Right-sided Predominance Research Articles

Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider Rotation Using the GUARD (Glider Used As a Rotary Device) Technique.

This video presents a case of L4-5 unstable spondylolisthesis treated with full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), emphasizing the GUARD (Glider Used as a Rotary Device) technique for nerve root protection. This innovative approach involves controlled rotation of the cage glider before cage insertion to minimize the risk of nerve root injury, a significant complication in Endo-TLIF procedures. The GUARD technique, validated in previous cadaveric studies, provides enhanced safety during cage insertion by protecting the nerve root. A 48-year-old woman with a 3-year history of progressive low back pain and bilateral lower extremity radiculopathy (right-sided predominance) was diagnosed with L4-5 unstable spondylolisthesis and spinal stenosis. After failure of conservative management, she underwent uniportal full-endoscopic facet-resecting transforaminal lumbar interbody fusion using the GUARD technique. Postoperatively, the patient experienced significant symptomatic improvement and resolution of radiculopathy, without any intraoperative nerve root injury or postoperative neurological deficits. This case demonstrates the effectiveness of the GUARD technique in reducing neurological complications and improving patient outcomes.

Comprehensive Analysis of Neurologic Complications Following Transradial Cerebral Angiography.

Transradial access (TRA) for cerebral angiography has become more popular due to fewer complications and greater patient comfort compared to transfemoral access. However, the frequency and nature of neurologic complications linked to TRA remain unclear. This study aimed to determine the incidence of symptomatic neurologic complications after transradial cerebral angiography, identify risk factors, and characterize clinical and imaging features of these complications. We retrospectively analyzed 1,679 consecutive cases of transradial cerebral angiography from a single institution between January 2018 and December 2020. Neurologic complications were defined as any symptomatic changes confirmed by diffusion-weighted imaging revealing ischemic lesions. A case-control matching method was used to enhance the reliability of the results. Clinical, procedural, and anatomical factors were examined for predictors of neurologic complications. Neurologic complications occurred in 1.0% (n=19) of cases, with 85% occurring within six hours post-procedure. No significant predictors of neurologic complications could be identified among the clinical, procedural, or anatomical factors assessed. Overall, 58% of patients experienced transient or reversible complications. Patients with permanent symptoms had mild to moderate disability (mRS scores of 1 or 2), with no severe disability (mRS score ≥3). Diffusion-weighted imaging commonly showed multifocal cortical or subcortical ischemic patterns, typically affecting the right middle cerebral artery territory or multiple territories, suggesting embolic mechanisms as a potential cause. Neurologic complications following transradial cerebral angiography were rare but occurred early in the post-procedural period. The observed ischemic patterns, particularly the right-sided predominance, suggest embolic mechanisms as a potential cause. However, further large-scale, multicenter prospective studies are essential to identify risk factors more clearly and enhance patient safety in this increasingly utilized transradial approach. ACA＝ anterior cerebral artery; ICAS＝ intracranial atherosclerotic stenosis; PCA＝ posterior cerebral artery; SCA＝ subclavian artery; TFA＝ transfemoral access; TRA＝ Transradial access; VAO＝ vertebral artery orifice; VBA＝ vertebrobasilar artery.

A study of the cerebral venous drainage patterns in craniosynostosis: nonsyndromic cases and the induction effect of Virchow's law on venous sinuses.

