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Sample records for anteromedial temporosphenoidal encephalocele

  1. Case Report: Anteromedial temporosphenoidal encephalocele with a clinically silent lateral bony defect in the greater wing of the sphenoid

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    Pandey Anoop

    2009-01-01

    Full Text Available Anteromedial temporosphenoidal encephalocele is the least common type of temporal encephalocele. It commonly presents with spontaneous cerebrospinal fluid rhinorrhea in adults. This article presents the CT cisternography and MRI findings of one such case, which also had an associated clinically silent defect in the greater wing of the sphenoid on the same side.

  2. Encephaloceles

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    ... to treat and prevent congenital brain disorders including neural tube defects such as encephaloceles. Information from the National Library of Medicine’s MedlinePlus Neural Tube Defects × What research is being done? The NINDS ...

  3. MANAGEMENT OF HUGE ENCEPHALOCELE

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    Rajeev

    2015-11-01

    Full Text Available Among all neural tube defects, encephalocele incidents are 1 in 5000 live births. (1 Newborn with encephalocele may be associated with other congenital malformations. Encephalocele patient’s management pose many challenge to neurosurgeon due to other associated anomalies that may present like ventriculocele, Dandy Walker and Arnold-Chiari malformation, and difficult positioning airway management to anaesthesiologist. We discuss a case of huge encephalocele and its management

  4. Giant high occipital encephalocele

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    Agrawal Amit

    2016-03-01

    Full Text Available Encephaloceles are rare embryological mesenchymal developmental anomalies resulting from inappropriate ossification in skull through with herniation of intracranial contents of the sac. Encephaloceles are classified based on location of the osseous defect and contents of sac. Convexity encephalocele with osseous defect in occipital bone is called occipital encephalocele. Giant occipital encephaloceles can be sometimes larger than the size of baby skull itself and they pose a great surgical challenge. Occipital encephaloceles (OE are further classified as high OE when defect is only in occipital bone above the foramen magnum, low OE when involving occipital bone and foramen magnum and occipito-cervical when there involvement of occipital bone, foramen magnum and posterior upper neural arches. Chiari III malformation can be associated with high or low occipital encephaloceles. Pre-operatively, it is essential to know the size of the sac, contents of the sac, relation to the adjacent structures, presence or absence of venous sinuses/vascular structures and osseous defect size. Sometimes it becomes imperative to perform both CT and MRI for the necessary information. Volume rendered CT images can depict the relation of osseous defect to foramen magnum and provide information about upper neural arches which is necessary in classifying these lesions.

  5. Facts about Encephalocele

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    ... a rare type of birth defect of the neural tube that affects the brain. The neural tube is a narrow channel that folds and closes ... opening in the skull. Encephalocele happens when the neural tube does not close completely during pregnancy. The result ...

  6. Anteromedial Approach to the Orbit

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    DEDA, Haluk; Ugur, Hasan Çaglar; Yorulmaz, Irfan; Kucuk, Babur

    2001-01-01

    This study evaluated the surgical results of the anteromedial approach for treatment of orbital lesions in 16 patients. Pre- and postoperatively, all patients underwent a complete physical examination focusing on the head and neck area including a thorough ophthalmologic evaluation, computerized tomography, and magnetic resonance imaging. The surgical approach was limited to a medial orbitotomy in five patients; the remaining 11 patients underwent a medial orbitotomy combined with an external...

  7. Anaesthetic management of giant encephalocele

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    Rajeev Kumar

    2015-12-01

    Full Text Available One of the several challenges to the anaesthesiologists, is management of child with difficult airway. Management of even normal airway in a neonate is different and complex as compared to airway of two year old child and that of adult. Definition of the difficult airway is related solely to tracheal intubation or problems with mask ventilation1.Among the different causes of difficult airway cranio facial and neoplastic anomalies are very common. We present a case report of difficult airway management in encephalocele patient. [Int J Res Med Sci 2015; 3(12.000: 3889-3892

  8. Primary Occipital Encephalocele in an Elderly Patient.

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    Barros, Fernanda Carvalho; Barros, Henrique Almeida; Júnior, Helvécio Marangon; Taitson, Paulo Franco

    2016-05-01

    The encephalocele is a condition characterized by the protrusion of the intracranial contents through a bone defect of the skull. The authors report a clinical case of an 80-year-old woman with primary occipital encephalocele on the right side and that was affected by trauma and presented liquor fistula and infection. Tomographic sections were obtained by injection intravenous of contrast. The images showed bone thickness thinning on the right occipital region and solution of continuity (encephalocele) with regular contours, reduction in brain volume, and hypodensity of the periventricular white substance were observed. The patient was successfully operated.

  9. Fronto-nasal Encephalocele. A Case Report

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    Rafael Ferrer Montoya

    2013-06-01

    Full Text Available Encephalocele is a herniation of the brain tissue through a congenital or acquired defect of the skull. The congenital condition is caused by a neural-tube defect attributable to an interaction among several genes and environmental factors. Anterior encephalocele is a rare entity and its incidence varies depending on the geographic area. We report the case of a newborn with a tumour protruding through the fronto-nasal region with a central pedunculated polypoid formation, in addition to the presence of bilateral cleft lip and palate. Surgical treatment was decided after consulting the Neurosurgery Department. This case report is interesting due to the rarity of this entity.

  10. Frontoethmoidal encephaloceles, a study of their pathogenesis

    NARCIS (Netherlands)

    Hoving, Eelco; Vermeij-Keers, C

    1997-01-01

    A prospective clinical study of 30 patients with frontoethmoidal encephaloceles was performed in order to find support for a proposed theory concerning its pathogenesis, based on a previously performed embryological study and relevant findings in the literature. According to this proposed theory the

  11. Large occipito-cervical encephalocele with Chiari III malformation

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    S Ambekar

    2011-01-01

    Full Text Available Chiari type III is the rarest of the Chiari malformations and is usually associated with high morbidity and mortality. Treatment consists of primary closure of the encephalocele with or without cerebro-spinal fluid (CSF shunting. In our case, the patient was treated with ventriculoperitoneal shunt followed by excision of the encephalocele. We propose that large encephaloceles should be treated with CSF shunting prior to repair of the sac so as to achieve optimal result.

  12. Congenital orbital encephalocele, orbital dystopia, and exophthalmos.

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    Hwang, Kun; Kim, Han Joon

    2012-07-01

    We present here an exceedingly rare variant of a nonmidline basal encephalocele of the spheno-orbital type, and this was accompanied with orbital dystopia in a 56-year-old man. On examination, his left eye was located more inferolaterally than his right eye, and the patient said this had been this way since his birth. The protrusion of his left eye was aggravated when he is tired. His naked visual acuity was 0.7/0.3, and the ocular pressure was 14/12 mm Hg. The exophthalmometry was 10/14 to 16 mm. His eyeball motion was not restricted, yet diplopia was present in all directions. The distance from the midline to the medial canthus was 20/15 mm. The distance from the midline to the midpupillary line was 35/22 mm. The vertical dimension of the palpebral fissure was 12/9 mm. The height difference of the upper eyelid margin was 11 mm, and the height difference of the lower eyelid margin was 8 mm. Facial computed tomography and magnetic resonance imaging showed left sphenoid wing hypoplasia and herniation of the left anterior temporal pole and dura mater into the orbit, and this resulted into left exophthalmos and encephalomalacia in the left anterior temporal pole. To the best of our knowledge, our case is the second case of basal encephalocele and orbital dystopia.

  13. Sincipital Encephaloceles: A Study of Associated Brain Malformations

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    Shashidhar Vedavyas Achar

    2016-01-01

    Full Text Available Objective: The aim of this study was to evaluate the associated intracranial malformations in patients with sincipital encephaloceles. Materials and Methods: A hospital-based cross-sectional study was conducted over 8 years from June 2007 to May 2015 on 28 patients. The patients were evaluated by either computed tomography or magnetic resonance imaging whichever was feasible. Encephaloceles were described with respect to their types, contents, and extensions. A note was made on the associated malformations with sincipital encephaloceles. Results: Fifty percent of the patients presented before the age of 3 years and both the sexes were affected equally. Nasofrontal encephalocele was the most common type seen in 13 patients (46.4%, and corpus callosal agenesis (12 patients was the most common associated malformation. Other malformations noted were arachnoid cyst (10 patients, hydrocephalus (7 patients, and agyria-pachygyria complex (2 patients. Conclusion: Capital Brain malformations are frequently encountered in children with sincipital encephaloceles. Detail radiological evaluation is necessary to plan treatment and also to prognosticate such rare malformations.

  14. TRANSTIBIAL VERSUS ANTEROMEDIAL PORTAL TECHNIQUES IN ACL RECONSTRUCTION

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    Luiz Gabriel Betoni Guglielmetti

    Full Text Available Abstract Introduction: Although the results of anterior cruciate ligament (ACL reconstruction are well documented in many studies, with good to excellent outcomes in most cases, some issues like tunnel positioning are still discussed and studied. Objective: To compare the objective and subjective clinical outcomes of ACL reconstruction using the transtibial and anteromedial portal techniques. Methods: Prospective randomized study of 80 patients undergoing anterior cruciate ligament reconstruction by the same surgeon, with 40 patients operated by the transtibial technique and 40 by anteromedial portal technique. The patients, 34 in the transtibial group and 37 in the anteromedial portal group (nine dropouts, were reassessed during a 2-year follow-up period. The clinical assessment consisted of physical examination, KT-1000TM evaluation, Lysholm score, and objective and subjective International Knee Documentation Committee - IKDC scores. Results: Regarding the Lachman and pivot shift tests, we observed more cases of instability in the transtibial group, but with no statistical significance (p=0.300 and p=0.634, respectively. Regarding the anterior drawer test, the groups presented similar results (p=0.977. Regarding KT-1000TM evaluation, the mean results were 1.44 for the transtibial group and 1.23 for the anteromedial portal group, with no statistical significance (p=0.548. We separated the objective IKDC scores into two groups: Group 1, IKDC A, and Group 2, IKDC B, C, or D, with no statistical significance (p=0.208. Concerning the Lysholm score, the transtibial group had a mean score of 91.32, and the anteromedial portal group had a mean score of 92.81. The mean subjective IKDC scores were 90.65 for the transtibial group and 92.65 for the anteromedial portal group. Three re-ruptures were encountered in the transtibial group and three in the anteromedial portal group. Conclusions: There were no significant differences in the subjective and

  15. Mammoth orbitofrontal neurofibromatosis with herniating meningo-encephalocele

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    Dhanraj Prema

    2010-01-01

    Full Text Available We are presenting a mammoth orbito-frontal neurofibroma with a herniating meningo-encephalocele in a 23 year old African male. The tumour measured 87cm Χ 54cm and occupied the right orbito-temporo-facial region and had destroyed the right orbit. A pre operative embolization of the feeding vessels was followed by a one stage near total excision of the tumour and repair of the meningo-encephalocele in hypotensive anaesthesia. The excised tumour weighed 8 Kg and, to the best of our knowledge, is the largest orbito-facial neurofibroma reported in literature.

  16. Rhinorrhoea from a frontal encephalocele after reduction of high intracranial pressure.

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    Yilmaz, Cem; Gulsen, Salih; Altinors, Nur; Caner, Hakan

    2008-12-01

    Acquired non-traumatic frontal sinus encephaloceles are very rare lesions that are usually caused by a tumour or hydrocephalus. We present a 31-year-old woman with a frontal sinus encephalocele who developed rhinorrhoea after a ventriculo-peritoneal shunt to treat her hydrocephalus and underwent radiotherapy for a tectum tumour.

  17. Pediatric encephaloceles: A series of 20 cases over a period of 3 years

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    Shashank Ravindra Ramdurg

    2015-01-01

    Full Text Available Background: Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact worldwide frequency is not known. Aims and Objectives: To determine the epidemiological features, patterns of encephalocele, and its postsurgical results. Materials and Methods: The study was carried from year July 2012 to June 2015. Patients with encephalocele were evaluated for epidemiological characteristics, clinical features, imaging characteristics, and surgical results. Results: 20 encephaloceles patients were treated during the study period. Out of these 12 (60% were male and 8 (40% female. Age range was 1 day to 6 years. The most common type of encephalocele was occipital 12 (60%, occipito-cervical 4 (20%, parietal 2 (10%, fronto-nasal 1 (5%, and fronto-naso-ethmoidal 1 (5%. One patient had a double encephalocele (one atretic and other was occipital with dermal sinus tract and limited dermal myeloschisis. Other associations: Chiari 3 malformation (2, meningomyeloceles (4, and syrinx (4. Three patients presented with rupture two of whom succumbed to meningitis and shock. Seventeen patients treated surgically did well with no immediate surgical mortality (except a case of Chiari 3 malformation who succumbed 6 months postsurgery to unrelated causes. Shunt was performed in 4 cases. Conclusion: The most common type of encephalocele is occipital in our set up. Early surgical management of encephalocele is not only for cosmetic reasons but also to prevent tethering, rupture, and future neurological deficits.

  18. Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures

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    Yin-Feng Zheng

    2016-01-01

    Conclusions: Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group. We can suggest that anteromedial plating is a clinically safe and effective way for humeral shaft fractures.

  19. Encephalocele presented in late third trimester: a case report

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    Hemant G. Deshpande

    2014-04-01

    Full Text Available In present era, most of the NTDs are diagnosed at quite early gestation, thanks to advancement in imaging technology. So it is rare to see a case of NTD in late gestational age. Encephalocele is still rare type of NTD, when we come across such a case in late gestational period associated with another risk factor (Previous LSCS, it can really present a challenge for management. We had to face such a case requiring skillful management. A 23 year, G2 P1 L1 with previous LSCS was referred to our institution for severe anemia. USG showed 37 weeks single, live fetus with absence of cranial vault and irregular compressed cystic structure attached to vault attached in occipital region. Previous USG done at 12 weeks showed no abnormality, while USG at 27 weeks showed Acrania. Ideal management of this patient could have been done if this anomaly was diagnosed before 20 weeks where option of MTP was clearly available. Though with high resolution technical and instrument and with expert sonologist encephalocele can be diagnosed by 14 weeks. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 460-462

  20. Torcular occipital encephalocele in infant: Report of two cases and review of literature

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    Satish Kumar Verma

    2013-01-01

    Full Text Available The presence of torcula or sinus in the occipital encephalocele presents a challenge during surgery. However, a detailed study of magnetic resonance image and magnetic resonance venography can aid in preoperative localization of the torcula. Knowing the encephalocele′s contents, its relationship with falx cerebri and falx cerebelli, and vigilance during surgery is a sure way to protect neural tissue. Visual Evoked Potential (VEP may be indicated in torcular encephalocele. Here, authors report two such cases, one presented with ruptured encephalocele with cerebrospinal fluid leak and another case presented six months after birth due to financial constraints. Pertinent literature and management is briefly reviewed.

  1. Intraorbital Encephalocele Presenting with Exophthalmos and Orbital Dystopia : CT and MRI Findings.

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    Asil, Kiyasettin; Gunduz, Yasemin; Yaldiz, Can; Aksoy, Yakup Ersel

    2015-01-01

    A 15-year-old female patient with progressive pulsatile exophthalmos caused by intraorbital encephalocele was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) in our clinic. She had no history of trauma or reconstructive surgery. When she was a little girl, she had undergone surgery for congenital glaucoma on the right eye. On the three-dimensional image of CT, a hypoplasic bone defect was observed in the greater wing of the right sphenoid bone. MRI and CT scan showed herniation through this defect of the arachnoid membrane and protruded cerebral tissue into the right orbita. Intraorbital encephalocele is an important entity that can cause pulsatile exophthalmos and blindness.

  2. Basal sphenoethmoidal encephalocele in association with midline cleft lip and palate: case report

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    Holanda, Maurus Marques de Almeida; Rocha, Artur Bastos; Santos, Rayan Haquim Pinheiro [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil); Furtado, Paulo Germano Cavalcanti [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil). Dept. de Pediatria e Genetica

    2011-11-15

    Association of basal sphenoethmoidal encephalocele with midline cleft lip and palate is extremely rare. The authors report the case of a nine-year-old girl presenting a midline facial cleft with meningocele that was noticeable through the palatine defect as a medial intranasal pulsatile mass. An analysis of clinical and radiological findings of the present case of cranial dysraphism is carried out. (author)

  3. Ultrastructural features of dopamine axon terminals in the anteromedial and the suprarhinal cortex of adult rat.

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    Séguéla, P; Watkins, K C; Descarries, L

    1988-02-23

    The ultrastructural features and synaptic relationships of dopamine (DA) axon terminals were examined in the prefrontal cortex of adult rat after immunocytochemical staining with a highly specific polyclonal antiserum directed against DA-glutaraldehyde-lysyl-protein conjugate (donated by M. Geffard). Single and serial ultrathin sections were obtained from the deep layers of the anteromedial and the suprarhinal DA fields. The DA axon terminals from both regions averaged 0.7 micron in diameter, contained a mixed population of small, round and clear synaptic vesicles associated with a few larger dense-cored or fully immunostained vesicles, and frequently exhibited synaptic contacts which were exclusively made on dendritic shafts and spines. These synapses were mostly of the symmetrical type (80%) and were more often seen on dendritic shafts than spines, particularly in the suprarhinal (89%) compared with the anteromedial cortex (62%). As estimated either by stereological extrapolation from single sections or by direct observation in serial sections, the synaptic incidence of these DA varicosities was significantly greater in the anteromedial than suprarhinal DA field. In the longest series of thin sections, a junctional complex could be observed on 93% of the DA varicosities from the anteromedial cortex but only on 56% in the suprarhinal cortex. Such an inter-regional disparity in the relational characteristics of the DA input will need to be taken into account in elucidating the role and properties of this monoamine in cerebral cortex.

  4. Distance Reached in the Anteromedial Reach Test as a Function of Learning and Leg Length

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    Bent, Nicholas P.; Rushton, Alison B.; Wright, Chris C.; Batt, Mark E.

    2012-01-01

    The Anteromedial Reach Test (ART) is a new outcome measure for assessing dynamic knee stability in anterior cruciate ligament-injured patients. The effect of learning and leg length on distance reached in the ART was examined. Thirty-two healthy volunteers performed 15 trials of the ART on each leg. There was a moderate correlation (r = 0.44-0.50)…

  5. A novel technique in airway management of neonates with occipital encephalocele.

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    Rangaswamy, N; Pramanik, A K

    2014-11-01

    Airway stabilization in neonates with occipital encephalocele (OE) is critical during surgery or if they develop hypoxic-respiratory failure. Endotracheal intubation can be challenging due to difficulty in positioning the head in a patient with large occipital mass. We describe a novel technique for positioning neonates with large OE using a commonly used hospital apparatus which facilitated appropriate positioning of the baby and successful endotracheal intubation with ease and no additional staff.

  6. The Syndrome of Frontonasal Dysplasia, Callosal Agenesis, Basal Encephalocele, and Eye Anomalies - Phenotypic and Aetiological Considerations.

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    Richieri-Costa, Antonio; Guion-Almeida, Maria Leine

    2004-01-01

    We report ten sporadic cases of Brazilian patients with facial midline defects, callosal agenesis, basal encephalocele, and ocular anomalies. This very rare cluster of anomalies has been well reported before. However, only until recently it is recognized as a syndrome belonging to frontonasal dysplasia spectrum. The ten cases confirm a distinct clinical entity and help to define the phenotype more precisely than previously. Up to now etiology remains unknown, although we conjecture that it is due to a mutation in TGIF gene.

  7. Congenital encephalocele in children%小儿先天性脑膨出

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    金惠明; 孙莲萍; 杨波

    2008-01-01

    目的 总结小儿先天性脑膨出的临床特点和诊治经验.方法 回顾分析1997年5月至2006年5月经外科手术及影像学证实48例先天性脑膨出.结果 本组男28例,女20例,年龄1d~15岁.CT和MRI是主要诊断手段.脑膨出位于枕后36例,前颅窝2例,顶部4例,颅底6例.脑膨出合并颅内畸形有灰质异位、胼胝体发育不全、透明隔缺如、脑积水、Chiari畸形、Dandy-Walker畸形和枕大池蛛网膜囊肿.48例中3例末行手术.4例合并脑积水分别于脑膨出修补前及同时做脑室腹腔分流术,2例脑膨出修补术后急性脑积水及时做脑室腹腔分流术,颅底脑膨出中有3例行经鼻内镜下脑膨出切除修补术.结论 脑膨出为先天性疾病.MRI是首选的诊断方法,推荐MRI检查同时作MR血管造影,明确硬膜静脉窦是否随膨出物突出,以利手术.%Objective To summerize the clinical characteristics and experiences of congenital encephalocele in children. Methods From May 1997 to May 2006, 48 cases of congenital encephalocele confirmed by surgical procedures and imageological studies were retrospectively analyzed. Results In this series, 28 cases were boys, 20 cases were girls, the age ranged from 1 day to 15 years. CT and MRI were the main means of diagnosis. The encephaloceles were located in occiput in 36, anterior cranium in 2, parietal region in 4 and basilar region in 6. Concomitan intracranial anomalies included gray matter heterotopia, callosal agenesis, septum pellucidum absence, hydrocephalus, Chiari malformation, Dandy-Walker syndrome and arachnoid cyst of cisterna magna. 3 of 48 cases did not undergo surgery. 4 cases with hydrocephalus received V-P shunts before or at the same time of encephalocele repair. 2 cases were put V-P shunts in time because of acute hydrocephalus after repair of encephalocele. Via nasendoscopy, 3 cases of basicranial encephaloceles underwent resection and repair. Conclusions Encephalocele is a congenital disease

  8. Combined supra-transorbital keyhole approach for treatment of delayed intraorbital encephalocele: A minimally invasive approach for an unusual complication of decompressive craniectomy

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    di Somma, Lucia; Iacoangeli, Maurizio; Nasi, Davide; Balercia, Paolo; Lupi, Ettore; Girotto, Riccardo; Polonara, Gabriele; Scerrati, Massimo

    2016-01-01

    Background: Intraorbital encephalocele is a rare entity characterized by the herniation of cerebral tissue inside the orbital cavity through a defect of the orbital roof. In patients who have experienced head trauma, intraorbital encephalocele is usually secondary to orbital roof fracture. Case Description: We describe here a case of a patient who presented an intraorbital encephalocele 2 years after severe traumatic brain injury, treated by decompressive craniectomy and subsequent autologous cranioplasty, without any evidence of orbital roof fracture. The encephalocele removal and the subsequent orbital roof reconstruction were performed by using a modification of the supraorbital keyhole approach, in which we combine an orbital osteotomy with a supraorbital minicraniotomy to facilitate view and access to both the anterior cranial fossa and orbital compartment and to preserve the already osseointegrated autologous cranioplasty. Conclusions: The peculiarities of this case are the orbital encephalocele without an orbital roof traumatic fracture, and the combined minimally invasive approach used to fix both the encephalocele and the orbital roof defect. Delayed intraorbital encephalocele is probably a complication related to an unintentional opening of the orbit during decompressive craniectomy through which the brain herniated following the restoration of physiological intracranial pressure gradients after the bone flap repositioning. The reconstruction of the orbital roof was performed by using a combined supra-transorbital minimally invasive approach aiming at achieving adequate surgical exposure while preserving the autologous cranioplasty, already osteointegrated. To the best of our knowledge, this approach has not been previously used to address intraorbital encephalocele. PMID:26862452

  9. Deep brain stimulation of the antero-medial globus pallidus interna for Tourette syndrome.

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    Perminder S Sachdev

    Full Text Available BACKGROUND: We have previously reported the results of Deep Brain Stimulation (DBS of the antero-medial globus pallidus interna (GPi for severe Tourette Syndrome (TS in 11 patients. We extend this case series to 17 patients and a longer follow-up to a maximum of 46 months. METHODS: 17 patients (14 male; mean age 29.1 years, range 17-51 years with severe and medically intractable TS were implanted with Medtronic quadripolar electrodes bilaterally in the antero-medial GPi. The primary outcome measure was the Yale Global Tic Severity Scale (YGTSS. Secondary outcome measures included the Yale-Brown Obsessive Compulsive Scale, Hamilton Depression Rating Scale, Gilles de la Tourette Quality of Life Scale and Global Assessment of Functioning. Follow up was at one month, three months and finally at a mean 24.1 months (range 8-46 months following surgery. RESULTS: Overall, there was a 48.3% reduction in motor tics and a 41.3% reduction in phonic tics at one month, and this improvement was maintained at final follow-up. 12 out of 17 (70.6% patients had a>50% reduction in YGTSS score at final follow up. Only 8 patients required ongoing pharmacotherapy for tics post-surgery. Patients improved significantly on all secondary measures. Adverse consequences included lead breakage in 4 patients, infection (1, transient anxiety (2, dizziness (1, poor balance (1 and worsening of stuttering (1. CONCLUSIONS: This case series provides further support that antero-medial GPi DBS is an effective and well tolerated treatment for a subgroup of severe TS, with benefits sustained up to 4 years.

  10. Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach

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    Kumar BS

    2016-03-01

    Full Text Available Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure. Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. RodriguezMerchan criteria was used to grade the functional outcome. Results: Of the 54 patients, 28 (58.85% were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%.The mean (+ SD duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%. Four (7.40% patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez – Merchan criteria showed that 37(68.51% of the patients had good and 12 (22.22% had excellent functional outcome.

  11. Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures

    Institute of Scientific and Technical Information of China (English)

    Yin-Feng Zheng; Jun-Lin Zhou; Xiao-Hong Wang; Lei Shan; Yang Liu

    2016-01-01

    Background:Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures,this study was to compare the mechanical properties of anteromedial,anterolateral,and posterior plating for humeral shaft fractures.Methods:A distal third humeral shaft fracture model was constructed using fourth-generation sawbones (#3404,composite bone).Atotal of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups:A,B,and C (n =8 in each group) for anteromedial,anterolateral,and posterior plating,respectively.All sawbones were subjected to horizontal torsional fatigue tests,horizontal torsional and axial compressive fatigue tests,four-point bending fatigue tests in anteroposterior (AP) and mediolateral (ML) directions and horizontal torsional destructive tests.Results:In the horizontal torsional fatigue tests,the mean torsional angle amplitude in Groups A,B,and C were 6.12°,6.53°,and 6.81°.In horizontal torsional and axial compressive fatigue tests,the mean torsional angle amplitude in Groups A,B,and C were 5.66°,5.67°,and 6.36°.The mean plate displacement amplitude was 0.05 mm,0.08 mm,and 0.10 mm.Group A was smaller than Group C (P < 0.05).In AP four-point bending fatigue tests,the mean plate displacement amplitude was 0.16 mm,0.13 mm,and 0.20 mm.Group B was smaller than Group C (P < 0.05).In ML four-point bending fatigue tests,the mean plate displacement amplitude were 0.16 mm,0.19 mm,and 0.17 mm.In horizontal torsional destructive tests,the mean torsional rigidity in Groups A,B,and C was 0.82,0.75,and 0.76 N.m/deg.The yielding torsional angle was 24.50°,25.70°,and 23.86°.The mean yielding torque was 18.46,18.05,and 16.83 N·m,respectively.Conclusions:Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group.We can suggest that

  12. The ultrasonographic diagnosis of fetal encephalocele at 13th gestational week

    Directory of Open Access Journals (Sweden)

    Šorak Marija

    2010-01-01

    Full Text Available Background. Encephalocele presents a rare anomaly of central nervous system, developed as a consequence of neural tube closing defect during early embrional development, and it is described by a baggy formation which prolaborates through the pores of the scull, filled with brain tissue, cerebrospinal liquor and entwined with meninges. According to literature search, until this day, the earliest it can be ultrasonically detected is the 13th gestation week, with the appliance of three-dimensional ultrasound. Case report. We presented 25 years old patient, ultrasonically diagnosed with occipital fetal encephalocela at the 13th gestation week. A gestation sack was located in the right uteral corn of the two-corned uterus with one cervix. The diagnosis was confirmed also by trippled value of alpha-fetoprotein in maternal serum: 75,98 IU/mL. Conclusion. Ultrasonic examination is the method of choice for prenatal detection of a fetal anomaly. It is possible to diagnose encephalocele if it prominates above the limits of the scull.

  13. OPEN REDUCTION OF HIP DISLOCATION IN PATIENTS WITH ARTHROGRYPOSIS MULTIPLEX CONGENITA – AN ANTEROMEDIAL APPROACH

    Science.gov (United States)

    Rocha, Luis Eduardo Munhoz da; Nishimori, Fábio Koiti; Figueiredo, Daniel Carvalho de; Grimm, Dulce Helena; Cunha, Luiz Antonio Munhoz da

    2015-01-01

    To evaluate the results from surgical treatment of hip dislocation through the anteromedial approach, in patients with arthrogryposis multiplex congenita (AMC). Methods: The medical files and radiographs of seven children with AMC who presented hip dislocation (total of 10 dislocated hips) were retrospectively reviewed. Pre and postoperative joint mobility was evaluated by summing the joint range of motion in flexion and abduction. The acetabular angle and height of the femoral neck before the operation, and the continuity of the Shenton arc, Sharp angle and center-edge (CE) angle after the operation, were evaluated radiographically. When avascular necrosis was identified, it was classified in accordance with Ogden and Bucholz. Results: The mean age of the children at the time of the surgery was 5.5 months (range: 3 to 11 months). The mean duration of follow-up for the patients was 9.5 years (range: 2 to 13 years). The mean amplitude of the sum of the joint range of motion in flexion and abduction in the preoperative examination was 108° (range: 70° to 155°) and postoperatively, it was 125° (range: 75° to 175°). In the last evaluation, eight hips were found to be centered and two were subluxated. Two hips had been subjected to Salter iliac osteotomy. Two hips (20%) had presented significant signs of Ogden type IV avascular necrosis. Eight hips had good results while two were fair. Conclusion: We consider that the anteromedial approach is a good option for treating hip dislocation in very young patients with arthrogryposis multiplex congenita. PMID:27022586

  14. Combined supra-transorbital keyhole approach for treatment of delayed intraorbital encephalocele: A minimally invasive approach for an unusual complication of decompressive craniectomy

    Directory of Open Access Journals (Sweden)

    Lucia di Somma

    2016-01-01

    Conclusions: The peculiarities of this case are the orbital encephalocele without an orbital roof traumatic fracture, and the combined minimally invasive approach used to fix both the encephalocele and the orbital roof defect. Delayed intraorbital encephalocele is probably a complication related to an unintentional opening of the orbit during decompressive craniectomy through which the brain herniated following the restoration of physiological intracranial pressure gradients after the bone flap repositioning. The reconstruction of the orbital roof was performed by using a combined supra-transorbital minimally invasive approach aiming at achieving adequate surgical exposure while preserving the autologous cranioplasty, already osteointegrated. To the best of our knowledge, this approach has not been previously used to address intraorbital encephalocele.

  15. SEPTO-OPTICDYSPLASIA WITH AN ANTERIOR ENCEPHALOCELE AND INTACT SEPTUM PELLUCIDUM: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Z. Razavi

    2008-06-01

    Full Text Available ObjectiveThe diagnosis of de Morsier syndrome or septo-optic dysplasia is made on the basis of the diagnosis of optic nerve hypoplasia. Septo-optic dysplasia is defined by a variable combination of dysgenesis of midline brain structures including optic nerve hypoplasia and hypothalamic-pituitary dysfunction often associated with a wide variety of brain malformations of cortical development.The importance of direct ophthalmoscopy of optic nerve abnormalities is stressed, as well as of magnetic resonance imaging, which has become a guideline in the classification of  this syndrome This article reports a 19-year-old female with bilateral optic nerve  hypoplasia,anterior encephalocele and intact septum pellucidum. She was diagnosed withdiabetes insipidus, short stature and the history of seizure.

  16. Perinatal factors associated with neural tube defects (anencephaly [correction of anancephaly], spina bifida and encephalocele).

    Science.gov (United States)

    Ogata, A J; Camano, L; Brunoni, D

    1992-01-01

    The objective of the present study was to determine the presence of risk factors for the occurrence of neural tube defects. Data for 33,535 births which occurred at Hospital do Servidor Público Estadual de São Paulo from July 1973 to December 1986 were collected in a prospective manner as recommended by "Estudo Colaborativo Latino-Americano de Malformações Congênitas" (ECLAMC, Collaborative Latin American Study on Congenital Malformations). Twenty-six cases of neural tube defects were detected (0.77/1000 births). Of these, 11 were cases of spina bifida (0.39/1000 births), 9 of anencephaly (0.27/1000 births) and 6 of encephalocele (0.18/1000 births). We observed a higher frequency of polyhydramnios, premature labor, Apgar scores of less than 7 at the first and fifth minutes, low birth weight and intrauterine growth retardation.

  17. Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Sukur, Erhan; Akman, , Yunus Emre; Senel, , Ahmet; Unkar, Ethem Ayhan; Topcu, , Huseyin Nevzat; Ozturkmen, , and Yusuf

    2016-01-01

    Background: Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research. Objective: We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement. Methods: ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement. Results: In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group. Conclusion: The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up. PMID:27733884

  18. The Syndrome of Frontonasal Dysplasia, Callosal Agenesis, Basal Encephalocele, and Eye Anomalies – Phenotypic and Aetiological Considerations

    Directory of Open Access Journals (Sweden)

    2004-03-01

    Full Text Available We report ten sporadic cases of Brazilian patients with facial midline defects, callosal agenesis, basal encephalocele, and ocular anomalies. This very rare cluster of anomalies has been well reported before. However, only until recently it is recognized as a syndrome belonging to frontonasal dysplasia spectrum. The ten cases confirm a distinct clinical entity and help to define the phenotype more precisely than previously. Up to now etiology remains unknown, although we conjecture that it is due to a mutation in TGIF gene.

  19. Frontonasal dysplasia, callosal agenesis, basal encephalocele, and eye anomalies syndrome with a partial 21q22.3 deletion.

    Science.gov (United States)

    Guion-Almeida, Maria Leine; Richieri-Costa, Antonio; Jehee, Fernanda Sarquis; Passos-Bueno, Maria Rita Santos; Zechi-Ceide, Roseli Maria

    2012-07-01

    We describe a girl with a phenotype characterized by frontonasal dysplasia, callosal agenesis, basal encephalocele, and eye anomalies who presents a 46,XX,r(21) karyotype. Array-comparative genomic hybridization using the Afflymetrix 100K DNA oligoarray set showed an interstitial deletion 21q22.3 of approximately 219 kb. Conventional karyotype of both parents was normal, and it was not possible to perform the molecular studies. In this report we raise the hypothesis that the deleted genes located at 21q22.3 could account to the phenotype.

  20. Use of anteromedial thigh perforator flap and immunological implications of Gorlin-Goltz syndrome: a case study.

    Science.gov (United States)

    Scalise, A; Calamita, R; Tartaglione, C; Bolletta, E; Di Benedetto, G; Pierangeli, M

    2016-12-02

    Gorlin-Goltz syndrome is mainly characterised by the development of numerous multicentric and relapsing cutaneous basal cell carcinomas (BCCs). A major problem for patients with Gorlin-Goltz syndrome is the large amount of BCCs that can invade the deep underlying structures, especially the face. Here, we describe the case of a 23-year-old male affected by Gorlin-Goltz syndrome. He had recurrent BCCs on a hairless scalp and dorsum since he was 17 years old and underwent four surgical procedures to excise BCCs, including a reconstruction with anteromedial thigh perforator flap. For each of the surgical procedures, a phenotypic study on peripheral blood mononuclear cells using flow cytometry was performed on the same day of surgery, and on days 7, 14 and 21 after surgery. The role of the tumour-specific cytolytic immune response as a potential future treatment of syndromic BCCs and its trend in relation to surgical ablation of large portions of tumour tissue was examined, and the cosmetic and therapeutic results are shown.

  1. Coronoid process of the ulna: paleopathologic and anatomic study with imaging correlation. Emphasis on the anteromedial ''facet''

    Energy Technology Data Exchange (ETDEWEB)

    Freitas Valle de Lemos Weber, Marcio [University of California, Department of Radiology, Veterans Affairs Medical Center, San Diego, CA (United States); Santa Maria, Rio Grande do Sul (Brazil); Barbosa, Diogo Miranda; Belentani, Clarissa; Negrao Ramos, Pedro Miguel; Trudell, Debra; Resnick, Donald [University of California, Department of Radiology, Veterans Affairs Medical Center, San Diego, CA (United States)

    2009-01-15

    The purpose of this study was to provide a detailed description of the anatomy of the coronoid process of the ulna and to use magnetic resonance (MR) images and anatomic correlation with cadavers to show the macroscopic configuration of this structure. Photography and high-resolution radiography were performed in 26 ulna specimens from the collection of a local museum. MR imaging of the coronoid process of 11 cadaveric elbows was performed. The images were compared with those seen on anatomic sectioning. The anteromedial rim of the coronoid process of the ulna had a regular surface, without osseous irregularities or facets in 69.2% of the specimens. In 30.8% of the specimens, the anteromedial rim was not regular and a small ridge could be identified. The insertion site of the joint capsule was onto the anterior aspect of the coronoid process, at an average distance of 5.9 mm distal to the tip. The attachment of the anterior band of the ulnar collateral ligament at the sublime tubercle was flush with the articular margin in 63.6% of the specimens. In 36.4% of the specimens, a more distal attachment, with a separation between the undersurface of the ligament and the adjacent tubercle, was seen. The brachialis tendon was attached to the coronoid process at a mean distance of 12.1 mm distal to the tip. The coronoid process of the ulna is a small osseous structure with a complex anatomy and presents some anatomical variations. (orig.)

  2. Intestinal atresia, encephalocele, and cardiac malformations in infants with 47,XXX: Expansion of the phenotypic spectrum and a review of the literature.

    Science.gov (United States)

    Bağci, Soyhan; Müller, Andreas; Franz, Axel; Heydweiller, Andreas; Berg, Christoph; Nöthen, Markus M; Bartmann, Peter; Reutter, Heiko

    2010-01-01

    Identification of the 47,XXX karyotype often occurs adventitiously during prenatal fetal karyotyping in cases of advanced maternal age. Although most females with 47,XXX appear healthy at birth, various types of congenital malformations have been reported, of which urinary tract anomalies are the most frequent. We report on 2 newborns with 47,XXX and congenital cardiac defects, one of whom had duodenal atresia and the other an occipital encephalocele. This expands the spectrum of malformations reported in association with the triple-X syndrome. We also present a review of the literature on non-urinary tract malformations in females with 47,XXX. We conclude that prenatal identification of the 47,XXX karyotype is an indication for detailed fetal ultrasonography which should include examination of multiple organ systems. Such prenatal screening for possible associated congenital malformations should help to ensure optimal perinatal clinical management of 47,XXX cases.

  3. Redução cirúrgica da luxação do quadril em pacientes com artrogripose múltipla congênita: acesso anteromedial Open reduction of hip dislocation in patients with arthrogryposis multiplex congenita: an anteromedial approach

    Directory of Open Access Journals (Sweden)

    Luis Eduardo Munhoz da Rocha

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados do tratamento cirúrgico da luxação do quadril através do acesso anteromedial em pacientes com artrogripose múltipla congênita (AMC. MÉTODOS: Retrospectivamente foram revisados os prontuários e radiografias de sete crianças com AMC que apresentavam luxação do quadril, totalizando 10 quadris luxados. Foi avaliada a mobilidade articular pré e pós-operatória através da somatória do arco de mobilidade articular em flexão e abdução. Radiograficamente foram avaliados, no pré-operatório, o ângulo acetabular e a altura do colo do fêmur e, no pós-operatório, a continuidade do arco de Shenton, ângulo de Sharp e ângulo CE (centro borda. Quando foi identificada a necrose avascular, esta foi classificada segundo Ogden e Bucholz. RESULTADOS: A média de idade das crianças na ocasião da cirurgia era de 5,5 meses (três a 11 meses. O seguimento médio dos pacientes foi de 9,5 anos (dois a 13 anos. A média de amplitude de movimento da somatória do arco de mobilidade articular em flexão e abdução no exame pré-operatório foi de 108° (70 a 155° e no pós-operatório foi de 125° (75° a 175°. Na última avaliação, oito quadris estavam centrados e dois subluxados. Dois quadris foram submetidos a uma osteotomia de ilíaco do tipo Salter. Dois quadris apresentaram sinais significativos de necrose avascular Ogden tipo IV. Oito quadris foram considerados como bons resultados e dois como regulares. CONCLUSÃO: Consideramos a via anteromedial uma boa opção para tratamento da luxação de quadril em pacientes de baixa idade com artrogripose múltipla congênita.OBJECTIVE: To evaluate the results of the surgical treatment of hip dislocation through the anteromedial approach in patients with arthrogryposis multiplex congenita (AMC. METHODS: A retrospective review of the charts and radiographs of 7 children with AMC that presented dislocation of the hiprevised, totalling 10 dislocated hips. : Pre and

  4. Contribution of thin slice (1 mm) oblique coronal proton density-weighted MR images for assessment of anteromedial and posterolateral bundle damage in anterior cruciate ligament injuries

    Energy Technology Data Exchange (ETDEWEB)

    Gokalp, Gokhan, E-mail: drgokhangokalp@yahoo.com [Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Demirag, Burak, E-mail: bdemirag@uludag.edu.tr [Department of Orthopedy, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Nas, Omer Fatih, E-mail: omerfatihnas@gmail.com [Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Aydemir, Mehmet Fatih, E-mail: fatiha@yahoo.com [Department of Orthopedy, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Yazici, Zeynep, E-mail: zyazici@uludag.edu.tr [Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa (Turkey)

    2012-09-15

    Purpose: To evaluate the diagnostic efficacy of using additional oblique coronal 1 mm proton density-weighted (PDW) MR imaging of the knee for detection and grading anterior cruciate ligament (ACL), anteromedial bundle (AMB) and posterolateral bundle (PLB) injuries. Materials and methods: We prospectively assessed preoperative MR images of 50 patients (36 men, 14 women; age range, 18–62 years). First, we compared the diagnostic performance of routine sagittal (3 mm) and additional oblique coronal images (1 mm) for ACL tears. Then, we compared the tear types (AMB or PLB) and grade presumed from oblique coronal MR imaging with arthroscopy. Results: Arthroscopy revealed ACL tear in 24 (48%) patients. There was significant difference between sagittal images and arthroscopy results for ACL tear recognition (p < 0.001). No significant difference was detected for oblique coronal images when compared with arthroscopy results (p = 0.180). Sensitivity and specificity values for ACL tear diagnosis were 37.04% and 95.65% for sagittal images; 74.07% and 91.30% for oblique coronal images. There was no significant difference between arthroscopy and oblique coronal MR images in grading AMB and PLB injuries (p > 0.05). Conclusion: Addition of thin slice oblique coronal images to conventional sequences could better contribute to better verifying the presence of ACL tear and in determining its grade.

  5. 重症颅脑损伤术中急性脑膨出45例临床分析%Analysis of Acute Encephalocele during Severe Craniocerebral Injury

    Institute of Scientific and Technical Information of China (English)

    郁明惠; 李伟生; 钱兴龙; 陆黎春

    2012-01-01

    Objective To discuss the causes and treatment of acute encephalocele during the operation of severe craniocerebral injury.Methods We reviewed and analyzed the clinical data of 45 patients with craniocerebral trauma who received craniotomy with the occurrence of acute encephalocele.Result All of 45 patients were evaluated in Glasgow outcome scale(GOS) after operation:7 patients reach favorable recovery(15.6%),7 cases with moderate disabled(15.6%),2 cases with severe disabled(4.4%),6 patients were in persistentvegetativestate(PVS)(13.3%),and 23 cases dead eventually(51.1%).Conclusion The main causes of acute encephalocele during the operation of severe craniocerebral injury were delayed intracranial haematoma and acute diffuse brain swelling.Processing of delayed intracranial haematoma,dural mesh incision,bilateral bone disc and other severe craniocerebral injury intraoperative acute encephalocele caused of heavy residual rate and mortality can be reduced.%目的 探讨重症颅脑损伤术中急性脑膨出的病因和术中处理.方法 对45例颅脑外伤开颅术中出现急性脑膨出的临床资料进行回顾分析.结果 45例术后根据格拉斯哥预后评分(GOS)评定:恢复良好7例(15.6%),轻残7例(15.6%),重残2例(4.4%),植物生存6例(1 3.3%),死亡23例(51.1%).结论 迟发性颅内血肿和急性弥漫性脑肿胀是重症颅脑损伤开颅术中发生急性脑膨出的主要原因.迟发性颅内血肿的处理、硬脑膜网状切开、双侧去骨瓣等可以降低重症颅脑外伤术中急性脑膨出的致重残率和病死率.

  6. The analysis of acute intraoperative encephalocele insevere head-injured patients%重型颅脑损伤术中急性脑膨出的临床分析

    Institute of Scientific and Technical Information of China (English)

    陈清坤

    2010-01-01

    Objective To summarize the causes and prophylactic theyapeutic methods of acute intraoperative encephalocele in severe head-injured patient.Methods Thirty-one severe head injured patients with acute intraoperative encephalocele were analysed retrospectively and the preventive and treating methods were implemented.Results Acute diffuse brain swelling,delayed intracranial heamatomas,larcerationwere,long-term brain herniation and cerebral anoxia were the main causes of intraoperative encephalocele.Conclusion According todifferent causes,the methods of treatment should be removes heamatomas completely,decreasing intracranial pressure gradually,intraoperative hyperventilation,large dose of mannitol and maintain of systolic blood pressure respectively,the acute intraoperative encephalocele in head injured patients could be prevented and treated effectively.%目的 探讨重型颅脑损伤手术中急性脑膨出的原因及有效的防治措施.方法 对31例重型颅脑损伤患者手术中出现急性脑膨出进行回顾性分析,总结其形成原因,比较各种防治措施的疗效.结果 急性弥漫性脑肿胀、迟发性颅内血肿、严重脑挫裂伤、脑疝时间长、脑组织缺血和缺氧等是造成重型颅脑损伤手术中急性脑膨出的主要原因.结论 针对不同病因采取相应措施如彻底清除颅内血肿、适当控制血压、使用脱水剂和激素、过度通气、缓慢降低颅内压等是防治术中出现急性脑膨出的有效措施,提高临床疗效.

  7. 股前内侧穿支皮瓣游离移植修复手部创面%Clinical application of anteromedial thigh perforator flap transplantation for repairing wounds in the hand

    Institute of Scientific and Technical Information of China (English)

    杨晓东; 刘杨武; 杨锦; 陈逸民; 付尚俊; 周阳; 丁建波; 楼旭鹏

    2012-01-01

    Objective To investigate the clinical effects of repairing wounds in the hand with free anteromedial thigh perforator flap transplantation. Methods From June 2008 to June 2011,15 cases were treated with free anteromedial thigh perforator flap transplantation for repairing the wound in the hand.There were 5 cases of volar defects,4 cases of defects on the ulnar aspect of the hand,1case of first web space wound and 5 cases of dorsal defects.Wound sizes ranged from 6 cm × 4 cm to 13 cm × 9 cm.Flap pedicles were anastomosed to the radial artery and cephalic vein of the recipient site in 11cases,and to the ulnar artery and basilic vein in 4 cases.Direct closure of the donor rite was possible in 9 cases,while skin graft was necessary in 6 cases. Results All the transplants survived.There was no vascular crisis.Postoperative follow-up ranged from 3 to 12 months.Satisfactory clinical results were recorded. Conclusion Anteromedial thigh perforator flap transfer is an effective method of repairing wounds in the hand.%目的 探讨应用股前内侧穿支皮瓣游离移植修复手部创面的临床疗效.方法 2008年6月至2011年6月,应用股前内侧穿支皮瓣游离移植修复手部创面共15例,其中手掌侧创面5例,尺侧创面4例,虎口区创面1例,手背创面5例;缺损面积:6 cm×4cm~13cm×9 cm;其中11例与受区桡动脉、头静脉吻合,4例与尺动脉、贵要静脉吻合.供区直接缝合9例,部分植皮6例.结果 本组15例皮瓣全部存活,未出现血管危象.随访3~ 12个月,临床效果满意.结论 应用股前内侧穿支皮瓣游离移植修复手部(正)面,临床效果满意,值得推广应用.

  8. Reconstrucción del ligamento cruzado anterior desde el portal anteromedial; evaluación de la fijación femoral en un modelo cadavérico

    OpenAIRE

    Torres Claramunt, Raúl; Cáceres i Palou, Enric

    2011-01-01

    Objectiu. Valorar el risc de lesió de les estructures posterolaterals del genoll realitzant una reconstrucció del Lligament Encreuat Anterior (LEA) mitjançant plàstia d'isquiotibials i fixació femoral am sistema Cross-Pin. Material. 10 genolls cadavèrics frescs. Reconstrucció artroscòpica del LEA mitjançant túnel anatòmic des del portal anteromedial. Dissecció anatòmica del genoll mesurant distàncies del Cross-Pin al Lligament Col·lateral Lateral (LCL), tendó popliti, nervi peroneo i tendó ga...

  9. 术中窦汇区迟发性硬膜外血肿致急性脑膨出的治疗%The treatment of malignant encephalocele caused by acute epidural hematoma around confluens sinuum in operation

    Institute of Scientific and Technical Information of China (English)

    徐勤义; 董吉荣; 蔡学见; 王玉海; 刘斌; 时忠华; 金东; 冯毅; 何建青

    2010-01-01

    目的 探讨颅脑损伤患者术中窦汇区迟发性硬膜外血肿所致急性脑膨出的临床特点及诊治经验.方法 回顾我院2007年5月至2009年5月收治的10例颅脑损伤患者,均为开颅术中发现急性脑膨出,术中复查头颅CT明确窦汇区迟发性硬膜外血肿的诊断后,取顶枕部"U"形切口,做窦汇区骨瓣成形加自体筋膜加压修补术.结果 根据GOS评分判断愈后:中残2例,重残1例,植物生存1例,死亡6例.结论 窦汇区硬膜外血肿做跨窦骨瓣成形术,骨瓣足够大,出血点完全暴露,再用自体筋膜加压修补术彻底止血,是理想的手术方法 .早期诊断及正确的手术方法 是救治成功的关键.%Objective To investigate the characteristics of malignant encephalocele caused by acute epidural hematoma around confluens sinuum during operation. Method Ten patients admitted from May 2007 to May 2009 in our hospital was reviewed. All cases presented malignant encephalocele during operation and acute epidural hematoma around confluens sinuum after CT scan. We made craniotomy with a bone flap under U - shape incision and self - fascia was used to patch compressively for hemostasis. Results According to the GOS score 2 cases had satisfactory outcome with moderately disability, 1 severe disability, 1 vegetative state, 6 dead.Conclusion Patients with acute epidural hematoma around confluens sinuum might be made craniotomy in a big enough bone - flap so that bleeding point exposed wholly and stopped bleeding by self - fascia patch repair compressively. Early diagnosis and correct operative technique might be key point for successful remedy.

  10. Clinical outcomes in the single-bundle anterior cruciate ligament reconstruction using antero-medial portal technique%前内侧入路解剖重建单束前交叉韧带的临床评估

    Institute of Scientific and Technical Information of China (English)

    张勇; 朱明生; 杨林; 谢伟杰

    2016-01-01

    Objective To assess the position and clinical outcomes of the reconstructed single-bundle anterior cruci-ate ligament ( ACL) through anteromedial portal ( AMP) techniques .Methods Arthroscopic single-bundle ACL re-construction with autologous hamstring tendon was performed using AMP technique in 25 patients.The bone tunnel position, upward angle , tension of graft were measured from magnetic resonance imaging examination and plain radio-graphs ,11 healthy subjects were used as a control group .The clinical outcome was assessed by the Lysholm knee score.Results The lateral radiographs demonstrate the femoral tunnels were anterior to the intersection of the inter -condylar roof and the femoral posterior cortex line , and the tibial tunnels were posterior to the slope of the intercondy-lar roof.The upward dip of ACL measured from MRI were 50.82°±4.57°.The center of the bibial tunnel was loca-ted 0.50 ±0.04 of the entire sagittal length of the tibial plateau from the anterior edge of the tibia ,compared with the control group about the two terms data , there was not significant difference ( P>0.05 ) .The follow-up period was 13~44 months.The Lysholm score increased from 64.76 ±7.16 points to 92.20 ±4.29 points (P<0.01).Con-clusions ACL reconstruction through anteromedial portal technique is closer to anatomy reconstruction , which pro-vides satisfactory radiological and early clinical outcomes .%目的:评估关节镜下经前内侧入路解剖重建单束前交叉韧带( ACL)的位置、形态及临床效果。方法对25例ACL断裂患者在关节镜下经前内侧入路应用解剖重建技术行单束ACL重建术,移植物应用自体腘绳肌腱。术后行X线、MRI检查,了解骨道情况,观察移植物形态及张力,并与11例健侧膝关节的正常ACL进行对比。应用Lysholm评分系统评估膝关节功能。结果术后X线片显示股骨隧道内口位于髁间窝顶与股骨后缘皮质线交叉点前缘,胫骨

  11. [Outcome of relaying anterolateral thigh perforator flap in resurfacing the donor site wound following free anteromedial thigh perforator flap transfer for reconstruction of defect after oral tumor radical resection].

    Science.gov (United States)

    Song, D J; Li, Z; Zhou, X; Zhang, Y X; Peng, X W; Zhou, B; Lyu, C L; Yang, L C; Peng, W

    2017-02-20

    Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two

  12. A clinical analysis of individualized anatomical anterior cruciate ligament reconstruction through anteromedial portal technique%经前内侧入路个体化解剖重建前交叉韧带的临床分析

    Institute of Scientific and Technical Information of China (English)

    张理选; 李映姗; 张华胜; 郭汉明; 王新光; 康明

    2015-01-01

    目的:分析经前内侧入路建立股骨骨道进行前交叉韧带(ACL)个体化解剖重建的临床疗效。方法自2012年1月~2013年7月,共有52例患者在关节镜下单束解剖重建膝关节 ACL,重建后用相同的方法进行康复锻炼,对所有患者进行随访,常规查 Lachman 试验,膝关节屈伸活动度,轴移试验,Lysholm 膝关节评分,并进行比较。结果所有患者的膝关节屈伸活动度都在正常范围以内,没有出现韧带撞击现象,患者术后进行 Lachman 试验显示Ⅰ度阳性2例,轴移试验均阴性。膝关节 Lysholm 评分:重建前、后膝关节 Lysholm 评分差异有统计学意义(P <0.001)。结论经前内侧入路能更精确地寻找 ACL 的股骨解剖止点并进行个体化解剖重建,操作手法简单且能较快恢复膝关节功能,对恢复膝关节的稳定性起到了很好的作用。%Objective To observe the clinical efficacy of the anatomical reconstruction of anterior cruciate ligament (ACL)through anteromedial (AM)portal femoral bone tract technique. Methods January 2012~July 2013 fifty-two cases underwent arthroscopy-guided anatomic single-bundle ACL reconstruction.All the patients did the same recovery exercises and were followed up.Traditional physical examination such as Lachman test,anterior draw test and pivot shift test were conducted for all these patients after the surgery. Lysholm knee joint score was done.And the obtained data was compared between the two groups. Results The flexion-extension motions of all knee joints were in the normal range.No ligament impact occurred.The pivot shift test results were negative in all cases.Post-operative Lachman test results showed 2 cases were grade I positive.Compared of pre-construction Lysholm knee joint scores to post-construction yielded statis-tical difference (P <0.001). Conclusion It seemed to be better to match the native femoral ACL footprint through AM portal,and reconstruct individualized anatomic ACL.It is a

  13. Clinical analysis of transplantation of single-bundle four-strand hamstring tendon via anteromedial approach for anterior cruciate ligament reconstruction%经前内侧入路单束四股腘绳肌腱重建前交叉韧带的临床分析

    Institute of Scientific and Technical Information of China (English)

    曹雪飞; 甄平

    2014-01-01

    Objective:To assess clinical effects of arthroscopic reconstruction of anterior cruciate ligament (ACL) using single-bundle four-strand hamstring tendon via anteromedial approach. Methods:20 cases of ACL fracture patients were treated with the single-bundle four-strand hamstring tendon via anteromedial approach for anterior cruciate ligament reconstruction, and guided them with functional exercises after operation. Lysholm score standard was used for the subjective function of the knee: before the operation, 6 months and 12 months after the operation. Results: The 20 cases were followed up for 12-18 months with an average of 14 months. The Lysholm score was improved from (53. 5±6. 9) points before the operation to (88. 4±5. 2) points (6 months after the operation) and (91. 6±4. 2) points (12 months after the operation), and the differences were statistically significant (P<0. 01). Conclusions:The arthroscopic reconstruction of anterior cruciate ligament using the single-bundle four-strand hamstring tendon via anteromedial ap-proach is an important method to maintain the stability of knee and recover the knee function, and worthy of strongly clinical research and extension.%目的:探讨关节镜下经前内侧入路( anteromedial,AM)行自体单束四股腘绳肌腱重建前交叉韧带( anterior cruciate ligament, ACL)的临床疗效。方法:对收治的20例 ACL 断裂患者采用 AM 法行自体单束四股腘绳肌腱重建前交叉韧带,术后指导患者行功能锻炼。采取 Lysholm 评分标准对患者术前、术后6个月、12个月膝关节主观功能进行评分。结果:随访20例患者,随访时间12~18个月,平均14个月。患者术前 Lysholm 评分(53.5±6.9),术后6个月 Lysholm 评分为(88.4±5.2),术后12个月 Lysholm 评分为(91.6±4.2),差异有统计学意义(P<0.01)。结论:关节镜下 AM 法行自体单束四股腘绳肌腱重建前交叉韧带是维持膝关节稳定、恢复膝关节功能的重要方法,值得临床研究推广。

  14. Estudio comparativo de la estabilidadrotacional y traslacional de dos técnicas quirúrgicas de reconstrucción del ligamento cruzado anterior mediante cirugía guiada por navegador: técnica monotúnel no anatómica vs técnica anteromedial anatómica

    OpenAIRE

    Minguell Monyart, Joan

    2015-01-01

    Objetivo: Comparar las técnicas de reconstrucción del LCA por portal Anteromedial (AM) y la técnica monotúnel o Transtibial modificada (TT) desde el punto de vista biomecánico, anatómico y clínico a corto plazo, con un seguimiento mínimo de 1 año. Hipótesis del estudio: La técnica AM reproduce mejor la anatomía y biomecánica de la rodilla con el consiguiente mejor resultado clínico. Material y Métodos: Estudio prospectivo y aleatorizado en 106 pacientes afectos de ruptura crónica del LCA (55 ...

