Zone Lesions Research Articles

Necrotizing Fascitis of the Neck: Rare Case Report

Introduction: necrotizing fasciitis corresponds to a bacterial infection of soft tissues, characterized by diffuse and rapidly progressive necrosis of the subcutaneous cellular tissue and musculoaponeurotic system, accompanied by marked systemic septic involvement. Clinical case: the case of a 63-year-old patient, former smoker, pack year 10, clinical picture of approximately 4 days is presented, characterized by generalized facial edema without improvement with pharmacological treatment, accompanied by unquantified thermal increases, intense pain. neck, general condition assessment and appearance of signs of phlogosis and ampullary lesions in zone 3 and 4 of the right neck. The diagnosis of necrotizing fasciitis of the neck with no apparent cause was established. A necrectomy was performed and the patient was admitted. Discussion: in this particular case, the unusual location of necrotizing fasciitis in the anterior region of the neck is striking; it generally occurs in people with diabetes mellitus and immunocompromised people and in this case it occurs without apparent cause. Conclusion: necrotizing fasciitis of the anterior region of the neck without apparent cause, rare infection, rapidly progressive and difficult to diagnose in the early stage.

PO-01-104 3D MODELING OF PRE-PROCEDURE CT SCAN TO PREDICT SEVERE ESOPHAGEAL HEATING DURING HIGH POWER SHORT DURATION ATRIAL FIBRILLATION ABLATION

The degree of esophageal heating during left atrial posterior wall (LAPW) ablation is a powerful predictor of esophageal injury. Esophageal temperature monitoring has not been shown, however, to reduce esophageal injury risk related to atrial fibrillation (AF) ablation. Esophageal proximity modeling based on pre-procedure CT scan using ADAS 3D software (ADAS3D Medical, Barcelona, Spain) is a novel method of identifying left atrial locations at high risk for severe esophageal heating. Given the mobile nature of the esophagus relative to the LAPW, the predictive value of esophageal proximity mapping is unclear. To determine the predictive value of esophageal proximity mapping to identify LAPW ablation sites at risk for severe esophageal heating. Pre-procedure CT scans were analyzed using ADAS 3D software in 10 patients undergoing AF ablation to create a 3D esophageal proximity model and left atrial tissue thickness map that were merged with a catheter based left atrial electroanatomic map (Ensite X, Abbott, Inc.). Esophageal proximity was defined as: Zone 1 – overlying esophagus, Zone 2 – within 5 mm of esophagus, or Zone 3 – > 5 mm from esophagus. LAPW ablation lesions were created with a contact-force sensing radiofrequency ablation catheter (Tacticath, Abbott, Inc.) at 45W, 10-20g of force, and 6 seconds duration. A 12 sensor esophageal temperature probe (Circa, Circa Scientific, Inc.) recorded the temperature increase related to each LAPW lesion. Ablation lesions in Zone 3 resulted in significantly lower esophageal temperature rise (degrees Celsius) as compared to either Zone 1 (mean 0.11 ± 0.27 vs 1.61 ± 1.39, p value <0.0001) or Zone 2 (mean 0.11 ± 0.27 vs 0.84 ± 1.1, p value <0.0001) (Fig A). Lesions in Zone 2 resulted in lower temperature rise as compared to Zone 1 (mean 0.84 ±1.1 vs. 1.61 ± 1.39, p value <0.0001) (Fig A). Within Zones 1 and 2, lesions with LAPW thickness > 2 mm resulted in significantly less esophageal temperature rise as compared to those on tissue with thickness of ≤ 2 mm (Fig B). Ablation lesions delivered >5mm from esophageal location at time of pre-procedure CT scan are very unlikely to result in significant esophageal heating. Ablation sites overlying esophagus with LAPW thickness ≤ 2mm were at greatest risk of significant esophageal heating. Analysis of pre-procedure CT scans to determine esophageal proximity and LAPW thickness may be useful in developing strategies to avoid esophageal injury during LAPW RF ablation.

