Mm In Female Patients Research Articles

Anatomic and Morphological Evaluation of the Quadriceps Tendon Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Background: The autograft of choice for anterior cruciate ligament (ACL) reconstruction remains controversial. The quadriceps tendon is the least utilized and least studied of the potential autograft options. Purpose: To determine if the quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are adequate, reproducible, and predictable when compared with the other commonly used autografts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Axial proton density magnetic resonance imaging (MRI) scans of 60 skeletally mature patients (30 male and 30 female) were evaluated. Volumetric analysis of 3-dimensional models of the patellar and quadriceps tendons was performed before and after the removal of a 10 mm–wide graft from both tendons. Length, thickness, and width measurements of the quadriceps tendon were made at predetermined locations. Anthropometric data were collected, and subgroup analysis, sex analysis, and linear regression were performed. Results: The mean percentage of volume remaining after removal of a 10 mm–wide graft from the patellar tendon was 56.6%, compared with 61.3% when harvesting an 80 mm–long graft of the same width from the quadriceps tendon. The intra-articular volume of the proposed quadriceps tendon graft was 87.5% greater than that of the patellar tendon graft. The mean length of the quadriceps tendon was 73.5 ± 12.3 mm in female patients and 81.1 ± 10.6 mm in male patients. These measurements were most highly correlated with patient height. The width of the quadriceps tendon decreased as one proceeded proximally from its insertion, and the thickness of the quadriceps tendon remained relatively constant. Conclusion: The quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are both reproducible and predictable, while yielding a graft with a significantly greater intra-articular volume than a patellar tendon graft with a similar width.

CT Assessment of the Nasolacrimal Canal in a Black African Population

Black Africans had been identified to have a lower prevalence of primary acquired nasolacrimal duct obstruction (PANDO). This has been attributed to the likely larger size of the nasolacrimal canal. However, there is paucity of studies that have quantitatively measured the dimension of the nasolacrimal canal in a homogeneous black population. The objective of this study was to determine the diameter of the bony nasolacrimal canal by CT in a normal adult Nigerian population. The authors measured the minimum CT diameter of the bony nasolacrimal canal in 401 consecutive eligible adult patients using retrospective axial CT scans obtained between January 2006 and December 2010. The measurements were taken on axial images using a preset bone window algorithm on a standalone computer workstation with a ClearCanvas viewer (width: 2500, level: 480). The software calipers could measure up to a tenth of a millimeter. The CT images were made up of 378 cranial scans and 23 scans of paranasal sinuses. There were 286 male patients and 115 female patients aged 16 to 86 years with a mean age of 48.5 ± 18 years. The mean difference in nasolacrimal canal diameter of 3.52 mm in male patients and 3.36 mm in female patients was found to be statistically significant (t = 2.238, df = 400, p = 0.026). There was no significant difference in the canal diameter across age groups. In addition, there was no significant difference in the diameter between the right and left sides in the authors' study population (t = 1.551, df = 400, p = 0.122). The mean bony nasolacrimal canal diameter as measured by CT in Nigerians is smaller than those reported in African Americans, Asians, and Caucasians despite the reported lower prevalence of PANDO among blacks.

Methods for Carving Expanded Polytetrafluoroethylene Prostheses in Augmentation Rhinoplasty and Their Impact on Nose Shape