  15. 驾驶摩托车致膝关节前内侧旋转不稳定的手术治疗%SURGICAL TREATMENT OF ANTERO-MEDIAL ROTATORY INSTABILITY OF KNEE JOINT CAUSED BY MOTORCYCLE

    Institute of Scientific and Technical Information of China (English)

    周炎; 丰峰; 瞿新丛; 方祖怡; 刘祥; 潘晓辉; 许来峰

    2012-01-01

    Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occurred in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.%目的 探讨手术治疗驾驶摩托车致膝关

  16. 术中非手术区迟发性颅内血肿致急性脑膨出的高危因素及抢救体会40例%The high risk factors and emergency treatments to the patients with in-traoperative acute encephalocele caused by delayed intracranial hematomas at non operating region:An investigate of 40 cases

    Institute of Scientific and Technical Information of China (English)

    赵刚; 刘帅; 李俊; 王宇; 孙继程; 张义; 王铂

    2014-01-01

    目的:探讨术中非手术区迟发性颅内血肿致急性脑膨出患者的临床高危因素及抢救经验。方法对2000年1月~2013年12月40例术中非手术区迟发性颅内血肿致急性脑膨出患者的临床资料进行回顾性分析,总结其高危因素及抢救经验。结果对冲伤22例。术前合并广泛脑挫裂伤14例,合并颅骨骨折16例,合并颅内小血肿(<15 mL)10例。致急性脑膨出的颅内血肿中对侧32例,其中硬膜外血肿24例。再手术32例,存活16例,总死亡率60%。结论术中非手术区迟发性颅内血肿致急性脑膨出高危因素为广泛脑挫裂伤、对侧颅骨骨折、非手术区的颅内小血肿。掌握其临床高危因素,有足够的预见性,充分的术前准备,正确的术中处理,术后科学系统的综合治疗才能最大限度地挽救患者生命。%Objective To investigate the high risk factors and emergency treatments to the patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region. Methods The clinical data of 40 patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region from January 2000 to December 2013 were analyzed retrospectively. Summarized the high risk factors and emergency treatments in this case. Results The 22 cases with contrecoup injury. 14 cases with extensive contusion of brain,16 cases with skull fracture and 10 cases with small intracranial hematoma (Volume <15mL).The delayed intracranial hematomas to the acute encephalocele include,32 cases at the offside. And 24 cases with epidural hematoma. 32 cases had to undergo reoperation, survived 16 cases. The total death rate was 60%. Conclusion The high risk factors are ex-tensive contusion of brain, offside skull fracture and the delayed intracranial hematomas at non operating region. Under-standing Its high risk factors in clinical, with much more foreseeability, and

  17. Nasal encephalocele in a child with Beckwith-Wiedemann syndrome

    NARCIS (Netherlands)

    Broekman, Marike L. D.; Hoving, Eelco W.; Kho, Kuan H.; Speleman, Lucienne; Sen Han, K.; Hanlo, Patrick W.

    2008-01-01

    Beckwith-Wiedemann syndrome (BWS) is a rare congenital syndrome characterized by gigantism, macroglossia, exophthalmos, postpartum hypoglycemia, and multiple midline defects such as omphalocele. The authors describe, to the best of their knowledge, the first case of a child in whom BWS was diagnosed

  18. Periventricular nodular heterotopia, frontonasal encephalocele, corpus callosal dysgenesis and arachnoid cyst: A constellation of abnormalities in a child with epilepsy

    Directory of Open Access Journals (Sweden)

    Prasad Krishnan

    2014-01-01

    Full Text Available A 7-year-old male child presented with poorly controlled generalized tonic-clonic seizures. On examination, he was mentally retarded, deaf and had a swelling at the root on the nose. Computed tomography scan done previously revealed a left temporal arachnoid cyst (AC due to which he was referred for surgery. However, magnetic resonance imaging revealed a constellation of abnormalities - all of which could be responsible for his seizures. The combination of periventricular nodular heterotopias with encepaholcele is rarely described in the literature, and more infrequently so its combination with AC and callosal dysgenesis - the Chudley-Mccullough syndrome. We describe the case and review relevant literature on this subject.

  19. Periventricular nodular heterotopia, frontonasal encephalocele, corpus callosal dysgenesis and arachnoid cyst: A constellation of abnormalities in a child with epilepsy.

    Science.gov (United States)

    Krishnan, Prasad; Chattopadhyay, Arijit; Saha, Manash

    2014-01-01

    A 7-year-old male child presented with poorly controlled generalized tonic-clonic seizures. On examination, he was mentally retarded, deaf and had a swelling at the root on the nose. Computed tomography scan done previously revealed a left temporal arachnoid cyst (AC) due to which he was referred for surgery. However, magnetic resonance imaging revealed a constellation of abnormalities - all of which could be responsible for his seizures. The combination of periventricular nodular heterotopias with encepaholcele is rarely described in the literature, and more infrequently so its combination with AC and callosal dysgenesis - the Chudley-Mccullough syndrome. We describe the case and review relevant literature on this subject.

  20. Reabilitação após reconstrução do ligamento cruzado anterior pela porta anteromedial com enxerto de isquiotibiais

    OpenAIRE

    Alves, João

    2011-01-01

    Este relatório, realizado no âmbito do Mestrado em Fisioterapia, decorreu no Esmoriz Ginásio Clube (EGC), entre 28 de Setembro de 2010 e 30 de Abril de 2011. É composto, fundamentalmente, por duas partes. A primeira refere-se a uma descrição do estágio desportivo em geral, onde começamos por fazer uma caracterização da modalidade desportiva, do clube e dos atletas. Esta última, de um modo geral e, também, por posições no campo. Analisou-se, de forma epidemiológica, as lesões de...

  1. 前交叉韧带中前内束与后外束功能上的差异研究%Differences of the function between the anteromedial bundle and posterolateral bundle of the anterior cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    田鑫铎; 尹文哲; 孙敏; 叶义杰; 江磊磊; 任聪

    2013-01-01

    Objective To investigate the trauma mechanism, injury characteristics, early diagnosis and treatment of the drivers with steering wheel injuries. Methods The clinical data of 122 patients who suffered from steering wheel injuries in our hospital from Jan. 2007 to Dec. 2011 were analyzed retrospectively. Results Among these 122 patients, there were 27 patients with cranial or cervical trauma,64 patients with chest trauma,56 patients with abdomen trauma,41 patients with extremities,pelvic or spine fracture. There were 81 patients with poly-trauma. Totally 115 patients were survived. The survival rate was 94. 3% ( 115/122) and the mortality was 5.1% (7/122) . The main cause of death was the injuries with cranial trauma. Conclution Steering wheel injuries in drivers usually were severe and accompanied with high poly-trauma rate. Mostly severe thoracoabdominal trauma need surgical treatment. .Blunt cardiac injuries and p anc re at ico duodenal injuries are easy to be miss-diagnosed and mis-diagnosed,so doctors should pay more attention to these conditions. iagnoseu,so doctors snoulu. pay more attention to tnese conditions.%目的 研究前交叉韧带(ACL)中前内束(AMB)与后外束(PLB)在维持膝关节稳定性方面所起的不同作用.方法 对12具新鲜冰冻尸体的膝关节标本在分别屈曲0°、15°、30°、60°及90°下对胫骨施加100N的前负荷及在0°、15°、30°下5Nm的胫骨内旋负荷,使两束韧带拉伸并带动电阻应变片形变引起阻值改变,从而引起输出电压值的变化.结果 在对胫骨施加100N前负荷的条件下,AMB在屈膝60°和90°时的原位拉力显著>屈膝0°和15°时(P屈膝30°、60°和90°时(PAMB(PPLB(PPLB(P0.05).结论 虽然在ACL 的双束中AMB起主要作用,但PLB的辅助作用仍不可忽视,其体现在膝关节接近伸直位维持前向和内旋稳定性方面.

  2. “I swear, I can't stop it!” – A case of severe Tourette's syndrome treated with deep brain stimulation of anteromedial globus pallidus interna

    Directory of Open Access Journals (Sweden)

    S Dwarakanath

    2017-01-01

    Conclusion: Tic severity reduced substantially post-surgery, with the YGTSS score improving by more than 72%. These improvements were sustained on follow-up visits with the patient successfully returning to join college. To our knowledge, this is the first such report from India and South Asia.

  3. MRI evaluation of the knee post double bundle ACL reconstruction: Association of graft findings and comparison with arthroscopy

    Directory of Open Access Journals (Sweden)

    Mohammed Farghally Amin

    2016-06-01

    Conclusion: Increased signal intensity within the anteromedial or posterolateral bundles of a double bundle ACL reconstruction is frequently associated with a partial tear. Impingement of the anteromedial graft is frequently associated with partial tear and increased signal intensity which is proved by arthroscopy/surgery. A low incidence of other complications is seen.

  4. Transplantation of single-bundle four-strand hamstring tendon via anteromedial approach for anterior cruciate ligament reconstruction%经前内侧入路单束4股腘绳肌腱移植重建前交叉韧带

    Institute of Scientific and Technical Information of China (English)

    徐长明; 杨乐; 胡玉华; 皇甫小桥

    2012-01-01

    10.3969/j.issn.2095-4344.2012.53.019%  背景:国内外对于经膝关节前内侧入路建立前交叉韧带股骨隧道的临床文献尚缺乏.目的:探讨经膝关节前内侧入路单束4股腘绳肌腱重建前交叉韧带的可行性.方法:65例前交叉韧带损伤患者随机分为两组,其中35例接受经前内侧入路单束4股腘绳肌腱重建前交叉韧带,30例接受经胫骨隧道技术4股腘绳肌腱重建前交叉韧带,重建后平均随访16个月,分别评估膝关节的前向稳定性、旋转稳定性和膝关节的整体功能.结果与结论:最后一次随访时,经胫骨隧道组和经前内侧入路组在 Lysholm 评分、膝关节前向稳定性方面差异均无显著性意义(P >0.05).经胫骨隧道组的轴移试验阳性率为23%,经前内侧入路组的阳性率为6%,两组之间差异有显著性意义(P <0.05).结果可见经膝关节前内侧入路制作股骨隧道重建前交叉韧带,不仅可以重建膝关节的前向稳定性,还可以较好地重建膝关节的旋转稳定性.

  5. Birth Defects Data and Statistics

    Science.gov (United States)

    ... or without cleft palate Limb deficiency Trisomy 18 (Edwards syndrome) Hypospadias Asian, Non-Hispanic Spina bifida without anencephaly ... Gastroschisis Omphalocele Black, Non-Hispanic Encephalocele Trisomy 18 (Edwards syndrome) Aortic valve stenosis Cleft lip with or without ...

  6. Urban-Rural Variation in the Occurrence of Neural Tube Defects in Texas

    Science.gov (United States)

    This study examined the pattern and magnitude of urban-rural variation in anencephaly, spina bifida without anencephaly, and encephalocele in Texas using four different indicators of urban-rural status for the period 1999 to 2003.

  7. Different Effect between Unilateral and Bilateral Decompressive Craniectomy on Acute Encephalocel During Surgery in Patients with Unilateral Severe Brain Injury%单、双侧去骨瓣减压对单侧重型颅脑损伤术中脑膨出的疗效差异

    Institute of Scientific and Technical Information of China (English)

    郭浩; 袁晖; 尹昌林; 徐世伟; 刘明华; 文亮

    2012-01-01

    Objective: To investigate the effect of the knowledge of nutrition and health education intervention on improving post-partum knowledge and behavior. Methods: The subjects,the late pregnancy women ofQingdao, were randomly divided into intervention group and control group. The objects of intervention group had accepted the education of nutritional and health knowledge. Results: The awareness rate of most nutritional health knowledge of the intervention group was significantly higher than those in the control group. The intervention group subjects from medical staff, books and magazines for nutrition and health knowledge (83.1%, 72.3%) were significantly higher than those in the control group (65.2%, 56%). Women in the intervention group object had intaked more potato, fish, soy products, green leafy vegetables, nuts, dietary fiber, niacin, calcium and vitamin C and lower egg, cholesterolthan those in control group. Conclusion: Targeted nutritional health education can improve the knowledge level of puerperal women and promote healthy dietary behavior. Therefore, targeted nutritional health and knowledge education should be promoted.%目的:探讨在单侧或以单侧为主的重型颅脑损伤病例中,何种手术方式更适宜处理手术中出现的急性脑膨出.方法:对我科自2008年5月至2010年12月收治的以单侧为主的重型颅脑损伤且术中出现急性脑膨出的52例临床资料进行回顾性分析,研究单、双侧去骨瓣减压术对患者颅内压( IcP)及伤后6个月时的GOS评分的影响.结果:单侧去骨瓣减压患者29例,分为恢复良好组(GOS 4-5分,n=6),不良组(GOS 2-3分,n=9)和死亡组(GOS 1分,n=14);双侧去骨瓣减压患者23例亦分为恢复良好组(n=6),不良组(n=12)和死亡组(n=5);两种减压术的死亡率差异显著(P<o.05).单侧和双侧去骨瓣减压术均明显降低ICP(P<0.05),但双侧减压的存活组其术后ICP( 17.2±4.2 mmHg)显著低于单侧减压的存活组(25.0±5.4mmHg)(P<0.05).结论:对以单侧为主的重型颅脑损伤,同次行双侧去骨瓣减压术较单侧减压更能有效降低术中急性脑膨出所致高颅压,降低死亡率.

  8. Hypertelorism and micro-orbit simultaneous correction in a patient with paramedian bilateral facial clefts.

    Science.gov (United States)

    Prada, José Rolando; Mendoza, María Bibiana

    2014-09-01

    The aim of this paper is to report a case of a patient with paramedian bilateral facial clefts and hypertelorism associated with a severe encephalocele and micro-orbit. The patient required a facial bipartition to correct a transsphenoidal encephalocele, and a modified medialization surgery of the orbits to simultaneously expand the micro-orbit and correct the hypertelorism. These procedures achieved hypertelorbitism correction, orbital expansion which allowed symmetrical facial growth, and a functional orbit that permitted the use of an ocular prosthesis. We present this unique case to highlight the predictable results of a procedure that combines 2 surgical reproducible techniques of craniofacial surgery.

  9. Diagnosis of Chiari III malformation by second trimester fetal MRI with postnatal MRI and CT correlation

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Alice B.; Glenn, Orit A. [University of California, San Francisco, Department of Radiology, San Francisco, CA (United States); Gupta, Nalin [University of California, San Francisco, Department of Neurosurgery, San Francisco, CA (United States); Otto, Carl [California Pacific Medical Center, Department of Perinatology, San Francisco, CA (United States)

    2007-10-15

    We report a case of Chiari III malformation diagnosed by fetal MRI. Ultrasound (US) performed at a gestational age of 18 weeks demonstrated a posterior skull base cyst. Repeat US at 19 weeks demonstrated neural tissue in the cyst, consistent with an encephalocele. MR imaging at 23 weeks confirmed the presence of an occipital encephalocele, demonstrated additional bony defect in the upper cervical spine, and identified abnormal morphology and position of the brainstem consistent with the diagnosis of Chiari III. Postnatal MRI and CT confirmed the fetal MRI findings and demonstrate the utility of fetal MRI in the early evaluation of songraphically detected posterior fossa abnormalities. (orig.)

  10. Clinical and magnetic resonance evaluation of the temporomandibular joint with rotational disc displacement

    Energy Technology Data Exchange (ETDEWEB)

    Chiba, Masatoshi; Sakurada, Motoyuki; Echigo, Seishi [Tohoku Univ., Sendai (Japan). School of Dentistry; Kumagai, Masahiro; Kochi, Shoko

    1998-03-01

    The most common direction of temporomandibular joint (TMJ) disc displacement is anterior. Anterior disc displacement is associated with lateral or medial disc displacement, termed rotational disc displacement (RDD). There have been few systematic studies of the clinical and magnetic resonance imaging (MRI) findings of TMJs with RDD. The aim of this study was to assess the prevalence of RDD and to evaluate the relations between the direction of disc displacement (anteromedial RDD, anterolateral RDD, and pure anterior disc displacement) and clinical findings, including joint pain, joint sound, and range of motion, as well as MRI findings, including disc shape, disc reduction, disc mobility, degree of disc displacement, bone changes of the condyle, and degree of condylar translation. The study was based on MRI of 529 TMJs in 409 patients with symptoms and signs of TMJ. Sagittal and coronal T1-weighted SE images (1.5 Tesla) were used. MRI showed anteromedial RDD in 96 joints (18.1%), anterolateral RDD in 64 joints (12.1%), and anterior disc displacement in 207 joints (39.1%). There were no statistical differences between anterolateral RDD, anteromedial RDD, and anterior disc displacement with regard to clinical findings. The incidence of reducible disc was higher in anterolateral RDD than in anteromedial RDD or anterior disc displacement. The incidence of bone changes was lower in anterolateral RDD than in anterior disc displacement. There were no significant differences between anteromedial RDD and anterior disc displacement with regard to MRI findings. In conclusion, anteromedial RDD may represent the same clinical entity as anterior disc displacement, but it remains unclear whether or not anterolateral RDD differs from anteromedial RDD or anterior disc displacement. (author)

  11. Folate and neural tube defects - Recommendations from a Danish working group

    DEFF Research Database (Denmark)

    Rasmussen, Lone Banke; Andersen, Niels Lyhne; Andersson, G.

    1998-01-01

    A working group was established to evaluate the need for an increased folate intake in Danish women to decrease the risk of neural tube defects (NTDs). NTD are birth defects a which include anencephaly, encephalocele and spina bifida. In Denmark the incidence is about 1.4 per 1,000 pregnancies...

  12. Maternal Antenatal Bereavement and Neural Tube Defect in Live-Born Offspring

    DEFF Research Database (Denmark)

    Ingstrup, Katja Glejsted; Wu, Chun Sen; Olsen, Jørn

    2016-01-01

    -up, 1,115 children were diagnosed with any NTDs: spina bifida (n = 889), anencephaly (n = 85) and encephalocele (n = 164). And 23 children were diagnosed with two types of NTDs. Overall, when comparing bereaved mothers to non-bereaved mothers, no significant increased prevalence of NTDs in the offspring...

  13. Anatomical reconstruction of the anterior cruciate ligament: a logical approach

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2015-08-01

    Full Text Available ABSTRACT We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP and femoral tunnel drilling through an accessory anteromedial portal (AMP. The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-intechnique is used and also can be used for double-bundle ACL reconstruction.

  14. NASO FRONTAL LESIONS IN THE MIDLINE OF CHILDREN

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    Juan Antonio Lugo Machado

    2015-04-01

    Full Text Available Congenital nasofrontal lesions of the midline are rare congenital abnormalities such as dermoid cysts, nasal gliomas and encephaloceles, with an occurrence of 1: 20,000 to 40,000 births. Its importance lies in the connection to the central nervous system. The biopsy of the lesions with intracranial communication, produce cerebrospinal fluid leaks or meningitis. Objective: To determine the prevalence of midline nasofrontal lesions in a tertiary hospital of regional referral and it´s relationship with other malformations. Material and Methods: Study Design: Transversal retrospective. Male and female patients aged 1 month to 13 years of age with congenital lesions of the nasofrontal midline, treated at Children's Hospital from 1990 to 2005. Sample: was obtained by a non-probabilistic sample of consecutive cases. Through the Statistical Package for the Social Sciences (SPSS version 13.0 which included descriptive statistics: median as a measure of central tendency and frequency distribution and proportion as a measure of dispersion. Results: a review of clinical records was conducted from 1990 to 2005, finding 38 of 67 records reviewed, 29 files were excluded because they correspond to the diagnosis of occipital encephalocele. Prevalence was 38 cases in 15 years. The gender distribution of nasofrontal midline lesions was slightly higher in females with 22 cases and 16 cases in males. The midline nasofrontal lesions found were midline encephalocele, gliomas and dermoid cysts. In our review most encephaloceles were not associated with the central nervous system and 11 cases did have an associated disorder; 5 cases with hydrocephalus and / or temporal or occipital cysts and 6 cases with nondevelopment of the corpus callosum plus hydrocephalus. Conclusion: Our prevalence was 38 cases in 15 years. Nasofrontal midline lesion disgnosis are usually made in the first months of life. Among the types of midline nasofrontal lesions, the most common type found

  15. Intratentorial lipomas with Meckel's cave and cerebellopontine angle extension.

    Science.gov (United States)

    Ruocco, M J; Robles, H A; Rao, K C; Armonda, R A; Ondra, S L

    1995-08-01

    An unusual case of bilateral intratentorial lipomas with extension into Meckel's caves and the cerebellopontine angle is described. Surgical and histopathologic correlation demonstrate that the lipoma encased the trigeminal nerve in Meckel's caves. The origin of the lipoma from the anteromedial margins of the tentorium is discussed and correlated with a recently proposed theory for the development of intracranial lipomas.

  16. Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease

    Directory of Open Access Journals (Sweden)

    Philip Benjamin

    2014-01-01

    Conclusion: Lacunes are important predictors of cognitive impairment in SVD. We highlight the importance of spatial distribution, particularly of anteromedial thalamic lacunes which are associated with impaired information processing speed and may mediate cognitive impairment via disruption of connectivity to the prefrontal cortex.

  17. The spread of injectate during saphenous nerve block at the adductor canal

    DEFF Research Database (Denmark)

    Andersen, H L; Andersen, S L; Tranum-Jensen, J

    2015-01-01

    by comparative dissections of the same limbs. RESULTS: The spread of the injectates was determined by the fascial limits and the muscles surrounding the adductor canal. The anteromedial limit of the adductor canal (the roof) was found to be a continuous fascia, with a thin proximal part and a thicker distal part...

  18. A Fetus with Iniencephaly Delivered at the Third Trimester

    Directory of Open Access Journals (Sweden)

    Esra Cinar Tanriverdi

    2015-01-01

    Full Text Available Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele and iniencephaly clausus (without encephalocele. Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1–5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination.

  19. Meckel-Gruber syndrome: A rare and lethal anomaly

    OpenAIRE

    Kheir, Abdelmoneim E.M.; Imam, Abdelmutalab; Omer, Ilham M.; Hassan, Ibtsama M.A.; Elamin, Sara A.; Awadalla, Esra A.; Gadalla, Mohammed H.; Hamdoon, Tagwa A.

    2012-01-01

    Meckel-Gruber syndrome is a rare and lethal autosomal recessive disorder characterized by occipital encephalocele, postaxial polydactyly and bilateral dysplastic cystic kidneys. It can be associated with many other conditions. Antenatal ultrasound examination establishes the diagnosis by identifying at least two of the major features described. We describe a female baby who had the typical triad of Meckel-Gruber syndrome and died shortly after birth.

  20. A lethal syndrome resembling branchio-oculo-facial syndrome.

    Science.gov (United States)

    Hing, A V; Torack, R; Dowton, S B

    1992-02-01

    Branchio-oculo-facial syndrome, a recently delineated autosomal dominant condition, is characterized by branchial cleft sinuses, ocular anomalies, and unusual facial appearance. A patient with branchial cleft fistulae, microphthalmia, nasomaxillary dysplasia, in addition to cardiac and CNS malformation (holoprosencephaly and meningo-encephalocele), is described. Although many features of this lethal malformation complex resemble those seen in the branchio-oculo-facial syndrome, the complex may represent a new multiple malformation syndrome.

  1. Congenital scalp defects and vitreoretinal degeneration: redefining the Knobloch syndrome.

    Science.gov (United States)

    Seaver, L H; Joffe, L; Spark, R P; Smith, B L; Hoyme, H E

    1993-04-15

    An apparently autosomal recessive syndrome of hereditary vitreoretinal degeneration (VRD) with retinal detachment, high myopia, and congenital encephalocele was described in 1971 by Knobloch and Layer [J Pediatr Ophthalmol 8:181-184]. Clinical confirmation of the presence of encephaloceles was lacking, and no neuropathologic studies were reported. We have evaluated a similarly affected family with 2 sibs with high myopia, VRD, and occipital scalp defects. Histologic examination of the scalp defects showed heterotopic neuronal tissue in both instances. The older girl has had a unilateral retinal detachment. Her other eye and both eyes of the younger sib have so far been treated successfully with prophylactic retinal cryotherapy. Both children have normal to above normal intelligence. The family reported by Knobloch and Layer [1971] and the sibship herein described appear to represent a distinct autosomal recessive trait. Analysis of the associated defects suggests an underlying defect in early cephalic neuroectodermal morphogenesis. Data from these families imply that congenital occipital scalp defects rather than true encephaloceles may, as is true in some cases of Meckel syndrome, accompany Knobloch syndrome. The presence of a congenital midline scalp defect should alert the clinician to possible underlying central nervous system and/or ocular pathology and should lead to consideration of further diagnostic evaluations and prophylactic measures.

  2. Transnasal endoscopic repair of pediatric meningoencephalocele

    Directory of Open Access Journals (Sweden)

    Amit Kumar Keshri

    2016-01-01

    Full Text Available Introduction: Encephaloceles in relation to the nose are rare lesions affecting the skull base. In the pediatric population, majority are congenital lesions manifesting as nasal masses requiring surgical intervention. Materials and Methods: A retrospective study of 6 consecutive patients below 12 years of age with intranasal meningoencephalocele treated by endonasal endoscopic approach at our tertiary centre was done. The follow up period ranged from 6 months to 2 years. A detailed clinical and radiological evaluation of these cases was done. Endonasal endoscopic repair (gasket seal/fat plug was carried out in all cases. Results: Out of 6 patients, 4 patients had post-traumatic and rest 2 cases had congenital meningo-encephaloceles. All patients were asymptomatic in post-operative follow up period. One patient had minor complication of nasal alar collapse due to intra-operative adherence of encephalocele to cartilaginous framework. Conclusion: Transnasal endoscopic repair of anterior skull base meningoencephalocele is a minimally invasive single stage surgery, and has advantage in terms of lesser hospital stay, cost of treatment, and better cosmesis. The repair technique should be tailored to the size of defect to provide a water-tight seal for better outcome.

  3. Prefrontal cortex and hippocampus in behavioural flexibility and posttraumatic functional recovery

    DEFF Research Database (Denmark)

    Rytter, Hana Malá; Andersen, Lykke Grønbech; Christensen, Rie Friis

    2015-01-01

    Within one experiment and one T-maze, we examined the consequences of (i) bilateral lesions of the anteromedial prefrontal cortex (PFC), (ii) bilateral transections of the fimbria-fornix (FF), or (iii) combined lesions of both PFC and FF (COMB) on rats' ability to perform reversal or set-shifting......Within one experiment and one T-maze, we examined the consequences of (i) bilateral lesions of the anteromedial prefrontal cortex (PFC), (ii) bilateral transections of the fimbria-fornix (FF), or (iii) combined lesions of both PFC and FF (COMB) on rats' ability to perform reversal or set......-shifting. Postoperatively, the animals were trained to perform a spatial discrimination go-right task. This was followed by (1) a spatial reversal go-left task (reversal learning), or (2) a visual pattern discrimination task (set-shift). Neither single (PFC or FF) lesion nor combined (COMB) lesions affected the animals...

  4. Olfactory receptor and neural pathway responsible for highly selective sensing of musk odors.

    Science.gov (United States)

    Shirasu, Mika; Yoshikawa, Keiichi; Takai, Yoshiki; Nakashima, Ai; Takeuchi, Haruki; Sakano, Hitoshi; Touhara, Kazushige

    2014-01-01

    Musk odorants are used widely in cosmetic industries because of their fascinating animalic scent. However, how this aroma is perceived in the mammalian olfactory system remains a great mystery. Here, we show that muscone, one musk odor secreted by various animals from stink glands, activates a few glomeruli clustered in a neuroanatomically unique anteromedial olfactory bulb. The muscone-responsive glomeruli are highly specific to macrocyclic ketones; interestingly, other synthetic musk odorants with nitro or polycyclic moieties or ester bonds activate distinct but nearby glomeruli. Anterodorsal bulbar lesions cause muscone anosmia, suggesting that this region is involved in muscone perception. Finally, we identified the mouse olfactory receptor, MOR215-1, that was a specific muscone receptor expressed by neurons innervating the muscone-responsive anteromedial glomeruli and also the human muscone receptor, OR5AN1. The current study documents the olfactory neural pathway in mice that senses and transmits musk signals from receptor to brain.

  5. Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

    OpenAIRE

    Yamakado Kotaro; Arakawa Hitoshi; Hayashi Seigaku

    2012-01-01

    Abstract A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation t...

  6. Arthroscopy-Assisted Closed Reduction and Percutaneous Nail Fixation of Unstable Ankle Fractures: Description of a Minimally Invasive Procedure

    OpenAIRE

    Kong, Christopher; Kolla, Lee; Wing, Kevin; Younger, Alastair S.E.

    2014-01-01

    When one is surgically managing an unstable ankle fracture, anatomic reduction of the syndesmosis is typically accomplished using an open surgical approach. We propose an arthroscopically assisted technique that restores normal anatomy while using a percutaneously placed intramedullary nail to fix the fibula. The patient is positioned supine, and the ankle is placed under traction by use of a tensor bandage. Standard anteromedial and anterolateral arthroscopy portals are used. The joint is ex...

  7. Use of Spherical Nanoindentation to Characterize the Anisotropic Properties of Microscale Constituents and Interfaces in Hierarchically Structured Composite Materials

    Science.gov (United States)

    2015-01-24

    endosteal and periosteal formative surfaces [23]. We chose one of these sites (the Antero-Medial or AM cortex) for our study. The growth of the...figure, instead of a uniform expansion of the cortex around the periosteal or endosteal surfaces, bone formation and resorption take place as a...mechanisms of bovine tibial cortical bone. Journal of Materials Science: Materials in Medicine, 2005. 16(10): p. 947-959. 3. Goodwin, K.J. and N.A

  8. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    OpenAIRE

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imagin...

  9. Fate of the psoas muscle after open reduction for developmental dislocation of the hip (DDH).

    Science.gov (United States)

    Bassett, G S; Engsberg, J R; McAlister, W H; Gordon, J E; Schoenecker, P L

    1999-01-01

    We evaluated the anatomic and functional consequences of psoas lengthening during operative intervention for developmental dislocation of the hip (DDH). Possible anatomic changes were assessed by magnetic resonance imaging (MRI), and functional assessment included strength determination by an isokinetic dynamometer and gait analysis. Six girls and one boy, ranging in age from 15 to 20 months, had operative reduction of a unilateral DDH. One closed and six open reductions (three anteromedial and three anterolateral approaches) were performed. Follow-up ranged from 4 years 0 months to 9 years 2 months. The cross-sectional area determined by MRI of the lengthened psoas muscles was markedly reduced for all of the six open-reduction patients (three moderate and three severe). Atrophy of the iliacus muscle also was apparent by MRI in five of the six open-reduction patients. Maximum flexion torque, as determined by the isokinetic dynamometer, was diminished on the DDH side for the three patients whose hips were reduced open through the anteromedial approach. Average hip-flexion torque over the entire range of motion was decreased for both anteromedial and anterolateral groups on the operated-on side. Lengthening of the psoas tendon during open reduction of a DDH is associated with considerable atrophy of the psoas muscle.

  10. Time trends in the prevalence and epidemiological characteristics of neural tube defects in Liaoning Province, China, 2006-2015: A population-based study.

    Science.gov (United States)

    Zhang, Tie-Ning; Gong, Ting-Ting; Chen, Yan-Ling; Wu, Qi-Jun; Zhang, Yuan; Jiang, Cheng-Zhi; Li, Jing; Li, Li-Li; Zhou, Chen; Huang, Yan-Hong

    2017-02-03

    To evaluate the time trends in the prevalence of neural tube defects and all their subtypes as well as to identify the epidemiological characteristics of these malformations documented in the Liaoning Province of northeast China from 2006 to 2015. This was a population-based observational study using data from 3,248,954 live births as well as from 6217 cases of neural tube defects, 1,600 cases of anencephaly, 2,029 cases of spina bifida, 404 cases of encephalocele, and 3,008 cases of congenital hydrocephalus from 14 cities in Liaoning Province from 2006 to 2015. All analyses were conducted using SPSS software. During the observational period, the prevalence of neural tube defects, anencephaly, spina bifida, encephalocele, and congenital hydrocephalus was 19.1, 4.9, 6.2, 1.2, and 9.3 per 10,000 live births, respectively. Significantly decreasing trends were observed in the prevalence of all these malformations except for encephalocele. Notably, relatively higher prevalence rates were found in isolated compared with non-isolated malformations, with significant differences in selected characteristics (e.g., prognosis status, gestational age, and birth weight) between isolated and non-isolated cases of these malformations. The prevalence of neural tube defects showed a downward trend in Liaoning Province from 2006 to 2015. However, more attention should be focused on non-isolated cases in the future because of the severe clinical manifestations. Future prevention efforts should be strengthened to reduce the risk of these malformations, especially the non-isolated subtype, in areas with high prevalence.

  11. Epidemiologic study of neural tube defects in Los Angeles County. II. Etiologic factors in an area with low prevalence at birth

    Energy Technology Data Exchange (ETDEWEB)

    Sever, L.E.

    1982-01-01

    Epidemiologic characteristics of neural tube defect (NTD) births occurring in Los Angeles County, California, residents during the period 1966-1972 are presented. The prevalence at birth was 0.52/1000 births for anencephalus, 0.51/1000 for spina bifida, and 0.08/1000 for encephalocele, rates considered to be low for a predominantly white population. We hypothesized that environmental (nongenetic) factors are of less etiologic importance in a low-prevalence population than in areas or time periods with high prevalence. We tested that hypothesis by examining epidemiologic characteristics of NTDs in Los Angeles County and comparing them with high-prevalence populations. The data did not support a major etiologic role for environmental factors: (1) no significant differences between rates by month of birth or conception; (2) no significant association with maternal age or parity for anencephalus; for spina bifida a significant maternal age effect (P < 0.01) and for encephalocele a parity effect (P < 0.02); and (3) no significant relationship with father's occupational class for either anencephalus or encephalocele but a marginally significant (P < 0.05) inverse association for spina bifida when a statistic based on ordinal relationships was used. Findings supporting the importance of genetic factors in etiology included: (1) a high percentage of males; (2) a higher twin concordance rate than in high-prevalence populations; and (3) an anencephalus rate among blacks comparable with rates for blacks in other United States populations. Our findings in conjunction with those from other areas and times of low prevalence suggest environmental factors play a relatively insignificant role in the etiology of NTDs in such populations.

  12. Congenital Subgaleal Cysts over the Anterior Fontanelle in Nigerians

    Science.gov (United States)

    Adeloye, Adelola; Odeku, E. Latunde

    1971-01-01

    Eighteen cases of a congenital cystic swelling located over the anterior fontanelle are described in Nigerian patients who were otherwise clinically normal, There was a female: male ratio of 2: 1. Radiologically and at operation, the cysts showed no evidence of intracranial connexion. Excision was curative. Of 14 cases which were histologically verified, all were dermoid cysts except one in which nerve tissue was present suggesting an encephalocele. Air cystography was the most useful diagnostic procedure. ImagesFIG. 2FIG. 3FIG. 4 PMID:5555494

  13. Rare cause of trigeminal neuralgia: Meckel's cave meningocele.

    Science.gov (United States)

    Alobaid, Abdullah; Schaeffer, Todd; Virojanapa, Justin; Dehdashti, Amir R

    2015-07-01

    The most common etiology of classic trigeminal neuralgia is vascular compression. However, other causes must be excluded. It is very unlikely that a meningocele presents with symptomatic trigeminal neuralgia. We present a rare case of a patient presenting with left trigeminal neuralgia. Thin-slice CT and MRI showed a transclival Meckel's cave meningocele. The patient underwent endoscopic repair of the meningocele, which resulted in complete resolution of her symptoms. Meckel's cave meningocele or encephalocele should be considered among the differential diagnoses of trigeminal neuralgia. Meningocele repair should be suggested as the first treatment option in this rare situation.

  14. Teratogenic effect of formaldehyde in rabbits

    Directory of Open Access Journals (Sweden)

    A. A. Al–Saraj

    2009-01-01

    Full Text Available Thirty three pregnant rabbits were exposed to vapour of 10% formaldehyde (12 ppm throughout the gestation period to know its effect on newborns. The results showed no abortion or foetal mortality but there were some anomalies (23.8% among the newborns rabbits which includes: meromelia (6.8%, encephalocele (6.1%, Oligodactyly (4.1%, Umbilical hernia (3.4% and Short tail (3.4%; besides that small for date and decrease in the body weight of the newborns were also noticed. These findings suggest that formaldehyde is a teratogenic agent.

  15. Serum zinc levels in newborns with neural tube defects.

    Science.gov (United States)

    Golalipour, Mohammad Jafar; Mansourian, Azad Reza; Keshtkar, Abasali

    2006-09-01

    Neural tube defects (NTD) comprise of a group of congenital malformations that include spina bifida, anencephaly and encephalocele. Reports have implicated zinc deficiency as one of the causative factors of NTDs. We compared the serum zinc level of 23 newborns having neural tube defects with 35 healthy controls by spectrophotometery during 2003-2004. Zinc deficiency was documented in 43.5% of the cases and 8.6% of the controls (P = 0.002). Multivariate logistic regression analysis revealed a significant association between the presence of NTDs and zinc deficiency (OR = 8.2, 95% Cl: 1.9-34.7).

  16. Spontaneous defects between the mastoid and posterior cranial fossa.

    Science.gov (United States)

    Rereddy, Shruthi K; Mattox, Douglas E

    2016-01-01

    Conclusions Spontaneous defects between the mastoid and the posterior cranial fossa are exceedingly rare. Patients with these lesions may have a lower BMI compared to those with middle cranial fossa encephaloceles, but are otherwise demographically similar. This study recommends repair via a transtemporal approach to allow for examination of the entire posterior face of the temporal bone. Objective To describe cases of spontaneous posterior cranial fossa defects. Methods This study reviewed all cases of spontaneous posterior fossa defects presenting to a tertiary referral center over the last decade and described clinical presentation, imaging, operative findings, and outcomes. We also compared these lesions to those previously reported in the literature as well as the more common spontaneous encephaloceles of the middle cranial fossa. Results This study identified five cases with a mean age of 61.4 years, female-to-male ratio of 4:1, and a mean BMI of 31. Three cases presented with spontaneous pneumocephalus, one with CSF otorrhea, and one as an incidental imaging finding. Four defects were found medial to the sigmoid sinus and one was in the lateral retrosigmoid air cells.

  17. A newborn with very rare von Voss-Cherstvoy syndrome: a case report

    Science.gov (United States)

    Sharma, Deepak; Gupta, Basudev; Shastri, Sweta; Sharma, Pradeep

    2016-01-01

    Introduction von Voss-Cherstvoy syndrome is a part of a group of syndromes with radial and hematologic abnormalities, and until now approximately ten cases have been reported in the literature. This syndrome is characterized by a triad of radial ray defects, occipital encephalocele, and urogenital abnormalities. Case presentation We report a neonate from Indian ethnicity who was diagnosed with von Voss-Cherstvoy syndrome. The neonate had radial ray defect, occipital encephalocele, tetralogy of Fallot, and bilateral agenesis of kidney, ureter, and bladder. The neonate was suspected to have von Voss-Cherstvoy syndrome on the basis of clinical features, which was further confirmed by fibroblast analysis showing somatic mosaicism for del(13q). Conclusion von Voss-Cherstvoy syndrome is a very rare syndrome that can be suspected on the basis of typical clinical features and confirmed by fibroblast analysis showing somatic mosaicism for del(13q). This adds a second case of this chromosome anomaly described in this syndrome. PMID:27499650

  18. O comprimento dos túneis femorais varia com a flexão do joelho na reconstrução anatômica do ligamento cruzado anterior Femoral tunnels' length changes with knee flexion angle in anatomical anterior cruciate ligament reconstruction

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    Julio Cesar Gali

    2012-04-01

    Full Text Available OBJETIVO: O propósito de nosso trabalho foi avaliar o efeito que o grau de flexão do joelho, durante a perfuração dos túneis femorais, pode causar no comprimento desses túneis, na reconstrução anatômica do ligamento cruzado anterior. MÉTODOS: Medimos o comprimento dos túneis femorais anteromedial e posterolateral do ligamento cruzado anterior, em 20 peças anatômicas de joelhos desemparelhadas, 10 direitas e 10 esquerdas, todas com a cartilagem e ligamentos cruzados íntegros. Os túneis foram perfurados com os joelhos flexionados a 90, 110 e 130 graus de flexão, através do portal anteromedial acessório, com uma broca de 2,5mm. Os estudos estatísticos foram realizadas pela análise de variância de Friedman e pelo teste de Mann-Whitney. RESULTADO: A média dos comprimentos dos túneis femorais anteromediais medidos com os joelhos flexionados a 90, 110 e 130 graus foram 33,7 ± 3,72mm, 37,4 ± 2,93mm e 38,8 ± 3,31mm, respectivamente. Para o comprimento dos túneis posterolaterais, os resultados obtidos a 90, 110 e 130 graus foram 32,1 ± 4,24mm, 37,3 ± 4,85mm e 38,4 ± 2,51mm, respectivamente. A análise de variância de Friedman mostrou diferença significativa entre os comprimentos dos túneis perfurados com 90 e 110 graus de flexão das peças, porém não mostrou diferença significativa entre os obtidos com flexão de 110e 130 graus (p OBJECTIVE: The objective of our study was to evaluate the effect that knee flexion angle while femoral tunnels are being drilled may have on the length of these tunnels, in anatomical reconstruction of the anterior cruciate ligament. METHODS: We measured the lengths of anteromedial and posterolateral tunnels for the anterior cruciate ligament in 20 unpaired anatomical knee specimens (10 right and 10 left knees, all with the cartilage and cruciate ligaments intact. Tunnels were drilled with the knees flexed at 90º, 110º and 130º, through the accessory anteromedial portal, with a 2.5 mm

  19. Study of supracondylar process of humerus

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    Ravi Vandana

    2014-01-01

    Full Text Available The supra condylar process is occasional beak like projection from anteromedial surface of distal 1/3 rd of humerus. It appears to be phylogenetic remnant of complete osseous bridge found in reptiles, marsupials, cats, lemurs and new world monkeys. Among 133 dried humeri studied only one right humerus showed SCP (incidence 0.75% whose dimensions were recorded and photographed. SCP is usually clinically silent but can be the cause for median or ulnar nerve and brachial artery compression syndrome especially when associated with Struthers ligament. Therefore the knowledge of presence of SCP is important for clinicians and radiologists along with anatomists and anthropologists.

  20. Response properties of cat AMLS neurons to optic flow stimuli

    Institute of Scientific and Technical Information of China (English)

    LI; Baowang(李宝旺); LI; Bing(李兵); CHEN; Hui(陈辉); XU; Ying(徐颖); DIAO; Yuncheng(刁云程)

    2002-01-01

    Spiral and translation stimuli were used to investigate the response properties of cat AMLS (anteromedial lateral suprasylvian area) neurons to optic flow. The overwhelming majority of cells could be significantly excited by the two modes of stimuli and most responsive cells displayed obvious direction selectivity. It is the first time to find a visual area in mammalian brain preferring rotation stimuli. Two representative hypotheses are discussed here on the neural mechanism of optic flow analysis in visual cortex, and some new viewpoints are proposed to explain the experimental results.

  1. NEURAL TUBE DEFECTS PREVALENCE IN A HOSPITAL-BASED STUDY IN URMIA

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    I. Abdi Rad

    2008-10-01

    Full Text Available AbstractObjectiveNeural tube defects including anencephaly, encephalocele, and spina bifida are major congenital malformations with multifactorial etiology, and with a great variation in their prevalence in different populations. The study on the prevalence of these malformations may be helpful in planning strategies for their prevention. The aim of this epidemiologic descriptive study was to determine the prevalence of neural tube defects and to describe their birth characteristics in Motahhari hospital, Urmia, West Azerbaijan.Materials and MethodsA cross-section observational study was carried on the hospital-based charts of consecutive 13997 live-births and 124 stillbirths during the period January 2001 through June 2005. The defects categorized based on the domains of anencephaly, spina bifida, and encephalocele according to standard definitions.ResultsDuring this period, 117 cases were detected with neural tube defects, giving an overall  prevalence of 8.29/1000. Of 117 cases, 81 (69.23% cases were seen among stillbirths and 36 (30.77% cases among live-births, that is, the prevalence of neural tube defects for stillbirths and live-births were 653.2/1000 and 2.57/1000 respectively. The yearly prevalence varies between 6.99/1000 and 9.82/1000 over the 4.5-year period. The major lesion was  anencephaly with prevalence of 5.52/1000 (66.67% of all neural tube defects. Approximately, two-thirds (66.09% of cases were found in females. Weights of 73.36% of anencephalic cases wereless than 1000 grams.ConclusionIn this study, the prevalence of neural tube defects is among the highest reported rates. There was a significance difference in the prevalence of anencephaly, as the most prevalent NTD, between live-births and stillbirths. These findings may necessitate an intensive approach to periconceptional folic acid supplementation as a possible strategy to reduce the prevalence of these defects. Keywords: Prevalence, Neural Tube Defects, Anencephaly

  2. Pre-tibial synovial cyst after reconstruction of the anterior cruciate ligament: case report,

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    Luís Eduardo Pedigoni Bulisani

    2014-12-01

    Full Text Available Arthroscopic reconstruction of the anterior cruciate ligament has been modernized through new surgical techniques and new materials. When tibial fixation is performed using an absorbable screw, complications may occur, such as formation of a pre-tibial cyst. The case described here is about a patient who presented an anteromedial synovial cyst in his right knee, three years after having undergone ACL reconstruction. The patient did not present any pain nor any complaints other than a mass that progressively increased in size, worsened after physical activities. Imaging examinations were requested: simple radiography of the knee and magnetic resonance. Anteromedial imaging of the knee showed a mass with well-delimited borders and internal fluid content, suggestive of a synovial cyst, with communication with the joint cavity through the tibial tunnel, without presenting enlargement or absorption of the bone tunnel. The cyst was surgically resected and the tibial tunnel occlusion was performed using a bone plug. The diagnosis of a synovial cyst was subsequently confirmed through the results from the anatomopathological examination. The patient presented good clinical evolution, with disappearance of the symptoms and a return to physical activities.

  3. MR imaging of the temporomandibular joint in patient with acute mandibular condylar fracture

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    Park, Il Soon; Na, Jae Boem; Kang, Su Jin; Kim, Jae Hyoung; You, Jin Jong; Lee, Sang Hwy; Kim, Il Hyun [Gyeongsang National Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To analyze various MR imaging findings and thus evaluate the usefulness of MR imaging of the temporomandibular joint in patient with acute mandibular condylar fracture. MR imaging was performed within 1 week after trauma in 25 patients (total joints studied = 31) in whom condylar fracture had been diagnosed by simple radiographs. We analyzed the signal intensity of bone marrow and disk, displacement of bone fragment and disk, deformity. In addition, MRI findings of retrodiskal tissue, joint capsule and joint effusion were evaluated. No abnormal signal intensity was noted in bone marrow or disk. Displacement of a condylar fracture fragment was observed in 24 joints(77 %) (anteromedial, 63 %; medial, 25 %; anterior, 4 %; anterolateral, 4 %; and lateral, 4 %). Disk displacement occurred in 23 joints(74 %) (anteromedial, 65 %; medial, 9 %; anterior, 18 %; anterolateral, 4 %; and lateral, 4%). In 17 joints (55 %) the disk was displaced along with the fractured condylar fragment, and disk deformity was noted in five joints(16 %). MR imaging (T2WI) revealed a capsular tear(n=1), joint effusion(n=26), and high signal intensity in the retrodiskal tissue(n=6). MR imaging provided information concerning condylar fragments, disk, retrodiskal tissue, capsules, and joint effusion. In patients with acute mandibular condylar fracture, MRI is therefore useful for evaluation of the temporomandibular joint.

  4. Relationship between the prefrontal function and the severity of the emotional symptoms during a verbal fluency task in patients with major depressive disorder: a multi-channel NIRS study.

    Science.gov (United States)

    Liu, Xiaomin; Sun, Gaoxiang; Zhang, Xiaoqian; Xu, Bo; Shen, Chenyu; Shi, Lujie; Ma, Xiangyun; Ren, Xiajin; Feng, Kun; Liu, Pozi

    2014-10-03

    Multi-channel near-infrared spectroscopy (NIRS) is a noninvasive and low-cost functional neuroimaging technique in psychiatric research, and it has been wildly used for detecting the spatiotemporal characteristics of brain activity. In order to evaluate the clinical value of NIRS data in the assistant diagnosis of major depressive disorder (MDD), prefrontal cortex (PFC) hemoglobin concentration exchange of 30 MDD patients combined with anxious and obsessive-compulsive symptom was detected by NIRS under voice fluency task (VFT), then the relationship between the severity of depressive, anxious and obsessive-compulsive symptom assessed by Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale (HAMA) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) with NIRS data in PFC was analyzed. Hypoactivation in lateral and lower PFC of MDD patients was confirmed in this study. Furthermore, Spearman correlation found that oxy-hemoglobin concentration ([oxy-Hb]) exchange in right-lateral PFC was associated with the severity of anxiety, while bilateral PFC and antero-medial PFC were associated with severity of depression. Meanwhile, no statistical correlation was observed on the severity of obsessive-compulsive symptom. The results prompted that MDD patients with anxiety and obsession-compulsion symptom showed a PFC hypoactivation state in NIRS. Furthermore, the function of right-lateral PFC was associated with anxiety symptom, while bilateral PFC and antero-medial PFC were associated with depression symptom. Different from depression and anxiety, obsession-compulsion may have a different biological character in PFC function.

  5. Temporal pole signal abnormality on MR imaging in temporal lobe epilepsy with hippocampal sclerosis: a fluid-attenuated inversion-recovery study; Anormalidade de sinal na imagem por RM do polo temporal na epilepsia do lobo temporal com esclerose hipocampal: um estudo pela sequencia inversao recuperacao com supressao da agua livre (FLAIR)

    Energy Technology Data Exchange (ETDEWEB)

    Carrete Junior, Henrique; Abdala, Nitamar; Szjenfeld, Jacob; Nogueira, Roberto Gomes [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem; Lin, Katia; Caboclo, Luis Otavio; Centeno, Ricardo Silva; Sakamoto, Americo Ceiki; Yacubian, Elza Marcia Targas [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil). Dept. de Neurologia e Neurocirurgia

    2007-09-15

    Objective: To determine the frequency and regional involvement of temporal pole signal abnormality (TPA) in patients with hippocampal sclerosis (HS) using fluid-attenuated inversion-recovery (FLAIR) MR imaging, and to correlate this feature with history. Method: Coronal FLAIR images of the temporal pole were assessed in 120 patients with HS and in 30 normal subjects, to evaluate gray-white matter demarcation. Results: Ninety (75%) of 120 patients had associated TPA. The HS side made difference regarding the presence of TPA, with a left side prevalence (p=0.04, {chi}{sup 2} test). The anteromedial zone of temporal pole was affected in 27 (30%) out of 90 patients. In 63 (70%) patients the lateral zone were also affected. Patients with TPA were younger at seizure onset (p=0.018), but without association with duration of epilepsy. Conclusion: Our FLAIR study show temporal pole signal abnormality in 3/4 of patients with HS, mainly seen on the anteromedial region, with a larger prevalence when the left hippocampus was involved. (author)

  6. Hypertensive thalamic hemorrhage. Clinical symptoms and outcomes in 40 cases

    Energy Technology Data Exchange (ETDEWEB)

    Munaka, Masahiro; Nishikawa, Michio; Hirai, Osamu; Kaneko, Takaaki; Watanabe, Syu; Fukuma, Jun; Handa, Hajime

    1988-12-01

    In the past six years, we have had experience with 40 patients with hypertensive thalamic hemorrhages, as verified by CT scan at our hospital within 24 hours. These patients were classified into the following three groups according to the location of the bleeding point and the size of the hematoma: (1) anteromedial (4 cases), (2) posterolateral (16 cases), and (3) massive (20 cases). The (1) and (2) hematomas were small (less than 3 cm in diameter), while those in (3) were large (more than 3 cm in diameter). Twenty cases (50% of all the thalamic hematomas) were small hematomas. The characteristic clinical symptoms of the anteromedial type were a mild disturbance of consciousness and thalamic dementia, while those of the posterolateral type were motor and sensory disturbance, and thalamic aphasia, respectively. Twenty cases (50%) were large hematomas. The clinical symptoms of these cases were mainly consciousness disturbance; 7 of them expired. Based on this experience, it may be considered that the patients whose hematoma size was larger than 3 cm had a poor prognosis and that the patients with the posterolateral type had a poor functional diagnosis.

  7. Three new species of Protogyrodactylus Johnston & Tiegs, 1922 (Monogenoidea: Dactylogyridae) from the gills of the longtail silverbiddy Gerres longirostris (Teleostei: Gerreidae) in the Red Sea.

    Science.gov (United States)

    Galli, Paolo; Kritsky, Delane C

    2008-03-01

    Twenty-one specimens of the longtailed silverbiddy Gerres longirostris (Gerreidae) were examined for dactylogyrid parasites from the Nabq Managed Resource Protected Area, Ras Mohammed National Park (Red Sea) near Sharm El-Sheikh, South Sinai, Egypt. The diagnosis of Protogyrodactylus Johnston & Tiegs, 1922 was amended, and three new species, P. federicae n. sp., P. zullinii n. sp. and P. alatus n. sp., were recovered and described; the prevalence of each species was 100%. P. federicae most closely resembled P. alienus Bychowsky & Nagibina, 1974, but differed from it by possessing two anteromedial projections on the ventral bar, a claw-like ventral anchor sclerite and spatulate dorsal bars. P. zullini was most similar to P. quadratus Johnston & Tiegs, 1922, from which it differed by having a distal hook on the superficial root of the dorsal anchor, an evenly curved ventral anchor shaft and point, and a flange on the bulbous base of the male copulatory organ. P. alatus was closest to P. youngi Bychowsky & Nagibina, 1974, from which it differed by having delicate anchors and two prominent anteromedial processes on the ventral bar.

  8. Double-bundle depiction of the anterior cruciate ligament at 3 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Adriaensen, M.E.A.P.M. [Atrium Medical Center Parkstad, Department of Radiology, Heerlen (Netherlands); Hogan, B. [Sports Surgery Clinic, Department of Radiology, Dublin (Ireland); Al-Bulushi, H.I.J. [Armed Forces Hospital, Department of Radiology, Muscat (Oman); Kavanagh, E.C. [Mater Misericordiae Hospital, Department of Radiology, Dublin (Ireland)

    2012-07-15

    Magnetic resonance imaging on 3 Tesla (3T MRI) with arthroscopic correlation has proven to adequately identify the anteromedial bundle (AMB) and posterolateral bundle (PLB) in cadaver knees. The purpose of this study was to describe the depiction of ACL bundle anatomy on 3T MRI in daily practice. In a retrospective cohort study, we included 50 consecutive patients who underwent standard 3T MRI of the knee and had an intact ACL. Two musculoskeletal radiologists independently reviewed all scans for depiction of ACL bundle anatomy using standardized forms. Descriptive statistics were used. Twenty-three right knees (46%) and 27 left knees (54%) were included in the study. Mean age of the patients was 35 years (range 12 to 68 years); 37 patients were male (74%). ACL bundle anatomy was best depicted in the axial plane in 44 knees (88%) and in the coronal plane in six knees (12%). Two bundles were seen in 47 knees (94%). The AMB was completely seen in 45 knees (90%). The PLB was completely seen in 40 knees (80%). Both bundles were completely seen in 37 knees (76%). The double-bundle anatomy of the ACL is visualized in 94% of patients on 3T MRI. Because of potentially associated clinical benefits, we advocate to report separately on the anteromedial bundle and posterolateral bundle in case of anterior cruciate ligament injury of the knee. (orig.)

  9. Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft

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    Ochi Mitsuo

    2011-12-01

    Full Text Available Abstract Background Preservation of the Anterior Cruciate Ligament (ACL remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction. Methods We used the far anteromedial (FAM portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D CT. The central anteromedial (AM portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch. Conclusion Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.

  10. Manual khalifa therapy in patients with completely ruptured anterior cruciate ligament in the knee: First results from near-infrared spectroscopy

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    Gerhard Litscher

    2013-01-01

    Full Text Available Background: Manual Khalifa therapy has been practiced in Hallein, Austria, for more than 30 years; however, there are no scientific results available on the topic. Aims: The goal of the present study was to investigate possible acute effects of Khalifa therapy on regional oxygen saturation of knee tissues in patients with completely ruptured anterior cruciate ligament. Materials and Methods: We investigated 10 male patients (mean age ± standard deviation (SD 35.9 ± 6.1 year using a four-channel oximeter. The sensors were applied anterolaterally and anteromedially, beside the patella, on both the injured and the healthy (control knee. Results: The results of the controlled study showed that values of oxygen saturation on the knee with the ruptured ligament were significantly increased (P < 0.001 immediately after Khalifa therapy, whereas the values on the control knee showed insignificant increases. Baselines values of the anterolateral side of the injured knee were significantly (P < 0.001 different from those of the anterolateral side of the control knee. The same effect was present on the anteromedial side; however, with a lower degree of significance (P < 0.05. Conclusions: Khalifa therapy was clinically successful in all 10 patients. Further, investigations and analyzes are necessary to explain the underlying mechanism.

  11. Neural tube defect and folic acid.

    Science.gov (United States)

    Wani, M A

    2000-01-01

    Neural tube defect (NTD) is a group of congenital anomalies, which include anencephaly, encephalocele, iniencephaly, meningocele, myelomeningocele, myeloschisis, lipomeningocele, and rashischisis. Congenital malformations of the central nervous system constitute more than half of all congenital malformations with an incidence of 1-2/1000 births. The condition is thought to arise from multifactorial etiology with a distinct genetic predisposition. This paper discusses the pathogenesis of NTD and explores the use of folic acid for the prevention of this serious congenital malformation. Two studies, which have shown a significant protective effect of folic acid use on NTD prevention in high-risk mothers, are cited. In considering the effectiveness of folic acid supplementation on NTD prevention, obstetricians, pediatricians, neonatologists, and family doctors are called to initiate a collective effort to increase awareness among women in the childbearing age on the need of daily multivitamin intake with folic acid prior to pregnancy.

