Cephalocaudal Direction Research Articles

When Hysteroscopy is the only way out; a case series of endometrial osseous metaplasia

Background: Endometrial osseous metaplasia (EOM) poses diagnostic and treatment dilemmas. Hysteroscopy is the gold standard in the diagnosis of endometrial pathologies and offers optimal treatment for osseous metaplasia. Case presentation: Five new cases of EOM were diagnosed within four years, giving an annual incidence of 5/101 (1.24%) of hysteroscopies and 5/583 (0.21%) of gynaecological surgeries. The patients’ mean age was 35.2 ± 10.0 years The diagnosis was made in all cases during evaluation for infertility with the duration of infertility ranging from 1-14 years. They all had a preceding pregnancy termination. All of the five patients had recurrent vaginal discharge, with durations ranging from 1-23 years. Bone tissue was retrieved from the endometrium in all cases, a long bone was impacted in a cephalo-caudal direction in one of the patients, requiring initial cephalad dislodgement before retrieval. After resection, the vaginal discharge stopped immediately and one of the patients conceived spontaneously and had a term delivery. Conclusion: EOM can best be diagnosed and treated by hysteroscopy. It is mostly preceded by pregnancy termination; with a mid-trimester dilatation and evacuation as the commonest risk factor. The indolent nature of the associated vaginal discharge makes EOM predominantly diagnosed during evaluation for infertility.

Cutaneous manifestations and sequelae of Chikungunya fever: a single centre experience

Background: Chikungunya fever is a common viral illness in the tropical and subtropical areas. Various cutaneous manifestations can develop during the acute phase and post-febrile convalescent phase. Objective: To determine the frequency and types of cutaneous manifestations associated with chikungunya fever in acute and post-febrile phase. Methods: We conducted a prospective, observational study including 20 patients with laboratory-confirmed chikungunya fever. All the patients were followed up for 1 year to detect any cutaneous sequelae. Results: Pruritic maculopapular rash was the most common cutaneous manifestation during the acute febrile phase, noted in 60% of the patients. The rash usually appeared within 1–3 days of fever onset and spread in cephalo-caudal direction. Cutaneous hyperpigmentation was the most common dermatologic sequelae in the post-febrile period, occurring in 3 (15%) patients. In all patients, pigmentation appeared 3–4 weeks after resolution of fever, and started on the nose, gradually spreading to the forehead. The pigmentation improved significantly with topical hydroquinone after 4 weeks. Other additional manifestations of chikungunya fever included joint pain and joint swelling. None of our patients presented with mucosal or systemic involvement. Conclusion: Maculopapular skin rash was the most common manifestation during acute febrile phase of chikungunya fever, while cutaneous hyperpigmentation was the most common dermatologic sequelae after resolution of fever.

Growth rate, impact of smoking and management of incidentally found paranasal sinus osteomas

To build upon existing literature regarding growth rate of asymptomatic, incidentally found paranasal sinus (PNS) osteomas, evaluate potential factors associated with growth rate and present an argument for how to follow up. At our institution, EPIC SlicerDicer was used to screen imaging studies using keyword 'osteoma' and included patients with at least 2 imaging studies 6months apart that both demonstrated a PNS osteoma(s). Imaging studies with the largest time interval were selected. Non-PNS osteomas were excluded. 47 patients that fit this criterion with a median duration of interval imaging of 35.9months. Growth rate was measured to be 0.39mm/year in the cephalocaudal direction and 0.45mm/year in the mediolateral direction, together averaging 0.42mm/year. Increases in growth rate additionally did not appear to impact the likelihood of developing conditions including nasal polyposis or chronic sinusitis and symptoms such as sinus pressure, headache, postnasal drip, or congestion. Those with interval scans >36months were found to have a slower growth rate than those with closer interval scans. Furthermore, former smokers and current smokers had significantly greater growth rates than nonsmokers. Given their slow growth rate, we conclude that select lesions likely do not require follow-up. If there is concern that growth could cause an obstructive complication, such as blocking the frontal outflow tract, we argue a single scan at one year is appropriate. If there is additional growth on this scan, surveillance scans up to 3years could be performed to assess stability. Lastly, while there was a significant growth rate for smokers compared to non-smokers, the slow growth rate is unlikely to influence management.

