Lateral Quadrants Research Articles

Local ex-vivo evaluation of the biomechanical properties of the ascending aortic aneurysms

Currently, surgical recommendations for aneurysm of the ascending aorta (AsAA) are based on the maximum diameter of the ascending aorta, but this factor is not reliable. Understanding the biomechanical properties of the aorta could lead to improve the prediction of the development of an AsAA. The aim of this study is to obtain the local patient specific elastic modulus distribution of the AsAA from a biaxial tensile test. Pathologic ascending aortic tissue samples ( n = 10) were obtained from patients undergoing elective surgical repair of AsAA ( Table 1 ). All the aortic wall samples were partitioned related to medial, posterior, lateral, and anterior quadrants. Each AsAA sample was cut in square size (15 mm × 15 mm, n = 89) with marking the circumferential and longitudinal directions. An average thickness was measured, using an electronic micrometer (Litematic VL-50, Mitutoyo®). The experiments were carried out by a biaxial tensile test machine (ElectroForce®). Each specimen was stretched at a rate of 10 mm/min until rupture. Maximum Elastic Modulus was calculated for each specimen. The longitudinal direction of the aorta is stiffer than the circumferential direction except in the medial quadrant in both tissue types. The lateral quadrant (outer curvature) of the aorta shows a higher stiffness, roughly the double value of the medial quadrant (inner curvature) ( Fig. 1 ). The thickness of TAV and BAV tissues did not show a significant difference in the four regions of the AsAA wall. Among the ten AsAA tissues, there are variations in the tissue stiffness according to their quadrants and the direction. It is expected to observe the regional variability in the thickness of the dilated samples corresponding the change of mechanical properties caused by valve disease. However, there was no significant correlation between the regional thickness and mechanical properties, neither TAV ( r =−0.3584) nor BAV ( r =−0.3107).

Analysis of Femoral Head Microstructure and Vasculature Relevant to Legg-Calve-Perthes Disease

Purpose: Legg-Calve-Perthes disease is an idiopathic avascular necrosis of the proximal femoral epiphysis. Interestingly, even in milder cases of Perthes, the anterior epiphysis collapses most reliably rather than the more weight-bearing lateral quadrant. The purpose of this study is to investigate whether there is a vascular or microstructural predisposition for anterior femoral epiphyseal collapse in Legg-Calve-Perthes Disease.Methods: 32 cadaveric proximal femoral epiphyses from 17 subjects (age 4-14 years old) underwent microcomputed tomography at 10-micron resolution. Specimens were divided into anterior, posterior, medial, and lateral quadrants. Vascular channels entering near the posterolateral epiphyseal tubercle (from the medial femoral circumflex artery) and at the ligamentum teres footprint (from the ligamentum teres vessels) were identified by correlating surface topography with cross-sectional imaging. Each quadrant was then analyzed for four surrogate markers of trabecular bone strength: Bone Volume/Total Volume (BV/TV), Trabecular Thickness, Trabecular Separation, and Trabecular Number.
 Results: One-way ANOVA revealed a significant difference between the quadrants in trabecular microstructure and vascular patterns (p<0.001). The medial quadrant had the lowest BV/TV, trabecular number, and the greatest trabecular separation (p<0.01 for each), consistent with the fact that the medial quadrant is the least weightbearing. However, there was no significant difference between the anterior and lateral quadrants for any of the four surrogate markers of bone strength. 32/32 (100%) specimens demonstrated vascular channels from the medial femoral circumflex artery penetrating the posterior aspect of the lateral quadrant. Ligamentum teres vascular channels were visualized in the medial epiphysis in 26/32 (81%) specimens overall and 11/16 (68%) subjects aged 4-8 years. Paired samples t test revealed that the posterior half of the epiphysis had significantly more vascular channels than the anterior half (8.7±4.0 vs 3.4±3.1 vascular channels, p<0.001). Vascular channel mapping illustrated the predominance of vessels in the posterior half of the epiphysis with both the ligamentum teres (medial quadrant) and the medial femoral circumflex vessels (lateral quadrant) entering the epiphysis at the 4 and 8 o’clock positions, respectively.Conclusions: The lack of microstructural differences between the anterior and lateral quadrants, and the predominance of vascular channels in the posterior half of the epiphysis suggest that the anterior femoral epiphysis may be a relative vascular watershed region which predisposes it to collapse after the vascular insult of Legg-Calve-Perthes.Significance: This is the first study to utilize micro-computed tomography to examine trabecular microarchitecture and map vascular channels in the developing human femoral epiphysis.