  12. Two Hundred Thirty-Six Children With Developmental Hydrocephalus: Causes and Clinical Consequences.

    Science.gov (United States)

    Tully, Hannah M; Ishak, Gisele E; Rue, Tessa C; Dempsey, Jennifer C; Browd, Samuel R; Millen, Kathleen J; Doherty, Dan; Dobyns, William B

    2016-03-01

    Few systematic assessments of developmental forms of hydrocephalus exist. We reviewed magnetic resonance images (MRIs) and clinical records of patients with infancy-onset hydrocephalus. Among 411 infants, 236 had hydrocephalus with no recognizable extrinsic cause. These children were assigned to 1 of 5 subtypes and compared on the basis of clinical characteristics and developmental and surgical outcomes. At an average age of 5.3 years, 72% of children were walking independently and 87% could eat by mouth; in addition, 18% had epilepsy. Distinct patterns of associated malformations and syndromes were observed within each subtype. On average, children with aqueductal obstruction, cysts, and encephaloceles had worse clinical outcomes than those with other forms of developmental hydrocephalus. Overall, 53% of surgically treated patients experienced at least 1 shunt failure, but hydrocephalus associated with posterior fossa crowding required fewer shunt revisions. We conclude that each subtype of developmental hydrocephalus is associated with distinct clinical characteristics, syndromology, and outcomes, suggesting differences in underlying mechanisms.

  13. ENDOSCOPIC ASSISTED APPROACH TOWARDS FRONTONASAL DERMOID CYST/CYST SINUS

    Directory of Open Access Journals (Sweden)

    Sharad B

    2015-07-01

    Full Text Available Nasofrontal masses belong to the group of congenital midface anomalies (CMFA in paediatric age group. The usual list of differential diagnosis for such masses can be narrowed to Frontonasal de rmoid, epidermoid, nasal encephalocele and nasal gliomas. Frontonasal dermoid with patent dermal sinus tract is a rare craniofacial anomaly resulting from the failure of normal embryonic development. Most of patients present in infancy or early childhood. CT, MRI and sinogram together are usually required for definitive diagnosis. Knowledge of embryonic development of nose & anterior skull base is important in understanding the pathologies of Frontonasal masses. Endoscopic ‘key - hole’ approach to these lesio ns via small incision allows better visualization & ensures complete removal.

  14. Application of inferior major bone flap craniotomy decompression in brain injury

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To summarize the application of inferior major boneflap craniotomy decompression in brain injury operation.Methods: A retrospective analysis was done in 218 cases with brain injuries who were admitted to our department from January 1995 to December 1999 and treated with the inferior major bone flap craniotomy decompression.Results: Of 218 cases, 121 cases (55.50%) were cured according to GOS, 39 (18.30%) were with good recovery or moderate disability, 13 (5.60%) with severe deformity, 3 (1.40%) vegetative life, the rest 42 (19.20%) died after operation; no encephalocele or incarceration were found.Conclusions: The inferior major bone flap craniotomy decompression can remove hematoma timely and completely, is better than general craniotomy decompression and has a positive effect on brain injuries especially when bone flap is small.

  15. Frecuencia de los defectos del tubo neural en Asturias: impacto del diagnóstico prenatal Prevalence of neural tube defects in Asturias (Spain: impact of prenatal diagnosis

    Directory of Open Access Journals (Sweden)

    Enrique García López

    2009-12-01

    Full Text Available Objetivo Describir la frecuencia de defectos del tubo neural (DTN -anencefalia, espina bífida y encefalocele-en Asturias, su evolución temporal y el impacto del diagnóstico prenatal. Métodos: Se estudiaron los casos de DTN en nacidos y abortos inducidos durante el período 1990-2004, utilizando la base de datos del Registro de Defectos Congénitos de Asturias, de base poblacional. Se calcularon las tasas de prevalencia total y al nacimiento. Resultados: La prevalencia total de DTN fue de 12,2 casos por 10.000 nacidos (5,9 anencefalias, 5,0 espinas bífidas y 1,3 encefaloceles y mostró una tendencia ligeramente descendente, con un descenso significativo de la espina bífida, mientras que las cifras de anencefalia y encefalocele se mantuvieron estables. Finalizaron en aborto inducido tras el diagnóstico prenatal el 88% de los casos (anencefalia 96,7%; espina bífida 80%; encefalocele 84,6%, lo que determinó una prevalencia al nacimiento muy baja (1,4 DTN por 10.000 nacidos. Conclusiones: En Asturias, en los últimos 15 años se ha producido un descenso selectivo en la prevalencia total de espina bífida de causa no aclarada. La prevención secundaria, mediante los programas de diagnóstico prenatal y la consiguiente interrupción del embarazo, fue el motivo del marcado descenso de la frecuencia en los nacidos; la simple recomendación de suplementación periconcepcional con ácido fólico no parece haber logrado el efecto buscado.Objective: To describe the frequency and prevalence trend for neural tube defects (NTD (anencephaly, spina bifida and encephalocele in Asturias (Spain, as well as the impact of prenatal diagnosis programs. Methods: All cases of NTD in births and induced abortions were studied, using data from the Registry of Congenital Defects of Asturias for 1990-2004. Total and birth prevalence rates were calculated. Results: The prevalence of NTD for 1990-2004 was 12.2 per 10,000 births (5.9 anencephaly, 5.0 spina bifida and 1

  16. Neural tube defects: recent advances, unsolved questions, and controversies.

    Science.gov (United States)

    Copp, Andrew J; Stanier, Philip; Greene, Nicholas D E

    2013-08-01

    Neural tube defects are severe congenital malformations affecting around one in every 1000 pregnancies. An innovation in clinical management has come from the finding that closure of open spina bifida lesions in utero can diminish neurological dysfunction in children. Primary prevention with folic acid has been enhanced through introduction of mandatory food fortification in some countries, although not yet in the UK. Genetic predisposition accounts for most of the risk of neural tube defects, and genes that regulate folate one-carbon metabolism and planar cell polarity have been strongly implicated. The sequence of human neural tube closure events remains controversial, but studies of mouse models of neural tube defects show that anencephaly, open spina bifida, and craniorachischisis result from failure of primary neurulation, whereas skin-covered spinal dysraphism results from defective secondary neurulation. Other malformations, such as encephalocele, are likely to be postneurulation disorders.

  17. Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects: World Health Organization guidelines.

    Science.gov (United States)

    Cordero, Amy M; Crider, Krista S; Rogers, Lisa M; Cannon, Michael J; Berry, R J

    2015-04-24

    Neural tube defects (NTDs) such as spina bifida, anencephaly, and encephalocele are serious birth defects of the brain and spine that occur during the first month of pregnancy when the neural tube fails to close completely. Randomized controlled trials and observational studies have shown that adequate daily consumption of folic acid before and during early pregnancy considerably reduces the risk for NTDs. The U.S. Public Health Service recommends that women capable of becoming pregnant consume 400 µg of folic acid daily for NTD prevention. Furthermore, fortification of staple foods (e.g., wheat flour) with folic acid has decreased folate-sensitive NTD prevalence in multiple settings and is a highly cost-effective intervention.

  18. Rare Posterior Pharyngeal Mass: Atypical Marginal Zone Hyperplasia.

    Science.gov (United States)

    Eliçora, Sultan Şevik; Güven, Mehmet; Varli, Ali F; Yilmaz, Mahmut S; Alponat, Selin

    2016-03-01

    Cases of posterior pharyngeal masses are quite rare, and are typically derived from schwannoma or encephalocele, or are of vascular or infectious origin. They are clinically significant due to their tendency to cause airway obstruction. The aim of this study was to present a rare atypical marginal hyperplasia case of a posterior pharyngeal wall mass. A 10-year-old male was admitted to our clinic with dyspnea. A plane-surfaced 4 × 3 × 3 cm mass was observed on the posterior pharyngeal wall upon physical examination. The patient underwent magnetic resonance imaging and surgical treatment. Following excision of material from the patient's mass, a pathologic diagnosis of atypical marginal zone hyperplasia was made. Atypical marginal zone hyperplasia of the posterior pharyngeal wall has not yet been reported in the literature. Marginal zone hyperplasia associated with a lymphoproliferative disease should be considered when making differential diagnoses of posterior pharyngeal wall masses.

  19. Meckel-Gruber Syndrome: a population-based study on prevalence, prenatal diagnosis, clinical features, and survival in Europe

    DEFF Research Database (Denmark)

    Barisic, Ingeborg; Boban, Ljubica; Loane, Maria;

    2015-01-01

    of Congenital Anomalies (EUROCAT) network. The study population consisted of 191 cases of MKS identified between January 1990 and December 2011 in 34 European registries. The mean prevalence was 2.6 per 100 000 births in a subset of registries with good ascertainment. The prevalence was stable over time......, but regional differences were observed. There were 145 (75.9%) terminations of pregnancy after prenatal diagnosis, 13 (6.8%) fetal deaths, 33 (17.3%) live births. In addition to cystic kidneys (97.7%), encephalocele (83.8%) and polydactyly (87.3%), frequent features include other central nervous system...... anomalies (51.4%), fibrotic/cystic changes of the liver (65.5% of cases with post mortem examination) and orofacial clefts (31.8%). Various other anomalies were present in 64 (37%) patients. As nowadays most patients are detected very early in pregnancy when liver or kidney changes may not yet be developed...

  20. Epidemiologic study of neural tube defects in Los Angeles County. I. Prevalence at birth based on multiple sources of case ascertainment

    Energy Technology Data Exchange (ETDEWEB)

    Sever, L.E. (Pacific Northwest Lab., Richland, WA); Sanders, M.; Monsen, R.

    1982-01-01

    Epidemiologic studies of the neural tube defects (NTDs), anencephalus and spina bifida, have for the most part been based on single sources of case ascertainment in past studies. The present investigation attempts total ascertainment of NTD cases in the newborn population of Los Angeles County residents for the period 1966 to 1972. Design of the study, sources of data, and estimates of prevalence rates based on single and multiple sources of case ascertainment are here discussed. Anencephalus cases totaled 448, spina bifida 442, and encephalocele 72, giving prevalence rates of 0.52, 0.51, and 0.08 per 1000 total births, respectively, for these neural tube defects - rates considered to be low. The Los Angeles County prevalence rates are compared with those of other recent North American studies and support is provided for earlier suggestions of low rates on the West Coast.

  1. Occipital meningoencephalocele with Cleft Lip, Cleft Palate and Limb Abnormalities- A Case Report.

    Science.gov (United States)

    Ganapathy, Arthi; T, Sadeesh; Swer, Mary Hydrina; Rao, Sudha

    2014-12-01

    A 21-week-old still born female fetus with occipital encepholocele, cleft lip and cleft palate was received from the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry and was studied in detail. It was born to Primigravida, of a second degree consanguineous marriage, with unremarkable family history. The biometric measurements were noted which corresponded to the age of the fetus. Further the fetus was embalmed and dissected. On examination an encephalocele of 2.7×1.5 cm was seen in the occipital region with a midline defect in the occipital bone and herniated brain tissue. Other anomalies observed were right unilateral cleft lip, right cleft palate, and bilateral syndactyly of the lower limbs and associated Congenital Talipus Equino Varus of the right foot. Other internal organs were developed appropriate for the age of the fetus.

  2. Risk factors, organ weight deviation and associated anomalies in neural tube defects: A prospective fetal and perinatal autopsy series

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    Asaranti Kar

    2015-01-01

    Full Text Available Introduction: Neural tube defects (NTD are a group of serious birth defects occurring due to defective closure of neural tube during embryonic development. It comprises of anencephaly, encephalocele and spina bifida. We conducted this prospective fetal autopsy series to study the rate and distribution of NTD, analyze the reproductive factors and risk factors, note any associated anomalies and evaluate the organ weights and their deviation from normal. Materials and Methods: This was a prospective study done over a period of 6 years from August, 2007 to July, 2013. All cases of NTDs delivered as abortion, still born and live born were included. The reproductive and risk factors like age, parity, multiple births, previous miscarriage, obesity, diabetes mellitus, socioeconomic status and use of folic acid during pregnancy were collected.Autopsy was performed according to Virchow′s technique. Detail external and internal examination were carried out to detect any associated anomalies. Gross and microscopic examination of organs were done. Results: Out of 210 cases of fetal and perinatal autopsy done, 72 (34.28% had NTD constituting 49 cases of anencephaly, 16 spina bifida and 7 cases of encephalocele. The mothers in these cases predominantly were within 25-29 years (P = 0.02 and primy (P = 0.01. Female sex was more commonly affected than males (M:F = 25:47, P = 0.0005 There was no history of folate use in majority of cases. Organ weight deviations were >2 standard deviation low in most of the cases. Most common associated anomalies were adrenal hypoplasia and thymic hyperplasia. Conclusion: The authors have made an attempt to study NTD cases in respect to maternal reproductive and risk factors and their association with NTD along with the organ weight deviation and associated anomalies. This so far in our knowledge is an innovative study which was not found in literature even after extensive search.

  3. NEURAL TUBE DEFECTS PREVALENCE IN A HOSPITAL-BASED STUDY IN URMIA

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    I. Abdi Rad

    2008-06-01

    Full Text Available ObjectiveNeural tube defects including anencephaly, encephalocele, and spina bifida are major congenital malformations with multifactorial etiology, and with a great variation in their prevalence in different populations. The study on the prevalence of these malformations may be helpful in planning strategies for their prevention. The aim of this epidemiologic descriptive study was to determine the prevalence of neural tube defects and to describe their birth characteristics in Motahhari hospital, Urmia, West Azerbaijan.Materials and MethodsA cross-section observational study was carried on the hospital-based charts of consecutive 13997 live-births and 124 stillbirths during the period January 2001 through June 2005. The defects categorized based on the domains of anencephaly, spina bifida, and encephalocele according to standard definitions.ResultsDuring this period, 117 cases were detected with neural tube defects, giving an overall prevalence of 8.29/1000. Of 117 cases, 81 (69.23% cases were seen among stillbirths and 36 (30.77% cases among live-births, that is, the prevalence of neural tube defects for stillbirths and live-births were 653.2/1000 and 2.57/1000 respectively. The yearly prevalence varies between 6.99/1000 and 9.82/1000 over the 4.5-year period. The major lesion was anencephaly with prevalence of 5.52/1000 (66.67% of all neural tube defects. Approximately, two-thirds (66.09% of cases were found in females. Weights of 73.36% of anencephalic cases wereless than 1000 grams.ConclusionIn this study, the prevalence of neural tube defects is among the highest reported rates. There was a significance difference in the prevalence of anencephaly, as the most prevalent NTD, between live-births and stillbirths. These findings may necessitate an intensive approach to periconceptional folic acid supplementation as a possible strategy to reduce the prevalence of these defects.

  4. MMPs 在膝前交叉韧带不同分束表达水平的实验研究%Experimental Study of The Expression Levels of MMPs in Bundles of Anterior Cruciate Liga-ment

    Institute of Scientific and Technical Information of China (English)

    王靖; 戴畅; 王愉思

    2016-01-01

    【目的】通过检测前交叉韧带(ACL)前内侧束和后外侧束基质金属蛋白酶(MMPs)的表达水平,探索 ACL 的潜在修复和重塑位点。【方法】从10具自愿捐赠的新鲜尸体上取膝关节,并取出膝关节 ACL ,提取总 RNA ,并反转录成 cDNA 后,应用实时定量 PCR(RT‐PCR)检测前内侧束和后外侧束中与肌腱修复相关的常见 MMPs 基因;将 ACL 的前内侧束和后外侧束两个功能纤维束标本固定、石蜡包埋,利用 MMP‐2和MMP‐3的多克隆抗体为一抗,进行免疫组化实验;将前内侧束和后外侧束两个功能纤维束中的组织分别收集,匀浆后提取总蛋白,用 Western blotting 分析不同分束中 MMP‐2、MMP‐3的表达量。【结果】MM P‐2、MMP‐3在前内侧束和后外侧束中的表达具有显著的差异,而 MMP‐1、MMP‐10、MMP‐13、MMP‐23等基因,在 ACL 不同束中的表达没有明显区别;免疫组化和 Western blotting 显示 MMP‐2在前内侧束比后外侧束表达高,MMP‐3在前内侧束比后外侧束表达低。【结论】膝关节 ACL 前内侧束具有较好的重塑能力,其胫骨止点前方更有可能成为临床肌腱重建的潜在位点。%Objective]To detect the expression level of MMPs in the anteromedial and posterolateral bun‐dles of anterior cruciate ligament and to explore the potential place for clinical tendon reconstruction of anterior cruciate ligament .[Methods]The knees and anterior cruciate ligaments (ACL) were cut out from 10 fresh ca‐davers that were donated voluntarily .The total RNA was extracted and reverse transcribed into cDNA ,then real‐time quantitative PCR was used to detect the MMP genes associated with tendon recovery in the anterome‐dial and posterolateral bundles of the ACL .Meanwhile the samples of anteromedial and posterolateral bundles of the anterior cruciate ligament were fixed and paraffin‐embedded .Immunohistochemistry

  5. Tectal codification of eye movements in goldfish studied by electrical microstimulation. f.

    Science.gov (United States)

    Salas, C; Herrero, L; Rodriguez, F; Torres, B

    1997-05-01

    This work compares the tectal codification of eye movements in goldfish with those reported for other vertebrate groups. Focal electrical stimulation was applied in various tectal zones and the characteristics of evoked eye movements were examined as a function of (i) the position of the stimulation over the tectal surface, (ii) the initial position of the eyes and (iii) the parameters (pulse rate, current strength, duration) of the stimulus. In a large medial zone, stimulation within the intermediate and deep layers of the tectum evoked contraversive saccades of both eyes, whose direction and amplitude were roughly congruent with the retinotopic representation of the visual world within overlying layers. These saccades were minimally influenced by the initial position of the eye in the orbit. The topographical arrangement of evoked saccades and body movements suggests that this tectal zone triggers orienting responses in a similar way to those described in other vertebrates. Stimulations applied within the caudal tectum also evoked contraversive saccades, but in disagreement with the overlying retinotopic map--the vertical component was absent. Taken together with electrically evoked body movements reported in free-swimming fish, these saccades could reveal that this zone is involved in escape responses. When stimulations were applied within the anteromedial zone of the tectum, contraversive movements of both eyes appeared much more dependent on initial eye position. Saccades elicited from this area displayed characteristics of "goal-directed saccades" which were similar to those described in the cat. The generation of goal-directed movements from the anteromedial zone suggests that this portion of the goldfish optic tectum has a different intrinsic organization or is connected with the brainstem saccade generator in a different fashion than the medial zone. Finally, stimulation of the extreme anteromedial zone evoked convergent eye movements. These movements and

  6. ELONGATED STYLOID PROCESS: A REPORT OF TWO CADAVERIC CASES

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    Komala Nanjundaiah

    2014-06-01

    Full Text Available Introduction: Styloid process is a part of temporal bone. It measures 2 to 3 cms in length and lies antero-medial to the mastoid process. An elongated styloid process can compress the vital vessels and nerves close to it. This can lead to pain, foreign body sensation in the pharyngeal region and can also cause dysphagia. Observation: During routine dissection, we encountered elongated styloid process in two cadavers. In one it was unilateral and in another it was bilateral. The measurements of the elongated styloid process were taken using digital Vernier slide calipers. Conclusion: The awareness of the embryological cause and the clinical implications of an elongated styloid process are important for accurate diagnosis and treatment

  7. Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

    Directory of Open Access Journals (Sweden)

    Yamakado Kotaro

    2012-02-01

    Full Text Available Abstract A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred.

  8. Comparative study of patellar subluxation syndrome and normal group using axial radiography and CT

    Energy Technology Data Exchange (ETDEWEB)

    Kitagawa, Mamoru; Tomonaga, Kunio; Egawa, Tadashi; Nakamura, Yasushi; Gotoh, Shoji; Mihara, Shigeru (Nagasaki Municipal Hospital (Japan))

    1989-10-01

    A comparative study was conducted on the 20 knees of 10 females with normal knee joints (age, 22-35 years) and on 7 knees of 7 patients with subluxation syndrome (age, 15-24 years), using axial radiography and CT. In axial radiography where the angle of knee flexion was 30 deg or 60 deg, no significant difference was recognized between the two groups with respect to tilting angle, patellofemoral angle, congruence angle and lateral shift. However, a significant difference was found using CT. Thus, CT was considered useful for diagnosis. Because of these results, all 7 cases underwent surgery for detachment of the lateral side and tightening of the medial side. Three cases underwent shifting of the tibial tuberosity to the anteromedial side, resulting in a favourable outcome. Here, we report the study. (author).

  9. Functional interrelationship of brain aging and delirium.

    Science.gov (United States)

    Rapazzini, Piero

    2016-02-01

    Theories on the development of delirium are complementary rather than competing and they may relate to each other. Here, we highlight that similar alterations in functional brain connectivity underlie both the observed age-related deficits and episodes of delirium. The default mode network (DMN) is a group of brain regions showing a greater level of activity at rest than during attention-based tasks. These regions include the posteromedial-anteromedial cortices and temporoparietal junctions. Evidence suggests that awareness is subserved through higher order neurons associated with the DMN. By using functional MRI disruption of DMN, connectivity and weaker task-induced deactivations of these regions are observed both in age-related cognitive impairment and during episodes of delirium. We can assume that an acute up-regulation of inhibitory tone within the brain acts to further disrupt network connectivity in vulnerable patients, who are predisposed by a reduced baseline connectivity, and triggers the delirium.

  10. Complex reconstruction after wide excision of juvenile aponeurotic fibromatoses of upper one-third of leg.

    Science.gov (United States)

    Akhtar, Md Sohaib; Basari, Rabeya; Khan, A H; Khurram, Mohd Fahud

    2014-08-01

    Juvenile musculoaponeurotic fibromatoses are benign tumors which arise from musculoaponeurotic stromal cells. They rarely occur in lower extremity and more rarely in children. They are locally invasive tumors with a high incidence of recurrence after surgery. Hence, wide local excision is the treatment of choice for such tumors. However, complex reconstruction is often required to cover the resulting soft tissue defect. This report presents a 12-year-old boy with a juvenile musculoaponeurotic fibromatosis in the anteromedial aspect of the upper third of a left leg. Following wide local excision, two local flaps, medial gastrocnemius and a distally based peroneal artery perforator flap, were used to reconstruct the soft tissue defect. Reconstruction has provided an acceptable functional and cosmetic result.

  11. Cushing’s Syndrome Secondary to isolated Micronodular Adrenocortical Disease (iMAD) associated with Rapid Onset Weight Gain and Negative Abdominal MRI Findings in a 3 year old Male

    Science.gov (United States)

    Henry, Rohan K.; Keil, Margaret F.; Stratakis, Constantine A.; Fechner, Patricia Y.

    2011-01-01

    Cushing’s syndrome (CS) is uncommon in childhood. CS may be either dependent or independent of adrenocorticotrophic hormone (ACTH). ACTH independent micronodular adrenocortical (MAD) disease may present in the second to third decade of life or between ages 2–3years. It may occur in isolation, or as a part of the Carney complex and it represents an elusive entity to diagnose. We present a 3 year 7 month old boy with isolated MAD (iMAD). Abdominal CT revealed prominent mildly lobulated anteromedial margin of adrenals with nodular appearance. Cardiac echo, thyroid and testicular ultrasounds performed as a work up for Carney complex were normal. Bilateral adrenalectomy confirmed MAD as the cause of CS. We present the history’ and identification of a unique case of iMAD. PMID:20662336

  12. [Calcifying tendinosis of the pectoralis major muscle with intraosseous migration].

    Science.gov (United States)

    Morán Blanco, L M; González Leyte, M

    2011-01-01

    Calcifying tendinosis is characterized by macroscopic deposits of hydroxyapatite within the tendon. Most cases involve the tendons of the rotator cuff, fundamentally the supraspinous tendon, and less frequently other tendons in practically any location. Cortical erosion with intraosseous migration of calcium deposits is rare. An atypical location combined with bone involvement can often lead to confusion with other processes like an infection or malignant tumor resulting in unnecessary biopsies or interventions. We present the case of a man who presented with pain and loss of function of the shoulder. Plain-film X-rays showed an erosion of the anteromedial cortex of the proximal diaphysis of the humerus with extra- and intra-osseous calcifications that made us suspect an infectious or malignant process. The findings at computed tomography, together with the clinical and radiological course, were key in enabling us to recognize this atypical presentation of calcifying tendinosis of the pectoralis major muscle.

  13. Reparación de las insuficiencias crónicas del ligamento cruzado anterior mediante plastia autóloga con hueso-tendón patelar-hueso y malla de poliéster en doble fascículo : estudio preliminar

    OpenAIRE

    Gastaldi Orquin, E.; Sanchis, V.; Gomar Sancho, Francisco

    1992-01-01

    Se presenta una nueva técnica de reconstrucción de las lesiones crónicas del ligamento cruzado anterior (LCA) en sus dos fascículos. Se estudian 30 paciente s intervenidos con un promedio de seguimiento de 19 meses. Se utiliza hueso-tendón patelar-hueso (H-T-H) reforzado con una malla de poliéste r en doble fascículo. El H-T-H, reforzado con la malla de poliéster, pasa a través de una tunelización isométrica tibial anteromedial y una tunelización isométrica femoral posterosuper...

  14. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: report of two cases.

    Science.gov (United States)

    Taketomi, Shuji; Inui, Hiroshi; Hirota, Jinso; Nakamura, Kensuke; Sanada, Takaki; Masuda, Hironari; Tanaka, Sakae; Nakagawa, Takumi

    2013-08-01

    Two patients underwent arthroscopic anatomic double-bundle anterior cruciate ligament (ACL) reconstruction using the EndoButton for femoral fixation. The femoral tunnels were created by the inside-out technique through a far anteromedial portal. The patients postoperatively developed moderate lateral knee pain without instability. At the second-look arthroscopic evaluation, the two EndoButtons were removed. Both patients were completely asymptomatic several months after implant removal, implying that the EndoButtons caused the mechanical irritation in the iliotibial band. This is the first report describing removal of EndoButtons because of pain caused by friction with the iliotibial band. In anatomic ACL reconstruction, if the femoral tunnel exit is positioned near the lateral femoral epicondyle, care should be taken to prevent iliotibial band friction syndrome that could result because of the EndoButton.

  15. Recurrent osteochondroma of the mandibular condyle: A case report

    Science.gov (United States)

    Kwon, Young-Eun; Choi, Karp-Shik; An, Chang-Hyeon; Choi, So-Young; Lee, Jae-Seo

    2017-01-01

    A 21-year-old woman presented with facial asymmetry. Crepitus and clicking of the temporomandibular joint were noted. The midline deviated 5.5 mm to the left, and secondary malocclusion was observed. Panoramic and cone-beam computed tomographic images showed an irregular and exophytic bony mass on the anteromedial surface of the right mandibular condyle. A 3-phase bone scan revealed increased tracer uptake on the affected side. The lesion was treated with excision and reshaping under the diagnosis of osteochondroma confirmed by a histopathological examination. The lesion recurred after 3 years, and the patient underwent condylectomy. Mandibular condylar osteochondroma is often resected because it causes functional and aesthetic problems, but it rarely recurs. To the best of our knowledge, only 2 cases of recurrent osteochondromas of the mandibular condyle have been reported previously. Surgical treatment of the osteochondroma should be performed considering the possibility of recurrence, and long-term follow-up is recommended. PMID:28361031

  16. Old Disease…New Location…Surgeons Be Alerted

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    K. B. Ashok

    2011-04-01

    Full Text Available Echinococcus granulosus causes a zoonotic infection called Cystic Echinococcosis (CE. Surgeons meet with hydatid cysts of the liver and lungs with reasonable frequency. However hydatid cyst may appear in other parts of the body too.A 30 yrs old lady presented with a smooth slow-growing subcutaneous nodule on the anteromedial side of the right thigh with no detectable primary site in the liver or lung. The case subsequently diagnosed as hydatid cyst of muscle and radical surgery was done under coverage of anihelminthic drug.The common practice in this type of case is to do FNAC taking the lesion to be a soft tissue neoplasm. The aim of this case presentation is to make aware of the fact that in a case of diffuse non-tender swelling with history of gradual increase in size hydatid cyst also has to be considered in the differential diagnosis.

  17. Randall Selitto pressure algometry for assessment of bone-related pain in rats

    DEFF Research Database (Denmark)

    Falk, S.; Ipsen, D. H.; Appel, C. K.

    2015-01-01

    , and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. Results: Randall Selitto pressure...... and pathological bone pain and compared the outcome with more traditional pain-related behaviour measures. Methods: Randall Selitto pressure algometry was performed over the anteromedial part of the tibia in naïve rats, sham-operated rats, and rats inoculated with MRMT-1 carcinoma cells in the left tibia...... algometry over the tibia resulted in reproducible withdrawal thresholds, which were dose-dependently increased by morphine. Cutaneous nociception did not contribute to Randall Selitto measures. In cancer-bearing animals, compared with sham, significant differences in pain-related behaviours were...

  18. Orbital Chondroma: A rare mesenchymal tumor of orbit

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    Ruchi S Kabra

    2015-01-01

    Full Text Available While relatively common in the skeletal system, cartilaginous tumors are rarely seen originating from the orbit. Here, we report a rare case of an orbital chondroma. A 27-year-old male patient presented with a painless hard mass in the superonasal quadrant (SNQ of left orbit since 3 months. On examination, best-corrected visual acuity of both eyes was 20/20, with normal anterior and posterior segment with full movements of eyeballs and normal intraocular pressure. Computerized tomography scan revealed well defined soft tissue density lesion in SNQ of left orbit. Patient was operated for anteromedial orbitotomy under general anesthesia. Mass was excised intact and sent for histopathological examination (HPE. HPE report showed lobular aggregates of benign cartilaginous cells with mild atypia suggesting of benign cartilaginous tumor - chondroma. Very few cases of orbital chondroma have been reported in literature so far.

  19. Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

    Science.gov (United States)

    Gross, Christopher E; Neumann, Julie A; Godin, Jonathan A; DeOrio, James K

    2016-04-01

    Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

  20. Difficulties encountered in preauricular approach over retromandibular approach in condylar fracture.

    Science.gov (United States)

    Jayavelu, Perumal; Riaz, R; Tariq Salam, A R; Saravanan, B; Karthick, R

    2016-10-01

    Fracture of mandible can be classified according to its anatomical location, in which condylar fracture is the most common one overall and is missed on clinical examination. Due to the unique geometry of the mandible and temporomandibular joint, without treatment the fractures can result in marked pain, dysfunction, and deformity. The condylar fracture may be further classified depending on the sides involved: unilateral/bilateral, depending on the height of fracture: intracapsular (within the head of condyle), extracapsular - head and neck (high condyle fracture), and subcondylar (low condyle fracture), and depending on displacement: nondisplaced, displaced (anteromedially, medially, and lateral), and dislocated. The clinical features include swelling and tenderness over the temporomandibular joint region, restricted mouth opening, and anterior open bite. A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery at Madha Dental College and Hospital; suffered fall trauma resulting in bilateral condyle fracture, dentoalveolar fracture in mandible with restricted mouth opening, and anterior open bite.

  1. Open Reduction of Subcondylar Fractures Using a New Retractor

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    Akira Sugamata

    2011-01-01

    Full Text Available Many operative approaches have been described for the open reduction of subcondylar fractures and rigid fixation. However, fracture portions are deep and embedded among facial nerves so that visual surgery in this region is extremely limited. Once the operative field is exposed, the displacement of the condylar head is often dislocated by the anteromedial pull of the lateral pterygoid muscle and the fracture end of the condylar process is pulled up to the mandibular fossa by contraction of the masseter muscle. We made a new retractor to achieve a better field of view. It is possible to pull down the condylar process by opening the tips of the retractor using the specially made wrench system without special effort and keep the condylar process in the same position during reduction. In using this retractor, the fracture stumps were clearly exposed and more easily reposited.

  2. Quantitative analysis of axonal fiber activation evoked by deep brain stimulation via activation density heat maps

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    Christian J. Hartmann

    2015-02-01

    Full Text Available Background: Cortical modulation is likely to be involved in the various therapeutic effects of deep brain stimulation (DBS. However, it is currently difficult to predict the changes of cortical modulation during clinical adjustment of DBS. Therefore, we present a novel quantitative approach to estimate anatomical regions of DBS-evoked cortical modulation. Methods: Four different models of the subthalamic nucleus (STN DBS were created to represent variable electrode placements (model I: dorsal border of the posterolateral STN; model II: central posterolateral STN; model III: central anteromedial STN; model IV: dorsal border of the anteromedial STN. Axonal fibers of passage near each electrode location were reconstructed using probabilistic tractography and modeled using multi-compartment cable models. Stimulation-evoked activation of local axon fibers and corresponding cortical projections were modeled and quantified. Results: Stimulation at the border of the STN (models I and IV led to a higher degree of fiber activation and associated cortical modulation than stimulation deeply inside the STN (models II and III. A posterolateral target (models I and II was highly connected to cortical areas representing motor function. Additionally, model I was also associated with strong activation of fibers projecting to the cerebellum. Finally, models III and IV showed a dorsoventral difference of preferentially targeted prefrontal areas (models III: middle frontal gyrus; model IV: inferior frontal gyrus.Discussion: The method described herein allows characterization of cortical modulation across different electrode placements and stimulation parameters. Furthermore, knowledge of anatomical distribution of stimulation-evoked activation targeting cortical regions may help predict efficacy and potential side effects, and therefore can be used to improve the therapeutic effectiveness of individual adjustments in DBS patients.

  3. Three dimensional assessment of condylar surface changes and remodeling after orthognathic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Hye; Lee, Jin Woo; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul [Dental Research Institute, Seoul National University, Seoul (Korea, Republic of); Shin, Jae Myung [Dept. of Oral and Maxillofacial Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2016-03-15

    This study was performed to evaluate condylar surface changes and remodeling after orthognathic surgery using three-dimensional computed tomography (3D CT) imaging, including comparisons between the right and left sides and between the sexes. Forty patients (20 males and 20 females) who underwent multi-detector CT examinations before and after surgery were selected. Three-dimensional images comprising thousands of points on the condylar surface were obtained before and after surgery. For the quantitative assessment of condylar surface changes, point-to-point (preoperative-to-postoperative) distances were calculated using D processing software. These point-to-point distances were converted to a color map. In order to evaluate the types of condylar remodeling, the condylar head was divided into six areas (anteromedial, anteromiddle, anterolateral, posteromedial, posteromiddle, and posterolateral areas) and each area was classified into three types of condylar remodeling (bone formation, no change, and bone resorption) based on the color map. Additionally, comparative analyses were performed between the right and left sides and according to sex. The mean of the average point-to-point distances on condylar surface was 0.11±0.03 mm. Bone resorption occurred more frequently than other types of condylar remodeling, especially in the lateral areas. However, bone formation in the anteromedial area was particularly prominent. No significant difference was found between the right and left condyles, but condylar surface changes in males were significantly larger than in females. This study revealed that condylar remodeling exhibited a tendency towards bone resorption, especially in the lateral areas. Condylar surface changes occurred, but were small.

  4. The results of Oxford unicompartmental knee arthroplasty in the United States

    Science.gov (United States)

    Emerson, R. H.; Alnachoukati, O.; Barrington, J.; Ennin, K.

    2016-01-01

    Aims Approved by the Food and Drug Administration in 2004, the Phase III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis (AMOA) in patients with an intact anterior cruciate ligament. This unicompartmental knee arthroplasty (UKA) is relatively new in the United States, and therefore long-term American results are lacking. Patients and Methods This is a single surgeon, retrospective study based on prospectively collected data, analysing a consecutive series of primary UKAs using the Phase III mobile-bearing Oxford Knee and Phase III instrumentation. Between July 2004 and December 2006, the senior author (RHE) carried out a medial UKA in 173 patients (213 knees) for anteromedial osteoarthritis or avascular necrosis (AVN). A total of 95 patients were men and 78 were women. Their mean age at surgery was 67 years (38 to 89) and mean body mass index 29.87 kg/m2 (17 to 62). The mean follow-up was ten years (4 to 11). Results Survivorship of the Oxford UKA at ten years was 88%, using life table analysis. Implant survivorship at ten years was 95%. The most common cause for revision was the progression of osteoarthritis in the lateral compartment. The mean knee score element of the American Knee Society Score (AKSS) was 50 pre-operatively and increased to 93 post-operatively. The mean AKSS function score was 56 pre-operatively rising to 78 post-operatively Conclusion This ten-year follow-up study of the Oxford UKA undertaken in the United States shows good survivorship and excellent function in a wide selection of patients with AMOA and AVN. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):34–40. PMID:27694514

  5. A new species of the genus Notozothecium (Monogenea, Dactylogyridae parasitizing the gills of Rhaphiodon vulpinus (Cynodontidae, Characiformes from the Paraná River, State of Paraná, Brazil Una especie nueva del género Notozothecium (Monogenea, Dactylogyridae, parásita de Rhaphiodon vulpinus (Cynodontidae, Characiformes del río Paraná, estado de Paraná, Brasil

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    Simone C. Cohen

    2008-08-01

    Full Text Available During parasitological studies on different localities along the Paraná River, State of Paraná, Brazil, a new species of Notozothecium (Dactylogyridae was found parasitizing gills of the freshwater fish Rhaphiodon vulpinus (Cynodontidae. The new species is allocated to Notozothecium based on the presence of a ventral bar with anteromedial projection, a copulatory complex comprising a coiled male copulatory organ (MCO with a counterclockwise incomplete ring and accessory piece with proximal articulation process and a dextrodorsal vagina, looping the right intestinal caecum. Notozothecium lamotheargumedoi n. sp. is similar to Notozothecium janauachensis, by the absence of terminal flabellate plate on the accessory piece, but differs from it in the shape of the bars, the copulatory complex and the difference of the size-ratio between ventral and dorsal anchors, which in N. janauachensis is larger.Durante varios estudios en diversas localidades del río Paraná, estado de Paraná, Brasil, una especie nueva de Notozothecium fue encontrada en los filamentos branquiales de Rhaphiodon vulpinus, peces de agua dulce pertenecientes a Cynodontidae. La especie nueva se asigna a Notozothecium con base en la barra ventral, que está provista de una proyección anteromedial, un complejo copulador que abarca un órgano copulador en espiral a la izquierda, una pieza accessoria con proceso proximal y la vagina dextrodorsal, dando la vuelta en el ciego intestinal derecho. Notozothecium lamotheargumedoi n. sp. se asemeja a Notozothecium janauachensis por la ausencia de placa flabelada terminal en la pieza accesoria; no obstante, difieren por la forma de las barras, por el complejo copulador y por la relación entre las anclas ventrales y dorsales, que en N. janauachensis es mayor.

  6. Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

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    Kraniotis, Pantelis; Petsas, Theodore [University Hospital of Patras, Department of Radiology, Rion, Patras (Greece); Maragkos, Spyridon; Tyllianakis, Minos [University Hospital of Patras, Department of Orthopedics, Rion, Patras (Greece); Karantanas, Apostolos H. [University Hospital, Heraklion, Department of Medical Imaging, Stavrakia, Crete (Greece)

    2012-07-15

    To detect radiographically occult cartilage lesions using CT arthrography (CTa) in patients with malleolar fractures treated with open reduction internal fixation and to correlate the lesions with the functional outcome score. Twenty-one patients (13 men and 8 women, mean age 35 years, range 16-55) underwent ankle CTa after a mean postoperative period of 565 days (range 271-756). CTa images were analyzed by two radiologists. Articular surface post-traumatic collapse and subsequent cartilage defects or erosions were recorded in millimeters and in a binary mode (i.e., present if >50% of cartilage thickness) respectively. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score by two orthopaedic surgeons. The statistical analysis correlated the AOFAS score with both imaging parameters and was performed with ANOVA using the MedCalc statistical package, version 11.3. Of the total of 12 articular surface steps recorded, 2/12 (16.67%) were anterolateral, 4/12 (33.33%) posterolateral, 5/12 (41.67%) anteromedial, and 1/12(8.33%) posteromedial. Of the total of 42 cartilage lesions, 7/42 (16.67%) were anterolateral, 14/42 (33.33%) posterolateral, 12/42 (28.57%) anteromedial, and 9/42 (21.43%) posteromedial. The mean AOFAS score was 8.67 (range 5.95-9.70). There was no statistically significant correlation between the AOFAS score and the post-traumatic internal derangement of the ankle joint (p = 0.524). CTa detects radiographically silent cartilage lesions in patients with fractures of the ankle joint. There is no correlation of the extent of lesions and the patient's AOFAS score. (orig.)

  7. Differential diagnosis between Tunga penetrans (L, 1758 and T. trimamillata Pampiglione et al., 2002 (Insecta, Siphonaptera, the two species of the genus Tunga parasitic in man

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    Pampiglione S.

    2004-03-01

    Full Text Available Of the ten currently known species of sand fleas, only two, Tunga penetrans and Tunga trimamillata, are known to be parasites of man, besides other warm blooded animals, most of which are peridomestic. The hosts of the other eight are limited to a few genera of wild mammals. T. trimamillata was only recently identified and differentiated from T. penetrans by features of the gravid female phase. In the present paper the different morphological characters of both for non-gravid females and males of the two species are described. In the non-gravid-females the distinguishing characters are : a differences in the length of the first two segments of the maxillary palps (the first is the longest in T. trimamillata, whereas the second is the longest in T. penetrans, this feature is associated with another character i.e. the presence of short, thick spines in addition to the bristles on the surface of the segments only in T. trimamillata ; b the presence, only in T. trimamillata, of a row of spines on the antero-medial surface of the tibia of the 3rd pair of legs ; c the last abdominal spiracle protrudes in T. trimamillata but not in T. penetrans ; d the hood of the hilla in spermatheca is surrounded by a papilla only in T. penetrans. The following morphological characters differentiate males of T. trimamillata and T. penetrans ; a T. trimamillata has a row of spines on the antero-medial surface of the tibia of the 3rd pair of legs ; b the diameter of the abdominal spiracles of T. trimamillata is smaller than that of T. penetrans and the edges of the spiracles are more regular ; c the claspers and aedeagus of T. trimamillata are shorter than those of T. penetrans ; d the profile of the aedeagal apodeme differs between the two species.

  8. Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models

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    Tashiro Y

    2014-04-01

    Full Text Available Yasutaka Tashiro,1 Ken Okazaki,1 Munenori Uemura,2 Kazutaka Toyoda,2 Kanji Osaki,1 Hirokazu Matsubara,1 Makoto Hashizume,2 Yukihide Iwamoto1 1Department of Orthopaedic Surgery, 2Department of Advanced Medical Initiatives, Kyushu University Hospital, Fukuoka, Japan Purpose: The purpose of this study was to assess the differences in bone tunnel apertures between the trans-accessory medial portal (trans-AMP technique and the transtibial (TT technique in double-bundle anterior cruciate ligament reconstruction. The extent of ovalization and the frequency of overlap of the two tunnel apertures were compared. Methods: The simulation of femoral tunnel drilling with the TT and the trans-AMP techniques was performed using three-dimensional computer aided design models from two volunteers. The incidence angle of drilling against the intercondylar wall, the femoral tunnel position, the ovalization, and the overlap were analyzed. The aperture and location of the tunnels were also examined in real anterior cruciate ligament reconstruction cases (n=36. Results: The surgical simulation showed that a lower drill incident angle induced by the TT technique made the apertures of two tunnels more ovalized, located anteromedial tunnels in a shallower position to prevent posterior wall blow out, and led to a higher frequency of tunnel overlap. The trans-AMP group had tunnel places within the footprint and had less ovalization and overlap. The results of analysis for tunnels in the clinical cases were consistent with results from the surgical simulation. Conclusion: In the TT technique, the shallow anteromedial tunnel location and more ovalized tunnel aperture can lead to a higher frequency of tunnel overlap. Compared with the TT technique, the trans-AMP technique was more useful in preparing femoral tunnels anatomically and avoiding tunnel ovalization and overlapping in double-bundle anterior cruciate ligament reconstruction. Keywords: anterior cruciate ligament

  9. [Normal and pathological ultrasonography of the fetal brain].

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    Alvarez, H; Levi, S

    1984-01-01

    Advanced ultrasonic technology enabled the bidimensional imaging of fetal brain throughout pregnancy. The number of visible structures increases with gestational age. In order to certify the described items they were compared to similar anatomical sections available from brain specimens or an atlas of anatomy. Real-time as well as automatic compound scanning machines were used to obtain echographic images of fetal brain anatomy in utero. Many different scans were collected along three orthogonal directions: every 2 mm, with the automated compound scan and as close from each other as possible with the linear array real-time scanner. The material included 59 normal fetuses between the 15th and 40th week of gestation. Eight typical sections are made but the only structures identified are those being visible on every section obtained at the same level. Brain structures such as grey and white matter, nuclei, vessels and ventricles have different sonic properties. They are subsequently distinguishable on the ultrasonic image if the equipment is capable of detecting and showing such differences. Grey matter is more echogenic than white, choroid plexuses are very reflective as are vessel walls which also pulsate. Four horizontal sections are described in detail (Figs. 2-7). The coronal planes are demonstrated at three different levels (Figs. 8-12) and the sagittal plane is represented by Fig. 13. Thirty five structures were identified (Table 2). In the second section some brain and skull anomalies are briefly described. The principal signs of the abnormalities and possible encountered variations are listed such as cranial defects in anencephaly, acrania, encephalocele, iniencephaly; the anomaly of size and shape of head and ventricle, as in hydrocephaly and microcephaly, cystic-like- and solid-tumor lesions and Dandy Walker syndrome and hydranencephaly. Attention is drawn to possible artifacts and pitfalls in the differential diagnosis between similar looking pictures

  10. Craniofacial abnormalities among patients with Edwards Syndrome

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    Rafael Fabiano M. Rosa

    2013-09-01

    Full Text Available OBJECTIVE To determine the frequency and types of craniofacial abnormalities observed in patients with trisomy 18 or Edwards syndrome (ES. METHODS This descriptive and retrospective study of a case series included all patients diagnosed with ES in a Clinical Genetics Service of a reference hospital in Southern Brazil from 1975 to 2008. The results of the karyotypic analysis, along with clinical data, were collected from medical records. RESULTS: The sample consisted of 50 patients, of which 66% were female. The median age at first evaluation was 14 days. Regarding the karyotypes, full trisomy of chromosome 18 was the main alteration (90%. Mosaicism was observed in 10%. The main craniofacial abnormalities were: microretrognathia (76%, abnormalities of the ear helix/dysplastic ears (70%, prominent occiput (52%, posteriorly rotated (46% and low set ears (44%, and short palpebral fissures/blepharophimosis (46%. Other uncommon - but relevant - abnormalities included: microtia (18%, orofacial clefts (12%, preauricular tags (10%, facial palsy (4%, encephalocele (4%, absence of external auditory canal (2% and asymmetric face (2%. One patient had an initial suspicion of oculo-auriculo-vertebral spectrum (OAVS or Goldenhar syndrome. CONCLUSIONS: Despite the literature description of a characteristic clinical presentation for ES, craniofacial alterations may be variable among these patients. The OAVS findings in this sample are noteworthy. The association of ES with OAVS has been reported once in the literature.

  11. Cerebral hemodynamics and functional prognosis in hydrocephalus

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    Hirai, Osamu; Nishikawa, Michio; Watanabe, Shu; Yamakawa, Hiroyasu; Kinoshita, Yoshimasa; Uno, Akira; Handa, Hajime (Hamamatsu Rosai Hospital, Shizuoka (Japan))

    1989-11-01

    The functional outcome of cerebral hemodynamics in the chronic stage of juvenile hydrocephalus was determined using single photon emission computed tomography (SPECT). Five patients including three with aqueductal stenosis, one with post-meningitic hydrocephalus, and one case with hydrocephalus having developed after repair of a huge occipital encephalocele. Early images of cerebral blood flow (CBF) were obtained 25 minutes after intravenous injection of 123-I-iodoamphetamine (IMP), and late images were scanned 3 hours later. Cerebral blood volume (CBV) was also measured using {sup 99m}Tc in three patients. Twenty cases with adult communicating hydrocephalus were also investigated from the point of view of shunt effectiveness. Although there was no remarkable change in the cerebrovascular bed in the juvenile cases, CBF of the remnant brain parenchyma was good irrespective of the degree of ventricular dilatation. There was a periventricular-related IMP uptake in each case; however, it somehow matched the ventricular span. Functional outcome one to 23 years after the initial shunt operation was good in every case, despite multiple shunt revisions. Redistribution on late images had no bearing on clinical states. In adult cases, 8 patients with effective shunting demonstrated a relatively localized periventricular low perfusion, with preoperative increased cerebrospinal fluid (CSF) pressure. On the contrary, 12 patients with no improvement with or without ventricular-reduced IMP uptake, despite low CSF pressure. The present study indicates that periventricular hemodynamics may play an important role in cerebral function compromised by hydrocephalus. (J.P.N.).

  12. Pyramidal tract abnormalities in the human fetus and infant with trisomy 18 syndrome.

    Science.gov (United States)

    Miyata, Hajime; Miyata, Mio; Ohama, Eisaku

    2014-06-01

    Trisomy 18 or Edwards syndrome is known to exhibit various developmental abnormalities in the central nervous system. We report dominant uncrossed pyramidal tract in trisomy 18 syndrome, based on the postmortem neuropathologic study of eight consecutive autopsied fetuses and infants with trisomy 18 ranging in age from 16 to 39 weeks of gestation, including six males and two females, along with autopsy cases of a stillborn triploid infant with 69XXX and two stillborn infants without chromosomal or neurodevelopmental abnormalities. Five out of eight cases with trisomy 18 showed a larger proportion of uncrossed than crossed pyramidal tract. All of these cases were male, and the anterior corticospinal tract on one side was constantly larger than the contralateral lateral corticospinal tract in the spinal cord on both sides, while the pyramidal tract was hypoplastic in female cases with trisomy 18 and a case with 69XXX. Abnormal pyramidal decussation has been found in cases with posterior fossa malformations such as occipital encephaloceles, Dandy-Walker malformation, Joubert syndrome and Möbius syndrome, but has not been described in cases with trisomy 18. Our data, together with the previous reports describing uncrossed aberrant ipsilateral pyramidal tract in patients with congenital mirror movements caused by DCC gene mutation in chromosome 18, and hypolasia and hyperplasia of the pyramidal tract in X-linked recessive disorders caused by L1CAM and Kal1 gene mutations, respectively, suggest a role of trisomy 18 in association with X-chromosome in the abnormal development of the pyramidal tract.

  13. Melatonin prevents neural tube defects in the offspring of diabetic pregnancy.

    Science.gov (United States)

    Liu, Shangming; Guo, Yuji; Yuan, Qiuhuan; Pan, Yan; Wang, Liyan; Liu, Qian; Wang, Fuwu; Wang, Jingjing; Hao, Aijun

    2015-11-01

    Melatonin, an endogenous neurohormone secreted by the pineal gland, has a variety of physiological functions and neuroprotective effects. However, its protective role on the neural tube defects (NTDs) was not very clear. The aim of this study was to investigate the effects of melatonin on the incidence of NTDs (including anencephaly, encephalocele, and spina bifida) of offspring from diabetic pregnant mice as well as its underlying mechanisms. Pregnant mice were given 10 mg/kg melatonin by daily i.p. injection from embryonic day (E) 0.5 until being killed on E11.5. Here, we showed that melatonin decreased the NTDs (especially exencephaly) rate of embryos exposed to maternal diabetes. Melatonin stimulated proliferation of neural stem cells (NSCs) under hyperglycemic condition through the extracellular regulated protein kinases (ERK) pathway. Furthermore, as a direct free radical scavenger, melatonin decreased apoptosis of NSCs exposed to hyperglycemia. In the light of these findings, it suggests that melatonin supplementation may play an important role in the prevention of neural malformations in diabetic pregnancy.

  14. Augmented Indian hedgehog signaling in cranial neural crest cells leads to craniofacial abnormalities and dysplastic temporomandibular joint in mice.

    Science.gov (United States)

    Yang, Ling; Gu, Shuping; Ye, Wenduo; Song, Yingnan; Chen, YiPing

    2016-04-01

    Extensive studies have pinpointed the crucial role of Indian hedgehog (Ihh) signaling in the development of the appendicular skeleton and the essential function of Ihh in the formation of the temporomandibular joint (TMJ). In this study, we have investigated the effect of augmented Ihh signaling in TMJ development. We took a transgenic gain-of-function approach by overexpressing Ihh in the cranial neural crest (CNC) cells using a conditional Ihh transgenic allele and the Wnt1-Cre allele. We found that Wnt1-Cre-mediated tissue-specific overexpression of Ihh in the CNC lineage caused severe craniofacial abnormalities, including cleft lip/palate, encephalocele, anophthalmos, micrognathia, and defective TMJ development. In the mutant TMJ, the glenoid fossa was completely absent, whereas the condyle and the articular disc appeared relatively normal with slightly delayed chondrocyte differentiation. Our findings thus demonstrate that augmented Ihh signaling is detrimental to craniofacial development, and that finely tuned Ihh signaling is critical for TMJ formation. Our results also provide additional evidence that the development of the condyle and articular disc is independent of the glenoid fossa.

  15. CC2D2A mutations in Meckel and Joubert syndromes indicate a genotype-phenotype correlation

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    Mougou-Zerelli, Soumaya; Thomas, Sophie; Szenker, Emmanuelle; Audollent, Sophie; Elkhartoufi, Nadia; Babarit, Candice; Romano, Stéphane; Salomon, Rémi; Amiel, Jeanne; Esculpavit, Chantal; Gonzales, Marie; Escudier, Estelle; Leheup, Bruno; Loget, Philippe; Odent, Sylvie; Roume, Joëlle; Gérard, Marion; Delezoide, Anne-Lise; Khung, Suonavy; Patrier, Sophie; Cordier, Marie-Pierre; Bouvier, Raymonde; Martinovic, Jéléna; Gubler, Marie-Claire; Boddaert, Nathalie; Munnich, Arnold; Encha-Razavi, Férechté; Valente, Enza Maria; Saad, Ali; Saunier, Sophie; Vekemans, Michel; Attié-Bitach, Tania

    2009-01-01

    The Meckel syndrome (MKS) is a lethal fetal disorder characterized by diffuse renal cystic dysplasia, polydactyly, a brain malformation that is usually occipital encephalocele and/or vermian agenesis, with intrahepatic biliary duct proliferation. Joubert syndrome (JBS) is a viable neurological disorder with a characteristic “molar tooth sign” (MTS) on axial images reflecting cerebellar vermian hypoplasia/dysplasia. Both conditions are classified as ciliopathies with an autosomal recessive mode of inheritance. Allelism of MS and JBS has been reported for TMEM67/MKS3, CEP290/MKS4, and RPGRIP1L/MKS5. Recently, one homozygous splice mutation with a founder effect was reported in the CC2D2A gene in Finnish fetuses with MKS, defining the 6th locus for MKS. Shortly thereafter, CC2D2A mutations were reported in JBS also. The analysis of the CC2D2A gene in our series of MKS fetuses, identified 14 novel truncating mutations in 11 cases. These results confirm the involvement of CC2D2A in MKS and reveal a major contribution of CC2D2A to the disease. We also identified three missense CC2D2A mutations in two JBS cases. Therefore and in accordance with the data reported regarding RPGRIP1L, our results indicate phenotype-genotype correlations, as missense and presumably hypomorphic mutations lead to JBS while all null alleles lead to MKS. PMID:19777577

  16. Accuracy of Ultrasound in Detection of Gross Prenatal Central Nervous System Anomalies after the Eighteenth Week of Gestation

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    M. Tahmasebi

    2007-10-01

    Full Text Available Background/Objective: Ultrasound (US detection of prenatal central nervous system (CNS anatomic anomalies is very important in making decision about therapeutic termination. In the present study, the accuracy of US in detection of gross prenatal CNS anatomic anomalies has been investigated."nPatients and Methods: 3012 pregnant women were scanned after 18 weeks of gestation by an expert operator in a referring center. All delivered fetuses were followed after birth through clinical examination and sonography."nResults: In this study, the accuracy of US in detection of gross CNS anatomic anomalies of fetuses after 18 weeks gestation was found to be 100%. The sensitivity, specificity, positive and negative predictive values of US were 100%. In sonographic examination of these 3012 pregnant women, 36 fetuses were detected with CNS anomalies, some of whom had more than one anomaly. Gross CNS anomalies observed included microcephaly, hydrocephaly, anencephaly, holoprosencephaly, ventriculomegaly, meningocele, encephalocele, lissencephaly, agenesis of corpus callosum, bilateral choroid plexus cysts and hypoplastic cerebellum."nConclusion: US is highly operator dependent and operator experience may be the most determinant affecting the results. Sonographic scanning after 18 weeks of gestation is associated with the best results.

  17. Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions.

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    Gilad Horowitz

    Full Text Available OBJECTIVE: To compare frontal sinus cranialization to obliteration for future prevention of secondary mucocele formation following open surgery for benign lesions of the frontal sinus. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic medical center. PATIENTS: Sixty-nine patients operated for benign frontal sinus pathology between 1994 and 2011. INTERVENTIONS: Open excision of benign frontal sinus pathology followed by either frontal obliteration (n = 41, 59% or frontal cranialization (n = 28, 41%. MAIN OUTCOME MEASURES: The prevalence of post-surgical complications and secondary mucocele formation were compiled. RESULTS: Pathologies included osteoma (n = 34, 49%, mucocele (n = 27, 39%, fibrous dysplasia (n = 6, 9%, and encephalocele (n = 2, 3%. Complications included skin infections (n = 6, postoperative cutaneous fistula (n = 1, telecanthus (n = 4, diplopia (n = 3, nasal deformity (n = 2 and epiphora (n = 1. None of the patients suffered from postoperative CSF leak, meningitis or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision surgery due to secondary mucocele formation. Statistical analysis using non-inferiority test reveal that cranialization of the frontal sinus is non-inferior to obliteration for preventing secondary mucocele formation (P<0.0001. CONCLUSION: Cranialization of the frontal sinus appears to be a good option for prevention of secondary mucocele development after open excision of benign frontal sinus lesions.