Sir:FigureProsthesis shape will directly impact postoperative nose aesthetics in augmentation rhinoplasty. This article reports methods of carving the prosthesis and their impact on nose shape. The commercial name of the expanded polytetrafluoroethylene used in our hospital operations was Tisuthes (Shanghai Suokang Medical Implants, Shanghai, People's Republic of China).1 Its dimensions were 70 × 15 × 8 mm. Low-lying noses were divided into three types: low nasion (type A), low nasal bridge (type B), and low nasal bridge and tip (type C) (Fig. 1, above). Prostheses were carved into a short willow shape, a long willow shape, or an L shape, respectively.Fig. 1: Three types of low-lying noses (low nasion, low nasal bridge, and low nasal bridge and tip) and the carving procedures to create the short willow-shaped, long willow-shaped, and L-shaped prostheses.For length (Fig. 1, second row), the starting point, A, was the horizontal line 3 to 4 mm above the midline between the eyebrows and eyes. The ending point, B, was the tangent point of the prosthesis and nasion skin for type A and B. For type C, it marked the junction of the facial vertical line of the columella-lobular angle and the prosthesis. A triangular section was cut from both sides of the prosthesis at point B to divide it into a long segment (used on the nasal bridge) and a short segment (used for the columella, approximately 10 mm). The width at the junction of the long and short segments was 3 to 5 mm. For the ventral surface (Fig. 1, third row), for type A, a triangular section was obliquely cut from both the cephalic end and nasal end of the ventral surface of the prosthesis to maximize the attachment between the ventral surface of the prosthesis and the nasal bridge. Type B was approached the same as type A. If there was a small bump on the nasal bridge, a hole was made at the corresponding spot on the ventral surface of the prosthesis. For type C, the long segment is the same as type B. The short segment of the prosthesis was obliquely trimmed from point B and varied from 1 to 3 mm thick beyond that point. For width (Fig. 1, fourth row), for types A and B, a wedge was cut from both sides of the prosthesis to achieve the desired width, which was approximately 12 mm for male patients and 10 mm for female patients. The width at point B was approximately 5 mm. For type C, the long segment is the same as for type B. The short segment was gradually tapered to 1 mm or to have an angle near its tip. For the dorsal surface (Fig. 1, fifth row), for type A, a 135- to 140-degree angle was carved at point A of the prosthesis dorsal surface, which was trimmed to a desired thickness of no more than 3 mm for type A. For type B, the thickness is usually no more than 8 mm for male patients and 6 mm for female patients. For type C, the long segment is the same as for type B. The prosthesis was cut open transversely at the superficial layer of the junction of the long and short segments. The short segment was then folded ventrally to form an L-shaped prosthesis. The impact of each factor on nose shape is summarized in Table 1.1–4Table 1: The Impact of Length, Width, Dorsal Surface, and Ventral Surface on Nose ShapeXudong Zhang, M.D. Qinjian Peng, M.D. Yongcheng Xu, M.D. Department of Cosmetic Surgery, Beijing Huangsi Aesthetical Surgery Hospital, Beijing, People's Republic of China DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Femoral Tunnel Length: Accessory Anteromedial Portal Drilling Versus Transtibial Drilling

To determine whether drilling using an anteromedial portal technique during single-bundle anterior cruciate ligament (ACL) reconstruction risks creating femoral tunnels less than 25 mm long in the clinical setting. Intraoperative measurements of femoral tunnel length in a group of 35 consecutive patients undergoing single-bundle primary ACL reconstruction with transtibial (TT) femoral drilling were compared with a subsequent group of 80 consecutive patients undergoing the same procedure with accessory anteromedial portal (AAMP) femoral drilling. The length of femoral tunnels created through the AAMP in male patients was compared with that in female patients, and the expected likelihood of obtaining tunnels shorter than 25 mm was determined for either gender. The mean femoral tunnel length in the AAMP group was significantly shorter than that in the TT group (35.6 mm and 40.7 mm, respectively; P < .0001). In male patients in the AAMP group, the femoral tunnel length was significantly greater on average than that in female patients in the same group (36.8 mm and 33.5 mm, respectively; P = .0001). The shortest measured femoral tunnel was 28 mm long. The statistical likelihood of femoral tunnels created by AAMP drilling being less than 25 mm in length was 0.47% for female patients and 0.1% for male patients. Although femoral tunnel length with AAMP drilling is, on average, approximately 5 mm (12.5%) shorter than with TT drilling, the likelihood of the tunnel being too short to allow for suspensory fixation with adequate graft placed within the femoral tunnel is very low. Female patients undergoing single-bundle ACL reconstruction with AAMP drilling have a femoral tunnel length that is approximately 3 mm (9%) shorter than that in male patients on average, but the expected likelihood of obtaining a tunnel shorter than 25 mm in female patients is still less than 1:200, compared with 1:1,000 for male patients. Level III, retrospective comparative study.