Correlation between subcutaneous fat measurements in knee MRI and BMI: relationship to obesity and related co-morbidities.

BackgroundObesity is a major public health disorder associated with multiple co-morbidities. Knee magnetic resonance imaging (MRI) permits visualization of the subcutaneous fat anatomy, which can be correlated to body mass index (BMI) and obesity-related co-morbidities.PurposeThis study intends to validate a method of correlating measurements of subcutaneous fat around the distal femur on axial MR images to BMI and obesity-related co-morbidities.Material and MethodsThe most proximal axial slice of each knee MRI was divided into four quadrants. Measurements of the thickest portion of the subcutaneous fat in each quadrant were independently obtained, yielding a value which was assigned the name of the SubCut fat index. The relationship between the SubCut fat index of each quadrant and the patient’s BMI was then evaluated. Receiver operating characteristic curves utilizing both the subcutaneous fat in the medial and lateral quadrants as well as BMI were performed with respect to obesity-related co-morbidities.ResultsSubCut fat index measurements in all four quadrants and BMI show the strongest correlation (all four, ANOVA P < 0.0001, r = 0.6), with subcutaneous fat measurements of the anterior medial (p < 0.0001) and posterior medial quadrants (P = 0.01). Additionally, BMI and medial quadrants SubCut indices showed strong association with obesity-related co-morbidities including sleep apnea, asthma, diabetes, hypertension, gastroesophageal reflux disease, and osteoporosis.ConclusionThe SubCut fat index, a marker of distal femur subcutaneous fat on axial MRI, correlates with severity of obesity (BI) and associated obesity-related co-morbidities.

Analysis of Trabecular Microstructure and Vascular Distribution of Capital Femoral Epiphysis Relevant to Legg–Calve–Perthes Disease

Legg-Calve-Perthes disease is characterized by the capital femoral epiphyseal collapse, which occurs more reliably in the anterior quadrant than the more weight-bearing lateral quadrant. The purpose of this study was to determine whether there is a vascular or microstructural predisposition for anterior femoral epiphyseal collapse in Perthes disease. Thirty-two cadaveric proximal femoral epiphyses from 17 subjects (age 4-14 years old) underwent micro-computed tomography at 10-μm resolution. Each quadrant was analyzed for four markers of trabecular architecture: bone volume fraction (BV/TV), trabecular thickness, trabecular separation (TbSp), and trabecular number (TbN). Vascular channels were then mapped in each quadrant, identified by correlating surface topography with cross-sectional imaging. One-way analysis of variance revealed an overall difference between quadrants (p < 0.001) in BV/TV, TbN, and TbSp. However, post hoc analysis revealed there was no significant difference between the anterior and lateral quadrants for any of the four markers of trabecular architecture. Vascular channel mapping illustrated a predominance of vessels in the posterior half of the epiphysis compared to the anterior half (8.7 ± 4.0 vs. 3.4 ± 3.1 vascular channels, p < 0.001). The lack of microstructural differences between the anterior and lateral quadrants, and the predominance of vascular channels in the posterior half of the epiphysis with posteriorly-based medial femoral circumflex and ligamentum teres vessels suggests that the anterior femoral epiphysis may be a relative vascular watershed region, which predisposes it to collapse after the vascular insult of Perthes disease. Clinical significance: Improved understanding of the pathophysiology of anterior femoral epiphyseal collapse may inform future treatments aimed at revascularization. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1784-1789, 2019.

