Medial Aspect Research Articles

Anatomical assessment of the Kambin's triangle for percutaneous posterolateral transforaminal endoscopic surgery of lumbar intervertebral discs: a magnetic resonance imaging based study.

The aim of the present study was to utilize magnetic resonance imaging (MRI) as a noninvasive tool for evaluation of the Kambin's triangle safe zone. Lumbar MRIs of 67 healthy subjects were analyzed. On the coronal plane, the distance from the superior endplate to the nerve root exiting from the dura (distance a), the distance from the lateral aspect of the dura to the medial aspect of the nerve root (distance b), and the angle between the nerve root and plane of the corresponding disc (angle α) was measured. On the axial plane, the vertical distance from the upper facet surface to the exiting nerve root and root-disc distance was also measured. On the sagittal plane, foraminal height, diameter, nerve root-disc distance, and nerve root-pedicle distance were measured. On the coronal plane, right and left α angle was 50.78±4.43 (range, 48.52-51.84 degrees) and 51.07±4.08 (range, 49.25-51.91) degrees, respectively. Distance of right 'a' was 17.86±3.86 mm (range, 10.56-24.84 mm) and left 'a' was 18.03±3.73 mm (range, 10.98-24.82 mm), distance of right 'b' was 15.57±2.61 mm (range, 10.54-20.70 mm) and left 'b' was 15.46±2.68 mm (range, 10.93-19.23 mm). All these measurements increased as the spine level went down. Foraminal height and diameter decreased caudally. Nerve root-facet distance did not show change as the level went down. The study indicated that radiologic measurement is feasible to evaluate the anatomy of the Kambin's triangle. At lower lumbar levels, the exiting nerve root is at risk of injury.

Desmoplastic Fibroblastoma (Collagenous Fibroma) of the Knee: A Case Report and Literature Review.

Desmoplastic fibroblastoma, also known as collagenous fibroma, is a rare benign mesenchymal neoplasm that primarily arises in the subcutaneous tissue of upper extremities and limb girdles. The knee is an uncommon location for desmoplastic fibroblastoma. Recent studies have demonstrated the presence of immunoreactivity for FOS like 1 (FOSL1) and rearrangements of FOSL1. A 70-year-old woman presented with a 1-year history of a palpable mass in the medial aspect of the right knee. Physical examination revealed a 4-cm, elastic hard, mobile, nontender mass. Magnetic resonance imaging (MRI) showed a well-defined mass with prominent low signal intensity on all pulse sequences. Contrast-enhanced MRI demonstrated mild internal enhancement with rim enhancement. After an open biopsy, the lesion was successfully treated by complete excision. Histologically, the tumor was composed of bland spindle or stellate-shaped cells embedded in an abundant collagenous stroma. Immunohistochemically, the tumor cells showed diffuse nuclear positivity for FOSL1. These findings were consistent with a diagnosis of desmoplastic fibroblastoma. The patient was asymptomatic and there was no evidence of local recurrence eight months after surgery. Desmoplastic fibroblastoma is a distinctive benign soft-tissue tumor with FOSL1 immunoreactivity and should be clearly distinguished from more biologically aggressive mesenchymal neoplasms.

The Goat as a Model for Temporomandibular Joint Disc Replacement: Techniques for Scaffold Fixation

A state-of-the-art scaffold capable of efficiently reconstructing the temporomandibular joint (TMJ) disc after discectomy remains elusive. The major challenge has been to identify a degradable scaffold that remodels into a TMJ disc-like tissue, and prevents increased joint pathology, among other significant complications. Tissue engineering research provides a foundation for promising approaches toward the creation of successful implants/scaffolds aiming to restore the TMJ disc. In light of improving the quality of life of patients who undergo TMJ disc removal, it is critical to establish a preclinical animal model to evaluate the properties of promising scaffolds implanted post-discectomy and to determine the most efficient implantation procedures to ensure a more reliable in-depth evaluation of the biomaterial replacing the articular disc. The present study evaluated the outcomes of two protocols for the implantation of an acellular scaffold composed of an extracellular matrix (ECM) derived from the small intestinal submucosa (SIS) of the pig, as a regenerative template for the TMJ disc in a goat model. The outcomes suggest that leaving one-half of the disc medially will allow anchoring the device to the medial aspect of the joint while avoiding lateral displacement of the ECM scaffold. The goat model is ideal to assess the longevity of tissue-engineered solutions for the TMJ disc as the goat chews for 12-16 hours a day. This study provides an important reference for selecting a suitable scaffold implantation procedure and the goat model for the development of new strategies to assess TMJ disc regeneration.