Carotid body tumors: a review

Carotid body tumor or paraganglioma, is located periadventitially in relation to the carotid bifurcation. Generally, the blood supply of carotid tumors is abundant, it comes mainly from the branches of the external carotid arteries, although cases have been reported where the irrigation comes from the internal carotid artery, vertebral artery, ascending pharyngeal artery and superior thyroid. Although its etiology is unknown, different factors have been associated that contribute to its incidence, such as genetic factors and states of chronic hypoxia. Histologically, they are well vascularized tumors. Between the capillaries there are groups of tumor cells known as Zellballen's pseudoalveolar pattern. These are cells with eosinophilic granular cytoplasm and small round or oval nuclei. The tumor is mobile, but with limitation to mobilization in the cephalocaudal direction. The mass can transmit the carotid pulse due to its proximity to the carotid, and it may also be accompanied by a murmur or thrill. Usually the carotid glomus is identified by clinical examination, so consideration of multiple differential diagnoses. The treatment of choice is surgical excision. The need for preoperative embolization is controversial. Embolization before surgery is recommended to improve surgical success with reduced blood loss as well as reduce the risk of cranial nerve injury. The decision to perform presurgical embolization or not depends on the surgeon.

Decreased diaphragm moving distance measured by ultrasound speckle tracking reflects poor prognosis in amyotrophic lateral sclerosis

Decreased cephalocaudal diaphragm movement may indicate respiratory dysfunction in amyotrophic lateral sclerosis (ALS). We aimed to evaluate diaphragm function in ALS using ultrasound speckle tracking, an image-analysis technology that follows similar pixel patterns. We developed an offline application that tracks pixel patterns of recorded ultrasound video images using speckle-tracking methods. Ultrasonography of the diaphragm movement during spontaneous quiet respiration was performed on 19 ALS patients and 21 controls to measure the diaphragm moving distance (DMD) in the cephalocaudal direction during a single respiration. We compared respiratory function measures and analyzed the relationship between the clinical profiles and DMD. DMD was significantly lower in ALS patients than in the control group (0.6±1.4 mm vs 2.2±2.2 mm, p<0.01) and positively correlated with phrenic nerve compound motor action potential amplitude (R=0.63, p=0.01). DMD was negatively correlated with the change in the ALS Functional Rating Scale-Revised scores per month after the exam (R=-0.61, p=0.02), and those with a larger rate of decline had a significantly lower DMD (p=0.03). Diaphragm ultrasound speckle tracking enabled the detection of diaphragm dysfunction in ALS. Diaphragm ultrasound speckle tracking may be useful for predicting prognosis.

Effect Sizes for Changes in Health and Well-Being Following Treatment With the One-To-Zero Technique in Individuals With Occipito-Atlantal Joint Dysfunction: A Repeated Measures Study