Lip Print Characteristics in Anatolian Population: Baskent University Sample

Background: Identification is of importance for any crime investigation. Among several other methods, lip prints, if available, should also be evalu-ated to point out the relationship between the individual and the committed crimes. Lip print evaluation is known as “cheiloscopy” and important for forensic anthropologists in identification process since they are unique for each individual as fingerprints. Sex estimation is from lip print. Methods: 143 male and 291 female, a total of 434 students, were participated to the study. Lip prints were taken from each individual by using a dark colored lipstick and cellophane tape and fixed on a white sheet of paper. Lip prints were evaluated after separated into six quadrants (upper lip and lower were divided into three quadrants). The print patterns in each quadrant were classified according to Tsuchihashi method. Results: Sex estimation was done by using binary logistic regression analysis. Forked grooves both in right and left upper quadrants and reticular grooves in the upper middle quadrant were the most commonly observed lip print patterns. The lower lip forked grooves in both lateral quadrants and complete vertical grooves in the middle quadrant were the most commonly observed patterns both in males and females. Statistical analysis indicated that by binary logistic regression equations sex could be estimated with an accuracy of 72.6%. Lip prints give good predictability in determining sex, but cannot be used as the key tool in sex identification.

A Prospective Study of the Inferio-Medial pedicle technique As an Oncoplastic Procedure for Upper and lateral Quadrants Breast Masses; Oncological Safety and Clinical Outcomes

A Prospective Study of the Inferio-Medial pedicle technique As an Oncoplastic Procedure for Upper and lateral Quadrants Breast Masses; Oncological Safety and Clinical Outcomes

Breast-shape changes during radiation therapy after breast-conserving surgery.

Background & purposeWith the introduction of more conformal techniques for breast cancer radiation therapy (RT), motion management is becoming increasingly important. We studied the breast-shape variability during RT after breast-conserving surgery (BCS).Materials & MethodsPlanning computed tomography (CT) and follow-up cone-beam CT (CBCT) scans were available for 71 fractions of 17 patients undergoing RT after BCS. First, the CT and the CBCT scans were registered on bones. Subsequently, breast-contour data were generated. The CBCT contours were analyzed in 3D in terms of deviations (mean and standard deviation) relative to the contour of the CT scan for the upper medial, lower medial, upper lateral, and lower lateral breast quadrants, and the axilla.ResultsRegional systematic and random standard deviations of the breast quadrants varied between 1.5 and 2.1 mm and 1.0–1.6 mm, respectively, and were larger for the axilla (3.0 mm). An absolute average shape change of ≥4.0 mm in at least one region was present in 21/71 fractions (30%), predominantly in breast volumes > 800 cc (p = <0.01). Furthermore, seroma was associated with larger shape changes (p = 0.04).ConclusionsBreast-shape variability varies between anatomic locations. Changes in the order of 4 mm are frequently observed during RT, especially for large breasts. This should be taken into account in the development of protocols for partial breast irradiation and boost treatment.

Histomorphometric and osteocytic characteristics of cortical bone in male subtrochanteric femoral shaft.

The histomorphometric properties of the subtrochanteric femoral region have rarely been investigated. The aim of this study was to investigate the age-associated variations and regional differences of histomorphometric and osteocytic properties in the cortical bone of the subtrochanteric femoral shaft, and the association between osteocytic and histological cortical bone parameters. Undecalcified histological sections of the subtrochanteric femoral shaft were obtained from cadavers (n=20, aged 18-82years, males). They were cut and stained using modified Masson-Goldner stain. Histomorphometric parameters of cortical bone were analysed with ×50 and ×100 magnification after identifying cortical bone boundaries using our previously validated method. Within cortical bone areas, only complete osteons with typical concentric lamellae and cement line were selected and measured. Osteocytic parameters of cortical bone were analyzed under phase contrast microscopy and epifluorescence within microscopic fields (0.55mm2 for each). The cortical widths of the medial and lateral quadrants were significantly higher than other quadrants (P<0.01). Osteonal area per cortical bone area was lower and cortical porosities were higher in the posterior quadrant than in the other quadrants (P<0.05). Osteocyte lacunar number per cortical bone area was found higher in the young subjects (≤50years) than in the older ones (>50years) both before and after adjustments for body height and weight (P<0.05). Moreover, significant but low correlations were found between the cortical bone and osteocytic parameters (0.20≤R2 ≤0.35, P<0.05). It can be concluded that in healthy males, the cortical histomorphometric parameters differ between the anatomical regions of the subtrochanteric femoral shaft, and are correlated with the osteocytic parameters from the same site. These findings may be of use when discussing mechanisms that predispose patients to decreasing bone strength.