Surgical intervention is commonly necessary for craniosynostosis. One of the preoperative concerns revolves around the cerebral venous drainage pattern and its potential involvement during surgery. Although there have been reports regarding venous drainage patterns in syndromic craniosynostosis, studies of nonsyndromic cases have been rare. In the present study, the aim was to study venous drainage patterns in nonsyndromic craniosynostosis. Nonsyndromic cases at a single institute were retrospectively reviewed, and cerebral venous drainage in the posterior (transverse sinus [TS]) and anterior (cavernous sinus [CS] and para-CS [ParaCS]) venous routes was systematically investigated. The occipital sinus (OS) and emissary veins were also evaluated. A total of 89 nonsyndromic cases were evaluated, including 12 right coronal synostosis (RCS), 14 left coronal synostosis (LCS), 15 bilateral coronal synostosis (BCS), 36 sagittal synostosis, 6 metopic synostosis, and 6 combined metopic-sagittal synostosis cases. All venous studies were performed using MR venography. There was a significant difference among all six groups in TS dominance (p = 0.0108). In unilateral coronal synostosis (UCS; including RCS and LCS) cases, 76.9% had TS dominance on the opposite side of the synostotic suture (20 of 26 UCS, including 10 of 12 RCS and 10 of 14 LCS). There was a significant difference in the incidence of OS, with the highest incidence observed in the BCS group (33.3%, p = 0.027). CS/ParaCS venous drainage was observed in 94.4% of cases on the right side and 95.5% on the left side, showing no significant difference among the groups on both sides. No visible emissary vein was observed in any of the groups. A significantly higher predominance of left TS was found in RCS cases, in contrast with the typical right-side predominance seen in the normal population. In addition, the majority of UCS cases exhibited TS dominance on the opposite side of the synostotic suture. Furthermore, the present results showed a significant difference in the prevalence of OS, which was predominantly observed in BCS cases. These findings could be explained by the induction effect on venous sinuses by the compensatory growth of the skull according to Virchow's law, suggesting that synostotic sutures induce compensatory skull expansion in regions farthest (diagonally) from the affected sutures, thereby enlarging nearby venous sinuses.

A Retrospective and Prospective Observational Study to Evaluate the Jugular Bulb Anatomical Variations Using High-resolution Computed Tomography

Introduction: The jugular bulb (JB) is a key anatomical structure of the temporal bone that shows variability that can impact otologic surgeries and symptoms. This study aimed to assess the presence and characteristics of bulb variations with high-resolution computed tomography (HRCT) and their distribution across different demographics. Materials and Methods: A total of 400 patients undergoing HRCT of the temporal bone were ambispectively analyzed. JB variations, including high-riding JB, dehiscent JB, and JB diverticulum, were identified. Data were further analyzed based on gender, age, and unilateral versus bilateral presence. Results: High-riding JB was observed in 20% of the patients. Dehiscent JB and JB diverticulum were less frequently found in 3% and 0.25% of the cases, respectively. Significant gender differences were noted with high-riding JB more prevalent in females (27.9%) compared to males (15.9%). Age-related variations showed high-riding JB most frequently in the 10–30 year ages. The majority of JB variations were unilateral with a right-sided predominance. Conclusion: The presence of JB variations highlights the need for careful preoperative assessment in otologic surgeries to avoid complications. The significant findings of gender- and age-related differences in JB variations underscore the importance of personalized diagnostic approaches. This study reinforces the value of HRCT in the detailed evaluation of anatomy for optimized planning of surgeries and patient management.

Clinical, Cortical, Subcortical, and White Matter Features of Right Temporal Variant FTD.

Eight patients with right temporal variant FTD were prospectively recruited and underwent a standardised neuropsychological assessment, clinical MRI, and quantitative neuroimaging. Our voxelwise grey analyses captured bilateral anterior and mesial temporal grey matter atrophy with a clear right-sided predominance. Bilateral hippocampal involvement was also observed, as well as disease burden in the right insular and opercula regions. White matter integrity alterations were also bilateral in anterior temporal and sub-insular regions with a clear right-hemispheric predominance. Extra-temporal white matter alterations have also been observed in orbitofrontal and parietal regions. Significant bilateral but right-predominant thalamus, putamen, hippocampus, and amygdala atrophy was identified based on subcortical segmentation. The clinical profile of our patients was dominated by progressive indifference, decline in motivation, loss of interest in previously cherished activities, incremental social withdrawal, difficulty recognising people, progressive language deficits, increasingly rigid routines, and repetitive behaviours. Right temporal variant FTD has an insidious onset and may be mistaken for depression at symptom onset. It manifests in a combination of apathy, language, and behavioural features. Quantitative MR imaging captures a characteristic bilateral but right-predominant temporal imaging signature with extra-temporal frontal and parietal involvement.

Cerebral arterial air embolism after esophageal stenting for recurrence of gastroesophageal junction cancer: a case report.

