ABSTRACT
BACKGROUND: Pes cavus is a progressive and ugly deformity of the foot. Although initially the deformity is painless, with time, painful callosities develop under metatarsal heads and arthritis supervenes later in feet. Mild deformities can be treated with corrective shoes, or foot exercises. However, in others, operative treatment is imperative. Soft tissue operations are largely unsatisfactory and temporary. Bony operations give permanent correction. We present our series of 18 patients of pes cavus in the adolescent age group, treated by Japas' V-osteotomy of the tarsus. MATERIALS AND METHODS: 18 patients of paralytic pes cavus deformity were treated by Japas osteotomy, between March 1995 and 2005, at our institute. The age of the patients ranged from 8.6 to 15 years (mean 11.3); 10 were boys and 8 girls. All cases had unilateral involvement, and all, but one, were post-polio cases. RESULT: The mean follow-up is 5.4 years. Of the 18 patients, 14 had excellent or good corrections; 4 had poor correction/complications. However, those patients could be salvaged by triple arthordesis or Dwyer's calcaneal osteotomy. CONCLUSION: Japas' osteotomy is a satisfactory option for correction of pes cavus deformity in adolescents. In patients who have rigid hind foot equinus or varus, however, the results are compromised.
ABSTRACT
Clozapine, an atypical antipsychotic has been associated with several side effects like sialorrhoea, sedation, tachycardia, agranulocytosis and seizure. Myotoxicity and neurotoxicity have also been reported with long-term use of clozapine. We report here a case of myotoxicity developing after acute overdose of clozapine. A 17-year-old daughter of a schizophrenic father consumed 3.9 g of clozapine in an attempted suicide. Clinical features of myotoxicity were detected on the third day, after the patient regained full consciousness. Elevated creatinine phosphokinase and muscle biopsy confirmed myositis. The patient also had tachycardia, which persisted for 10 days. This combination of myositis-induced muscle weakness and tachycardia is likely to be associated with poor outcome in clozapine overdose.