Reliability and Diagnostic Thresholds for Ultrasound Measurements of Dermal Thickness in Breast Lymphedema.

Lymphedema of the breast, secondary to treatment for breast cancer, is difficult to assess due to the shape of the breast and the nature of the tissue. Ultrasound measurement of dermal thickness has been previously used to assess breast swelling; however, the reliability of the measurements, or what should be considered an abnormal thickness, is currently known. Thirty-eight women with breast edema were recruited and underwent assessment using ultrasound. During the assessment, the four quadrants (superior, inferior, medial, and lateral) of the affected and unaffected breasts were imaged three times each. Dermal thickness was then measured by two assessors, on two occasions for each captured image. The interimage, intrarater, and inter-rater reliability was all found to be excellent (Cronbach's alpha = 0.995; ICC(3,1) = 0.962 and 0.851; and ICC(2,1) = 0.977, respectively). A dermal thickness of >1.6 mm in the superior and lateral quadrants and 2.0 mm in the medial and inferior quadrants was determined, by receiver-operating characteristics curve analysis, as the optimal diagnostic threshold to detect breast edema. Dermal thickness measurements can be reliably completed on breasts with edema secondary to breast cancer. Future study is needed to determine the utility of the dermal thickness thresholds established as well as to investigate changes in dermal thickness as a response to treatment of breast edema.

Residual strains in the intervertebral disc annulus fibrosus suggest complex tissue remodeling in response to in-vivo loading

The annulus fibrosus (AF) of the intervertebral disc (IVD) serves the dual roles of containing hydrostatic pressure from the inner nucleus pulposus (NP) and allowing flexible connection between adjacent vertebral bodies. Previous work has indicated that in the unloaded state, the AF is under a state of residual circumferential strain that, on average, is comparable to that which is believed to reduce peak stresses in other pressure containing organs. The complex in-vivo loading of the IVD, however, led us to hypothesize that variations with anatomical region should also exist. Residual strains were measured by imaging bovine caudal IVDs at both macro and micro scales in both the intact state (under residual strain) and opened into anterior, posterior, and lateral quadrants (residual strains relieved). Calculation of macro scale residual strains using changes in lamellar arc length and thickness confirmed circumferential tension (anterior: 0.63±2.1%, lateral: 8.3±1.5%, posterior: 4.4±2.1%) and radial compression (anterior: 12.4±5.8%, lateral: 11.120±2.8%, posterior: 4.8±4.2%) around the outer zone of the AF. The inner zone, however, had residual circumferential strains ranging from 28.7±3.4% compression in the anterior region to 3.4±3% tension in the posterior region, with radial strains of 9.7±5.5% tension and 0.2±4.4% compression respectively. This pattern of residual circumferential strain was corroborated at the microscale by comparing the crimp period of collagen fiber bundles in the intact and open states. The results of this study point toward a complex pattern of residual strains in the AF, which develop in response to stresses from both NP pressurization and bending movements.

Vertical force distribution in the paws of sound Labrador retrievers during walking

In contrast to gait analysis in humans, where pedobarography is an integral part of biomechanical studies, veterinary researchers have rarely investigated vertical force distribution (VFD) in the paws of dogs. The aim of this study was to investigate the VFD of peak of vertical force (PFz), vertical impulse (IFz) and time of occurrence of PFz during stance phase (TPFz) in 20 sound, adult Labrador retrievers walking normally on a pressure plate. A technique was used that divided the canine paw prints into quadrants. A general linear model was introduced to investigate the effects of forelimbs/hindlimbs, body side, and medial/lateral and cranial/caudal quadrants on VFD as they related to the total force (sum of all PFz/IFz values).For PFz and IFz, there were significantly greater effects on VFD in the lateral quadrants compared to the medial quadrants, respectively (6.49 ± 2.56% vs. 6.01 ± 2.60% and 6.62 ± 3.06% vs. 5.88 ± 3.21%; P < 0.001), in the forelimbs compared to the hindlimbs (8.02 ± 2.13% vs. 4.48 ± 1.61% and 8.02 ± 2.83% vs. 4.48 ± 2.36%; P < 0.001), and in the cranial quadrants compared to the caudal quadrants (7.87 ± 2.09% vs. 4.63 ± 1.93% and 8.57 ± 2.17% vs. 3.88 ± 1.98%; P < 0.001). The cranial/caudal ratio was higher in the hindlimbs than in the forelimbs (PFz: 2.10 ± 0.45 vs. 1.65 ± 0.32; P = 0.001; and IFz: 3.35 ± 0.80 vs. 2.04 ± 0.46; P < 0.001). The TPFz was reached earlier in the hindlimbs than in the forelimbs (46.86 ± 19.16% vs. 54.08 ± 19.62%; P < 0.001) and in the caudal quadrant than in the cranial quadrant (32.57 ± 5.77% vs. 68.37 ± 10.01%; P < 0.001). These data from sound Labrador retrievers could be used as a basis for future research investigating orthopedically- and/or neurologically-impaired animals.