The purpose of this study was to determine effect sizes (ES) for changes in self-reported measures of musculoskeletal pain and dysfunction resulting from the one-to-zero method using a repeated measures study design. Twenty participants presenting with articular dysfunction of the occipito-atlantal (C0-C1) complex were treated using the one-to-zero method, a high-velocity low-amplitude thrust administered between the C0-C1 complex before treating other restrictive segments in a cephalocaudal direction. The participants completed online questionnaires using Google Forms that assessed aspects of the biopsychosocial model of pain at baseline and within a week after treatment. The questionnaires included the following: (1) Demographic and Health Behavior Survey; (2) Neck Bournemouth Questionnaire (NBQ) or Neck Disability Index (NDI); (3) Beck Anxiety Index (BAI); (4) Insomnia Severity Index (ISI); and (5) 36-Item Short Form Health Survey (SF-36). Paired t test or Wilcoxon signed ranks test was performed, dependent on normality. Cohen's d values were calculated for each questionnaire score (0.20 indicative of small; ≥0.50 medium; and ≥0.80 large ES). The NDI, NBQ, BAI, and ISI had a large ES (all d ≥ 0.80). In the SF-36, 4 subscales had a small to near-medium ES, 1 subscale had a medium to near-large ES, and the remaining 2 had a large ES (d ≥ 0.80). The physical and mental component summary had a large (d = 0.88) and small ES (d = 0.35), respectively. The effect sizes suggest the one-to-zero treatment induces change in various aspects of the biopsychosocial model.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Location In Vivo of the Innervation Zone in the Human Medial Gastrocnemius Using Imposed Contractions: A Comparison of the Usefulness of the M-Wave and H-Reflex.

The anatomical territory where the neuromuscular junctions are grouped corresponds to the innervation zone (IZ). This can be located in-vivo using high-density electromyography and voluntary muscle contractions. However, in patients with motor impairment, the use of contractions imposed by electrical stimulation (ES) could be an alternative. The present study has two aims: Firstly, to describe the location of the IZ in-vivo of the medial gastrocnemius (MG) using imposed contractions by ES. Secondly, to compare the usefulness of M-waves and H-reflexes to localize the IZs. Twenty-four volunteers participated (age: 21.2 ± 1.5 years). ES was elicited in the tibial nerve to obtain M-waves and H-reflexes in the MG. The evaluators used these responses to localize the IZs relative to anatomical landmarks. M-wave and H-reflex IZ frequency identification were compared. The IZs of the MG were mostly located in the cephalocaudal direction, at 39.7% of the leg length and 34% of the knee's condylar width. The IZs were most frequently identified in the M-wave (83.33%, 22/24) compared to the H-reflex (8.33%, 2/24) (p &gt; 0.001). Imposed contractions revealed that the IZ of the MG is located at 39.7% of the leg length. To locate the IZs of the MG muscle, the M-wave is more useful than the H-reflex.

Dorsal Hump Reduction Based on the New Ethmoidal Point Classification: A Clinical and Radiological Study of the Keystone Area in 138 Patients.

Hump resection often requires reorganization of the keystone area. The authors sought to describe the importance of the point where the perpendicular plate of ethmoid joins the septal cartilage (SC) and the nasal bones (NB) (Ethmoidal point [E-point]) for hump resection surgical planning. Measurements from mid-sagittal slices in nasal computed tomography scans taken in adult Caucasian patients between January 2015 and December 2018 were compared between patients seeking primary rhinoplasty due to a nasal hump and patients not seeking rhinoplasty (control group). Patients with previous nasal surgery or trauma, genetic or congenital facial disorders, and high septal deviation were excluded. The length of overlap between NB and SC was compared between the 2 groups. The location of the E-point in relation to the beginning of the nasal hump in the cephalocaudal direction was documented in the patients seeking rhinoplasty. The study population included 138 patients, 69 seeking and 69 not seeking rhinoplasty (96 females). The mean age was 32.9 years (range, 18-55 years). The length of overlap between NB and SC was similar between both groups (11.7 ± 3.3 vs 10.8 ± 3.3; P = 0.235). The E-point was located before the beginning of the nasal hump in 97% (67/69) of nasal hump patients, and it could be found a mean distance of 2.3 (±2.3) mm cephalic to the latter. As a rule, the perpendicular plate of the ethmoid does not contribute to the nasal hump; therefore, only in exceptional cases should this be addressed while performing dorsal reduction.

