Medial Segment Research Articles

Optic Tract as an Upper Limit in Amygdalectomy: Microsurgical Study.

In surgeries involving resection of the amygdala, despite clear relations established with the medial, lateral, anterior, posterior, and inferior segments, the upper limit remains controversial. The optic tract (OT) has been anatomically considered as a good landmark immediately inferior to the striatopallidal region. This anatomic structure has barely been explored by microsurgical study, generating uncertainty about the exact relationship with the surrounding structures. To describe the OT in its entire length through microsurgical study, showing its superior, inferior, medial, and lateral relationships and highlighting its value as a landmark in superior amygdala resection. Microsurgical anatomic dissection of the OT, from its origin in the chiasm to the lateral geniculate nucleus was performed in 8 alcohol-fixed human hemispheres, showing its different segments and relations. Photographs were taken from different angles to facilitate surgical orientation. We performed a dissection of the OT, showing its position relative to caudate and hippocampal formations. We exposed the structures related to the OT superiorly (striatopallidal region and superior caudate fasciculus), inferiorly (head of the hippocampus, amygdala, anterior choroidal artery, perforating artery branch of the anterior choroidal artery, terminal stria, and basal vein), medially (internal capsule and midbrain), and laterally (temporal stem [uncinate and inferior fronto-occipital fascicle], anterior perforated substance, and superior caudate fasciculus). To date, there is a paucity of articles describing the anatomy of the OT from a neurosurgery perspective. In this study, we describe the microsurgical anatomic path of the OT, as a reliable upper limit landmark for amygdala resection.

Technical Variations in the Management of the Medial Crural Reduction According to the Settlement of the Angulation Deformities Over Hypertrophic Lower Lateral Cartilages.

Medial crural (MC) overlay is reliable method used in tip deprojection. Most cases with lower lateral cartilage (LLC) hypertrophy present by variations of MC and dome shapes needing specific technical maneuvers. Thirteen hundred fourteen primary rhinoplasties were performed between 2018 and 2021. Patients with LLC hypertrophy who underwent MC deprojection were analyzed. Three variations in LLC hypertrophy were recognized. In type I, tip-defining points (TDP) were localized at the median plane with no angulation deformities at the LLC, which was managed by horizontal cuts of the lobular segments 4 to 6 mm below the domes. The cut fragments overlapped for 2 to 5 mm. In type II, TDP was lateralized due to widened divergence angles at the columellalobular junctions, which were managed by horizontal cuts over columellalobular junctions. The cut fragments overlapped 4 to 6 mm. In type III, TDP was localized at the median plane, there were dense angulations at the medial genu, which was managed with symmetrical removal of 4 to 5 mm cartilage from lobular segments. The domes were sutured over the medial segments. Nineteen patients with LLC hypertrophy were included in the study among 314 patients. Twelve patients were female and 7 patients were male. The mean age was 32 years (25-42). Type I, II, and III LLC hypertrophies were detected in 10, 3, and 6 patients, respectively. A harmonious relationship between dorsum and tip and satisfactory tip stability was reached in all patients. By classification of variations of MC and domal shapes, LLC hypertrophies may be managed with proper technical maneuvers specific to each type.

A new approach to artefact detection and its effect on the normal range of segmental strain and strain rate values

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Nord HNF1458-19 Background Definition of normal ranges of myocardial segmental deformation are important in clinical studies and routine echocardiographic practice. It is known that artefacts hamper segmental strain and strain rate (S/SR) analysis. Purpose This study is based on a new approach for artefact detection. We intended to investigate to what degree different types of artefacts and their localization bias the result of measurements and to establish corrected normal ranges for segmental S/SR parameters. Methods The study is based on a collaboration project between the Russian cross-sectional study "Know your heart" and the Norwegian "Tromso-7" study. From 2207 participants we identified 840 individuals (511 females and 329 males, age range 40-79) with normal cardiac function by excluding left ventricular ejection fraction <50%, moderate or severe valvular heart disease, LV- dilatation, pulmonary hypertension, Q-waves and bundle branch block signs on ECG, high blood pressure, history of heart attack, use of antihypertensive drugs or high level of NT-proBNP. End-systolic longitudinal epi- myo- and endocardial strain and peak systolic SR and diastolic SR E and SR A were assessed for the calculation of segmental normal ranges. In addition to noise and foreshortening artefacts, we introduced a concept of "curve artefact" which can be defined as unphysiological strain curve shapes. Panel A of the figure shows examples of these curve artefacts, A: diastolic mismatch B: blunted curve, and C: floating curve. All strain curves were assessed for the presence of one of these unphysiological shapes and 2D images were visually assessed for the presence of noise, reverberations, or missing parts of the myocardium. Results The bar-chart for segmental strain demonstrates significantly reduced strain values at the presence of curve artefacts and increased strain at the presence of foreshortening. Normal ranges for basal septal, basal, medial, and apical segments excluding segments with artefacts and foreshortening are displayed in the table. The presence of curve artefacts matched the presence of noise or other 2D image artefacts in 88% of cases. Conclusions Strain artefacts result in systematically reduced peak-strain values. Thus, the detection and exclusion of curve artefacts seem to be an important measure for the correct interpretation of strain curves for a definition of normalcy and pathology. The selection of artefact-free strain curves reveals high strain and SR gradients increasing from epi to endocardial position and basal-septal towards apical segments. Abstract Figure. normal range Abstract Figure. artefacts

Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction.

Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20–40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones.

The unique role of the frontal aslant tract in speech and language processing

The frontal aslant tract (FAT) is a recently described intralobar tract that connects the superior and inferior frontal gyri. The FAT has been implicated in various speech and language processes and disorders, including motor speech impairments, stuttering disorders, opercular syndrome, and verbal fluency, but the specific function(s) of the FAT have yet to be elucidated. In the current study, we aimed to address this knowledge gap by investigating the underlying role that the FAT plays in motor aspects of speech and language abilities in post-stroke aphasia. Our goals were three-fold: 1) To identify which specific motor speech or language abilities are impacted by FAT damage by utilizing a powerful imaging analysis method, High Angular Resolution Diffusion Imaging (HARDI) tractography; 2) To determine whether damage to the FAT is associated with functional deficits on a range of motor speech and language tasks even when accounting for cortical damage to adjacent cortical regions; and 3) To explore whether subsections of the FAT (lateral and medial segments) play distinct roles in motor speech performance. We hypothesized that damage to the FAT would be most strongly associated with motor speech performance in comparison to language tasks. We analyzed HARDI data from thirty-three people with aphasia (PWA) with a history of chronic left hemisphere stroke. FAT metrics were related to scores on several speech and language tests: the Motor Speech Evaluation (MSE), the Western Aphasia Battery (WAB) aphasia quotient and subtests, and the Boston Naming Test (BNT). Our results indicated that the integrity of the FAT was strongly associated with the MSE as predicted, and weakly negatively associated with WAB subtest scores including Naming, Comprehension, and Repetition, likely reflecting the fact that performance on these WAB subtests is associated with damage to posterior areas of the brain that are unlikely to be damaged with a frontal lesion. We also performed hierarchical stepwise regressions to predict language function based on FAT properties and lesion load to surrounding cortical areas. After accounting for the contributions of the inferior frontal gyrus, the ventral precentral gyrus, and the superior precentral gyrus of the insula, the FAT still remained a significant predictor of MSE apraxia scores. Our results further showed that the medial and lateral subsections of the FAT did not appear to play distinct roles but rather may indicate normal anatomical variations of the FAT. Overall, current results indicate that the FAT plays a specific and unique role in motor speech. These results further our understanding of the role that white matter tracts play in speech and language.

Застарелое инородное тело среднедолевого бронха правого легкого (клинический случай и обзор литературы)

This article is devoted to a review of the literature on the aspiration of foreign bodies into the lower respiratorytract. A brief analysis of modern ideas about the etiology, classification and clinical picture of foreign bodyaspiration into the lower respiratory tract was carried out. Questions of methods of diagnostics and principlesof treatment, possible complications are considered. An example of a clinical case from our own practice of anold foreign body in the bronchus of the medial segment of the middle lobe of the right lung is also given, witha 10-year-old aspiration episode, the clinical manifestation of which was recurrent hemoptysis for 5 years.

