Translation and Validation of 'Foot Health Status Questionnaire' in Dutch.

The aim of our study was to develop a Dutch version of the Foot Health Status Questionnaire (FHSQ-NL) and evaluate its measurement properties according to the COSMIN definition (COnsensus-based Standards for the selection of health Measurement INstruments). After translation of the FSHQ, a group of 119 randomly selected patient who visited the outpatient clinic for conditions affecting the foot and ankle were asked to participate, of which103 patients were included in the analysis. The FHSQ-NL, a validated Dutch FAOS and a visual analogue scale (VAS) for pain and function were used in this study as outcomes measures. Reliability was assessed by calculating intraclass correlation coefficient (ICC), internal consistency by Cronbach's alpha, and the smallest detectable change (SDC). Construct validity was evaluated by use of a priori hypotheses concerning Spearman's correlation coefficient between FHSQ subscales and FAOS and VAS. All domains of the FHSQ-NL, besides 'General health,' indicated good internal consistency with a Cronbach's alpha ranging from 0.61 to 0.91. Test-retest reliability of all FHSQ domains was poor with an ICC ranging from 0.47 to 0.77. At individual level, the SDC ranged from 35.1 to 60.6 and at a group level (n = 50) from 5.0 to 8.6. Construct validity was supported by confirmation of 75% of all a priori hypotheses. The FHSQ-NL has good internal consistency and smallest detectable change (SDC) at group level. However, reliability and SDC on individual level show suboptimal results. Therefore, the questionnaire is more suitable for evaluating foot complaints at group level instead of individual level.

A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus.

BACKGROUND: The aim of this study was to evaluate the results following total first metatarsophalangeal (FMTP) joint replacement arthroplasty using a modular three component press fit prosthesis at two year follow up. METHODS: All patient data was collected in a prospective way in four study centres. Both preoperative and postoperative evaluation consisted of an assessment using the AOFAS-HMI score, visual analogue scale for pain, evaluation of the range of motion and patient satisfaction scores. Postoperative X-rays were reviewed for loosening and radiolucency up to two years. RESULTS: Fifty-five feet were available for analysis at 24 months. Two implants were removed during the study. Six more feet had additional surgery due to stiffness or malalignment. Postoperative AOFAS-HMI scores improved significantly by 32.4 points at two year follow-up (p<0.001). The visual analogue scale for pain improved significantly from 6.8 (std 1,6) preoperatively to 1.6 (std 1,9) postoperatively (p<0.0001). Mean dorsiflexion improved from 12.6 (std 10,1) degrees preoperatively to 31.2 (std 16,8) degrees postoperatively. Eighty-seven percent of patients were moderately to well satisfied with the end result. Eighteen prostheses showed radiolucency at 24 months. CONCLUSION: Implantation of a Metis® modular three component press fit prosthesis for the metatarsophalangeal joint in hallux rigidus shows significant improvement in AOFAS-HMI scores and a decrease in pain. Concerns remain with regard to early reoperation rate (14.5%) and long term survival of the implant. Future studies will have to address these aspects.

First metatarsophalangeal joint replacement: long-term results of a double stemmed flexible silicone prosthesis.

BACKGROUND: The aim of this retrospective study was to evaluate the long-term results of a Swanson type silicone prosthesis used for the first metatarsophalangeal (FMTP) joint replacement. It compares implants with and without the use of grommets. METHODS: Fifty-nine FMTP joints were replaced. The average follow-up period was 9 years. Subjective and clinical findings were scored according to the AOFAS-HMI (American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal) score. X-ray examination was carried out by evaluation of the presence of reactive bone areas around the implant. RESULTS: Ninety-five percent of patients had relief of pain. Clinical findings showed a reasonable function (range of motion >30°) in 77% of the FMTP joints. A trend for decrease in radiolucency and lytic bone was seen in areas around the implant with the use of grommets. CONCLUSION: The prosthesis shows good results concerning pain relief and a reasonable to good function (>30° range of motion) of the FMTP joint in most patients. Reactive bone areas around the implant decreased by the use of grommets.

Preoperative acidosis and infant development following surgery for congenital heart disease.

OBJECTIVE: Prenatal diagnosis has been shown to decrease pre-operative acidosis and might prevent the occurrence of disturbed developmental outcome. The aim of this study is to evaluate parameters for acidosis and their predictive value on developmental outcome in newborns with congenital heart disease. METHODS: A total of 117 patients requiring surgery for structural heart disease in the first 31 days of life were included. Diagnosis was established either pre- or postnatally. Preoperative values of lactate, pH and base excess levels were compared to the occurrence of disturbed developmental outcome, i.e. an underperformance of more than 10% on the P90 of a standardized Dutch developmental scale. Patients were divided into groups according to blood levels of acidosis parameters, using receiver operating characteristics curves to determine cut-off values for pH, base excess and lactate. RESULTS: No significant difference in developmental outcome was found using values for pH or base excess as a cut-off level. Preoperative lactate values exceeding 6.1 mmol/l resulted in a significant increase in impaired development compared to infants with a pre-operative lactate lower than 6.1 mmol/l: 40.9% vs 15.1% in (p=0.03). CONCLUSIONS: Pre-operative lactate values might have a prognostic value on developmental outcome in newborns with congenital heart disease. The limited prognostic value of pH can be explained by the fact that pH can be easily corrected, while lactate better reflects the total oxygen debt experienced by these patients.

Characterization of Wue-1, a novel monoclonal antibody that stimulates the growth of plasmacytoma cell lines.

A new monoclonal antibody, Wue-1, which specifically recognizes normal and malignant plasma cells, is characterized. Biochemical studies showed that monoclonal antibodies (mAbs) recognize a protein of 94 kDa. Using triple-staining flow cytometry and double-labeling immunohistochemical techniques, two populations of plasma cells, i.e. lymphoplasmocytoid plasma cells located in the germinal center of lymphoid organs and reticular plasma cells at the paracortex or medullary cords of secondary lymphoid tissues, were distinguished. Wue-1 is expressed when B-cell markers become lost and secretory activity with plasma cell morphology appears. Cell surface markers were identified on normal plasma cells and compared with their malignant counterpart in vivo. Terminal plasma-cellular differentiation of malignant low- and high-grade B-cell lymphoma and anaplastic plasmacytoma, otherwise difficult to identify with conventional B-cell markers on tissue sections or fluorescence-activated cell sorter analyses, were detectable by Wue-1. In cell culture, Wue-1 enhanced the proliferation of myeloma cell lines but not normal plasma cells in a dose-dependent manner. Since Wue-1-induced proliferation was increased by interleukin (IL)-6, Wue-1 recognizes a so far unidentified antigen with functional properties. Therefore, Wue-1 represents a useful new tool for therapy and for the in vivo and in vitro studying of B-cell lymphomas and the mechanisms of B-cell differentiation.