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Purpose: We examined the process and causes of diagnostic delay, defined as the interval from symptom onset to diagnosis, for testis (germ cell) cancer and the change with time. Diagnostic delay influences disease burden and may be subdivided into symptomatic interval, defined as symptom onset to first presentation, and diagnostic interval, defined as first presentation to diagnosis., Materials and Methods: We performed a single center review of 100 consecutive cases. Diagnostic delay in weeks, and symptomatic and diagnostic intervals in days were calculated, and related factors were recorded. Previous reports by the senior author (JT) in the same health care system allowed the examination of change during 2 decades., Results: Mean±SD diagnostic delay was 12.5±17.4 weeks (median 6, range 1 to 104), a substantial decrease in the mean of 10 months reported by one of us (JT) in 1987. Mean symptomatic interval was 65.4±100.9 days (median 29, range 0 to 720). Mean diagnostic interval was 21.9±63.5 days (median 7, range 1 to 540). Symptomatic interval exceeded or was equal to diagnostic interval in 80 men., Conclusions: This terminology allows detailed examination of the diagnostic process for testis cancer. Aberrant diagnostic delay for testis cancer is decreasing and is now dominated by patient dependent factors. Select cases suggest that physician error remains a factor in a minority., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Pain at the second or third metatarsophalangeal joint associated with objective instability and roentgenographic displacement is a common forefoot problem. In 53 patients (60 feet), surgical correction of the painful deformity was completed by resecting the bases of the proximal phalanges of Toes 2 and 3 combined with subtotal webbing of the toes. At an average follow-up period of 29.8 months, 38% were wholly satisfied; 37%, satisfied with minor reservations; 15%, satisfied with major reservations; and 10% were not satisfied. When graded for pain, cosmesis, and footwear use, the most improvement was noted for pain symptoms. No significant effect of earlier forefoot surgery was noted. Residual complaints, such as persistent pain and unstable sensation of the webbed toes, were rarely disabling and usually minor compared to the preoperative status.