Posterior Extension Research Articles

Morphological Biomarkers in the Amygdala and Hippocampus of Children and Adults at High Familial Risk for Depression.

Major Depressive Disorder (MDD) is highly familial, and the hippocampus and amygdala are important in the pathophysiology of MDD. Whether morphological markers of risk for familial depression are present in the hippocampus or amygdala is unknown. We imaged the brains of 148 individuals, aged 6 to 54 years, who were members of a three-generation family cohort study and who were at either high or low familial risk for MDD. We compared surface morphological features of the hippocampus and amygdala across risk groups and assessed their associations with depression severity. High- compared with low-risk individuals had inward deformations of the head of both hippocampi and the medial surface of the left amygdala. The hippocampus findings persisted in analyses that included only those participants who had never had MDD, suggesting that these are true endophenotypic biomarkers for familial MDD. Posterior extension of the inward deformations was associated with more severe depressive symptoms, suggesting that a greater spatial extent of this biomarker may contribute to the transition from risk to the overt expression of symptoms. Significant associations of these biomarkers with corresponding biomarkers for cortical thickness suggest that these markers are components of a distributed cortico-limbic network of familial vulnerability to MDD.

PD31-10 PATIENT AND STRICTURE VARIABLES ASSOCIATED WITH FAILURE AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES

You have accessJournal of UrologyCME1 May 2022PD31-10 PATIENT AND STRICTURE VARIABLES ASSOCIATED WITH FAILURE AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES Kevin Flynn, Shawn Grove, Nejd Alsikafi, Joshua Broghammer, Jill Buckley, Sean Elliott, Jeremy Myers, Andrew Peterson, Keith Rourke, Thomas Smith, Alex Vanni, Lee Zhao, and Bradley Erickson Kevin FlynnKevin Flynn More articles by this author , Shawn GroveShawn Grove More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Jill BuckleyJill Buckley More articles by this author , Sean ElliottSean Elliott More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Alex VanniAlex Vanni More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethroplasty is the gold standard treatment for urethral stricture disease (USD) with historically high success rates. Still, failures occur and reasons for failure are not always readily apparent. While variations in technique (i.e. dorsal/ventral buccal placement, excisional/non-transection) may play some role, studies have yet to show clear superiority of one modern technique over another when performed by surgeons facile with a specific technique. Herein we look at patient and stricture variables, and their association with bulbar stricture urethroplasty (BU) failure, from a large multi-institutional surgical outcomes study group. METHODS: The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) prospective database was used to create a cohort of bulbar (S1a/S1b; no posterior or penile urethral extension) urethral strictures that underwent single-stage BU from 2010 to 2018 with minimum 3-year clinical follow-up (database + retrospective chart review) not associated with hypospadias. Patient (BMI, age) and stricture (length, etiology, prior endoscopic procedures, location) variables were analyzed for association with failure (secondary repair and/or inability to traverse repair with flexible cystoscope) using both uni- and multivariable methods. RESULTS: At a median follow-up time was 65.1 months there were 195 (13.2%) failures amongst the 1480 patients undergoing BU. The uni- and multi-variable predictors of failure are shown in the Table. All variables other than age were associated with failure in univariable models. In the multivariable model, factors statistically associated with failure included higher BMI, pre-urethroplasty endoscopic procedure count, recurrent strictures and inflammatory strictures, with distal bulbar extension and radiation history nearing significance. CONCLUSIONS: A multitude of readily obtainable patient and stricture variables were found to be independently associated with BU failure in this large cohort of patients with long follow-up, including stricture length, pre-urethroplasty endoscopic count, BMI and stricture etiology, validating associations previously noted in smaller cohorts. Source of Funding: NIDDK 1R21DK115945-01 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e545 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Flynn More articles by this author Shawn Grove More articles by this author Nejd Alsikafi More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Jeremy Myers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Lee Zhao More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD31-11 PATIENT, STRICTURE, AND URETHROPLASTY PREDICTORS OF ERECTILE DYSFUNCTION AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES

You have accessJournal of UrologyCME1 May 2022PD31-11 PATIENT, STRICTURE, AND URETHROPLASTY PREDICTORS OF ERECTILE DYSFUNCTION AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES Justin Drobish, Shawn Grove, Nejd Alsikafi, Joshua Broghammer, Jill Buckley, Sean Elliott, Jeremy Myers, Andrew Peterson, Keith Rourke, Thomas Smith, Alex Vanni, Lee Zhao, and Bradley Erickson Justin DrobishJustin Drobish More articles by this author , Shawn GroveShawn Grove More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Jill BuckleyJill Buckley More articles by this author , Sean ElliottSean Elliott More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Alex VanniAlex Vanni More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bulbar urethroplasty (BU) for urethral stricture disease can significantly improve urinary quality of life (QOL). However, prior studies have shown that while erectile dysfunction (ED) is rare, its presence after BU negatively affects QOL and satisfaction regardless of stricture outcome. Herein we analyze patient, stricture and urethroplasty variables and their association with post-BU ED. METHODS: The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) prospective database was used to create a cohort of bulbar (S1a/S1b; no posterior or penile urethral extension) urethral strictures that underwent single-stage BU from 2010 to 2018 with minimum 3-year clinical follow-up (database + retrospective chart review) not associated with hypospadias. Patient, stricture, and repair variables were analyzed for their association with ED, which was determined with retrospective chart review of both urologic and non-urologic clinical visits in the 12 months after BU, looking for patient complaints of ED and/or new prescriptions for ED medications, with uni- and multivariable models. Patient-reported recovery of erectile function was also assessed with chart review. RESULTS: At a median follow-up time was 65.1 months, 108 (7.3%) of 1480 study subjects were noted to have clinically significant post-BU ED. Uni- and multivariate predictors of post-BU ED are shown in the Table. On multivariate analysis, a history of pelvic radiation and BU involving urethral excision/transection significantly increased the odds of ED. Recovery of function was confirmed 56 (51.9%) at a median follow-up of 19 mo. and was not affected by repair type. CONCLUSIONS: Clinically significant changes in erectile function occurs in at least 7% of BU cases, with urethral excision/transection and radiation history significantly increasing the odds. Notably, traditional patient factors associated with ED, including as age, BMI and smoking history, did not affect the development of de novo post-BU ED. Most, but not all, patients appear to recover with time. Source of Funding: NIDDK 1R21DK115945-01 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e545 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Drobish More articles by this author Shawn Grove More articles by this author Nejd Alsikafi More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Jeremy Myers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Lee Zhao More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Descriptions of Two New Species, Sillago muktijoddhai sp. nov. and Sillago mengjialensis sp. nov. (Perciformes: Sillaginidae) from the Bay of Bengal, Bangladesh

Due to difficulty in recognition, many true species have been covered under the synonyms of wide-spread species. To justify the identification of a widely distributed species, Sillago sihama from the Bay of Bengal, Bangladesh, an integrated approach including morphology and DNA barcoding was used. Two unrecognized species of Sillago, i.e., Sillagomuktijoddhai sp. nov. and S. mengjialensis sp. nov., were identified from the coastal area of Bangladesh. S. muktijoddhai sp. nov. has marked differences in the body color, anal fin color, number of gill rakers, snout length, and swimbladder. S. mengjialensis sp. nov. has notable differences in the anal fin color, snout length, and swimbladder and is distinguished from S. muktijoddhai sp. nov. by the body color and swimbladder. The morphological characters of 14 documented Sillago species with two posterior extensions of the swimbladder were referenced and distinguished to accredit the two new species. Genetic analyses of partial mitochondrial cytochrome oxidase subunit I and 16S ribosomal RNA also supported the validity of the new species. This study has increased the number of recognized species of Sillago in the world and confirmed the prevailing misidentification of these two new species in Bangladesh as so-called S. sihama. Moreover, the study confirmed the misidentification of S. mengjialensis sp. nov. in Indonesia as S. sihama and the identification of unknown Sillago sp.1 in India.

Long-term development of surgical outcome of laparoscopic sacrohysteropexy with anterior and posterior mesh extension.