Assessing the progression of segmental fibrosis in chronic liver disease using extracellular volume fractions

PurposeTo assess the segmental difference of liver fibrosis during the progression of chronic liver disease (CLD) using hepatic extracellular volume fractions (fECVs) obtained by dual-energy CT. MethodsA total of 218 patients (92 men and 126 women; mean age, 67.8 ± 11.7 years) with CLD and 85 patients (44 men and 41 women; mean age, 62.8 ± 13.7 years) without CLD as a control underwent dual-energy computed tomography (CT) of the liver (5-min equilibrium phase images). The iodine densities of the lateral, medial, anterior, and posterior segments and the aorta were measured, and fECVs were calculated. Comparisons of the fECV of each segment and for each albumin–bilirubin (ALBI) grade were then statistically analyzed. ResultsIn the control group and ALBI grades 1 and 3, no significant difference in fECV was found between each segment, whereas in ALBI grade 2, the fECVs were significantly larger in the medial and anterior than in the other segments (p < 0.001). The fECVs of the lateral and posterior segments significantly increased with higher ALBI grade (p < 0.001). The fECVs of the medial and anterior segments were significantly increased with higher ALBI grade, up to grade 2 (p < 0.001), but no significant difference was found between ALBI grades 2 and 3. ConclusionDuring the progression of CLD, fibrosis antecedently progressed in the medial and anterior segments, followed by the other liver segments.

Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

BackgroundThe impact of postero-anterior and medio-lateral mitral valve (MV) tethering patterns on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR) is unknown.MethodsThe ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in MV segment 2 was defined as postero-anterior tethering asymmetry. Medio-lateral tethering asymmetry was assessed as the ratio of the medial (segment 3) to lateral (segment 1) MV tenting area. We used receiver-operating characteristics and a Cox regression model to identify cut-off values of asymmetric anteroposterior and medio-lateral tethering for prediction of 2 year all-cause mortality after TMVR.ResultsAmong 178 SMR patients, postero-anterior tethering was asymmetric in 67 patients (37.9%, PLA/ALA ratio > 1.54). Asymmetric medio-lateral tethering (tenting area ratio > 1.49) was observed in 49 patients (27.5%). M-TEER reduced MR to ≤ 2 + in 92.1% of patients; MR reduction was less effective in the presence of asymmetric postero-anterior tethering (p = 0.02). A multivariable Cox regression model identified both types of asymmetric MV tethering to be associated with increased all-cause 2-year mortality (postero-anterior tethering asymmetry: HR = 2.77, CI 1.43–5.38; medio-lateral tethering asymmetry: HR = 2.90, CI 1.54–5.45; p < 0.01).ConclusionsAsymmetric postero-anterior and medio-lateral MV tethering patterns are associated with increased 2-year mortality in patients undergoing M-TEER for SMR. A detailed echocardiographic analysis of MV anatomy may help to identify patients who profit most from M-TEER.Graphical abstract

Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction.

Current methods of assessing rib cartilage dimensions for laryngotracheal reconstruction (LTR) are inexact, making surgical planning difficult. The purpose of this study was to determine the most appropriate rib for costal cartilage graft LTR to minimize the number of ribs harvested and improve surgical outcomes. Retrospective review. Computed tomography imaging of chest scans in 25 children aged 1 to 18 years was evaluated. The lengths and widths of medial and lateral cartilaginous segments of ribs 4 to 7 were measured bilaterally. Right and left cartilaginous rib dimensions were compared using a two-sample t-test. Linear mixed-effect regression was performed to develop models quantifying the relationship between rib size and patient height, rib side, and rib number. Regression analysis established strong models for medial rib length (R2 =0.89) and for medial and lateral rib width (R2 =0.71, 0.77, respectively). There was no difference in rib dimensions across chest sides. Rib length and width increased with child height. Total cartilaginous rib length increased from superiorly to inferiorly, primarily due to an increase in the dimensions of the medial portion of each rib. Cartilaginous rib lengths and widths were associated with patient height, with taller children having longer ribs. Inferior ribs were longer than superior ribs, suggesting that inferior ribs may be preferred for LTR. There was no difference in cartilaginous rib length across chest side. Results may help surgeons with preoperative planning. NA Laryngoscope, 132:1682-1686, 2022.

Clinical assessment of cardiac impairment favored by two-dimensional speckle tracking echocardiology in patients with systemic sclerosis.