Knee Stability After Posterior Cruciate Ligament Reconstruction in Female Versus Male Patients: A Prospective Matched-Group Analysis

To analyze outcome differences after posterior cruciate ligament (PCL) reconstruction in male and female patients. A prospective database of 234 PCL reconstructions (53 female and 181 male patients) with either isolated or combined procedures was analyzed. Patients were followed up for a mean of 62 months (range, 34 to 110 months) by use of stress radiography and the International Knee Documentation Committee score. We included 32 female patients for a matched-group analysis and compared them with 32 matching male patients. Matching parameters were number/type of reconstructed ligaments, revision/primary surgery, autograft/allograft use, preoperative tibial displacement, time interval from injury to surgery, follow-up interval, and age. There was no preoperative difference in posterior stress radiographs (12.9 ± 3.0 mm in female patients and 13.2 ± 2.3 mm in male patients). After surgery, both groups showed a significant reduction in posterior displacement (6.0 ± 2.5 mm [54% reduction] in female patients and 7.8 ± 2.2 mm [40% reduction] in male patients). There was a significant greater reduction of posterior laxity in female patients. International Knee Documentation Committee scoring showed a significant improvement in both groups. We found in this specific patient series a superior reduction of posterior tibial laxity in female patients compared with male patients, indicating that possible gender-related differences exist after PCL surgery. Level III, retrospective comparative study using prospective data.

Nodular melanomas associated with nevi

To the Editor: Nodular melanoma (NM) represents approximately 9% to 15% of invasive melanomas. The histopathologic definition of NM is based on the absence of a radial growth phase. Most frequently, it manifests itself in midlife with a median age at presentation of 53 years, and it is more common in males than in females. In 11% to 25% of the cases, NM is histologically associated with nevi. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. Between January 1, 1982 and October 1, 2009, 95 patients with cutaneous NM were identified from a group of 1865 patients with histologically confirmed melanoma; the incidence was 5.1% (95/1865). Of the 95 patients evaluated, 49 (51.6%) were males and 46 (48.4%) were females. All patients were white. The average age was 54.5 years (range, 15-91). Primary melanomas were found in different body sites as follows: eight (8.4%) lesions were on the head and neck, 32 (33.7%) on the trunk, 22 (23.2%) on the upper extremities, and 33 (34.7%) on the lower extremities. The lesions appeared most frequently on the trunk in male patients and on the lower extremities, upper extremities, and trunk in female patients. None of our 95 cases had a documented family history of melanoma. With regard to invasive melanomas, Breslow thickness ranged from 0.5 mm to 11 mm, with a mean thickness of 3.9 mm. The mean Breslow thickness was 4.4 mm in male patients and 3.4 mm in female patients. Ten out of 95 patients (10.5%) showed histologic evidence of an associated nevus; five patients were male and five were female. The average age of these 10 patients was 55.9 years. In seven patients, melanoma arose in association with an acquired nevus (2 dysplastic nevus and 5 other acquired nevi). In the remaining three patients, melanoma arose in association with a small congenital nevus. When examined by anatomic location, one lesion was on the head and neck, five were on the trunk, one was on the upper extremities, and three were on the lower extremities. The mean Breslow thickness for these 10 patients was 2.3 mm. When comparing the two groups (NM vs NM associated with nevi), the second group showed a thinner Breslow thickness (4.04 mm vs 2.3 mm). Our findings support the belief that in most cases, NM arises in absence of a precursor lesion. NM often fails to exhibit the original ABCD diagnostic criteria,

Acetabulum protrusio and center edge angle: new MR-imaging measurement criteria—a correlative study with measurement derived from conventional radiography