Long-term durability and functional outcome of laparoscopic sacrohysteropexy (LSH) remains to be confirmed. We set out to assess the development of surgical outcome in women with increasing minimal follow-up. All women after LSH with anterior and posterior mesh extension operated for advanced apical uterine prolapse at Geoffroy Saint-Hilaire clinic from July 2005 to June 2020 were enrolled in this retrospective study. Last known follow-up information was used for the analysis and allocation into groups. The surgical success was defined as no prolapse beyond hymen, no symptomatic recurrence or no retreatment. Functional outcome was evaluated from validated questionnaires and presence of pelvic floor disorders. The outcomes were compared with preoperative state using chi-square and Fisher's test; p < 0.05 was considered significant. In total, 270 patients after LSH with a follow-up of up to 14.5years were enrolled and divided into groups according to their last follow-up length: ≥ 1 year 242, ≥ 3 years 112, ≥ 5years 76, ≥ 7years 45 and ≥ 10 years 18 women. Increase of minimal follow-up was associated with gradual decrease in surgical success. Rates of stress urinary incontinence were unchanged by the surgery, while anal incontinence and constipation rates decreased significantly; 14.5% of women were operated on for SUI in the follow-up. The PFDI-20, PFIQ-7 and VAS bother scores decreased significantly regardless of minimal follow-up length. LSH with anterior and posterior mesh extension is a safe, effective and durable surgery with a positive long-term effect on quality of life. Although the surgical success gradually decreases, LSH remains a surgical success in most women.

The Anatomy, Physiology, and Histology of Optic Nerve

The optic nerve (Nervus opticus) is the second of the 12 cranial nerves and is considered to be a part of the central nervous system. It carries visual information from the neurosensory retina to the occipital cortex. The nerve consists of the axons of retinal ganglion cells (RGCs). These axons extend in an organized pattern from the RGC soma to the lateral geniculate nucleus where the neuron's synapse. The nerve is subdivided into fascicles by connective tissue and glial septa, and it is surrounded by cerebrospinal fluid. The optic nerve has intraocular, intraorbital, intracanalicular, and intracranial parts and a length of approximately 50 mm. The central retinal artery, the Zinn-Haller circle formed by the short posterior ciliary artery extensions, and pial vessels take part in the blood supply of the nerve.

A new comprehensive grading for giant pituitary adenomas: SLAP grading

Aim Giant pituitary adenomas are difficult to resect due to multicompartmental extension. We developed a new grading system for giant pituitary adenomas (GPAs) considering possible extension in superior, lateral, anterior, and posterior (SLAP) directions. We also related the degree of resection to the SLAP grading. Methods A review of case files and radiological images of patients with the GPAs defined as pituitary adenomas with a size of more than 4 cm in any dimension was done. The extent of the tumour was noted and scored as per the SLAP system. The maximum total score is 10 and represents a large tumour with maximum extensions in all directions. The subtotal resection (STR) was defined as a residual tumour volume of more than 10%. The association between individual and total score on the degree of resection was determined. Results A total of 103 cases of GPAs were analyzed. All patients had a suprasellar (S) extension. The lateral (L) extension was seen in 97.3% of cases. The anterior (A) extension was seen in 28 (27.2%) cases. The posterior (P) extension was seen in 45 (43.7%). Forty-eight (46.6%) had a total score of 5 or more. The STR was achieved in 64 (62.2%) cases. On regression analysis, a total score of ≥5 was associated with odds of 5.02 (1.69–14.93), p-value 0.004 for STR. Conclusion The SLAP grading is a comprehensive grading system that can be applied easily to the GPAs and gives a complete picture of the extension of the tumour.

Chalarosthrix gen. nov., a new taxon of the Sphingothrix-Triathrix clade (Harpacticoida: Cletodidae) from the Province of Cortez, Eastern Mexican Pacific.

Seven species of four cletodid genera previously described or reported from Mexico (Cletodes, Enhydrosoma, Geehydrosoma, and Stylicletodes) and an undescribed genus presumably related to Sphingothrix and Triathrix, were found in sediment samples from a coastal system in north-western Mexico. The Bayesian analysis of 95 morphological characters of thirty-four cletodid genera revealed that the new genus, Chalarosthrix gen. nov., is closely related to Sphingothrix. The clade Sphingothrix-Chalarosthrix bears a sister group relationship with Triathrix. These three genera constitute a monophyletic group defined by the presence of a posterior chitinous extension of the cephalothorax with four sensillum-bearing socles, and the presence of a median tube-pore on the anal operculum. Other synapomorphies for Sphingothrix and Triathrix proposed by earlier researchers are re-evaluated upon the latest definition of the Cletodidae. Our analysis supports previous studies in that Sphingothrix can be objectively defined by i) the reduction of the distal outer seta of the last exopodal segment of the first swimming leg being at most as long as the subdistal outer spine, and ii) the distal inner seta of the same segment inclined outwards intersecting the distal outer element at its base. On the other hand, no (aut)apomorphies were detected for Triathrix. The new genus, Chalarosthrix gen. nov., is defined here by the apomorphic secondary loss of the inner element of the second endopodal segment of the first swimming leg. Some comments on the relationships of the new genus are given.

