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Diffuse Large B-Cell Lymphoma of the Ankle
A Case Study of Surgical Intervention and Outcome
The most common type of non-Hodgkin’s lymphoma is the B-cell type. We report herein a type of B-cell lymphoma in an adult ankle. A 63-year-old woman presented with a painful growth on the anteromedial aspect of her right ankle that was later diagnosed as a form of non-Hodgkin’s lymphoma. Clinically, the single mass appeared bluish in color, painful on palpation, and warm to the touch. The overlying skin was friable, and the lesion did not transilluminate. Histopathologic examination revealed a diffuse large B-cell lymphoma of germinal center origin on surgical excision. This case report focuses on the clinical presentation, surgical intervention, and overall outcome of a rare case of lymphoma of the ankle. (J Am Podiatr Med Assoc 100(6): 505–510, 2010)
Background: An unanticipated decrease in applications to podiatric medical schools in the late 1990s has resulted in a decline in the number of podiatric physicians per capita in the United States. This study explores the implications of five possible scenarios for addressing this decline.
Methods: With the help of an advisory committee and data from the American Podiatric Medical Association, projections of the supply of podiatric physicians were developed using five different scenarios of the future. Projections of several factors related to the demand for podiatric physicians were also developed based on a review of the literature.
Results: The projections reveal that unless the number of graduations of new podiatric physicians increases dramatically, the supply will not keep up with the increasing demand for their services.
Conclusion: The growing supply-demand gap revealed by this study will be an important challenge for the podiatric medical profession to overcome during the next couple of decades.
This study examined the effect of customized insoles in relieving postwork discomfort in healthy individuals whose jobs require long periods of standing and walking. CompuSole insoles were worn by 122 New York City Police Department officers for up to 5 weeks for an average of 7 hours per day. The officers walked an average of 3 miles per day. Before the study, one-fifth of the police officers in this study experienced foot pain or discomfort at the end of their workday; 15% had calluses, corns, or athlete’s foot; 18% had sought treatment for a foot problem in the past; and 20% had worn foot orthoses. There was a significant reduction in tiredness in the feet at the end of the day after wearing the insoles, but no improvement in back or leg discomfort. At the end of the workday, 68% had less foot discomfort and 60% were more comfortable at work when wearing the insoles. (J Am Podiatr Med Assoc 91(10): 515-520, 2001)
INTRODUCTION AND OBJECTIVES: Due to its inert character and desired biocompatibility, titanium (Ti) implants have been universally accepted as safer alternatives to the previous conventional orthopedic hardware implants. However, a recent emergence of Type IV hypersensitivity reactions to Ti have displayed symptoms that include eczema, contact dermatitis, prolonged fever, sterile osteomyelitis, and impaired fracture and wound healing. The following case presents a patient with postoperative incision dehiscence and devascularization of cortical surfaces in contact with Ti hardware after undergoing a medial displacement calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis. To our knowledge, this is the only reported case of an allergic reaction to a Ti implant in the foot or ankle in the United States.
METHODS: Diagnostic tools to confirm a Ti hypersensitivity reaction include a patch test and lymphocyte transformation test. The lymphocyte transformation test can be utilized if a false negative patch test is suspected. Potential treatment options include immunosuppressants, removal or substitution of the Ti hardware, and external fixation.
RESULTS: In this case, the patient's allergy to Ti was confirmed with a patch test, and all hardware was subsequently removed with no other complications.
CONCLUSIONS: A hypersensitivity reaction to Ti should remain a differential diagnosis for a patient presenting with symptoms such as prolonged fever, contact dermatitis, sterile osteomyelitis, and impaired wound healing. Preoperative diagnostic tools, such as the patch test, can be utilized to prevent allergic reactions from occurring. Treatments for Ti hypersensitivity should be tailored to fit the patient's needs and can include removal or substitution of the Ti hardware, external fixation, and immunosuppressants.
Background:
Diabetic foot wounds remain a significant health-care issue. Healing these wounds in a timely manner is of paramount importance because the duration of ulceration correlates with increased rates of infection and amputation, costing billions of dollars yearly. Collagen-based matrices have been used as wound covers and have been shown to improve and expedite healing. We present our experience with equine pericardium biomatrix for the treatment of neuropathic foot wounds.
Methods:
Thirty-four patients with 37 diabetic foot wounds were evaluated at two institutions prospectively. All of the wounds were debrided, and equine pericardium biomatrix was applied. Secondary dressings were changed every 48 to 72 hours until healed or for 12 weeks after application. Healing rate at 12 weeks, time to wound closure, and complications were evaluated.
Results:
Twenty-two men and 12 women (mean age, 56.9 years) were treated and evaluated. Mean and median wound sizes at initial treatment were 715.8 and 440 mm2, respectively. The overall wound healing rate by 12 weeks was 75.7% (n =28). Mean and median times to wound closure were 7.2 and 7.0 weeks, respectively. No device or procedure-related complications were reported.
Conclusions:
The use of equine pericardium as a temporary biological scaffold is safe and effective for the treatment of chronic neuropathic foot wounds. (J Am Podiatr Med Assoc 102(5): 352–358, 2012)
Do US Veterans Wear Appropriately Sized Shoes?
The Veterans Affairs Shoe Size Selection Study
Poorly fitting footwear has frequently been cited as an etiologic factor in the pathway to diabetic foot ulceration. However, we are unaware of any reports in the medical literature specifically measuring shoe size versus foot size in this high-risk population. We assessed the prevalence of poorly fitting footwear in individuals with and without diabetic foot ulceration. We evaluated the shoe size of 440 consecutive patients (94.1% male; mean ± SD age, 67.2 ± 12.5 years) presenting to an interdisciplinary teaching clinic. Of this population, 58.4% were diagnosed as having diabetes, and 6.8% had active diabetic foot ulceration. Only 25.5% of the patients were wearing appropriately sized shoes. Individuals with diabetic foot ulceration were 5.1 times more likely to have poorly fitting shoes than those without a wound (93.3% versus 73.2%; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–21.9; P = .02). This association was also evident when assessing only the 32.3% of the total population with diabetes and loss of protective sensation (93.3% versus 75.0%; OR, 4.8; 95% CI, 1.1–20.9; P = .04). Poorly fitting shoes seem to be more prevalent in people with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. This implies that appropriate meticulous screening for shoe-foot mismatches may be useful in reducing the risk of lower-extremity ulceration. (J Am Podiatr Med Assoc 96(4): 290–292, 2006)
Two randomized, double-blind, placebo-controlled studies assessed the analgesic efficacy of valdecoxib in patients with moderate-to-severe pain after bunionectomy. Study 1 (N = 374) assessed the efficacy of two regimens of valdecoxib on the day after surgery (valdecoxib, 40 mg, with a 20-mg redose [n = 127]; valdecoxib, 40 mg, with a placebo redose [n = 122]; and placebo/placebo [n = 125]), and study 2 (N = 478) examined the efficacy of two different multiple-dose regimens on postoperative days 2 through 5 (valdecoxib, 20 mg, twice daily [n = 160]; valdecoxib, 20 mg, once daily [n = 159]; and placebo [n = 159]). Valdecoxib provided significant pain relief and reduced the use of opioid rescue medication. This efficacy was accompanied by improved global scores, decreased pain interference with function, and increased patient satisfaction. (J Am Podiatr Med Assoc 96(5): 393–407, 2006)