Treatment for Nontype 1 Retinopathy of Prematurity by Intravitreal Injection of Antivascular Endothelial Growth Factor Drugs.

To explore clinical characteristics and treatment reasons for intravitreal injection of antivascular endothelial growth factor (anti-VEGF) drugs in the treatment of nontype 1 retinopathy of prematurity (ROP). A retrospective study was conducted to screen the nontype 1 ROP from the collected ROP patients who received intravitreal injections of anti-VEGF drugs in Henan Eye Hospital from September 2018 to June 2021. A total of 138 ROP cases (262 eyes) were included in this study, including 39 cases (28.3%), 65 eyes (24.8%) that were the nontype 1 ROP. Compared with the type 1 ROP group, the nontype 1 ROP group had slightly later treatment time (39.8 ± 2.7 weeks vs 38.1 ± 2.6 weeks, P < 0.05) and a higher proportion of fusion protein drugs (87.2% vs 54.5%, P < 0.05). After intravitreal injection of anti-VEGF drugs, 27 eyes (41.5%) were cured and 38 eyes (58.5%) improved in the nontype 1 ROP group, without recurrence and aggravation cases. There were more lesions in zone II (63 eyes, 96.9%), with stage 2 (40 eyes, 61.5%) and stage 3 (23 eyes, 35.4%), and 58 eyes (89.2%) showed preplus in the nontype 1 ROP group. Treatment reasons included preplus in 58 eyes (89.2%), ridge aggravation in 22 eyes (33.8%), simultaneous treatment of the contralateral eye in 9 eyes (13.8%), no regression of lesions in the persistent stage 2 or 3 over PMA 44 weeks of follow-up in 8 eyes (12.3%), and logistical considerations in 4 eyes (6.2%). Considering some peculiar clinical characteristics, treatment by intravitreal injection of anti-VEGF drugs may be considered carefully for some nontype 1 ROP in critical conditions.

Improving colposcopic accuracy for cervical precancer detection: a retrospective multicenter study in China

BackgroundColposcopy alone can result in misidentification of high-grade squamous intraepithelial or worse lesions (HSIL +), especially for women with Type 3 transformation zone (TZ) lesions, where colposcopic assessment is particularly imprecise. This study aimed to improve HSIL + case identification by supplementing referral screening results to colposcopic findings.MethodsThis is an observational multicenter study of 2,417 women, referred to colposcopy after receiving cervical cancer screening results. Logistic regression analysis was conducted under uni- and multivariate models to identify factors which could be used to improve HSIL + case identification. Histological diagnosis was established as the gold standard and is used to assess accuracy, sensitivity, and specificity, as well as to incrementally improve colposcopy.ResultsMultivariate analysis highlighted age, TZ types, referral screening, and colposcopists’ skills as independent factors. Across this sample population, diagnostic accuracies for detecting HSIL + increased from 72.9% (95%CI 71.1–74.7%) for colposcopy alone to 82.1% (95%CI 80.6–83.6%) after supplementing colposcopy with screening results. A significant increase in colposcopic accuracy was observed across all subgroups. Although, the highest increase was observed in women with a TZ3 lesion, and for those diagnosed by junior colposcopists.ConclusionIt appears possible to supplement colposcopic examinations with screening results to improve HSIL + detection, especially for women with TZ3 lesions. It may also be possible to improve junior colposcopists’ diagnoses although, further psychological research is necessary. We need to understand how levels of uncertainty influence diagnostic decisions and what the concept of “experience” actually is and what it means for colposcopic practice.