Cerebral arterial air embolism (CAE) is a rare complication after esophageal stenting, but it can be life-threatening. It is especially a concern for those with a history of previous gastrointestinal cancer therapies. We report a case of CAE after esophageal stenting in a patient with recurrent gastroesophageal junction cancer and a history of multiple cancer treatments. A 71year-old man with a history of a proximal gastrectomy, resection of the lower esophagus, chemotherapy, and radiation presented to our hospital 2weeks after stenting with epigastric and back pain. Mediastinitis was suspected and conservative treatment was begun. The patient suddenly developed altered mental status, left hemiplegia, and anisocoria after drinking water. A brain computed tomography (CT) revealed right-sided predominance of multifocal CAE. Chest and abdominal CT showed a hematoma in the gastric and duodenal wall and an intraluminal hematoma from the esophagus, around the stent, to the upper ileum. CAE was thought to be due to rupture of the recurrent tumor. Unfortunately, despite intensive care, the patient died about 5h after the onset of neurological symptoms. It has been reported that prior treatments, such as chemotherapy and radiotherapy, increase the risk of life-threatening adverse events, including CAE after esophageal stenting. Clinicians should keep in mind the possibility of CAE after esophageal stenting in patients with a history of multiple cancer treatments.

Functional Outcome of Lower Limb Long Bone Trauma Management in Pregnant Mothers: A Prospective Study of 30 Cases From a Tertiary Care Centre in North India.

The occurrence of orthopedic injuriesduring pregnancy carries considerable morbidity and mortality for both the mother and fetus. Successful care of lower limb fractures during pregnancy requires a multidisciplinary approach. Both operative and non-operative treatments must be taken into account by the treating orthopedic physician. There is limited literature available on the management of these lower limb fractures in pregnancy, and peri-operative management of this obstetric and orthopedic trauma is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death, having a significant public health burden to both the mother and child. The aims and objectives of this study were to review the common causes of lower limb long bone trauma during pregnancy and their functional outcome in terms of morbidity and mortality. This study evaluates various operative and conservative methods of treatment to provide a comprehensive management approach to pregnant patients with lower limb trauma. A prospective study on functional outcomes of 30 pregnant females who were admitted with lower limb long bone fractures from 2017 to 2021 was done. The patients were randomly selected intra-operatively for various procedures based on the surgeon's preference. All patients were followed for two years or till union occurred, and the radiographic union score for tibial (RUST) and modified radiographic union score for tibial (mRUST) fracture criteria were used to assess bony union clinico-radiologically. Results: During this study, the mean age of patients was 27 years (range 19-38), having right-side (53.33%) predominance with road traffic accidents (n=22) and falls (n=6) as the most common causes of injury. Two cases of domestic violence were also reported. In our study, the maximum number of cases was 17-25 weeks of their gestation; 12 (40%) patients had tibial fractures, and 18 (60%) had femoral fractures. Six tibial fractures were handled conservatively, while all femoral fractures required surgical intervention. Out of 18 femoral fractures, which were treated surgically, dynamic compression plating was done in 15 (83.33%) patients, while interlock nailing was done in three patients. Six tibial fractures have been operated upon, two (66.66%) with dynamic compression plating and four (33.33%) with an interlocking nail. A multidisciplinary approach in terms of both operative and non-operative methods must be taken into account for treating pregnant mothers by the orthopedic physician while carefully weighing the benefits and risks of both procedures. Based on the pattern and displacement of the fracture, many prenatal fractures can be treated conservatively. Another alternative that is frequently safe is to postpone the surgical procedure until childbirth. The physiologic changes associated with pregnancy and any potential dangers to the fetus must be taken into account by the orthopedic surgeon when fractures necessitate surgical intervention. The surgeon is responsible for the patient's correct placement, the C-arm's use, the radiation dose, and the intra-operative fetal monitoring, as well as the danger brought on by anesthetics, antibiotics, analgesics, and anticoagulants.

Asymmetrical cortical surface area decrease in epilepsy patients with postictal generalized electroencephalography suppression.