Publics in local media reporting on harm reduction: Rightfully worried local witnesses or uneducated obstacles to change

BackgroundIn 2018, the planned opening of a second Needle and Syringe Exchange Program (NSP) unit in Stockholm, Sweden, was stopped with reference to protests from the public. Local Stockholm media cited stakeholders who claimed that the initiative was led by politicians with “zero knowledge about what makes citizens upset” and referred to reported public concern over a preschool located near the planned NSP unit. This case highlights the significant role of the public – and the idea of public opinion – in relation to political and medial aspects of alcohol and other drug (AOD) issues. Our aim is to scrutinize how “the public” is produced in local print media reports on harm reduction measures such as the NSP, to illuminate how these representations operate and what reality/ies they co-produce. MethodsWe analyzed 171 articles reporting on harm reduction in local Stockholm print media from 2012 to 2023. The themes identified in the analysis emerged from a combination of data-driven empirical observations and a theory-driven approach grounded in the influential literature on publics and counterpublics by Michael Warner and Nancy Fraser. ResultsThe overarching articulation in the material is that of a singular and homogeneous public. Public opinion regarding local experiences of individual drug use and harm reduction is depicted as being driven by fear and worry over living alongside “messy others”, thereby producing a public of worried local community witnesses. This production of the public takes on two different meanings depending on the narrative of the articles: 1) as righteous and entitled, 2) as ignorant and irrational. As a result, the public comes to operate as either a consulted public deserving consideration in the implementation of harm reduction policies or as an uneducated political obstacle to change. Consequently, the public is assigned both a counterpublic and a dominant public identity. ConclusionsWhen the representation of the worried public is repeatedly echoed by the media, it becomes hard to ignore in policy-making processes. The implications of such media representations are significant, as they risk disguising the complex nature of publics as a diverse group of individuals while reproducing taken-for-granted ideas about local communities opposing harm reduction measures. In addition, the appropriation of a counterpublic identity narrows the discursive space for action. Taken together, the repetition of a singular worried public and the appropriation of the counterpublic position make it nearly impossible to imagine alternative public responses to harm reduction. As a consequence, this can limit well-needed policy responses to AOD issues.

Medial Hamstring Snapping Knee Syndrome: Case Report of an Unusual Presentation Due to Osteochondroma

Medial hamstring snapping knee syndrome is an infrequent clinical entity, with osteochondroma being an exceptionally rare etiology. This report details a case of a 21-year-old female presenting with a 4-month history of persistent left knee pain, snapping, and clicking, which developed following a fall. Despite initial conservative management, the symptoms persisted. Advanced imaging, including MRI, revealed a small osteochondroma on the medial aspect of the proximal tibia, which was the underlying cause of the snapping. A targeted physiotherapy regimen emphasizing quadriceps and hamstring strengthening was subsequently employed, leading to effective symptom management. This case highlights the necessity of a meticulous clinical evaluation and the role of advanced imaging in diagnosing rare etiologies of snapping knee syndrome. Furthermore, it demonstrates the efficacy of focused physiotherapy in managing such conditions.

Congenital partial diaphragmatic eventration presenting with Chilaiditi’s sign: a case report

BackgroundChilaiditi’s sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.Case presentationA 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi’s sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.ConclusionsIt is obvious that Chilaiditi’s sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.

A novel framework for elucidating the effect of mechanical loading on the geometry of ovariectomized mouse tibiae using principal component analysis.