  18. Neuroembryology and functional anatomy of craniofacial clefts

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    Ewings Ember

    2009-10-01

    Full Text Available The master plan of all vertebrate embryos is based on neuroanatomy. The embryo can be anatomically divided into discrete units called neuromeres so that each carries unique genetic traits. Embryonic neural crest cells arising from each neuromere induce development of nerves and concomitant arteries and support the development of specific craniofacial tissues or developmental fields. Fields are assembled upon each other in a programmed spatiotemporal order. Abnormalities in one field can affect the shape and position of developing adjacent fields. Craniofacial clefts represent states of excess or deficiency within and between specific developmental fields. The neuromeric organization of the embryo is the common denominator for understanding normal anatomy and pathology of the head and neck. Tessier′s observational cleft classification system can be redefined using neuroanatomic embryology. Reassessment of Tessier′s empiric observations demonstrates a more rational rearrangement of cleft zones, particularly near the midline. Neuromeric theory is also a means to understand and define other common craniofacial problems. Cleft palate, encephaloceles, craniosynostosis and cranial base defects may be analyzed in the same way.

  19. Standard large trauma craniotomy for severe traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    L(U) Li-quan 吕立权; JIANG Ji-yao 江基尧; YU Ming-kun 于明琨; HOU Li-jun 侯立军; CHEN Zhi-gang 陈志刚; ZHANG Guang-ji 张光霁; ZHU Cheng 朱诚

    2003-01-01

    Objective: To study the effect of standard large trauma craniotomy(SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS≤8).Methods: 230 patients with severe TBI were randomly divided into two groups.115 patients underwent SLTC (10 cm×12 cm) as an SLTC group, and other 115 patients underwent temporo-parietal or fronto-temporal craniotomy (6 cm×8 cm) according to the position of hematomas as a routine craniotomy (RC) group.Other treatments were identical in two groups.According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated and the complications were compared between two groups.Results: 27 patients got good outcome and moderate disability (23.5%), 40 severe disability and vegetative survival (34.8%), and 48 died (41.7%) in SLTC group.21 patients got good outcome and moderate disability (18.3%), 28 severe disability and vegetative survival (24.3%), and 66 died (57.4%) in RC group.The incidence of incision hernia was lower in SLTC group than in RC group.However, the incidence of operative encephalocele, traumatic epilepsy and intracranial infection were not different in two groups.Conclusions: Standard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.

  20. Advances in Etiology of Neural Tube Defects%神经管缺陷的病因学研究进展

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    谢远杰; 赵国军; 莫中成; 龙治峰

    2009-01-01

    Neural tube defects (NTDs) are a group of complex congenital defects of the CNS, commonly including anencephaly, spina bifida and encephaloceles which arise from the malformations of neural tube closure during the process of neurulation. Both environmental and genetic factors are involved in the etiology of NTDs, and many of them have been identified as risk factors of neural tube defects. Despite exhaustive research efforts, little is known about the actual genetic mechanisms governing the primary events involved in neural tube defects. We will review these factors in details.%脊柱裂、无脑儿和脑膜脑膨出通常被统称为神经管缺陷(neural tube defects,NTDs),是在神经胚形成过程中由于神经管闭合异常导致的中枢神经系统先天性疾病.其病因极其复杂,目前认为与神经管发育有关的基因异常和诸多环境因素均能导致NTDs,尽管很多学者对NTDs的病因做了大量的研究,但目前对于导致人NTDs的关键病因仍知之甚少.本文就目前研究最多的与神经管缺陷有关的基因和环境因素作一综述.

  1. 中国30个县(市)1993~2000年神经管畸形在出生人群中的患病率及变动趋势分析%Prevalence of neural tube defects at birth in 30 counties and cities of China, 1993-2000

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    叶荣伟; 李松; 郑俊池; 洪世欣; 陈新; 王太梅; 任爱国; 王丽娜; 李竹

    2002-01-01

    Objective:To describe the prevalence rates of neural tube defects (NTD) and yearly trends (1993-2000) in China. Methods: All the data were obtained from the Birth Defects Surveillance System in thirty counties/cities of China. The calculation of NTD prevalence rates and time trend analyses were based on the data for live (L) and stillbirths (S) only, the denominator used was total births (L+S). Linear regression analysis of the prevalence rate over years has been used to measure time trends. Results: In the period of 1993-2000, there were 1 264 neural tube defects among 1 189 126 total births in 30 counties/cities in China. The overall neural tube defects rate was 10.63 per 10000 births, and rates were higher (18.99 per 10 000 births) in the year 1993, lower (6.05 per 10 000 births) in 1998. The prevalence rates of anencephaly, spina bifida and encephalocele were 4.71,4.39 and 1.53 per 10 000 births respectively. Of all index NTD cases, anencephaly and spina bifida were most frequent, making up 44.3% and 41.3%, and encephalocele represented 14.4%. The stillbirth proportion was 69.3% over all index NTD cases, 95.4% in anencephaly cases, 43.7% in spina bifida, and 62.6% in encephalocele cases. Linear trend analysis indicated a significant decline for NTD rate (F=11.818, β=-0.814,P=0.014). Analysis by specific defect showed significant declines for the rates of anencephaly (P=0.004) and spina bifida (P=0.026), but no significant annual variation of encephalocele (P=0.227). Results of comparing with data reported from other surveillance systems (1994-1999) showed that the highest NTD rate (9.41 per 10000 births) was seen in China, nearly7 times the lowest rate (1.44 per 10000 births) in England and Wales. Conclusion: The overall neural tube defects rate in 30 counties/cities of China presented a significant downward trend between 1993 and 2000, and China still had the higher neural tube defects prevalence. %目的:描述中国30个县(市)1993

  2. Comparison of two methods of femoral tunnel preparation in single-bundle anterior cruciate ligament reconstruction: a prospective randomized study Comparação entre dois métodos de preparação de túnel femoral na reconstrução do ligamento cruzado anterior em feixe único: estudo prospectivo randomizado

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    Qiang Zhang

    2012-08-01

    Full Text Available PURPOSE: To prospectively compare therapeutic effect of femoral tunnel preparation through the tibial tunnel and the anteromedial (AM portal in single-bundle anterior cruciate ligament (ACL reconstruction. METHODS: Between June 2008 and October 2010, 76 patients underwent single-bundle ACL reconstruction by autogenous grafting of semitendinosus and gracilis tendon. All cases were randomly divided into two groups according to the method of femoral tunnel preparation: transtibial (TT group (n=38 and anteromedial (AM group (n=38. Lysholm knee score and the KT-1000 anterior laxity at 30° of pre-and post-operation were assessed for two groups. RESULTS: Sixty-five patients (TT group, 34; AM group, 31 were followed up for more than 12 months, with a follow-up rate of 86%. The Lysholm knee score and the KT-1000 anterior laxity 12 months after operation were significantly better than before reconstruction. The Lysholm knee score and the KT-1000 anterior laxity were not significantly different between the TT and AM groups after operation. CONCLUSION: Femoral tunnel preparation through tibial tunnel or the anteromedial portal in single-bundle anterior cruciate ligament reconstruction shows same therapeutic effects.OBJETIVO: Comparar prospectivamente o efeito terapêutico da preparação do túnel femoral através do túnel tibial (TT ou da porta ântero-medial(AM na reconstrução do ligamento cruzado anterior(LCA em feixe único. MÉTODOS: Entre junho de 2008 e outubro de 2010, 76 pacientes foram submetidos à reconstrução do LCA em feixe único pelo enxerto autógeno de tendão semitendíneo egrácil.Todos os casos foram divididos aleatoriamente em dois grupos de acordo como método de preparação do túnel femoral: grupo transtibial (TT (n=38 e grupo ântero-medial (AM (n=38. Foi usado o escore Lysholm para joelho. O relaxamento anterior do joelho a 30° sob força tênsil de 133,32N foi determinado com o medidor KT-1000 no pré e no p

  3. Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model

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    Fickert, S.; Niks, M.; Lehmann, L. [University Medical Center Mannheim, Center of Orthopaedics and Traumatology, Mannheim (Germany); Dinter, D.J.; Hammer, M.; Weckbach, S.; Schoenberg, S.O.; Jochum, S. [University Medical Center Mannheim, Department of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2013-03-15

    Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection. The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model. Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference. The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle. In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the

  4. Temporal pole signal abnormality on MR imaging in temporal lobe epilepsy with hippocampal sclerosis: a fluid-attenuated inversion-recovery study Anormalidade de sinal na imagem por RM do pólo temporal na epilepsia do lobo temporal com esclerose hipocampal: um estudo pela seqüência inversão recuperação com supressão da água livre (FLAIR

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    Henrique Carrete Junior

    2007-09-01

    Full Text Available OBJECTIVE: To determine the frequency and regional involvement of temporal pole signal abnormality (TPA in patients with hippocampal sclerosis (HS using fluid-attenuated inversion-recovery (FLAIR MR imaging, and to correlate this feature with history. METHOD: Coronal FLAIR images of the temporal pole were assessed in 120 patients with HS and in 30 normal subjects, to evaluate gray-white matter demarcation. RESULTS: Ninety (75% of 120 patients had associated TPA. The HS side made difference regarding the presence of TPA, with a left side prevalence (p=0.04, chi2 test. The anteromedial zone of temporal pole was affected in 27 (30% out of 90 patients. In 63 (70% patients the lateral zone were also affected. Patients with TPA were younger at seizure onset (p=0.018, but without association with duration of epilepsy. CONCLUSION: Our FLAIR study show temporal pole signal abnormality in 3/4 of patients with HS, mainly seen on the anteromedial region, with a larger prevalence when the left hippocampus was involved.OBJETIVO: Determinar a freqüência e o envolvimento regional da anormalidade de sinal do pólo temporal (APT em pacientes com esclerose hipocampal (EH utilizando seqüência inversão recuperação com supressão da água (FLAIR por RM, e correlacioná-la com a história. MÉTODO: Foram analisadas as imagens coronais FLAIR dos pólos temporais de 120 pacientes com EH e de 30 indivíduos normais, para avaliar a demarcação entre substâncias branca e cinzenta. RESULTADOS: Noventa (75% dos 120 pacientes tinham APT associada. Houve prevalência do lado esquerdo (p=0.04, chi2 teste na relação entre APT e o lado da EH. A zona ântero-medial estava acometida em 27 (30% destes pacientes. Em 63 (70% pacientes também a zona lateral estava acometida. Pacientes com APT apresentaram início da epilepsia quando mais jovens (p=0.018, porém sem associação com a sua duração. CONCLUSÃO: A seqüência FLAIR mostra haver ATP em 3/4 dos pacientes com EH

  5. 食管癌术后声带麻痹的CT表现及病因分析%Analysis of CT findings and the cause of vocal cord paralysis after resection of esophageal carcinoma

    Institute of Scientific and Technical Information of China (English)

    宋涛; 李辛; 胡鸿涛; 黎海亮

    2012-01-01

    Objective To analyse CT performances of vocal cord paralysis after resection of esophageal carcinoma and its relation-ship with mediastinal lymph node metastasis, in order to improve the recognition of the imaging manifestations of it. Methods 40 cases of vocal cord paralysis clinically after resection of esophageal carcinoma confirmed were retrospectively analysed. Results CT findings of vocal cord paralysis included: thickening and anteromedial displacement of the ipsilateral aryepiglottic folds, ipsilateral piriform sinus dilatation in 34 cases (85%) ;vocal cord atrophy and lateral displacement,ipsilateral laryngeal ventricle dilatation in 31 cases(77. 5%) ; anteromedial displacement of the ipsilateral arytenoid cartilage in 16 cases(40%) etc. Mediastinal lymph node me-tastasis in 38 cases(95%) and anastomotic recurrence of esophageal carcinoma in 4 cases(10%). Conclusion CT scan is helpful in diagnosing vocal cord paralysis and its etiology.%目的 分析食管癌术后声带麻痹的CT表现及其与纵隔淋巴结转移的关系,提高对其影像学表现的认识.方法 回顾性分析临床诊断为食管癌术后并发声带麻痹的40例患者的CT资料.结果 声带麻痹CT表现:患侧杓会厌皱襞增厚、向前内侧移位,同侧梨状隐窝扩大34例 (85%);患侧声带萎缩外展,同侧喉室扩大31例 (77.5%);患侧杓状软骨向前内侧移位16例 (40%)等.38例(95%)患者发现纵隔淋巴结转移,4例(10%)患者发现吻合口复发.结论 CT检查为声带麻痹的确诊提供了重要依据,而且有助于明确引起声带麻痹的原因.

  6. Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

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    Suomalainen P

    2014-08-01

    Full Text Available Piia Suomalainen,1 Tommi Kiekara,2 Anna-Stina Moisala,1 Antti Paakkala,2 Pekka Kannus,3 Timo Järvelä4 1Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, 2Medical Imaging Centre, Tampere University Hospital, Tampere, 3Injury and Osteoporosis Research Center, UKK Institute, Tampere, 4Arthroscopic and Sports Medicine Center Omasairaala, Helsinki, Finland Purpose: The purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI findings of a reconstructed anterior cruciate ligament (ACL have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee. Methods: This study is a level II, prospective clinical and MRI study (NCT02000258. The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used. Results: We found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations. Conclusion: Anterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this

  7. Positioning of the femoral tunnel for arthroscopic reconstruction of the anterior cruciate ligament: comparative study of 2 techniques Posicionamento do túnel femoral na reconstrução artroscópica do LCA: estudo comparativo de duas técnicas

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    Roberto Freire da Mota Albuquerque

    2007-01-01

    Full Text Available OBJECTIVE: To compare the accuracy of positioning of the femoral tunnel in reconstructing the anterior cruciate ligament by means of 2 techniques: tibial tunnel and anteromedial portal. METHOD: Femoral tunnels were drilled in 20 knees from human cadavers by means of arthroscopy. Group I had the femoral tunnel drilled via a trans-tibial tunnel, and Group II via the anteromedial portal. Four variables were measured: A posterior wall thickness; B tunnel positioning at the notch; C tunnel inclination in relation to the femoral axis; and D distance between the wire guide exit and the lateral epicondyle. RESULTS: As above, respectively, A 2.23 mm for group I and 2.36 mm for group II (P =.54; B 25.5° for group I and 30.0° for group II (P =.23; C 23.9° for group I and 32.0° for group II (P =.02; D 7.8 cm for group I and 3.9 cm for group II (P OBJETIVO: Comparar a acurácia do posicionamento do túnel femoral na reconstrução do ligamento cruzado anterior através de duas vias: túnel tibial e portal ântero - medial. MÉTODO: Foram perfurados túneis femorais em vinte joelhos de cadáveres humanos por via artroscópica. Grupo I: túnel femoral por acesso trans túnel tibial. Grupo II: via portal ântero-medial. Quatro variáveis foram estudadas: A espessura da parede posterior; B posicionamento do túnel no intercôndilo; C angulação do túnel em relação ao eixo do fêmur; D distância entre a saída do fio guia e o epicôndilo lateral. RESULTADO: A grupo I: 2,23 mm, grupo II: 2,36 mm (p=0,543; B grupo I: 25,5º, grupo II: 30º (p=0,226; C grupo I: 23,9º, grupo II: 32º (p= 0,014; D grupo I: 7,8 cm, grupo II 3,9 cm (p<0,001. CONCLUSÃO: As duas técnicas obteveram o posicionamento desejado da entrada do túnel femoral e espessura adequada da cortical posterior. A perfuração via portal ântero-medial pode propiciar maior proteção contra rotura da parede posterior.

  8. Difficulties encountered in preauricular approach over retromandibular approach in condylar fracture

    Science.gov (United States)

    Jayavelu, Perumal; Riaz, R.; Tariq Salam, A. R.; Saravanan, B.; Karthick, R.

    2016-01-01

    Fracture of mandible can be classified according to its anatomical location, in which condylar fracture is the most common one overall and is missed on clinical examination. Due to the unique geometry of the mandible and temporomandibular joint, without treatment the fractures can result in marked pain, dysfunction, and deformity. The condylar fracture may be further classified depending on the sides involved: unilateral/bilateral, depending on the height of fracture: intracapsular (within the head of condyle), extracapsular - head and neck (high condyle fracture), and subcondylar (low condyle fracture), and depending on displacement: nondisplaced, displaced (anteromedially, medially, and lateral), and dislocated. The clinical features include swelling and tenderness over the temporomandibular joint region, restricted mouth opening, and anterior open bite. A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery at Madha Dental College and Hospital; suffered fall trauma resulting in bilateral condyle fracture, dentoalveolar fracture in mandible with restricted mouth opening, and anterior open bite. PMID:27829774

  9. Traumatic Fracture in a patient of Osteopoikilosis with review of literature

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    Rohan Bansal

    2013-04-01

    Full Text Available Introduction: Osteopoikilosis or osteopathia condensans disseminata is a rare hereditary autosomal dominant sclerosing bone dysplasia. Patients are usually asymptomatic and the diagnosis is usually made incidentally on radiographs which show presence of symmetric, multiple, well defined, small ovoid areas of increased radiodensity clustered in peri-articular osseous regions with propensity for epiphyseal and metaphyseal involvement. There are no increased risks of pathological fracture in a case of osteopoikilosis and traumatic fracture healing in a case of osteopoikilosis is similar to fracture occurring in other normal patients. Case Report: A 34 years male, electrician came with history of accidental fall from height while working in office leading to development of pain and swelling over left lower leg and ankle diagnosed with Ruedi-Allgower classification type I pilon fracture(without fibula fracture no distal neuro-vascular deficit. Patient was offered surgical treatment in form of open reduction and internal fixation of tibial fracture by plate osteosynthesis using antero-medial approach , showed complete union and was followed up for eight months. Conclusion: Osteopoikilosis has a benign course and it should always be kept as a possible differential diagnosis for osteoblastic metastasis to avoid diagnositic dilemma. Diagnosis can be settled by routine x-rays ( for type ,extent and site of lesions, bones affected, clinical features of patient , histopathology and other systemic or pre-existing conditions. Keywords: Fracture , Osteopoikilosis , union, Pilon, Osteoblastic metastasis

  10. Impact of Fixed-Bearing and Mobile-Bearing Tibial Insert in Unicondylar Knee Arthroplasty

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    Mehmet Faruk Çatma

    2016-06-01

    Full Text Available INTRODUCTION: The aim of the study is to investigate the impact of fixed or mobile-bearing tibial inserts on patellofemoral arthrosis and evaluate which one to be preferred for patients with patellofemoral arthrosis. METHODS: Operated in our clinic between January 2009 and February 2013, 33 with patellofemoral arthritis together with anteromedial compartment arthritis were included in the study. Patellofemoral joints of patients were evaluated according to the scoring system defined by Fulkerson-Shea. RESULTS: Unicondylar knee arthroplasty with fixed-bearing tibial insertsand 22 (66,6% (male: 3, female: 19 and unicondylar knee arthroplasty with mobile-bearing tibial inserts 11 (33,9 % (male: 2, female: 9 were implanted.Average knee flexion was found to be 116,5 (100-135 degrees in 22 patients with mobile-bearing tibial inserts, and 114,5 (95-135 in 11 patients with fixed-bearing tibial inserts. DISCUSSION AND CONCLUSION: Patellofemoral arthrosis is an important factor for unicondylar knee arthroplasty prognosis and one of the determinants of patient satisfaction. Significantly less patellofemoral complaints were seen with UKA with fixed-bearing tibial insert compared to mobile-bearing tibial insert.

  11. Neural basis of interpersonal traits in neurodegenerative diseases.

    Science.gov (United States)

    Sollberger, Marc; Stanley, Christine M; Wilson, Stephen M; Gyurak, Anett; Beckman, Victoria; Growdon, Matthew; Jang, Jung; Weiner, Michael W; Miller, Bruce L; Rankin, Katherine P

    2009-11-01

    Several functional and structural imaging studies have investigated the neural basis of personality in healthy adults, but human lesions studies are scarce. Personality changes are a common symptom in patients with neurodegenerative diseases like frontotemporal dementia (FTD) and semantic dementia (SD), allowing a unique window into the neural basis of personality. In this study, we used the Interpersonal Adjective Scales to investigate the structural basis of eight interpersonal traits (dominance, arrogance, coldness, introversion, submissiveness, ingenuousness, warmth, and extraversion) in 257 subjects: 214 patients with neurodegenerative diseases such as FTD, SD, progressive nonfluent aphasia, Alzheimer's disease, amnestic mild cognitive impairment, corticobasal degeneration, and progressive supranuclear palsy and 43 healthy elderly people. Measures of interpersonal traits were correlated with regional atrophy pattern using voxel-based morphometry (VBM) analysis of structural MR images. Interpersonal traits mapped onto distinct brain regions depending on the degree to which they involved agency and affiliation. Interpersonal traits high in agency related to left dorsolateral prefrontal and left lateral frontopolar regions, whereas interpersonal traits high in affiliation related to right ventromedial prefrontal and right anteromedial temporal regions. Consistent with the existing literature on neural networks underlying social cognition, these results indicate that brain regions related to externally focused, executive control-related processes underlie agentic interpersonal traits such as dominance, whereas brain regions related to internally focused, emotion- and reward-related processes underlie affiliative interpersonal traits such as warmth. In addition, these findings indicate that interpersonal traits are subserved by complex neural networks rather than discrete anatomic areas.

  12. The Effects of Patellar Taping on Dynamic Balance and Reduction of Pain in Athletic Women with Patellofemoral Pain Syndrome(PFPS

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    N Khoshraftare Yazdi

    2012-08-01

    Full Text Available Introduction: Patellofemoral pain syndrome(PFPS is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who attend to the sport medical clinics. Patellofemoral is more common among female athletes especially adolescents and young adults. Patellar taping provides an effective treatment in alleviating the symptoms of a high proportion of subjects who suffer from PFPS, though the mechanisms of pain reduction have not completely been established following its application. The purpose of this study was to investigate the effects of taping on dynamic balance and reduction of pain in athletic women with patellofemoral pain syndrome. Methods: Fifteen female athletes with patellofemoral pain syndrome participated in the study. Therefore, dynamic balance was assessed using a SEBT(Star Excursion Balance Test before and after application of patellar taping. The severity of pain was measured by VAS(Visual Analog Scale. Results: The results of variance analysis by VAS(p<0/008 in repeated measure indicated a statistically significant improvement in pain and in knee function in anterior, anteromedial, medial, posteromedial and anterolateral directions(p<0/05. Conclusion: The study results confirmed a significant improvement in reducing pain and increasing function (dynamic balance of female athletes with patellofemoral pain syndrome after patellar taping.

  13. Outcome of anterior cruciate ligament reconstruction with emphasis on sex-related differences.

    Science.gov (United States)

    Ahldén, M; Sernert, N; Karlsson, J; Kartus, J

    2012-10-01

    The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using the four-strand semitendinosus-gracilis (ST/G) autograft in male (n=141) vs female (n=103) patients. The patients were operated on between 1996 and 2005, using interference screw fixation and drilling the femoral tunnel through the anteromedial portal. The pre-operative assessments and demographics, apart from age (males 29 years, females 26 years; P=0.02), were comparable at the time of surgery. At 25 (23-36) months post-operatively, no significant differences were found between the study groups in terms of anterior side-to-side knee laxity, manual Lachman test, Tegner activity level, Lysholm knee score, range of motion or donor-site morbidity. Both study groups improved significantly in most clinical assessments and functional scores compared with their pre-operative values. Two years after ACL reconstruction using ST/G autografts, there were no significant differences between male and female patients in terms of clinical outcome or functional scores.

  14. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for 'isolated' anterior cruciate ligament rupture.

    Science.gov (United States)

    Bourke, H E; Gordon, D J; Salmon, L J; Waller, A; Linklater, J; Pinczewski, L A

    2012-05-01

    The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time. ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis.

  15. A Comparison between Clinical Results of Selective Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Yoo, Yon-Sik; Song, Si Young; Yang, Cheol Jung; Ha, Jong Mun; Kim, Yoon Sang

    2016-01-01

    Purpose The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle. Materials and Methods The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach. Results The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all pACL tears offers comparable clinical results to DB reconstruction in complete ACL tears. PMID:27401652

  16. “Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap

    Science.gov (United States)

    Hughes, Tom; Yu, Jonathan T.S.; Wong, Kai Yuen; Malata, Charles M.

    2013-01-01

    INTRODUCTION Necrotising fasciitis (NF) is a rare, severe, rapidly progressing and life-threatening synergistic infection primarily affecting the superficial fascia. A novel method of definitive and aesthetic reconstruction of NF thigh defects by using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap without recourse to temporising skin grafts is presented. PRESENTATION OF CASE A 30-year-old parous woman presented in extremis with fulminant NF of her left anteromedial thigh. Following emergency radical debridement and intensive care stabilisation she was reconstructed 48 h later in a single stage with a pedicled TRAM flap islanded on the ipsilateral deep inferior epigastric vessels. There was excellent contour restoration of her thigh and coverage of the exposed femoral vessels. DISCUSSION Pedicled flaps based on the rectus abdominis muscle provide a large, readily available reconstructive option for correction of substantial regional defects as herein illustrated. They are robust when based on dominant inferior vascular pedicle with a long reach and wide arc of rotation when designed transversely (as a TRAM flap). CONCLUSION This case also illustrates that definitive flap reconstruction of NF can be successfully undertaken in the emergent setting, thereby negating the need for large areas of skin grafting which can lead to contractures with consequent functional impairment and suboptimal aesthetic results. PMID:23548707

  17. Hamstring tendons insertion - an anatomical study

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    Cristiano Antonio Grassi

    2013-09-01

    Full Text Available OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical rela-tionships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT, tibial plateau (TP and tibial tuberosity (TT. A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT was calculated using Image Pro Plus software. RESULTS: The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT was 20.3 ± 4.9°. CONCLUSION: In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°.

  18. Focal lesions within the ventral striato-pallidum abolish attraction for male chemosignals in female mice.

    Science.gov (United States)

    Agustín-Pavón, Carmen; Martínez-García, Fernando; Lanuza, Enrique

    2014-02-01

    In rodents, socio-sexual behaviour is largely mediated by chemosensory cues, some of which are rewarding stimuli. Female mice display an innate attraction towards male chemosignals, dependent on the vomeronasal system. This behaviour likely reflects the hedonic value of sexual chemosignals. The anteromedial aspect of the olfactory tubercle, along with its associated islands of Calleja, receives vomeronasal inputs and sexually-dimorphic vasopressinergic innervation. Thus, we hypothesised that this portion of the ventral striato-pallidum, known to be involved in reward processing, might be important for sexual odorant-guided behaviours. In this study, we demonstrate that lesions of this region, but not of regions in the posterolateral striato-pallidum, abolish the attraction of female mice for male chemosignals, without affecting significantly their preference for a different natural reward (a sucrose solution). These results show that, at least in female mice, the integrity of the anterior aspect of the medioventral striato-pallidum, comprising a portion of the olfactory tubercle and associated islands of Calleja, is necessary for the attraction for male chemosignals. We suggest that this region contributes to the processing of the hedonic properties of biologically significant odorants.

  19. Corticospinal Tract Compression by Hematoma in a Patient with Intracerebral Hemorrhage: A Diffusion Tensor Tractography and Functional MRI Study

    Science.gov (United States)

    Jang, Sung-Ho; Lee, Mi Young; Ahn, Sang Ho; Kim, Joong Hwi; Jeong, Dong-Hoon; Choi, Byung Yeun; Lee, Dong Gyu

    2006-01-01

    The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract. PMID:16502496

  20. Reconstruction of bone defect with autograft fibula and retained part of tibia after marginal resection of periosteal osteosarcoma: a case report.

    Science.gov (United States)

    Hu, Tongyu; Chen, Wei; Li, Jianheng; Du, Chenguang; Zhang, Yingze

    2015-06-18

    Periosteal osteosarcoma is a rare subtype of osteosarcoma. Wide surgical removal is the commonly used treatment-method algorithm. However, the limb-salvage procedure of periosteal osteosarcoma in the distal tibia is a technical challenge to orthopedic surgeons because of the scarcity of soft tissue and subcutaneous nature in the anteromedial aspect. We encountered a 16-year-old female patient with periosteal osteosarcoma in the distal half of the left tibia diagnosed preoperatively based upon the CT images and a needle biopsy. A unique identical surgical technique was applied in the case, including marginal resection of the periosteal osteosarcoma with part of the tibia retained at the same level of bone defect and reconstruction using the autologous fibula graft. A combination of cisplatin and doxorubicin was received as chemotherapy after the operation. Postoperative incisional biopsy was performed, and the hematoxylin-eosin-stained results confirmed the diagnosis of periosteal osteosarcoma. The patient was followed up for 11 years. Radiological and clinical evaluation was performed at each follow-up. The retained tibia incorporated well with the fibula autograft, and excellent limb functional recovery was achieved. The patient was free from neoplastic disease at the latest follow-up. In conclusion, young patients with periosteal osteosarcoma without intramedullary involvement can be treated by marginal resection of the lesion with part of the tibia retained at the level of bone defect and reconstructed using a long autologous fibula graft. Subsequent chemotherapy with administration of cisplatin and doxorubicin is recommended.

  1. Subpleural lung cysts in Down syndrome: prevalence and association with coexisting diagnoses

    Energy Technology Data Exchange (ETDEWEB)

    Biko, David M. [Pennsylvania Hospital, Department of Radiology, Philadelphia, PA (United States); Schwartz, Michael; Anupindi, Sudha A. [Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Altes, Talissa A. [Children' s Hospital of Philadelphia, Philadelphia, PA (United States); University of Virginia, Charlottesville, VA (United States)

    2008-03-15

    Although subpleural cysts are known to be associated with Down syndrome, their etiology and prevalence remains unknown. To determine the prevalence of subpleural cysts in children with Down syndrome and the association with prematurity, congenital heart disease (CHD), extracorporeal membrane oxygenation (ECMO), and chronic ventilator support. A review of the CT examinations of 25 children with Down syndrome was performed to determine the presence, location, and distribution of cysts along with associated abnormalities. Charts were reviewed and coexistent diagnoses and past treatments were recorded. The prevalence of subpleural cysts was 36% with no significant association with CHD, ECMO, or chronic ventilator support. An association was found in the two children with a history of prematurity. The cysts were most commonly found in the anteromedial portion of the lung. Subpleural cysts are common in Down syndrome and should not be confused with another pathological process. An association with prematurity was found, but the low number of children in this study makes the connection uncertain. The etiology remains unclear, but it has been hypothesized that the cysts are associated with lung hypoplasia. (orig.)

  2. Re-analysis of the hominid radii from Cave of Hearths and Klasies River Mouth, South Africa.

    Science.gov (United States)

    Pearson, O M; Grine, F E

    1997-06-01

    Two of the few postcranial fragments from the late Early Stone Age and/or the Middle Stone Age of southern Africa are the proximal radii from the Cave of Hearths and Klasies River Mouth. The Cave of Hearths fossil is metrically indistinguishable from both archaic (e.g., Neandertals) and recent humans, and presents a mosaic of primitive and modern features. The primitive include a relatively slender neck and thick cortical bone (the latter of which distinguishes recent humans from archaic, Early Modern, and Upper Paleolithic hominids); the modern includes an anteromedially (rather than medially) facing radial tuberosity. Its extreme collo-diaphyseal angle is unusual, although it can be matched by modern homologues. The neck-shaft angle of some Neandetral and Early Modern radii also appears to match that of the Cave of Hearths specimen. The Klasies River Mouth radius also has thick cortical bone of the neck. It is morphologically indistinguishable from Early Modern and Neandertal homologues. These, and other fossils, suggest a mosaic pattern of evolution in the postcranial skeleton of the late Early Stone Age and/or Middle Stone Age inhabitants of sub-Saharan Africa.

  3. Perinatal development of the mammillothalamic tract and innervation of the anterior thalamic nuclei.

    Science.gov (United States)

    Alpeeva, E V; Makarenko, I G

    2009-01-12

    Axonal projections originating from the mammillary bodies represent important pathways that are essential for spatial information processing. Mammillothalamic tract is one of the main efferent projection systems of the mammillary body belonging to the limbic "Papez circuit". This study was aimed to describe the schedule of the mammillothalamic tract development in the rat using carbocyanine dye tracing. It was shown for the first time that fibers of the mammillothalamic tract being the collaterals of the mammillotegmental tract axons start bifurcating from the mammillotegmental tract on E17. The axons of the mammillothalamic tract grow simultaneously and reach the ventral region of the anterior thalamus where they form first terminal arborizations on E20-E21. Ipsilateral projections from the medial mammillary nucleus to the anteromedial and anteroventral thalamic nuclei develop from E20 to P6. Bilateral projections from the lateral mammillary nucleus to the anterodorsal thalamic nuclei develop later, on P3-P6, after the formation of the thalamic decussation of the mammillary body axons. Unique spatial and temporal pattern of the perinatal development of ascending mammillary body projections to the anterior thalamic nuclei may reflect the importance of these connections within the limbic circuitry.

  4. Panoramic Image of Mandibular Condyle According to Head Position

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Hwa; Choi, Soon Chul [Dept. of Oral Radiology, College of Dentistry, Seoul National, Seoul (Korea, Republic of)

    1990-08-15

    Panoramic radiography is convenient in clinic and visualizes those areas which other technique do not give. But the technique has limitation of image distortion which results from the relationship of the ramus to the focal trough and from the direction of the central ray. This study is, using 7 dry skulls, to determine the effect of rotation of patient's head on reducing those distortion and determine the magnification ratio of images of mandibular condyle in rotated patient head position. The obtained results were as follows: 1. Generally, in panoramic radiography the anterolateral portion of the mandibular condyle was best to be visualized. 2. There are no significant difference between the image readability of anteromedial portion and that of antercentral portion of the mandibular condyle. 3. Anterolateral portion of the mandibular condyle was better visualized in rotated head position by 20 degree or horizontal condylar inclination than in conventional position or in rotated head position by 10 degree. 4. The magnification ratio of the anteroposterior diameter in the image of mandibular condyle was least in the rotated head position by horizontal inclination of the mandibular condyle and was largest by 20 degree.

  5. Load transfer in the proximal tibia following implantation with a unicompartmental knee replacement: a static snapshot.

    Science.gov (United States)

    Simpson, D J; Kendrick, B J L; Dodd, C A F; Price, A J; Gill, H S; Murray, D W

    2011-05-01

    Unicompartmental knee replacement (UKR) is an appealing alternative to total knee replacement when the patient has isolated medial compartment osteoarthritis. A common observation post-operatively is radiolucency between the tibial tray wall and the bone. In addition, some patients complain of persistent pain over the proximal tibia antero-medially; this may be related to elevated bone strains in the tibia. Currently, there is no intentionally made mechanical bond between the vertical wall of an Oxford UKR and the adjacent bone; whether one exists or not will influence the load transmission in the proximal tibia and may affect the elevated tibia strain. The aim of this study was to investigate how introducing a mechanical tie between the tibial tray wall and the adjacent bone might alter the load carried into the tibia for both cemented and cementless UKRs. Strain energy density in the region of bone adjacent to the tray wall was considerably increased when a mechanical tie was introduced; this has the potential of reducing the likelihood of a radiolucency occurring in that region. Moreover, a mechanical tie had the effect of reducing proximal tibia strain, which may decrease the incidence of pain following implantation with a UKR.

  6. Morphological study in internal derangement of the temporomandibular joint with MRI. The relationships between the state of the articular disc and limitation of motion of the mandibular head

    Energy Technology Data Exchange (ETDEWEB)

    Miyazu, Hiroko; Sakurai, Takashi; Numayama, Sukenao; Furuya, Nobuaki; Kashima, Isamu [Kanagawa Dental Coll., Yokosuka (Japan)

    1997-12-01

    In this study, we used MRI to investigate the relationships between these factors in temporomandibular joint (TMJ) patients, especially with regard to the range of condylar movement. Bone configurations and articular disc conditions were analyzed in a total of 367 TMJ of 255 internal derangement patients using MRI. We examined the influence of articular disc condition on functional disorder and identified the tendencies of the pathology of patients with internal derangements. Anterolateral displacement was more frequent than anteromedial displacement, and lateral rotary displacement was more frequent than medial rotary displacement. Therefore, the articular disc displaced more readily laterally, rather than medially. With regard to the relationship between the articular disc configuration and reduction, enlargement of the posterior band and biconvex discs showed a tendency for articular disc displacement that did not reduce, while discs with even thickness showed a tendency of articular disc displacement which would reduce. Folding and biconvexity tended to limit condylar movement while less limitation occurred with discs of even thickness. In cases of disc displacement without reduction, there was a significantly higher percentage of cases with limited condylar movement than in cases of displacement with reduction. (K.H.)

  7. What is the Best Route to the Meckel Cave? Anatomical Comparison between the Endoscopic Endonasal Approach and a Lateral Approach.

    Science.gov (United States)

    Van Rompaey, Jason; Bush, Carrie; Khabbaz, Eyad; Vender, John; Panizza, Ben; Solares, C Arturo

    2013-12-01

    Background Traditionally, a pterional approach is utilized to access the Meckel cave. Depending on the tumor location, extradural dissection of the Gasserian ganglion can be performed. An endoscopic endonasal access could potentially avoid a craniotomy in these cases. Methods We performed an endoscopic endonasal approach as well as a lateral approach to the Meckel cave on six anatomic specimens. To access the Meckel cave endoscopically, a complete sphenoethmoidectomy and maxillary antrostomy followed by a transpterygoid approach was performed. For lateral access, a pterional craniotomy with extradural dissection was performed. Results The endoscopic endonasal approach allowed adequate access to the Gasserian ganglion. All the relevant anatomy was identified without difficulty. Both approaches allowed for a similar exposure, but the endonasal approach avoided brain retraction and improved anteromedial exposure of the Gasserian ganglion. The lateral approach provided improved access posterolaterally and to the superior portion. Conclusion The endoscopic endonasal approach to the Meckel cave is anatomically feasible. The morbidity associated with brain retraction from the open approaches can be avoided. Further understanding of the endoscopic anatomy within this region can facilitate continued advancement in endoscopic endonasal surgery and improvement in the safety and efficacy of these procedures.

  8. Differentiation of sensorimotor neuronal structures responsible for induction of motor evoked potentials, attenuation in detection of somatosensory stimuli, and induction of sensation of movement by mapping of optimal current directions.

    Science.gov (United States)

    Pascual-Leone, A; Cohen, L G; Brasil-Neto, J P; Valls-Solé, J; Hallett, M

    1994-06-01

    Transcranial magnetic stimulation (TMS) of the sensorimotor cortex can evoke motor evoked potentials (MEPs), attenuation in detection of somatosensory stimuli (ADSS), and sensation of movement (SOM) referred to the same body part. In this study we tried to differentiate the substrates responsible for these effects. In 6 normal volunteers, TMS was applied with a nearly monopolar Dantec stimulator and a butterfly coil. Optimal scalp location and current direction were determined for induction of MEPs in abductor pollicis brevis (APB), first dorsal interosseous (FDI), and adductor digiti minimi (ADM); SOM in digits 2 and 5 in an ischemically paralyzed hand; and ADSS applied to digits 2 and 5. All 3 muscles' MEPs and SOM and ADSS in both digits were optimally activated from a single scalp position. In all subjects, optimal current directions for MEPs pointed anteriorly; those for ADSS and SOM pointed posteriorly. Optimal current directions showed the same progression in all subjects for MEPs (ADM, FDI, and APB from antero-lateral to antero-medial), ADSS (digit 5 postero-medial, 2 postero-lateral), and SOM (digit 1 through 5 postero-lateral to postero-medial). We conclude that neuronal networks targeting corticospinal neurons responsible for MEPs are different from those leading to SOM and ADSS (which could not be differentiated).

  9. Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5-S1 through a Unilateral Approach: Technical Feasibility and Outcomes

    Directory of Open Access Journals (Sweden)

    Won-Suh Choi

    2016-01-01

    Full Text Available Background. Minimally invasive spinal transforaminal lumbar interbody fusion (MIS-TLIF at L5-S1 is technically more demanding than it is at other levels because of the anatomical and biomechanical traits. Objective. To determine the clinical and radiological outcomes of MIS-TLIF for treatment of single-level spinal stenosis low-grade isthmic or degenerative spondylolisthesis at L5-S1. Methods. Radiological data and electronic medical records of patients who underwent MIS-TLIF between May 2012 and December 2014 were reviewed. Fusion rate, cage position, disc height (DH, disc angle (DA, disc slope angle, segmental lordotic angle (SLA, lumbar lordotic angle (LLA, and pelvic parameters were assessed. For functional assessment, the visual analogue scale (VAS, Oswestry disability index (ODI, and patient satisfaction rate (PSR were utilized. Results. A total of 21 levels in 21 patients were studied. DH, DA, SLA, and LLA had increased from their preoperative measures at the final follow-up. Fusion rate was 86.7% (18/21 at 12 months’ follow-up. The most common cage position was anteromedial (15/21. The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up. PSR was 88%. Cage subsidence was observed in 33.3% (7/21. Conclusions. The clinical and radiologic outcomes after MIS-TLIF at L5-S1 in patients with spinal stenosis or spondylolisthesis are generally favorable.

  10. The SIGN nail for knee fusion: technique and clinical results

    Directory of Open Access Journals (Sweden)

    Anderson Duane Ray

    2016-01-01

    Full Text Available Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males with an average age of 30.5 years (range, 18–50 years underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months. Diagnoses included tuberculosis (two knees, congenital knee dislocation in two knees (one patient, bacterial septic arthritis (one knee, malunited spontaneous fusion (one knee, and severe gout with 90° flexion contracture (one knee. The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options.

  11. MRI pattern of infarcts in basal ganglia region in patients with tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Nair, P.P.; Kalita, J.; Misra, U.K. [Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Neurology, Lucknow (India); Kumar, S. [Sanjay Gandhi Postgraduate Institute of Medical sciences, Department of Radiology, Lucknow (India)

    2009-04-15

    This study aimed to evaluate the pattern of infarct in basal ganglia region in tuberculous meningitis (TBM) and ischemic strokes and its sensitivity and specificity in the diagnosis of these disorders. Patients with TBM and ischemic strokes in basal ganglia region were retrospectively evaluated from our tuberculous meningitis and ischemic stroke registry. Magnetic resonance imaging findings were grouped into anterior (caudate, genu, anterior limb of internal capsule, anteromedial thalamus) and posterior (lentiform nuclei, posterior limb of internal capsule, posterolateral thalamus). The sensitivity and specificity of these patterns in diagnosing TBM and ischemic stroke were evaluated. There were 24 patients in each group. Infarct in TBM was purely anterior in eight patients and in ischemic stroke purely posterior in 18 patients. The frequency of caudate infarct was significantly higher in TBM compared to ischemic stroke (37.5% vs 8.3%). In TBM patients, purely posterior infarcts were present in seven patients; three had associated risk factors of ischemic stroke. The sensitivity of pure anterior infarct in the diagnosis of TBM was 33%, specificity 91.66%. For ischemic stroke, the sensitivity of posterior infarct was 75% and specificity 70.83%. TBM patients having infarcts in posterior region should be looked for associated risk factors of ischemic stroke. (orig.)

  12. MRI of double-bundle ACL reconstruction: evaluation of graft findings

    Energy Technology Data Exchange (ETDEWEB)

    Kiekara, Tommi; Paakkala, Antti [Tampere University Hospital, Medical Imaging Centre, Tampere (Finland); Jaervelae, Timo [Sports Clinic and Hospital Mehilaeinen, Tampere (Finland); Huhtala, Heini [University of Tampere, School of Health Sciences, Tampere (Finland)

    2012-07-15

    To demonstrate the magnetic resonance imaging (MRI) findings of double-bundle (DB) anterior cruciate ligament (ACL) reconstruction grafts. Sixty-six patients with DB ACL reconstruction were evaluated with MRI 2 years postoperatively. Graft thickness was measured separately by two musculoskeletal radiologists. The MRI findings of graft disruption, signal intensity (SI) changes, cystic degeneration, arthrofibrosis, and impingement were analyzed. The statistical significance of the association between MRI findings was calculated. The mean anteromedial (AM) graft thickness was reduced 9% and the mean posterolateral (PL) graft thickness was reduced 18% from the original graft thickness. Disruption was seen in 3% of AM grafts and 6% of PL grafts and a partial tear in 8 and 23%, respectively. Both grafts were disrupted in 3% of patients. Increased SI was seen in 14% of intact AM grafts and in 60% of partially torn AM grafts (p = 0.032). In PL grafts the increased SI was seen in 51% of the intact grafts and in 93% of the partially torn grafts (p = 0.005). Cystic degeneration was seen in 8% of AM grafts and in 5% of PL grafts. Diffuse arthrofibrosis was seen in 5% of patients and a localized cyclops lesion in 3% of patients. Impingement of the AM graft was seen in 8% of patients. Both grafts were disrupted in 3% of patients. Also, the frequencies of other complications were low. The use of orthogonal sequences in the evaluation of the PL graft SI seems to cause volume-averaging artefacts. (orig.)

  13. Finite element study on the anatomic transtibial technique for single-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Bae, Ji Yong; Kim, Geon-Hee; Seon, Jong Keun; Jeon, Insu

    2016-05-01

    The anatomic transtibial (TT) technique is proposed as a new approach for single-bundle anterior cruciate ligament (ACL) reconstruction. Geometric models of the anatomic TT and anteromedial (AM) portal techniques were fabricated with a reconstructed knee joint model and virtual surgical operations. Grafts of 7 mm diameter were modeled and inserted into tunnels drilled in each model. In the models, the shape of the graft between the femur and the tibia, the lengths of the bone tunnels, and the femoral graft bending angles were evaluated. To evaluate the biomechanical effects of both techniques on the grafts, the contact pressures and maximum principal stresses in the grafts were calculated using the finite element method. The anatomic TT technique placed the femoral tunnel to the anatomic position of the native ACL femoral attachment site. In addition, it decreased the peak contact pressure and the maximum principal stress at the full extension position of the graft compared with the AM portal technique. The anatomic TT technique may be regarded as a superior surgical technique compared with the conventional TT and AM portal techniques. Because of the easy surgical operation involved, the technique decreases the operation time for ACL reconstruction and it provides a deformation behavior of grafts similar to that in the native ACL in a knee joint. With its few side effects, the anatomic TT technique may considerably help patients.

  14. Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report

    Directory of Open Access Journals (Sweden)

    George Paraskevas

    2016-11-01

    Full Text Available Objective. In the current study a brief review is presented of the coracobrachialis muscle’s morphological variability, action, embryological development and clinical significance. Case report. We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. Conclusion. Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects.

  15. Reward, motivation, and emotion systems associated with early-stage intense romantic love.

    Science.gov (United States)

    Aron, Arthur; Fisher, Helen; Mashek, Debra J; Strong, Greg; Li, Haifang; Brown, Lucy L

    2005-07-01

    Early-stage romantic love can induce euphoria, is a cross-cultural phenomenon, and is possibly a developed form of a mammalian drive to pursue preferred mates. It has an important influence on social behaviors that have reproductive and genetic consequences. To determine which reward and motivation systems may be involved, we used functional magnetic resonance imaging and studied 10 women and 7 men who were intensely "in love" from 1 to 17 mo. Participants alternately viewed a photograph of their beloved and a photograph of a familiar individual, interspersed with a distraction-attention task. Group activation specific to the beloved under the two control conditions occurred in dopamine-rich areas associated with mammalian reward and motivation, namely the right ventral tegmental area and the right postero-dorsal body and medial caudate nucleus. Activation in the left ventral tegmental area was correlated with facial attractiveness scores. Activation in the right anteromedial caudate was correlated with questionnaire scores that quantified intensity of romantic passion. In the left insula-putamen-globus pallidus, activation correlated with trait affect intensity. The results suggest that romantic love uses subcortical reward and motivation systems to focus on a specific individual, that limbic cortical regions process individual emotion factors, and that there is localization heterogeneity for reward functions in the human brain.

  16. Combined Isolated Laugier’s Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Directory of Open Access Journals (Sweden)

    Walid Osman

    2016-01-01

    Full Text Available Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

  17. Capsular attachment of the brachialis muscle (Portal's muscle): an anatomical and functional study.

    Science.gov (United States)

    Tubbs, R Shane; Yablick, Michael W; Loukas, Marios; Shoja, Mohammadali M; Ardalan, Mohammad; Oakes, W Jerry

    2008-05-01

    There is a paucity of information regarding the detailed anatomy of the capsular part of the brachialis muscle in the extant literature. Our current study seeks to further elucidate the presence, morphology, and potential function of this muscle. Thirty-six cadaveric upper extremities underwent dissection of their anterior elbow joint capsule with special attention to any fibers attaching onto it from the brachialis muscle. We found that the majority of fibers of the brachialis simply passed superficial to the anterior elbow joint capsule. The highest concentration of fibers was noted to be onto the anteromedial joint capsule via connective tissue and not direct muscle attachment. No specimen was found to have a distinct muscle belly associated with these connections to the joint capsule. On all sides, such fibers were simply deeper attachments of the brachialis muscle. Following tension on these deeper fibers, retraction of the joint capsule was not noted. We would speculate, based on our study, that these fibers of the brachialis do not represent a separate muscle per se and do not retract the anterior elbow joint capsule with flexion of the forearm as has been theorized. These data may be of use to surgeons who operate this region so that attention to preservation of such fibers may be of less importance.

  18. Normal and shear stresses on a residual limb in a prosthetic socket during ambulation: comparison of finite element results with experimental measurements.

    Science.gov (United States)

    Sanders, J E; Daly, C H

    1993-01-01

    Interface stresses on a below-knee amputee residual limb during the stance phase of gait calculated using an analytical finite element model were compared with experimental interface stress measurements. The model was quasi-static and linear. Qualitatively, shapes of analytical and experimental interface stress waveforms were similar in that they were double-peaked with some distinct features apparent. However, quantitatively analytical resultant shear stress magnitudes were less than experimental values at all transducer measurement sites. Analytical normal stresses were less than experimental values at postero-proximal, postero-distal, and anteromedial proximal sites, but were greater than experimental values at antero-lateral distal and antero-lateral proximal sites. Anterior resultant shear angles were directed more distally in the model than in clinical data, an expected result since there was no relief for the tibial crest in the model. Model sensitivity analyses to shank loads showed interface normal and resultant shear stresses were most sensitive to axial force, sagittal bending moment, or sagittal shear force. The finite element model presented in this paper is significant because it contributes toward development of an analytical modeling technique to predict interface stress distributions for proposed prosthetic designs, provides insight into physical explanations of features apparent in interface stress waveforms (thereby enhancing understanding of interface mechanics), and provides insight into nonlinear characteristics that need to be added to improve the model.

  19. Anatomical study of the positioning of guide wires for the reconstruction of the two bands of the anterior cruciate ligament using transtibial technique Estudo anatômico do posicionamento dos fios-guia para a reconstrução das duas bandas do ligamento cruzado anterior pela técnica transtibial

    Directory of Open Access Journals (Sweden)

    Christiano Saliba Uliana

    2012-05-01

    Full Text Available PURPOSE: To determine whether it is possible and the difficulty of anatomical placement of guide wires for reconstruction of the two bands of the anterior cruciate ligament using transtibial technique and to measure the angle and positioning of the anatomic tibial guide wires for this technique. METHODS: Ten cadaver knees were dissected and a guide wire was positioned in the center of origin and insertion of each band. Were collected measurements of the distance from: 1 the entry point of the guide wire on tibial tuberosity; 2 the medial end of the tibia; 3 the tibial articular surface. Were also measured the medial and caudal angles of the guide wires. RESULTS: For the anteromedial band the medial angle was 19±5º and the caudal was 44±4º.The distances were 20±2 mm from anterior tuberosity, 26±5 mm from the tibial plateau and 25±5 mm from the medial end of the tibia. For the posterolateral band the medial angle was 26±5º and the caudal one was 36±8°. The distances were 31±6 mm for the anterior tuberosity, 24±4 mm for the tibial plateau and 17±7 mm from the end of the tibia. CONCLUSIONS: It is possible to position the guide wires of the two bands to reconstruct the anterior cruciate ligament using transtibial technique. The parameters for the proper positioning of the guide wire from anteromedial band is caudal angle of 44º with entry point 20 mm from anterior tuberosity; for the posterolateral band the caudal angle is 36º; from the tibial tuberosity the distance is 31 mm. This technique is difficult to perform leaving its questionable reproducibility.OBJETIVOS: Determinar se é possível o posicionamento anatômico dos fios-guia para reconstrução das duas bandas do ligamento cruzado anterior pela técnica transtibial, sua dificuldade técnica e medir o posicionamento angular dos parâmetros anatômicos dos fios-guia tibiais para esta técnica. MÉTODOS: Dez joelhos de cadáveres foram dissecados e um fio guia foi posicionado no

  20. Combined Isolated Laugier's Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Science.gov (United States)

    Osman, Walid; Alaya, Zeineb; Naouar, Nader; Ben Ayeche, Mohamed

    2016-01-01

    Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes. PMID:28070435

  1. Topography and areal organization of mouse visual cortex.

    Science.gov (United States)

    Garrett, Marina E; Nauhaus, Ian; Marshel, James H; Callaway, Edward M

    2014-09-10

    To guide future experiments aimed at understanding the mouse visual system, it is essential that we have a solid handle on the global topography of visual cortical areas. Ideally, the method used to measure cortical topography is objective, robust, and simple enough to guide subsequent targeting of visual areas in each subject. We developed an automated method that uses retinotopic maps of mouse visual cortex obtained with intrinsic signal imaging (Schuett et al., 2002; Kalatsky and Stryker, 2003; Marshel et al., 2011) and applies an algorithm to automatically identify cortical regions that satisfy a set of quantifiable criteria for what constitutes a visual area. This approach facilitated detailed parcellation of mouse visual cortex, delineating nine known areas (primary visual cortex, lateromedial area, anterolateral area, rostrolateral area, anteromedial area, posteromedial area, laterointermediate area, posterior area, and postrhinal area), and revealing two additional areas that have not been previously described as visuotopically mapped in mice (laterolateral anterior area and medial area). Using the topographic maps and defined area boundaries from each animal, we characterized several features of map organization, including variability in area position, area size, visual field coverage, and cortical magnification. We demonstrate that higher areas in mice often have representations that are incomplete or biased toward particular regions of visual space, suggestive of specializations for processing specific types of information about the environment. This work provides a comprehensive description of mouse visuotopic organization and describes essential tools for accurate functional localization of visual areas.

  2. Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report.

    Science.gov (United States)

    Simpson, Brad G; Simon, Corey B

    2014-05-01

    A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain.

  3. Accessory brachialis muscle associated with high division of brachial artery

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    Krishnamurthy A

    2010-10-01

    Full Text Available During routine dissection for the undergraduate students in the Department of Anatomy, Kasturba Medical College, Mangalore, of a male cadaver aged 73 years, we encountered an additional slip of brachialis muscle taking origin in the flexor compartment of left arm and inserting into the forearm. The origin of the additional muscle belly was from the anteromedial surface of shaft and medial supracondylar ridge of lower end of humerus. The additional muscle slip merged with the tendon of pronator teres before inserting on the lateral surface of the shaft of radius. The median nerve pierced the muscle at a distance of 6 cm from the medial epicondyle of humerus, supplied it and had a routine course later. Associated with the muscular abnormality was the high division of brachial artery into radial and ulnar arteries 17.5 cm from the medial epicondyle. The ulnar artery passed beneath the accessory brachialis muscle along with the median nerve. The role of additional muscles in compression syndrome is a well known phenomenon. The altered anatomy of the blood vessels may make them more vulnerable to trauma and to hemorrhage but at the same time more accessible for cannulation. Medical fraternity including orthopedicians and neurologists need to be aware of such variations when dealing with upper limb injuries or operations around the elbow joint.

  4. A CASE REPORT OF MULTIPLE ARTERIAL ANOMALIES IN A CADAVE R

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    Anbumani

    2015-03-01

    Full Text Available During routine dissection in our department, multiple arterial variations were observed in a cadaver. The following arterial variations are present. They are, superficial brachioulnar artery, which originated at the level of junction of upper and middle th ird of arm. It runs a superficial course anterior to median nerve in the arm and terminates in the formation of superficial palmar arch. The brachial artery terminated as radial and common interosseous artery. Subscapular artery and circumflex humeral arte ry arose as a common trunk from the third part of axillary artery. The circumflex humeral artery later divides into anterior circumflex humeral and posterior circumflex humeral arteries. The right common carotid artery bifurcated into internal carotid arte ry anteromedially and external carotid artery posterolaterally at the level of upper lamin a of th yroid cartilage. A proper knowledge of variations in the arterial pattern is a must for a good treatment outcome, especially in the fields like vascular surge ry, reconstructive surgery, cardiac surgery, angiogram, arterial cannulation, arterio - venous fistula for renal dialysis. etc.

  5. A pattern formed by preferential orientation of tangential fibres in layer I of the rabbit's cerebral cortex.

    Science.gov (United States)

    Fleischhauer, K; Laube, A

    1977-12-01

    1. The tangential organization of layer I has been studied in frozen sections impregnated according to a modified Liesegang method and in Bodian impregnated paraffin sections cut tangentially to the dorsal surface of the rabbit's cerebral cortex. 2. It is shown that sublamina tangentialis of layer I contains a system of parallel nerve fibres forming a distinct pattern in the tangential plane. 3. This pattern has been reconstructed for a large region of the dorsal surface of the cerebral cortex including the striate areas as well as the peristriate, parietal and precentral agranular regions and parts of the retrosplenial area. 4. In most parts of the region investigated, the tangential fibres of layer I are oriented in an antero-medial to postero-lateral direction, forming an angle of about 50 degrees with the sagittal plane. 5. Deviations from this pattern are found in the furrows formed by the lateral sulcus and the frontal impression and also in the caudal part of the retrosplenial area. In these regions, which are characterized by comparatively steep changes of the cortical relief, the fibres course in a more sagittal direction.

  6. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity.

    Science.gov (United States)

    Guardamagna, Luca; Seedhom, Bahaa B; Ostell, Alistair E

    2004-01-01

    In this study, the anterior laxity and internal rotation of five cadaveric knee joints were compared when the anterior cruciate ligament (ACL) was intact, after its reconstruction with the anteromedial band (AMB) only, then after its reconstruction with the double band, with the posterolateral band (PLB) tensioned first at 20 degrees and then at 90 degrees, and finally with the ACL resected. The tests were performed using a mechanical apparatus that allowed the joint 6 degrees of freedom and also the application of external loads and torques on the tibia. The loads used were 50, 90, and 130 N for the anterior laxity test, and a torque of 2, 3, and 4 Nm in the internal rotation test. In all cases, laxity with double-band reconstruction was closer to the natural value than when it was constructed with the AMB only. In some cases, double-band reconstruction imposed a higher constraint on the joint than did the natural ACL. Measurement of the residual tension on the PLB after its final anchoring was also performed during passive flexion. This test revealed a high tension on this band with the knee in hyperextension, followed by a decrease in value through to 45 degrees and a slight increase at 90 degrees, thus following a similar trend to that of the natural PLB.