Postictal generalized electroencephalographic suppression is a possible electroencephalographic marker for sudden unexpected death in epilepsy. We aimed to investigate the cortical surface area abnormalities in epilepsy patients with postictal generalized electroencephalographic suppression. We retrospectively included 30 epilepsy patients with postictal generalized electroencephalographic suppression (PGES+), 21 epilepsy patients without postictal generalized electroencephalographic suppression (PGES-), and 30 healthy controls. Surface-based analysis on high-resolution T1-weighted images was conducted and cortical surface areas were compared among the three groups, alongside correlation analyses with seizure-related clinical variables. Compared with PGES- group, we identified reduced surface area in the bilateral insula with more extensive distribution in the right hemisphere in PGES+ group. The reduced right insular surface area was associated with younger seizure-onset age. When compared with healthy controls, PGES- group presented reduced surface area in the left caudal middle frontal gyrus; PGES+ group presented more widespread surface area reductions in the right posterior cingulate gyrus, left postcentral gyrus, middle frontal gyrus, and middle temporal gyrus. Our results suggested cortical microstructural impairment in patients with postictal generalized electroencephalographic suppression. The significant surface area reductions in the insular cortex supported the autonomic network involvement in the pathology of postictal generalized electroencephalographic suppression, and its right-sided predominance suggested the potential shared abnormal brain network for postictal generalized electroencephalographic suppression and sudden unexpected death in epilepsy.

P023 Serological markers of intestinal barrier function in patients with primary sclerosing cholangitis after liver transplantation

Abstract Background Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease associated with inflammatory bowel disease. Liver transplantation (LT) is the only curative treatment for most patients with PSC. Recurrence of PSC (rPSC) is a common long-term complication after liver transplantation in this patient group, affecting graft survival and overall patient survival. There are several lines of evidence indicating that dysregulation of the microbiome and gut barrier dysfunction are key etiologic factors in the pathogenesis of PSC. The aim of this study was to evaluate serological markers of intestinal barrier function in patients with PSC after LT and in control group, to determine potential biomarkers for rPSC. Methods This is a cross-sectional study of patients after LT for PSC at the Institute for Clinical and Experimental Medicine, Prague. The control group consists of patients who underwent liver transplantation for alcohol-related liver disease and/or hepatocellular carcinoma. The rPSC was assessed by MRCP and/or liver biopsy according to the Mayo criteria. IBD status was assessed by endoscopy, biopsy, and faecal calprotectin. We performed ELISA for Zonulin and Reg3a. The Kruskal-Wallis and Mann-Whitney test were used to evaluate the statistical differences. Results A total of 85 patients were included in the study after LT for PSC and 56 controls. rPSC was detected in 18 (21.18%) patients. IBD was diagnosed in 77 (90.5%) patients, of which 3 (3.9%) were categorised as Crohn’s disease. The remainder, 82 patients, were classified as ulcerative colitis, 41.9% with right-sided predominance and 24.3% with back-wash ileitis. The IBD treatment consisted of 5-ASA in 58 patients, azathioprine in 12 patients, vedolizumab in 5 patients, anti-TNFa in 1 patient and 9 patients were on 10 mg or more of prednisone or equivalent. MayoDAI was evaluated at the time of the visit with mean 1.74 (SD ±2.06). There was a significant difference in Reg3a levels between patients with IBD and control subjects (p<0.05, Figure 1.). No significant difference in Reg3a levels was found between rPSC patients and controls (p=0.3). Interestingly, Zonulin levels were significantly higher in the control group than in PSC patients with or without IBD (p<0.001). No significant difference in Reg3a and Zonulin was found between PSC and rPSC patients and between patients in remission and with active IBD. Conclusion Reg3a was associated with PSC-IBD in patients with PSC after LT, but its association with rPSC is unclear and should be investigated in a prospective setting. Zonulin reached higher levels in the control group.

Magnetic resonance venography study of venous structures of the transverse-sigmoid sinus region in the Han Chinese population: A cross-sectional study