Murine models are used to test the effect of anti-osteoporosis treatments as they replicate some of the bone phenotypes observed in osteoporotic (OP) patients. The effect of disease and treatment is typically described as changes in bone geometry and microstructure over time. Conventional assessment of geometric changes relies on morphometric scalar parameters. However, being correlated with each other, these parameters do not describe separate fractions of variations and offer only a moderate insight into temporal changes. The current study proposes a novel image-based framework that employs deformable image registration on in vivo longitudinal images of bones and Principal Component Analysis (PCA) for improved quantification of geometric effects of OP treatments. This PCA-based model and a novel post-processing of score changes provide orthogonal modes of shape variations temporally induced by a course of treatment (specifically in vivo mechanical loading). Errors associated with the proposed framework are rigorously quantified and it is shown that the accuracy of deformable image registration in capturing the bone shapes (∼1 voxel = 10.4μm) is of the same order of magnitude as the relevant state-of-the-art evaluation studies. Applying the framework to longitudinal image data from the midshaft section of ovariectomized mouse tibia, two mutually orthogonal mode shapes are reliably identified to be an effect of treatment. The mode shapes captured changes of the tibia geometry due to the treatment at the anterior crest (maximum of 0.103mm) and across the tibia midshaft section and the posterior (0.030mm) and medial (0.024mm) aspects. These changes agree with those reported previously but are now described in a compact fashion, as a vector field of displacements on the bone surface. The proposed framework enables a more detailed investigation of the effect of disease and treatment on bones in preclinical studies and boosts the precision of such assessments.

Clinical and instrumental characteristics of osteoarthritis in hyperuricemia

Objective: to investigate in a multicentre single-stage study the relationships between hyperuricemia (HU) and clinical, instrumental and laboratory parameters of osteoarthritis (OA).Material and methods. The study included 200 patients aged 40 to 75 years with a definite diagnosis of knee (KN) OA that met ACR criteria, with stage I–III OA by Kellgren–Lawrence. The mean age of the patients was 55.9±10.3 years and the body mass index (BMI) was 29.4±6.2 kg/m2. An individual chart was completed for each patient, including anthropometric parameters, medical history and clinical examination data, visual analogue scale (VAS) assessment of KN pain, WOMAC, patient's general health assessment (GHA) and information on comorbidities. All patients underwent standard radiography and magnetic resonance imaging (MRI) of the KN (WORMS), dual-energy X-ray absorptiometry of the lumbar spine and femoral neck, and laboratory examination.Results and discussion. HU was diagnosed in 57 (28.5) patients when the serum uric acid (UA) level was above 360 μmol/L. Patients were divided into two groups according to the presence or absence of HU. The age of the patients in the two groups was comparable, but they differed significantly in terms of disease duration, BMI, waist and hip circumference, which were greater in the HU group (p <0.05). Statistically significant differences were also found in the assessment of the severity of OA course: there were higher pain indices according to VAS, WOMAC total score and its components (pain and functional impairment, FI), GHA in the HU group. On MRI, osteitis was more common in the medial aspect of the tibia (odds ratio 5.75; 95% confidence interval 1.29–25.6; p=0.03). Patients with HU had higher concentrations of CRP, COMP, leptin, insulin, triglycerides and creatinine (p <0.05 for all values).Spearman correlation analysis confirmed the association between HU and duration and radiological stage of OA, the presence of osteitis in the medial aspect of tibia detected by MRI, pain according to VAS and WOMAC, FI according to WOMAC and GHA (p<0.05).Conclusion. At high UA levels, pain values according to VAS and WOMAC are higher, GHA is worse, and CRP and COMP levels are elevated. MRI shows more frequent osteitis in the medial aspect of the tibia in patients with HU. Deciphering the mechanisms that determine the relationship between HU and OA is important for the development of new methods for the prevention and treatment of these diseases.

Giant cellulitis-like Sweet syndrome mimicking cellulitis: a case report

BackgroundSweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous papules, plaques, or nodules on the skin. There are various subtypes, such as classical, drug-induced, malignancy-associated, and the less common variant giant cellulitis-like Sweet syndrome. This case is unique due to its presentation of the giant cellulitis-like variant of Sweet syndrome in a patient from Ethiopia. The unusual distribution of the skin lesions and the initial lack of response to antibiotics make this case particularly noteworthy. It underscores the importance of considering Sweet syndrome in differential diagnoses when faced with atypical skin manifestations and ineffective antibiotic treatment. This contribution adds valuable insights to the scientific literature by highlighting the need for heightened awareness of this rare variant and improving diagnostic accuracy in similar clinical scenarios.Case presentationA 60-year-old Ethiopian male patient who presented to the accident and emergency department with a 5-day history of fever, chills, sweating, and rigor accompanied by a reddish skin color change around the anterolateral region of the right chest wall. On physical examination, there were erythematous, indurated tender plaques with ill-defined borders over the right antero- and posterolateral chest wall with extension to the lateral part of the right neck and medial aspect of the right arm. Subsequently, the patient was started on antibiotics, but there was a suboptimal response. Skin biopsy revealed features suggestive of giant cellulitis-like Sweet syndrome. He was then started on steroids, which significantly improved his symptoms.ConclusionA cautious stance is essential when identifying Sweet syndrome in individuals displaying erythematous plaque-like skin lesions in atypical areas of the body with uneven distribution. Such presentation may signal Sweet syndrome rather than a common infection. If conventional treatments, such as antibiotics, fail to resolve symptoms, consider Sweet syndrome as a potential diagnosis. This approach ensures timely and appropriate treatment, preventing treatment delay and misdiagnosis.