An investigation into the accuracy of orbital X-rays, when using CR, in detecting ferromagnetic intraocular foreign bodies

PurposeThe aim of this study is to determine the accuracy of orbital X-rays, when using computed radiography (CR), in detecting ferromagnetic intra-ocular foreign bodies (IOFBs) prior to magnetic resonance imaging (MRI). MethodsA total of 64 orbital X-rays of an anthropomorphic head phantom were acquired using CR. For each image 1, 2, 3, or 4, large, medium, or small IOFBs were fixed to the anterior surface of the left or right orbit. Each of the acquired images with an IOFB was duplicated in order to increase the sample size. A further 16 normal images (no IOFB) were also included in the sample. Observers were invited to review the images and were permitted to manually magnify and window the images to detect any IOFBs present on each image. Results10 observers (4 radiographers; 4 reporting radiographers; 2 consultant radiologists) independently reviewed the images. The mean (SD) sensitivity and specificity were 72.1% (7.3%) and 99.2% (0.8%) for all observers, respectively. According to size the sensitivity in detecting small, medium and large IOFB were 46%, 76% and 93%, respectively. According to location, the lower lateral quadrants had the lowest sensitivity (53%) whereas the upper medial had the greatest (88%). ConclusionFindings from this study using CR support previous conclusions that conventional X-rays fail to detect metallic IOFBs in all cases. Diagnostic performance is governed by IOFB size and location.

Carotid plaque fissure: An underestimated source of intraplaque hemorrhage

Background and aimsPlaque fissuring, a phenomenon morphologically distinct from the classical rupture of a thinned fibrous cap, has not been well characterized in carotid atherosclerosis. The aim of this study was to establish the prevalence of plaque fissures in advanced carotid plaques with an otherwise intact luminal surface, and to determine whether they might be a source of intraplaque hemorrhage (IPH). MethodsWe evaluated 244 surgically intact, ‘en bloc’ embedded, serially sectioned carotid endarterectomy specimens and included only those plaques with a grossly intact luminal surface. ResultsAmong the 67 plaques with grossly intact luminal surface, cap fissure was present in 39 (58%) plaques. A total of 60 individual fissures were present, and longitudinally mean fissure length was 1.3 mm. Most fissures were found distal to the bifurcation (63%), proximal to the stenosis (88%), and in the posterior (opposite the flow divider) or lateral quadrants (80%). 36% of the fissures remained in the superficial third of the plaque. 52% extended from the lumen surface to the middle third of the plaque and 12% reached the outer third of the plaque on cross section. Fissures often occurred between two tissue planes and were connected to IPH (fresh: 63%; any type: 92%) and calcifications (43%). No correlation was found with patient characteristics such as symptom status, carotid stenosis, hypertension, diabetes, smoking and medications (statins or antiplatelet agents). ConclusionsPlaque fissures are common in advanced carotid plaques with an otherwise grossly intact luminal surface and are associated with fresh intraplaque hemorrhage. As they occur on the interface between plaque components with different mechanical properties, further biomechanical studies are needed to unravel the underlying failure mechanisms.

Tuberous breast deformity: A modified technique for single-stage correction.