Assessment of Variations in Sphenoid Sinus Pneumatization in South Indian Population

Introduction Morphometric study of sphenoid sinus shows various degrees of pneumatization. Knowledge of such variability is extremely important to guide the surgeon in predicting what type of surgical approach will be safer for the pathologies involving skull base region. Considering recent advances in trans-nasal trans-sphenoidal endoscopic interventions and improved visualization, it has become imperative to become familiar with the anatomical variations which are likely to be encountered during surgical procedures. Materials and Methods A retrospective study was conducted on the basis of CT scan records of 120 patients to evaluate variability in pneumatization of sphenoid bone and its extensions in South Indian population. Results The study revealed the prevalence of conchal, pre-sellar, incomplete sellar and complete sellar types of sphenoid pneumatization in 02%, 08%, 28% and 62% cases respectively. Posterior or clival extension was the commonest type seen in 80% cases which included sub-dorsal (50%), dorsal(15%) and occipital(15%) types of clival variants. In lateral extensions, pterygoid sub-type was observed in 37% of patients whereas lesser wing, greater wing and full lateral sub-types were present in 20%, 14% and 09% cases respectively. Various combinations of lateral sub-types were seen in 15% of study population. Conclusion In our study higher percentage of pneumatization of sphenoid sinus and its extensions was observed when compared to Egyptian and Chinese populations. High prevalence in South Indian population also provides an additional armament in the hands of surgeon to reach the otherwise unreachable lesions involving middle and posterior cranial fossae through trans-sphenoidal approach.

The Evaluation of Variations in Patterns of Sphenoid Sinus Pneumatization Using Computed Tomography in a South Indian Population.

Background and objectiveKnowledge about sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to avoid serious complications like postoperative meningitis, sinusitis, cerebrospinal fluid (CSF) rhinorrhea, and intracranial hematoma. In this study, we aimed to assess the proportion of anatomical variants in sphenoid sinus pneumatization and to determine the common sphenoid pneumatization pattern in a South Indian population.MethodsThis retrospective study was conducted over a period of six months from July 2019 to December 2019 among 573 patients who underwent non-contrast CT (NCCT) or contrast-enhanced CT (CECT) of the brain, paranasal sinuses (PNS), orbit, and face.ResultsMost of the patients were in the age group of 20-39 years. The male-to-female ratio was 2.45:1. Among the posterior extensions, the most common variant was type D, followed by type C, type B, and type A. Among the clival extensions, the most common variant was Cliv-A, followed by Cliv-B, Cliv-C, and Cliv-D. The most common lateral wall pneumatization was bilateral lateral wall pneumatization followed by unilateral sinus wall pneumatization. Lat-A was the most common lateral wall pneumatization pattern followed by Lat-D, Lat-B, and Lat-C.ConclusionOur study intends to classify the sphenoid sinus pneumatization pattern and identify the most common variant among them, thereby guiding the skull base and FESS surgeons in choosing the correct mode of the operative procedure and also anticipating and avoiding complications of surgery.

Finite Element Analysis of Spinal Cord Stress in a Single Segment Cervical Spondylotic Myelopathy.

BackgroundSpinal cord ischemia is largely caused by cervical spondylotic myelopathy (CSM), which has a corresponding biomechanical basis. Finite element analysis of spinal cord stress in diseased segments of CSM was performed to provide a biomechanical basis for the pathogenesis of CSM.MethodsA single segment (C4-5) in a patient with CSM was selected for mechanical simulation of three-dimensional (3D) computed tomography scanning, and a 3D finite element model of the cervical vertebra was constructed. Based on the patient's age, sex, height, weight, and other parameters, a finite element analysis model of an individual with healthy cervical vertebrae in our hospital was selected as the control to compare the stress changes between the patient and control groups in the analysis of the cervical vertebrae under anterior flexion, posterior extension, lateral flexion, and rotating load in the diseased spinal cord segment.ResultsIn the CSM patient, the diseased segment was C4-5. Under loading conditions of forward flexion, posterior extension, left flexion, right flexion, left rotation, and right rotation, the maximum stress on the spinal cord in the control group was 0.0044, 0.0031, 0.00017, 0.00014, 0.0011, and 0.001 MPa, respectively, whereas those in the spinal cord in the CSM group were 0.039, 0.024, 0.02, 0.02, 0.0194, and 0.0196 MPa, respectively.ConclusionThe maximum stress on the diseased segments of the spinal cord in the CSM group was higher than that in the control group, which contributed to verifying the imaging parameters associated with spinal cord compression stress.