Chest X-Ray Results in Covid-19 Positive Individuals Diagnosed at the Corona Center Using the British Society of Thoracic Imaging CXR Arrangement

Aim: To assess Chest X-ray results in COVID-19 positive individuals diagnosed at the Corona Percolation Center, Mayo Hospital, Lahore, using the British Society of Thoracic Imaging CXR classification. Methods: Altogether RT-PCR COVID-19 positive individuals tested at the Corona Percolation Epicenter, Mayo Hospital, Lahore between June 25th, 2020 and May 20th, 2021 included in this research. The cohort's mean age with age range was computed. The present symptoms and co-morbidities have been examined and tallied in rapports of facts and percentages. The outcomes of portable CXRs were categorized using the BSTI categorization and described in terms of numbers and percentages. Results: The participants' average age remained 46 years. Cough (69%) was the most common symptom, followed by fever (20%), difficulty breathing (42%), sore throat (6%), and loss of flavor and aroma (6%). (18 percent). The most common co-morbidity included hypertension (six) (22 percent). 3 participants (8%) had normal CXRs, whereas eight (25%) showed characteristic COVID CXRs. There were 23 (73%) ambiguous individuals, with just one (4%) having solitary long illness. Five (14% of individuals) had widespread lung disease, whereas 20 (64%) had detection of lung participation. The majority of 21 individuals (65%) had bilateral middle and lower zonal lesions. Conclusion: COVID-19 CXRs in this investigation showed a range of opacities from pure clear glass to mixed grounds glass opacification to accumulation in the contralateral peripheral intermediate and reduced lung zones. In these cases, the BSTI CXR writing categorization of Corona is legitimate, with both the inclusion of central zonal participation in conventional COVID-19 requirements rather than actually lower zone engagement. Keywords: Chest X-ray results in COVID-19 positive, diagnosed, Mayo Hospital, Lahore.

Fusion US/MRI prostate biopsy using a computer aided diagnostic (CAD) system.

The aim of this study was to investigate the impact of computer aided diagnostic (CAD) system on the detection rate of prostate cancer (PCa) in a series of fusion prostate biopsy (FPB). Two prospective transperineal FPB series (with or without CAD assistance) were analyzed and PCa detection rates compared with per-patient and per-target analyses. The χ2 and Mann-Whitney test were used to compare categorical and continuous variables, respectively. Univariable and multivariable regression analyses were applied to identify predictors of any and clinically significant (cs) PCa detection. Subgroup analyses were performed after stratifying for PI-RADS Score and lesion location. Out of 183 FPB, 89 were performed with CAD assistance. At per-patient analysis the detection rate of any PCa and of cs PCa were 56.3% and 30.6%, respectively; the aid of CAD was negligible for either any PCa or csPCa detection rates (P=0.45 and P=0.99, respectively). Conversely in a per-target analysis, CAD-assisted biopsy had significantly higher positive predictive value (PPV) for any PCa versus MRI-only group (58% vs. 37.8%, P=0.001). PI-RADS Score was the only independent predictor of any and csPCa, either in per-patient or per-target multivariable regression analysis (all P<0.029). In a subgroup per-patient analysis of anterior/transitional zone lesions, csPCa detection rate was significantly higher in the CAD cohort (54.5%vs.11.1%, respectively; P=0.028), and CAD assistance was the only predictor of csPCa detection (P=0.013). CAD assistance for FPB seems to improve detection of csPCa located in anterior/transitional zone. Enhanced identification and improved contouring of lesions may justify higher diagnostic performance.

Interobserver agreement of Prostate Imaging\u2013Reporting and Data System (PI-RADS\u2013v2)