Introduction:Tuberous breast deformity is one of the most challenging congenital breast anomalies. Severe forms present as hypoplasia of lower medial and lateral quadrants and breast base constriction. We present a modified technique based on redistribution of breast tissue for single-stage aesthetic correction of this deformity.Material, Methods and Surgical Technique:The technique is based on Lejour's method of single vertical scar breast reduction. The breast tissue is divided into three superiorly based pedicles. However, instead of joining the three pedicles, they are spread to redistribute tissue to quadrants which are deficient. This technique is combined with implant insertion if the breast volume is deficient or mastopexy if there is significant ptosis. The level of nipples is matched to achieve symmetry and areolar reduction done where indicated. We have used this for six patients with Type I/II/III (von Heimburg, 2000) tuberous breast deformity.Results and Discussion:The aesthetic results have been very good in terms of shape, volume, symmetry and patient satisfaction. A historical summary of the development of techniques for correction of tuberous breast is presented along with description of our method and its results.

Experimental Post-traumatic Stress Disorder Decreases Astrocyte Density and Changes Astrocytic Polarity in the CA1 Hippocampus of Male Rats

Post-traumatic stress disorder (PTSD) is a psychiatric condition resulting from exposure to a traumatic event. It is characterized by several debilitating symptoms including re-experiencing the past trauma, avoidance behavior, increased fear, and hyperarousal. Key roles in the neuropathology of PTSD and its symptomatology have been attributed to the hippocampus and amygdala. These regions are involved in explicit memory processes and context encoding during fear conditioning. The aim of our study was to investigate whether PTSD is capable of altering the morphology, density and expression of glial fibrillary acidic protein (GFAP) in astrocytes from the CA1 region of the hippocampus and the medial amygdala and correlate the data obtained with the orientation index of the polarity of astrocytes. Thirty male rats were divided in two groups: control (n = 15) and PTSD (n = 15). The inescapable shock protocol, in which the animals are exposed to a single episode of footshock, was used to induce PTSD. Our results show that, in the hippocampus, PTSD is capable of decreasing the density of GFAP+ astrocytes as well as altering astrocytic morphology, as shown by the reductions observed in the total number of primary processes, in the number of primary processes in the lateral quadrants, and the degree of branching in the lateral quadrants. The analysis of the orientation index indicates that PTSD alters the polarity of hippocampal astrocytes. No alterations were observed in the amygdala astrocytes. Therefore, this study demonstrates notable changes in hippocampal astrocytes, supporting the concept that these cells play an important role in PTSD symptomatology.

The Role of the Plastic Surgeon in Sentinel Lymph Node Biopsy of Internal Mammary Nodes.

The Role of the Plastic Surgeon in Sentinel Lymph Node Biopsy of Internal Mammary Nodes.

Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer.

BackgroundAlthough therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations.MethodsThe study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy.ResultsThirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed.ConclusionTM using a medial pedicle is a safe and appealing technique among women with tumors at different locations.

Distribution of mesoscale elastic properties and mass density in the human femoral shaft

Cortical bone properties are determined by tissue composition and structure at several hierarchical length scales. In this study, the spatial distribution of micro- and mesoscale elastic properties within a human femoral shaft has been investigated. Microscale tissue degree of mineralization (DMB), cortical vascular porosity Ct.Po and the average transverse isotropic stiffness tensor CMicro of cylindrical-shaped samples (diameter: 4.4 mm, N = 56) were obtained from cortical regions between 20 and 85% of the total femur length and around the periphery (anterior, medial, posterior and lateral quadrants) by means of synchrotron radiation µCT (SRµCT) and 50-MHz scanning acoustic microscopy (SAM). Within each cylinder, the volumetric bone mineral density (vBMD) and the mesoscale stiffness tensor CMeso were derived using a numerical homogenization approach. Moreover, microelastic maps of the axial elastic coefficient c33 measured by SAM at distinct cross-sectional locations along the femur were used to construct a 3-D multiscale elastic model of the femoral shaft. Variations of vBMD (6.1%) were much lower than the variations of mesoscale elastic coefficients (11.1–21.3%). The variation of DMB was only a minor predictor for variations of the mesoscale elastic properties (0.05 ≤ R2 ≤ 0.34). Instead, variations of the mesoscale elastic properties could be explained by variations of cortical porosity and microscale elastic properties. These data were suitable inputs for numerical evaluations and may help to unravel the relations between structure and composition on the elastic function in cortical bone.