Diagnostic imaging findings in lame Warmblood horses with bone injuries of the medial proximal phalanx glenoid cavity.

This retrospective study aims to describe baseline and follow-up imaging findings in subchondral and trabecular bone damage occurring outside of the sagittal groove in the proximal phalanx (P1) glenoid in a case series of lame Warmblood horses. Thirteen lame horses (16 forelimbs) with standing magnetic resonance imaging (sMRI) evidence of nonsagittal groove glenoid subchondral and trabecular bone injury of P1 as the main lesion were included. All injuries were located at the medial aspect of the P1 glenoid. At sMRI, changes included subchondral bone plate thickening and trabecular sclerosis, bone marrow edema-like signal, subchondral bone resorption (11/16), and new bone production (8/16). Subchondral bone resorption in the transverse plane was linear (8/11), round (2/11), or ill-defined (1/11). Sclerosis, bone resorption, and new bone production were seen radiographically in 10, 4, and 5 limbs, respectively. All limbs had concurrent metacarpal condyle sMRI imaging abnormalities, osteophytosis, and joint effusion. Follow-up sMRIs were obtained in 8 of 16 limbs, five of which showing progression of the resorptive lesion. One horse encountered a comminuted fracture of the affected P1 18 months after the follow-up sMRI examination. The imaging appearance of the medial glenoid bone injuries of P1 in this case series is consistent with chronic bone overload. The linear configuration of bone resorption seen in eight lesions suggests short, incomplete stress fractures, which is supported by the ultimate catastrophic fracture occurring in one case.

PERCUTANEOUS RELEASE OF THE MEDIAL COLLATERAL LIGAMENT DURING KNEE ARTHROSCOPY

The complete visualisation of the internal joint space is crucial for effective knee arthroscopy. However, limited access to certain areas can lead to complications, including cartilage damage. Percutaneous partial release of the medial collateral ligament has been shown to effectively widen the medial compartment of the joint. Objective. This study aimed to determine the effect of percutaneous release of the medial collateral ligament on the postoperative period and restoration of knee joint function. Methods. The patients were divided into two groups: the study group (n = 32) and the comparison group (n = 36). T he study group underwent partial resection of the medial meniscus in combination with percutaneous partial release of the medial collateral ligament, while the comparison group underwent only partial removal of the medial meniscus without widening the medial joint gap. The assessment included pain, functional recovery according to the Tegner Lisholm scale, and the possibility of developing medial instability. Results. The analysis of VAS scores showed a significant reduction in pain in both groups over time. However, there was no significant difference in pain intensity between the two groups during the study. According to the Tegner Lysholm scale, there was a statistically significant improvement in the functional status of patients 6 months after surgery compared to preoperative values in both the study group (p = 0.0034) and the control group (p = 0.0071). However, there was no statistically significant difference between the groups on t he s ame s cale ( p = 0 .871). The study g roup s howed a s light increase in valgus deviation of the tibia (no more than 5o) in 14 (43.75%) patients during the valgus stress test performed on days 7–10 postoperatively. However, after 6 weeks, none of the patients reported any subjective instability or weakness of the knee joint. Therefore, it can be concluded that the procedure was successful. Conclusion. Percutaneous release of the medial collateral ligament to widen the medial aspect during knee arthroscopy has no effect on the postoperative period or the results of partial removal of the medial meniscus.

A variant deep femoral artery passing anterior to femoral vein: an anatomical observation with implication in femoral vein cannulation.