BackgroundA retrospective study was conducted on 71 consecutive patients with suspected prostate cancer (PCa) with a mean age of 56 years and underwent mp-MRI of the prostate at 3 Tesla MRI. Two readers recognized all prostatic lesions, and each lesion had a score according to Prostate Imaging–Reporting and Data System version 2 (PI-RADS-v2).Purpose of the studyTo evaluate the interobserver agreement of PI-RADS-v2 in characterization of prostatic lesions using multiparametric MRI (mp-MRI) at 3 Tesla MRI.ResultsThe overall interobserver agreement of PI-RADS-v2 for both zones was excellent (k = 0.81, percent agreement = 94.9%). In the peripheral zone (PZ) lesions are the interobserver agreement for PI-RADS II (k = 0.78, percent agreement = 83.9%), PI-RADS III (k = 0.66, percent agreement = 91.3 %), PI-RADS IV (k = 0.69, percent agreement = 93.5%), and PI-RADS V (k = 0.91, percent agreement = 95.7 %). In the transitional zone (TZ) lesions are the interobserver agreement for PI-RADS I (k = 0.98, percent of agreement = 96%), PI-RADS II (k = 0.65, percent agreement = 96%), PI-RADS III (k = 0.65, percent agreement = 88%), PI-RADS IV (k = 0.83, percent agreement = 96%), and PI-RADS V (k = 0.82, percent agreement = 92%).ConclusionWe concluded that PI-RADS-v2 is a reliable and a reproducible imaging modality for the characterization of prostatic lesions and detection of PCa.

Fusion US/MRI prostate biopsy using a Computer Aided Diagnostic (CAD) system.

BACKGROUND The aim of this study was to investigate the impact of computer aided diagnostic (CAD) system on the detection rate of prostate cancer (PCa) in a series of fusion prostate biopsy (FPB). METHODS Two prospective transperineal FPB series (with or without CAD assistance) were analyzed and PCa detection rates compared with per-patient and per-target analyses. The χ2 and Mann-Whitney test were used to compare categorical and continuous variables, respectively. Univariable and multivariable regression analyses were applied to identify predictors of any and clinically significant (cs) PCa detection. Subgroup analyses were performed after stratifying for PI-RADS Score and lesion location. RESULTS Out of 183 FPB, 89 were performed with CAD assistance. At per-patient analysis the detection rate of any PCa and of cs PCa were 56.3% and 30.6%, respectively; the aid of CAD was negligible for either any PCa or csPCa detection rates (P=0.45 and P=0.99, respectively). Conversely in a per-target analysis, CAD-assisted biopsy had significantly higher positive predictive value (PPV) for any PCa versus MRI-only group (58% vs. 37.8%, P=0.001). PI-RADS Score was the only independent predictor of any and csPCa, either in per-patient or per-target multivariable regression analysis (all P<0.029). In a subgroup per-patient analysis of anterior/transitional zone lesions, csPCa detection rate was significantly higher in the CAD cohort (54.5%vs.11.1%, respectively; P=0.028), and CAD assistance was the only predictor of csPCa detection (P=0.013). CONCLUSIONS CAD assistance for FPB seems to improve detection of csPCa located in anterior/transitional zone. Enhanced identification and improved contouring of lesions may justify higher diagnostic performance.

Genomic Detection of Bovine Digital Dermatitis Treponemes in Sole Ulcers

Objective- Evaluation of possible contamination of sole ulcers with digital dermatitis Treponema spp . Design- Clinical detection Animals- Thirty-three cows with sole ulcer lesion. Procedures- Hoof trimmings were done by professional veterinarian hoof trimmer on a regular basis. Sole ulcer and digital dermatitis recorded as a wounded lesion in zone 4 and 10 of the hooves during hoof trimming and recorded in special sheets. A total of Thirty-three tissue samples from sole ulcers in zone 4 of digits were taken and the 16S rRNA gene was followed by PCR assay. Results- Annual incidence of clinical digital dermatitis recorded as 7.1 percent as the second prevalent digital lesion in the farm following sole ulcer. Treponema spp . was found in 42 percent of the samples, none of the positive samples show concurrent lesion of digital dermatitis and sole ulcer.Conclusion and Clinical Relevance- Since no concurrent lesions were found in sole ulcer samples, finding Treponema spp. in tissues may be a result of the possible pathogenic presence of the bacteria in this region. Multifactorial causes of sole ulcer make different clinical presentations for the lesion and a microbial cause for the sole ulcer that led to non-healing ulcers were reported.