Objective: Venous structures of the transverse-sigmoid sinus region have been insufficiently studied by magnetic resonance venography, especially in the healthy Han Chinese population. Methods: Magnetic resonance venography data were reconstructed. The relevant parameters were recorded. A paired t-test was used to compare the diameters of the inferior petrous sinus at the origin and termination. An unpaired t-test, a chi-squared test or Fisher’s exact test was used to compare other data. Results: One hundred healthy participants were included. The average age was 36.6 ± 17.1 years, and the ratio of males to females was 1:1. The development of the transverse-sigmoid sinus had a right-sided predominance in 51% of patients. Statistical analysis revealed significant differences ( p < 0.05) in the lengths of bilateral TSs, the lengths of bilateral partial TSs from the torcular to lateral tentorial sinus, the diameters between bilateral TSs at the origin and the lateral tentorial sinus, the diameters between bilateral TS-sigmoid sinus junctions and sigmoid sinus terminations, and the inferior petrous sinus diameters at the origin and termination. Statistical analysis revealed that the right lateral tentorial sinus was more likely to originate from the TS ( p < 0.05). Statistical analysis revealed no significant differences ( p < 0.05) between transverse-sigmoid sinus development and inferior petrous sinus continuity or between transverse-sigmoid sinus development and inferior petrous sinus continuity and bilateral inferior petrous sinus continuity. Conclusions: This study revealed that the right transverse-sigmoid sinus was predominantly larger in diameter, the torcular Herophili tended to deviate to the right, and the right lateral tentorial sinus tended to drain into the TS. The inferior petrous sinus at the origin was thicker than that at the termination, and the right inferior petrous sinus was thicker than the left inferior petrous sinus. transverse-sigmoid sinus development had no effect on inferior petrous sinus continuity, and there was no difference in inferior petrous sinus continuity between the left and right sides.

Commentary on A Patient with Third-Space Fluid Loss.

This is an interesting clinical case highlighting the value of body fluid testing to assist in diagnosing a complex patient presenting with multiple effusions. The clinical presentation of unilateral pleural effusion is usually more suggestive of exudative causes, although bilateral effusion with right-side predominance is observed in transudative effusions. Bilateral leg swelling is observed more often with transudates, such as those caused by heart or liver failure (1). Severe hypoalbuminemia is frequently caused by renal failure associated nephrotic syndrome and/or end stage liver failure associated with reduced synthetic output. Renal and liver impairment were inconsistent with clinical findings until the globin predominance prompted protein electrophoresis, which returned a diagnosis of myeloma as an explanation for severe hypoalbuminemia. It is possible that severe hypoalbuminemia may have contributed to the transudative pleural effusion as well as ascites. The successful chemotherapeutic treatment for myeloma resolved the ascites and presumably the pleural effusion as serum albumin normalized. Lack of measurement of serum or plasma NT-ProBNP makes heart failure a questionable contributor to the transudative effusion, and follow-up may be warranted posttreatment to definitively rule out cardiac disease.

Epidemiological characteristics and distribution of congenital thumb duplication in south China: An analysis of 2,300 thumbs in 2,108 children

The objective of this study was to evaluate epidemiological and anatomical characteristics of children with congenital thumb duplication (CTD). We retrospectively reviewed 2108 children with CTD. Data regarding sex, age at the surgery, laterality, uni- or bilateral involvement, and dominant side were retrieved from the medical charts. Plain radiographs were used to classify all CTD according to Wassel-Flatt, Rotterdam and Chung classification systems and to evaluate the patho-anatomy of the duplication as well as the presence of associated anomaly. A total of 796 girls and 1,312 boys with CTD (n = 2,300 thumbs) met the inclusion criteria. The male to female and unilateral to bilateral ratio were 1.6:1 and 10:1, respectively. Associated anomaly was found in 238/2108 patients (11.3%), and the middle phalanx deformity of the 5th finger was the most common one. A dominant thumb, larger and more developed, was on the ulnar side in 2270/2,300 cases (98.7%).According to the Wassel-Flatt classification, type IV (40.2%) was the most common deformity and the extra thumb was connected to the main thumb by a joint in most cases (437/780); overall, 15.7% of thumbs (n = 360) did not fit the Wassel-Flatt classification.According to the Rotterdam classification, type IV (51.3%) was the most common form; in most cases (363/1180) the thumb was hypoplastic or floating. Overall, 3/2,300 thumbs (0.1%) could not be classified according to Rotterdam classification.According to the Chung classification, type A was the most common subtype (44.1%); in most cases (716/1015) the duplication was at the level of the metacarpal bone. Overall, 2/2,300 thumbs (0.1%) did not fit the Chung classification. In patients from southern China, CTD shows male and right-sided predominance with ulnar-dominant thumb. Abnormalities of the middle phalanx of the 5th finger are more frequent in patients with associated anomaly. The development of a simple and comprehensive classification system is needed to guide treatment and to adequately assess the epidemiological characteristics of patients with CTD in order to facilitate comparison between different patients' populations. III.