Cardiac involvement is a major cause of death in SSc, while early detection remains a challenge. The purpose of this study was to investigate the prevalence and clinical implications of cardiac impairment in SSc. Ninety-five consecutive SSc patients [55.6 (13.8) years old, 5.3 (8.1) years from diagnosis] were included in the study. Patients with heart diseases onset prior to SSc were excluded. All patients underwent two-dimensional speckle-tracking echocardiology (2D-STE) with measuring left and right ventricular global longitudinal strain (GLS/RGLS). Clinical manifestation, laboratory evaluation (CRP, cTnI, antibodies, etc.) and ECG were collected at the same time. Comparisons between the SSc subgroups (lcSSc and dcSSc) were performed using Student's t-test, Mann-Whitney U or Fisher's exact test. Binary logistic regression was applied to determine the independent effects of variables in cardiac impairment. Early left and right ventricular impairment measured by GLS and RGLS were detected in 22.1% and 24.2% of the SSc patients, respectively. In comparison, only 2.1% showed reduced left ventricular ejection fraction (LVEF). Impaired GLS was mainly observed in the basal and medial segments of anterior, lateral and posterior left ventricle walls, and more profound in dcSSc. Elevated CRP (OR 3.561 95% CI: 1.071, 11.839, P <0.05) was associated with reduced GLS/RGLS. The adoption of GLS/RGLS enhanced the efficacy of routine screening for cardiac impairment that 52.6% of patients showed potential cardiac impairment. Cardiac impairment is a common manifestation in SSc. Increasing awareness of early cardiac impairment is warranted with elevated CRP and dcSSc.

S2651 Acute Liver Infarct with a Superimposed Liver Abscess as a Consequence of Hypercoagulable State in a Patient with COVID-19 Without Respiratory Manifestations

Introduction: COVID-19 infection have been associated to a hypercoagulable state. We present a case of a 66-year-old man with SARS-CoV-2 infection without respiratory symptoms that debuted with thrombosis of the portal vein and branches of the hepatic artery, liver infarction and superimposed hepatic abscess as the only clinical manifestation. Hepatocellular carcinoma, liver cirrhosis, intra-abdominal and pelvic inflammation or infection were absent. No history of coagulopathies reported. We postulate that the hypercoagulable state associated to COVID-19 led to thrombosis of the portal vein and branches of the hepatic artery leading to patient's clinical presentation and ultimate complications. Case Description/Methods: A 66-year-old man presented to the ED complaining of fever, night sweats, generalized malaise, unintentional weight loss, and epigastric pain. Ten days prior, a COVID- 19 PCR test was done with positive results. Physical examination demonstrated bilateral clear lungs and a benign abdomen. Labs showed neutrophilic leukocytosis, reactive thrombocytosis, normocytic normochromic anemia, elevation of liver enzymes and inflammatory markers. Abdominal US revealed acute PVT. He was admitted and started on vancomycin, piperacillin/tazobactam and full anticoagulation with enoxaparin. Chest CT scan excluded pulmonary consolidations and ground glass opacities. Abdominopelvic contrast CT scan confirmed the PVT involving the main, right and left portal veins without collateral vessels. No other infectious foci was identified. Contrast MRI findings were consistent with a multiseptated liver abscess within the left liver lobe lateral segment and PVT associated with a large infarction involving the right liver lobe anterior segment and the left liver lobe medial and lateral segments. Blood and urine cultures, stool ova and parasite, E. histolytica IgG ELISA and viral hepatitis panel were negative. After 12 days, the patient was discharged to complete 4 weeks of antibiotics and 6 months of full anticoagulation. Follow-up contrast CT scan showed new cavernous transformation of the porta hepatis and resolution of the liver abscess. Discussion: Physicians should be aware that patients with COVID-19 infection can debut with thromboembolic phenomenon and potential involvement of hepatic circulation as the only clinical manifestation of COVID-19. Prompt recognition can help physicians to direct appropriate therapy earlier for these complications, which can have a significant impact in patient's outcomes and prognosis. (Table Presented).

Position of the choroid plexus of the fourth ventricle in first‐ and second‐trimester fetuses: a novel approach to early diagnosis of cystic posterior fossa anomalies