The common femoral artery (CFA) typically gives rise to its superficial and deep branches, with the deep femoral artery (DFA) being the largest and most substantial of these branches. This case study presents a rare variation of the DFA characterized by an unusual branching pattern and its specific relationship with the femoral vein within the subinguinal region. In nutshell, the DFA and the medial femoral circumflex artery shared a common origin from the medial aspect of the CFA. The DFA assumed an unusual course, initially passing anterior to the femoral vein above the saphenofemoral junction, followed by a spiraling trajectory around the medial aspect of the femoral vein before running posteriorly. The embryological origins and clinical implications of this anatomical variation are thoroughly examined. This unusual vascular relationship in the subinguinal region may potentially result in arterial injury during femoral vein cannulation or formation of arteriovenous fistula after the procedure.

Arthroscopic Mobilization Techniques for Retracted Immobile Rotator Cuff Tears

The treatment of massive, retracted rotator cuff tears remains a significant challenge to orthopaedic surgeons. While debridement and partial repair has been described as a viable option, surgeons seeking to perform a complete repair often must employ advanced mobilization techniques to lateralize retracted immobile rotator cuff tissue. Tears that appear irreparable often may be effectively mobilized with elements of capsular release, anterior interval slide, or posterior interval slide. When rotator cuff tissue is mobilized to the medial aspect of the anatomic footprint, a low-tension repair can be performed with good clinical outcomes.

Axillary lesion in a young adult ends up to a peculiar diagnosis: primitive neuro-ectodermal tumor (PNET) of ulnar nerve: a rare case report

Introduction and importance: Primitive neuro-ectodermal tumor (PNET) is a highly aggressive tumor composed of small round blue cells, mostly developing in children and young adults. Being a member of Ewing’s Sarcoma Family of Tumors (ESFT); it has been discussed in two subcategories of central and peripheral PNET. PNETs of peripheral nerves are very uncommon pathologic findings, as to the best of our knowledge only 12 well-documented cases have been yet reported. Case presentation: A 30-year-old male presented with progressive paresthesia of his right hand’s little finger and painless swelling of the right axilla. Magnetic resonance (MR) neurography demonstrated a heterogeneous, high-signal, round mass within the right axilla fossa in proximity to the medial aspect of brachial plexus branches. The clinical and radiological study failed to an accurate diagnosis, thus surgical resection of the tumor was done for tissue evaluation. Histopathologic study of the lesion revealed a neoplasm comprising sheets of small, round, blue cells (Hematoxylin and Eosin stain), which immunohistochemically consisted with the diagnosis of PNET. Clinical discussion: The differential diagnosis of axillary fossa masses, focusses on peripheral nerve tumors like Schwannoma and PNET. MR neurography aids in evaluation, but tissue diagnosis remains crucial. Treatment involves surgical resection, chemotherapy, and radiotherapy tailored to individual patients. Conclusion: Although pPNET is not apparently the first differential diagnosis coming to mind when encountering a rapidly growing mass in the axillary fossa with peripheral nerve origin, its highly malignant behavior, makes it crucial to be considered in the differential diagnoses.

Successful remission of a recurrent metacarpal osteosarcoma of a Warmblood gelding after radiation therapy

SummaryA 15‐year‐old Warmblood gelding was presented with recurrence of a histologically confirmed osteosarcoma of the left second and third metacarpal bones 3 years after initial diagnosis and treatment. Initially, surgical excision was performed, followed by local injection of carboplatin 11 weeks later. The horse was sound after surgery and was used for low‐level dressage and jumping. Three years later, the horse developed an acute onset of lameness in the left forelimb and a painful soft tissue swelling at the proximomedial metacarpal region. Radiographs showed a spiculated periosteal reaction on the medial aspect of the third metacarpal bone, indicating re‐activation of the lesion. Stereotactic radiation therapy was performed with a protocol consisting of three fractions under general anaesthesia (Mo‐We‐Fr schedule), and a total dose of 30 Gy. The technique used was volumetric‐modulated arc therapy guided by cone beam computed tomography for daily positioning. Following the radiation therapy, the horse became sound at walk, and 1 month later, it became sound at trot. Follow‐up by veterinary examination 18 months after final treatment revealed no lameness at walk and trot, and a stable radiographic appearance.

Altered structure and functional connection of subcortical gray matter in female patients with classical trigeminal neuralgia.