  7. Asymmetric class III malocclusion: association with cranial base deformation and occult torticollis.

    Science.gov (United States)

    Yuan, Joyce T; Teng, Edward; Heller, Justin B; Kawamoto, Henry K; Bradley, James P

    2012-09-01

    The etiology of Angle class III malocclusion with facial asymmetry has not been fully elucidated. To investigate the etiology, patients with asymmetric prognathism (n = 30) from a single institution were assessed for previously undiagnosed torticollis and cranial base asymmetry. Presence of torticollis was determined by measuring restricted head movement when turning the head against a wall and cranial base tilt with upward gaze. Cranial base asymmetry was evaluated by preoperative three-dimensional computed tomography scans. Thirty-one percent of patients with prognathism presented with concurrent facial asymmetry. In patients with asymmetric prognathism, cranial base tilt was present on upward gaze in all patients; mean angle between head and wall was 31 degrees greater than that in control patients, and a 22% to 36% difference in the angle was present when comparing one side with the other. Based on these findings, all patients with asymmetric prognathism were found to be affected by torticollis. By computed tomography scan, 85% of these torticollis patients showed slight anteromedial displacement of the glenoid fossa ipsilateral to torticollis, and 73% demonstrated temporal fossa shift of 4 mm or greater. The current study demonstrates a strong association between asymmetric class III malocclusion, torticollis, and cranial base asymmetry. We conclude that undiagnosed torticollis is a likely etiology for otherwise idiopathic cranial base asymmetry and that cranial base asymmetry in turn causes facial asymmetry and malocclusion. This study highlights the importance of evaluating cranial base asymmetry and torticollis in patients with class III malocclusion to allow for earlier treatment and improved outcomes.

  8. A new species of the genus Amolops (Amphibia: Ranidae) from southeastern Tibet, China.

    Science.gov (United States)

    Jiang, Ke; Wang, Kai; Yan, Fang; Xie, Jiang; Zou, Da-Hu; Liu, Wu-Lin; Jiang, Jian-Ping; Li, Cheng; Che, Jing

    2016-01-18

    A new species of the genus Amolops Cope, 1865 is described from Nyingchi, southeastern Tibet, China, based on morphological and molecular data. The new species, Amolops nyingchiensis sp. nov. is assigned to the Amolops monticola group based on its skin smooth, dorsolateral fold distinct, lateral side of head black, upper lip stripe white extending to the shoulder. Amolops nyingchiensis sp. nov. is distinguished from all other species of Amolops by the following combination of characters: (1) medium body size, SVL 48.5-58.3 mm in males, and 57.6-70.7 mm in females; (2) tympanum distinct, slightly larger than one third of the eye diameter; (3) a small tooth-like projection on anteromedial edge of mandible; (4) the absence of white spine on dorsal surface of body; (5) the presence of circummarginal groove on all fingers; (6) the presence of vomerine teeth; (7) background coloration of dorsal surface brown, lateral body gray with yellow; (8) the presence of transverse bands on the dorsal limbs; (9) the presence of nuptial pad on the first finger in males; (10) the absence of vocal sac in males. Taxonomic status of the populations that were previously identified to A. monticola from Tibet is also discussed.

  9. Management of medial compartment knee arthritis with unicompartimental arthroplasty: our experience

    Science.gov (United States)

    Ramos, Pablo; Arteaga, Gonzalo; Vargas, Medardo

    2017-01-01

    Objectives: the purpose of this presentation is to review the indications and benefits for the use of the Unicompartimental Knee Arthroplasty (UKA) for the treatment of the anteromedial osteoarthritis of the knee, and to make an early report of our series. Methods: 37 UKA were performed by our group between 2013 y 2016, as a first experience, with 22 male patients and 15 females. The limit ages were 28 and 85 years. All received a Vangard PFR System (Zimmer Biomet Warsaw In). Results: All the patients reported a better life quality, and the main difference that we noticed is the subjective feeling that the operated knee felt “like own” by the patients, which is consistent with the fact that the ligaments were intact, even in the 6 cases where we performed an ACL reconstruction, (although we know that the stable knee is a known prerequisite for this kind of surgery). Conclusion: The unicondilar knee replacement is a technically demanding procedure that requires a careful patient selection and a steep learning curve, but even in this short series, we agree with most of the recent papers that state the benefits of the UKA, and we are looking to start a prospective series of cases to evaluate the outcomes with functional scores.

  10. The Effects of Plyometric Type Neuromuscular Training on Postural Control Performance of Male Team Basketball Players.

    Science.gov (United States)

    Asadi, Abbas; Saez de Villarreal, Eduardo; Arazi, Hamid

    2015-07-01

    Anterior cruciate ligament injuries are common in basketball athletes; common preventive programs for decreasing these injures may be enhancing postural control (PC) or balance with plyometric training. This study investigated the efficiency of plyometric training program within basketball practice to improve PC performance in young basketball players. Sixteen players were recruited and assigned either to a plyometric + basketball training group (PT) or basketball training group (BT). All players trained twice per week, but the PT + BT followed a 6-week plyometric program implemented within basketball practice, whereas the BT followed regular practice. The star excursion balance test (SEBT) at 8 directions (anterior, A; anteromedial, AM; anterolateral, AL; medial, M; lateral, L; posterior, P; posteromedial, PM; and posterolateral, PL) was measured before and after the 6-week period. The PT group induced significant improvement (p ≤ 0.05) and small to moderate effect size in the SEBT (A = 0.95, AM = 0.62, AL = 0.61, M = 0.36, L = 0.47, P = 0.27, PM = 0.25, PL = 0.24). No significant improvements were found in the BT group. Also, there were significant differences between groups in all directions except PM and PL. An integrated plyometric program within the regular basketball practice can lead to significant improvements in SEBT and consequently PC. It can be recommended that strength and conditioning professionals use PT to enhance the athletes' joint awareness and PC to reduce possible future injuries in the lower extremity.

  11. Association of different uncus lesions on magnetic resonance imaging with epilepsy

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    Bilge Öztoprak

    2016-09-01

    Full Text Available SUMMARY Objective: Uncus is the hook-like most anteromedial portion of the parahippocampal gyrus and is a part of the limbic system. It is the only gyrus, together with the amygdala, that contains nuclei and is associated with seizures accompanied by olfactory hallucinations. The aim of this study is to examine the relationship between different uncus lesions detected by magnetic resonance imaging (MRI and epilepsy/seizures. Method: 33 patients with unilateral or bilateral uncus lesions on MRI obtained between March 2008 through May 2014 were enrolled in the study. MR images and clinical charts of patients were retrospectively investigated for MRI findings and presence of epilepsy/seizures. Results: Bilateral uncus involvement was observed in herpes encephalitis (n=5, autoimmune limbic encephalitis (n=2, mesial temporal sclerosis (n=3, metastasis (n=1 and Rasmussen encephalitis (n=1, whereas unilateral involvement of the uncus was seen in glial tumors (n=4, metastases (n=4, mesial temporal sclerosis (n=4, cavernous angioma (n=2, dysembryoplastic neuroepithelial tumor (DNET, n=5, herpes encephalitis (n=1, and autoimmune limbic encephalitis (n=1. Epilepsy/seizures were present in two-thirds of patients. However, none of the 5 patients with a metastatic uncus lesion showed epilepsy/seizures. Conclusions: Many uncus pathologies can be detected by MRI and most of them are associated with epilepsy. Keywords: Epilepsy, Hippocampus; Magnetic resonance imaging; Uncus; Uncinate gyrus

  12. Difficulties encountered in preauricular approach over retromandibular approach in condylar fracture

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    Perumal Jayavelu

    2016-01-01

    Full Text Available Fracture of mandible can be classified according to its anatomical location, in which condylar fracture is the most common one overall and is missed on clinical examination. Due to the unique geometry of the mandible and temporomandibular joint, without treatment the fractures can result in marked pain, dysfunction, and deformity. The condylar fracture may be further classified depending on the sides involved: unilateral/bilateral, depending on the height of fracture: intracapsular (within the head of condyle, extracapsular - head and neck (high condyle fracture, and subcondylar (low condyle fracture, and depending on displacement: nondisplaced, displaced (anteromedially, medially, and lateral, and dislocated. The clinical features include swelling and tenderness over the temporomandibular joint region, restricted mouth opening, and anterior open bite. A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery at Madha Dental College and Hospital; suffered fall trauma resulting in bilateral condyle fracture, dentoalveolar fracture in mandible with restricted mouth opening, and anterior open bite.

  13. The effect of variable rest intervals and chronic ankle instability on triplanar ankle motion during performance of the Star Excursion Balance Test.

    Science.gov (United States)

    Kwon, Yong Ung; Blaise Williams, D S

    2017-02-12

    Inadequate rest intervals may contribute to impaired performance during functional tests. However, the effect of different rest intervals on performance of the SEBT in individuals with and without CAI is not known. Our purposes were to determine whether different rest intervals impact ankle kinematics during the SEBT and whether there differences between those two populations. 24 controls and 24 CAI completed 3 trials in 3 reach directions (anteromedial; AM, medial; M, posteromedial; PM). The order of rest intervals and reach distance were randomized and counterbalanced. Three visits were required to complete the 3 rest interval conditions (10, 20, 40s). Rest interval did not impact ankle kinematics between controls and CAI during the SEBT. Dorsiflexion (DF) (AM:partial η(2)=0.18; M:partial η(2)=0.23; PM:partial η(2)=0.23) for all directions and tibial internal rotation (TIR) excursions (AM:partial η(2)=0.20) for AM direction were greater in individuals with CAI regardless of rest interval length. Rest intervals ranging from 10 to 40s did not influence ankle kinematics. Differences exist in DF and TIR between controls and CAI during the SEBT. These findings suggest that clinicians can use any rest interval between 10 and 40s when administrating the SEBT. However, triplanar motion differs during a complex functional movement in controls compared to CAI.

  14. False positives to confusable objects predict medial temporal lobe atrophy.

    Science.gov (United States)

    Kivisaari, Sasa L; Monsch, Andreas U; Taylor, Kirsten I

    2013-09-01

    Animal models agree that the perirhinal cortex plays a critical role in object recognition memory, but qualitative aspects of this mnemonic function are still debated. A recent model claims that the perirhinal cortex is required to recognize the novelty of confusable distractor stimuli, and that damage here results in an increased propensity to judge confusable novel objects as familiar (i.e., false positives). We tested this model in healthy participants and patients with varying degrees of perirhinal cortex damage, i.e., amnestic mild cognitive impairment and very early Alzheimer's disease (AD), with a recognition memory task with confusable and less confusable realistic object pictures, and from whom we acquired high-resolution anatomic MRI scans. Logistic mixed-model behavioral analyses revealed that both patient groups committed more false positives with confusable than less confusable distractors, whereas healthy participants performed comparably in both conditions. A voxel-based morphometry analysis demonstrated that this effect was associated with atrophy of the anteromedial temporal lobe, including the perirhinal cortex. These findings suggest that also the human perirhinal cortex recognizes the novelty of confusable objects, consistent with its border position between the hierarchical visual object processing and medial temporal lobe memory systems, and explains why AD patients exhibit a heightened propensity to commit false positive responses with inherently confusable stimuli.

  15. The Anterior Thalamus Provides A Subcortical Circuit Supporting Memory And Spatial Navigation

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    Shane M O‘Mara

    2013-08-01

    Full Text Available The anterior thalamic nuclei, a central component of Papez’ circuit, are generally assumed to be key constituents of the neural circuits responsible for certain categories of learning and memory. Supporting evidence for this contention is that damage to either of two brain regions, the medial temporal lobe and the medial diencephalon, is most consistently associated with anterograde amnesia. Within these respective regions, the hippocampal formation and the anterior thalamic nuclei (anteromedial, anteroventral, anterodorsal are the particular structures of interest. The extensive direct and indirect hippocampal-anterior thalamic interconnections and the presence of theta-modulated cells in both sites further support the hypothesis that these structures constitute a neuronal network crucial for memory and cognition. The major tool in understanding how the brain processes information is the analysis of neuronal output at each hierarchical level along the pathway of signal propagation coupled with neuroanatomical studies. Here, we discuss the electrophysiological properties of cells in the anterior thalamic nuclei with an emphasis on their role in spatial navigation. In addition, we describe neuroanatomical and functional relationships between the anterior thalamic nuclei and hippocampal formation.

  16. The anterior thalamus provides a subcortical circuit supporting memory and spatial navigation.

    Science.gov (United States)

    Jankowski, Maciej M; Ronnqvist, Kim C; Tsanov, Marian; Vann, Seralynne D; Wright, Nicholas F; Erichsen, Jonathan T; Aggleton, John P; O'Mara, Shane M

    2013-08-30

    The anterior thalamic nuclei (ATN), a central component of Papez' circuit, are generally assumed to be key constituents of the neural circuits responsible for certain categories of learning and memory. Supporting evidence for this contention is that damage to either of two brain regions, the medial temporal lobe and the medial diencephalon, is most consistently associated with anterograde amnesia. Within these respective regions, the hippocampal formation and the ATN (anteromedial, anteroventral, and anterodorsal) are the particular structures of interest. The extensive direct and indirect hippocampal-anterior thalamic interconnections and the presence of theta-modulated cells in both sites further support the hypothesis that these structures constitute a neuronal network crucial for memory and cognition. The major tool in understanding how the brain processes information is the analysis of neuronal output at each hierarchical level along the pathway of signal propagation coupled with neuroanatomical studies. Here, we discuss the electrophysiological properties of cells in the ATN with an emphasis on their role in spatial navigation. In addition, we describe neuroanatomical and functional relationships between the ATN and hippocampal formation.

  17. Four-headed biceps brachii muscle with variant course of musculocutaneous nerve: anatomical and clinical insight

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    Aggarwal A

    2009-10-01

    Full Text Available A rare case of four-headed biceps brachii muscle with variation in the course of musculocutaneous nerve was observed in left arm of a 48-year-old embalmed male cadaver. One of the extra head (third was fleshy throughout, originated from anteromedial surface of shaft of humerus and merged with the deep surface of short head. Fourth thin tendinous head originated just below lesser tuberosity of humerus and joined with the third head. Both accessory heads were lying under cover of short head of biceps. Musculocutaneous nerve was coursing between two supernumerary heads and subsequently between third head and short head of biceps brachii muscle. Origin of third head from shaft of humerus led to passage of nerve between this head and short head, before acquiring normal position between biceps brachii and brachialis muscles, and emerging out as lateral cutaneous nerve of forearm. Intramuscular course of nerve may be a potential site for nerve compression by hypertrophied biceps associated with strenuous regular physical activity of biceps or weight lifting.

  18. Form and function of the masticatory musculature in the tree sloths, Bradypus and Choloepus.

    Science.gov (United States)

    Naples, V L

    1985-01-01

    The tree sloths, Bradypus and Choloepus, show unusual masticatory specializations, compared to each other and to other mammals. Both have an incomplete zygomatic arch with descending jugal process, a complex superficial masseter, a large temporalis and medial pterygoid musculature, and a lateral pterygoid with two heads. In Choloepus the deep masseter and zygomaticomandibularis are typical when compared to other mammals. However, in Bradypus there is an ascending jugal process from which enlarged and vertically oriented deep masseter and zygomaticomandibularis muscles originate. Although both sloths are folivores, the anterior teeth in Choloepus are caniniform, while those of Bradypus have lost such elongation. In both sloths the glenoid cavity is similarly located; however, in Bradypus the craniomandibular joint is raised above the occlusal plane, and the pterygoid flanges are elongated. Prediction of the evolutionary sequence of cranial changes from Choloepus-like (primitive) to Bradypus-like (derived) morphology is based upon the most parsimonious model of masseter-medial pterygoid complex changes for masticatory efficiency improvement. The model proposes that the condylar neck in Bradypus was elongated and that this single change predicated a series of other structural changes. Mandibular movement patterns in both sloths showed anteromedially directed unilateral power strokes as in other mammals. Puncture-crushing, tooth-sharpening, and chewing cycles are distinct in Choloepus, less so in Bradypus. The masticatory rate is slow in sloths compared to other mammals of similar body size, averaging 590 ms per cycle for Choloepus and 510 ms for Bradypus.

  19. Anatomic assessment of femoral tunnel by transtibial drilling technique in double-bundle anterior cruciate ligament reconstruction: an in vivo study

    Institute of Scientific and Technical Information of China (English)

    XU Hu; ZHANG Chun-li; LI Guang-zheng; WANG Ying-chun; FAN Hong-bin; ZHU Qin-sheng

    2013-01-01

    Objective:To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction.Methods:Two tibial tunnels,anteromedial (AM) and posterolateral (PL),were drilled 45° and 55° to tibial plateau respectively.On the femoral side,the AM and PL tunnels were drilled through anteriomedial portal.After the four tunnels were established,the shaft of a reamer was introduced into the joint through tibial tunnel and reached against the lateral wall of intercondylar notch.The position that the reamer shaft can reach was marked and recorded.Results:Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases.The evaluation through the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached.On the other hand,in 12 cases (24%) the femoral AM tunnel opening and in 10 cases (20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel.Conclusion:The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized.

  20. Value of B-type ultrasound in management of patients sustaining craniocerebral injury in Wenchuan earthquake%B超在地震灾害颅脑损伤中的应用

    Institute of Scientific and Technical Information of China (English)

    刘伦波; 唐运涛; 陈宏刚; 冯爱平; 王双; 梅华; 刘弟模

    2009-01-01

    目的 探讨地震灾害中B超在颅脑损伤术中及术后的应用价值.方法 对于地震灾害中颅脑损伤患者术中急性脑膨出,怀疑有多发性颅内血肿者,应用B型超声仪实时扫查,术后经骨缺损或颅骨钻孔处进行水平、冠状、或滑行扫查.结果 在地震灾害中共进行了58例开颅手术,24例术中进行了B超扫查,不同部位的颅内血肿或积血18例,同侧脑内血肿2例,B超引导下手术清除血肿14例.58例手术患者口术后28例同时进行CT和B超检查,检查结果基本一致.结论 术中B超扫查可以定位多发性颅内血肿,对明确术中急性脑膨出的原因具有重要意义;术后经骨缺损扫查能准确检出迟发性血肿,能快速及时准确的指导医生进行手术,提高救治成功率.%Objective To investigate the value of B-type ultrasound during and after operations in patients sustaining craniocerebral injury in Wenchuan earthquake. Methods The patients with suspected multiple intracranial hematomas due to intraoperative acute encephalocele were referred for B-type ultrasonic examination. After the operation, B-type ultrasonic examination was performed at the cranial defects or the site of cranial drilling by horizontal coronal or sweep scanning. Results Open cranial surgery was performed in 58 cases of craniocerebral injury resulting from the earthquake. Intraoperative B-type ultrasound was used in 24 cases, and intracranial hematomas or hemorrhage in different brain regions were found in 18 cases. Hematomas in the injured hemisphere were found in 2 cases, and ultrasound-guided hematoma clearance was performed in 14 cases. In 28 cases, postoperative B ultrasonic examination was carried out along with CT scanning, and the results demonstrated basic agreement between the two medalities. Conclusions Intraoperative B-type ultrasound may help accurately localize multiple intracranial hematomas and can be crucial to identify the causes of intraoperative acute

  1. Dynamic variation of incidence of neural tube defects during 2002 to 2010 in Shandong province%2002-2010年山东省神经管缺陷发生率的动态变化

    Institute of Scientific and Technical Information of China (English)

    周凤荣; 李舸; 陈志欣; 张蓬; 范媛媛; 郝宝珍

    2012-01-01

    [目的]了解2002-2010年山东省神经管缺陷(neural tube defects,NTDs)发生率的变化趋势,为进一步开展预防工作提供依据. [方法]采用以医院为基础的监测方法收集资料,调查对象为孕28周至生后7d的围产儿,对2002-2010年全省17市出生缺陷监测网监测的642 282例围产儿,242例NTDs病例进行回顾性分析. [结果]NTDs发生率由2002年6.8/万下降到2010年的2.1/万,9年下降了69.1%,年下降率13.7%,农村NTDs下降幅度为75%,城市为61.1%;脊柱裂、脑膨出发生率分别下降了70.8%、80.0%. [结论]山东NTDs发生率呈下降趋势,农村下降幅度大于城市;脊柱裂、脑膨出发生率下降较快,进一步加强预防和产前诊断是降低发生率的有效措施.%[Objective] To study the variation trend in incidence of neural tube defects (NTDs) during 2002 to 2010 in Shandong Province. {Methods] Data were collected by hospital-based monitoring, with women of gestation of 28 weeks to seven days after birth as study subjects. And 642 282 perinates were monitored in the Provincial Birth Defect Monitoring Network in 17 regions all over the province,and 242 cases of NTDs during 2002 to 2010 were recorded and analyzed. [Results] Incidence of NTDs was 2. 1 per 10 000 in 2010,69. 1% reduction from 6. 8 per 10 000 in 2002,and yearly average reduction of 13. 7%. Incidence of NTDs decreased by 61. 1% and 75% in rural and urban areas,respectively,and incidence of spina bifida and encephalocele fell by 70. 8% and 80. 0%,respectively. [Conclusions] Incidence of NTDs showed a falling trend in Shandong province,more decrease in rural areas than in urban areas,and incidences of spina bifida and encephalocele fell faster. Babies with NTDs were in poor birth quality,higher perinatal mortality and poor prognosis. Effective preventive measures and prenatal diagnosis should be strengthened to reduce the occurrences of neural tube defects.

  2. Limb body wall complex or body stalk complex or cyllosomas: a case report

    Directory of Open Access Journals (Sweden)

    S. Saritha

    2013-04-01

    Full Text Available Limb body wall complex (LBWC is also called Body stalk complex and Cyllosomas. We present this rare congenital malformation complex highlighting the importance of early sonographic imaging findings in LBWC along with differentiation from other anterior abdominal wall defects. Limb body wall complex / Body stalk anomaly refers to a rare complicated polymalformative fetal malformation syndrome of uncertain etiology and results in head, heart, lung, diaphragm, kidney or gonadal abnormalities. LBWC was first described by Van Allen et al; in (1987. The two of the three following anomalies must be present to establish the diagnosis: 1. Exencephaly / Encephalocele with facial clefts, 2. Thoraco-Abdominoschisis / ventral body wall defects and 3. Limb defects. LBWC arises as a result of early amnion disruptions or error in embryonic development. If all components of the syndrome are present, the condition is lethal. LBWC is invariably fatal and incompatible with life. No case of postnatal survival is reported so far. Serum alpha-fetoprotein measurement and ultrasonography examination is the key to the prenatal diagnosis and followed by medical termination of pregnancy. It presents two distinct phenotypes described by Russo et al (1993 and later Cusi et al in (1996, according to the foetoplacental relationships: 1. Placento-cranial and 2.Placento-abdominal types. Among the 168 live births at S.V.S. Medical College & hospital Mahabubnagar (INDIA during the period of 2010-2011 we came across an aborted female fetus. It was weighing 1800gms, 30 weeks of gestation diagnosed by antenatal ultrasonography as ventral body wall defect. It was associated with ompholocele, severe scoliosis and limb defects. Its confirmation of the diagnosis of Limb body wall complex with Placento-abdominal type was done by postmortem fetography. [Int J Res Med Sci 2013; 1(2.000: 132-137

  3. The evaluation of cases with pneumothorax in the neonatal intensive care unit

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    Müsemma Karabel

    2013-09-01

    Full Text Available Objectives: Early diagnosis and treatment is essentialin reducing mortality in newborns with pneumothorax. Inthis study, newborns with a diagnosis of pneumothorax inneonatal intensive care unit of our hospital were evaluatedand aimed to increase the awareness of physicians.Methods: 12 cases with pneumothorax were evaluatedretrospectively. The gender, birth weight, gestational age,mode of delivery, the presence of underlying disease,pneumothorax localization, implementation of the surfactantand mechanical ventilation and existence or absenceof mortality were recorded.Results: During the study, pneumothorax was detected12 patients. Male/female ratio was 1.4. Eight of the patientshad born with cesarean delivery, the mean birthweight of cases was 2623±912 g and, 66.7% of caseswere term babies. Pneumothorax was observed in thefirst week of life in all patients and it occurred spontaneouslyin 4 patients. The frequency of bilateral pneumothoraxwas 41.7%. For the treatment, closed tube drainagewas performed in 9 patients. The overall mortality ratewas 66.7%. Half of the patients who died had congenitalanomalies such as diaphragmatic eventration (n=1,hydrocephalus (n=1, encephalocel (n=1, non-immunehydrops fetalis (n=1.Conclusion: Additional congenital anomalies, such asPDAs and persistent pulmonary hypertension were foundto be effective on mortality in neonates with pneumothorax.Although, it is a life-threatening condition, the emergencytreatment is life saving. Therefore, in patients withrisk factors, keeping pneumothorax in mind is also thefirst step of the treatment. J Clin Exp Invest 2013; 4 (3:289-292Key words: Newborn, respiratuar distress, pneumothorax,treatment, outcome

  4. Joubert syndrome: A model for untangling recessive disorders with extreme genetic heterogeneity

    Science.gov (United States)

    R, Bachmann-Gagescu; JC, Dempsey; IG, Phelps; BJ, O’Roak; DM, Knutzen; TC, Rue; GE, Ishak; CR, Isabella; N, Gorden; J, Adkins; EA, Boyle; N, de Lacy; D, O’Day; A, Alswaid; AR, Devi; L, Lingappa; C, Lourenço; L, Martorell; À, Garcia-Cazorla; H, Ozyürek; G, Haliloğlu; B, Tuysuz; M, Topçu; P, Chance; MA, Parisi; I, Glass; J, Shendure; D, Doherty

    2016-01-01

    Background Joubert syndrome (JS) is a recessive neurodevelopmental disorder characterized by hypotonia, ataxia, cognitive impairment, abnormal eye movements, respiratory control disturbances, and a distinctive mid-hindbrain malformation. JS demonstrates substantial phenotypic variability and genetic heterogeneity. This study provides a comprehensive view of the current genetic basis, phenotypic range and gene-phenotype associations in JS. Methods We sequenced 27 JS-associated genes in 440 affected individuals (375 families) from a cohort of 532 individuals (440 families) with JS, using molecular inversion probe-based targeted capture and next generation sequencing. Variant pathogenicity was defined using the Combined Annotation Dependent Depletion (CADD) algorithm with an optimized score cut-off. Results We identified presumed causal variants in 62% of pedigrees, including the first B9D2 mutations associated with JS. 253 different mutations in 23 genes highlight the extreme genetic heterogeneity of JS. Phenotypic analysis revealed that only 34% of individuals have a “pure JS” phenotype. Retinal disease is present in 30% of individuals, renal disease in 25%, coloboma in 17%, polydactyly in 15%, liver fibrosis in 14% and encephalocele in 8%. Loss of CEP290 function is associated with retinal dystrophy, while loss of TMEM67 function is associated with liver fibrosis and coloboma, but we observe no clear-cut distinction between JS-subtypes. Conclusion This work illustrates how combining advanced sequencing techniques with phenotypic data addresses extreme genetic heterogeneity to provide diagnostic and carrier testing, guide medical monitoring for progressive complications, facilitate interpretation of genome-wide sequencing results in individuals with a variety of phenotypes, and enable gene-specific treatments in the future. PMID:26092869

  5. Endoscopic third ventriculostomy

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    Yad Ram Yadav

    2012-01-01

    Full Text Available Endoscopic third ventriculostomy (ETV is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of

  6. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Breysem, L.; Bosmans, H.; Dymarkowski, S.; Demaerel, P.; Vanbeckevoort, D.; Smet, M. [Department of Radiology, University Hospitals, Herestraat 49, 3000, Leuven (Belgium); Schoubroeck, D.Van; Witters, I.; Deprest, J. [Department of Obstetrics and Gynecology, University Hospitals, Herestraat 49, 3000, Leuven (Belgium); Vanhole, C.; Casaer, P. [Department of Pediatrics, University Hospitals, Herestraat 49, 3000, Leuven (Belgium)

    2003-07-01

    The aim of this study was to evaluate the role of MR imaging of the fetus to improve sonographic prenatal diagnosis of congenital anomalies. In 40 fetuses (not consecutive cases) with an abnormality diagnosed with ultrasound, additional MR imaging was performed. The basic sequence was a T2-weighted single-shot half Fourier (HASTE) technique. Head, neck, spinal, thoracic, urogenital, and abdominal fetal pathologies were found. This retrospective, observational study compared MR imaging findings with ultrasonographic findings regarding detection, topography, and etiology of the pathology. The MR findings were evaluated as superior, equal to, or inferior compared with US, in consent with the referring gynecologists. The role of these findings in relation to pregnancy management was studied and compared with postnatal follow-up in 30 of 40 babies. Fetal MRI technique was successful in 36 of 39 examinations and provided additional information in 21 of 40 fetuses (one twin pregnancy with two members to evaluate). More precise anatomy and location of fetal pathology (20 of 40 cases) and additional etiologic information (8 of 40 cases) were substantial advantages in cerebrospinal abnormalities [ventriculomegaly, encephalocele, vein of Galen malformation, callosal malformations, meningo(myelo)cele], in retroperitoneal abnormalities (lymphangioma, renal agenesis, multicystic renal dysplasia), and in neck/thoracic pathology [cervical cystic teratoma, congenital hernia diaphragmatica, congenital cystic adenomatoid lung malformation (CCAM)]. This improved parental counseling and pregnancy management in 15 pregnancies. In 3 cases, prenatal MRI findings did not correlate with prenatal ultrasonographic findings or neonatal diagnosis. The MRI provided a more detailed description and insight into fetal anatomy, pathology, and etiology in the vast majority of these selected cases. This improved prenatal parental counseling and postnatal therapeutic planning. (orig.)

  7. Neural tube defects in Costa Rica, 1987-2012: origins and development of birth defect surveillance and folic acid fortification.

    Science.gov (United States)

    Barboza-Argüello, María de la Paz; Umaña-Solís, Lila M; Azofeifa, Alejandro; Valencia, Diana; Flores, Alina L; Rodríguez-Aguilar, Sara; Alfaro-Calvo, Thelma; Mulinare, Joseph

    2015-03-01

    Our aim was to provide a descriptive overview of how the birth defects surveillance and folic acid fortification programs were implemented in Costa Rica-through the establishment of the Registry Center for Congenital Anomalies (Centro de Registro de Enfermedades Congénitas-CREC), and fortification legislation mandates. We estimated the overall prevalence of neural tube defects (i.e., spina bifida, anencephaly and encephalocele) before and after fortification captured by CREC. Prevalence was calculated by dividing the total number of infants born with neural tube defects by the total number of live births in the country (1987-2012).A total of 1,170 newborns with neural tube defects were identified from 1987 to 2012 (1992-1995 data excluded); 628 were identified during the baseline pre-fortification period (1987-1991; 1996-1998); 191 during the fortification period (1999-2002); and 351 during the post-fortification time period (2003-2012). The overall prevalence of neural tube defects decreased from 9.8 per 10,000 live-births (95 % CI 9.1-10.5) for the pre-fortification period to 4.8 per 10,000 live births (95 % CI 4.3-5.3) for the post-fortification period. Results indicate a statistically significant (P neural tube defects from the pre-fortification period to the post-fortification period. Folic acid fortification via several basic food sources has shown to be a successful public health intervention for Costa Rica. Costa Rica's experience can serve as an example for other countries seeking to develop and strengthen both their birth defects surveillance and fortification programs.

  8. Agnathia-holoprosencephaly associated with a 46,XY,-21,+t(21q;21q) karyotype

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    Niedermeyer, K.K.; McCorquodale, M.M.; Burton, B.K. [Univ. of Illinois, Chicago, IL (United States)

    1994-09-01

    We report an unusual case of agnathia-holoprosencephaly associated with Down syndrome due to a 21/21 translocation. The patient presented prenatally at 21 wks gestation. A fetal ultrasound revealed multiple CNS anomalies including hydrocephalus, compressed cerebellum, absent septum pellucidum and possible cranial meningocele or encephalocele. High resolution ultrasound & fetal karyotype were recommended. The patient refused & elected to have a pregnancy termination. Chromosomal analysis performed on products of conception revealed a 46,XY,-21,+t(21q;21q) karyotype. Fluorescence in situ hybridization was performed and confirmed the 21/21 translocation chromosome. An autopsy revealed agnathia and multiple CNS anomalies including absence of the septum pellucidum, absence of the corpus callosum, arhinencephaly, an occiptal meningoencephalocele, dilation of the lateral ventricles, and extensive dysgenesis & heterotopias of the central cerebrum & mid-brain. Additional abnormalities included a persistent left superior vena cava, atrial & ventricular septal defects, irregular length of the fingers with absence of the middle phalanges of the right 2nd and 5th & left 5th digits and bilateral simian creases. Agnathia can be an isolated abnormality but often is associated with holoprosencephaly and/or situs inversus. The majority of familial case of agnathis-holoprosencephaly was caused by an inherited unbalanced translocation resulting in duplication of 6p and monosomy of 18p. Our patient had a translocation form of trisomy 21 but did not have a phenotype consistent with Down syndrome. Trisomy 21 has not been previously reported in other cases of agnathia-holoprosencephaly. Whether the chromosomal abnormality caused the phenotypic abnormalities or if it is a coincidental finding cannot be determined.

  9. Neural Tube Defects in Native Fars Ethnicity in Northern Iran

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    MJ Golalipour

    2010-09-01

    Full Text Available "nBackground: Neural tube defects (NTD are one of the leading causes of infant mortality worldwide. This study was de­signed to determine the prevalence of NTDs among native Fars ethnic groups during 1998-2005, and to identify maternal and demographic factors associated with NTDs. "nMethods: We performed a descriptive cross-sectional hospital-based study in Dezyani Hospital, Gorgan, North of Iran, since January 1998 until December 2005. The design was based on a sample of 30,639 births of native Fars ethnic groups. Data were analyzed by using spss V13.5 software and were compared with the chi-square test."nResults: The prevalence of NTDs in Native Fars during the 8-year period was 25.4 per 10000 births (95% confidence inter­val: 20.1-31.8. The prevalence of NTDs was 20.6/10000 and 30.6/10000 in males and females respectively but this differ­ence was not significant. The prevalence of spina bifida, anencephaly and encephalocele were 12.7, 11.4 and 1.3 per 10000 respec­tively. The rate of NTD was 48.9/10000 in newborns with mothers aged > 35 years. The highest rate of NTDs and spina bi­fida was in 2002. The highest and lowest rate of anencephaly was in 2005 and 2003 respectively. Twenty eight percent of the parents had consanguineous marriages. Degree relatedness 3, 4, 5 and 6 of consanguineous marriages were 12.8%, 9%, 3.8%, 2.5%, respectively. Also 47.5% of the parents resided in rural areas.  "nConclusion: This investigation showed that the rate of NTDs in Native Fars was higher in Iran. In addition, this rate is higher than the Canada and Ukraine and lower than Chinese people.

  10. The child with a cephalocele: etiology, neuroimaging, and outcome.

    Science.gov (United States)

    Martínez-Lage, J F; Poza, M; Sola, J; Soler, C L; Montalvo, C G; Domingo, R; Puche, A; Ramón, F H; Azorín, P; Lasso, R

    1996-09-01

    We report a series of 46 children who were treated for one of the diverse forms of cranium bifidum during a period of 22 years. The purpose of the survey was to investigate pathogenetic factors involved in the development of cranial dysraphism and to analyze clinical and pathological factors that influence the patients' outcome. We also investigated the existence of associated intracranial anomalies, in a systematic way, using modern methods of neuroimaging, and related the findings to the patients' final results. The lesions were classified as encephalocele (n = 15), cranial meningocele (n = 3), atretic cephalocele (n = 26), cranium bifidum occultum (n = 1), and exencephaly (n = 1). There was an excess of the atretic form of cephaloceles in our series, a fact that probably reflects geographical variations described for cephaloceles in general. The location of the lesions was occipital in 29 children, parietal in 16, and temporal and frontobasal in one case each. In seven cases there was parental consanguinity. A familial history of malformations of the central nervous system was encountered in eight instances. Associated systemic abnormalities were present in 23 patients, while central nervous system anomalies were found in 36 children. Cephalocele repair was undertaken on 35 occasions. There were no surgical fatalities in the series. The mean follow-up time was of 7 years. Overall mortality for the whole group was of 17/46 or 36%. Twenty of the 29 survivors had no neurological sequelae, but only 18 children exhibited a competitive intelligence level. A good outcome was found to correlate well with: an average head size at birth, a normal initial neurological condition, operability of the lesions, and an absence of disorders of the neuronal migration. Neurological outcome depended also on the occurrence or not of hydrocephalus, while the intelligence level was mainly related to the absence of cerebral tissue within the sac of the malformation.

  11. Morphological evaluation of fetus CNS and its related anomalies; The advantages and limitations of prenatal diagnosis by means of MRI, US, and CT

    Energy Technology Data Exchange (ETDEWEB)

    Oi, Shizuo; Tamaki, Norihiko; Matsumoto, Satoshi; Katayama, Kazuaki; Mochizuki, Matsuto (Kobe Univ. (Japan). School of Medicine)

    1989-08-01

    The fetal central nervous system was evaluated morphologically by ultrasonography (US), magnetic resonance imaging (MRI), and CT scan to analyze the prenatal diagnostic value for anomalies. A total of 31 patients with 42 lesions had been diagnosed during the preceding 7 years. The patients included 24 with hydrocephalus, three with anencephaly, three with myeloschisis, three with holoprosencephaly, three with an encephalocele, two with a Dandy-Walker cyst, one with hydroencephalodysplasia, one with an intracranial neoplasm, one with sacrococcygeal teratoma, and one with sacral agenesis. Compared with US and MRI, CT proved to be more accurate in the detection of spine and cranium-bone morphology. This finding seems to be valuable in the diagnosis of spina bifida, cranium bifidum and some cases of hypertensive hydrocephalus, especially in the axial view. MRI was definitely superior in the anatomico-pathological diagnosis of cerebral dysgenesis, ventriculomegaly, intracranial tumors, and other brain parenchymal changes in view of multi-dimensional analysis. MRI performed poorly in the diagnosis of spine and cranium morphology. A super-conducting MRI system is still insufficient to demonstrate the spinal cord of a fetus. US used routinely and multidimensional slices were valuable for screening the CNS abnormalies. Intracranial hematomas had a specific echogenecity on US. However, US sometimes failed to demarcate the cerebral parenchymal or subdural morphological changes because its artifacts had hyperchoic shadows. While US, MRI, and CT were valuable diagnostic tools in the morphological evaluation of fetal CNS anomalies, each modality has different advantages and disadvantages. Diagnostic advandage,depending on the nature of the anamoly, can be achieved by using the complementary imaging modalities.

  12. Induction of terata in hamsters by solanidane alkaloids derived from Solanum tuberosum.

    Science.gov (United States)

    Gaffield, W; Keeler, R F

    1996-03-01

    The potential induction of terata by solanidanes has been of public health concern since a report in 1972 hypothesized that certain birth defects in humans could be attributed to ingestion of blighted potatoes. The potential teratogenicity of solanidane alkaloids from potatoes and tomatoes in domestic livestock had been considered even earlier. In the present report, oral administration of the steroidal alkaloid glycosides alpha-solanine and alpha-chaconine and their aglycone solanidine is shown to induce craniofacial malformations (exencephaly, encephalocele, and anophthalmia) in Syrian hamsters. All three alkaloids, that were either isolated or obtained by hydrolysis from Solanum tuberosum (var. Kennebec) sprouts, possessed the 22-(R),25(S)-configuration in the indolizidine moiety with no other isomers present. Toxicity constraints precluded administration of dosages high enough to induce statistically significant levels of terata in litters dosed with alpha-chaconine and permitted the attainment of only marginal statistical significance for alpha-solanine. However, malformation induction at p toxicity nor is the oligosaccharide portion of steroidal alkaloid glycosides required to facilitate passage of the teratogen to the fetus. The teratogenicity of solanidine N-oxide, a putative metabolite, suggests that N-oxidation is not an effective mammalian detoxification pathway. Relative teratogenic potencies (RTP) were assigned to solanidanes by conversion of literature data to equimolar doses compared to the powerful Veratrum teratogen jervine and the nonteratogenic spirosolane tomatidine. RTP values are as follows: jervine (100), 22(S),-25(R)-solanidanes (50), alpha-chaconine (43), alpha-solanine (32), 22(R),25(S)-solanidine (32), solanidine N-oxide (32), 5 alpha,6-dihydrosolanidine (9), and tomatidine (0).

  13. Technique of stepwise intracranial decompression combined with external ventricular drainage catheters improve the prognosis of acute post-traumatic hemispheric brain swelling patients

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    Lei eShi

    2015-09-01

    Full Text Available Background: Acute post-traumatic cerebral hemispheric brain swelling (ACHS is a serious disorder that occurs after traumatic brain injury (TBI, and it often requires immediate treatment. The aim of our clinical study was to assess the effects of stepwise intracranial decompression combined with external ventricular drainage catheters on the prognosis of ACHS patients.Methods: A retrospective study was performed on 172 cases of severe craniocerebral trauma patients with acute cerebral hemispheric swelling. The patients were divided into two groups: unilateral stepwise standard large trauma craniectomy (S-SLTC combined with external ventricular drainage (EVD catheter implants (n = 86 and unilateral routine frontal temporal parietal SLTC (control group, n = 86.Result: No significant differences in age, sex, or preoperative Glasgow Coma Scale score were observed between groups (P < 0.05. There were no significant differences in the ipsilateral subdural effusion incidence rates between the S-SLTC+EVD treatment group and the routine SLTC group. However, the incidence rates of intraoperative acute encephalocele and contralateral epidural and subdural hematoma in the S-SLTC+EVD group were significantly lower than those in the SLTC group (17.4% and 3.5% vs. 37.2% and 23.3%, respectively. The mean intracranial pressure (ICP values of patients in the S-SLTC+EVD group were also lower than those in the SLTC group at days 1 through7 (P<0.05. A positive neurological outcome (GOS score 4 to 5, 50.0% and decreased mortality (15.1% was observed in the S-SLTC+EVD group compared to the neurological outcome (GOS score 4 to 5, 33.8%; 36.0% in the SLTC group (P<0.05.Conclusions: Our data suggest that S-SLTC+EVD is more effective for controlling ICP, improving neurological outcome, and decreasing mortality rate compared with routine SLTC.

  14. 儿童组织细胞坏死性淋巴结炎并中枢神经系统损害4例%Histiocytic necrotizing lymphadenitis combined with central nervous system damage in 4 children

    Institute of Scientific and Technical Information of China (English)

    郭欣; 陈荷英; 李绍英; 胡惠丽; 陈天明; 刘钢

    2016-01-01

    Objective To summarize the clinical features of histiocytic necrotizing lymphadenitis (HNL) and the lesion of central neural system in children.Methods Data of the 4 cases in Beijing Children's Hospital from January 2009 to December 2014 were reviewed and analyzed,as well as other files of 12 patients from PubMed,CNKI,etc.Results All 4 patients mentioned above started from fever and lymphadenopathy,3 cases had headache,2 cases of them experienced altered mental status,and 1 case had cclampsia.The findings of cerebrospinal fluid (CSF) test was similar to viral encephalitis;2 cases had normal magnetic resonance imaging (MRI) result;1 case with MRI test indicated brain white matter diseases with extensive intracerebral hemorrhage,and 1 case had small range of encephalomalacia in left cerebral hemisphere and cerebral dura mater.Through CSF examination,2 cases were positive to Epstein-Barr viral capsid antigen (EBV-VCA)-IgM,while the 2 other cases had no positive trace of EBV-VCA-IgM.Lymph node biopsy was in accordance with HNL typical changes,1 case was positive for Epstein-Barr virus encoded RNA (EBER).Twelve cases in previous literatures were diagnosed as HNL by lymph node biopsy,and their clinical features of central nervous system were headache and altered mental status.There was no change in pathogen.It is also found that the cases in which CSF was performed had shown being negative.CT/MRI image descriptions involved in temporosphenoid lobe,hippocampus,caudate lobe,leptomeninges,etc.Conclusions HNL can be complicated with lesions of the central nervous system,characterized by aseptic meningitis,encephalitis,etc.The prognosis of most cases is good,a few can have neurological sequelae.HNL may relapse,so long-term follow-up is ne-cessary.Epstein-Barr virus in HNL and lesion of central nervous system mechanism still needs further research.%目的 总结儿童组织细胞坏死性淋巴结炎(HNL)合并中枢神经系统损害的临床特点.方法 回顾性分析2009

  15. 磁共振成像扩散峰度成像技术对抑郁症患者脑微观结构变化的评估价值%Cerebric Microstructure Changes of Depression Patients Using Magnetic Resonance Imaging Diffusion Kurtosis Imaging

    Institute of Scientific and Technical Information of China (English)

    黄海燕; 田兄玲; 王俭; 姜春晖; 马娟; 程晓阳; 张德清; 刘文亚; 母代斌

    2014-01-01

    difference in FA values of bilateral superior frontal gyrus,mid-dle frontal gyrus,inferior frontal gyrus,the occipital lobe,the genu of corpus callosum and the splenium corporis callosi between the case group and the control group(P>0. 05). FA value of the bilateral temporal lobe of the case group was significantly lower than that of the control group(P0. 05 ) . The MK value of the bilateral superior frontal gyrus and the temporosphenoid lobe of the case group was significantly lower than that of the control group(P0. 05 ) . Conclusion DKI tech-nique can show cerebric microstructure change of depressed patients. The atrophy may exist in white matter fiber tracts of bilateral superior frontal gyrus and temporal lobe,which may contribute to the diagnosis of depression.

  16. 关节镜外侧半月板下入路技术用于外侧半月板前角层裂下层的切除%Arthroscopic Resection of the Inferior Leaf of the Anterior Horn through Sub-meniscal Route for Horizontal Tear of the Lateral Meniscus

    Institute of Scientific and Technical Information of China (English)

    闫辉; 崔国庆; 敖英芳

    2012-01-01

    Objective To evaluate the efficacy of arthroscopic partial meniseectomy via sub-meniscal route for unstable inferior leaf of the anterior horn in horizontal tear of the lateral meniscus. Methods Between January 2008 and December 2010, 10 patients with horizontal tear in the anterior horn of the lateral meniscus underwent arthroscopic partial meniscectomy through submeniscal route. Three routes, anteromedial, anterolateral, and sub-meniscal route, were employed in our patients. An arthroscope was placed via an anteromedial route, and then the superior leaf of the anterior horn was averted by a probe through the anterolateral route for a better visualization of the lesion. Finally the inferior leaf of the anterior horn was excised with a punch through the sub-meniscal route. Results No postoperative complications occurred in our patients. They were followed up for 12 -45 months with a mean of 18.9 months, during which, 9 patients had the pain in the knee joints disappeared completely, and the other occasionally had the knee joint pain after doing sports. The flexion range of the knee joints recovered to a normal range in all the 10 patients, and the Lysholm score increased from 68.7 ± 12. 9 preoperation to 94. 4 ±5.7 ( paired t test, t=7.79, P = 0.00). Conclusion Sub-meniscal route provides a safe and effective alternative for resection of the interior leaf of the anterior horn for horizontal tear of the lateral meniscus.%目的 探讨关节镜外侧半月板下入路切除外侧半月板前角下层的效果. 方法 2008年1月~2010年12月,对10例外侧半月板前角层裂采用关节镜外侧半月板下入路切除外侧半月板前角层裂中不稳定的下层.采用3个入路:膝前外侧入路,前内侧入路及外侧半月板下入路.自前内侧入路置入关节镜观察;经前外侧入路使用探沟翻转层裂上层,并尽可能显露下层;经外侧半月板下入路使用直头Punch(篮钳)切除半月板前角层裂的下层. 结果

  17. Osteotomia proximal da tíbia: estabilização da abertura medial com enxerto tricortical de ilíaco Proximal tibial osteotomy: stabilization of the medial opening with atricortical iliac bone graft

    Directory of Open Access Journals (Sweden)

    Roberto da Cunha Luciano

    2010-01-01

    Full Text Available OBJETIVO: Avaliação radiográfica do alinhamento do membro inferior, nos planos frontal e sagital, após osteotomia alta da tíbia. Para estabilização da osteotomia foi utilizado enxerto tricortical de ilíaco e parafuso de posicionamento. MÉTODOS: Estudo prospectivo envolvendo 46 pacientes com idade entre 17 e 61 anos, sendo 42 portadores de geno varo secundário à osteoartrose e quatro por outras causas. A telerradiografia foi realizada para planejamento cirúrgico, utilizando o método de Frank Noyes modificado por Fugizawa. Foi realizado acesso cirúrgico convencional de 3cm para retirada do enxerto tricortical de ilíaco. A osteotomia foi realizada sob controle de radioscopia, por incisão anteromedial de 3cm com liberação da porção superficial do ligamento colateral medial. O enxerto foi colocado na porção posterior da osteotomia, para manter inalterado o slope tibial. O parafuso cruzou a osteotomia ortogonalmente para proteger a cortical lateral. Foram estabelecidos critérios radiográficos pré e pós-operatórios para avaliação dos resultados. RESULTADOS: Houve consolidação em 100% dos casos e manutenção do eixo mecânico, obtido no intraoperatório, em 94%. A inclinação posterior do platô tibial, no plano sagital, variou entre 7º e 12º. A mobilidade articular foi restabelecida em todos os pacientes operados. Onze pacientes apresentaram dor temporária no local da retirada do enxerto; no entanto, nenhum apresentou parestesia. A incidência de complicações foi de 8% (infecção, perda da correção, fratura articular. CONCLUSÃO: A técnica mostrou-se reprodutível, simples, biológica, precisa e com baixos custos, podendo ser uma alternativa às técnicas já existentes.OBJECTIVE: Roentgenographic assessment of lower limb alignment, in the frontal and sagittal planes, after a high tibial osteotomy. To stabilize the osteotomy, a tricortical iliac graft was used along with a positioning screw. METHODS

  18. 伴焦虑强迫症状的抑郁症患者前额叶血红蛋白浓度变化的近红外光图谱分析%Analyzing prefrontal cortex hemoglobin concentration exchange spectrum in patients with major depressive disorder combined with anxiety and obsession through near-infrared spectroscopy

    Institute of Scientific and Technical Information of China (English)

    刘晓敏; 张小芊; 徐波; 申晨煜; 史璐洁; 马湘雲; 任夏瑾; 孙高翔; 冯坤

    2014-01-01

    anxiety (r =0.370,0.380,both P < 0.05),while that in bilateral prefrontal cortex and antero-medial prefrontal cortex were associated with severity of depression (r =0.391,0.375,0.403,0.492,0.396,0.362,0.384,all P < 0.05).And no statistical correlation was observed between severity of obsession and prefrontal cortex.Conclusion It indicated hypoactivation state of prefrontal cortex was in MDD patients,while the severity of anxiety and depression may be associated with right-lateral prefrontal cortex,bilateral and antero-medial prefrontal cortex.

  19. Anatomic double bundle anterior cruciate ligament reconstruction with six-stranded hamstring tendons%双束双隧道6股腘绳肌腱解剖重建前交叉韧带

    Institute of Scientific and Technical Information of China (English)

    黄长明; 董辉详; 范华强; 付仰攀; 韩亮

    2011-01-01

    Objective To study the feasihility and short-term effects of anatomic douhle bundle anterior cruciate ligament ( ACL ) reconstruction with six-strand hamstring tendons autograft.Methods Arthroscopic ACL reconstruction was carried out in 28 patients with ACL injuries by using the quadruple hamstring tendon autograft.It was reconstructing of the anteromedial( AM ) tunnel and posterolateral( PL ) tunnel separately while creating 2 femoral and 2 tibial bone tunnels close to each other at the ACL footprint.The semitendinous tendon was used to make one three-stranded graft and the gracilis tendon was used to make one three-stranded graft.Feromal anteromedial bundle( AMB ) and posterolateral bundle( PLB ) fixation were performed by means of two Endobutton devices, tibial AM fixation was done with Bio-Intrafix devices, and tibial PL fixation was done with Milagro bioresorbable interference screws.Results A follow-up check up was made in the 28 patients for 12 ~ 24( 19.54 ± 3.84 )months.The Lysholm scores were improved from a preoperative score of 18 ~ 60( 34.79 ± 12.53 ) to 90 ~ 98( 95.54 ±2.06 ) at follow-up.There were significant difference in the Lysholm scores ( t = 26.51 ,P < 0.01 ).No postoperative complications such as synovitis and ligament rupture and movement restriction occurred.Conclusions Anatomic double bundle ACL reconstruction with six-strand hamstring tendons autograft can be simple, effective, useful, reproducible and gives a satisfactory shortterm results.%目的 探讨双束双隧道6股腘绳肌腱重建前交叉韧带(ACL)的可行性及近期疗效.方法 对28例ACL损伤患者行关节镜下ACL重建术.采用股骨胫骨双隧道建立前内侧束(AMB)及后外侧束(PLB).分别将股薄肌腱、半腱肌腱编织成3股肌腱,用于重建PLB与AMB.AMB与PLB股骨端均用Endobutton钢板固定,胫骨端AMB用Bio-Intrafix固定,PLB用Milagro可吸收界面螺钉固定.结果 28例均获随访,时间12~24(19.54±3.84)个月.根

  20. 关节镜下经前内侧入路行前交叉韧带重建术的临床疗效%The Clinical Efficacy of Arthroscopic Anterior Medial Approach for Anterior Cruciate Ligament Reconstruction

    Institute of Scientific and Technical Information of China (English)

    魏宁波; 郭志强; 杨帅胜

    2016-01-01

    Objective Discussion was before arthroscopic anteromedial cross ligament reconstruction methods and effects. Methods Retrospective analysis of the medial joint line of endoscopic anterior cruciate ligament anatomic single-bundle reconstruction of 32 cases of patients with anterior cruciate ligament rupture data were preoperatively, 1 year postoperatively using Lysholm knee score for overall function assessed after the physical understanding of the front cruciate ligament reconstruction of knee function and stability of the fracture.Results After 1 year follow-up, 32 cases of knee anterior drawer test was negative, Lachman test was negative in 30 patients, two cases Lachman test was positive, forward about 0.5cm; pivot shift test was negative in all cases; according to Lysholm knee score criteria: excellent in 27 cases, good in 5 cases, good rate of 100%. All patients recovered their daily work, joint stability improved significantly.ConclusionAfter anteromedial before anatomic single-bundle anterior cruciate ligament reconstruction excellent rate, postoperative joint function recovery, better able to ensure the stability of the knee motion.%目的:探讨关节镜下经前内侧入路前交叉韧带重建的方法及疗效。方法回顾分析关节镜下经前内侧入路行前交叉韧带单束解剖重建术的32例前交叉韧带断裂患者资料,分别在术前、术后1年采用Lysholm评分对膝关节的整体功能进行评估,通过体格检查了解前交叉韧带断裂重建后膝关节功能及稳定性。结果术后1年随访结果,32例膝关节前抽屉试验阴性,30例患者Lachman试验阴性,2例Lachman试验阳性,前移0.5cm左右;所有病例轴移试验阴性;按Lysholm膝关节功能评分标准:优27例,良5例,优良率达100%。术后所有患者均恢复日常工作,关节稳定性明显改善。结论经前内侧入路单束解剖重建前交叉韧带优良率高,术后关节功能恢复好,能更好保

  1. Clinical anatomy of the tibial insertion of the anterior cruciate ligament%前交叉韧带胫骨附着处临床解剖学研究

    Institute of Scientific and Technical Information of China (English)

    何国超; 汪青春; 向孝兵; 胡星荣

    2011-01-01

    Objective To study the morphological features of the tibial attachment of anterior cruciate ligament (ACL) and discuss the significance of parameters of ACL attachment on suitable styles of ACL reconstruction. Methods Ten formalin fixed adult knee joint specimens were dissected. The anteromedial bundle (AMB) and the posterolateral bundle (PLB) of ACL were identified according to the extension-flexion tensions of ACL. And then, ACL was resected from the tibial attachment site. The anatomical parameters of tibial attachment were measured and analyzed by Photoshop software. Results ACL can be divided into the anteromedial and posterolateral bundles functionally. The irregular shape of the ACL tibial insertion involved in the reversed triangle, oval and quadrilateral shapes. The anteroposterior and transverse diameters of ACL tibial insertion were (17.89±2.44)mm and (13.85 ± 1.79)mm respectively. The area of the tibial attachment of the AMB and the PLB were (101.18±32.28) mm2 and (77.61±19.86)mm2 respectively, and the distance between the gravity points of AMB and PLB was (8.03±1.51)mm. Conclusions This study shows an useful measurement through the improved digital photographs. Parameters of tibial insertion of ACL obtained by this way is a valuable reference for selecting adequate ACL reconstruction skill.%目的 研究前交叉韧带(ACL)胫骨附着处的解剖形态学特点,并探讨ACL胫骨附着处测量值埘选择ACL重建方式的意义.方法 对10例福尔马林处理的成人膝关节标本进行解剖.在屈伸膝关节时根据ACL纤维张力区分前内束和后外束,然后从胫骨附着处切断韧带,用Photoshop软件测量附着处的相关数据.结果 ACL存在着两个不同的功能束,即前内束和后外束;胫骨附着处的形状不规则,可分为倒三角形、椭1形及四边形三种;ACL胫骨附着处的前后径与横径分别为(17.89±2.44)mm、(13.85±1.79)mm;前内束和后外束胫骨附着处的面积分别为(101.18±32

  2. Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury

    Energy Technology Data Exchange (ETDEWEB)

    Gorbachova, Tetyana; Wang, Peter S.; Hu, Bing [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Horrow, Jay C. [Drexel University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA (United States)

    2016-06-15

    To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI. The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 1/2 year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05. PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %). PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle. (orig.)