The aim of this study was to describe the sonographic appearance and position of the choroid plexus of the fourth ventricle (4thVCP) between 12 and 21 weeks' gestation in normal fetuses and in fetuses with posterior fossa anomalies. Two-dimensional ultrasound (US) images of the midsagittal and coronal views of the brain through the posterior fontanelle and three-dimensional volumes datasets were obtained between 12 and 21 weeks prospectively from 90 normal singletons and retrospectively from 41 fetuses identified as having an abnormal posterior brain on first-trimester ultrasound examination. In all cases the diagnosis was confirmed at MRI, prenatally and/or postnatally, and/or at postmortem examination. During the study period, 41 fetuses, with apparently isolated cystic posterior fossa anomaly based on first trimester ultrasound assessment of intracranial spaces, were reviewed in the second trimester and were found to have Dandy Walker Malformation (DWM) in 8 cases, Blake's Pouch Cyst (BPC) in 29 and they were normal in 4 patients. The position of 4thVCP was different in DWM, BPC and normal cases either at first and at second trimester examination. In particular, in normal fetuses no cyst was present, and on median and coronal planes of posterior fossa the choroid plexus appeared as an echogenic and oval shaped structure located inside the 4th ventricle apparently attached to the cerebellar vermis. In fetuses with DWM, on median view of posterior fossa, it was not possible to visualize the CP. It was infero-laterally dislocated due to the presence of a cyst which displaced the 4thVCP and could be visualized only on a coronal plane of the posterior brain. In all DWM cases the CP was positioned outside the cyst. In BPC, the 4VthCP was always located inside the cyst, on its superior part, near the vermis and was visualized on median and coronal planes. Our study demonstrated that a longitudinal ultrasound assessment of 4thVCP and its temporal changes from 12 to 21 weeks is feasible. The ability to define the position of the 4thVCP as inside or outside the cyst is a novel finding which can be assessed in the first trimester of pregnancy and it is useful to differentiate DWM from BPC, consistently with the pathophysiology of the two conditions. This article is protected by copyright. All rights reserved.

MYCOTIC PULMONARY ARTERY PSEUDOANEURYSM TREATED WITH ENDOVASCULAR COILING

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mycotic pulmonary artery pseudoaneurysm (PAP) presents with a focal dilatation of the affected vessel as a result of infection that leads to significant wall weakening. PSA can be life-threatening if rupture occurs, thus aggressive intervention is usually thought to prevent catastrophic hemorrhage. Coil embolization or stent placement are the most frequently used treatments. We present a case of right middle lobe (RML) pulmonary artery segmental branch pseudoaneurysm successfully treated with endovascular coiling in a patient with history of tricuspid valve (TV) endocarditis, bacteremia, and septic pulmonary emboli. CASE PRESENTATION: Patient is a 27-year-old female with past medical history of IV drug use and Hepatitis C. She had recently been hospitalized for 45 days due to methicillin-susceptible S. aureus (MSSA) bacteremia and native TV endocarditis with septic emboli to the lungs. 5 days prior to discharge, CT pulmonary angiogram showed a 1.8 cm enhancing lesion concerning for a pseudoaneurysm within medial segment of the RML. Subsequent outpatient evaluation by interventional radiology two weeks later revealed normal hemodynamic parameters (HR 87 bpm, BP 143/88 mmHg, RR 20 breaths/min, O2 sat 97% on room air), and unremarkable coagulation profile (including Hb of 11.3 g/dL and Hct of 35%). Endovascular embolization of the PAP was planned. Briefly, pulmonary artery was accessed using a 0.035-inch guidewire & pigtail catheter. Initial non-selective pulmonary angiogram demonstrated faint visualization of the RML PAP. Subsequent selective right pulmonary artery medial branch angiogram confirmed the location of the PAP. The pigtail catheter was exchanged for a vertebral artery catheter through which a PROGREAT® microcatheter was advanced into the pseudoaneurysm sac. Position of the catheter within the sac was confirmed. Coil embolization was performed using Concerto™ coils. Post-coiling RML pulmonary artery angiogram showed obliteration of the aneurysmal sac with preservation of distal vessels. The patient tolerated the procedure well and was discharged the following day. DISCUSSION: The etiology of PAPs can be iatrogenic, infectious, traumatic, or related to malignancy. When linked to infection, PAPs most commonly occur in the settings of TV endocarditis and septic embolism, with Staphylococcus and Streptococcus as the usual culprits. In our patient, IV drug use led to the development of MSSA bacteremia and TV endocarditis. The subsequent hematogenous spread of septic emboli to the pulmonary artery resulted in pseudoaneurysm formation. CONCLUSIONS: Mycotic PAPs can occur in patients with S. aureus TV endocarditis and can be treated with endovascular coil embolization. REFERENCE #1: Chen, Y., Gilman, M. D., Humphrey, K. L., Salazar, G. M., Sharma, A., Muniappan, A., Shepard, J.-A. O., & Wu, C. C. (2017). Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings. American Journal of Roentgenology, 208(1), 84–91. https://doi.org/10.2214/AJR.16.16312 REFERENCE #2: Guillaume, B., Vendrell, A., Stefanovic, X., Thony, F., & Ferretti, G. R. (2017). Acquired pulmonary artery pseudoaneurysms: A pictorial review. In British Journal of Radiology (Vol. 90, Issue 1074). British Institute of Radiology. https://doi.org/10.1259/bjr.20160783 DISCLOSURES: No relevant relationships by Emad Chishti, source=Web Response No relevant relationships by Gaby Gabriel, source=Web Response No relevant relationships by Marianna Zagurovskaya, source=Web Response