Validation of 9-Grid Scheme for Localizing Osteochondral Lesions of the Talus.

Background:A 9-grid scheme has been integrated into the foot and ankle literature to help clinicians and researchers localize osteochondral lesions of the talus (OLTs). We hypothesized that fellowship-trained orthopedic foot and ankle surgeons would have a high rate of intra/inter-observer reliability when localizing OLTs, therefore validating the scheme.Methods:We queried our institution’s foot and ankle radiographic database for magnetic resonance images with OLTs. Each MRI was reviewed by the senior author, and 2 key images (widest OLT diameter) from each tangential view were copied and combined onto one slide. Fifty consecutive deidentified images of ankles were then sent to 4 practicing fellowship-trained foot and ankle surgeons. Each was asked to identify which zone the OLT was localized within. A radiologist’s report served as the control. Statistical analyses were performed using Cohen and Fleiss kappa tests.Results:The reviewers demonstrated majority consensus on 45/50 images with substantial agreement for zones 4 and 6. The interobserver reliability was moderate with a κ = 0.55. The mean intraobserver reliability was substantial, with a κ = 0.79. A musculoskeletal radiologist determined there were 3 lesions in zone 7, 18 lesions in zone 4, and 29 lesions in zone 6.Conclusion:This study is the first to critically evaluate the 9-grid scheme and its reliability among orthopedic foot and ankle surgeons. Our study found that the 9-grid scheme is an accurate method of localization for OLTs with high intra- and moderate interobserver reliability between surgeons.Level of Evidence:Level IV, retrospective diagnostic study.

Findings on repaired full-thickness acetabular articular cartilage defects during revision hip arthroscopy allowing a second look.

Full-thickness acetabular articular cartilage defects (FAACD) are found on most hips with femoroacetabular impingement (FAI) with a wave sign in the acetabulum. When not repaired it can produce pain and catching sensation. Multiple arthroscopic techniques for repairing this chondral lesion exist, but only few show the quality of the repair on a second look. The purpose of this study is to evaluate the quality of the repaired cartilage during revision hip arthroscopy (RHA) allowing a second look in patients treated of FAACD. A total of 13 hips with FAACD repaired in the past underwent RHA for ongoing pain. Signs of persistent chondral defects or the ability to elevate the articular cartilage from subchondral bone were evaluated by zones. Those with persistent defects were re-repaired. All patients had FAACD lesions in zones I, II and III diagnosed in the index hip arthroscopy. The most common finding at the RHA was the presence of bone growth or residual impingement. Before FAACD repair, 11 (85%) hips had the wave sign, while 2 (15%) hips had it in RHA. Five (38%) hips had residual delamination in the second look, these patients had residual FAI, were ≥58 years or waited >6 months to be revised. The wave sign was not observed in 85% of the revised hips, indicating the technique was successful in most cases and was not the principal cause of their ongoing pain. This technique achieved the stated goal of stabilizing the articular cartilage seen in the wave sign.

Pathologic findings in prostate gland at autopsy with topographic distribution of these diseases within the prostatic zones: Eleven-month prospective study in Oauthc, Ile-Ife, Nigeria

