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Adenocarcinoma of the esophagus is an aggressive malignancy that frequently occurs with lymph node involvement. Current management strategies may incorporate adjuvant therapeutic modalities in an attempt to improve the typical dismal outcome. There is frequent association of esophageal adenocarcinoma with Barret's metaplasia. Isolated bone and soft tissue metastases are rare and may present a diagnostic challenge in asymptomatic patients.

The leg-length discrepancy in patients with proximal femoral focal deficiency is difficult to treat and is often unmanageable except by amputation. To identify candidates for ablative and nonablative surgery and to outline a rational treatment program, 91 patients (120 femurs) were retrospectively analyzed to determine the relationship of absolute femoral length, relative femoral length, and pelvofemoral stability to the functional effects at maturity of various operative and nonoperative management. The direct relationship of function to Aitken classification was documented and correlated with percent femoral inhibition (p less than 0.01), and pelvofemoral stability as determined by the acetabular index (p less than 0.05), shelf index (p less than 0.001), and acetabular dysplasia (p less than 0.001). In unilateral cases, two therapeutic subgroups were identified: Class I (patients with less than 17 cm of projected extremity shortening, and evidence of pelvofemoral stability), and Class II (patients with greater than 17 cm of predicted extremity shortening). Class I patients are potential candidates for height equalization by ipsilateral lengthening and/or contralateral shortening. Class II patients should have early ablative procedures and conversion to an above-knee or below-knee amputee. In bilateral PFFD, function at maturity was primarily dependent upon leg-length differential, foot position, and associated anomalies.

The case histories of 91 patients (54 male, 37 female) with proximal femoral focal deficiency identified measurements which allow the physician to predict ultimate growth and pelvo-femoral stability early in the patient's life. For unilateral patients, the classification correlated with percentage of femoral inhibition, acetabular index, shelf index and acetabular dysplasia, enabling prediction to be made within the first two years of life. A constant percentage of femoral inhibition was confirmed in both unilateral and bilateral patients, and the effects of classification and associated anomalies were determined. Bilateral proximal femoral focal deficiency occurred twice as frequently among males, and function at maturity was primarily dependent upon leg-length differential, foot position and associated anomalies, and secondarily upon absolute leg-length and pelvo-femoral stability.