AP-PA field orientation followed by IMRT reduces lung exposure in comparison to conventional 3D conformal and sole IMRT in centrally located lung tumors

Little attention has been paid to the fact that intensity modulated radiation therapy (IMRT) techniques do not easily enable treatment with opposed beams. Three treatment plans (3 D conformal, IMRT, and combined (anterior-posterior-posterio-anterior (AP-PA) + IMRT) of 7 patients with centrally-located lung cancer were compared for exposure of lung, spinal cord and esophagus. Combined IMRT and AP-PA techniques offer better lung tissue sparing compared to plans predicated solely on IMRT for centrally-located lung tumors

Assessment of insulin resistance by a 13C glucose breath test: a new tool for early diagnosis and follow-up of high-risk patients

<p>Abstract</p> <p>Background/Aims</p> <p>Insulin resistance (IR) plays an important role in the pathogenesis of diabetes and non-alcoholic fatty liver disease (NAFLD). Current methods for insulin resistance detection are cumbersome, or not sensitive enough for early detection and follow-up. The BreathID^®system can continuously analyse breath samples in real-time at the point-of-care. Here we determined the efficacy of the BreathID^®using the ¹³C-Glucose breath test (GBT) for evaluation of insulin resistance.</p> <p>Methods</p> <p>Twenty healthy volunteers were orally administered 75 mg of ¹³C-glucose 1-¹³C. An oral glucose tolerance test (OGTT) was performed immediately; followed by serum glucose and insulin level determinations using GBT. GBT and OGTT were repeated following exercise, which alters insulin resistance levels.</p> <p>Results</p> <p>Within-subject correlations of GBT parameters with serum glucose and serum insulin levels were high. Before and after exercise, between-subjects correlations were high between the relative insulin levels and the % dose recoveries at 90 min (PDR 90), and the cumulative PDRs at 60 min (CPDR 60). Pairwise correlations were identified between pre-exercise Homeostasis Model Assessment (HOMA) IR at 90 min and PDR 90; HOMA B (for beta cell function) 120 and CPDR 30; HOMA IR 60 and peak time post-exercise; and HOMA B 150 with PDR 150.</p> <p>Conclusions</p> <p>The non-invasive real-time BreathID^®GBT reliably assesses changes in liver glucose metabolism, and the degree of insulin resistance. It may serve as a non-invasive tool for early diagnosis and follow up of patients in high-risk groups.</p

Peroneus longus tear and its relation to the peroneal tubercle: A review of the literature

Tear of the peroneal tendon may occur in different anatomical sites. The most prevalent site is around the lateral malleolus. Tear of the peroneus longus at the level of the peroneal tubercle is unusual. Anatomically, the lateral surface of the calcaneous can be divided into thirds. The middle third includes the peroneal tubercle, which separates the peroneus longus tendon from the peroneus brevis. An anatomic variation of the peroneal tubercle may lead to chronic irritation of the peroneus longus tendon that could ultimately cause a longitudinal tear. We conducted this review aiming to clarify the anatomy, biomechanics of the tendon, and the clinical features of tear of the peroneus longus tendon on the lateral surface of the calcaneous due to an enlarged peroneal tubercle. In addition, we reviewed the diagnostic and treatment options of peroneal tendon tears at this sit

Chronic insertional Achilles tendinopathy: surgical outcomes

Background and objective: insertional Achilles tendinopathy is a common condition among athletes and joggers. One fifth of the injuries involves the insertion of the tendon. The etiology is either due to mechanical overuse related to sports activity, or a systemic inflammatory disease. The clinical appearance includes pain and movement restriction. The primary treatment is conservative. The surgery referred to in this study (Calcaneal Osteotomy) is performed by decompression of the posterior margin of the calcaneus. If the tendon is degenerative, debridement is needed. There is controversy on the surgical outcome and the surgical approach. A retrospective analytic observational study. Methods: 20 patients who were diagnosed with IAT (21 feet) and were operated on between the years 2000-2007 by calcaneal osteotomy. Main outcome measures: the primary measure of success was diminished pain. It was demonstrated in the AOFAS score and in the VAS scale of pain. Results: the average grade in the AOFAS questionnaire improved by 20 points, and the average grading of pain in the VAS scale was decreased by 4.21. The median satisfaction rate was 8, the average was 5.81. 62% of the patients would repeat the surgery/ recommend it. We found a significant relationship (p=0.022) between patients who avoided sports activity while suffering from insertional Achilles tendinopathy and the satisfaction rate from the surgery. Conclusions: using the calcaneal osteotomy technique as a surgical treatment for IAT is successful, and improves measures of pain and function. Low compliance with avoiding sports activity while suffering from an IAT might lead to a need for surger

A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones

Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. We aimed to determine the optimal method for sesamoid bone reduction in HV surgery. Methods: We reviewed the records of 53 patients who underwent HV surgery by a single surgeon from 2017 to 2019 according to one of three techniques: open chevron osteotomy (n=19), minimally invasive V-shaped osteotomy (n=18) and a modified, straight minimally invasive osteotomy (n=16). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs. Results: Postoperative sesamoid position scores were significantly lower (better) following the modified osteotomy than following open chevron osteotomy and V-shaped osteotomy (1.44±0.81, 3.74±1.48 and 4.61±1.09, respectively, P&lt;0.001); and the mean change in score was greater (P&lt;0.001). Conclusion: Modified minimally invasive osteotomy was superior to the two other techniques, in the correction of HV deformity in all planes, including sesamoid reduction

Cerebrovascular accidents associated with hip fractures: morbidity and mortality—5-year survival

Abstract Background Hip fractures are associated with increased cerebrovascular accidents (CVAs) in the first postoperative year. Long-term follow-up for CVA and mortality after hip fracture is lacking. The purpose of this study was to identify risk factors for CVA and follow mortality in hip fractures in a cohort with greater than 2 years follow-up. Methods We compared past medical history of patients with hip fractures to long-term survival and the occurrence of CVA. Past medical history, surgical intervention, CVA occurrence, and death were queried from the electronic medical recorder system. Level of significance was set at p < 0.05 with 95% confidence interval. Results Two thousand one hundred ninety-five patients met inclusion criteria. Mean follow-up was 5 years. One hundred ten (5.01%) patients were diagnosed with post-fracture CVA. Forty-one patients had CVA in the first year and 55 patients had CVA between 1 to 5 years after surgery. Among the potential risk factors, hypertension (HTN), atrial fibrillation (AF), and diabetes mellitus (DM) had the highest odds ratio for CVA (OR = 1.885, p value = 0.005; OR = 1.79, p value = 0.012; OR = 1.66, p value = 0.012). The median survival time in patients with CVA was 51.12 ± 3.76 months compared to 59.60 ± 0.93 months in patients without CVA (p = 0.033). Conclusions HTN, AF, and DM are significant risk factors for the occurrence of CVA after hip fracture. The majority of CVAs occur between the first and fifth year postoperatively, and CVA is a negative prognostic factor for postoperative survival