Henle Fiber Layer Hemorrhage in Macular Telangiectasia Type 2: Is Right Eye Dominance Coincidence or Consequence?

To summarize all reported cases of Henle fiber layer (HFL) hemorrhage in the absence of subretinal neovascularization (SRNV) in patients with macular telangiectasia type 2 (MacTel2) and to propose a mechanism for the right-sided predominance of this unique presentation. Perspective. Collection, review, and analysis of all cases in the literature and in the authors' databases of HFL hemorrhage in MacTel2, including analysis of baseline and follow-up multimodal retinal imaging findings of selected cases. Elucidation of the complex interplay of systemic venous pressure with the deep retinal capillary plexus and hypothesis regarding the right-sided predilection of HFL hemorrhage complicating MacTel2. Ten patients presented with a unilateral, characteristic radial macular hemorrhage within the HFL that affected only the right eye in all cases. Absence of SRNV was confirmed by fluorescein angiography and/or optical coherence tomography angiography. The hemorrhage resolved spontaneously in at least 7 of the 10 eyes. The HFL hemorrhage may plausibly be explained by dysfunction of the deep capillary plexus in MacTel2 combined with an acute rise in central venous pressure, for which the right side may be at increased risk. HFL hemorrhage can complicate MacTel2 in the absence of SRNV, and the radial pattern of blood affecting only the right eye is remarkable. The right eye predominance may be multifactorial in etiology. Related factors may include the right-sided predilection of MacTel2 and/or increased right-sided dural sinus drainage related to normal anatomical variation.

Bilateral thalamic responsive neurostimulation for multifocal, bilateral frontotemporal epilepsy: illustrative case.

BACKGROUNDPatients with refractory, bilateral, multifocal epilepsy have few treatment options that typically include a combination of antiseizure medications (ASMs) and vagus nerve stimulation (VNS). A man in his 40s presented with epilepsy refractory to a combination of five ASMs plus VNS; he was still experiencing 7–10 seizures per week. His seizure network involved multiple foci in both frontal and temporal lobes. Bilateral depth electrodes were implanted into the centromedian/parafascicular (CM/PF) complex of the thalamus and connected to the responsive neurostimulation (RNS) system for closed-loop stimulation and neurophysiological monitoring.OBSERVATIONSThe patient reported clear improvement in his seizures since the procedure, with a markedly reduced number of seizures and decreased seizure intensity. He also reported stretches of seizure freedom not typical of his preoperative baseline, and his remaining seizures were milder, more often with preserved awareness. Generalized seizures with loss of consciousness have decreased to about one per month. RNS data confirmed a right-sided predominance of the bilateral seizure onsets.LESSONSIn this patient with multifocal, bilateral frontotemporal epilepsy, RNS of the CM/PF thalamic complex combined with VNS was found to be beneficial. The RNS device was able to detect seizures propagating through the thalamus, and stimulation produced a decrease in seizure burden and intensity.

Trends in horizontal periocular asymmetry

ObjectifVérifier s'il existe une prédominance quant à la latéralité dans la dimension horizontale de la région périoculaire. NatureÉtude rétrospective. ParticipantsPatients de plus de 18 ans qui se sont présentés au département d'ophtalmologie d'une seule université. Les critères d'exclusion comprenaient les antécédents de traumatisme ou de chirurgie faciale, d'injections pour des raisons esthétiques ou d'autres interventions touchant la zone périoculaire. MéthodesAprès avoir pris des photos numériques standardisées, on a mesuré les structures périoculaires à l'aide du logiciel ImageJ. La ligne médiane se définissait comme le point central entre les canthus internes. Les distances mesurées comprenaient la distance entre la ligne médiane et le canthus interne, le centre de la pupille, le canthus externe et l'os zygomatique latéral. La largeur de la fente palpébrale a été mesurée en tant que la distance entre le canthus externe et le canthus interne. Les données analytiques ont d'abord porté sur l'ensemble de la cohorte. Par la suite, on a analysé les données en fonction du genre auquel s'identifiaient les patients. RésultatsLes structures périoculaires ont été mesurées chez 83 patients (50 femmes et 33 hommes) dont l’âge moyen se chiffrait à 57,0 ± 16,2 ans (fourchette : 22 à 84 ans). On a observé une tendance d'importance croissante quant à la prédominance droite pour les variables suivantes: de la ligne médiane au centre de la pupille (31,34 mm vs 31,08 mm; p < 0,01), de la ligne médiane au canthus externe (42,57 mm vs 42,23 mm; p < 0,005) et de la ligne médiane à l'os zygomatique latéral (65,70 mm vs 64,01 mm; p < 0,001). ConclusionsL'analyse photographique d'adultes sans antécédents de modification de la zone périoculaire a révélé la présence d'une prédominance droite dans la dimension horizontale en ce qui a trait à la distance entre la ligne médiane et la pupille, le canthus externe et l'os zygomatique, et cette tendance était d'importance croissante. L'asymétrie des mesures périoculaires horizontales était plus fréquente chez les hommes.