Congenital cystic adenomatoid malformation associated with right aortic arch with mirror image branching and absence of left pulmonary artery in an adult

BackgroundCongenital cystic adenomatoid malformation is an uncommon developmental anomaly that is diagnosed prenatally or during early childhood and is rare to present in adulthood. Type 2 congenital cystic adenomatoid malformation is often associated with other anomalies such as congenital cardiac anomalies. We present a case of type 2 congenital cystic adenomatoid malformation in an adult male associated with absence of left pulmonary artery and right aortic arch with mirror image branching. To our knowledge, this is the first case report with the combination of all three anomalies.Case presentationA 33-year-old male presented to the Department of Pulmonary Medicine with high-grade fever, chills and rigor, breathlessness, and productive cough for a duration of one week. He had multiple similar self-limiting episodes in the past which did not require hospitalization. The plain radiograph showed right aortic arch and a small left hilum. CT thorax showed multiple cystic lesions of size 0.5–2.0 cm in the apico-posterior segment of the left upper lobe; anterior, posterior, and lateral segments of the left lower lobe; and the apical segment of the right upper lobe with a maximal cyst wall thickness of 2 mm. Volume of left lung was reduced with trans-thoracic herniation of the medial segment of the right middle lobe; bronchiectatic changes were seen in the apical, anterior, and posterior segments of the right upper lobe; and fibrotic strands were seen in the apical segment of the right lower lobe and the apico-posterior segment of the right upper lobe. Mediastinal window showed right-sided aortic arch with mirror image branching. The pulmonary trunk was seen to continue as the right pulmonary artery with absent left pulmonary artery.ConclusionsThough congenital cystic adenomatoid malformation is a disease of infancy and childhood, it should also be considered in adults presenting with recurrent lower respiratory tract infections and/or pneumothorax. Radiologists must be aware of the types of congenital cystic adenomatous malformation (CCAM) and their associations, as type 2 CCAM has a high association with congenital cardiac disease. Proximal interruption of pulmonary artery should be considered if the pulmonary trunk continues as either right or left pulmonary artery.

Influence of arm position on proton density fat fraction in the liver using chemical shift-encoded magnetic resonance imaging

PurposeTo evaluate the influence of arm position on B1 and proton density fat fraction (PDFF) in the liver using chemical shift-encoded magnetic resonance imaging. Materials and methodsParticipants were 8 healthy volunteers without liver disease and 36 patients with presumed or proven fatty liver. We assessed two preliminary examinations in healthy subjects, i.e., arm position influence on B1 and the variability of the PDFF between two scans within a short period of time. To verify the changes in PDFF measurement, 36 patients with fatty liver were conducted to compare 2 different arm positions—the elevated arms and side arms positions. The measurement location was based on the Healey & Schroy classification. The Wilcoxon test was used to analyze the difference in B1 in between the elevated arms and side arms positions. The Bland-Altman analysis was used to assess the agreement between two measurements of PDFF: two same scans within a short period of time, and two scans with different arms positions. ResultsB1 was significantly different in all segments except for medial segment. The variability of the PDFF between two scans within a short period of time was small in all segments. Some patients had large fluctuations in all segments, although the mean differences in PDFF were small. Upper and lower limits of agreement were 2.064% to 2.871% and − 2.430% to −1.462%, respectively. The relative difference in the rate of PDFF changes as the median (interquartile range [IQR]) in the lateral, medial, anterior, and posterior segments between both the arms positions were 0.0% (9.4), 1.1% (7.3), 1.5% (8.2) and − 0.2% (10.3), respectively. ConclusionsArm position can significantly affect B1 and PDFF in the liver. Although the absolute change in PDFF between arm positions was not so large, the difference in arm positions can cause large relative PDFF fluctuations.

3D Reconstruction of the Clarified Rat Hindbrain Choroid Plexus.