  3. Use of lateral circumflex femoral artery system free flaps in skull base reconstruction.

    Science.gov (United States)

    Camporro, Daniel; Fueyo, Angel; Martín, Clara; Carnero, Susana; Llorente, José L

    2011-05-01

    We present a 10-year retrospective study at a tertiary center designed to evaluate the advantages, complications, and comparative results using lateral circumflex femoral artery (LCFA) system free flaps for cranial base reconstruction. In this study, a cranial base defect refers to exposed intracranial contents to the skin, paranasal sinuses, nasopharynx, oropharynx, or oral cavity. These defects resulted from resections of primary or recurrent neoplasms or from secondary problems after cranial base surgery. We performed 20 flaps in 20 patients. The selection of flap was as follows: 8 combinations of anterolateral/anteromedial thigh flaps with vastus lateralis muscle or tensor fascia lata flaps, 6 ALT fasciocutaneous flaps, and 6 muscle/myocutaneous flaps. The flap's success rate was 95% (19/20). Early major complications included 1 perioperative death, and there was 1 myocardial infarction. Minor complications included 1 partial (12%) flap loss, 2 temporal cerebrospinal fluid leak, 2 donor-site hematoma, 2 minor wound breakdown, 3 facial nerve weakness, and 4 donor-site numbness. Among 20 patients undergoing LCFA system flap reconstruction, 12 are alive and disease free. Local recurrence occurred in 1 patient. She underwent ablative surgery and a new successful free flap (forearm flap); after 2 years, the patient is disease free. The LCFA system flaps in skull base reconstruction provide versatility in flap design and availability of adequate tissues to fill dead space, and it offers vascularized fascia to augment dural repairs. It also provides a very long pedicle and allows simultaneous flap harvest with low donor-site morbidity.

  4. Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

    Directory of Open Access Journals (Sweden)

    Rajasekhar Gali

    2016-01-01

    Full Text Available Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a the ease of access for retrieval, reimplantation and fixation of the proximal segment; b the postoperative approach related complications; c the adequacy of anatomical reduction and stability of fixation; d the occlusal changes; and the e TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby

  5. Spinal cord stimulation modulates cerebral function: an fMRI study

    Energy Technology Data Exchange (ETDEWEB)

    Moens, M. [Universitair Ziekenhuis Brussel, Department of Neurosurgery and Center for Neuroscience, Brussels (Belgium); Sunaert, S.; Peeters, R. [UZ Leuven, Katholieke Universiteit Leuven, Department of Radiology, Leuven (Belgium); Marien, P. [ZNA Middelheim General Hospital, Department of Neurology, Antwerp (Belgium); Vrije Universiteit Brussel, Department of Clinical and Experimental Neurolinguistics, Brussels (Belgium); Brouns, R.; Smedt, A. de [Universitair Ziekenhuis Brussel, Department of Neurology and Center for Neuroscience, Brussels (Belgium); Droogmans, S. [Universitair Ziekenhuis Brussel, Department of Cardiology, Brussels (Belgium); Schuerbeek, P. van [Universitair Ziekenhuis Brussel, Department of Radiology, Brussels (Belgium); Poelaert, J. [Universitair Ziekenhuis Brussel, Department of Anesthesiology, Brussels (Belgium); Nuttin, B. [UZ Leuven, Katholieke Universiteit Leuven, Department of Neurosurgery, Leuven (Belgium)

    2012-12-15

    Although spinal cord stimulation (SCS) is widely used for chronic neuropathic pain after failed spinal surgery, little is known about the underlying physiological mechanisms. This study aims to investigate the neural substrate underlying short-term (30 s) SCS by means of functional magnetic resonance imaging in 20 patients with failed back surgery syndrome (FBSS). Twenty patients with FBSS, treated with externalized SCS, participated in a blocked functional magnetic resonance imaging design with stimulation and rest phases of 30 s each, repeated eight times in a row. During scanning, patients rated pain intensity over time using an 11-point numerical rating scale with verbal anchors (0 = no pain at all to 10 = worst pain imaginable) by pushing buttons (left hand, lesser pain; right hand, more pain). This scale was back projected to the patients on a flat screen allowing them to manually direct the pain indicator. To increase the signal-to-noise ratio, the 8-min block measurements were repeated three times. Marked deactivation of the bilateral medial thalamus and its connections to the rostral and caudal cingulate cortex and the insula was found; the study also showed immediate pain relief obtained by short-term SCS correlated negatively with activity in the inferior olivary nucleus, the cerebellum, and the rostral anterior cingulate cortex. Results indicate the key role of the medial thalamus as a mediator and the involvement of a corticocerebellar network implicating the modulation and regulation of averse and negative affect related to pain. The observation of a deactivation of the ipsilateral antero-medial thalamus might be used as a region of interest for further response SCS studies. (orig.)

  6. A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

    Directory of Open Access Journals (Sweden)

    Di Giorgio Luigi

    2013-10-01

    Full Text Available 【Abstract】Objective: The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a combined anterolateral/anteromedial approach is suitable buta high rate of complicat ion has been reported. In our retrospective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods: Based on an anatomic study of tibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lateral (Tillaux-Chaput involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were: (1 presence of an anterior/anterolateral type fragment or a posterior (Volkmann type fragment involving >25% of the articular surface, (2 a minimum follow-upof 12 months, (3 a fibula f racture associated with a medial column fracture of the distaltibia, and (4 soft tissue conditions at the time of operation that did not compromise the choice of surgical access (Tscher ne classi fication for closed fr actures: grade 0 and grade 1. Tibial plafond fractures were classified into two groups: one presenting anterior and the other with posterior rim (Volkmann fragments. Resul ts: Most patients achieved a good clinical recovery in terms of range of motion and Olerud-Molander scale scores. Only three patient s presented a grade 2 osteoarthritis at the 12 month follow-up. Conclusion: Our two-choice strategy highlights concepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture patterns and their association should be further investigated. Key words: Tibial fractures; Fracture fixation; Surgical procedures, operative; Intraoperative complications

  7. The trajectory of sensory pathways from the lamina terminalis to the insular and cingulate cortex: a neuroanatomical framework for the generation of thirst.

    Science.gov (United States)

    Hollis, Jacob H; McKinley, Michael J; D'Souza, Moyra; Kampe, Juliane; Oldfield, Brian J

    2008-04-01

    The pathways involved in the emotional aspects of thirst, the arousal and affect associated with the generation of thirst and the motivation to obtain satiation, have been studied but remain poorly understood. Rats were therefore injected with the neurotropic virus pseudorabies in either the insular or cingulate cortex. After 2 days of infection, pseudorabies-positive neurons were identified within the thalamus and lamina terminalis. In a separate group of rats, the retrograde tracer cholera toxin subunit b (CTb) was used in combination with either isotonic (0.15 M NaCl) or hypertonic (0.8 M NaCl) saline (1 ml/100 g body wt ip). Rats injected with CTb in the insular cortex and stimulated with hypertonic saline had increased numbers of Fos/CTb double-positive neurons in the paraventricular, rhomboid, and reuniens thalamic nuclei, whereas those rats injected with CTb in the cingulate cortex and challenged with hypertonic saline had increased numbers of Fos/CTb double-positive neurons in the medial part of the mediodorsal, interanteromedial, anteromedial, and ventrolateral part of the laterodorsal thalamic nuclei. Rats injected with CTb in the dorsal midline of the thalamus and challenged with hypertonic saline had increased numbers of Fos/CTb double-positive neurons within the organum vasculosum of the lamina terminalis (OVLT), median preoptic nucleus, and insular cortex but not the subfornical organ. A small proportion of the CTb-positive neurons in the OVLT were immunopositive for transient receptor potential vanilloid 1, a putative osmoresponsive membrane protein. These results identify functional thalamocortical pathways involved in relaying osmotic signals to the insular and cingulate cortex and may provide a neuroanatomical framework for the emotional aspects of thirst.

  8. A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system.

    Science.gov (United States)

    Araki, Daisuke; Kuroda, Ryosuke; Kubo, Seiji; Fujita, Norifumi; Tei, Katsumasa; Nishimoto, Koji; Hoshino, Yuichi; Matsushita, Takehiko; Matsumoto, Tomoyuki; Nagamune, Koki; Kurosaka, Masahiro

    2011-03-01

    We conducted a prospective randomised study of anatomical single-bundle (A-SB group) versus double-bundle (A-DB group) anterior cruciate ligament (ACL) reconstruction using the hamstrings tendons. Twenty patients with unilateral ACL deficiency were randomised into two groups. We created the bone tunnels at the position of the original insertion of the anteromedial bundle footprint and posterolateral bundle footprint in the A-DB group and at the central position between these two bundles in the A-SB group. All of the patients were tested before ACL reconstruction and one year after surgery. The KT-1000 measurements, isokinetic muscle peak torque and heel-height difference were evaluated and the general knee condition was assessed by Lysholm score. For pre- and postoperative stability assessment, we used the six-degrees-of-freedom of knee kinematic measurement system using an electromagnetic device (the EMS) for quantitative assessment during the Lachman test and the pivot shift test. There were no significant differences in the KT-1000 measurements, isokinetic muscle peak torque, heel-height difference, and Lysholm score at one-year follow-up between these two groups. The EMS data showed there were significant differences in the acceleration of the pivot shift test between the operated knee and the contralateral normal knees in the A-SB group. In conclusion, clinical outcomes were equally good in both groups. However, the EMS data showed the anatomical double-bundle ACL reconstruction tended to be biomechanically superior to the single-bundle reconstruction.

  9. The course and the anatomo-functional relationships of the optic radiation: a combined study with ‘post mortem’ dissections and ‘in vivo’ direct electrical mapping

    Science.gov (United States)

    Sarubbo, Silvio; De Benedictis, Alessandro; Milani, Paola; Paradiso, Beatrice; Barbareschi, Mattia; Rozzanigo, Umbero; Colarusso, Enzo; Tugnoli, Valeria; Farneti, Marco; Granieri, Enrico; Duffau, Hugues; Chioffi, Franco

    2015-01-01

    Even if different dissection, tractographic and connectivity studies provided pure anatomical evidences about the optic radiations (ORs), descriptions of both the anatomical structure and the anatomo-functional relationships of the ORs with the adjacent bundles were not reported. We propose a detailed anatomical and functional study with ‘post mortem’ dissections and ‘in vivo’ direct electrical stimulation (DES) of the OR, demonstrating also the relationships with the adjacent eloquent bundles in a neurosurgical ‘connectomic’ perspective. Six human hemispheres (three left, three right) were dissected after a modified Klingler's preparation. The anatomy of the white matter was analysed according to systematic and topographical surgical perspectives. The anatomical results were correlated to the functional responses collected during three resections of tumours guided by cortico-subcortical DES during awake procedures. We identified two groups of fibres forming the OR. The superior component runs along the lateral wall of the occipital horn, the trigone and the supero-medial wall of the temporal horn. The inferior component covers inferiorly the occipital horn and the trigone, the lateral wall of the temporal horn and arches antero-medially to form the Meyer's Loop. The inferior fronto-occipital fascicle (IFOF) covers completely the superior OR along its entire course, as confirmed by the subcortical DES. The inferior longitudinal fascicle runs in a postero-anterior and inferior direction, covering the superior OR posteriorly and the inferior OR anteriorly. The IFOF identification allows the preservation of the superior OR in the anterior temporal resection, avoiding post-operative complete hemianopia. The identification of the superior OR during the posterior temporal, inferior parietal and occipital resections leads to the preservation of the IFOF and of the eloquent functions it subserves. The accurate knowledge of the OR course and the relationships

  10. A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

    Institute of Scientific and Technical Information of China (English)

    Luigi Di Giorgio; Georgios Touloupakis; Emmanouil Theodorakis; Luca Sodano

    2013-01-01

    Objective:The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures.For complex fracture pattems a combined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported.In our retrospective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment ofpilon fractures with anterior or posterior fragmentation.Methods:Based on an anatomic study oftibial pilon fractures,we retrospectively analyzed the fractures with primary posterior,posterior-lateral or anterior,anterior-lateral (Tillaux-Chaput) involvement of the distal tibia.This retrospective study consisted of 18 patients with a closed tibial plafond fracture.The inclusion criteria were:(1) presence of an anterior/anterolateral type fragment or a posterior (Volkmann) type fragment involving >25% of the articular surface,(2) a minimum follow-up of 12 months,(3) a fibula fracture associated with a medial column fracture of the distal tibia,and (4) soft tissue conditions at the time of operation that did not compromise the choice of surgical access (Tscherne classification for closed fractures:grade 0 and grade 1).Tibial plafond fractures were classified into two groups:one presenting anterior and the other with posterior rim (Volkmann) fragments.Results:Most patients achieved a good clinical recovery in terms of range of motion and Olerud-Molander scale scores.Only three patients presented a grade 2 osteoarthritis at the 12 month follow-up.Conclusion:Our two-choice strategy highlights concepts which have been previously debated and described in the literature.But a new extended protocol for surgical approach to the distal tibia,including more fracture patterns and their association should be further investigated.

  11. Malformação venosa associada a hiperelasticidade cutânea e atrofia do tecido subcutâneo

    Directory of Open Access Journals (Sweden)

    Ana Julia de Deus Silva

    2016-01-01

    Full Text Available Resumo A rigidez da parede venosa pode aumentar em síndromes em que há uma redução da quantidade de elastina, ocasionando malformações venosas mesmo em indivíduos que possuem mosaicismo para tais síndromes. Casos com apresentação de afecções colagenosas em áreas delimitadas não foram descritos na literatura. O paciente apresentava lesão bem delimitada em região anteromedial da coxa com aumento de elasticidade e presença de vasos tortuosos apenas no local da lesão, não apresentando nenhuma síndrome colagenosa. Foi realizada uma biópsia que evidenciou alterações em relação ao padrão das fibras elásticas e proliferação de vasos sanguíneos. A malformação venosa foi tratada satisfatoriamente com embolização. As doenças do colágeno causam hiperextensibilidade cutânea, o que provoca flacidez e propicia traumas. As colagenoses bem delimitadas são raras, pois geralmente esse grupo de doenças envolve acometimento sistêmico. As malformações vasculares podem ocorrer em diversas doenças do colágeno, mas de forma generalizada e não localizada, e uma explicação para isso seria o mosaicismo genético.

  12. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty

    Science.gov (United States)

    Bottomley, N.; Jones, L. D.; Rout, R.; Alvand, A.; Rombach, I.; Evans, T.; Jackson, W. F. M.; Beard, D. J.; Price, A. J.

    2016-01-01

    Aims The aim of this to study was to compare the previously unreported long-term survival outcome of the Oxford medial unicompartmental knee arthroplasty (UKA) performed by trainee surgeons and consultants. Patients and Methods We therefore identified a previously unreported cohort of 1084 knees in 947 patients who had a UKA inserted for anteromedial knee arthritis by consultants and surgeons in training, at a tertiary arthroplasty centre and performed survival analysis on the group with revision as the endpoint. Results The ten-year cumulative survival rate for revision or exchange of any part of the prosthetic components was 93.2% (95% confidence interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to 97.6, number at risk 16). Trainee surgeons had a cumulative nine-year survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35). Although there was no differences in implant survival between consultants and trainees (p = 0.30), there was a difference in failure pattern whereby all re-operations performed for bearing dislocation (n = 7), occurred in the trainee group. This accounted for 0.6% of the entire cohort and 15% of the re-operations. Conclusion This is the largest single series of the Oxford UKA ever reported and demonstrates that good results can be achieved by a heterogeneous group of surgeons, including trainees, if performed within a high-volume centre with considerable experience with the procedure. Cite this article: Bone Joint J 2016;(10 Suppl B):22–7. PMID:27694512

  13. Iliopsoas tendon insertion footprint with surgical implications in lesser trochanterplasty for treating ischiofemoral impingement: an anatomic study.

    Science.gov (United States)

    Gómez-Hoyos, Juan; Schröder, Ricardo; Palmer, Ian J; Reddy, Manoj; Khoury, Anthony; Martin, Hal David

    2015-12-01

    The objective of this study was to describe the footprint location of the iliopsoas tendon on the lesser trochanter to clarify the surgical implications of the lesser trochanterplasty for treating ischiofemoral impingement. Ten non-matched, fresh-frozen, cadaveric hemipelvis specimens (average age, 62.4 years; range, 48-84 years; 7 male and 3 female) were included. Registered measures included bony parameters of the lesser trochanter (lesser trochanteric area, distances from the tip to the base in a coordinate system, height and area) and tendinous iliopsoas footprint descriptions (areas and detailed location). The mean height of the lesser trochanter was 13.1 (SD ± 1.8) mm, with female having a smaller lesser trochanter on average (11.3, SD ± 2.0). A double tendinous footprint was found in 7 (70%) specimens. The average area of the single- and double-footprint was 211.2 mm(2) and 187.9 mm(2), respectively. An anterior cortical area with no tendinous insertion on the anterior aspect of lesser trochanter was present in all specimens and measured 4.9 mm (SD ± 0.6) on average. The mean ratio between the bald anterior wall and the lesser trochanter height was 38% (SD ± 0.05). The iliopsoas tendon footprint is double (psoas and iliacus) in most cases and is located on the anteromedial tip of the lesser trochanter. A bald anterior wall on the bottom of the lesser trochanter indicates that a partial or total lesser trochanterplasty for increasing the ischiofemoral space without detaching partially or entirely the iliopsoas tendon is improbable.

  14. Arthroscopic psoas tenotomy.

    Science.gov (United States)

    Wettstein, Michael; Jung, Jochen; Dienst, Michael

    2006-08-01

    Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months.

  15. Mapping neurotransmitter networks with PET: an example on serotonin and opioid systems.

    Science.gov (United States)

    Tuominen, Lauri; Nummenmaa, Lauri; Keltikangas-Järvinen, Liisa; Raitakari, Olli; Hietala, Jarmo

    2014-05-01

    All functions of the human brain are consequences of altered activity of specific neural pathways and neurotransmitter systems. Although the knowledge of "system level" connectivity in the brain is increasing rapidly, we lack "molecular level" information on brain networks and connectivity patterns. We introduce novel voxel-based positron emission tomography (PET) methods for studying internal neurotransmitter network structure and intercorrelations of different neurotransmitter systems in the human brain. We chose serotonin transporter and μ-opioid receptor for this analysis because of their functional interaction at the cellular level and similar regional distribution in the brain. Twenty-one healthy subjects underwent two consecutive PET scans using [(11)C]MADAM, a serotonin transporter tracer, and [(11)C]carfentanil, a μ-opioid receptor tracer. First, voxel-by-voxel "intracorrelations" (hub and seed analyses) were used to study the internal structure of opioid and serotonin systems. Second, voxel-level opioid-serotonin intercorrelations (between neurotransmitters) were computed. Regional μ-opioid receptor binding potentials were uniformly correlated throughout the brain. However, our analyses revealed nonuniformity in the serotonin transporter intracorrelations and identified a highly connected local network (midbrain-striatum-thalamus-amygdala). Regionally specific intercorrelations between the opioid and serotonin tracers were found in anteromedial thalamus, amygdala, anterior cingulate cortex, dorsolateral prefrontal cortex, and left parietal cortex, i.e., in areas relevant for several neuropsychiatric disorders, especially affective disorders. This methodology enables in vivo mapping of connectivity patterns within and between neurotransmitter systems. Quantification of functional neurotransmitter balances may be a useful approach in etiological studies of neuropsychiatric disorders and also in drug development as a biomarker-based rationale for targeted

  16. The regional distribution of T2-relaxation times in MR images of the substantia nigra and crus cerebri

    Energy Technology Data Exchange (ETDEWEB)

    Maenz, Constantin; Bender, Benjamin; Ernemann, Ulrike; Klose, Uwe [University of Tuebingen, Department of Diagnostic and Interventional Neuroradiology, Tuebingen (Germany); Godau, Jana; Berg, Daniela [University of Tuebingen, Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tuebingen (Germany)

    2010-08-15

    When scanning the size of the substantia nigra (SN), for example in Parkinson's disease, it is important to precisely locate its true anatomic location. The hypointense areas on T2-weighted magnetic resonance images (T2w) at the level of the upper midbrain are usually labeled as the SN. Recent studies showed that the line of demarcation between the SN and the crus cerebri (CC) in T2w images seems not to be clear. The purpose of our study was to evaluate the depiction of the SN and the CC on calculated R2 maps by analyzing the regional distribution of T2 values in both regions. In 36 healthy subjects, triple echo turbo spin echo were obtained at 1.5 T and R2 maps calculated. Proton density-weighted turbo spin echo images (PDw) were used as reference. The CC and SN were manually traced on PDw sections (CCP and SNP) and also the hyperintense areas on the R2 maps, suggestive of the SN (DT2). The obtained volumes were evaluated in terms of total size, intersections size, and residual areas, as well as the corresponding T2 values. DT2 corresponded to anterolateral parts of the SNP and showed an extension to anteromedial part of the CC. The intersections between DT2 and CCP and DT2 and SNP presented both decreased but different T2 values (102 {+-} 5 and 95 {+-} 4 ms). An exact differentiation of the SN from the CC is not possible on the basis of T2w images but rather on the basis of the underlying calculated T2 values from the triple echo sequence. (orig.)

  17. The human sacrum and safe approaches for screw placement.

    Science.gov (United States)

    Arman, Candan; Naderi, Sait; Kiray, Amaç; Aksu, Funda Taştekin; Yilmaz, Hakan Sinan; Tetik, Süleyman; Korman, Esin

    2009-08-01

    The human sacrum is the target of lumbosacral instrumentation and decompression procedures. Such surgical interventions require detailed knowledge of the anatomy of the human sacrum. The aim of this study was to measure surgically relevant parameters. Several factors, including the one-piece composition of the sacrum, the angles of the sacral pedicles and the anteroposterior diameter of the sacral vertebral bodies distinguish the sacrum from other parts of spine. Thirty-two measurements of shape, angles and distances between parts were taken of the sacra of 100 adult West Anatolian people using a Vernier caliper accurate to 0.1 mm and goniometer. According to this morphometric study, when measured from the sagittal, the S1 facet angle was measured as 35.71 degrees +/-9.59 and 34.70 degrees +/-9.66, the sacral pedicle anteromedial screw trajectory angle was 35.65 degrees +/-4.73 and 31.95 degrees +/-3.95 and the anterolaterally oriented sacral wing screw trajectory angle was 32.65 degrees +/-3.51 and 29.10 degrees +/-3.14, on the right and left sides, respectively. The distance of the midline oriented S1 pedicle screw was 51.12 mm and 51.26 mm on the right and left side, respectively. The distance for sacral wing oriented screw placement was 50.13 mm and 50.46 mm on the right and left side, respectively. The anteroposterior and transverse diameter of the sacral spinal canal were 21.81 mm and 31.31 mm, respectively. Thus, this study describes anatomical specifications of the sacrum. These defined morphometric details should be taken into consideration during surgical procedures. This study also describes anatomical landmarks which will allow injury of the sacrum during surgery to be avoided.

  18. The course and the anatomo-functional relationships of the optic radiation: a combined study with 'post mortem' dissections and 'in vivo' direct electrical mapping.

    Science.gov (United States)

    Sarubbo, Silvio; De Benedictis, Alessandro; Milani, Paola; Paradiso, Beatrice; Barbareschi, Mattia; Rozzanigo, Umbero; Colarusso, Enzo; Tugnoli, Valeria; Farneti, Marco; Granieri, Enrico; Duffau, Hugues; Chioffi, Franco

    2015-01-01

    Even if different dissection, tractographic and connectivity studies provided pure anatomical evidences about the optic radiations (ORs), descriptions of both the anatomical structure and the anatomo-functional relationships of the ORs with the adjacent bundles were not reported. We propose a detailed anatomical and functional study with 'post mortem' dissections and 'in vivo' direct electrical stimulation (DES) of the OR, demonstrating also the relationships with the adjacent eloquent bundles in a neurosurgical 'connectomic' perspective. Six human hemispheres (three left, three right) were dissected after a modified Klingler's preparation. The anatomy of the white matter was analysed according to systematic and topographical surgical perspectives. The anatomical results were correlated to the functional responses collected during three resections of tumours guided by cortico-subcortical DES during awake procedures. We identified two groups of fibres forming the OR. The superior component runs along the lateral wall of the occipital horn, the trigone and the supero-medial wall of the temporal horn. The inferior component covers inferiorly the occipital horn and the trigone, the lateral wall of the temporal horn and arches antero-medially to form the Meyer's Loop. The inferior fronto-occipital fascicle (IFOF) covers completely the superior OR along its entire course, as confirmed by the subcortical DES. The inferior longitudinal fascicle runs in a postero-anterior and inferior direction, covering the superior OR posteriorly and the inferior OR anteriorly. The IFOF identification allows the preservation of the superior OR in the anterior temporal resection, avoiding post-operative complete hemianopia. The identification of the superior OR during the posterior temporal, inferior parietal and occipital resections leads to the preservation of the IFOF and of the eloquent functions it subserves. The accurate knowledge of the OR course and the relationships with the

  19. Cranial morphology of Aegyptopithecus and Tarsius and the question of the tarsier-anthropoidean clade.

    Science.gov (United States)

    Simons, E L; Rasmussen, D T

    1989-05-01

    New crania of the Oligocene anthropoidean Aegyptopithecus provide a test of the hypothesized tarsier-anthropoidean clade. Three cranial characters shared by Tarsius and some modern anthropoideans (apical interorbital septum, postorbital septum, "perbullar" carotid pathway) were examined. 1) An apical interorbital septum is absent in Aegyptopithecus. A septum does occur in Galago senegalensis (Lorisidae) and Microcebus murinus (Cheirogaleidae), so the presence of a septum is not strong evidence favoring a tarsiiform-anthropoidean clade. 2) In Aegyptopithecus and other anthropoideans, the postorbital septum is formed mainly by a periorbital flange of the zygomatic that extends medially from the lateral orbital margin onto or near the braincase. The postorbital plate of Tarsius is formed by frontal and alisphenoid flanges that extend laterally from the braincase to the zygomatic's frontal process, which is not broader than the postorbital bars of other prosimians. Periorbital flanges evolved in Tarsius for support or protection of the enormous eyes, as suggested by the occurrence of maxillary and frontal flanges that cup portions of the eye but do not separate it from temporal muscles. 3) The internal carotid artery of Aegyptopithecus enters the bulla posteriorly and crosses the anteroventral part of the promontorium. The tympanic cavity was probably separated from the anteromedial cavity by a septum stretching from the carotid channel to the ventrolateral bullar wall. In Tarsius, the carotid pathway is prepromontorial, and a septum stretches from the carotid channel to the posteromedial bullar wall. Quantitative analyses indicate that anterior carotid position has evolved because of erect head posture. The cranium of Oligocene anthropoideans thus provides no support for the hypothesized tarsier-anthropoidean clade.

  20. Connections of the juxtaventromedial region of the lateral hypothalamic area in the male rat.

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    Joel D Hahn

    2015-05-01

    Full Text Available Evolutionary conservation of the hypothalamus attests to its critical role in the control of fundamental behaviors. However, our knowledge of hypothalamic connections is incomplete, particularly for the lateral hypothalamic area (LHA. Here we present the results of neuronal pathway-tracing experiments to investigate connections of the LHA juxtaventromedial region, which is parceled into dorsal (LHAjvd and ventral (LHAjvv zones. Phaseolus vulgaris leucoagglutinin (PHAL, for outputs and cholera toxin B subunit (CTB, for inputs coinjections were targeted stereotaxically to the LHAjvd/v. RESULTS: LHAjvd/v connections overlapped highly but not uniformly. Major joint outputs included: Bed nuc. stria terminalis (BST, interfascicular nuc. (BSTif and BST anteromedial area, rostral lateral septal (LSr- and ventromedial hypothalamic (VMH nuc., and periaqueductal gray. Prominent joint LHAjvd/v input sources included: BSTif, BST principal nuc., LSr, VMH, anterior hypothalamic-, ventral premammillary-, and medial amygdalar nuc., and hippocampal formation (HPF field CA1. However, LHAjvd HPF retrograde labeling was markedly more abundant than from the LHAjvv; in the LSr this was reversed. Furthermore, robust LHAjvv (but not LHAjvd targets included posterior- and basomedial amygdalar nuc., whereas the midbrain reticular nuc. received a dense input from the LHAjvd alone. Our analyses indicate the existence of about 500 LHAjvd and LHAjvv connections with about 200 distinct regions of the cerebral cortex, cerebral nuclei, and cerebrospinal trunk. Several highly LHAjvd/v-connected regions have a prominent role in reproductive behavior. These findings contrast with those from our previous pathway-tracing studies of other LHA medial and perifornical tier regions, with different connectional behavioral relations. The emerging picture is of a highly differentiated LHA with extensive and far-reaching connections that point to a role as a central coordinator of behavioral

  1. Torvosaurus gurneyi n. sp., the largest terrestrial predator from Europe, and a proposed terminology of the maxilla anatomy in nonavian theropods.

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    Christophe Hendrickx

    Full Text Available The Lourinhã Formation (Kimmeridgian-Tithonian of Central West Portugal is well known for its diversified dinosaur fauna similar to that of the Morrison Formation of North America; both areas share dinosaur taxa including the top predator Torvosaurus, reported in Portugal. The material assigned to the Portuguese T. tanneri, consisting of a right maxilla and an incomplete caudal centrum, was briefly described in the literature and a thorough description of these bones is here given for the first time. A comparison with material referred to Torvosaurus tanneri allows us to highlight some important differences justifying the creation of a distinct Eastern species. Torvosaurus gurneyi n. sp. displays two autapomorphies among Megalosauroidea, a maxilla possessing fewer than eleven teeth and an interdental wall nearly coincidental with the lateral wall of the maxillary body. In addition, it differs from T. tanneri by a reduced number of maxillary teeth, the absence of interdental plates terminating ventrally by broad V-shaped points and falling short relative to the lateral maxillary wall, and the absence of a protuberant ridge on the anterior part of the medial shelf, posterior to the anteromedial process. T. gurneyi is the largest theropod from the Lourinhã Formation of Portugal and the largest land predator discovered in Europe hitherto. This taxon supports the mechanism of vicariance that occurred in the Iberian Meseta during the Late Jurassic when the proto-Atlantic was already well formed. A fragment of maxilla from the Lourinhã Formation referred to Torvosaurus sp. is ascribed to this new species, and several other bones, including a femur, a tibia and embryonic material all from the Kimmeridgian-Tithonian of Portugal, are tentatively assigned to T. gurneyi. A standard terminology and notation of the theropod maxilla is also proposed and a record of the Torvosaurus material from Portugal is given.

  2. Torvosaurus gurneyi n. sp., the largest terrestrial predator from Europe, and a proposed terminology of the maxilla anatomy in nonavian theropods.

    Science.gov (United States)

    Hendrickx, Christophe; Mateus, Octávio

    2014-01-01

    The Lourinhã Formation (Kimmeridgian-Tithonian) of Central West Portugal is well known for its diversified dinosaur fauna similar to that of the Morrison Formation of North America; both areas share dinosaur taxa including the top predator Torvosaurus, reported in Portugal. The material assigned to the Portuguese T. tanneri, consisting of a right maxilla and an incomplete caudal centrum, was briefly described in the literature and a thorough description of these bones is here given for the first time. A comparison with material referred to Torvosaurus tanneri allows us to highlight some important differences justifying the creation of a distinct Eastern species. Torvosaurus gurneyi n. sp. displays two autapomorphies among Megalosauroidea, a maxilla possessing fewer than eleven teeth and an interdental wall nearly coincidental with the lateral wall of the maxillary body. In addition, it differs from T. tanneri by a reduced number of maxillary teeth, the absence of interdental plates terminating ventrally by broad V-shaped points and falling short relative to the lateral maxillary wall, and the absence of a protuberant ridge on the anterior part of the medial shelf, posterior to the anteromedial process. T. gurneyi is the largest theropod from the Lourinhã Formation of Portugal and the largest land predator discovered in Europe hitherto. This taxon supports the mechanism of vicariance that occurred in the Iberian Meseta during the Late Jurassic when the proto-Atlantic was already well formed. A fragment of maxilla from the Lourinhã Formation referred to Torvosaurus sp. is ascribed to this new species, and several other bones, including a femur, a tibia and embryonic material all from the Kimmeridgian-Tithonian of Portugal, are tentatively assigned to T. gurneyi. A standard terminology and notation of the theropod maxilla is also proposed and a record of the Torvosaurus material from Portugal is given.

  3. Science.gov (United States)

    Iacoangeli, M.; Di Somma, L.; Alvaro, L.; Nasi, D.; Magliulo, G.; Gioacchini, F.M.; Fradeani, D.; Scerrati, M.

    2016-01-01

    SUMMARY We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours. Pre- and postoperative neuroradiological evaluation was always obtained by magnetic resonance imaging (MRI), computed tomographic (CT) scanning and dynamic cranio-vertebral junction x-ray. Pre- and postoperative neurologic disability assessment was obtained by Ranawat classification for patients with rheumatoid arthritis and by Nurick classification for the others. At a mean follow-up of 31 months (range: 14-73 months), an improvement of at least one Ranawat or Nurick classification level was observed in 6 patients, while in another 4 patients neurological conditions were stable. Radiological follow-up revealed an adequate bulbo-medullary decompression in all patients and a regular bone fusion in cases of C1 and/or C2 fractures. In all patients spinal stability was preserved and none required subsequent posterior fixation. The endoscopic endonasal surgery provided adequate exposure and a low morbidity minimally invasive approach to the antero-medial located lesions of the CCJ, resulting in a safe, effective and well-tolerated procedure. This approach allowed preservation of the anterior C1 arch and the avoidance of a posterior fixation in all patients of this series, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial

  4. Reconstrução anatômica do LCA com duplo feixe: primeiros 40 casos Anatomical ACL reconstruction with double bundle: first 40 cases

    Directory of Open Access Journals (Sweden)

    Ari Zekcer

    2011-01-01

    Full Text Available OBJETIVO: Discutir a técnica de reconstrução anatômica do ligamento cruzado anterior (LCA com duplo feixe, a curva de aprendizado e os resultados preliminares. MÉTODOS: Quarenta pacientes com lesão do LCA foram submetidos à reconstrução anatômica com duplo feixe, utilizando-se do tendão semitendinoso para refazer a banda anteromedial (AM e gracilis para refazer a banda posterolateral (PL do joelho. RESULTADOS: Tivemos dois casos de limitação de extensão, sendo que em um deles foi necessária a realização de artrólise artroscópica, e um caso de trombose venosa profunda. CONCLUSÃO: A reconstrução do LCA com duplo feixe se mostrou factível, apesar de apresentar uma maior curva de aprendizado; e as vantagens da técnica proposta ainda deverão ser comprovadas se comparada com a técnica de feixe único.OBJECTIVE: To discuss the technique of anatomical reconstruction of the anterior cruciate ligament (ACL with double beam, the learning curve and preliminary results. METHODS: Forty patients with ACL injury underwent reconstruction with anatomical double-bundle, using the semitendinosus tendon to remake the band anterior medial (AM and gracile to remake the band posterior lateral (PL of the knee. RESULTS: We had two cases of limitation of extension, and in one of them were necessary to perform arthroscopic artrolise, and one case of deep vein thrombosis. CONCLUSION: ACL reconstruction with double bundle proved feasible, despite having a higher learning curve, and the advantages of the proposed technique still must be proven compared to the single-beam technique.

  5. Pattern of regional cortical thinning associated with cognitive deterioration in Parkinson's disease.

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    Javier Pagonabarraga

    Full Text Available BACKGROUND: Dementia is a frequent and devastating complication in Parkinson's disease (PD. There is an intensive search for biomarkers that may predict the progression from normal cognition (PD-NC to dementia (PDD in PD. Mild cognitive impairment in PD (PD-MCI seems to represent a transitional state between PD-NC and PDD. Few studies have explored the structural changes that differentiate PD-NC from PD-MCI and PDD patients. OBJECTIVES AND METHODS: We aimed to analyze changes in cortical thickness on 3.0T Magnetic Resonance Imaging (MRI across stages of cognitive decline in a prospective sample of PD-NC (n = 26, PD-MCI (n = 26 and PDD (n = 20 patients, compared to a group of healthy subjects (HC (n = 18. Cortical thickness measurements were made using the automatic software Freesurfer. RESULTS: In a sample of 72 PD patients, a pattern of linear and progressive cortical thinning was observed between cognitive groups in cortical areas functionally specialized in declarative memory (entorhinal cortex, anterior temporal pole, semantic knowledge (parahippocampus, fusiform gyrus, and visuoperceptive integration (banks of the superior temporal sulcus, lingual gyrus, cuneus and precuneus. Positive correlation was observed between confrontation naming and thinning in the fusiform gyrus, parahippocampal gyrus and anterior temporal pole; clock copy with thinning of the precuneus, parahippocampal and lingual gyrus; and delayed memory with thinning of the bilateral anteromedial temporal cortex. CONCLUSIONS: The pattern of regional decreased cortical thickness that relates to cognitive deterioration is present in PD-MCI patients, involving areas that play a central role in the storage of prior experiences, integration of external perceptions, and semantic processing.

  6. Orbitofrontal cortex function and structure in depression.

    Science.gov (United States)

    Drevets, Wayne C

    2007-12-01

    The orbitofrontal cortex (OFC) has been implicated in the pathophysiology of major depression by evidence obtained using neuroimaging, neuropathologic, and lesion analysis techniques. The abnormalities revealed by these techniques show a regional specificity, and suggest that some OFC regions which appear cytoarchitectonically distinct also are functionally distinct with respect to mood regulation. For example, the severity of depression correlates inversely with physiological activity in parts of the posterior lateral and medial OFC, consistent with evidence that dysfunction of the OFC associated with cerebrovascular lesions increases the vulnerability for developing the major depressive syndrome. The posterior lateral and medial OFC function may also be impaired in individuals who develop primary mood disorders, as these patients show grey-matter volumetric reductions, histopathologic abnormalities, and altered hemodynamic responses to emotionally valenced stimuli, probabilistic reversal learning, and reward processing. In contrast, physiological activity in the anteromedial OFC situated in the ventromedial frontal polar cortex increases during the depressed versus the remitted phases of major depressive disorder to an extent that is positively correlated with the severity of depression. Effective antidepressant treatment is associated with a reduction in activity in this region. Taken together these data are compatible with evidence from studies in experimental animals indicating that some orbitofrontal and medial prefrontal cortex regions function to inhibit, while others function to enhance, emotional expression. Alterations in the functional balance between these regions and the circuits they form with anatomically related areas of the temporal lobe, striatum, thalamus, and brain stem thus may underlie the pathophysiology of mood disorders, such as major depression.

  7. Altered brain processing of decision-making in healthy first-degree biological relatives of suicide completers.

    Science.gov (United States)

    Ding, Y; Pereira, F; Hoehne, A; Beaulieu, M-M; Lepage, M; Turecki, G; Jollant, F

    2016-12-13

    Suicidal behavior is heritable, with the transmission of risk being related to the transmission of vulnerability traits. Previous studies suggest that risky decision-making may be an endophenotype of suicide. Here, we aimed at investigating brain processing of decision-making in relatives of suicide completers in order to shed light on heritable mechanisms of suicidal vulnerability. Seventeen healthy first-degree biological relatives of suicide completers with no personal history of suicidal behavior, 16 relatives of depressed patients without any personal or family history of suicidal behavior, and 19 healthy controls were recruited. Functional 3 T magnetic resonance imaging scans were acquired while participants underwent the Iowa Gambling Task, an economic decision-making test. Whole-brain analyses contrasting activations during risky vs safe choices were conducted with AFNI and FSL. Individuals with a family history of suicide in comparison to control groups showed altered contrasts in left medial orbitofrontal cortex, and right dorsomedial prefrontal cortex. This pattern was different from the neural basis of familial depression. Moreover, controls in comparison to relatives showed increased contrast in several regions including the post-central gyrus, posterior cingulate and parietal cortices, and cerebellum (culmen) in familial suicide; and inferior parietal, temporal, occipital, anteromedial and dorsolateral prefrontal cortices, and cerebellum (vermis) in familial depression. These findings most likely represent a complex combination of vulnerability and protective mechanisms in relatives. They also support a significant role for deficient risk processing, and ventral and dorsal prefrontal cortex functioning in the suicidal diathesis.Molecular Psychiatry advance online publication, 13 December 2016; doi:10.1038/mp.2016.221.

  8. Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

    Science.gov (United States)

    Kiekara, Tommi; Paakkala, Antti; Suomalainen, Piia; Huhtala, Heini; Järvelä, Timo

    2017-01-01

    Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results. PMID:28203605

  9. Distal tibial fracture: An ideal indication for external fixation using locking plate

    Institute of Scientific and Technical Information of China (English)

    Jing-wei Zhang; Nabil A.Ebraheim; Ming Li; Xian-Feng He; Joshua Schwind; Li-Mei Zhu; Yi-Hui Yu

    2016-01-01

    Objective:To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures.Methods:In this non-control prospective study,28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate.There were 21 males and 7 females,with a mean age of 43 years (19-63).According to AO/OTA fracture classification,there were 9 cases of Type A1,9 of Type A2,10 of Type A3 fractures.There were 21 close and 7 open fractures.The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal metaphysis and diaphysis.The radiographic and clinic results were evaluated.Results:All patients were followed up for the average of 16 months (ranging from 12 to 21 months).The average surgery duration was 38 (25-60) minutes.The mean time to fracture healing were 14.6 ± 2.67,17.5 ± 3.66,and 18.4 ± 3.37 (p < 0.05) weeks in type A1,A2,and A3 fractures respectively.By the end of the follow-ups,the mean AOFAS score were 96.11 ± 2.32,92.67 ± 1.80 and 92.00 ± 2.06 (p > 0.05) in type A1,A2,and A3 fractures respectively.None of nonunion,deep infection,or breakage of screw or plate were observed.Conclusions:Distal tibial fracture was the ideal indication for external fixation using locking plate.The external plating is characterized by ease of performance,less invasive,fewer soft tissue impingement,improved cosmesis,and convenient for removal.

  10. Characterization of cognitive deficits in rats overexpressing human alpha-synuclein in the ventral tegmental area and medial septum using recombinant adeno-associated viral vectors.

    Directory of Open Access Journals (Sweden)

    Hélène Hall

    Full Text Available Intraneuronal inclusions containing alpha-synuclein (a-syn constitute one of the pathological hallmarks of Parkinson's disease (PD and are accompanied by severe neurodegeneration of A9 dopaminergic neurons located in the substantia nigra. Although to a lesser extent, A10 dopaminergic neurons are also affected. Neurodegeneration of other neuronal populations, such as the cholinergic, serotonergic and noradrenergic cell groups, has also been documented in PD patients. Studies in human post-mortem PD brains and in rodent models suggest that deficits in cholinergic and dopaminergic systems may be associated with the cognitive impairment seen in this disease. Here, we investigated the consequences of targeted overexpression of a-syn in the mesocorticolimbic dopaminergic and septohippocampal cholinergic pathways. Rats were injected with recombinant adeno-associated viral vectors encoding for either human wild-type a-syn or green fluorescent protein (GFP in the ventral tegmental area and the medial septum/vertical limb of the diagonal band of Broca, two regions rich in dopaminergic and cholinergic neurons, respectively. Histopathological analysis showed widespread insoluble a-syn positive inclusions in all major projections areas of the targeted nuclei, including the hippocampus, neocortex, nucleus accumbens and anteromedial striatum. In addition, the rats overexpressing human a-syn displayed an abnormal locomotor response to apomorphine injection and exhibited spatial learning and memory deficits in the Morris water maze task, in the absence of obvious spontaneous locomotor impairment. As losses in dopaminergic and cholinergic immunoreactivity in both the GFP and a-syn expressing animals were mild-to-moderate and did not differ from each other, the behavioral impairments seen in the a-syn overexpressing animals appear to be determined by the long term persisting neuropathology in the surviving neurons rather than by neurodegeneration.

  11. An extrahippocampal projection from the dentate gyrus to the olfactory tubercle

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    Künzle Heinz

    2005-05-01

    Full Text Available Abstract Background The dentate gyrus is well known for its mossy fiber projection to the hippocampal field 3 (CA3 and its extensive associational and commissural connections. The dentate gyrus, on the other hand, has only few projections to the CA1 and the subiculum, and none have clearly been shown to extrahippocampal target regions. Results Using anterograde and retrograde tracer techniques in the Madagascan lesser hedgehog tenrec (Afrosoricidae, Afrotheria it was shown in this study that the dentate hilar region gave rise to a faint, but distinct, bilateral projection to the most rostromedial portion of the olfactory tubercle, particularly its molecular layer. Unlike the CA1 and the subiculum the dentate gyrus did not project to the accumbens nucleus. A control injection into the medial septum-diagonal band complex also retrogradely labeled cells in the dentate hilus, but these neurons were found immediately adjacent to the heavily labeled CA3, while the tracer injections into the rostromedial tubercle did not reveal any labeling in CA3. Conclusion The dentate hilar neurons projecting to the olfactory tubercle cannot be considered displaced cells of CA3 but represent true dentato-tubercular projection neurons. This projection supplements the subiculo-tubercular projection. Both terminal fields overlap among one another as well as with the fiber terminations arising in the anteromedial frontal cortex. The rostromedial olfactory tubercle might represent a distinct ventral striatal target area worth investigating in studies of the parallel processing of cortico-limbic information in tenrec as well as in cat and monkey.

  12. [Anterior cruciate ligament-plasty using the "U-dos" technique].

    Science.gov (United States)

    Morales-Trevizo, C; Paz-García, M; Leal-Berumen, I; Leal-Contreras, C; Berumen-Nafarrate, E

    2013-01-01

    The knee is a compound diarthrodial joint, vulnerable to serious injuries such as ligament injuries of: medial collateral ligament, lateral collateral ligament, anterior cruciate ligament and posterior cruciate ligament, as cruciate ligaments limit rotation movement in the joint. The purpose of our study was to create a new technique to treat injuries of the anterior cruciate ligament, which is composed of two bundles--anteromedial and posterolateral--trying to achieve an anatomical reconstruction that allows for a normal biomechanical recovery. This technique reduces the use of fixation material and costs. The diagnosis of anterior cruciate ligament injuries was made with the pivot shift test. There are currently two repair methods for anterior cruciate ligament injuries: single bundle or double bundle repair; none of these techniques is considered as the gold standard, as their results are very similar. This paper describes a technique used for the treatment of anterior cruciate ligament injuries, known as "U-dos", and its clinical results. Cross-sectional, observational study that enrolled 20 patients with total anterior cruciate ligament injuries who underwent anterior cruciate ligament plasty using the "U-dos" technique between June 2009 and June 2010. The technique requires the use of bone bank allograft, in this case of the anterior tibial ligament. Patients were assessed using the Lysholm scale and the pivot shift test. Our results show that all the pivot shift tests were negative and assessments according to the Lysholm scale were from normal to excellent in 95% of cases (19/20). Only one failure was reported, with avulsion of the graft attachment which required a surgical intervention.

  13. Anterior cruciate ligament reconstruction with double bundle versus single bundle: experimental study Reconstrução do ligamento cruzado anterior com duplo feixe versus feixe único: estudo experimental

    Directory of Open Access Journals (Sweden)

    Roberto F. Mota e Albuquerque

    2007-01-01

    Full Text Available OBJECTIVE: To test an intra-articular reconstruction of the anterior cruciate ligament of the knee in 10 human cadavers by replacing 2 anterior cruciate ligament bundles, with the purpose of producing a surrogate that would be structurally more similar to the anatomy of the anterior cruciate ligament and would provide the knee with more stability. METHODS: We reconstructed the anteromedial and posterolateral bundles using a quadriceps muscle tendon graft that included a patellar bone segment. The anteromedial bundle was replaced in 10 knees (5 right and 5 left knees from different cadavers by a quadriceps-bone tendon graft, and the anteromedial and posterolateral bundles were replaced in the matching pairs of these knees. In the latter, the bone segment was fixed to the tibia, and the tendinous portion of the graft was divided longitudinally creating two 5-mm wide bundles that were inserted individually into the femur through 2 independent bone tunnels. Then, the knees were tested mechanically to evaluate the tibial anterior dislocation in relation to the femur, as well as the rigidity of the graft. The control group was formed by the knees with intact anterior cruciate ligaments, before being resected to be reconstructed. RESULTS: The results obtained did not show superiority of double-bundle reconstruction over single-bundle reconstruction, and neither technique provided the knee with the same stability and rigidity of the intact anterior cruciate ligament. CONCLUSION: Our hypothesis, based on the anatomy and biomechanics of the knee, that reconstruction of the anterior cruciate ligament using 2 bundles would result in a more anatomic reconstruction and provide better containment of the anterior tibial translation was not supported by the results of this study.OBJETIVO: Testar uma técnica de reconstrução intra-articular do ligamento cruzado anterior do joelho em 10 cadáveres humanos com substituição de dois feixes do ligamento cruzado

  14. 超声在产前诊断胎儿颅脑疾病中的应用%Application of ultrasonography in screening the defects of fetal brain and skull

    Institute of Scientific and Technical Information of China (English)

    焦光琼; 徐惠英; 洪向丽; 殷舫; 谭晶

    2010-01-01

    Objective To explore the application of three-dimensional (3D) ultrasonography in screening the defects of fetal brain and skull.Methods Thirty-one cases of the fetal were detected in 3D ultrasonography.The ultrasonic data were compared with magnetic resonance imaging(MRI) and pathology.Results Among 31 cases according to 3D ultrasonography,there were 2 of anencephaly, 1 of exencephaly,2 of encephalocele,5 of holoprosencephaly,2 of arachnoidcyst, 1 of vein of Galen aneurysm,2 of agenesis of the corpus callosum, 1 of schizencephaly, 3 of Dandy-Walker syndrome, 7 of ventriculomegaly, and 5 of enlargement of cisterna magna.Compared with the results of MRI,the diagnostic accordance rate was 100% by 3D,it was 93.5% by 2D.Conclusions The structure of fetal brain and skull were viewed more clearly in 3D ultrasonography than 2D ultrasonography and the defects of fetal brain and skull can screened more exactly.%目的 探讨超声检查在产前诊断胎儿颅脑疾病中的应用价值.方法 对31例患胎儿颅脑疾病孕妇行二维超声、三维超声、磁共振检查,并与病理结果对照分析.结果 31例胎儿超声提示2例无脑儿,1例露脑,2例脑膨出,5例全前脑,2例蛛网膜囊肿,1例Galen静脉瘤,2例胼胝体发育不全,1例脑裂,3例Dandy-Walker畸形,7例侧脑室扩张,5例颅后窝池增宽,通过磁共振检查核对,三维超声诊断符合率100%,二维超声诊断符合率93.5%.结论 超声检查在胎儿颅脑疾病中有很高价值,三维超声比二维超声检查更直观.

  15. Value of lateral ventricle and cerebellum plane scanning in diagnosis of fetal midline structure abnormalities%侧脑室及小脑平面对胎儿神经系统中线结构畸形的诊断价值

    Institute of Scientific and Technical Information of China (English)

    符忠蓬; 林如; 戴蓓蓓; 谢梦; 黄晓微; 任芸芸; 严英榴; 孙莉; 孔凡斌; 赵蔚; 姚英; 胡雁来; 曹丽

    2015-01-01

    Objective:To evaluate the value of the lateral ventricle and cerebellum plane scanning in the diagnosis of fetal central nerve system (CNS) midline structure abnormalities. Methods:Ultrasound imaging features of 97 fetuses with fetal CNS midline structure abnormalities from 3 921 abnormal fetuses were analyzed retrospectively. Results: Among the 97 fetuses, there were 9 cases of encephalocele, 7 cases of anencephaly, 4 cases of meningocele, 11 cases of transparent septum widened, 16 cases of complete agenesis of the corpus callosum (ACC), 15 cases of partial ACC, 15 cases of holoprosencephaly, 4 cases of arachnoid cyst, 10 cases of Dandy-Walker malformation, 4 cases of malformation Arnold-Chiari typeⅡ, and 2 cases of vein of Galen aneurysm malformation. Conclusion: The lateral ventricle and cerebellum plane scanning is a safe, liable, practical and quick method to diagnose the fetal CNS midline structure abnormalities.%目的:探讨在产前常规超声检查中,侧脑室及小脑平面对胎儿中枢神经系统中线结构畸形的诊断价值。方法:从复旦大学附属妇产科医院3921例畸形胎儿中选出97例中枢神经系统中线结构畸形胎儿,对其声像图特征进行回顾性分析。结果:产前超声诊断胎儿中枢神经系统中线结构畸形97例,其中脑膜脑膨出9例、无脑儿7例、脑膜膨出4例、透明隔腔增宽11例、完全型胼胝体缺失(ACC)16例、部分型ACC 15例、全前脑15例、蛛网膜下腔囊肿4例、Dandy-Walker畸形10例、Arnold-Chiari畸形Ⅱ型4例、Galen静脉瘤2例。结论:胎儿侧脑室平面及小脑平面的超声检查安全有效、方便快捷,是胎儿中枢神经系统畸形筛查最常用的切面,对胎儿中枢神经系统中线结构畸形检出率高。

  16. Resection of Ethmoidal Sinus Tumors Invading Anterior Skull Base%侵犯前颅底的筛窦肿瘤切除

    Institute of Scientific and Technical Information of China (English)

    沈志森; 谢光天; 李幼珍; 龚晓放; 成立新

    2000-01-01

    目的:探讨侵犯前颅底筛窦肿瘤的手术方式及前颅底重建的方法.方法:对1994~1998年间的4例侵犯前颅底的筛窦肿瘤采用额骨硬脑膜外进路颅面联合手术,分别用带蒂额骨膜瓣或帽状腱膜瓣及颅骨内板结合耳脑胶重建前颅底.结果:4例创口一期愈合,均未见脑脊液鼻漏及脑膜脑膨出,1例术后出现一过性尿崩症,1例术后视力提高,术后随访半年至5年,4例均存活.结论:额骨硬脑膜外入路颅面联合手术是切除侵犯前颅底筛窦肿瘤的有效方法,带蒂额骨膜瓣或帽状腱膜瓣与颅骨内板结合重建前颅底可有效地防止脑脊液鼻漏及脑膜脑膨出.%Objective:The surgical method of ethmoidal sinus tumors invading anterior skull base and it'a rehibilitation arestudied. Methods:4 cases of patients with ethmoidal sinus neoplasms were operated of frontal bone. The anterior skull basewas rehibilitated with the flaps of frontal bone and membrane,caplike tendinous membrane, interior plate of skull boneand ECear-beadadhesive respectively. Results:There were no complication of cerebrospinal rhinorrhea and meningo-encephalocele in 4Cases. The temporary diabetes iuspidus took place in one case during 12 days postoperatively. There was enhancement of theeyesight in 1 Case. All these patients were alive after followed-up for 0.5~5 years. Conelusion:the combined intracranial facialresection by the way of frontal bone is the effective therapeutic methed of the ethmoidal sinus tumors invading anterior skullbase. The flaps of frontal bone membrane, Caplike tendinous membrane, interior plate of skull bone and ECadhesive are better materials for the reparation of anterior skull bese.

  17. ANALYSIS OF NEURAL TUBE DEFECT AND RELATIVE FACTORS THROUGH PRENATAL ULTRASONOGRAPHIC SCREENING%超声诊断胎儿神经管畸形及其相关发病因素分析

    Institute of Scientific and Technical Information of China (English)

    王欣业; 任雁林; 李采青; 王义成; 温德惠

    2011-01-01

    Objective To investigate peripartum women having babies with neural tube defects by ultrasound diagnoses and to explore its influence factors. Methods The questionnaire was conducted for 89 peripartum women having babies with neural tube defects by ultrasound diagnoses during 2005 to 2009 in our hospital, and its influence factors were analyzed. Results Of the investigated women who had babies with neural tube defects, hydrocephalus with spina bifida was 37 cases, spina bifida 5 cases,encephalocele 9 cases, uncover brain abnormalities and anencephalus 28 cases, and anencephalus with spina bifida 10 cases. Pregnancy season, diet habit and different demographic characteristics were related with the neural tube defects. Conclusion It is necessary to give up unhealthy diet habit and pay attention to strengthen nutrition, supplement folic acid regularly in order to prevent neural tube defects.%目的 通过超声检查和流行病调查了解胎儿神经管畸形分类,分析其相关发病因素.方法 回顾性分析2005-2009年超声筛查确诊为胎儿神经管畸形89例,进行问卷调查,材料汇总,对比分析.结果 胎儿神经管畸形89例,其中脑积水合并脊柱裂 37例,脊柱裂5例,脑膨出 9 例,露脑畸形和无脑儿28例,无脑儿合并脊柱裂10例.神经管畸形发病因素与孕妇受孕季节、生活饮食习惯及人口学特征等密切相关.结论 改变不合理生活饮食习惯,孕期加强营养,按时服用叶酸增补剂可预防神经管畸形发生.