The etiology of classical trigeminal neuralgia (CTN) is still unclear. A better understanding of the cerebral structural and functional changes in female patients with CTN may provide important novel insights into the pathophysiologic mechanisms of female CTN. A total 37 female CTN patients were included and referred to MRI scans, comprising with 19 left CTN and 18 right CTN patients. We analyzed the volume and shape of subcortical gray matter (GM), and the functional connectivity (FC) between the accumbens nucleus (NAc) and whole brain in right and left CTN patients respectively. We found left CTN patients had a reduced right NAc volume compared to controls, similarly, the right CTN had the decreased volume in the left NAc. Vertex-wise shapes of right NAc in left CTN patients showed significant regional shape deformation on the anterior, medial and ventroposterior aspects, in contrast, left NAc of right CTN patients showed significant regional shape deformation on the anterior and posterior aspect. Furthermore, patients with left CTN showed significantly lower FC between the right NAc and right orbitofrontal cortex than control subjects. The volume of NAc in all CTN was significantly related to the perception of present pain intensity. The CTN might be majorly caused by volume reduction in NAc. A greater understanding of the neurobiological basis of pain-related changes in NAc will provide the knowledge for the development of novel NAc based therapeutic targets for pain management or even prevention in CTN patients.

Anatomy and connectivity of the Göttingen minipig subgenual cortex (Brodmann area 25 homologue)

BackgroundThe subgenual gyrus is a promising target for deep brain stimulation (DBS) against depression. However, to optimize this treatment modality, we need translational animal models.AimTo describe the anatomy and connectivity of the Göttingen minipig subgenual area (sgC).Materials and methodsThe frontal pole of 5 minipigs was cryosectioned into 40 μm coronal and horizontal sections and stained with Nissl and NeuN-immunohistochemistry to visualize cytoarchitecture and cortical lamination. Eight animals were unilaterally stereotaxically injected in the sgC with anterograde (BDA) and retrograde (FluoroGold) tracers to reveal the sgC connectivity.ResultsIn homology with human nomenclature (Brodmann 1909), the minipig sgC can be subdivided into three distinct areas named area 25 (BA25), area 33 (BA33), and indusium griseum (IG). BA25 is a thin agranular cortex, approximately 1 mm thick. Characteristically, perpendicular to the pial surface, cell-poor cortical columns separate the otherwise cell-rich cortex of layer II, III and V. In layer V the cells are of similar size as seen in layer III, while layer VI contains more widely dispersed neurons. BA33 is less differentiated than BA25. Accordingly, the cortex is thinner and displays a complete lack of laminar differentiation due to diffusely arranged small, lightly stained neurons. It abuts the IG, which is a neuron-dense band of heavily stained small neurons separating BA33 directly from the corpus callosum and the posteriorly located septal nuclear area.Due to the limited area size and nearby location to the lateral ventricle and longitudinal cerebral fissure, only 3/8 animals received sgC injections with an antero- and retrograde tracer mixture. Retrograde tracing was seen primarily to the neighbouring ipsilateral ventral- and mPFC areas with some contralateral labelling as well. Prominent projections were furthermore observed from the ipsilateral insula, the medial aspect of the amygdala and the hippocampal formation, diencephalon and the brainstem ventral tegmental area. Anterograde tracing revealed prominent projections to the neighbouring medial prefrontal, mPFC and cingulate cortex, while moderate staining was noted in the hippocampus and adjoining piriform cortex.ConclusionThe minipig sgC displays a cytoarchitectonic pattern and connectivity like the human and may be well suited for further translational studies on BA25-DBS against depression.

The association between the “T” vein and ulceration of the lateral aspect of the leg