Partial breast radiotherapy with simple teletherapy techniques

A prospective pilot study of partial breast irradiation (PBI) with conventional vs hypofractionated schedules was set out. The study aimed to determine efficacy, acute and late side effects, and the preference of photon vs electron irradiation based on individual features. Patients were enrolled according to internationally accepted guidelines on PBI. Conformal radiotherapy plans were generated with both photon and electron beams, and the preferred technique based on dose homogeneity and the radiation exposure of healthy tissues was applied. For electron dose verification, a special phantom was constructed. Patients were randomized for fractionation schedules of 25 × 2 vs 13 × 3Gy. Skin and breast changes were registered at the time of and ≥1 year after the completion of radiotherapy. Dose homogeneity was better with photons. If the tumor bed was located in the inner quadrants, electron beam gave superior results regarding conformity and sparing of organ at risk (OAR). If the tumor was situated in the lateral quadrants, conformity was better with photons. A depth of the tumor bed ≥3.0cm predicted the superiority of photon irradiation (odds ratio [OR] = 23.6, 95% CI: 5.2 to 107.5, p < 0.001) with >90% sensitivity and specificity. After a median follow-up of 39 months, among 72 irradiated cases, 1 local relapse out of the tumor bed was detected. Acute radiodermatitis of grade I to II, hyperpigmentation, and telangiectasia developed ≥1 year after radiotherapy, exclusively after electron beam radiotherapy. The choice of electrons or photons for PBI should be based on tumor bed location; the used methods are efficient and feasible.

Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications

Background. Use of an autologous latissimus dorsi (LD) flap in breast reconstruction accounts for a flexible and natural look of reconstructed breast and has maintained a strong popularity because of its ease of harvest, reliability, and ability to provide additional prosthetic coverage. Different complications (hematoma, seroma, flap necrosis, infection, hypertrophic scarring, and postoperative back pain) linked to this type of breast reconstruction. The aim of this study was to evaluate the complications and aesthetic outcome of (LD) flap breast reconstruction after breast cancer surgery. Materials and methods. forty patients underwent breast reconstruction using (LD) flap with a follow-up period ranged from 6 to 18 months. Patients with small to medium sized breasts underwent complete reconstruction by extended (LD) flap after mastectomy either subcutaneous or skin sparing mastectomy while patients with large pendulous breast underwent Augmentation by (LD) miniflap after conservative surgery by wide local excision (WLE) with safety margin. All patients gave their informed consent for the procedure and were aware of the potential complications and the possibility of secondary procedures. Results. The ages of the patients in our study ranged from 25 to 65 years old. 28 (70%) patients underwent (WLE) and reconstruction with (LD) miniflap while modified radical mastectomy, skin sparing mastectomy and subcutaneous mastectomy were done in 2(5%), 4(10%) and 6(15%) patients respectively with complete reconstruction by extended(LD) flap. The complication rates were noted as follows: partial flap necrosis in 4 patients (10%), wound breakdown in 2 patients (5%), lymphorrhea in 2 patients (5%), seroma in 6 patients (15%). Some of patients showed a minor deformity in the back, which disappeared with time and most patients, had temporary limitation of shoulder movements postoperatively but all recovered completely within few weeks. No patients underwent secondary nipple and areola reconstruction. No local recurrence or distant metastasis in any patient during the follow up period of our study. Evaluation of aesthetic results by patients revealed that 30 patients (75%) were deeply satisfied, 6 patients (15%) were satisfied and 4 patients (10%) were poorly satisfied. While, surgeon aesthetic evaluation was good in 28 patients (70%), satisfactory in 8 patients (20%) and fair in 4 patients (10%). Conclusion. (LD) flap breast reconstruction is a very versatile, safe and satisfactory technique with high success rate and is even suitable for high-risk patients. Donor site seroma is the most common complication and can be treated by repeated aspiration in outpatient clinic. Latissimus dorsi (LD) miniflap is the mainstay of breast reconstruction after partial mastectomy to repair defects in the lateral quadrants and the lower inner pole with low donor site morbidity and deep patient satisfaction