Adjacent digit fingerprint white line count differences: a pointer to sexual dimorphism for forensic application

BackgroundSex determination is one of the leading criterion in identification and verification of an individual. However, the potential roles of differences in adjacent fingerprint white line count (FWLC) in sex inference are not well elucidated in the literature especially among Hausa population. The study was conducted to determine sexual dimorphism and predict sex using adjacent digit FWLC difference (adj. DFWLCD) among Hausa population of Kano state, Nigeria.MethodsThe study population involved 300 participants. FWLC was determined from a plain fingerprint captured using live scanner. The formula for adj. DFWLCD of thumb and fifth digit is dR15 for right hand. The same applied for possible combination in cephalocaudal direction. Mann-Whitney and t tests were used for comparison of variables between sexes. Binary logistic regression analyses were employed for determination of sex.ResultsWe observed a significantly larger adj. DFWLCD in males compared with females in most of the digit combination. A significant sexual dimorphism was observed in most of the adj. DFWLCD involving ring digit in both right (dR14, dR24, and dR34) and left (dL14, dL24, and dL34). The best discrimination was observed in adjacent FWLC difference of second and fourth digits in both right and left digits (dR24 and dL24). This was further supported by stepwise logistic regression analyses.ConclusionThe adj. DFWLCD exhibits sexual dimorphism. The best prediction potentials were found to be dR24 and dL24 for right and left hands respectively.

Evaluation of a more ventral starting point for thoracic pedicle screws: higher maximal insertional arc and more medial and safer screw angulation.

OBJECTIVETo demonstrate that a more ventral starting point for thoracic pedicle screw insertion, produced by aggressively removing the dorsal transverse process bone down to the superior articular facet (SAF), results in a larger margin for error and more medial screw angulation compared to the traditional dorsal starting point (DSP). The margin for error will be quantified by the maximal insertional arc (MIA).METHODSThe study population included 10 consecutive operative patients with adult idiopathic scoliosis who underwent primary surgery. All measurements were performed using 3D visualization software by an attending spine surgeon. The screw starting points were 2 mm lateral to the midline of the SAF in the mediolateral direction and in the center of the pedicle in the cephalocaudal direction. The DSP was on the dorsal cortex. The ventral starting point (VSP) was at the depth of the SAF. Measurements included distance to the pedicle isthmus, MIA, and screw trajectories.RESULTSTen patients and 110 vertebral levels (T1-11) were measured. The patients' average age was 41.4 years (range 18-64 years). The pedicle isthmus was largest at T1 (4.04 ± 1.09 mm), and smallest at T5 (1.05 ± 0.93 mm). The distance to the pedicle isthmus was 7.47 mm for the VSP and 11.92 mm for the DSP (p < 0.001). The MIA was 15.3° for the VSP and 10.1° for the DSP (p < 0.001). Screw angulation was 21.7° for the VSP and 16.8° for the DSP (p < 0.001).CONCLUSIONSA more ventral starting point for thoracic pedicle screws results in increased MIA and more medial screw angulation. The increased MIA represents an increased tolerance for error that should improve the safety of pedicle screw placement. More medial screw angulation allows improved triangulation of pedicle screws.

Preliminary study on contrast flow analysis of thoracic transforaminal epidural block.

BackgroundThe thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs.MethodsA total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy.ResultsThe cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00–2.00) for Group A, 2.50 (2.00–3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00–3.00) for Group B, and 2.00 (2.00–3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image.ConclusionsInjection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.

Identifying the level of trunk control of healthy term infants aged from 6 to 9 months

This study identified the level of trunk control of healthy term infants aged from six to nine months. This cross-sectional study included fifty-five infants aged from six to nine months. The levels of trunk control was investigated by using the Segmental Assessment Trunk Control (SATCo). The infants remained seated on a wooden bench and a neutral pelvic position was maintained. The SATCo score was considered as dependent variable. The results showed that infants aged six and seven months presented levels of trunk control in the thoracic region while infants aged from eight to nine months presented full trunk control. These results demonstrate that younger infants present less levels of trunk control while older infants present full trunk control, confirming that trunk control development takes place in a segmental way and in a cephalocaudal direction. These results also might be used as a reference to distinguish infants that show a delay in trunk control from those who have suitable motor development and, thus intervene at an early stage to minimize later delays in these infantś global motor development.