The “T” vein is a tributary of The Great Saphenous Vein (GSV) located in the upper third of the leg with a perpendicular course to the GSV. It usually crosses the tibial bone and feeds by reflux of varicose veins of the lateral aspect of the leg. It is of surgical interest because it is involved with a significant percentage of varicose networks. The aim of this study is to analyze the prevalence of the T vein pattern in a cohort of patients affected by Chronic Venous Insufficiency (CVI), as well as its possible association with Venous Leg Ulcers (VLU) of the lateral aspect of the leg. One thousand nine hundred and twenty-two consecutive patients (1441 females and 481 males) were evaluated from January 2013 to May 2024 by means of clinical examination and the same Duplex Ultrasound Scanning (DUS) protocol. We assessed the frequency of patients presenting with the T vein pattern and the percentage of patients in which it causes symptomatic reflux. We also evaluated the susceptibility, respectively in the T vein and in the CVI cohort, of venous ulcerations (C5-C6 clinical classes according to the Clinical, Etiological, Anatomical, and Pathophysiological, CEAP, classification) in the medial and/or in the medial and lateral aspect of the leg vs exclusively in the lateral aspect of the leg. A p-value <0.05 has been considered significant. Overall, the presence of the T vein pattern was observed in 64 patients (3.33%). There is no statistically significant difference in the prevalence of T vein configuration in males (4.16%) and in females (3.05%) (p-value=0.24). A bilateral T vein pattern has been detected in just one case. T vein was involved in varicose vein networks, with only 2 patients being asymptomatic and without signs of CVI (3.1%). Noteworthy VLU (C5-C6) affected respectively 10 patients of the T vein cohort and 74 of the control population; in the T vein cohort, 80% of patients presented with VLU in the lateral perimalleolar region, while 72.9% of patients in the control group had VLU in the typical medial perimalleolar area (p-value=0.000852). Sometimes the clinician is doubtful about the venous pathogenesis of ulcerations visible in the lateral area of the leg. Our study suggests in these cases to investigate by DUS an eventual reflux coming from the T vein.

Efficacy of Fat and Perifascial Areolar Tissue Graft in Refractory Esotropia: A Case Report

Purpose: This case report presents a novel approach for the management of refractory esotropia using adhesiolysis and fat and perifascial areolar tissue (PAT) transplantation.Case summary: A 62-year-old male presented with left eye strabismus fixus following iatrogenic medial rectus (MR) muscle injury and medial orbital wall fracture during endoscopic sinus surgery. One month later, he underwent MR laceration repair and orbital wall reconstruction. Despite three subsequent interventions for exotropia and its subsequent conversion to esotropia, the left eye esodeviation progressively worsened, culminating in strabismus fixus. Initial examination revealed significant left eye esotropia with fixed gaze and 5-mm enophthalmos. Surgery included implant removal, adhesiolysis between the eyeball and surrounding tissues, scar and MR recession, and placement of a fat and PAT graft on the medial aspect of the eyeball to prevent postoperative re-adhesion. Three years of follow-up demonstrated sustained orthophoria in primary gaze with improved extraocular muscle function and enophthalmos.Conclusions: Fat and PAT graft has potential in oculoplastics for preventing re-adhesion and augmenting orbital volume in patients with refractory restrictive strabismus due to multiple surgeries.

Evaluation of Two Clinical Stem-Fit Philosophies Within the Femoral Canal Using a Preoperative Planning Tool: Could a Hybrid Approach Be Best?

BackgroundTotal hip arthroplasty (THA) has transformed patient lives, yet evolving expectations and the number of postoperative foot angle changes have underscored the need for precise component positioning. The objective of this study was to use 3-dimensional (3D) preoperative planning to evaluate stem alignment and orientation for three THA systems using two different stem-fit algorithms. It was hypothesized that the different stem alignments would yield similar changes in stem orientation and placement within the canal for all 3 systems. MethodsThis study introduced a novel 3D preoperative planning tool, comparing two different surgical stem-fit philosophies within the canal: “canal fit” (CF) and “anatomical fit” (AF). We virtually implanted 10 subjects with three different THA implant systems using both philosophies, evaluating 60 total fits within the canals. The CF philosophy aimed to minimize cortical bone removal. In contrast, the AF philosophy prioritized aligning the implanted head with the anatomical head center. ResultsDetailed analyses revealed that AF led to fixation occurring mainly on the medial aspect of the stem, while CF exhibited a more even distribution between medial and lateral sides. The AF philosophy achieved significantly closer placement of the implanted head to the anatomical center (2.0 to 2.1 mm) compared to the CF philosophy (3.0 to 6.0 mm) (P < 0.01). The AF resulted in neutral stem orientation (0°) across all stems, whereas the CF exhibited greater malrotation (2.0 to 7.0°) (P < 0.02). The AF required more bone removal (0.13 to 0.46 cm³) than the CF (0.02 to 0.06 cm³) (P < 0.01). ConclusionsThe findings underscore the importance of 3D planning, emphasizing its potential to improve stem version alignment in THA. The results from this study may advocate 3D preoperative planning with robotic surgery to plan stem placement within the canal while maintaining anatomical femoral head restoration.