Are rotational passive stiffness and translational passive stiffness correlated? A porcine in vitro study

BackgroundQualitative clinical assessments of spinal stiffness have been demonstrated to show moderate correlations with one-another. We hypothesized that these correlations would improve in an in vitro model of the functional spinal unit. If the stiffness of spinal units are different across loading regimes (e.g. flexion-extension versus shear), then it may provide one explanation as to the variability in findings from clinical assessments, since these tests tend not to discriminate rotational and translational degrees-of-freedom. Therefore, the purpose of this investigation was to quantify the relationships between rotational and translational stiffness measures in vitro. MethodsForty-eight porcine cervical spine functional units were used in this investigation (20 C3-C4, 28 C5-C6). While under constant 300 N compressive load, range-of-motion tests for both flexion-extension (± 8 Nm, 0.5 deg./s) and anteroposterior shear (± 400 N, 0.2 mm/s) were conducted, to quantify moment-angle and force-deflection curves. Representative stiffness values were then obtained for flexion, extension, anterior shear, and posterior shear using segmented regression. The correlation matrix between these four measures was then used to explore their potential relationships. FindingsOf the six correlations conducted, only the relationship between posterior shear and extension stiffness was statistically significant (p = 0.014), despite featuring a low correlation coefficient (R2 = 0.123). InterpretationThe poor correlations between stiffness metrics in this study supports the disparate findings of tissue stiffness in vivo. Results from this investigation suggest that clinicians should be cognizant of which degrees-of-freedom they are assessing in the spine, as their stiffness values vary independently.

Modified posterior approach of the knee in patients with diffuse pigmented Villonodular synovitis: case series of a single Institution’s experience

BackgroundDiffuse pigmented villonodular synovitis (DPVNS) is a challenging tumor-like disorder that mainly occurs in the anterior aspect of the knee joint. The growth may sometimes extend to the posterior knee joint. Surgical excision is the mainstream treatment for DPVNS, and the posterior approach of tumor excision is adopted when the dominant tumor shows posterior extension. However, the optimal surgical approach over the posterior knee remains unknown.MethodsPatients with DPVNS of the knee joint who received the posterior approach of synovectomy from 1995 to 2019 were retrospectively reviewed to describe the modified separate posterior (SP) approaches, and evaluate the treatment outcomes in a case series of DPVNS knees. The results of the SP approach was also compared with those of traditional direct posterior (DP) approach. Postoperative functional outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) standardized questionnaire and clinician-completed Musculoskeletal Tumor Society (MSTS) functional rating system at outpatient department.ResultsA total of 20 DPVNS knees were included. Thirteen patients who received SP approaches were included in the SP group, while seven patients who received the DP approach were included in the DP group. The median follow-up times were 5.7 years (IQR, 2-8.8) in the SP group and 3 years (IQR, 2-5.3) in the DP group. Both groups showed satisfactory safety. The SP group presented higher postoperative mean WOMAC (91.23 ± 7.20) and mean MSTS (24.23 ± 2.68) than the DP group (mean WOMAC: 76.00 ± 16.57; mean MSTS: 22.43 ± 4.69). The Wilcoxon signed-rank test was use to compare preoperative and postoperative range of motion (ROM) for each group. The significant difference in SP group (p = 0.004) was found while p = 0.131 in DP group.ConclusionsThe SP approach provides an effective approach with satisfactory outcomes for the surgical treatment of DPVNS knees.

The Efficacy of Manipulation with Distension Arthrography to Treat Adhesive Capsulitis: A Multicenter, Randomized, Single-Blind, Controlled Trial.

Objective To determine whether arthrographic distention combined with manipulation for frozen shoulder provides additional benefits. Methods A total of 180 participants from five clinical centers with pain and stiffness in predominantly 1 shoulder for >3 months entered the study, and 165 completed the study. The control group was treated with arthrographic distention alone, and the treatment group underwent manipulation after resting for 5 minutes following arthrographic distention. Patients were followed up at the one and two weeks and at three and six months. For the clinical evaluation, shoulder-specific disability measure (SPADI) score, the visual analog scales (VASs) for pain, and range of active motion were used. Results 83 patients out of 90 in the treatment group and 82 out of 90 in the control finished the entire study period. SPADI, VAS, Constant-Murley (CM), and range of motion (ROM) were improved after treatments in both groups. The statistical differences were not observed in the CM, adduction, internal rotation, and posterior extension function between groups (P > .05) after the first treatment. And the statistical differences were not observed in the internal rotation, the extorsion, and posterior extension function (P > .05) after the second treatment. Conclusion Distention arthrography plus manual therapy provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in AROM of the shoulder than distention arthrography alone in patients with frozen shoulder.