The goal of this study was to identify a method of measurement for acetabulum protrusio and center edge angle (CEA) using MR imaging of the pelvis that correlated with classic methods using radiographic landmarks. MR images and radiographs of the pelvis in 67 patients (132 hips) were used to identify reliable MR-imaging methods for measuring protrusio acetabulum and CEA that correlated strongly with established radiographic measurements. Protrusio acetabulum was determined using the radiographic criterion that the acetabular line projects medial to the ilioischial line by 3 mm or more in men and 6 mm or more in women. Pearson correlation factor was used to determine inter-observer variability and those methods that demonstrated the strongest correlation. The mean and standard deviation of MR-imaging and radiographic measurements for both the normal and protrusio hips were established. Several MR methods correlated strongly with radiographic measurements. The preferred method employed axial MR images at the level of the ischial spine with measurement of the distance between the medial most point of the acetabular fossa and a line perpendicular to the horizontal axis that passed through the lateral margin of the posterior inner pelvic wall. The Pearson's correlation factor between radiographic and MR measurements using this method was 0.84, and inter-observer correlation was 0.80. There were 126 hips in 63 patients (17 female and 44 male) that did not meet the radiographic criteria for protrusio acetabula. In this group of normal hips, the mean and standard deviation of radiographic measurements were 1.9 and 2.8 mm in male patients and -0.5 and 1.7 mm in female patients, and the mean and standard deviation for the preferred MR method was 1.3 and 2.5 mm in male patients and -0.8 and 1.9 mm in female patients. A total of six hips in four patients (two female and two male) met the radiographic criteria for protrusio acetabula. In this group of patients, the mean and standard deviation of radiographic measurements were -3.7 and 1 mm in male patients and -5.4 and 0.9 mm in female patients, and the mean and standard deviation for the preferred MR method was -4.1 and 0.4 mm in male patients and -6.5 and 0.3 mm in female patients. Our study also showed that the CEA was best measured using anterior to middle coronal MR images. Posterior coronal MR-imaging measurements correlated poorly with radiographic measurements. MR imaging can be used to assess acetabular morphology and measure acetabulum protrusio.

Conservative treatment of fractures at the middle third of the clavicle: The relevance of shortening and clinical outcome

Fractures of the clavicle are common and most often occur in the middle third. The clavicle has several important functions, each of which may be affected after fracture and malunion. In this retrospective study, we reviewed 132 patients with united fractures of the middle third of the clavicle after conservative management. Residual symptoms and overall patient satisfaction after treatment were assessed through a questionnaire. Clavicular shortening after union was calculated on a standardized anteroposterior chest radiograph. Intraobserver variability and interobserver variability of measurements by use of this method are insignificant. The mean follow-up was 30 months (range, 12-43 months). The mean modified Constant score was 84 (range, 62-100). Of the patients, 34 (25.8%) were dissatisfied with the result of their management. Final clavicular shortening of more than 18 mm in male patients and of more than 14 mm in female patients was significantly associated with an unsatisfactory result.

Protrusio Acetabuli in Marfan Syndrome: Age-Related Prevalence and Associated Hip Function

Protrusio acetabuli is known to occur in patients with Marfan syndrome, but its prevalence, its effects on hip function, and its possible association with the subsequent development of degenerative hip disease have not been studied in a large population. Nevertheless, some clinicians have recommended prophylactic hip surgery for preadolescents with Marfan syndrome and protrusio acetabuli. We performed a cross-sectional study of 173 patients (346 hips) with Marfan syndrome who were interviewed and examined for calculation of the Iowa hip score. Anteroposterior radiographs of the pelvis were made, and two radiographic indices of acetabular depth were measured: (1) the center-edge angle of Wiberg and (2) the acetabular-ilioischial distance. The presence of protrusio was defined with use of two extant definitions: (1) a center-edge angle of >50 degrees or (2) an acetabular-ilioischial distance of >/=3 mm in male patients or >/=6 mm in female patients. Linear regression analyses were performed between these radiographic indices of acetabular depth and patient age, Iowa hip scores, the magnitude of the radiographic joint space, and range of motion. The prevalence of protrusio acetabuli was 27% according to the center-edge angle criterion and 16% according to the acetabular-ilioischial distance criterion. The prevalence of protrusio increased until the age of twenty years and remained stable after the age of twenty years. Slight but significant negative correlations were detected between the two radiographic indices of acetabular depth and both the Iowa hip score and the summed range of motion (p < 0.02 for all). No significant relationship was found between the two radiographic indices and pain scores. In patients with Marfan syndrome who were more than forty years old, the Iowa hip scores for hips with protrusio were not significantly lower than those for hips without protrusio. In patients with Marfan syndrome, the prevalence of protrusio acetabuli increases during the first two decades of life and then plateaus in terms of both population-wide prevalence and radiographic severity. In this population, protrusio generally is not associated with severely problematic hip function but it is associated with slightly decreased range of motion of the hip. We concluded that prophylactic surgical intervention is not indicated for most patients with Marfan syndrome who have a radiographic diagnosis of protrusio.