Introduction: Different zones of prostate harbor different prostatic pathology. The peripheral zone shows majorly prostatic adenocarcinoma, which is among the common causes of cancer death in men in sub-Saharan Africa. Aim: The study aimed to determine the spectrum of prostate pathologies in routine autopsies of adult male 30 years and above whose death was unrelated to prostate diseases. Methods: A total of eighty cases of prostate glands were harvested over an 11-month period. These glands were fixed for 48 h, grossed, and processed. The hematoxylin- and eosin-stained slides were examined using multiheaded microscope. Results: The age range of patients was 30–85 years with a mean age of 41.84 ± 12.63 years standard deviation. The most common cause of death in these patients was trauma secondary to road traffic accident followed by cardiovascular diseases. The most common lesions in each prostatic zone as observed in this study were chronic prostatitis 26.3% in the central zone; nodular hyperplasia 16.3% in the transitional zone; prostatic atrophy (13.8%) and adenocarcinoma (8.3%) in the posterior peripheral zone (one of the cases (1.3%) showed multiple carcinomatous foci); and chronic prostatitis 15.0% in the anterior fibromuscular zone. Four patients' ages 30, 31, 32, and 48 years had Schistosoma haematobium infections observed in the seminal vesicles, whereas patient aged 48 years had in addition adenocarcinoma of prostate gland and prostatic atrophy (PA). A case (1.3%) of prostatic calculi and simple cyst of the prostate was seen in ages 56 and 85 years, respectively. Conclusion: Different zones of the prostate are associated with different disease entities, and S. haematobium show an association with adenocarcinoma of prostate in one individual

ASSOCIATION OF CONSERVATIVE TECHNIQUE WITH RESECTION OF AMELOBLASTOMA: A CASE REPORT

The patient C.O.R., who was 54 years old, male, and white, went to the oral diagnosis department for evaluation of swelling in the mental zone with recent development and painful symptomatology of lower incisors. Clinical examination revealed expansive process intra- and extraoral in the mental zone, which was normochromic and covered by normal skin and mucosa. Image examinations revealed extensive radiolucent lesion in the mental zone with perforation of cortical bone, resorption of dental roots, and pathologic fracture of the mandible. An incisional biopsy was performed, and the sample was sent for histopathologic examination. The report confirmed the initial hypothesis of ameloblastoma. A marsupialization was made with maintenance of a shutter for reduction of cystic component and basilar recovery. After 8 months, the patient was referred for resection surgery with basilar preservation, which decreases morbidity and sequels and facilitates his rehabilitation. The follow-up will last 5 years to monitor a possible relapse. Currently, he is under treatment for prosthetic rehabilitation.

The Neurosurgeons' Armamentarium for the Management of Refractory Post-Herpetic Neuralgia

Abstract INTRODUCTION Post-herpetic neuralgia (PHN) can be refractory to medical treatment. Its complex pathophysiology explains the numerous neurosurgical procedures available. The present study summarizes all available neurosurgical strategies for the management of resistant PHN and evaluates respective safety and efficacy. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PubMed and Cochrane Library databases were searched up to October 2018. RESULTS A total of 38 studies comprising 811 patients with refractory PHN were included. Ten studies with 243 patients reported use of spinal cord stimulation. The mean visual analog scale (VAS) score was 7.6 and 2.7 before and after the procedure. Dorsal root entry zone (DREZ) lesioning was performed in 85 patients. The mean VAS score before and after the procedure was 8.6 and 3.7. During the postoperative period, 42.3% of patients developed motor deficits. Five studies investigated intrathecal (IT) injections or pump insertions. The combined IT injections demonstrated a strong analgesic effect 87% of patients reported pain reduction &gt;50%. Spinal trigeminal nucleotomy was reported in 4 studies with a total of 60 patients with 78.3% of patients pain-free during long-term follow-up. However, motor and sensory deficits occurred in 75% to 100%. DRG pulsed radiofrequency lesioning was reported by 2 studies (69 patients) with mean VAS before and after was 6.9 and 2.7, respectively. Peripheral nerve simulation was reported by 3 studies comprising 10 patients in total. This strategy was among the safest and most effective, demonstrating a VAS pain reduction from 8.6 to 2 without any complications. CONCLUSION Neurosurgical approaches for recalcitrant PHN include neuromodulatory and ablative procedures. Patients with resistant PHN should undergo minimally invasive procedures first, including SCS, PNS, or DRG radiofrequency lesioning. More invasive procedures should be reserved for refractory cases. Comparative studies are needed in order to construct a PHN neurosurgical management algorithm.