An Innovative Technique for Craniocaudal Pedicle Screw Guidance: A Technical Note.

In spine surgery, pedicle screw instrumentation is being used very commonly. However, putting pedicle screws in the right place and direction needs the use of image intensifier in 2 orthogonal planes. This consumes valuable time while moving the image intensifier and operating table multiple times during the surgery and also excess radiation exposure. Here, we present a simple technique to apply surgical pearl to angulate the pedicle screws in cephalocaudal direction using simple instrument available on table. This may help in reducing the usage of image intensifier and expedite the procedure.

Development of the axial, paired and unpaired fin skeleton in three species of Patagonian zoarcids

Zoarcids are abundant in the intertidal zone of the Argentine Patagonian coast. However, their osteological development has not yet been described. Thus, the aim of this work is to describe the ontogeny of the axial skeleton and that of the paired and unpaired fins of the zoarcids Iluocoetes elongatus, Phucocoetes latitans and Dadyanos insignis. The three species studied showed a high degree of development at hatching and meristic counts coincide with those of the adults. At hatching, most of the structures showed that the appearance of bones was in progress. In the three species studied, this process occurred in a cephalo-caudal direction and, in most of the structures, the appearance of bones is observed from the middle to the rim.

Adrenalectomy abolishes hypergravity-induced gastric acid hyposecretion.

Jet fighter pilots experience high gravitational acceleration forces in the cephalocaudal direction (+Gz), causing severe stress. Stress affects different physiological functions of the gastrointestinal tract. Although the effects of exposure to hypergravity on cardiovascular and cerebral functions have been the subject of numerous studies, crucial information regarding potential pathophysiological alterations following hypergravity exposure in the gastrointestinal tract is lacking. We recently documented a significant decrease in gastric secretory activity in rats after acute exposure to hypergravity. In the present study, we investigated the effects of adrenalectomy on gastric acid secretion and plasma gastrin level in hypergravity-exposed rats. Male Sprague-Dawley rats were adrenalectomized and exposed to +10Gz three times for 3 min. Gastric juice and blood samples were collected, and the volume and total acidity of gastric juice and plasma level of gastrin were measured. Consistent with our previous data, acute exposure to +10Gz significantly altered the gastric juice parameters in the sham-operated rats. The volume (P < 0.001) and acidity (P < 0.001) of gastric juice in the hypergravity-exposed rats were significantly lower than those in the nonexposed rats. In contrast, in adrenalectomized rats, the differences in the gastric juice volume (P = 0.712) and acidity (P = 0.279) were not statistically significant between the hypergravity-exposed and nonexposed rats. We demonstrated that adrenalectomy abolished hypergravity-induced gastric acid hyposecretion, but did not influence gastrin release. These findings suggest that the adrenal glands are required for hypergravity-induced gastric acid hyposecretion.

Neurosphere formation potential resides not in the caudal cell mass, but in the secondary neural tube.

The caudal cell mass (CCM) is known as the main player in secondary neurulation, forming the secondary neural tube (2NT). This suggests that the CCM may have the character of neural progenitor cells. The neural potential of the CCM and the 2NT (CCM + 2NT) was assessed by in vitro culture of neurospheres during Hamburger and Hamilton stages (HH) of secondary neurulation (HH16 to HH32). We also analyzed the neural potential of the developing central nervous system (CNS) by comparing the neurosphere culture from the brain, upper / lower spinal cord, and CCM + 2NT from various HH stages. The CCM + 2NT was capable of forming neurospheres. Of the various HH stages, the greatest number of neurospheres from CCM + 2NT were cultured at HH28. Because the 2NT is most prominent at HH28, we hypothesized that the 2NT, rather than the CCM, had the main potential to produce neurospheres. When the neurospheres were cultured separately from the CCM and the 2NT, 2NT made significantly more neurospheres. When comparing different parts of the CNS, at HH16, the greatest number of neurospheres was formed from the brain. At HH32, it was the CCM + 2NT. The region with the greatest number of neurospheres progressed in a cephalo-caudal direction during development. This study showed that neurospheres can be cultured from CCM + 2NT, and the main player in neurosphere formation was the 2NT. The present study has also revealed cephalo-caudal trend in the neural potential of developing CNS.

