Lege Artis Medicinae

[Treatment of clubfoot with the Ponseti method]

KISS Sándor, TEREBESSY Tamás, HORVÁTH Nikoletta, DOMOS Gyula, GRESITS Orsolya, SZŐKE György

APRIL 20, 2014

Lege Artis Medicinae - 2014;24(04)

[INTRODUCTION - Congenital clubfoot is a severe developmental disorder. Without treatment, only the lateral border of the foot can be loaded and the sole faces the contralateral side. Good results can usually be achieved with early redression by serial casting (generally from the first week after birth) followed by extensive surgery at age six months (Achilles tendon lengthening, capsulotomy of the talo-crural and subtalar joints). The above procedure has been revolutionised by the method described by Ignacio Ponseti based on his own experiences, which has modified the casting technique and has also radically changed the surgical intervention. In this paper we report our experiences with Ponseti’s method and draw attention to this less invasive procedure. PATIENTS AND METHODS -The essence of Ponseti’s techniqe is reposition of the talonavicular joint, for which the foot is corrected in a different way compared with previous practice. Following redression for 8-10 weeks, percutaneous complete Achilles tenotomy is performed and the foot is fixed for further three weeks. A special orthesis is worn in the following 6 months for 24 hours a day and the same ortézis is suggested for overnights afterwards. In our institution, 171 clubfeet (45 unilateral, 126 bilateral; 84 right, 87 left; 25 girls, 83 boys) were treated between 2007 and 2012. Our results were evaluated with the help of the Pirani score, which is a widely used method for assessment of clubfoot treatment. RESULTS - Results were evaluated at the beginning of the treatment, at the end of redression and after percutaneous Achilles tenotomy. Pirani scores were 4.54±1.30; 1.48±1.02 and 0.59±0.45 respectively. The average dorsal flexion of the ankle joints was 23±12 degrees. CONCLUSION - Our own observations support the good results published in the literature, therefore the less invasive Ponseti method is suggested for the primary treatment of congenital clubfoot.]



Further articles in this publication

Lege Artis Medicinae

[Vaccine coverage of invasive and carried Streptococcus pneumoniae isolates in Hungary]

TÓTHPÁL Adrienn, LAUB Krisztina, KARDOS Szilvia, NAGY Károly, DOBAY Orsolya

[Vaccination against Streptococcus pneumoniae will be mandatory for infants and children from 1 July 2014 in Hungary. Since the introduction of the conjugate vaccine against Pneumococcus, the distribution of Pneumococcus serotypes has changed significantly. Surveillance data from the National Centre for Epidemiology show that certain vaccine-type pneumococcal serotypes have almost disappeared owing to the immunization program, while other serotypes have emerged. Nowadays serotype 3 and the multiresistant 19A serotype are the most frequent causes oif invasive infections. A study analysing the nasal carriage of children attending kindergartens also confirmed the decline of vaccine- serotypes parallel to vaccination coverage and the simultaneous emergence of previously very types, such as 19A. The most recent study examining nasal carriage of children attending nursery (age < 3 years) showed that the 13-valent conjugate vaccine has efficiently decreased the carriage of serotypes 3 and 19A, verifying that the immunisation program should be continued using the vaccine providing the broadest coverage against Pneumococcus.]

Lege Artis Medicinae

[Diagnostic challenges in our adolescent patient with lymphoma]

MAGYARI Ferenc, RAJNAI Hajnalka, BARNA Sándor, MILTÉNYI Zsófia, VÁRÓCZY László, CSOMOR Judit, UDVARDY Miklós, ILLÉS Árpád

[OBJECTIVES - Unclassifiable B-cell lymphoma, which shows intermediate features typical for both diffuse, large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma (HL) is a novel category of diffuse, large B-cell lymphomas (DLBCL/HL), described in the WHO classification in 2008. This rare type of lymphomas presents peculiar clinical, morphological and immunophenotypical patterns, previously called gray-zone lymphomas. CASE REPORT - In December 2011 a 17- year old boy was diagnosed with mixedcellularity subtype of classical HL on the basis of left inguinal lymph node biopsy. Staging examinations revealed a IV/BXS (abdominal bulky) stage disease with unfavourable prognosis. Because of the unusally extended disease (nodal-extranodalbulky), a histological revision was performed. After a half course of ABVD chemotherapy the patient’s symptoms disappeared and the sizes of the involved lymph nodes decreased. On the basis of the histological revision, the diagnosis was changed to DLBCL/HL, so the treatment was modified to R-CHOP-14 regimen. After 3 cycles of R-CHOP-14 a complete metabolic remission (CMR) was achieved, which was confirmed by a 18FDG-PET/CT scan. Staging examinations after further 4 cycles of RCHOP- 14 therapy showed that the patient was still in CMR, but a PET-negative large mass (7×3 centimeter) still remained visible in the abdominal region. Considering this residual tumour and the agressive subtype of lymphoma the patient was referred for an autologous haemopoietic stem cell transplantation (AHSCT). After 2 cycles of R-DHAP regimen, successful CD34- positive stem cell collection was performed in August 2012. In September 2012, a RLAM-BEAM conditioning was performed followed by AHSCT. Posttransplantation 18FDG-PET/CT scan revealed further morphological regression, no symptom of the underlying disease appeared and the patient is in complete remission for 15 months. CONCLUSIONS - This case exemplifies that in case of atypical clinical findings and unusual progress of the disease it might be worthwile to re-evaluate the case and the (histological) diagnosis, which requires a close cooperation between the clinician and the pathologist.]