  18. Prevalence of birth defects and risk-factor analysis from a population-based survey in Inner Mongolia, China

    Directory of Open Access Journals (Sweden)

    Zhang Xingguang

    2012-08-01

    Full Text Available Abstract Background Birth Defects are a series of diseases that seriously affect children's health. Birth defects are generally caused by several interrelated factors. The aims of the article is to estimate the prevalence rate and types of birth defects in Inner Mongolia, China, to compare socio-demographic characteristics among the children with birth defects and to analyze the association between risk factors and birth defects. Methods Data used in this study were obtained through baseline survey of Inner Mongolia Birth Defects Program, a population-based survey conducted from 2005 to 2008. The survey used cluster sampling method in all 12 administrative districts of Inner Mongolia. Sampling size is calculated according to local population size at a certain percentage. All live births, stillbirths and abortions born from October 2005 to September 2008, whose families lived in Inner Mongolia at least one year, were included. The cases of birth defects were diagnosed by the clinical doctors according to their experiences with further laboratory tests if needed. The inclusion criteria of the cases that had already dead were decided according to death records available at local cites. We calculated prevalence rate and 95% confidence intervals of different groups. Outcome variable was the occurrence of birth defects and associations between risk factors and birth defects were analyzed by using Poisson regression analysis. Results 976 children with birth defects were diagnosed. The prevalence rate of birth defects was 156.1 per 10000 births (95%CI: 146.3-165.8. The prevalence rate of neural tube defect (20.1 per 10000 births including anencephaly(6.9 per 10000, spina bifida (10.6 per 10000, and encephalocele (2.7 per 10000 was the highest, followed by congenital heart disease (17.1 per 10000. The relative risk (RR for maternal age less than 25 was 2.22 (95%CI: 2.05, 2.41. The RR of the ethnic Mongols was lower than Han Chinese (RR: 0.84; 95%CI: 0

  19. Trisomy 2p: Analysis of unusual phenotypic findings

    Energy Technology Data Exchange (ETDEWEB)

    Lurie, I.W.; Ilyina, H.G.; Gurevich, D.B. [Belorussian Research Institute of Hereditary Disease, Minsk (Russian Federation)] [and others

    1995-01-16

    We present three probands with partial trisomies 2p21-23 due to ins(4;2)(q21;p21p23) pat, 2p23-pter due to t(2;4)(p23;q35)mat, and 2p21-pter due to t(2;11)(p21;q23.3)mat. More than 50 cases of partial trisomy 2p have been reviewed and some abnormalities, unusual for most other types of structural autosomal imbalance, have been found in patients with inherited forms of 2p trisomy and in their non-karyotyped sibs. Neural tube defects (anencephaly, occipital encephalocele, and spina bifida) were found in five probands and 4/6 affected non-karyotyped sibs. The only triplicated segment common to all was 2p24. Different forms of {open_quotes}broncho-pulmonary a/hypoplasia{close_quotes} (including two cases of lung agenesis) were described in four patients (overlapping triplicated segment was 2p21-p25). Three patients (with overlapping triplicated segment 2p23-p25) had diaphragmatic hernia. Abnormal rotation of the heart or L-transposition of large vessels (with or without visceral heterotaxia) was found in two infants (overlapping triplicated segment 2p23-p24). In two patients with common triplicated segment 2p22.3-p25, neuroblastoma has been described. The occurrence of all these defects may be explained either by the action of the same gene(s) mapped to 2p24 or by action of some independent factors located in different segments of the short arm. Although the latter hypothesis is much less probable, it can not be rejected at the present time. We propose the existence of a genetic system controlling surveillance of an abnormal embryo to explain the phenotypic differences between patients with the same imbalance within a family. In some {open_quotes}restrictive{close_quotes} combinations the abnormal embryos will die, although in {open_quotes}permissive{close_quotes} combinations they can survive. 47 refs., 2 figs., 3 tabs.

  20. Application of emergent drilling on the skull bone and sequential dural incision to surgery for especially severe brain injury accompained with cerebral hernia%紧急钻颅及顺序硬脑膜剪开术治疗特重型颅脑损伤伴脑疝

    Institute of Scientific and Technical Information of China (English)

    林友城; 严国凤; 苏肇植; 丁国榕; 黄瑞宏

    2011-01-01

    Objective To explore the method to prevent the acute encephalocele during the surgery for especially severe brain injury (ESBI) accompanied with cerebral hernia. Methods Of 40 patients with ESBI compained with cerebral hernias, 21 were treated by emergent drilling on the skull bone for the evaculation of extradural hematomas, sequential dural incision (SDI) for the controllable and gradual decompression and standard decompressive craniectomy (observed group) and 19 by the standard decompressive craniectomy (control group). Results The occurrent rate of intraoperative acute encephalocele (23.8%, 5/21) was significantly lower in the observed group than that (73.7%, 14/19) in the control group (P<0.05). The dilated pupils returned to normal in 8 patients, were partly recovered in 11 and unchanged in 2 in the observed group during the surgery, when the dilated pupils returned to normal in 3 patients, were partly recovered in 5 and unchanged in 11 in the control group. The rate of the dilated pupils recovery (90.5%, 19/21) was significantly higher in the observed group than that (42.1%, 8/19) in the control group (P<0.01). Of 21 patients in the ovbserved group, 15 were recovered well or moderately disabled and 6 severely disabled or vegetative survivor or died 6 months after the surgery, when 5 were recovered well or moderately disabled and 14 severely disabled or vegetative survivor or died in the control group. The rate of recovery and moderate disability (71.4%, 15/21) was significantly higher in the observed group than that (26.3%, 5/19) in the control group (P<0.05). Conclusion The application of emergent drilling on the skull bone for the evaculation extradural hematomas and SDI to the surgery, which is helpful to improving the prognosis, is a good method to treat the patients with ESBI accompained with cerebral hernias.%目的 探讨联合应用紧急钻颅和顺序硬脑膜剪开术治疗特重型颅脑损伤伴颅内血肿、脑挫

  1. Three-dimensional finite element analysis of unstable intertrochanteric fracture in different fixation ways%不稳定股骨转子间骨折不同内固定方式的三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    陈少明; 邱玉金; 卢斌; 杨志强; 王宝九; 冯振东

    2016-01-01

    优缺点,可以根据需要选择合适的内固定装置。%BACKGROUND:The morphological and mechanical transfers of unstable intertrochanteric fractures were complicated, so it is difficult to analyze the biomechanical characteristicsof the common experimental methods in a comprehensive way. Moreover, the high cost, long cycle and poor repeatability of common tests limit its application in biomechanics. OBJECTIVE:To analyze the biomechanical characteristics of unstable intertrochanteric fracture in different fixation ways by three-dimensional finite element analysis. METHODS:Intertrochanteric fracture locking dynamic hip fixation model (C1), Gamma nail fixation model (C2) and proximal femoral anatomical locking plate model (C3) were established. The distal end of the femur was fixed, and subjected to the hip reaction force of 2800 N and abduction muscle strength of 1 200 N. Three-dimensional finite element analysis was used to analyze the stress distribution, stress concentration and maximum displacement of unstable intertrochanteric fracture in three different fixation ways. RESULTS AND CONCLUSION:(1) Stress: the anterolateral stress and anteromedial stress of C3 were the maximum. Posterolateral stress and posteromedial stress ofC3 were the minimum. There were significant differences among the three groups (alP< 0.05). (2) Stress of fracture space: significant differences in anterolateral stress, anteromedial stress, posterolateral stress and posteromedial stress were determined in C1, C2 and C3 (P< 0.05). Anterolateral stress of C3 was significantly less than anterolateral stresses of C1 and C2 (P< 0.05). Anteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). Posterolateral stress of C1 was significantly larger than that of C2 and C3 (P<0.05). Posteromedial stress of C1 was significantly larger than that of C2 (P< 0.05). Posteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). (3) Significant differences

  2. 前交叉韧带方位角变化的解剖学测量研究%Anatomical Study of the ACL Azimuth Angle Change

    Institute of Scientific and Technical Information of China (English)

    罗令; 孙晓峰; 张杰; 刘洋波; 禹晓东; 黄文华

    2015-01-01

    目的:探讨前交叉韧带(anterior cruciate ligament,ACL)在膝关节不同屈曲角度时的方位角变化,为ACL损伤诊断和重建研究提供解剖学支持.方法:成人膝关节标本10具,解剖观察ACL形态,用Photoshop软件测量膝关节不同屈曲角度下ACL方位角变化.结果:0°、30°位膝关节中ACL胫骨角大于ACL股骨角,有显著性差异(P<0.01);60°、90°位膝关节中的ACL胫骨角小于股骨角,有显著性差异(P<0.01).膝关节0°、30°、60°、90°ACL胫骨角由大渐小,各角度间均有显著性差异(均P<0.01).膝关节0°和30°的ACL股骨角比60°和90°时小,有显著性差异(均P<0.01),0°与30°间无显著性差异(P>0.05),60°小于90°,有显著性差异(P<0.01).结论:ACL于膝关节0°和30°位时,后外侧束(posterolateral bundle,PLB)发挥主要作用,ACL诊断或重建主要参考胫骨角;60°、90°时ACL前内侧束(anteromedial bundle,AMB)发挥主要作用,ACL诊断或重建主要参考股骨角.ACL方位角可作为ACL损伤诊断和手术重建的重要参考.

  3. Bone tunnel diameter measured with CT after anterior cruciate ligament reconstruction using double-bundle auto-hamstring tendors: Clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Soo Jeong; Yoon, Young Cheol; Bae, So Young; Wang, Joon Ho [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    To evaluate the correlation between bone tunnel diameter after anterior cruciate ligament (ACL) reconstruction measured by computed tomography (CT) using multiplanar reconstruction (MPR) and stability or clinical scores. Forty-seven patients (41 men and 6 women, mean age: 34 years) who had undergone ACL reconstruction with the double bundle technique using auto-hamstring graft and had subsequently received CT scans immediately after the surgery (T1: range, 1-4 days, mean, 2.5 days) and at a later time (T2: range, 297-644 days, mean, 410.4 days) were enrolled in this study. The diameter of each tunnel (two femoral and two tibial) at both T1 and T2 were independently measured using MPR technique by two radiologists. Stability and clinical scores were evaluated with a KT-2000 arthrometer, International Knee Documentation Committee objective scores, and the Lysholm score. Statistical analysis of the correlation between the diameter at T2 or the interval diameter change ratio ([T2 - T1] / T1) and clinical scores or stability was investigated. The tibial bone tunnels for the anteromedial bundles were significantly widened at T2 compared with T1 (observer 1, 0.578 mm to 0.698 mm, p value of < 0.001; observer 2, 0.581 mm to 0.707 mm, p value of < 0.001). There was no significant correlation between the diameter at T2 and stability or clinical scores and between the interval change ratio ([T2 - T1] / T1) and stability or clinical scores (corrected p values for all were 1.0). Intraobserver agreement for measurements was excellent (> 0.8) for both observers. Interobserver agreement for measurement was excellent (> 0.8) except for the most distal portion of the femoral bone tunnel for anterior medial bundle in immediate postoperative CT, which showed moderate agreement (concordance correlation coefficient = 0.6311).Neither the diameter nor its change ratio during interval follow-up is correlated with stability or clinical scores.

  4. Characterization of muscular involvement in patients with Duchenne muscular dystrophy by magnetic resonance imaging%Duchenne型肌营养不良症患者肌肉磁共振成像特征的演变

    Institute of Scientific and Technical Information of China (English)

    陈维; 冯善伟; 冯慧宇; 张成

    2014-01-01

    目的 研究Duchenne肌营养不良症(Duchenne muscular dystrophy,DMD)患者随疾病发展肌肉受累的顺序及程度.方法 用多重连接依赖性探针扩增技术(multiplex ligation-dependent probeamplification,MLPA)检测患者dystrophin基因的突变情况.采用磁共振成像(magnetic resonanceimaging,MRI)对患者双侧大腿肌肉进行扫描并分析图像.结果 MLPA检测发现6例患者均携带dystrophin基因的缺失或重复突变.DMD患者肌肉受累的顺序依次为:臀大肌、大收肌、股四头肌、股直肌和股二头肌,而半膜肌、半腱肌、缝匠肌、股薄肌选择性受累,程度依次减轻.结论 MRI检查可以客观地反映DMD患者骨骼肌受累的顺序、范围和程度,并且反映不同阶段受损骨骼肌的病理改变,可能成为检查和诊断的重要手段.患者病情的严重程度与突变性质无明显关联.%Objective To study the order and degree of muscular affection in patients with Duchenne muscular dystrophy (DMD) during the course of disease.Methods Multiplex ligation dependent probe amplification (MLPA) was used to detect potential mutation of dystrophin gene.Magnetic resonance imaging (MRI) was used to scan the anteromedial aspect of thigh muscles.Results All of the 6 patients were found to have deletion or duplication mutations.The order of affection has been gluteus maximus,adductor magnus,quadriceps femoris,rectus femoris and biceps muscle of the thigh,while semimembranous muscle,semitendinosus,sartorius muscle and musculus gracilis are selectively affected and in a decreasing order.Conclusion MRI can reflect the order,extent and degree of skeletal muscle involvement in patients with DMD,and can reflect pathological changes of damaged skeletal muscle at each stage,which may provide an important means for patient examination and diagnosis.No apparent correlation between the severity of disease and the nature of mutations was noted.

  5. 特发性髁突吸收的颞下颌关节锥形束CT分析%Investigation on radiographic signs of temporomandibular joint in the idiopathic condylar resorption with cone beam computed tomography

    Institute of Scientific and Technical Information of China (English)

    欧发荣; 郑有华; 王剑宁; 张志光

    2014-01-01

    目的利用特发性髁突吸收(ICR)患者的锥形束CT(CBCT)资料,探讨其颞下颌关节的变化。方法对39例ICR患者及28例正常人行颞下颌关节的CBCT扫描,测量颞下颌关节结构的各相关指标,并进行统计学分析。结果 ICR组与正常组间髁突内外径、前后径、水平角、关节结节斜度、关节上间隙等测量指标之间的差异均有统计学意义(P=0.000),表现为ICR组的髁突内外径、前后径、结节斜度、关节上间隙等减小,水平角则增大。结论 ICR的影像学主要表现是髁突的变小、前斜面的吸收、结节斜度的降低,同时髁突有往前内旋转和往上移动的趋势,这些指标可用来评估ICR的进展、疗效及预后。%Objective Study the radiological change of temporomandibular joint (TMJ) in the idiopathic condylar resorption (ICR) with cone beam computed tomography (CBCT) data. Methods Thirty-nine patients with idiopathic condylar resorption and 28 volunteers without TMJ disorders were underwent CBCT examinations. Then the parameters of condyle-fossa relationship were assessed and statistically analyzed. Results Significantly statistical difference between the ICR group and normal group were detected in condylar medial-lateral distance, anteroposterior distance, articular eminence inclination, and joint space. Conclusions Shortened condyle, resorption of former cant, reduced articular eminence inclination, and an upward-moved and anteromedially-rotated condyle are good indicators for assessing ICR development and its treatment effect and prognosis .

  6. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    Science.gov (United States)

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  7. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments.

    Science.gov (United States)

    Franklyn, Melanie; Oakes, Barry

    2015-09-18

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  8. Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair

    Directory of Open Access Journals (Sweden)

    Maffulli Nicola

    2008-06-01

    Full Text Available Abstract Background Rotator cuff tears are frequently associated with pathologies of the long head of the biceps tendon (LHBT. Tenotomy and tenodesis of the LHBT are commonly used to manage disorders of the LHBT. Methods We present an arthroscopic soft tissue LHBT tenodesis associated with a Roman Bridge (double pulley – suture bridges repair Results Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL, double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL, are placed in the medial aspect of the footprint. A shuttle is passed through an anterior point of the rotator cuff and through the LHBT by means of a Penetrator or a BirdBeak suture passer (Arthrex, Naples, FL. A tenotomy of the LHBT is performed. All the sutures from the anteromedial anchor are passed through a single anterior point in the rotator cuff using a shuttle technique. All the sutures from the posteromedial anchor are passed through a single posterior point in the rotator cuff. The sutures in the medial row are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. The two free suture limbs are then used to produce suture bridges over the tendon, using a Pushlock (Arthrex, Naples, FL, placed 1 cm distal to the lateral edge of the footprint. The same double pulley – suture bridges technique is repeated for the other two suture limbs from the two medial anchors. Conclusion This technique allows to perform a double pulley – suture bridges repair for a rotator cuff tear, associated with a soft tissue tenodesis for the management of LHBT pathology. The tenodesis of the LHBT is performed just with the passage of a shuttle inside the LHBT, after passing it through the anterior portion of the rotator cuff, with successive detachment of the LHBT from the

  9. P12.09MALIGNANT TUMORS OF ANTERIOR SKULL BASE: IS THE ROLE OF SURGERY ENHANCED IN THE ENDOSCOPY ERA?

    Science.gov (United States)

    Nasi, D.; Iacoangeli, M.; Dallari, S.; Salvinelli, F.; Dobran, M.; di Somma, L.; Colasanti, R.; Nocchi, N.; Vaira, C.; Scerrati, M.

    2014-01-01

    they expand, creating natural corridors for their resection via an antero-medial approach. The complementary information provided by endoscopy can assist the surgeon in safely extend the approach maximizing the extent of resection and decompression in hidden angles. Nonetheless, these minimal access approaches should be considered a complement to well-established open approaches, which are still necessary in most advanced tumors.

  10. Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report

    Directory of Open Access Journals (Sweden)

    Tajima Takuya

    2012-10-01

    Full Text Available Abstract Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy. We present herein a previously unreported anterior cruciate ligament (ACL reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An

  11. Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

    Energy Technology Data Exchange (ETDEWEB)

    Hayeri, Mohammad Reza [Children' s National Medical Center, Department of Radiology, Washington, DC (United States); Shiehmorteza, Masoud; Trudell, Debra J.; Resnick, Donald [University of California San Diego, Department of Radiology, San Diego, CA (United States); Hefflin, Tori [Museum of Man San Diego, San Diego, CA (United States)

    2010-09-15

    Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines. A total of 35 tibial bone specimens were evaluated for the degree of osteoarthritis and presence of eburnation. Each plateau was also divided into four quadrants and the presence and size of bone outgrowths were recorded in each quadrant. The ''medial/lateral tibial intercondylar spine index'' for each specimen was calculated as follows: (medial/lateral intercondylar tibial spine height)/(anteroposterior width of the superior tibial surface). The relationships between medial and lateral tibial height indexes with the degree of osteoarthritis were then tested. Osteophytes were observed more frequently in the anterior quadrants of both tibial plateaus than in the posterior quadrants (29 vs 16 for the medial tibial plateau [p = 0.01] and 28 vs 20 for the lateral tibial plateau [p = 0.04]). Eburnation was seen more frequently in the posterior regions of both tibial plateaus than in the anterior regions (17 vs 5, p < 0.01). In specimens with no signs of osteoarthritis the lateral intercondylar tibial index was significantly lower than that in specimens with some degree of osteoarthritis (p = 0.02). The medial intercondylar tibial index of the specimens with no signs of osteoarthritis was not significantly different from that of the specimens with some degree of osteoarthritis (p = 0.45). There was a positive correlation between the lateral spine height index and the overall grading of osteoarthritis, (r = 0.6, p < 0.01). In the anteromedial and posteromedial quadrants of the lateral tibial plateau, the association between the lateral

  12. The importance of early arthroscopy in athletes with painful cartilage lesions of the ankle: a prospective study of 61 consecutive cases

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    Riyami Masoud

    2006-09-01

    Full Text Available Abstract Background Ankle sprains are common in sports and can sometimes result in a persistent pain condition. Purpose Primarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. Secondly, in applicable cases, to evaluate the accuracy of MRI in detecting these injuries. Type of study: Prospective consecutive series. Methods Over around 4 years we studied 61 consecutive athletes with symptomatic chondral lesions to the talocrural joint causing persistent exertion ankle pain. Results 43% were professional full time athletes and 67% were semi-professional, elite or amateur athletes, main sports being soccer (49% and rugby (14%. The main subjective complaint was exertion ankle pain (93%. Effusion (75% and joint line tenderness on palpation (92% were the most common clinical findings. The duration from injury to arthroscopy for 58/61 cases was 7 months (5.7–7.9. 3/61 cases were referred within 3 weeks from injury. There were in total 75 cartilage lesions. Of these, 52 were located on the Talus dome, 17 on the medial malleolus and 6 on the Tibia plafond. Of the Talus dome injuries 18 were anteromedial, 14 anterolateral, 9 posteromedial, 3 posterolateral and 8 affecting mid talus. 50% were grade 4 lesions, 13.3% grade 3, 16.7% grade 2 and 20% grade 1. MRI had been performed pre operatively in 26/61 (39% and 59% of these had been interpreted as normal. Detection rate of cartilage lesions was only 19%, but subchondral oedema was present in 55%. At clinical follow up average 24 months after surgery (10–48 months, 73% were playing at pre-injury level. The average return to that level of sports after surgery was 16 weeks (3–32 weeks. However 43% still suffered minor symptoms. Conclusion Arthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain

  13. MRI VERSUS ARTHROSCOPY: A COMPARISON OF FINDINGS

    Directory of Open Access Journals (Sweden)

    Somashekhara Reddy

    2016-06-01

    Full Text Available The purpose of this study is to correlate the findings of Magnetic Resonance Imaging with Arthroscopy in internal derangements of knee and to assess the sensitivity, specificity and accuracy of Magnetic Resonance Imaging in comparison to Arthroscopy. METHODS AND MATERIALS Fifty six patients with history of suspected internal derangement of knee were evaluated prospectively with MRI and correlated with arthroscopy during a one and half a year period from March 2012 to September 2013.1.5 Tesla MRI machine using a closed extremity coil is used. Sequences used in MRI of the knee include Turbo-spin echo (TSE, FFE (Gradient echo and Short Tau Inversion Recovery (STIR sequences in Axial, Sagittal and Coronal planes using a slice thickness of 3 mm with a 0.3 mm slice gap. Arthroscopy of the knee with standard anteromedial and anterolateral portals with the patient in supine position done in all the cases. RESULTS The diagnostic sensitivity, specificity and accuracy of MRI in detecting cruciate ligament and meniscal injuries as compared to Arthroscopy are as follows: Anterior Cruciate Ligament (ACL: 97.29%, 89.47%, 94.64%; Posterior Cruciate Ligament (PCL: 100%, 100%, 100%; Medial Meniscus (MM: 100%, 93.33%, 98.21% and Lateral Meniscus (LM: 93.10, 92.59, 92.85. Most common lesions found were ACL and Medial Meniscal tears (posterior horn of MM being the most common site. SUMMARY AND CONCLUSION  MRI is a useful non-invasive modality having high sensitivity, specificity and accuracy in diagnosing cruciate ligament and meniscal injuries.  MRI should be considered as the first line of investigation in all patients with suspected internal derangements of knee.  MRI being easily available and non-invasive is useful as a pre-operative screening modality, thus improves the quality of diagnostic and therapeutic arthroscopies and further reduces the morbidity.  Arthroscopy is the standard diagnosing tool in all patients with suspected internal

  14. Surgical treatment for patients of simple elbow dislocations with posteromedial instability%后内侧不稳定简单型肘关节脱位患者的手术治疗

    Institute of Scientific and Technical Information of China (English)

    冯明光; 王海洋; 江旭未; 许文峰; 麦佳佳

    2016-01-01

    the ligament, joint capsule and tendon were recorded. Relations between injuries of soft tissues and the elbow and correspondent violence were defined. Postoperative progressive functional rehabilitation training with the brace was conducted under the protection of the elbow. Regular outpatient follow-up was conducted.Results Avulsion injury was 100% for the medial collateral ligament and anteromedial capsule, 60% for the lfexor tendon and 30% for the biceps tendon. The elbow injury occurred in supination, abduction and valgus position. In the latest follow-up, the overall mean Mayo Elbow Performance Score was 93.2, ulnar nerve injury occurred in 5 elbows, and heterotopic calciifcation was noted in 1 patient.Conclusions Elbow extension and supination under axial hyperextension and valgus stress is the injury mechanism of simple elbow dislocations with posteromedial instability. It mainly involves anteromedial stable structure. Early repair with wired screws can achieve satisfactory results.

  15. 股骨颈关节囊内骨样骨瘤的临床及影像特点%Clinical and imaging features of intra-articular osteoid osteoma in the femoral neck

    Institute of Scientific and Technical Information of China (English)

    曾泳瀚; 程晓光; 栾贻新; 顾翔; 李江涛

    2012-01-01

    Objective To evaluate the clinical and imaging characteristics of osteoid osteoma in femoral neck and to improve diagnostic accuracy of this disease.Methods Twenty-one patients (18 males and 3 females,age,7-26 years,median age,13 years) with pathologically proven osteoid osteoma of the femoral neck were retrospectively analyzed for their clinical profile and radiologic features.CT and X-ray examinations were performed in all patients,10 of them pefformed post-contrast CT scan and 4 of them performed MRI examinations.Results Nineteen patients had hip pain (pain worse at night in 11,and 8 received salicylates treatment with good response),and 2 patients only with intermittent claudication.The duration ranged from 2 months to 54 months (median duration 12 months).X-ray: Nidus was seen on plain film in 10 cases,18 cases showed different degrees of bone sclerosis of the nidus.CT: Nidus was demonstrated in all cases.Among them,8 were intracortical,6 were subperiosteal,7 were endosteal.Twenty cases showed different degrees of bone sclerosis of the nidus-extra-articular anteromedial cortical surface of the femur neck.Nineteen cases showed "vascular groove sign".MRI: Nidus was seen in 4 cases.Bone sclerosis was low signal on all sequences.Three cases had joint effusion,4 cases had bone marrow edema,and 2 cases had synovial thickening.Conclusions Although osteoid osteoma of femoral neck has non-specific clinical features,the radiographic findings are usually typical.The nidus of osteoid osteoma is often located within the joint.Bony sclerosis occurs at the area of extra-articular anteromedial cortical surface of the femur neck.CT examination remains an optimal method to identify the nidus.%目的 分析股骨颈骨样骨瘤的临床及影像特点,提高对本病的诊断水平.方法 回顾性分析21例经手术病理证实的股骨颈骨样骨瘤的临床及影像学资料.其中男18例、女3例;年龄7~26岁,中位年龄13岁.所有病例均行常规X线及CT检

  16. 妇女怀孕前后被动吸烟与神经管畸形关系的病例对照研究%Maternal passive smoking and the risk of neural tube defects: a case-control study in Shanxi province,China

    Institute of Scientific and Technical Information of China (English)

    李智文; 刘建蒙; 任爱国; 张乐; 郭湛英; 李竹

    2008-01-01

    目的 探讨母亲怀孕前后被动吸烟与子代发生神经管畸形(NTD)危险性的关系.方法 资料来源于北京大学生育健康研究所在山西省平定、昔阳、太谷和泽州4个县开展的以人群为基础的出生缺陷病例对照研究.病例为2003年1月到2007年6月监测到的515例NTD病例(其中无脑儿236例,脊柱裂237例,脑膨出42例),对照组为同期在同地区调查的682例无体表出生缺陷的婴儿.研究人员在妇女分娩一周内问卷调查妇女怀孕前后的被动吸烟及其他信息.用非条件logistic回归模型调整混杂因素.结果 与无被动吸烟的妇女相比,怀孕前后有被动吸烟的妇女生育NTD的危险性(OR值)为1.84(95%CI:1.39~2.44).妇女被动吸烟频度与子代发生NTD危险性之间存在显著的剂量反应关系.与无被动吸烟的妇女相比,偶尔有被动吸烟的妇女和每天有被动吸烟的妇女生育NTD的OR值分别为1.51和2.44(趋势x2=24.9,P<0.001).结论 妇女怀孕前后被动吸烟增加生育NTD患儿的危险性.%Objective To explore the relationship between maternal passive smoking during early pregnancy and the risk of neural tube defects (NTDs). Methods Data was derived from a populationbased case-control study on birth defects in Shanxi province. The study subjects included 515 NTDs defects cases (236 cases of anencephaly, 237 spina bifida and 42 encephalocele) ascertained during January 2003 and June 2007 in the study areas and 682 normal controls randomly selected in the same residence during the same period as cases. Results The risk of NTDs in their offspring was 1.84 (95 % CI : 1.39-2.44) for mothers with passive smoking history during peri-conceptional period. There was a marked dose-response relation between maternal passive smoking and the risk of NTDs in offspring. Compared to the women without passive smoking, the NTDs risk in offspring was 1.51 for women with occasional passive smoking and 2.44 for women with passive

  17. Analysis on the prevalence of perinatal neural tube defects in Guangxi from 2006 to 2011%2006~2011年广西围产儿神经管缺陷发生状况分析

    Institute of Scientific and Technical Information of China (English)

    姚慧; 丘小霞; 田晓先; 曾萼; 李映

    2013-01-01

    目的:了解广西出生缺陷医院监测网神经管缺陷(NTDs)变化趋势及影响因素,为政府决策提供依据.方法:按照中国出生缺陷监测方案的要求,对2006 ~ 2011年的41所出生缺陷医院监测点的神经管缺陷资料进行流行病学分析,将在医疗保健机构住院分娩的孕28周至产后7天的围产儿作为监测对象.结果:6年间共监测的围产儿有484 304人,其中NTDs为231例,NTDs总发生率4.77/万,年度发生率呈逐年下降趋势,降幅达64.57%.其中无脑畸形、脊柱裂、脑膨出发生率分别是2.44/万、1.67/万、0.66/万.围产儿NTDs的发生率男性为4.60/万,女性为4.75/万.城镇为2.45/万,乡村为6.52/万;产妇年龄别发生率的差异有统计学意义,<20岁组发生率最高(11.04/万).产前确诊的比例74.46%,产前B型超声波诊断的比例为77.06%.结论:2006~2011年广西围产儿NTDs的发生率出现下降趋势,农村育龄妇女是NTDs干预的重点人群.%Objective: To understand the change trend and influencing factors of Neural Tube Defects ( NTDs) of Guangxi Birth Defect Surveillance Network, and provide evidence for governments to make decisions. Methods: An epidemiological analysis on the data of neural tube defects in 41 birth defect surveillance hospitals from 2006 to 2011 in accordance with the requirements of China Birth Defect Surveillance Scheme. Surveillance subjects were the perinatal infants from 28 gestational weeks to 7 days after birth in healthcare institutions. Results: There were 484 304 perinatal infants under surveillance from 2006 to 2011 , and 231 cases were found with NTDs, the incidence rate was 4. 77/10 000. The annual incidence rate decreased gradually by 64. 57%. The incidence rates of anencephaly, spina bifi-da, and encephalocele were 2. 44/10 000, 1. 67/10 000, and 0. 66/10 000, respectively. The perinatal incidence rates of NTDs were 4. 60/ 10 000 in males and 4. 75/10 000 in females, 2. 45/10 000 in urban

  18. Analysis of monitoring results of birth defects in Jingning county in 2009 and 2010%景宁县2009-2010年出生缺陷监测结果分析

    Institute of Scientific and Technical Information of China (English)

    王佩英

    2012-01-01

    Objective To analyze incidence of birth defects in Jingning county and relevant influential factors for the development and evaluation of preventive measures. Methods Birth defects monitoring data were obtained from 4 hospitals in 2009 and 2010 in Jingning county following guidelines of Birth defects monitoring program of Jingning county. The data were analyzed including the incidence of birth defects, defect type, occurrence of birth defects of mothers during pregnancy and all the cases were followed up. Results In two years, the total incidence rate of birth defects was 1.064%, in a total of 26 cases of birth defects, 23 were single defect and 3 were multiple defects. Defect types included five multiple fingers, congenital heart disease, cleft lip, cleft palate, encephalocele. Conclusions Birth defects show a trend of increase in this county. This is most likely due to improvement of technology in perinatal prenatal diagnosis and early postnatal diagnosis. Influential factors that may cause birth defects include maternal illness, unsafe medications during pregnancy and maternal genetic factor. These results indicate that it is necessary to enhance pre-pregnancy care, improve the quality of premarital medical examination, pay attention to genetic consulting and prenatal health care, especially in early pregnancy care. It is also necessary to carry out prenatal screening and improve knowledge on birth defects prevention so as to reduce the occurrence of birth defects.%目的 分析浙江省景宁县出生缺陷的发生状况和影响因素,为制定和评价预防措施提供依据.方法 对景宁县内4家医院依据《景宁县出生缺陷监测方案》要求上报的2009年和2010年出生缺陷监测数据进行汇总,分析出生缺陷的发生率、缺陷类型、发生出生缺陷儿母亲孕期情况,并跟踪随访.结果 共监测景宁县两年中2 443例围产儿,出生缺陷26例,总出生缺陷发生率为10.64‰,其中单发缺陷23

  19. Experience on Diagnosis and Treatment of 125 cases with craniocerebral trauma combined with thoracic injury%152例颅脑、胸部复合伤的诊治体会

    Institute of Scientific and Technical Information of China (English)

    牟晓东; 李敏

    2013-01-01

    目的:总结颅脑外伤合并胸部外伤的救治经验和疗效.方法:回顾152例颅脑外伤合并胸部外伤的治疗.行急诊开颅手术85例,其中合并肋骨骨折、肺挫伤的51例药物保守治疗胸部外伤,合并血气胸的34例行胸腔闭式引流术;行急诊开胸术10例;采用药物保守治疗57例.结果:根据GOS评分,本组恢复良好51例,轻残21例,重残33例,植物状态10例;死亡37例,死亡率24.3%,分别死于:脑疝21例(56.8%),原发性脑干损伤7例(18.9%),呼吸窘迫综合征4例(10.8%)及多器官功能衰竭5例(13.5%).结论:严重颅脑外伤合并胸部外伤救治原则强调争分夺秒,快速准确诊断是患者生存的关键,同时加强多科室协作,紧紧围绕呼吸、循环和脑受压三个环节展开救治,及早手术治疗,积极防治并发症,从而有效降低病死率和病残率.%Objective:To summary the methods and experience on treatment of craniocerebral trauma combined with thoracic injury.Methods:The clinical data of 125 cases with craniocerebral trauma combined with thoracic injury were analyzed retrospectively.In the 75 patients received emergency craniotomy,50 cases with rib fractures or pulmonary contusion were treated by conservative treatment such as medication.chest bandage fixation and so on,and the other 25 hemopneumothorax cages were performed closed drainage of thoracic cavity.Four cases were carried out emergency thoracotomy,and 46 cases were treated by conservative treatment in neurosurgery or ICU.Results:According to Glasgow outcome scale(GOS),45 patients were cured,11 were mild disability,27 were severe disability and 10 were vegetative state.32 cases died and the mortality was 25.6%.Among the death cases.18 died of encephalocele,5 of primary brainstem injury,3 of hemorrhagic shock associated with thoracic cavity angiorrhexis,and 6 of multiple organ failure. Conclusion:To the patients of serious craniocerebral trauma

  20. Brain tissue aspiration neural tube defect Aspiração de tecido cerebral em casos de defeitos de fechamento do tubo neural

    Directory of Open Access Journals (Sweden)

    Luiz Cesar Peres

    2005-09-01

    Full Text Available The study aimed to find out how frequent is brain tissue aspiration and if brain tissue heterotopia could be found in the lung of human neural tube defect cases. Histological sections of each lobe of both lungs of 22 fetuses and newborn with neural tube defect were immunostained for glial fibrillary acidic protein (GFAP. There were 15 (68.2% females and 7 (31.8% males. Age ranged from 18 to 40 weeks of gestation (mean= 31.8. Ten (45.5% were stillborn, the same newborn, and 2 (9.1% were abortuses. Diagnosis were: craniorrhachischisis (9 cases, 40.9%, anencephaly (8 cases, 36,4%, ruptured occipital encephalocele and rachischisis (2 cases, 9.1% each, and early amniotic band disruption sequence (1 case, 4.5%. Only one case (4.5% exhibited GFAP positive cells inside bronchioles and alveoli admixed to epithelial amniotic squames. No heterotopic tissue was observed in the lung interstitium. We concluded that aspiration of brain tissue from the amniotic fluid in neural tube defect cases may happen but it is infrequent and heterotopia was not observed.O objetivo do estudo foi identificar qual a freqüência de aspiração de tecido cerebral e a existência de heterotopia nos pulmões de casos humanos de defeito de fechamento do tubo neural através da reação imuno-histoquímica para proteína fibrilar glial ácida (GFAP em cortes histológicos de todos os lobos de ambos os pulmões de 22 casos de fetos e neonatos com defeito de fechamento do tubo neural. Havia 15 casos femininos (68,2% e 7 masculinos (31,8%, com idade gestacional variando de 18 a 40 semanas (média= 31,8, sendo natimortos e neomortos 10 (45,5% cada e 2 (9,1% abortos. Os diagnósticos foram: Craniorraquisquise (9 casos, 40,9%, anencefalia (8 casos, 36,4%, encefalocele occipital rota e raquisquise (2 casos, 9,1% e 1 (4,5%caso de seqüência de disruptura amniótica precoce. Somente 1 caso (4,5% apresentou células positivas dentro de bronquíolos e alvéolos em meio a células epiteliais

  1. Equoterapia na reabilitação da meningoencefalocele: estudo de caso Hyppotherapy in meningoencephalocele rehabilitation: a case study

    Directory of Open Access Journals (Sweden)

    Sissa Mara Nicodemo Sanches

    2010-12-01

    . Outcome measures were obtained by means of the Berg and Tinetti balance scales and the Brazilian version of the Pediatric Evaluation of Disability Inventory (for general functional abilities, all applied before and after therapy, and at an 8-week follow-up assessment. Results showed the child's significantly improved balance and motor coordination, which reflected on functional movement control, basic for performing daily living activities. Functional gain was also perceived by the child's mother. This study provides a new insight into hippotherapy as a useful physical therapy modality for improving motor and functional ability of children with encephalocele.

  2. Prevalence study on the ultrasonography screening for neural tube defects in the secondary prevention%超声检查在神经管缺陷二级预防中的应用现况研究

    Institute of Scientific and Technical Information of China (English)

    卢庆彬; 孟才; 高莉洁; 宫蕊; 孙喜红; 王志萍; 王金桃; 赵仲堂

    2011-01-01

    Objective To explore the utilization and effectiveness of ultrasound screening for neural tube defects (NTDs),so that to provide scientific evidences for the secondary prevention of NTDs.MethodsFour hundred and fifty-nine women who delivered or gestated NTDs babies or fetuses were randomly selected from Shandong Province and Shanxi Province,and the related information was collected with structured questionnaire by trained interviewers.Results Of the 459 cases,the ultrasonography utilization rate was 98.7%,and 6 cases (1.3%) never took examinations by ultrasonography during the whole pregnancy period.The total diagnosis rate of ultrasound screening for NTDs was 85.9%,and those of anencephalus,spina bifida and encephalocele were 96.4%,79.6% and 73.8% respectively (P0.05).Conclusions The detection rates of NTDs and the subtypes by ultrasonography are low at different pregnant periods and in different medical institutions.It is important to increase the utilization rate of ultrasound screening by pregnant women and improve the NTDs diagnostic level of primary health care institutions,so that to improve the efficacy of secondary prevention strategy for NTDs in China.%目的 探讨超声筛查神经管缺陷(neural tube defects,NTDs)及各亚型的应用现状及其效果,为制定适宜的NTDs二级预防模式提供科学依据.方法 选取山东省和山西省八地(市)孕育NTDs胎儿妇女459例,对其孕期超声检查情况进行流行病学调查,分析NTDs及各亚型的确诊情况及其影响因素.结果 ①研究对象超声检查使用率为 98.7%,6例(1.3%)在孕期从未进行超声检查.②超声筛查NTDs总确诊率为 85.9% (389/453),无脑儿、脊柱裂和脑膨出分别为 96.4%、79.6%和 73.8% (P0.05).结论 各医疗机构和不同孕期NTDs及各亚型超声检出率均较低.相关卫生部门应采取措施进一步提高超声检查使用率,提高NTDs超声检出率,重点做好基层医疗机构的产前超声筛查,以更

  3. Prevalência de defeitos de fechamento de tubo neural no Vale do Paraíba, São Paulo Prevalence of neural tube defects in Vale do Paraíba, São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Luiz Fernando C. Nascimento

    2008-12-01

    Full Text Available OBJETIVO: Estimar a prevalência de defeitos de fechamento do tubo neural no Vale do Paraíba paulista e identificar possíveis fatores maternos e neonatais associados a tais defeitos. MÉTODOS: Realizou-se um estudo transversal com dados secundários obtidos na Secretaria Estadual da Saúde referentes aos nascimentos ocorridos em 2004 no Vale do Paraíba paulista, que compreende 35 municípios e conta com população de 2 milhões de habitantes. Anencefalia, encefalocele e espina bífida (mielocele e mielomeningocele foram considerados defeitos de fechamento do tubo neural. As variáveis maternas foram: idade, escolaridade, cor da pele, número de consultas no pré-natal, número de filhos vivos e relato de óbito fetal prévio. As variáveis relativas ao recém-nascido foram: peso, idade gestacional e escore de Apgar. Realizou-se comparação das médias por meio do teste t de Student e obtiveram-se os valores das razões de chance com intervalos de confiança de 95%. RESULTADOS: Foram analisados 33.653 nascidos vivos. Trinta e oito recém-nascidos com o defeito foram encontrados (1,13/1.000 nascidos vivos, sendo 23 casos de espina bífida. Houve associação com baixo peso ao nascimento, prematuridade e menores escores de Apgar de cinco minutos. CONCLUSÕES: A prevalência desta anomalia foi inferior à de outros estudos nacionais e sua presença esteve associada ao baixo peso, à prematuridade e à baixa vitalidade ao nascer.OBJECTIVE: To estimate the prevalence of neural tube defects in Vale do Paraíba, São Paulo, Brazil, and to identify possible maternal and neonatal variables associated with these defects. METHODS: This cross-sectional study used secondary records of the Health Department of São Paulo State related live births during 2004 in Vale do Paraíba, São Paulo, Brazil. This region has 35 cities and 2 million inhabitants. Anencephaly, encephalocele and spina bifida (myelocele and myelomeningocele were considered as neural tube

  4. 标准大骨瓣减压术治疗大面积脑梗死随机对照临床研究%Randomized controlled clinical research in treatment of massive cerebral infarction with standard hemicraniec-tomy

    Institute of Scientific and Technical Information of China (English)

    黎华清; 黎志洲; 张旺明

    2015-01-01

    ,postoperative encephalocele,epilepsia)(P < 0. 05),while the patients in treated group also had less operative time and operative blood loss than control group(P < 0. 05). Conclusion Performing standard hemicraniectomy - endocranium enlarged plasty for patient with massive cerebral infarction will reduce postoperative complications,improve quality of life,shorten operative time and reduce the amount of bleeding during the repair of Ⅱ phase skull defect.

  5. Treatment of terrible tyriad of the elbow:a cohort study%肘关节“恐怖三联征”的治疗:成组病例报告

    Institute of Scientific and Technical Information of China (English)

    樊军; 罗意; 隆晓涛; 万革; 王蕾

    2016-01-01

    at least 6 months;(5 )The time from injury to surgery should be less than 3 weeks. Exclusion criteria:(1)other dislocations or injuries such as olecranal fracture,etc.;(2 )the affected limb is accompanied with neurovascular injuries or fractures in other parts;(3 )elbow dysfunction before injury;(4 )patients with conservative treatment.Fracture types:Mason classification was applied in the radial head fracture and Regan-Morry classification was applied in the ulnar coronoid process fracture.Surgical method:the patient was on supine position with a thin pad under the ipsilateral scapula.The affected limb was flexed and put on the chest.Under tourniquet control,the lateral incision of elbow was firstly made till deep fascia and the lateral intramuscular septum was separated to further expose the radial head,lateral collateral ligament and joint capsule.Attention should be paid to protect the radial nerve.Then the anteromedial incision was made to separate the flexor till the elbow joint capsule of anteromedial side and expose the medial collateral ligament and the fragments of ulnar coronoid process.The articular cavity was irrigated to clean blood blot and tiny fragments of bone and cartilage.The repair was carried out by the following orders:ulnar coronoid process → medial collateral ligament and anteromedial joint capsule → fracture of radial head →lateral collateral ligament → common extensor origin.The fractures of ulnar coronoid process and radial head were fixed with mini screw plate system,Herbert screws,cannulated screws or different sutures according to classification and fragment size. The medial and lateral collateral ligaments were reconstructed with suture anchors or sutures and then the elbow was immobilized with the hinged brace after surgery.Postoperative management:The patient was asked to move the ipsilateral fingers as the anesthesia faded.The flexion and extension exercises of fingers could train the isometric contraction of forearm muscles

  6. Outcomes of Autologous Chondrocyte Implantation in the Knee following Failed Microfracture

    Science.gov (United States)

    Riff, Andrew Joseph; Yanke, Adam Blair; Tilton, Annemarie K.; Cole, Brian J.

    2016-01-01

    patellar anteromedialization, 9 patients underwent meniscal allograft, and 6 underwent realignment ostetomies (5 HTO, 1 DFO). Follow-up was available on 84 of 92 patients (91%) at an average length of follow-up of 47 months (range, 24-102 months). The control group of patients was well matched with regard to age, gender, BMI, workers compensation status, and preoperative subjective scores. Failure, defined by need for further cartilage restoration or knee arthroplasty, occurred in 8 patients (3 osteochondral allograft, 3 TKA, 1 revision ACI, 1 Denovo NT). Seventeen additional patients underwent reoperation for intra-articular debridement. There was no difference between the failure rate (8.7% v. 2.9%, p=0.21) or reoperation rate (27.2% v. 27.2%, p=0.98) in the study and control groups. For the study group, significant improvements were witnessed postoperatively for all measured questionairre parameters. No significant differences were witnessed between the study and control groups (p>0.05) with regard to any of the postoperative subjective parameters (Figure). Conclusion: In patients with discrete articular cartilage lesions of the knee and history of failed microfracture, ACI may render favorable clinical outcomes comparable to primary ACI. While other series have demonstrated inferior results following previous microfracture, our series suggests that in appropriately selected patients ACI may be used successfully as a second line treatment following failed microfracture.

  7. 关节镜下单束重建治疗前交叉韧带部分断裂的临床研究%Single-bundle augmentation technique in treatment of partial anterior cruciate ligament injury

    Institute of Scientific and Technical Information of China (English)

    谭平先; 叶淦湖; 侯之启; 王晋; 任绍东; 周国新

    2012-01-01

    目的 探讨关节镜下单束重建治疗前叉韧带部分断裂的临床疗效及手术方法.方法 回顾性分析2007年6月至2009年10月关节镜下应用单束重建治疗前叉韧带部分断裂12例患者的资料.12例患者中,男9例,女3例,平均年龄37岁.根据IKDC、Lysholm膝关节功能评分进行功能恢复评估.结果 12例患者平均随访13个月,所有患者术后均无感染.术后最后一次随访时Lachman试验(﹢)、前抽屉实验(-)2例,其他患者前抽屉试验、Lachman试验均为阴性.11例膝关节屈伸活动度正常,1例膝关节伸直缺失10°,IKDC评级:11例正常,1例接近正常.术前IKDC主观评分(48.33±12.77),Lysholm膝关节功能评分(55.42±15.01);术后末次随访IKDC主观评分(91.42±4.94),Lysholm膝关节功能评分(95.33±6.02),差异有统计学意义(P<0.01).结论 关节镜下单束单隧道重建治疗前叉韧带部分断裂的短期临床疗效满意,保留残存纤维束重建虽然有一定难度,但手术在熟练的关节镜技术下可以顺利施行.%Objective To investigate the surgical skills and short term clinical outcomes of arthroscopic single-bundle augmentation technique in treatment of partial cruciate ligament (ACL) injury. Methods From June 2007 to October 2009, 12 patients with partial curciate ligament injury were treated with single bundle reconstruction, preserving the intact ACL bundle as well. 10 cases underwent reconstruction with autologous hamstring ligament, and two cases with allogenic tendon. The International Knee Documentation Committee ( IKDC ) , Lysholm knee score and Lachman test were used to measure the knee function preoperatively and postoperatively. Results The ACL tear involved the anteromedial bundle ( AMB) in eight cases, and the posterolateral bundle (PLB) in four cases. The mean IKDC subjective evaluation scores were (48.33 ± 12.77) preoperatively and (91.42 ±4.94) at the last follow-up (P<0.01). The mean Lysholm knee scores were (55

  8. [The effect of central anatomical single-bundle versus anatomical double-bundle reconstruction of the anterior cruciate ligament on knee stability. a clinical study].

    Science.gov (United States)

    Komzák, M; Hart, R; Smíd, P; Puskeiler, M

    2014-01-01

    PURPOSE OF THE STUDY A comparison of the efficacy of central anatomical single-bundle (CASB) reconstruction with that of double-bundle (DB) repair of the anterior cruciate ligament (ACL) in relation to knee stability in anteroposterior translation (APT), internal rotation (IR) and external rotation (ER) of the joint. MATERIAL AND METHODS A total of 40 patients were evaluated; 20 had ACL reconstruction by the CASB technique using hamstrings and 20 underwent DB repair surgery. The average age was 31.3 years, and the group included 22 men and 18 women with 19 right and 21 left knees. The KT-1000 test was used to assess the amount of APT in the knee and rotational deviations were measured by the Rolimeter. In the DB patients, measurements were performed before surgery (on joints with ACL injury), then after reconstruction of the anteromedial (AM) or the posterolateral (PL) bundle and subsequently after repair of both ACL bundles. The CASB patients were assessed before and after graft insertion. RESULTS The average APT value was 18.5 mm for the pre-operative knees and it fell to 8.9 mm after AM bundle reconstruction. However, when the PL bundle was inserted in the first place, the average APT value was 13.1 mm only. The average values recorded after the DB and CASB reconstructions were 6.1 mm and 9.1 mm, respectively. The average IR range of motion in the pre-operative joints was 18.6 degrees. After AM bundle reconstruction it was 13.9 degrees and after PL bundle repair it was 15.3 degrees. In DB reconstruction the average IR value achieved 10.4 degrees, and in CASB repair surgery it was 13.7 degrees. The average ER range of motion in the pre-operative joints was 17.8 degrees. After AM bundle reconstruction it was 14.5 degrees and after PL bundle repair it was 14.9 degrees. In DB reconstruction the average ER value achieved 11.4 degrees, and in CASB repair surgery it was 14.5 degrees. DISCUSSION Rotational stability of the knee after ACL reconstruction is one of the

  9. Value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia%射频热凝术前磁共振B-FFE序列三叉神经成像评估

    Institute of Scientific and Technical Information of China (English)

    胡芸; 金朝林; 王翔; 张树桐; 蔡毅

    2015-01-01

    目的:探讨 CT 定位射频温控热凝治疗原发性三叉神经痛术前,磁共振平衡式快速梯度回波(B-FFE)序列三叉神经成像检查的必要性和临床意义。方法采用B-FFE 序列扫描63例拟行射频温控热凝治疗的原发性三叉神经痛患者的患侧三叉神经,观察三叉神经脑池段、半月神经节及其三大分支的解剖形态、走行方式,半月神经节与卵圆孔之间的位置关系,指导术中CT定位穿刺。结果本研究63例患者中,23例(37%)病变侧三叉神经跨岩骨尖时呈聚拢束状,40例(63%)病变侧三叉神经跨岩骨尖时呈三支分散状。眼神经走行于前内侧,下颌神经走行于后外方,上颌神经则走行于两者之间。三叉神经跨岩骨尖角度(150.11±8.32)°。卵圆孔至半月神经节距离(12.37±3.21) cm。结论三叉神经痛射频热凝温控治疗术前行磁共振B-FFE 序列三叉神经成像检查,明确相应解剖结构关系,可以提高术中 CT 定位的准确性,缩短手术时间,减低手术风险,具有较高的临床实用价值。%Objective To analyze the value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia..Methods The B-FFE Sequence were performed on 63 patients with primary trigeminal neuralgia before CT-guided radiofrequency thermocoagulation..MR images were analyzed to identify the relationship between trigeminal nerves and surrounding vessels,.the anatomy of trigeminal ganglion in Meckel′s caves and their branches,.the relationship between the trigeminal semilunar ganglion and the oval foramen..Results The affected trigeminal nerve roots were bundled (23/63, 37%) or divided (40/63, 63%) at (150.11±8.32) angle at the petrous apex before entering the Meckel′s caves. The ophthalmic division travelled anteromedially,.maxillary division in the middle,.and mandibular division posterolaterally

  10. Rheumatoid arthritis involving shoulder joints:Early diagnostic value of ultrasonography%超声对类风湿性肩关节炎的早期诊断价值

    Institute of Scientific and Technical Information of China (English)

    毛剑莹; 赵小虎; 张兰; 高晓珺; 陆玲玲

    2012-01-01

    Objective To explore the early diagnostic value of ultrasonography for rheumatoid arthritis (RA) involving shoulder joints. Methods Forty RA patients (RA group) and 20 health subjects (control group) were enrolled. All subjects underwent examination of high frequency ultrasound (HFUS) , and the following indicators were observed: The syno-vial thickness and effusion in shoulder joint cavity (axillary fossa and posterior recess), subacromial-deltoid bursa, and the sheath of long biceps tendon; bone surface erosion in greater tubercle, anteromedial and posterolateral head of humerus; and the injure of rotator cuff. In addition, blood flow signal in the synovial membrane and the lesions were also observed with power Doppler ultrasound (PDUS). Results In RA group, five types of lesions were found. The specific lesion type and detection rate were as following: Articuli hydrops (42.50%, 102/240), synovial proliferation (39.58%, 95/240), vascular hyperplasia (20. 83%, 50/240), rotator cuff tear (31. 67% , 19/60) and bone erosion (36. 11% , 65/180). In control group, neither effusion in shoulder cavity nor blood flow signal in synovial membrane was found. The thickness of synovial membrane in RA group significantly increased compared with the control group (P<0. 01). Conclusion HFUS and PDUS can contribute to early diagnosis of many kinds of lesions in rheumatoid arthritis involving shoulder joints.%目的 探讨超声在类风湿性关节炎(RA)肩关节病变中的早期诊断价值.方法 应用高频超声(HFUS)对40例RA患者(RA组)的60侧病变肩关节进行扫查,观察肩关节腔腋囊侧及后隐窝侧、肩峰下滑囊、肱二头肌长头肌腱鞘4个区域内滑膜厚度、积液深度;观察肱骨头(大结节、前内侧及后外侧)骨表面侵蚀及肩袖损伤;利用能量多普勒超声(PDUS)观察病变区域滑膜血流情况,并与20名健康志愿者(对照组)40侧肩关节扫查结果进行对比.结果 超声检出RA组5种病变类型:关

  11. 颞下颌关节紊乱病患者口腔不良习惯与髁突骨质改变相关性的影像学研究%Relationship between oral habits and temporomandibular joint radiographic findings showed by cone beam computed tomography in temporomandibular disorder patients

    Institute of Scientific and Technical Information of China (English)

    张伟华; 余丽霞; 王晓冬; 李晓箐

    2012-01-01

    Objective The purpose of this retrospective study was to investigate the relationship between oral habits and temporomandibular joint (TMJ) bony change of temporomandibular disorder (TMD) patients. Methods One hundred and six TMD patients diagnosed according to Research Diagnostic Criteria (RDC/TMD) were selected. All the patients had undergone cone beam computed tomography (CBCT) imaging of TMJ, and their oral habits had been investigated. The associations between oral habits and TMJ radiographic findings were analysed. Results Among 106 patients, the incidence of bruxism, clenching, chewing on one side and being fond of hard food were high. Preferring to hard food increased the risk of ill -defined cortical bone change. Hobby of hard food increased the risk of bony changes in the anterolateral and posterolateral part of the condyle, as well as in the articular tubercle. Chewing on one side could increase the risk of bony changes in the anteromedial aspect of articular fossa. Conclusion Oral habits of TMD patients were associated with type and position TMJ bony change.%目的 研究颞下颌关节病患者口腔不良习惯与颞下颌关节髁突骨质改变之间的关系.方法 选取诊断为颞下颌关节紊乱病的患者106例,问卷调查患者的口腔不良习惯,并行双侧颞下颌关节锥形束CT成像,分析患者口腔不良习惯与颞下颌关节髁突骨质影像学改变的相关性.结果 106例患者中,口腔不良习惯以偏侧咀嚼、紧咬牙、夜磨牙和喜食硬物较常见.经统计学分析,喜食硬物是出现髁突骨皮质模糊消失型改变的危险因素(P =0.019,OR=2.570).喜食硬物是髁突前外侧(P =0.025,OR =2.298)、髁突后外侧(P =0.023,OR =2.692)及关节结节(P=0.020,OR =3.067)易出现骨质改变的危险因素.偏侧咀嚼习惯则是关节窝前内侧(P=0.013,OR =0.311)易出现骨质改变的危险因素.结论 口腔的不良习惯与颞下颌关节骨质改变的类型及部位有一定相关性.

  12. Exercise Countermeasures for Bone Loss During Space Flight: A Method for the Study of Ground Reaction Forces and their Implications for Bone Strain

    Science.gov (United States)

    Peterman, M.; McCrory, J. L.; Sharkey, N. A.; Piazza, S.; Cavanagh, P. R.