DEVELOPMENT OF THE TYPICAL CERVICAL VERTEBRAE IN THE WHITE NEW ZEALAND RABBIT (ORYCTOLAGUS CUNICULUS)

In order to study the pattern of ossification of the components of the postcranial axial skeleton of the white new Zeeland rabbit, intact embryos were isolated between days (d) 13 and 28 of pregnancy, and postnatal till three months old rabbit. All specimens were fixed in 95% ethanol for at least one week, a group was bulk-stained using alizarin and Alcian blue, in order to stain bone and cartilage, respectively, and cleared. Another group was histologically stained with H&amp;E and Mason Trichrome. A third group was examined with CT and X-ray. The time of the first appearance of ossification centers of these prenatal and postnatal specimens was analyzed. The findings demonstrated that, with the exception of the atlas and axis, all of the cervical vertebrae studied had similar growth patterns. The time of appearance of the various centers of ossification in the skeletal elements studied proceeded in a similar order to that described by previous authors, although there were some discrepancies in the exact time of the first appearance of certain ossification centers. Secondary ossification for the epiphysis cranialis and caudalis (the bony collar) appear in cervical region and then extend in cephalocaudal direction till complete appearance at the age of 45-days old rabbit. The data presented here provide useful baseline information on the normal sequential pattern of ossification in the typical cervical vertebrae and the characteristic growth pattern of the individual components in the rabbit.

The Evolution of Sagittal Spinal Alignment in Sitting Position During Childhood.

This is a cross-sectional descriptive study. The purposes of this study are to describe normative data of the sagittal plane in the sitting position within the pediatric population and document the evolution of sagittal alignment during the growth. Surgical procedures addressing the deformity aim to make the maximal correction on the coronal and transverse planes and to restore the physiological curves on the sagittal plane. Prerequisite for sagittal plane reconstruction is to know the physiological values. Children between 3 and 17 years of age, followed by pediatrics unit for nonskeleton disease with lateral radiographs of the entire spine and pelvis on sitting positions, were included to the study. Children with history of surgery or disease that may affect spine development were excluded. Children were evaluated in 4 age groups (3-6, 7-9, 10-12, and 13-17 yr) in terms of spinal sagittal alignment on sitting position. Of the screened, 124 children (49 girls, 75 boys) were included. Descriptive statistics of all possible segmental angles were summarized. Thoracic kyphosis and lumbar lordosis values were lower on sitting position than on standing position. Thoracic segmental angulations steadily increased from T1-T2 to midthoracic segments and then decreased in caudal direction. Moreover, lumbar segmental angulations steadily increased in cephalocaudal direction. Sacral slope, L4-S1 angulation, and T1-T12 and T1-S1 distance tend to increase as the age increases. Sagittal spinal alignment in the sitting position is different than that in the standing position and it changes as the child grows. There is a statistically significant difference between different age groups, especially at the cervicothoracic, thoracolumbar, and lumbosacral junctions. These findings should be taken into consideration for young nonambulatory patients who require spinal instrumentation and/or fusion. 2.

Carpentering in Septorhinoplasty: A Novel Technique to Straighten the Deviated Nasal Septum

Septal deviation presents a considerable challenge in septorhinoplasty because it leads to functional and esthetic problems. This deformity may displace the nasal tip, disturb nasal valve patency, and affect the final outcomes of septorhinoplasty. This report describes an innovative technique that can be used in patients with C-shaped deviation of the septum in a cephalocaudal direction. Because the procedure is similar to carpentering, it was named a "carpenter spreader graft." In this technique, the deviated dorsal cartilage is separated and displaced to a new straightened position.