Lege Artis Medicinae

[Dilemmas in the Research of Rare Diseases ]

VARGA Orsolya

Lege Artis Medicinae

[Fulvestrant therapy resulting long progression free survival in case of symptomatic, metastatis breast cancer]

KÓSZÓ Renáta, KAHÁN Zsuzsanna

Lege Artis Medicinae

[Correlations between Health, Happiness and Well-being in the Modern Society ]

PIKÓ Bettina

All articles in the issue

Related contents

Lege Artis Medicinae

[Vitamin D treatment: hormone therapy for patients who need it or simply a supplementation for everyone?]


[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]

Hypertension and nephrology

[Hypertension and diabetes mellitus]

SZEGEDI János, KISS István

[Hypertension and diabetes mellitus are endemics which affect large crowds; they play an important role in the morbidity and mortality of the population. Both diseases are cardiovascular risk factors, their co-occurrence increases the coronary risk. According to forecasts, there will be 60% increase in the number of hypertensive patients by 2025; it will affect 29% of the world’s adult population, 1.56 billion people. The number of patients with diabetes increases in all countries; 552 million diabetic patients should be expected by 2030. The simultaneous occurrence of both diseases may be a coincidence, but there is also causal relationship between the two diseases (diabetic nephropathy, metabolic syndrome). The two diseases often occur in endocrine diseases, and in connection with medicinal therapy (steroids, etc.). The simultaneous occurrence of these two diseases determines the therapeutic strategy. During the prevention and treatment of both diseases, the change in lifestyle has an important role (obesity, salt intake, physical activity).]

Lege Artis Medicinae


NAGY Viktor

[There are several evidence-based recommendations for the antihypertensive treatment of diabetic patients. The treatment should be chosen in such way that the target blood pressure (<130/80 Hgmm) is reached and the risk of target organ failure and cardiovascular mortality is minimized. Based on the studies, it seems that the angiotensin converting enzyme II receptor blockers and low-dose thiazide diuretics, along with their combinations can be recommended as first-line treatment in diabetes mellitus. Beta-receptor blockers and calciumchannel inhibitors are more effective than placebo and may be can be combined with angiotensin converting enzyme inhibitors, angiotensin converting enzyme II blockers and diuretics. This is important, because the effective antihypertensive treatment and the prevention of complications in diabetic patients can rarely be achieved with monotherapy only.]

Clinical Neuroscience

[Treatment of complex regional pain syndrome with amitriptyline]


[Introduction - Complex regional pain syndrome is a di­stressing neuropathic pain condition without known etiology and evidence based treatment. Case presentation - Here a posttraumatic severe case of complex regional pain syndrome is presented, successfully treated by amitriptyline monotherapy. Amitriptyline is one of the most effective evidence based treatments of peri­pheral diabetic neuropathic pain and other neuropathic pain syndromes. Discussion - Amitriptyline seems to be effective to decrease pain, autonomic and motor symptoms in chronic regional pain syndrome. Conclusion - Controlled trials may be warranted to test the effectiveness of amitriptyline in complex regional pain syndrome.]

Hypertension and nephrology

[Significance of patient adherence in the treatment of hypertension]


[Hypertension is the one of most frequent chronic disease which a major but modifiable cardiovascular risk factor. In treating of hypertension after life style therapy, drug treatment has an essential role. Patient adherence plays a significant role achieving target blood pressure. One of most important cause of resistant hypertension is the non-adherence. Factors influencing adherence include the number of drugs, their daily dosage frequency, the properties of the drug groups used, age and gender too. According to international and domestic studies, the number of people leaving medication is very high. The disadvantage is clear because these patients lack of benefit from the protective effects of drugs.]