Posterior Labral Tear Extension Concomitant With Shoulder Bankart Injuries Is not Uncommon

PurposeTo identify the rate and risk factors of posterior labral involvement in operatively managed Bankart lesions and assess the effectiveness of MRI arthrogram for preoperative identification of such injury patterns.MethodsA consecutive cohort of patients undergoing arthroscopic Bankart repair were retrospectively reviewed. All subjects underwent a prearthroscopy MRI arthrogram. Operative findings were used as the gold standard for posterior labral tear extension. Patient demographic and surgical data were then analyzed to identify independent factors associated with the presence of concomitant posterior labral injury.ResultsOf 124 patients undergoing arthroscopic Bankart stabilization, 23 (19%) were noted to demonstrate posterior labral injury on arthroscopic evaluation. Factors associated with injury to the posterior labrum included those sustaining two or fewer dislocations events (P =.001), an earlier average presentation (P = .001), and a reported “contact” mechanism of dislocation (P = .02). Posterior labral involvement did not correlate with surgical positioning (beach-chair versus lateral) or the need for revision surgery. On the basis of review of preoperative imaging, MRI arthrogram demonstrated a sensitivity of 83% and a specificity of 95% for detection of posterior labral injury.ConclusionsPosterior propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. Risk factors for posterior labral extension include two or fewer dislocations, early presentation from the time of injury, and contact sports. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of these lesions.Level of EvidenceLevel III, retrospective case-controlled study.

Association of the Posterior Acromion Extension with Glenoid Retroversion: A CT Study in Normal and Osteoarthritic Shoulders.

Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint were examined in the scapular coordinate system. Four acromion angles were defined from these two acromion landmarks: the acromion posterior angle (APA), acromion tilt angle (ATA), acromion length angle (ALA), and acromion axial tilt angle (AXA). Shoulder computed tomography scans of 112 normal scapulae and 125 patients with primary glenohumeral osteoarthritis were analyzed with simple and stepwise multiple linear regressions between all morphological acromion parameters and glenoid retroversion. In normal scapulae, the glenoid retroversion angle was most strongly correlated with the posterior extension of the AA (R2 = 0.48, p < 0.0001), which can be conveniently characterized by the APA. Combining the APA with the ALA and ATA helped slightly improve the correlation (R2 = 0.55, p < 0.0001), but adding the AXA did not. In osteoarthritic scapulae, a critical APA > 15 degrees was found to best identify glenoids with a critical retroversion angle > 8 degrees. The APA is more strongly associated with the glenoid retroversion angle in normal than primary osteoarthritic scapulae.

Hinge fractures reaching the tibial plateau can be caused by forcible opening of insufficient posterior osteotomy during open-wedge high tibial osteotomy.

The purpose of this study was to use the finite element method (FEM) to reproduce fracture lines that reach the lateral tibial plateau during open-wedge high tibial osteotomy (OWHTO) in patients with Type III lateral hinge fracture (LHF). It was hypothesized that the FEM could clarify biomechanical causes of Type III LHF, enabling prevention of adverse complications. This study used the nonlinear FEM to analyze the data of eight knees in eight patients (two males and six females) with Type III LHF among 82 patients who underwent OWHTO, as well as the data of eight individuals with no LHF. To predict the onset of Type III LHF, simulation models were also developed in which posterior osteotomy sufficiency varied from 50% to perfect, the latter defined as osteotomy reaching the hinge point. Real-life instances of Type III LHF caused by insufficient posterior osteotomy were reproduced in all patient-specific FEM models, and these models accurately predicted fracture types and locations. During opening of the osteotomy gap, the fracture line reached the lateral tibial plateau, and extended vertically from the end of the insufficient posterior osteotomy, avoiding the rigid proximal tibiofibular joint. In contrast, sufficient posterior osteotomy resulted in a lack of LHF. Posterior osteotomy extension ≥ 70% of the width of the osteotomy plane was the cut-off value to prevent Type III LHF. Forced opening of insufficient posterior osteotomy was found to be a biomechanical cause of Type III LHF that extended perpendicularly to the lateral tibial plateau, avoiding the proximal tibiofibular joint. The clinical significance of this study is that sufficient posterior osteotomy during OWHTO, defined as at least 70% of the width of the osteotomy plane, can prevent Type III LHF.

Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals.

The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.

The Relationship of the Sural Nerve and Anatomic Landmarks Relevant to the Extensile Lateral and Sinus Tarsi Approaches: A 3T MRI Study

Category:Hindfoot; TraumaIntroduction/Purpose:The extensile lateral and sinus tarsi approaches are commonly used during foot and ankle surgery, and pose a risk of iatrogenic injury to the sural nerve, a cutaneous nerve that innervates the ankle and lateral foot. Our understanding of the SN's location is based primarily on anatomic cadaver studies with small sample sizes. Our research analyzes a large cohort of high-field 3 Tesla (3T) magnetic resonance images (MRI) of the ankle to obtain a more generalizable, in-vivo sample of the distal course of the SN. A better understanding of the course and variability of the sural nerve will allow surgeons to minimize the risk of iatrogenic injury to the SN.Methods:High-field 3T MRI studies of the ankle performed at our institution between January 2015 and December 2020 were analyzed. The vertical distance of the SN to the distal tip of the lateral malleolus (DTLM), horizontal distance of the SN to the DTLM, and the lateral border of the Achilles tendon (LBA) at the level of the DTLM were measured by 3 blinded reviewers. Also measured was the horizontal distance of the SN to the LBA at the level of superior Achilles insertion (SAI) onto the calcaneus, as well as 5 cm above the SAI. We then analyzed upper and lower quartile ranges to compare the outer anatomic distribution frequencies of the SN to the locations of common approach incision lines. This outer limit analysis may serve to quantify the variability of the SN.Results:A total of 204 3T MRIs of the ankle were included. 1st and 4th quartile ranges for vertical distance from the SN to the DTLM were 0.9-1.9 cm and 2.5-3.6 cm respectively. 1st and 4th quartile ranges for horizontal distance of the SN to the DTLM at the level of DTLM were 0.8-1.5 cm and 2.0-3.0 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA at the level of DTLM were 1.0-1.6 cm and 2.1-2.9 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA at the level of the SAI were 1.4-2.3 cm and 2.8-3.7 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA, 5 cm above SAI were 0.4-0.8 cm and 1.0-1.8 cm, respectively.Conclusion:The vertical distance from SN to DTLM was greater than the previously reported maximum of 2.6cm in 25% of cases. This highlights the risk of injury to the sural nerve with the extensile lateral approach. Our first quartile range for vertical distance of SN to DTLM of 0.9-1.9cm indicates that even at the lowest range of values, the SN remains clear of the incision line used in the sinus tarsi approach, which extends from the DTLM to the base of the fourth metatarsal. The sural nerve is still at risk during posterior extension or retraction of the sinus tarsi incision.

A new species of the genus Paurodontella Husain &amp; Khan, 1968 (Nematoda: Hexatylina, Sphaerularioidea) with its molecular phylogenetic study

Abstract A new species of the genus Paurodontella, Paurodontella minora n. sp., collected from Alborz Province, Iran, is described and illustrated based on morphological and molecular characters. The new species is characterized by its body length of 393 (350–438) μm and 380 (n = 1) μm in female and male, respectively, 6–7 incisures in lateral field, lip region annulated and continuous with body contour, and total stylet 6.1 (5.5–7.0) μm long. Basal pharyngeal bulb with small posterior extension projecting reaching to the intestine. Excretory pore situated at the level of basal pharyngeal bulb region, no post-uterine sac, conical tail, narrowing to a rounded tip, and rare male with slender tylenchoid spicules and adanal bursa. The new species comes close in morphology and morphometrics to four known species of the genus, namely Paurodontella asymmetrica, Paurodontella balochistanica, Paurodontella densa and Paurodontella niger. In molecular phylogenetic analyses using D2–D3 expansion segments of the large subunit rDNA gene sequence, P. minora n. sp. formed a major clade with species of the genera in the family Sphaerulariidae (Paurodontella, Paurodontoides, Veleshkinema and Sphaerularia) and a sister relation with the members in the families Neotylenchidae and Anguinidae with the same clade support values in Bayesian inference.