Ultrasound-guided hyaluronic acid injection for the treatment of insertional Achilles tendinopathy: A prospective case series

BackgroundHeel pain is a common condition and often involves the Achilles tendon and is classified as insertional or non-insertional. Several operative and non-operative treatments have been described, but there is no consensus on the most effective therapy. The aim of this study is to evaluate a case series of patients with insertional Achilles tendinopathy refractory to conservative treatment submitted to a single-dose ultrasound-guided injection of hyaluronic acid (40 mg/2.0 mL). MethodsWe prospectively included 25 patients (29 feet) who underwent a single ultrasound-guided injection of hyaluronic acid after conservative treatment failure. Clinical outcomes such as pain (using the Visual Analog Scale – VAS), function (using the American Orthopedic Foot & Ankle Society – AOFAS score), personal satisfaction, and complications were evaluated. Statistical analysis was performed using the R software. ResultsMost patients were female (80%) and there was a right-side predominance (55%). The median VAS was 8 points [range 4–10] at baseline, decreasing to 3 points [range 0–8] at the six-month follow-up, with statistical significance (p < .001). The median AOFAS score was 71 points [range 38–87] at baseline, increasing to 90 points [range 48–100] at the six-month follow-up (p < .001). The personal satisfaction level was 69%, and 48% of patients considered the result excellent. There were no Achilles tendon ruptures, infections, or allergic reactions post injection. ConclusionSingle-dose injection of hyaluronic acid is a safe treatment option, improving function and reducing pain for six months in patients with insertional Achilles tendinopathy after conservative treatment failure. Level of evidenceIV, case series.

A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.&lt;/p&gt;

Malignant cardiac tumors: a single-centre 25-year review

Abstract Background Primary cardiac tumors are extremely rare and are usually diagnosed late due to the nonspecific symptoms. Surgery is the main treatment option, and despite chemotherapy, the prognosis remains poor. Cardiac invasion by metastatic tumors, while more common, also entails an unsatisfactory outcome. The aim of this study was to review patients (P) with malignant cardiac tumors that were diagnosed by transthoracic echocardiogram (TTE) or transoesophageal echocardiogram (TOE) in a tertiary center between 1995 and 2020. Methods Retrospective analysis of clinical data, echocardiographic assessment of tumor location and morphology, histology results and survival outcomes. Results A total of 44 malignant cardiac tumors were diagnosed: 12 primary tumors (A) and 32 metastatic tumors (B). A: Regarding primary cardiac tumors, the most common types were angiosarcomas (6), undifferentiated pleomorphic sarcomas (2), fibrosarcomas (2), myxofibrosarcoma (1) and primary cardiac lymphoma (1). The mean age of P at time of diagnosis was 43±15 years, 50% male. The most frequent presentation was heart failure symptoms (50%) followed by arrhythmias (20%). 1 P presented with pruritus and polyarthralgias. On TTE, the most prevalent tumor location was in the right-heart chambers (70%) – mostly the right atrium (50%), with mean dimensions of 40±18x27±11 mm. 85% of P had preserved biventricular systolic function and there was severe pericardial effusion in 38%. The most frequent metastatic involvement at diagnosis was pulmonary (33%) and hepatic (33%). 50% of P were submitted to tumor resection and 40% to chemotherapy. Regarding angiosarcomas, the most common immunohistochemical markers were vimentin, CD31 and CD34. The authors found a mortality rate of 10P (83%) in P with primary cardiac tumors, with a median time to mortality of 5.5 (IQR 2–10) months (Figure 1), in a median follow-up of 6.2 (IQR 2.5–15) months (minimum of 20 days and maximum of 19 years). In the latter case, the P was submitted to heart transplantation after diagnosis of a fibrosarcoma and is still alive and well. B: Regarding secondary cardiac invasion, there was a diagnosis of the following primary tumor sites: 12 lung carcinomas, 7 thymomas, 4 lymphomas, 3 hepatocellular carcinomas, 2 bladder carcinomas, 1 parathyroid carcinoma, 1 soft tissue sarcoma, 1 uterine sarcoma and 1 melanoma. The mean age of P was 57±19 years, 57% male. On TTE/TOE the authors found a right-sided chambers predominance (12 P, 38%) vs left-sided chambers in (8 P, 25%), with pericardial metastasis also present in 13 P (41%). Cardiac tamponade occurred in 6P (19%). The mortality rate was 75% (24P), with a median time to mortality of 1.1 (IQR 0.6–3.8) months (minimum of 7 days, maximum of 44 months), in a median follow-up of 2.3 (IQR 0.8–14) months. Conclusion Cardiac malignant tumors generally present in a late stage with a dismal prognosis. When possible, heart transplantation can be an option with a favourable outcome. Funding Acknowledgement Type of funding sources: None. Figure 1. Kaplan-Meier analysis

