Lateralising DMMO (MIS) for simultaneous correction of a pes adductus during surgical treatment of a hallux valgus.

The surgical correction of a hallux valgus deformity presenting with a pes adductus has long proven to be a difficult undertaking. The medial shift of the metatarsal bones limits the scope for surgical correction and leads to inherently high reoccurrence rates. Current invasive treatments often give rise to profound soft tissue trauma and prolonged swelling, while requiring strict relief from weight-bearing in the affected foot. In this paper, it is aimed to introduce an easy and useful modification of the Distal Metatarsal Minimal-invasive Osteotomy (DMMO) to perform the effective, simultaneous correction of a pes adductus during surgical treatment of a hallux valgus. We followed-up 143 patients with a hallux valgus and simultaneous pes adductus deformity who underwent one of three additional interventions contemporaneous to the lateralising DMMO: The assessment of radiological and clinical outcomes after a follow-up period of 12-25 months showed a sustained and effective correction of the pes adductus with a well-aligned hallux. The surgery was characterised by a low incidence of postoperative complications and high patient satisfaction while allowing for pain-adapted, post-operative weight-bearing. Level of Clinical Evidence: 3.

Differential diagnosis of pleural effusions by fuzzy-logic-based analysis of cytokines.

Pleural effusions can be caused by highly different underlying diseases and are characterized by complex interactions of various local and circulating cells as well as numerous soluble parameters like interleukins (IL). Knowledge about this complex network could help to indicate underlying disease. Therefore, we have investigated immunoreactive concentrations of IL-4, IL-6, IL-11, IL-15, IL-17, IL-18, and tumor necrosis factor-alpha (TNF-alpha) in pleural effusions and peripheral blood from patients with tuberculosis, bronchial carcinoma and other carcinomas as well as congestive heart failure (CHF) and pneumonias. To determine the value of cytokine measurement for differential diagnosis, statistical and fuzzy-logic methods were applied. Quantitative analysis showed high concentrations of IL-6 and IL-11 only in pleural effusions. IL-15, IL-17, IL-18 and TNF-alpha could be detected also in blood plasma. Lowest amounts were detected in CHF indicating the non-inflammatory origin of effusions. Statistical analysis did not provide evidence for diagnostic relevance of singular cytokines. Fuzzy-logic analysis was able to assign patients to the correct diseases with 80% accuracy using IL-6 and IL-15 measurement. Our results confirm the pathogenetic role of these cytokines in pleural effusions. Fuzzy-logic-based procedures may help to characterize and distinguish effusions of unknown origin even in small patient groups.