The surgical treatment of hallux valgus using distal metatarsal osteotomy and stabilization with a hallux splint. Preliminary results.

The preliminary results of the surgical treatment of hallux valgus using subcapitate chevron-type osteotomy of the 1st metatarsal modified using a dynamic interfragmentary device are reported. The method satisfies the need to restore angular metatarsophalangeal and intermetatarsal values and improves metatarsal pain caused by hallux valgus correction, which influences the cosmetic results.

The scarf osteotomy for the treatment of hallux valgus deformity: a review of 84 cases.

This study reviewed the subjective, clinical and radiological outcome of 71 patients (84 feet) treated by scarf osteotomy for hallux valgus deformity at our institution from 1995 to 1998 with an average follow-up time of 22 months (range, 17 to 48 months). At the time of follow-up, 39% of the patients were very satisfied, 50% were satisfied and 11% were not satisfied. The mean AOFAS score raised significantly from 43 points (14-68) preoperatively to 82 points (39 to 100) at follow-up (p < 0.001). The radiological angles including M1-M2, M1-P1, M1-M5 and DMAA improved significantly (p < 0.001). Among the 16 complications recorded, seven (8%) were minor and nine (11%) required an additional procedure. The scarf osteotomy of the first metatarsal coupled with a lateral soft-tissue release and, in three-quarters of our cases, with a basal closing wedge varisation osteotomy of the first phalanx, resulted in overall high satisfaction rate as well as significant clinical and radiological improvements in our series. Nevertheless, the range of motion of the first MP joint remained low: 30 degrees to 74 degrees in 52 patients (62%) and <30 degrees in four patients (5%). Furthermore, the mobility of the first ray as well as the consequences of the procedure in the sagittal plane need to be assessed more accurately, and this may be achieved by incorporating measurement of the plantar pressures in the forefoot area into the global rating system.

Recurrent or aggressive bladder cancer. Indications for adjuvant intravesical therapy.

Advances in understanding of the variables that adversely affect the prognosis of patients with superficial bladder cancer allow more accurate predictions of the aggressive biologic potential of tumors. Intravesical therapy appears to be an effective and essential adjuvant in those patients with high-risk tumor variables. Multiple risk factors related to the tumor, individual patient characteristics, and treatment modality must be evaluated. Assignment of the relative importance of these risk factors will differ from patient to patient. Factors useful for predicting tumor aggressiveness in order to decide the appropriateness of adjuvant intravesical therapy include tumor size, configuration, and grade; ploidy status; Tis and T1 categories; multifocality; postoperative cytologic analysis; the failure of prior intravesical therapy; and prostatic urethral involvement. The integration of this information with formulation of a treatment plan represents both the art and the science of urologic oncologic practice. Research efforts need to be directed at the development of better tumor markers for superficial bladder cancer.

Urethral duplication.

Duplication of the urethra is a rare congenital anomaly. While it is true that in some instances reconstructive surgery is not necessary, those cases that require repair pose a significant challenge to the urologist. Our experience with 3 cases illustrates the potential complexity of this deformity. Two patients presented with significant renal compromise secondary to bladder outlet obstruction and required reconstruction of the entire anterior urethra. The third patient presented with a urethral fistula after circumcision and repair was done by ventral-to-dorsal urethrourethrostomy. A workable classification of duplicated and accessory urethra is outlined. This classification is based on the source of the secondary channel, its point of emptying (that is internal, external or blind) and the relationship of the secondary channel to the normal urethra (that is dorsal or ventral).

Spermatic vessel ligation (Fowler-Stephens maneuver): experimental results with regard to fertility.

The effect of unilateral testicular infarction following torsion on contralateral testis spermatogenesis has been studied directly in rats and indirectly in man. Adverse effects on semen quality in humans and on testis biopsy in the experimental animal have been demonstrated. The spermatogenic function of normal contralateral testes following orchiopexy is known to be suboptimal. We studied the effects of transient testis ischemia produced by spermatic vessel ligation (the Fowler-Stephens maneuver) on spermatogenesis in the normal (contralateral) testis in mature Sprague-Dawley rats with spermatogenic activity determined in 10 days. Also, a group of prepubertal rats were operated upon and allowed to reach maturity to determine if prepubertal ischemia would result in any effect on the contralateral testis. Testis injury caused by acute ligation of the total testis blood supply does not cause morphological or spermatogenic changes in the contralateral testis. Ligation of the spermatic vessels may result in varying degrees of testicular injury. Often this injury is much greater histologically than one would expect from gross examination of the testis. However, the effects of this injury on the sperm production in the contralateral testis are negligible in rats and did not result in an iatrogenic decrease in fertility.

Involvement of the genitourinary system in multiple primary malignant neoplasms: a review.

A case is presented of a patient with separate primaries of the cervix, breast, bladder, and kidney. In a review of 352,073 cancer patients in the literature, the genitourinary system appears to be at a greater risk of this phenomenon. The entity of multiple primary malignant neoplasms is reviewed with an analysis of the involvement of the genitourinary system.