Correlation of Foot Posture Index With Plantar Pressure and Radiographic Measurements in Pediatric Flatfoot

OBJECTIVE: To investigate the correlation between the Foot Posture Index (FPI) (including talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, talonavicular bulging, congruence of the medical longitudinal arch, and abduction/adduction of the forefoot on the rare foot), plantar pressure distribution, and pediatric flatfoot radiographic findings. METHODS: Nineteen children with flatfoot (age, 9.32+/-2.67 years) were included as the study group. Eight segments of plantar pressure were measured with the GaitView platform pressure pad and the FPI was measured in children. The four angles were measured on foot radiographs. We analyzed the correlation between the FPI, plantar pressure characteristics, and the radiographic angles in children with flatfoot. RESULTS: The ratio of hallux segment pressure and the second through fifth toe segment pressure was correlated with the FPI (r=0.385, p=0.017). The FPI was correlated with the lateral talo-first metatarsal angle (r=0.422, p=0.008) and calcaneal pitch (r=-0.411, p=0.01). CONCLUSION: Our results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot.

Endoscopic Minor Papilla Intervention in a Patient with Traumatic Ductal Leak without Pancreas Divisum / 대한소화기내시경학회지

Endoscopic treatment has been performed in a variety of pancreatic ductal diseases such as stones, strictures, sphincter stenosis, and ductal disruption and is known to be an effective therapy in some patients. Endoscopic treatment through the minor papilla is frequently done in patients with pancreas divisum. Few data are, however, available concerning endoscopic minor papilla interventions in patients without pancreas divisum but with difficult access to the main pancreatic duct at the major duodenal papilla. We present a 49-year-old man, who had pancreatic ductal leak caused by previous pancreatic surgery. He was treated by endoscopic naso-pancreatic drainage and pancreatic ductal stenting through the minor papilla, so called pancreatic rendezvous technique. Follow-up ductography after two-weeks of naso-pancreatic drainage showed no leak. This case shows that minor papillar orifice could be an alternative access for therapeutic endoscopic intervention in a patient with traumatic pancreatic ductal leak without pancreas divisum.

Non-exposed type of ampullary adenoma presenting as acute pancreatitis / 대한내과학회지

The adenoma of major duodenal pallilla is a rare cause of acute pancreatitis. Also, ampullary adenoma is known as a premalignant lesion having the potential for malignant transformation. Especially, the diagnosis of the unexposed (intramural) type of ampullary adenoma, which shows normal overlying mucosa, is known to be very difficult. We report a case of an unexposed type of ampullary adenoma presented as acute pancreatitis. On duodenoscopic examination, mucocal abnormality of the mapulla of Vater was not noted. After endoscopic sphicterotomy, a nodular mass was exposed and the tubular adeonoma was histologically confirmed with endoscopic biopsy.