Anatomic and Radiographic Considerations for Placement of Transiliac Screws in Lumbopelvic Fixations

Lumbopelvic fixation in spinal and pelvic surgery relies on rods or screws as an iliac anchor. Secure placement of screws with maximum diameter and length for the greatest pullout strength requires knowledge of the iliac structure and of intraoperative fluoroscopic landmarks for secure placement. Therefore, the authors evaluated the intrailiac length, inner width, and cortical thickness of three different transiliac screw anchor paths aimed toward the anterior inferior iliac spine and initiated at the iliac tubercle, posterior superior iliac spine, or posterior inferior iliac spine. Measurements were made using two- and three-dimensional computed tomographic reformations in 40 consecutive trauma patients (27 measurements in 21 males, 16 to 75 years old; 28 measurements in 19 females, 16 to 78 years old). In addition, fresh and dry human cadaveric specimens were marked with metal wires at the previously determined optimal screw path to determine fluoroscopic landmarks for easiest and best controlled transiliac screw placement. The posterior superior iliac spine-anterior inferior iliac spine path had the largest bony canal lengths, with 141 mm in male and 129 mm in female patients. Two stereotypic iliac constrictions allowed placement of 8-mm implants in male and 6- to 7-mm implants in female patients. Cortical thickness at that optimal extraarticular path was 5.2 mm in the male and 4.7 mm in the female patients. Transiliac screws can be placed during operation under fluoroscopic control using standard lateral and obturator oblique-outlet views, the latter presenting a stereotypical teardrop figure above the acetabulum.

Manifestations of Insulin‐Dependent Diabetes Mellitus in the Periodontium of Young Brazilian Patients

The periodontal condition of patients with insulin-dependent diabetes mellitus was evaluated in terms of plaque, gingival indices, pocket depth, and alveolar bone loss. Thirty male and female diabetic patients aged 5 to 18 years were compared with 30 non-diabetic subjects and correlated with sex and age. Statistical analyses of the data showed that the mean plaque index was significantly higher (P less than 0.01) among the diabetic patients (1.23) than among the control subjects (0.81). The plaque index was significantly higher (P less than 0.01) among diabetic females (1.34) than among diabetic males (1.10), whereas no sex differences were observed in the control group. The arithmetic means obtained for gingival index were statistically higher (P less than 0.01) for the diabetics (0.58) when compared with the controls (0.15), but no significant differences were obtained when the values were correlated with sex and age. Pocket depth did not differ statistically between groups. When pocket depth was correlated with sex, a statistically significant difference (P less than 0.05) was observed only for the palatal region, with a depth of 2.1 mm in female patients and 1.92 mm in male patients. When pocket depth was correlated with age, a positive correlation (P less than 0.01) was detected in the diabetic group for all regions investigated, whereas the correlation was not significant in the control group. Mean alveolar bone loss was higher in the anterior upper (1.94 mm) and anterior lower (1.87 mm) regions of the diabetic group when compared to the controls (1.52 and 1.37 mm respectively), the difference being significant at the 5% level of probability.(ABSTRACT TRUNCATED AT 250 WORDS)

Lower Eyelid Laxity and Ocular Symptoms

We measured lower eyelid length in 288 healthy subjects to establish a norm and then in 95 patients with complaints of intractable photophobia, foreign-body sensation, chronic tearing, or chronic recurrent conjunctivitis. The difference in length was statistically significant (34.25 +/- 2.43 mm for healthy men vs 36.51 +/- 2.59 mm in male patients [P - .001] and 32.97 +/- 2.46 mm for healthy women vs 33.95 +/- 2.9 mm for female patients [P = .01]). There appears to be a cause-and-effect relationship between a flaccid lower eyelid and these ocular symptoms.