Prevalence of arytenoid adduction asymmetry in normophonic speakers: a retrospective study.

This study aimed to assess the incidence and severity of arytenoid adduction asymmetry in normophonic speakers and to identify related demographic characteristics. A retrospective observational clinical study on normophonic patients was conducted. Videos of flexible laryngoscopy of the study group (aged 18 to 45 years) were reviewed. Arytenoid adduction asymmetry, if present, was graded as mild (grade 1), moderate (grade 2) and severe (grade 3). Video recordings of 347 normophonic patients were analysed. The total prevalence of arytenoid adduction asymmetry was 36.4 per cent, with a predominance in males and on the right side. Right-sided predominance was statistically significant (p < 0.01). A total of 60.3 per cent of patients with arytenoid adduction asymmetry had only mild asymmetry, whereas 34.9 per cent had moderate asymmetry. Only 4.8 per cent showed severe asymmetry. Arytenoid adduction asymmetry is found in more than one third of the normophonic population, has significant right-sided preponderance and was more common in males.

A prospective study of surgical management of fractures of proximal femur using proximal femoral nail

Background and Objectives: Proximal third fractures of femur like intertrochanteric and subtrochanteric fractures, are a leading cause of hospital admissions in elderly people. The number of such admissions is on a raise because of increasing life span and sedentary habits. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. This study is done to analyze the surgical management of proximal third fractures of femur using Proximal Femoral Nail. Methods: This is a prospective study of 30 cases of fresh trochanteric and subtrochanteric fractures admitted to Vijayanagar institute of medical sciences Ballari From september 2015 to august 2017. Cases were taken according to inclusion and exclusion criteria i.e., patients with Proximal third fracture femur above the age of 18yrs. Medically unsuitable and patients not willing for surgery were excluded from the study. Results: In our series of 30 cases there were 19 males and 11 females, maximum age of 81 and minimum age of 21 years most of the patients were between 61-80 years. Mean age of 57.4 years. 80% cases were admitted due to slip and fall and with slight predominance of right side. Out of 30 cases, 19 were trochanteric and 11 were subtrochanteric. In trochanteric fractures 36.84% were Boyd and Griffin type 2, in subtrochanteric fractures 27.27% were Seinsheimer type 3a. Mean duration of hospital stay is 15 days and mean time of full weight bearing is 15 weeks. 30 case were followed up. Out 30 cases 19 trochanteric and were 11 subtrochanteric. Good to excellent results are seen in 89.47% of trochanteric fractures and 81.81% subtrochanteric fractures. Overall, we had good to excellent results in 86.66%, fair in 13.33%, we had no case with poor results. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of Peritrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier and exactly performed osteosynthesis.