The choroid plexus (CP) acts as a regulated gate between blood and cerebrospinal fluid (CSF). Despite its simple histology (a monostratified cuboidal epithelium overlying a vascularized stroma), this organ has remarkably complex functions several of which involve local interaction with cells located around ventricle walls. Our knowledge of CP structural organization is mainly derived from resin casts, which capture the overall features but only allow reconstruction of the vascular pattern surface, unrelated to the overlying epithelium and only loosely related to ventricular location. Recently, CP single cell atlases are starting to emerge, providing insight on local heterogeneities and interactions. So far, however, few studies have described CP spatial organization at the mesoscale level, because of its fragile nature and deep location within the brain. Here, using an iDISCO-based clearing approach and light-sheet microscopy, we have reconstructed the normal rat hindbrain CP (hCP) macro- and microstructure, using markers for epithelium, arteries, microvasculature, and macrophages, and noted its association with 4th ventricle-related neurovascular structures. The hCP is organized in domains associated to a main vessel (fronds) which carry a variable number of villi; the latter are enclosed by epithelium and may be flat (leaf-like) or rolled up to variable extent. Arteries feeding the hCP emerge from the cerebellar surface, and branch into straight arterioles terminating as small capillary anastomotic networks, which run within a single villus and terminate attaching multiple times to a large tortuous capillary (LTC) which ends into a vein. Venous outflow mostly follows arterial pathways, except for the lateral horizontal segment (LHS) and the caudal sagittal segment. The structure of fronds and villi is related to the microvascular pattern at the hCP surface: when LTCs predominate, leaflike villi are more evident and bulge from the surface; different, corkscrew-like villi are observed in association to arterioles reaching close to the CP surface with spiraling capillaries surrounding them. Both leaf-like and corkscrew-like villi may reach the 4th ventricle floor, making contact points at their tip, where no gap is seen between CP epithelium and ependyma. Contacts usually involve several adjacent villi and may harbor epiplexus macrophages. At the junction between medial (MHS) and lateral (LHS) horizontal segment, arterial supply is connected to the temporal bone subarcuate fossa, and venous outflow drains to a ventral vein which exits through the cochlear nuclei at the Luschka foramen. These vascular connections stabilize the hCP overall structure within the 4th ventricle but make MHS-LHS joint particularly fragile and very easily damaged when removing the brain from the skull. Even in damaged samples, however, CP fronds (or isolated villi) often remain strongly attached to the dorsal cochlear nucleus (DCN) surface; in these fronds, contacts are still present and connecting “bridges” may be seen, suggesting the presence of real molecular contacts rather than mere appositions.

Chronic plantar fasciitis reduces rearfoot to medial-forefoot anti-phase coordination

BackgroundIt is commonly assumed that abnormal foot biomechanics cause plantar fasciitis; however, this assumption is not well supported. In this study, we investigated rearfoot to medial-forefoot coordination of healthy and plantar fasciitis individuals. We hypothesized that chronic plantar fasciitis individuals would exhibit greater intersegmental rearfoot to medial-forefoot anti-phase coordination and greater coordinative variability than a healthy cohort. MethodsTwenty-two individuals with chronic plantar fasciitis (symptomatic mean 4.5 years) and 22 healthy individuals participated. Three-dimensional kinematics of the rearfoot and medial forefoot segments were captured using reflective markers for walking trials. After resolving rearfoot and medial-forefoot segment angle data, a modified vector coding method was used to compute coupling angles, anti-phase movements, and coordinative variability. FindingsCompared to healthy individuals, individuals with plantar fasciitis exhibited fewer anti-phase movements (frontal plane: P = 0.003, effect size = 0.38). No group differences were detected in coordinative variability magnitude (sagittal, frontal, transverse, respectively: P = 0.99, 0.72, 0.86; effect sizes = 0.00, 0.12, 0.04). There were significant main effect differences in coupling variability between stance periods (P < 0.0001). InterpretationContrary to our hypothesis, these data suggest that a relative reduction of rearfoot to medial-forefoot anti-phase movements with a chronic plantar fasciitis injury indicates a coordinative deficit, and that a greater frequency of anti-phase movements is associated with healthy foot function. Pain, guarding, and/or the state of chronic injury may be impairing fluid inter-segmental motion. Although no group differences were found in coordinative variability, this variability increased around transitions between loading, weight acceptance, and propulsive phases of gait.

T2 MRI at 3T of cartilage and menisci in patients with hyperuricemia: initial findings.