Cognitive mpMRI/TRUS biopsy of the prostate with using strain elastography

Purpose. To evaluate the effectiveness of prostate cancer detection with method of cognitive mpMRI/TRUS fusion biopsy using strain sonoelastography.Materials and methods. Cognitive transrectal fusion biopsy of prostate was performed in 32 patients. According to the data of a preliminary conducted mpMRI, 33 foci suspicious of prostate cancer were included (PIRADSv2 = 3–5). Before the biopsy, all patients underwent ultrasound planning using compression sonoelastography.Results. The overall sensitivity was 76% for the targeted biopsy, and 49% for systematic biopsy. The number of biopsy specimens with a clinically significant Gleason grade in the targeted biopsy group was 85% of all columns with cancer specimens, in the systematic biopsy group this number was 68%. On average, the Gleason grade after targeted biopsy was 7.5 ± 0.9, and it was 7.2 ± 0.9 in the columns after systematic biopsy. On average, the percentage of tumor in the columns after targeted biopsy was 72% ± 29% and it was 55% ± 35% in the columns after systematic biopsy. The false positive for mpMRI was 15%. The overall sensitivity for the strain sonoelastography was 69% in this study, clinically significant cancer was detected in 71% of all columns with cancer specimens. False positive for elastography was observed in 18% of cases.Conclusion. Comparing with systematic biopsy, cognitive mpMRI / TRUS fusion biopsy can improve the detection rate of clinically significant prostate cancer and reduce the number of detected cases of clinically insignificant cancer. In cases of a total or subtotal tumor lesion in the peripheral zone detected on mpMRI, it is possible to take fewer columns for morphological verification of the tumor. The use of compression sonoelastography as an additional parameter of navigation in cognitive mpMRI/TRUS fusion biopsy can be considered as a promising way to increase the detection rate of clinically significant prostate cancer.

Is there a Histopathologic Correlation of Prostatic PI-RADS Score 3 Lesions in Transition Zone in MRI with the Dynamic Contrast Curve Type? A Retrospective Single-Center Study

Is there a Histopathologic Correlation of Prostatic PI-RADS Score 3 Lesions in Transition Zone in MRI with the Dynamic Contrast Curve Type? A Retrospective Single-Center Study

Anteromedial Labral Tears: Surgical Prevalence and Relationship with Chondral Damage of the Hip

AbstractStructural abnormalities of the hip joint have been identified as a common cause of labral and chondral lesions of the hip joint. However, labral and chondral damage can occur in the absence of structural abnormalities. The authors examined the incidence of anteromedial (AM) labral lesions, occurring in a nonimpinging region of the hip joint, and determined if the prevalence and location of concomitant chondral lesions differ between patients with AM lesions and those without. Between 2001 and 2013, they assessed 2,080 hips (1,818 patients) undergoing hip arthroscopy for the presence of AM labral lesions (between 4 and 6 o'clock position) and documented incidence of these lesions. The articular cartilage of the posterior, superior, and anterior regions of the acetabulum and femoral head was assessed. The degree of damage was classified as absent, mild (grades I/II), or severe (grades III/IV). The prevalence and severity of lesions in each region were compared between patients with AM lesions and those without. The authors identified 1,140 hips (1,028 patients) (55%) with labral tears in the AM region of the acetabulum. The cohort consisted of 689 females and 328 males, with an average age of 37.9 ± 12 years. Chondral lesions were present in all regions of the femoral head and acetabulum in both patients with AM lesions and those without. There is a relationship between the presence of AM lesion and prevalence of chondral lesions in the posterior and anterior femoral head and acetabulum, with a higher prevalence of lesions observed in patients without AM tears. Their findings show that lesions in the AM region of the acetabular labrum can occur with high prevalence in patients. These lesions are often associated with concomitant injuries to the anterior chondral surfaces, which may differ from lesions in the impingement zone. A thorough evaluation of all regions of the hip joint is warranted during arthroscopy to identify and treat all potential lesions.

