestinal tract metastases. Upper gastrointestinal endoscopic findings of metastatic lesions may vary but often produce a characteristic single or multiple bulls eye or target lesion. Therefore, whenever single or multiple target lesions are seen in the stomach on upper gastrointestinal endoscopy or barium study, the examination should include careful radiographic evaluation of the chest. Moreover, when the patient is known to have lung cancer, metastatic disease should be suspected. With a correct diagnosis and proper treatment, relief of symptoms and prolongation of life can sometimes be achieved, A case in reported involving squamous cell lung cancer with stomach metastasis in a 73 year-old woman. The patient was diagnosed by bronchoscopy, upper gastrointestinal endoscopy, chest CT, and abdominal CT. The chest and abdominal CT revealed a poorly marginated, lobulated, and 4 x 3 cm sized mass lesion in the right lower lobe causing obstruction of right lower lobe bronchus with invasion to the left atrium. right inferior pulmonary vein, and superior vena cava. Mediastimal lymph node enlargement and liver metastasis was also detected. Upper gastrointestinal endoscopy showed two "bulls eye" lesions with different sizes and two nodules without tip ulceration.
Subject(s)
Aged , Female , Humans , Barium , Breast Neoplasms , Bronchi , Bronchoscopy , Carcinoma, Large Cell , Carcinoma, Squamous Cell , Diagnosis , Endoscopy, Gastrointestinal , Gastric Mucosa , Gastrointestinal Tract , Heart Atria , Life Support Care , Liver , Lung Neoplasms , Lung , Lymph Nodes , Melanoma , Neoplasm Metastasis , Pulmonary Veins , Stomach , Thorax , Tomography, X-Ray Computed , Ulcer , Vena Cava, SuperiorABSTRACT
Thymoma has been associated with a variety of diseases, including myasthenia gravis, pure red cell aplasia (PRCA), hypogammaglobulinemia, and other abnormal immune and endocrine disorders. Herein we report a case of PRCA associated with invasive thymoma in a 65-year-old man. In spite of total thymectomy and irradiation to the mediastinum, no significant response was observed. The mechanisms and management of PRCA associated with invasive thymoma are reviewed.