To compare and evaluate T2 values of compartmental femorotibial cartilage and subregional menisci in patients with hyperuricemia at 3T. Thirty-two subjects were included in this study and subdivided into two subgroups: 15 healthy controls (3 females, 12 males; mean age = 45.3 ± 10.9years), 17 patients with hyperuricemia (2 females, 15 males; mean age = 44.4 ± 12.7years). All subjects were assessed on a 3T MR scanner using an 8-channel phased-array knee coil (transmit-receive). Wilcoxon rank sum test and analysis of covariance (ANCOVA) were performed to determine whether there were any statistically significant differences in T2 values of compartmental femorotibial cartilage and subregional menisci between the two subgroups. Lateral tibial cartilage (48.6 ± 3.5ms) in healthy subgroup had significantly lower (p < 0.05) T2 values than all subcompartments of femorotibial cartilage in hyperuricemia subgroup. Medial tibial cartilage (56.5 ± 4.3ms) in hyperuricemia subgroup had significantly higher (p < 0.05) T2 values than all subcompartments of femorotibial cartilage except medial tibial cartilage in healthy subgroup. Medial anterior horn of meniscus (39.4 ± 2.9ms) in healthy subgroup had significantly lower (p < 0.05) T2 values than all subregional menisci except both medial anterior horn and medial body segment of meniscus in hyperuricemia subgroup. T2 values in certain compartmental femorotibial cartilage and subregional menisci in patients with hyperuricemia are evidently and abnormally heightened compared with those in healthy subjects, to which special attention should be paid when diagnosing and treating the patients with hyperuricemia in the clinical setting. The LT cartilage had significantly lower T2 values (48.6 ± 3.5ms) in healthy subgroup compared to all compartmental femorotibial cartilage in cohort with HU. MF cartilage had significantly lower T2 values (51.6 ± 2.9ms) in healthy subgroup compared to both LF (54.4 ± 4.1ms) and MT (56.5 ± 4.3ms) in cohort with HU. MT cartilage had significantly higher T2 values (56.5 ± 4.3ms) in cohort with HU subgroup compared to LF (52.5 ± 3.0ms) in healthy subgroup. T2 mapping may be promising and potential sensitive discriminator of understanding and examining the early compositional and structural change in proteoglycan-collagen matrix of human femorotibial cartilage in patients with hyperuricemia.

COPD and preclinical cardiovascular disease

Objective: to assess cerebral blood flow and reveal early myocardial remodeling in COPD patients with varying degrees of airflow restriction. Materials and methods: the research included 105 patients with COPD from 1 to 4 degrees of severity, depending on the degree of restriction of FEV1 without CVD, diabetes mellitus, chronic kidney disease, obesity, other systemic and oncological diseases. Average age was 57.12 ± 0.68 years, men 45%. 5 groups were identified: mild severity of COPD (GOLD1, = 24), moderate (COLD2, n = 39), severe (GOLD3, n = 30), very severe (GOLD4, n = 12). Control group (n = 37) was tobacco free and CVD. Blood pressure and ultrasound tracranial dopplerography were performed in all groups. Transtoral echocardiography with assessment of global and local LV longitudinal deformation by the strain method and determination of left ventricular diastolic dysfunction (DDLV) was performed in GOLD1 and GOLD2 groups. Parameters of average values of deformation in basal, medial and apical segments are evaluated. Results were processed with Microsoft Excel 2016 and STATISTICA 10 (StatSoft, Inc., USA). Results: arterial hypertension (AH) was detected in 56.4% of patients in the COLD2 group; 56.7% of patients in the GOLD3 group and 100% of patients in the GOLD4. Сhanges in cerebral blood flow were not found in the GOLD1-3 groups. Significant increase of linear blood flow rate of middle cerebral arteries and index of peripheral vascular resistance were detected in group GOLD4 relative to control and GOLD1-3 groups (p &lt; 0.05). DDLV of 1 type was revealed in 27.7% of patients of COPD and was higher at patients with COPD and AH - 62.5% (χ²=11.5, р =0.009). Pathological patterns were identified at the level of the basal and medial parts of the left ventricle in patients with COPD. Conclusion: preclinical signs of target organ involvement identified in COPD patients without cardiovascular disease. Changes in cerebral blood flow in the form of an increase in linear blood flow rate and peripheral vascular resistance index were detected in the GOLD4 group. DDLV of 1 type was detected in the GOLD1-2 groups and was found more frequently in the combination of COPD with AH. Pathological patterns were identified at the basal and medial left ventricular levels in a combination of COPD and AH. Changes in target organs indicate the need for an in-depth search to reclassify cardiovascular risk and identify an individual prevention plan.

Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.