Is there a Histopathologic Correlation of Prostatic PI-RADS Score 3 Lesions in Transition Zone in MRI with the Dynamic Contrast Curve Type? A Retrospective Single-center Study

Is there a Histopathologic Correlation of Prostatic PI-RADS Score 3 Lesions in Transition Zone in MRI with the Dynamic Contrast Curve Type? A Retrospective Single-center Study

Long term survival analysis of cementless Spotorno femoral stem in young patients

ObjectiveThe aim of this study was to analyze the survivorship and clinical outcome of Cementless Spotorno (CLS) stem in young patients. MethodsA total of 99 consecutive hip arthroplasties using CLS stem were performed on 84 patients younger than 50 years of age between 1993 and 2001. 63 patients were available for final follow-up (mean age: 39 ± 7.8 (range: 22–50)). Patients' Harris Hip Scores (HHS) and survivorship estimates were calculated. Radiographs were analyzed for acetabular implant status, canal fill index (CFI), stem alignment, osteolysis, and stress shielding. ResultsMean follow-up time was 18 years (13–3), and mean HHS was 88.7 (58–100). Patients with femoral neck fracture had a more favorable functional outcome (p = 0.027), while those with stems in varus had lower scores (p = 0.017). 31 stems (49%) were undersized and 30 hips (47%) had perifemoral osteolysis. Acetabular impairment was strongly associated with osteolysis in Gruen zones 1 and 7 (p < 0.01). Seventeen of the osteolytic lesions occurred in Gruen zone 1, 4 lesions in zone 2, 9 in zone 6 and 22 in zone 7. Forty nine stems were well aligned, 10 were in varus and 5 in valgus. Six patients presented with grade 1 stress shielding, 42 with grade 2, 9 with grade 3 and 7 with grade 4. Pedestal formation was evident in 13 cases. Kaplan-Meier survivorship estimates at 18 years with revision for any reason as the end point and with septic revisions excluded were 91.2% (95% CI: 83.7%–98.7%) and 95.1% (95% CI: 89.5%–100%), respectively. There was no difference between survival estimates of patients with different etiologies. ConclusionCLS stems in young patients have high survival estimates in the long term with good-excellent results. Spotorno stems perform equally well in all etiologies with no difference in terms of survivorship. Level of EvidenceLevel IV Therapeutic study.

Clinical course of acute zonal occult outer retinopathy complicated by choroidal neovascularization

PurposeTo report the clinical course and multimodal imaging features of acute zonal occult outer retinopathy (AZOOR) complicated by choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) treatment or photodynamic therapy (PDT).MethodsObservational case series. Retrospective analysis of patients presenting to different institutions with evidence of AZOOR and neovascular lesions. Diagnosis of AZOOR was made on the basis of clinical presentation and multimodal imaging. All patients underwent a comprehensive ophthalmic evaluation and multimodal retinal imaging, including color fundus photos, fundus autofluorescence, fundus fluorescein angiography and spectral-domain optical coherence tomography.ResultsFour patients (three males, mean age 53.5 years) were included in the study. Mean follow-up was 5.1 years. Presentation of AZOOR was unilateral in two patients and bilateral in the remainder two patients. One of the patients presenting with unilateral AZOOR developed zonal lesions in the fellow eye during follow-up. All patients presented with unilateral type 2 (subretinal) CNV. Three patients underwent intravitreal anti-VEGF injections and one patient underwent a single PDT. Multimodal retinal imaging showed zonal or multizonal progression during treatment. After treatment, visual acuity and CNV stabilization was observed in all patients.ConclusionsThe presence of CNV expands the clinical spectrum of AZOOR. CNV complicating AZOOR may be effectively treated with intravitreal injections of anti-VEGF, despite progression of the zonal lesions. Further studies are required to define the role of treatment in the progression of the zonal lesions.