    1999-01-01

    Effective countermeasures to prevent loss of bone mineral during long duration space flight remain elusive. Despite an exercise program on MIR flights, the data from LeBlanc et al. (1996) indicated that there was still a mean rate of loss of bone mineral density in the proximal femur of 1.58% per month (n=18, flight duration 4 - 14.4 months). The specific mechanisms regulating bone mass are not known, but most investigators agree that bone maintenance is largely dependent upon mechanical demand and the resultant local bone strains. A plausible hypothesis is that bone loss during space flight, such as that reported by LeBlanc et al. (1996), may result from failure to effectively load the skeleton in order to generate localized bone strains of sufficient magnitude to prevent disuse osteoporosis. A variety of methods have been proposed to simulate locomotor exercise in reduced gravity. In such simulations, and in an actual microgravity environment, a gravity replacement load (GRL) must always be added to return the exercising subject to the support surface and the resulting skeletal load is critically dependent upon the magnitude of the GRL. To our knowledge, GRLs during orbital flight have only been measured once (on STS 81) and it is likely that most or all prior treadmill exercise in space has used GRLs that were less than one body weight. McCrory (1997) has shown that subjects walking and running in simulated zero-G can tolerate GRLs of 1 if an appropriate harness is used. Several investigators have attempted to measure in vivo strains and forces in the bones of humans, but have faced ethical and technical limitations. The anteromedial aspect of the tibial midshaft has been a common site for the placement of strain gauges; one reason to measure strains in the anterior tibia is that this region is surgically accessible. Aamodt et al. (1997) were able to measure strains on the lateral surface of the proximal femur only because their experimental subjects were

  13. 黄颡鱼(Pelteobagrus fulvidraco)鳃的超微结构研究%FINE STRUCTURE OF GILLS IN TELEOST (PELTEOBAGRUS FULVIDRACO)

    Institute of Scientific and Technical Information of China (English)

    罗芬; 陈礼强; 康斌

    2011-01-01

    应用光学和电子显微成像技术对黄颡鱼鳃的表面形态特征、鳃小片血管分布及其内部超微结构进行了观察。结果表明,黄颡鱼鳃耙呈长锥形,鳃弓表面具棘状小刺,鳃小片呈褶皱状,镶嵌排列在长条形鳃丝两侧。光镜可观察到鳃小片两侧红色的入鳃和出鳃动脉以及中部片状毛细血管网。鳃耙、鳃弓、鳃丝及鳃小片表面均被扁平上皮细胞覆盖,其表面微嵴形态结构各异。鳃弓和鳃丝表面有线粒体密集细胞和粘液细胞开口,鳃小片表面未发现分泌细胞开口但附着大量粘液。鳃小片主要由单层或数层上皮细胞和由支持细胞包裹的血管腔构成。线粒体密集细胞分布于鳃小片边缘和血管周围,可分为两个亚型。黄颡鱼鳃上皮细胞和线粒体密集细胞的超微结构特征与其相应的呼吸功能和体内离子转运、能量代谢生理功能相适应。%Using optical and electron microscopic imaging techniques, we studied the fine structure of gills in teleost (Pelteobagrus fulvidraco), including surface morphology, lamellar vascular distribution, and internal ultrastructure of gill iliamerit. The results showed that the prick-shaped gill rakers were presented on the anteromedial side of the arch opposite to the gill filaments, and abundant small spines were presented on the dorsal surface of the gill arch. Many gill lamellae were arranged on both sides of each filament, and interwove with each other. The red afferent filamental artery, the efferent filamental artery, and the capillary network of lamellae were clearly observed under an optical microscope. The gill rakers, gill arches, and branchial filaments were all covered by a layer of stratified epithelium, whereas distinct morphology of microridges were presented on the surface of pavement cells. In the stratified epithelium, the pillar cells, the mucous cells, the pavement cells, and the mitochon- dria-rich cells

  14. 合并冠状突骨折的肘关节骨折脱位治疗进展%Progress in treatment of elbow fracture-dislocation combined with coronary fractures

    Institute of Scientific and Technical Information of China (English)

    王晓龙; 魏巍; 王鹏飞; 张堃; 宋哲

    2016-01-01

    肘关节骨折脱位是典型的高能量损伤,冠状突骨折经常是此类损伤的一部分.成功处理合并冠状突骨折的肘关节骨折脱位需要识别损伤的类型,早期治疗可获得足够的肘关节稳定性.尽管部分特定的肘关节损伤“三联征”可以保守治疗,但绝大多数需通过手术修复.冠状突尖部骨折常用缝合套索、钢丝张力带或袢钢板固定,修复或置换桡骨头,修复外侧副韧带.冠状突前内侧面骨折常发生于内翻后内侧旋转不稳定损伤.一小部分可以保守治疗,骨折块较大或肘关节不稳时,推荐使用支撑钢板固定、修复外侧副韧带.经鹰嘴骨折脱位最好通过手术复位滑车切迹并稳定.如果肘关节仍不稳定,则需要修复内侧副韧带或使用铰链式外固定支架维持同心圆复位,早期开始活动.%Elbow fracture-dislocations are typically high-energy injury.Fractures of the coronoid process are usually part of this injury.Successful management of elbow fracture-dislocations associated with coronoid fracture requires recognition of the injury pattern and early treatment to obtain adequate elbow stability.Although some special cases of terrible triad of the elbow can be managed non-operatively,the majority of the fracture-dislocations are repaired by surgery.Tip fractures are usually repaired with a lasso suture,steel wire tension band or loop plating along with repair or replacement of the radial head and the lateral collateral ligament.Fractures of the anteromedial coronoid are theorized to occur from varus posteromedial rotatory injury.A subset of the injury can be managed non-operatively.Internal fixation with a buttress plate and reattachment of the lateral collateral ligament is recommended for injuries associated with large fracture fragments or elbow instability.Transolecranon fracture-dislocations are best treated surgically with stable restoration of the trochlear notch.If the elbow is still unstable,it is

  15. Aneurismectomia do ventrículo esquerdo: avaliação tardia Left ventricular aneurysmectomy: late follow-up

    Directory of Open Access Journals (Sweden)

    José Luiz Dancini

    1996-03-01

    Full Text Available Com o objetivo de avaliar tardiamente o efeito da aneurismectomia do ventrículo esquerdo quanto a sintomatologia e função ventricular global, foram analisados 40 pacientes consecutivos operados de agosto/87 a novembro/94, com um período de seguimento de 12 a 99 meses. A localização mais comum foi a ântero-medial e a maioria dos pacientes apresentava um quadro misto de angina e ICC. A pd2VE média preoperatoria foi de 25,9 mmHg. Cinco (12,5% faleceram durante a internação, por insuficiência miocárdica aguda e 6 (15%, durante o pós-operatório tardio. Quando se divide a série em dois grupos, aqueles operados de 1991 a 1994 (últimos 22 pacientes mostram uma sobrevida de 91% ao final de 4 anos. Dos 29 sobreviventes, 12 (30% encontram-se assintomáticos, enquanto que 42,5% cursam com algum grau de angina ou ICC. O ecocardiograma bidimensional demonstrou normalização dos diâmetros ventriculares, das frações de ejeção e encurtamento em apenas 43% dos casos. Ao final de um ano, somente 50% dos pacientes estão livres de sintomas. Em conclusão, a aneurismectomia do ventrículo esquerdo promoveu melhora sintomática na maioria dos pacientes, com mortalidade aceitável, embora não totalmente confirmada pelos índices de função global ao ecocardiograma bidimensional.Forty consecutive patients operated on between August 1987 and November 1994 were analysed, aiming at the late assessment of left ventricular aneurysmectomy in terms of symptomatology and global ventricular function. The follow-up ranged from 12 to 99 months. The most common location was anteromedial and most of the patients had both angina and CHF. The average preoperative LVEDP was 25.9 mmHg. Five patients (12.5% died during hospitalization, due to acute myocardial failure, and 6 (15% during the late postoperative period. When the series is divided into two groups, the survival rate among those operated on between 1991 and 1994 (the last 22 patients is 91 % after 4

  16. 后外侧入路钢板固定治疗后踝骨折的临床疗效分析%Clinical efficiency of posterior malleolus fractures by plate fixation via the posterolateral approach

    Institute of Scientific and Technical Information of China (English)

    叶书熙; 杨成亮; 熊然; 王华; 李涛; 韩卫雨; 樊仕才

    2013-01-01

    Objective To study the role of the anteromedial bundle ( AMB) and posterolateral bundle (PLB) of the anterior cruciate ligament ( ACL) in maintaining knee joint stability. Methods In this study,12 fresh-frozen human cadaveric knees were tested under two kinds of external loading conditions including a 100N anterior tibial load with the knee at 0°,15° ,30° ,60°and 90°of flexion; and a 5Nm pronation load with the knee at 0° , 15°and 30° of flexion. The two bunches of ligament were pulled tight that led the strain gauge to deformation, and changed output voltage value. Results In response to a 100N anterior tibial load,the situ force in the AMB was significantly greater at 60°and 90°than at full extension and 15°of flexion(P 0. 05) . Conclusion Though the AMB plays an important role in the ACL,the role of PLB should, not be ignored, in maintaining anterior and internal rotational stability at low flexion angles.%目的 探讨后外侧入路钢板固定后踝骨折的手术方法及临床疗效.方法 2008年5月~2012年3月,采用后外侧入路钢板固定治疗后踝骨折37例.根据Lauge-Hansen踝关节骨折分型,旋后外旋型23例,旋前外展型6例,旋前外旋型8例.术后定期门诊随访,观察骨折愈合及踝关节功能情况.结果 本组患者手术时间为63~105min,平均82.0min;所有患者均获随访,随访时间13~17个月,平均14.5个月.所有患者切口均Ⅰ期愈合,X线片检查示所有骨折均获骨性愈合,随访期间未见内固定物移位、松动或断裂;末次随访时,踝关节功能根据Phillips踝关节评分标准,本组评分为110~150分,平均141.0分;获优21例、良好11例、一般3例、差2例;优良率为86.5%.结论 采用后外侧入路钢板固定治疗后踝骨折,创伤小,手术显露清晰,可直接地精确复位关节面,并进行稳定固定.

  17. Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation.

    Science.gov (United States)

    Zhao, Jie; Hou, Tiesheng; Wang, Xinwei; Ma, Shengzhong

    2003-04-01

    Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiffness seen with pedicle screw instrumentation, and we concluded that cages should not be used posteriorly without other forms of fixation. On the other hand, placement of two cages using a posterior approach does have the disadvantage of risk to the bilateral nerve roots. We therefore performed a prospective study to determine whether PLIF can be accomplished by utilizing a single diagonal fusion cage with the application of supplemental transpedicular screw/rod instrumentation. Twenty-seven patients underwent a PLIF using one single fusion cage (BAK, Sulzer Spine-Tech, Minneapolis, MN, USA) inserted posterolaterally and oriented anteromedially on the symptomatic side with unilateral facetectomy and at the same level supplemental fixation with a transpedicular screw/rod system. The internal fixation systems included 12 SOCON spinal systems (Aesculap AG, Germany) and 15 TSRH spinal systems (Medtronic Sofamor Danek, USA). The inclusion criteria were grade 1 to 2 lumbar isthmic spondylolisthesis, lumbar degenerative spondylolisthesis, and recurrent lumbar disc herniations with instability. Patients had at least 1 year of low back pain and/or unilateral sciatica and a severely restricted functional ability in individuals aged 28-55 years. Patients with more than grade 2 spondylolisthesis or adjacent-level degeneration were excluded from the study. Patients were clinically assessed prior to surgery by an independent assessor; they were then reassessed at 1, 3, 6, 12, 18, and 24

  18. 标准化超声切面筛查孕11~13+6周胎儿结构畸形的临床意义%Ultrasound screening for fetal structural abnormalities with standard ultrasound views during 11-13+6 weeks

    Institute of Scientific and Technical Information of China (English)

    王莉; 吴青青; 陈焰; 马玉庆; 姚苓

    2014-01-01

    2812/2822);漏诊率43.5%(10/23,4例心脏畸形,1例脐膨出,2例肢体双足畸形;1例膈疝均于孕中晚期连续筛查检出,2例畸形出生后诊断)。结论孕早期标准化超声筛查切面能检出露脑、无脑、腹裂、脐膨出、胸外心及单心室等严重胎儿畸形。但孕早期超声筛查胎儿畸形有一定局限性,对复杂性心脏大血管畸形、肢体等畸形需待孕中晚期超声检查时诊断。因此,建立孕早、中、晚期连续动态筛查系统非常必要。%Objective The clinical value of ifrst-trimester standard ultrasound views in screening for fetal structural abnormalities. Methods From September 2008 to March 2011, transabdominal sonographic screening by standard ultrasound views was performed in 3 134 viable singleton pregnancies during the ifrst trimester at Beijing Obstetrics and Gynecology Hospital. Used the following views:(1) Fetal proifle;(2) Neck sagittal;(3) Skull and brain;(4) Thorax;(5) Abdomen;(6) Bladder;(7) Upper limbs, and (8) Lower limbs. The women underwent 20-to 24-week and 28-to 32-week ultrasound examination if the anatomical survey was normal during the ifrst trimester. Follow-up was obtained by reviewing of the birth records from hospital charts. Results Sixteen prenatal abnormalities were detected at 11-to 13-week scan (including one case of encephalocele and meningoceles, one case of endothelial cushion defect and single umbilical artery, one case of ectopia cordis, gastroschisis, and spinal abnormalities, two cases of exencephaly, one case of anencephaly, one case of gastroschisis and lower limb malformation, two cases of omphalocele, one case of encephalocele, ectopia cordis, and gastroschisis, one case of single ventricle, one case of endothelial cushion defect, four cases of hyhrop). All of the 13 women decided on termination of pregnancy. Three suspected structural abnormalities (hydrops) detected at the ifrst-trimester scan were found as normal after birth

  19. 孕妇血清叶酸和维生素B12水平与子代神经管畸形发生的关系%Maternal serum level of vitamin B12 and folate and the risk of fetal neural nube defects

    Institute of Scientific and Technical Information of China (English)

    谢华; 任玉秀; 梁晋魁; 赵莉

    2010-01-01

    vitamin B12 and folate levels were detected compared with the control group. While, in those complicated with anencephaly, only lower levels of maternal folate were shown. There was no statistical significance in maternal serum concentrations of vitamin B12 and folate between those cases with encephalocele and controls. Higher risk of NTDs were found in pregnant women with lower level of vitamin B12 and folate (AOR = 2. 58, 95% CI: 1. 20-5. 51; AOR= 2. 76, 95%CI: 1. 30-5. 87). Conclusions Deficiency or insufficiency of folate or vitamin B12 is associated with the increased risk of NTD, especially in high risk population.

  20. 2006-2012年北京市房山区神经管缺陷流行特征%Epidemiological characteristics of neural tube defects in Fangshan district of Beijing from 2006 to 2012

    Institute of Scientific and Technical Information of China (English)

    马瑞新; 杨燕芬; 刘辉; 靳蕾

    2015-01-01

    Objective ToexplorethedynamicprevalenceofneuraltubedefectsinFangshandistrictofBeijing from 2006 to 201 2. Methods Data collected through routine birth defects surveillance system in Fangshan district during 2006 and 201 2 were used.The dynamic prevalence,distribution by population characteristics and the proportions of prenatal diagnosis of neural tube defects were analyzed. Results From 2006 to 201 2,61 neural tube defects were identified among 50 234 births,with a prevalence of 1 2.1 per 1 0 000.The prevalence of anencephaly,spina bifida and encephalocele was 5.4 per 1 0 000,4.8 per 1 0 000 and 2.0 per 1 0 000,respectively.The prevalence of neural tube defects of the floating population (20.0 per 1 0 000)was 2.3 times higher than that of the permanent local residents (8.8 per 1 0 000).After the implementation of folic acid supplementation program in 2009,the prevalence of neural tube defects among floating population showed a downward trend during 201 0 to 201 2,but the prevalence among permanent residents rebounded in 201 2.The proportion of prenatal diagnosis of neural tube defects was 80.0% from 2006 to 201 2, and the proportion of prenatal diagnosis before 28 gestational weeks was 68.3%. Conclusion The prevalence of neural tube defects in Fangshan district was slightly higher than the prevalence of Beijing and some of its districts.Moreover,the prevalence of neural tube defects of the floating population was higher than that of the permanent residents.Education and management of folic acid supplementation before pregnancy need to be strengthened.Moreover,the ability of prenatal diagnosis of neural tube defects in this district needs to be improved.%目的:了解2006—2012年北京市房山区神经管缺陷患病率的变化趋势。方法以2006—2012年房山区的出生缺陷监测数据为基础,分析神经管缺陷的患病率变化趋势、人群分布特征及产前诊断情况。结果2006—2012年房山区出生人口数为50234

  1. 青龙满族自治县围产儿出生缺陷情况分析及对策研究

    Institute of Scientific and Technical Information of China (English)

    王民; 肖斌; 孟晓丽; 刘凤楼; 李淑民

    2016-01-01

    Objective Understand the present situation of perinatal birth defects qinglong manchu autonomous county, tofind the cause of perinatal birth defects, explore study of the various measures to prevent birth defects, which will provide a scientific basis for regional service decision of eugenic and superior nurture.Methods Relying on national free pregnancy eugenics health check project, from January 2013 to September 2015, collecting reproductive health care to qinglong manchu autonomous county hospital to participate in national free pregnant eugenics health check after the project plan of 20271 pregnant women of childbearing age, around the pregnancy pregnancy follow-up found abnormal termination of the fetus, and data on the retrospective statistical analysis.Results Found a total of 156 cases of perinatal birth defects of perinatal birth defects 7.69‰, and a downward trend in 3 years. Perinatal birth defects in the main line, spina bifida, anencephaly encephalocele, congenital hydrocephalus, etc.; Lead to the main factors of perinatal birth defects of the economy, the living environment, living habits, access to health services, for the master degree of knowledge of eugenic and superior nurture, taking of nutrients during pregnancy, etc.Conclusion In order to reduce the perinatal birth defects, we must strengthen eugenics health knowledge propaganda, improve women of childbearing age consciousness of eugenic and superior nurture, through the national free eugenics health examination before childbirth programs at the same time, actively promote prenatal screening technology,strengthen the efforts in prenatal screening and prenatal diagnosis, actively carry out women take folic acid, pregnancy and the early stages of pregnancy to prevent birth defects "tertiary prevention measures”, can effectively prevent the occurrence of perinatal birth defects, reduce the incidence of birth defects.%目的:了解青龙满族自治县围产儿出生缺陷现状,寻找

  2. 额颞极内减压术在重型颅脑损伤救治中的临床应用%The clinical research of internal decompression by anterior frontal or(and) temporal lobectomy in operation of severe trau-matic brain injury

    Institute of Scientific and Technical Information of China (English)

    李庆新; 王卫红

    2014-01-01

    Objective To explore the operative strategy and guideline of severe traumatic brain injury ( sTBI) with internal decom-pression by anterior frontal or ( and) temporal lobectomy .Methods Forty-three patients with sTBI who were admitted in our department from August 2011 to April 2014 were divided into two groups according to therapeutic method:treatment group ( internal decompression and exter-nal decompression),control group (single external decompression ).In all cases,we applied stepwise controlled decompression to prevent a-cute encephalocele intraperatively ,and analyzed the signs and CT imagings postoperatively ,and the glasgow outcome scores before discharging were also involved .Results The intracranial pressure ( ICP ) of all the patients decreased to some degree postoperatively .In the treatment group,8 cases achieved good recovery ,14 cases had disability and 2 cases were dead.In the control group,4 cases achieved good recovery ,10 cases were with disability and 5 cases dead .The prognosis of the treatment group was much better than that of the control group ,and there was significant difference in statistics(P<0.05).Conclusion The additional internal decompression by anterior frontal or (and) temporal lobec-tomy in the operation of sTBI is a more effective way to decrease ICP .Its recent prognosis is better than single hematoma and contusion resec-tion,but we still need future research to value the long-term effect.%目的:分析总结额极或(和)颞极内减压术在重型颅脑损伤患者手术救治中的应用经验,以期有效提高手术治疗的成功率。方法选取我科2011年8月至2014年4月收治的43例重度颅脑损伤患者( GCS 3~8分),均行大骨瓣开颅外减压手术;治疗组24例患者配合额极或(和)颞极部分切除内减压术(左侧10例、右侧14例),对照组19例患者单纯行血肿并挫伤脑组织清除术。术中均行逐次减压方法预防急性脑膨出,术后分析两

  3. 7336例孕妇羊水甲胎蛋白检测结果分析及临床应用评价%Analysis and clinical application evaluation of amniotic fluid AFP in 7 336 gravida

    Institute of Scientific and Technical Information of China (English)

    林飞; 郑海洋; 徐钰琪; 韦升开; 俸诗瀚; 阙婷; 陈少科

    2015-01-01

    Objective To establish the median value of amniotic fluid AFP(AFAFP)in each gestational age,which was used for monitoring and diagnosis of fetal neural tube defects(NTDs),and to discuss the clinical value of AFAFP test. Methods ELISA was used in quantitive test of AFAFP in 7 336 gravida in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from 2013 to 2014,subjects with positive result were diagnosed by the color doppler ultrasound. Results AFAFP level went down as fetus grown and gestation prolonged,Ln(AFAFP)and gestation was negative correlated,mathematical equation was Ln(AFAFP level)= - 0. 17 *gestation + 14. 29( R - squared = 0. 9244). Cut - off value of AFAFP in 16 - 23 gestation were 42211. 88 ng/ mL, 35634. 28 ng/ mL,25 562. 80 ng/ mL,25 394. 18 ng/ mL,21 437. 18 ng/ mL,18 096. 75 ng/ mL,15 276. 85 ng/ mL,12 896. 35 ng/mL respectively. The detection rate was high in some particular clinical diagnosis such as anencephaly,heart bulging,encephalocele, acromphalus,stillbirth. The concentration of AFAFP did not increased with the increment of gravida age. Conclusion The study established the mathematical equation of AFAFP value and gestational age,and the median value of each gestational age. The AFAFP testing program could be used to evaluate the safety of the fetus,combing with color doppler ultrasonic testing and other comprehensive analysis of clinical indicators,it?could be use to discovery,diagnose and prevent the birth of the major malformation fetus in early pregnant,which was important to the improvement of the accuracy and sensitivity of the screening.%目的:建立各孕周羊水甲型胎儿球蛋白(amniotic fluid AFP,AFAFP)的中位数值,用于胎儿神经管缺损(neural tube defects,NTDs)的监测与诊断,并探讨 AFAFP 检测的临床价值。方法2013~2014年广西壮族自治区妇幼保健院采用酶联免疫法对具有羊膜腔穿刺指征的7336例孕妇进行 AFAFP 定量检测,筛查阳性

  4. Efeito da fortificação alimentar com ácido fólico na prevalência de defeitos do tubo neural Efecto de la fortificación alimentaria con ácido fólico en la prevalencia de defectos del tubo neural Effects of folic acid fortification on the prevalence of neural tube defects

    Directory of Open Access Journals (Sweden)

    Sâmya Silva Pacheco

    2009-08-01

    defectos del cierre del tubo neural fueron definidos de acuerdo con el Códigos Internacional de Enfermedades- 10ª Revisión: anencefalia, encefalocele y espina bífida. Se compararon las prevalencias en los períodos anterior (2000 - 2004 y posterior (2005-2006 al período obligatorio de fortificación. Se analizó la tendencia temporal de las prevalencias trimestrales de defectos del cierre del tubo neural por las pruebas de Mann-Kendall y Sen's Slope. RESULTADOS: No se identificó tendencia de reducción en la ocurrencia del hecho (Teste de Mann-Kendall; p= 0,270; Sen's Slope = - 0,008 en el período estudiado. No hubo diferencia estadísticamente significativa entre las prevalencias de defectos de cierre del tubo neural en los períodos anterior y posterior a la fortificación de los alimentos con ácido fólico de acuerdo con las características maternas. CONCLUSIONES: A pesar de que no haya sido observada reducción de los defectos de cierre del tubo neural posterior al período obligatorio de fortificación de alimentos con ácido fólico, los resultados encontrados no permiten descartar el beneficio del mismo en la prevención de esta malformación. Son necesarios estudios evaluando mayor período y considerando el nivel de consumo de los productos fortificados por las mujeres en edad fértil.OBJECTIVE:To analyze the effect of folic acid-fortified foods on the prevalence of neural tube defects in live newborns. METHODS: Longitudinal study with newborns from the city of Recife, Northeastern Brazil, between 2000 and 2006. Data analyzed were obtained from the Sistema Nacional de Informações de Nascidos Vivos (National Information System on Live Births. Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10: anencephaly, encephalocele, and spina bifida. Prevalences from the periods before (2000-2004 and after (2005-2006 the mandatory fortification period were compared. Time trend of three

  5. A clinical investigation of the mechanism of growing skull fractures in children%儿童颅骨生长性骨折的机制再探讨及早期手术

    Institute of Scientific and Technical Information of China (English)

    鲍南; 徐织; 杨波; 宋云海; 陈成

    2012-01-01

    Objective Many theories have been offered to explain growing skull fractures (GSFs),such as dural tears,arachnoid herniation,increased intracranial pressure,bone absorption due to the ischemia of the fracture line,and delayed or ceased bone growth.These theories,however,are limited by certain inadequacies.In this prospective study,we sought to uncover the mechanisms of GSFs,and their treatment method in children.Methods Ten patients with GSFs who received treatment at our hospital between November 2000 and June 2010 were retrospectively analyzed.The age at injury,duration from the time of injury to the appearance of the GSFs,fracture width,and imaging characteristics were analyzed.Cranioplasty was carried out,while duraplasty was not performed.Results The age at injury ranged from 2 to 21 months,and the age at surgery ranged from 3 to 5 years.The injuries included 7 fail injuries and 3 automobile collision injuries.All were linear skull fractures.The duration from the time of injury to the appearance of a GSFs was < 1 month in 4 cases and < 2 months in 6 cases.Six patients had frontal bone fractures,2 had parietal bone fractures,and 2 had occipital bone fractures.The fracture width ranged from 1.5 to 2.5 cm.The growing fractures became stationary just after the onset,without further progression.Computed tomography (CT) revealed 4 cases of encephalocele underneath the fracture and 6 cases of encephalomalacia due to brain contusion.Follow - up ranged from 1 to 7 years.Titanium plate fixation was stable,without loosening or displacement.There were no skull deformities in any patient.Conclusion GSFs usually occur in young children.The dural tear and the rapid growth of the brain in young children produce an outward expansion force,which plays a crucial role in GSFs development.It is possible that the current theories such as arachnoid herniation,increased intracranial pressure,bone absorption due to ischemia of the fracture line,and delayed or ceased bone growth

  6. 复杂肱骨远端骨折手术治疗的临床探讨%Clinical evaluation of operative treatment of complicated distal humerus fractures

    Institute of Scientific and Technical Information of China (English)

    赵龙; 宋有鑫; 崔成喜; 张宇轩; 张宝琦; 龚平; 武云鹤; 尚瑞松; 陈宾

    2014-01-01

    Background Distal humeral fracture is a severe damage around the elbow joint,and is often seen in young adults.It accounts for 2% of all adult fractures and about 50% of all humerus fractures.It′s one of the fractures that is difficult to deal with.The types of distal humeral fracture are divergent. Distal humerus fractures are often comminuted which make operative reduction difficult.Secondary loss of reduction and elbow ankylosis are common postoperative complications. All these difficulties make the distal humerus fracture one of the unresolved problems in fracture treatment.This study is to evaluate the clinical outcome of complex distal humeral fractures treated by operation.Methods (1)General data:twenty-four cases of operative treated distal humerus fractures in author′s hospital from January 2004 to December 2013 were included in this study.There were 1 5 males and 9 females,aging from 1 7 to 73,averaged 41.AO/OTA Classification:A3:9 cases;B1, B2:6 cases;C3:9 cases.Two cases were combined with nerve injury.Two cases had histories of high blood pressure and diabetes.(2 ) Operative method:The patient was placed in the supine position,and the elbow to be operated on was positioned at 90°of abduction and supported on a lucent operating table.A pneumatic tourniquet was placed as proximally as possible on the arm.With the elbow flexed at about 60°,the first incision was made about 7 cm proximal to the tip of the medial epicondyle.In the initial cases,the ulnar nerve was isolated,released from the ulnar nerve groove, and protected carefully.In later cases,the nerve was only exposed.The medial and anteromedial side of the distal humerus was exposed through the opening between the brachial muscle and the medial intermuscular septum.The common origin of the flexor muscles was partially dissected and reflected distally,leaving a 5-mm strut to be re-sutured in situ at completion of surgery.The anterior capsule was incised.The articular surface of the trochlea was

  7. Arthroscopic procedures for ankle arthritis%踝关节炎的关节镜手术

    Institute of Scientific and Technical Information of China (English)

    倪磊; 吕厚山; 陈坚

    2004-01-01

    目的探讨踝关节关节镜手术的适应证、手术方法和临床疗效.方法 1990~2001年使用4 mm30°关节镜常规经前外和前内入口,偶经后外入口对79例(83踝)踝关节炎患者进行检查.男37例,女42例;年龄17~68岁,平均(42.5±13.3)岁.诊断包括滑膜炎39例(41踝)、骨关节炎34例、滑膜软骨瘤病4例和大骨节病2例(4踝).在手工牵引下对43例患者行滑膜切除术(39例滑膜炎、4例滑膜软骨瘤病)、47例行软骨修整术(34例骨关节炎、11例滑膜炎、2例大骨节病)、20例行胫骨骨赘切除术(18例骨关节炎、2例大骨节病)、14例行游离体取出术(10例骨关节炎、4例滑膜软骨瘤病).结果 7例出现手术并发症,包括关节血肿3例、浅表感染2例和麻木2例.68例获得1~12年随访,平均(4.8±3.5)年.症状改善s6例、无变化7例、不满意5例(4例再次关节镜手术).结论在该组病例中,通过关节镜诊治,使82.4%的踝关节炎患者关节肿痛症状得到改善,但对踝关节炎的功能改善还不够理想.有8.4%的病例出现手术并发症.%Objective: To investigate indications,techniques and follow-up results of operative arthroscopy for ankle arthritis.Methods: 79 patients (83 ankles) who included 37 males and 42 females at a mean age of (42.5+13.3) years (range 17~68) were underwent by ankle arthroscopy from 1990 to 2001.30°arthroscope 4.0 mm in diameter was introduced into ankle through both anterolateral and anteromedial portalsroutinely,as well as posterolateral portals occasionally.Diagnosis included synovitis in 39 patients,osteoarthritis (OA) in 34,synovial chondralmatosis (SCM) in 4 and Kaschin-Beck disease in 2.The arthroscopic procedures included synovectomy in 43 patients (synovitis 39,SCM 4),debridement of articular surfaces in 47(OA 34,synovitis 11,Kaschin-Beck disease 2),smoothing of anterior tibial lip osteophytes in 20 (OA 18,KaschinBeck disease 2) and removal of loose-bodies in 14 (OA 10,SCM 4

  8. Surgical treatment of postoperative deep wound infection after posterior lumbar interlumbar fusion of the lumbar stenosis%腰椎管狭窄症椎体间植骨融合术后急性切口深部感染的处理

    Institute of Scientific and Technical Information of China (English)

    王兆红; 吴德慧; 马超; 戴维享

    2012-01-01

    Objective;To evaluate the clinical effects of double-bundle reconstruction of anterior cruciate ligament (ACL) using hamstring tendon auto graft under arthroscopy. Methods: From April 2009 to March 2010 ,25 patients (13 males and 12 females) with ACL deficiency were treated with arthroscopy,ranging in age from 17 to 43 years,with an average of 25.8 years. There were 17 patients caused by sports injuries,6 patients caused by accidental falling,and 2 patients caused by traffic injury. The average duration of the disease was 3 months. The main symptom was knee instability in 8 patients,and knee pain and swelling in other patients. Pivot shift test was positive in 15 cases,and Lachman test was positive in 25 cases,the ADT (anterior drawer test) was positive in 25 cases. The anterior transition of the tibia measured by KT2000 instrument was (7.1 ±2.4) mm more than the contralateral knee. The average Lysholm score was 40.0±5.4. The Tegner activity scores averaged 3.2+0.7. The double tibial tunnels and double femoral tunnels were drilled on the footprint of the ACL to reconstruct the anteromedial and posterolateral bundles under arthroscopy. Tendons were fixed with Endo-buttons at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed during follow-up period. The anterior transition of the tibia was measured by KT2000,and the Lysholm score and Tegner scores were used for evaluating knee function. Statistically analyzed was performed with SPSS 15.0. Results:All the patients were followed up,and the duration ranged trom 24 to 35 months (averaged,27 months).At the latest follow-up,there was no positive pivot shift,while the Lachman test and ADT were negative or positive of grade I. The average Lysholm score of the 25 cases was 40.0±5.4 before operation, and 85.0± 4.5 at the latest follow-up,3.2±0.7 before operation and 7.5±0.2 at the latest follow-up for Tegner activity score. Statistically, the

  9. The design of a new unicompartmental ultra high molecular weight polyethylene prosthesis and the biomechanical study on its stability%新型单髁聚乙烯假体的设计及其稳定性的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    鲁世保; 李之芳; 王庆一; 胥少汀; 李放; 姜金卫; 李增洲

    2001-01-01

    Objective To Compare the stability of a newly designed unicompartmental pure polyethylene prosthesis with the currently used ones. Methods Three kinds of unicondylar pure polyethylene prosthesis were investigated. The three kinds of prosthesis have the same shallow dish structure in the superior surface; however, the structures of the undersurface are different. The smooth typed prosthesis has a smooth undersurface, ‘ # ’ shape prosthesis has a under surface with grooves, which is used clinically at present, and the newly designed three peg prosthesis has three pegs anteriorly, posteriorly, and medially. Eighteen tibia specimens were divided into three groups randomly, all prostheses were cemented onto the medial compartment of the tibias. Each specimen was tested in a biomechanical machine(CSS- 1101). A 147 N and 981 N load was applied anteromedially. The anterior and posterior micromovements were measured for 1,2,3,4,5,10,15,20,25,30 cycles at the load of 147 N and 981 N. Results There was no significant difference between three peg prosthesis and ‘ # ’ shape prosthesis during anterior and posterior micromovements at a load of 147 N. But at a 981 N load , the micromovements of three peg prostheses were significantly lower than that of ‘ # ’ shape prosthesis. Conclusion The stability of the newly designed three peg prosthesis was better than that of ‘ # ’ shape prosthesis currently used clinically.%目的比较新型单髁聚乙烯假体与临床常用假体的稳定性,为新型假体应用于临床提供试验依据。方法试验中使用三种类型的单髁胫骨聚乙烯假体:光滑型、“井”字型及“三柱”型。三种假体的上表面均为浅碟形,底面的结构各不相同:光滑型假体的底面光滑,无任何立体构型;“井”字型假体是临床使用的假体,其底面带有“井”字形分布的沟槽;“三柱”型假体是新型假体,其底面带有三个短柱,分别位于底

  10. 面神经管迷路段先天变异的 HRCT 表现%HRCT appearance of congenital rariation in the labyrinthine segment of facial nerre canal

    Institute of Scientific and Technical Information of China (English)

    高燕军; 董季平; 马鸣岳; 刘红生; 杨想春; 孙东海; 赵芸芸; 曲长君

    2014-01-01

    Objectire:To study the HRCT appearance of congenital variation in the labyrinthine segment of facial nerve canal and associated middle and inner ear malformation.Methods:The HRCT images of temporal bone of 16 patients with congenital variation in the labyrinthine segment of facial nerve canal were analyzed retrospectively.Based on the origi-nal axial images,the multi-planar reformation (MPR)and curved-planar reformation (CPR)images of bilateral ossicular chain,inner ear structure and facial nerve canal were reconstructed.HRCT appearance of congenital variation in the labyrin-thine segment of facial nerve canal were analyzed,including its initial sites,dehiscence,length,the angle of first genu and as-sociated middle and inner ear malformation.Results:Five types of congenital variation in the labyrinthine segment of facial nerve canal were found in 30 sides of 16 cases,including dehiscence in geniculate fossa in 17 sides,anteromedial displacement at the beginning sites in 18 sides (with widening of Bill′s bar in 5 cases),enlargement of the angle of first genu in 21 sides with average value 107.2°(96.0°~126.0°),increase of length in 21 sides with average length 6.8mm (5.2~8.3 mm),bi-furcation in 1 side.Associated middle ear malformation in 4 sides and inner ear malformation in 25 sides were found.Conclu-sion:A variety of congenital variations may occur in labyrinthine segment of facial nerve canal and often associated with mid-dle or inner ear malformation,which can be clearly displayed by HRCT with MPR and CPR images.%目的:探讨面神经管迷路段先天变异和伴发的中耳、内耳畸形的 HRCT。方法:回顾性分析16例面神经管迷路段先天变异患者的颞骨 HRCT 图像,在观察常规横轴面 CT 图像的基础上,进行双侧听骨链、内耳结构及面神经管的多平面重组(MPR)和曲面重组(CPR),从面神经管迷路段的起始部位、管壁情况、管腔长度、第一膝角度及

  11. STUDY OF THE PEPPER PEST GENUS, LANKA MAULIK, AND DESCRIPTIONS OF TWO NEW SPECIES FROM CHINA (COLEOPTERA,CHRYSOMELIDAE, ALTICINAE)%胡椒害虫——突顶跳甲属及中国二新种记述

    Institute of Scientific and Technical Information of China (English)

    王书永; 葛斯琴; 李文柱; 崔俊芝; 杨星科

    2012-01-01

    3 mm. Holotype 2 , China, Yunnan, Xishuangbanna, Nabanhe National Natural Reserve, Anmaxinzhai (22. 19°N, 100. 64°E; alt. 772 m), 16 Apr. 2009, leg. MENG Ling-Hui. The new species is close to Lanka laevigata (Chen et Wang) , but can be distinguished by the punctures of pronotum and elytra; the new species with dense and fine punctures, interspace of elytra wide and flat. But the latter with very fine and unclear punctures, interspace of elytra slightly convex.Etymology. From Latin, punctatus and collaris, means pronotum with clear punctures.Lanka regularia Wang et Ge, sp. nov. (Figs 2 - 5)Body elongate ovoid, dorsum convex. Body black, central of vertex, antennae, fore- and mid-legs, tarsi of hind-legs reddish brown; underside of body and tibiae of hind-legs black. Vertex convex, antero-lateral part with one big puncture on each side; smooth and impunctate; frontal tubercles elongate-ovoid, almost absent; with furrow closed to posterior of compound eyes, with one big puncture near furrow on each side (Fig. 3). Antennae exceeding to middle of elytra, antennomere 1 robust, 2 short, half length of antennomere 2, antennomere 3 1.5 times as long as 2, slightly shorter than 4, antennomeres 5-11 robust, longer than 4. Pronotum broad quadrate, 2 times broader than long, central disc convex, lateral sides slightly arched; behind anterior angles with tricobothia; middle of posterior margin anched before scutellum, with one longitudinal depression closed to lateral side; disc with dense and fine punctures, shagreened among punctures. Scutellum half rounded, surface granulate. Elytra with humeral calli convex, punctures of elytra slightly coarser than pronotum, with regular striae, interstice flat, impunctate. First segment of male tarsi broad, pear-shaped (Fig. 4). First segment of abdomen with one hippocrepiform carina antero-medially ( Fig. 5 ). Body length 3 mm. The new species is close to L. nigra (Chujo) from Taiwan, but can be distinguished by the following characters

  12. Clinical Research of Two Transcervical Approaches of Surgical Treatment of Parapharyngeal Space Tumor%两种入路摘除咽旁间隙肿瘤临床研究

    Institute of Scientific and Technical Information of China (English)

    罗兴谷; 江青山; 廖剑绚; 卢永田

    2016-01-01

    approach is a useful technique for the removal of tumors located anteromedially to the carotid sheath .%目的:比较内镜辅助口内入路与颈部入路摘除咽旁间隙肿瘤的疗效,探讨内镜辅助口内入路的适应症、优点和手术技巧。方法回顾性分析深圳市第二人民医院耳鼻咽喉科2012-01—2015-06间收治的23例咽旁间隙肿瘤患者病历资料,根据肿瘤的位置、肿瘤与周围重要结构的关系,分成观察组7例(采用内镜辅助口内入路)和对照组16例(采用经颈部入路)。比较两组患者的手术时间、术中出血量、住院时间,并行统计学分析。结果观察组手术时间(127.00±9.08) min,术中出血(86.00±12.94)mL,住院时间(5.80±0.84)d;对照组手术时间(128.00±11.46)min,术中出血(235.67±15.80)mL,住院时间(9.07±0.88) d。两组患者肿瘤均完全切除,均未出现严重并发症,所有患者术后随访0.5~3年均无复发。观察组与对照组手术时间差异无统计学意义( P>0.05);术中出血量、住院时间差异有统计学意义( P<0.05)。结论内镜辅助口内入路较颈部入路在减少术中出血、缩短住院时间方面有明显优势。内镜辅助口内入路最大的优点是能保存颜面部美观,适用于位于颈动脉鞘内侧及前内侧良性肿瘤的摘除。

  13. Anatomy of anterolateral portals of elbow arthroscopy%肘关节镜前外侧入路的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    吴关; 鲁谊

    2016-01-01

    anterior position than the conventional approach, or we delivered implants at a more anterior position than the conventional approach to perform fracture fixation.Our findings are reported below.Methods Ten fresh upper limb specimens were selected, all males,mean age 58 years (43 to 78 years),all elbow joints free of external deformities,surgical scars or mobility limitation.Study tools included anatomical instruments (scalpel,forceps,scissors, toothed forceps etc.),4 mm diameter Steinmann pins,20 ml disposable syringes,18-Gauge epidural needles,and vernier caliper (accuracy of 0.1 mm).Surgical procedure:flex the elbow at 90°,fix the upper arm on operation table,mark important anatomical landmarks individually including epicondyle of the humerus and radial head etc., mark the sites of conventional lateral elbow arthroscopic approach and experimental (improved ) lateral elbow arthroscopic approach. Choose of the conventional approach was in accordance with previous literatures,and improved approach was 5 mm anterior to the conventional approach. Conventional approaches included proximal anterolateral approach (2 cm proximal and 1 cm anterior to the humeral epicondyle),anterolateral approach (1 cm anterior to the humeral epicondyle),and lateral approach (3 cm distal and 1 cm anterior to the humeral epicondyle ). A 18-Gauge epidural needle was used for puncture via the anteromedial approach,inject normal saline into the joint to expand articular capsule,make a small incision on the previously marked 3 conventional approach sites and 3 experimental approach sites, expand subcutaneous tissues using straight forceps.Under 90° elbow flexion or forearm at neutral position respectively,insert a 4 mm diameter Steinmann pin into center of the joint,remove all skin and subcutaneous tissues of lower 1/3 upper arm and upper 1/3 forearm to dissect the radial nerve.Under 90°elbow flexion position,the shortest distance between the radial nerve and adjacent Steinmann pin was measured

  14. 骨移植治疗肩关节后脱位伴肱骨头前内侧骨缺损的中期疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘刚; 石波; 康斌

    2013-01-01

    /allograft reconstruction for defects of the humeral head associated with posterior dislocations of the shoulder. There were 5 males and 2 females with the mean age of 43.9 years(range, 29~55 years). These patients had 25%~42%(mean, 31%) anteromedial articular surface defects of humeral head associated with locked posterior shoulder dislocation. Among them, 4 had lesser tuberosity fracture,1 had lesser tuberosity as well as surgical neck fracture. The during from injury to diagnosis was 1 to 58 days with an average of 22.7 days.Imaging finding,Constant score and joint function were evaluated after operation. Results The patients were followed up for 12 to 36 months with an average period of 20.7 months. At the final follow-up, no collapse of articular surface or osteoarthritis was seen on the radiographs of the shoulder in 5 patients, and partly absorption of the humeral head or graft collapse and osteoarthritis were present in the radiographs of the shoulder in 2 patients. However, all patients got fine functionary recovery. The mean Constant score of these patients was 85.1 (range,75~91). Limitation of external rotation of shoulder joint was well improved, from-14.3 degrees to +16.4 degrees. Conclusion Bone auto/allograft reconstruction for defects of the humeral head associated with posterior dislocations of the shoulder can obtain excellent clinical efficacy, which restoring shoulder function and stability.

  15. 舌咽神经、迷走神经和副神经断层解剖与 MRI%Sectional Anatomy and MRI of Glossopharyngeal, Vagus and Accessory Nerves

    Institute of Scientific and Technical Information of China (English)

    汤煜春; 刘树伟; 孙博; 林祥涛; 梁长虎; 葛海涛; 冯蕾; 尹群生; 王政; 杨林林

    2013-01-01

    Objective:To explore the course and adjacent structures of glossopharyngeal , vagus and ac-cessory nerves in order to provide intimate morphological data for clinical image diagnosis and surgical opera -tions of the diseases in this region .Methods:Serial transverse sections of 36 Chinese adult head specimen and serial coronal sections of 15 head specimen were obtained to investigate the course and adjacent structures rela -tionship of the glossopharyngeal , vagus and accessory nerves in the cranial cavity with the corresponding 3D-CISS MR images.Results:The glossopharyngeal, vagus and accessory nerves originated from the retroolivary sulcus of medulla oblongata , crossed the medulla oblongata cistern and passed through the jugular foramen to the out of cranium.According to their course, the three cranial nerves could be divided into inter -medullar oblongata segment, cistern segment and jugular foramen segment .In the cistern segment, the glossopharyngeal nerve ran upside, the vagus nerve and accessory nerve ran downside and combined together tightly .In the jugu-lar foramen segment, the relationship between the three cranial nerves and vessels were as follows :the internal carotid artery lied in the most anterior part , the internal carotid vein lay extreme -lateral, the glossopharyngeal nerve ran cross the anteromedial superior part with a sole spinal dura mater covered , the vagus nerve and acces-sory nerve combined together to form a complex and ran posterolateral inferior to it .Conclusions:Combining se-rial sections with 3D-CISS MR images offers a better understanding of the course and adjacent structures of glossopharyngeal, vagus and accessory nerves , especially the identification of key structures .%  目的:探讨舌咽神经、迷走神经和副神经的走行和毗邻关系,为影像学诊断及临床开展该区手术提供形态学依据。方法:利用36例成尸头部连续横断层标本和15例成尸头部连续冠状断层标本

  16. Clinical observation of knee arthroscopy with double ETHIBOND sutures in the treatment of tibial avulsion fractures of the posterior cruciate ligament%关节镜下双股ETHIBOND线固定治疗后交叉韧带胫骨止点撕脱骨折的疗效观察

    Institute of Scientific and Technical Information of China (English)

    倪建龙; 时志斌; 党晓谦; 王坤正

    2016-01-01

    Objective To study the surgical method and clinical results of knee arthroscopy with double ETHIBOND sutures in the treatment of tibial avulsion fractures of the posterior cruciate 1igment ( PCL ).Methods From June 2014 to October 2015, a total of 18 patients with PCL tibial avulsion fractures who were treated with double ETHIBOND sutures under knee arthroscopy were enrolled. There were 10 males and 8 females, whose mean age was ( 32.5 ± 8.7 ) years old. Anteromedial, anterolateral, posteromedial and high posteromedial portals were built before the operation, which aimed to explore the knee joint. Both the avulsed bone block and the tibia bone bed were refreshed via the double posteromedial portals. The 2 bone tunnels ( 4.5 mm in diameter ) was completed with the assistance of PCL director drill guide. Double ETHIBOND sutures were used during the reduction to ifx the avulsed bone by double posteromedial portals. The sutures were pulled out through the 2 bone tunnels and tied in front of the tibia. Reduction and healing of the avulsion fractures and mobility degree of the knee were observed after the operation. Lysholm and the international knee documentation committee subjective knee form ( IKDC ) scores were calculated to evaluate the functional recovery of the knee.Results All the cases were followed up from 8 to 24 months, with an average of ( 14.2 ± 3.2 ) months. All the avulsion fracture healing was achiveved without displacement according to the X-ray and CT scanning, and the average healing time was 2.5 months. The posterior drawer test showed negative results in all the cases. The knee extension was unlimited, and 15° lfexion limitation was found in 1 case due to delayed rehabilitation. The average range of lfexion was ( 135.5 ± 3.5 ) °. The average Lysholm scores were increased from ( 37.8 ± 3.5 ) points to ( 95.6 ± 3.2 ) points (P < 0.001 ), and the average IKDC scores were increased from ( 54.7 ± 6.5 ) points to ( 95.2 ± 4.5 ) points (P < 0

  17. Efficacy and safety of "Five-Sequential-Portal Method" in elbow arthroscopy%肘关节镜"序贯五入路法"的有效性与安全性分析

    Institute of Scientific and Technical Information of China (English)

    汪华清; 唐康来; 龚继承; 谭晓康; 许建中

    2008-01-01

    into the "soft spot" to make the first portal. The second portal was established anterolaterally under the arthroscopy in the first portal. The third portal was established an-teromedially through the second portal, passing the coronoid process, to make the incision of skin by the in-side-out technique. The forth and the fifth portals were established posterolaterally and postcromcdially on both sides of the triceps tendon. The joint was explored in sequence and an etiotropic procedure was taken. After surgery, rehabilitation exercises were performed under algesia controller. The Mayo elbow-performance indexes before and after surgery were compared. Results In this group, 46 patients were followed up for 6 to 34 (average, 11.65) months. The preoperative Mayo elbow-performance indexes ranged from 45 to 85 (average, 66.8±11.5) points. Fourteen cases were rated as good, 21 fair, and 11 poor. The postoperative Mayo el-bow-performance indexes ranged from 55 to 100 (average, 84.5±10.5) points. Sixteen cases were rated as excellent, 21 good, 8 fair, and 1 poor. Two patients had transient nerve palsy, involving one ulnar nerve and one deep branch of the radial nerve, but recovered in 3 months. Condusions Our "Five-Sequential-Portal Method" can ensure satisfactory exposure and clear view in elbow arthroseopy. The portals are safe, leading to low incidence of postoperative complications. It is recommendable in clinic.

  18. 皮质骨螺钉内固定治疗下胫腓联合分离的 CT 研究%Internal fixation with cortical bone screws for the treatment of distal tibiofibular syndesmosis separation:a CT study of 32 patients

    Institute of Scientific and Technical Information of China (English)

    鲁建作; 林央央; 杨杰; 董晓敏

    2015-01-01

    Objective:To explore the effect of internal fixation with cortical bone screws on the distal tibiofibular syndesmosis. Methods:The clinical records of 32 patients who were treated with cortical bone screws internal fixation for distal tibiofibular syndesmosis were analyzed retrospectively.The patients consisted of 18 males and 14 females,and ranged in age from 28 to 64 years (Median =43.5 yrs).The distal tibiofibular syndesmosis separation located in left leg for 14 cases and right leg for 18 cases.According to the Danis -Weber classification,the injuries belonged to types B(12)and C(20).Fibula fracture combined with posterior malleolus injury and medial malleolus injury or deltoid ligament injury were found in 11 patients,and fibula fracture combined with medial malleolus injury or deltoid ligament injury were found in 21 patients.Bilateral distal tibiofibular transverse CT films were taken in all patients.The tibiofibula congru-ence angle,fibular outward displacement and backward displacement relative to peroneal sinus of tibia were measured on the CT films and were analyzed.Results:The tibiofibula congruence angle and fibular outward displacement relative to peroneal sinus of tibia of affected side were less than those of uninjured side(68.66 +/-9.28 vs 79.49 +/-14.66 degrees,t =2.998,P =0.025;5.65 +/-1.79 vs 7.66 +/-2.05 mm,t =2.131,P =0.012),while fibular backward displacement relative to peroneal sinus of tibia of affected side was greater than that of uninjured side(4.94 +/-1.49 vs 1.90 +/-3.34 mm,t =14.089,P =0.002).Conclusion:After cortical bone screws internal fixa-tion for the treatment of distal tibiofibular syndesmosis separation,there is a trend for anteromedial rotation of distal tibiofibular syndesmosis of affected side compared to uninjured side.%目的:探讨皮质骨螺钉内固定对下胫腓联合的影响。方法:回顾性分析32例行皮质骨螺钉内固定术治疗的下胫腓联合分离患者的临床资料,男18例、女14

  19. 异体胫前肌腱"Y"形双束双隧道重建后十字韧带的疗效分析%Posterior cruciate ligament reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft

    Institute of Scientific and Technical Information of China (English)

    黄华扬; 郑小飞; 李凭跃; 张余; 王泽锦

    2010-01-01

    Objective To investigate the clinical results of posterior cruciate ligament (PCL) reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft. Methods From March 2001 to January 2008, 47 patients underwent PCL reconstruction were included. The allogeneic adult anterior tibialis tendon was prepared into the Y-shape double bundles with the length of 130 mm; A bundle was defined as A-side; B-side was two short bundle (B1, B2 bundle). A bundle was 70 mm in length with a diameter of 10-12 mm. B1 bundle (anterolateral bundle) was 55 mm long with a diameter of 6 mm; B2 bundle(posteromedial bundle) was about 50 mm with a diameter of 6 mm. The allograft ligament was installed through the antero-medial approach. Absorbable interface screws were fixed in the tibial tunnel firstly, and then in the femoral tundles. When being fixed, anterolateral bundle was in flexion of 90°, postero-medial bundle was in 30°. Assisted exercise with knee an angle-locked walking aid had continued for 8-10 weeks. Results The average operating time were 45 min. The average follow-up time was 49.5 months. Preoperative Lachmann was positive in all cases while Lachmann was negative in 39 cases, weakly positive in 5 cases, and positive in 4 cases postoperatively. Post-operative KT-1000 testing, Lysholm score and Tegner activity levels has improved significantly compare with the pre-operative ones. Conclusion The double folded bundles of adult anterior tibialis tendon has sufficient length and diameter for posterior cruciate ligament reconstruction with power tension. The methods of ligament passing through the tunnel has improved to ease the procedure.%目的 探讨异体胫前肌腱"Y"形双柬双隧道移植重建后十字韧带(posterior cruciate ligament,PCL)的临床效果.方法 2001年3月至2008年1月,采用将异体胫前肌腱编织成"Y"形双束韧带的方法治疗PCL损伤患者,其中47例具有完整随访资料,男39例,女8例;年龄18~43

  20. Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection%股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损

    Institute of Scientific and Technical Information of China (English)

    徐中飞; 代炜; 张恩礁; 段维轶; 刘法昱; 谭学新; 黄绍辉; 秦兴军; 孙长伏

    2012-01-01

    PURPOSE; To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator -based chimeric anterolateral thigh (ALT)flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d- LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cmx4cm to 16cmx7cm and muscular flap was 3cm x4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications (fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet therequirements of

  1. Wide resection and knee joint reconstruction for malignant tumors of the proximal tibia%胫骨上端恶性骨肿瘤广泛切除与重建

    Institute of Scientific and Technical Information of China (English)

    杨志平; 杨强; 李昕; 李振峰; 李建民

    2011-01-01

    bone tumors of proximal tibia,27 males and 18 females,28 years in average (range, 12 -62 years). The tumors,including 25 osteosarcomas,7 malignant giant cell tumors,6 chondrosarcomas,3 malignant fibrous histiocytomas,3 fibrosarcomas and 1 lymphoma were treated with wide resection which performed through anteromedial incision in 30 cases and anterolateral incision in 15. The superior tibiofibuiar joints were involved and the proximal tibia resected en bloc in 13. Two knee joints were involved and extraarticuler resection were performed. Partial tumorous bone was devitalized and replanted in 5 cases and the anterior tibial vessels were ligated in 28. The involved knee joints were reconstructed with domestic-made prostheses and soft tissue coverage was improved by medial or lateral gastrocnemius flap and sagittal split anterior tibial muscle flap in some patients which tibia was removed longer. Neoadjuvant chemotherapy were performed to the patients with osteosarcoma and malignant fibrous histiocytoma. [ Result] With an average follow-up of 4.6 years ( range,8 months -9 years ),local recurrences occurred in four cases and lung metastases in six cases. One patients with malignant fibrous histiocytoma of proximal tibia had metastasis to L* after 6 years postoperatively and was treated with total en bloc spondylectomy. The complications related to the prostheses included peri-prosthetic infection in 3, prosthetic dis-location in 3, prosthesis loosening in 2, peri-prosthesis fracturein 1 and prosthetic fracture in 1. The average range of motion were 92 degrees (50 - 120 degrees) with the 4.4 degrees (0 - 20 degrees) of average extension lag. According to the Musculoskeletal Tumor Society ( MSTS ) Scoring system, the average functional score was 76.7%. [ Conclusion ] Wide resection and reconstruction for malignant tumor of proximal tib-la I- highly demanding. To achieve the goal of Limb salvage and _■■?." function, il is necessary to employ standard reseolion lech

  2. 肘关节镜辅助下复位固定治疗尺骨冠状突骨折%Elbow arthroscope assisted reduction and fixation treatment for coronoid fracture

    Institute of Scientific and Technical Information of China (English)

    杨顺; 向明; 杨国勇; 陈杭; 胡小川; 唐浩琛

    2014-01-01

    function requirements of patients,and minimally invasive surgery is more and more become a safe and effective treatment of intra-articular fractures.Because arthroscopy surgery has the advantages of little trauma and quick recovery in recent years,the application in the elbow fracture has made rapid progress.In acute elbow trauma,elbow arthroscopy technology can not only clean up small pieces fragment including cartilage ones,but also compete reduction and internal fixation of fracture feasiblly.And radial head fractures,olecranon fractures, coronoid process fractures,humerus condyle fracture reduction and internal fixation were reported. Adams reported 7 cases of ulna coronary condyle fracture appling elbow arthroscopy technology for reduction and fixation,final follow-up showed the curative effect is satisfied,with no heterotopic ossification and elbow arthritis.Operation approach of elbow arthroscopy are anterolateral approach and anteromedial approach in the position of elbow flexion.Because:(1 )there is safest distance of ulnar nerve and median nerve in anterolateral approach in the elbow-flexion position,it is the safest approach in the medial approach into the road (the distance to the ulnar nerve is 1 5.5 mm,the distance to the median nerve is 13.8 mm).(2 )there is safest distance (10 mm )to radial nerve in the anterolateral approach to,With the advantage of flexible operation and good microscopic field of vision, it is the most safe and effective one of the lateral approachs into the way;(3)We choose the position of 90°elbow flexion position to puncture operation since nerve is away from point of puncture.For Regan-Morrey Ⅱ type comminuted fracture,preoperative CT fully estimated size of fracture block,due to the small fracture fragment,cannulated screws may break down the fracture fragment and the fixing effect is not exact.To prevent this occurs,for Regan-Morrey Ⅱ type frature.we fix with kirschner wire from the back of the elbow to coronary direction ;For

  3. Arthroscopic fixation in the treatment of Rockwood Ⅴ acute acromioclavicular joint dislocation%关节镜下四骨道双束固定治疗急性肩锁关节Rockwood Ⅴ型脱位

    Institute of Scientific and Technical Information of China (English)

    陆伟; 王大平; 朱伟民; 欧阳侃; 柳海峰; 彭亮权; 李皓; 冯文哲

    2014-01-01

    coracoid neck is the center between the two preparatively drilled bone tunnels.Make the cross line vertical to line P,and the bone tunnels are located in the I and II quadrant.The distance between two bone tunnels is 6 mm.(3 )Surgical techniques:According to the data of preoperative measurement of bone tunnel,the self-designed 4-tunnel double-bundle locator is applied.The 4-tunnel double-bundle acromioclavicular joint fixation is carried out with the method of two Endobutton loops in each of two groups.The technique includes the following 5 parts:① Acromioclavicular joint exploration and exposure of subcoracoid surface: make the routine posterior approach of acromioclavicular joint with arthroscope of 70°,4.5 mm and guide the anterior approach.Gradually separate the anteromedial joint capsule with radiofrequency coblation from the inside of the subscapularis tendon above to the subcoracoid surface.Clean the soft tissue on its lower surface to expose the coracoid neck.② Acromioclavicular joint exploration,acromioclavicular joint disc excision and partial excision and plasty of the clavicular lateral end:make a 2-3 cm transverse incision above the acromioclavicular joint parallel to the clavicle,layered the cut,expose the acromioclavicular joint, remove ruptured joint disc, and rub the clavicular lateral end. Afterwards, reduce the acromioclavicular joint and fix it temporarily with Kirschner wire.③ The self-designed locator (Patent No.ZL 20132021 7047.4)is adopted.Put the head of the locator on the lower surface of coracoid neck,and the transverse bar and 2.4 mm guide pin are arranged on the clavicular surface.The guide pin is inserted into the hole A,drilling through the subcoracoid surface with a 3.5 mm hollow drill for reaming.Adjust the transverse bar to the pre-determined angle of scapular axis and coronal section 6 mm away from hole A,and then ream the hole B with 2.4 mm guide pin inserted.④ After connecting the ring with an Endobutton button plate and 3 Utra