Superior Lateral Quadrant Research Articles

The biomechanical effects of femoral neck shortening on femoral head and neck

Objective Using finite element analysis to study how the biomechanics of femoral head and neck changes after neck shortening, and discuss the mechanism of obvious higher osteonecrosis of the femoral head (ONFH) rate in femoral neck shortening cases. Methods MIMICS was used to build three femoral neck fracture models with Pauwells angle of 70 degrees. The neck lengths of the three models respectively were normal, 2.5 mm shortened and 5.0 mm shortened. Every model was assembled with 3 hollow screws, and imported into the finite element analysis software ABAQUS. The stress change of femoral head and neck was analyzed by loading and restraint. Results When the femoral neck length was normal, 2.5 mm shortened and 5.0 mm shortened, the maximal tensile stress of hollow screws in upper part of the femoral neck was 15.7, 14.1 and 12.4 mPa, and the compressive stress of lower part of femoral neck was 20.2, 19.1 and 17.8 mPa, respectively. Meanwhile, the high stress bearing district was transfered to right above the femoral head from its superior lateral quadrant, and the maximum stress of non-main stress bearing district was 10.6, 12.8 and 17.2 mPa respectively. Conclusion The femoral neck shortening reduces the proximal femoral eccentricity. It doesn’t affect the stabilities of internal fixation and fracture ends, but it transfers the stress bearing district of femoral head and causes the forming of high stress bearing district in non-main stress bearing district. Key words: Femoral neck fracture; Femoral neck shortening; Biomechanics

The distribution of lymph nodes and their nutrient vessels in the groin region: an anatomic study for design of the lymph node flap.

The groin lymph node flap transfer has been used for treatment of extremity lymphedema. The design of this flap is based on the superficial circumflex iliac artery/vein (SCIA/V), or superficial inferior epigastric artery/vein (SIEA/V). The purpose of this study is to delineate the distribution of lymph nodes in the groin area and their relationship to inguinal vessels by the use of multidirector-row CT angiography (MDCTA). MDCTA was performed in 52 patients who underwent the deep inferior epigastric perforator (DIEP) flap or transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction. The MDCTA data were used to analyze the locations of lymph nodes and their adjacent vascular vessels. The groin region was divided into the superior lateral (I), superior medial (II), inferior lateral (III), and inferior medial (IV) quadrants based on the point where SCIV joined into great saphenous vein. The number of lymph nodes in each of the four quadrants was counted and the dominant vessels were observed. The mean number of lymph nodes in quadrants I-IV were 3.3 ± 1.6, 2.0 ± 1.2, 1.5 ± 1.3, and 1.9 ± 1.4, respectively. The difference between the four quadrants was statistically significant (P < 0.001). In quadrant I, the appearance rate of SCIA was 100% while SIEA was 6.6%. In quadrant II, no SCIA was observed but the appearance rate of SIEA was 78.0%. There were neither SCIA nor SIEA observed in quadrants III and IV. The superior lateral quadrant of the groin region was found to have the most lymph nodes. The superficial circumflex iliac vessels are the major sources for blood supply to this region. The findings from this study provide evidence for the clinical design of the lymph node flap from the groin area.

Orbital lymphomas: Clinical and radiological features

The purpose of this prospective study was to evaluate the clinical and radiological features of a consecutive series of orbital lymphomas in two Institutions in the North West of Italy.A prospective study was performed of all cases of diagnosed orbital lymphomas. Data on patient demographics, symptoms and clinical findings, histological type of lymphoma, site of lesion, imaging, and systemic involvement were recorded in each case. The mean age of the enrolled 20 patients was 63.65 years. Most orbital lymphomas were located in the superior-lateral quadrant. Superior rectus muscle was the most frequently involved orbital structure. Most patients were affected by extranodal marginal-zone lymphomas. The diagnosis of orbital lymphomas may be challenging, because these neoplasms present few specific features. Although not typically performed by the maxillofacial surgeon, an understanding of the staging process is crucial for multidisciplinary management of orbital lymphomas.

Orbital lymphoma: imaging features and differential diagnosis

PurposePatterns of orbital lymphoma at diagnosis and follow-up are described. We also discuss differential diagnosis of orbital masses.Materials and methodsThis pictorial review contains 19 cases of orbital lymphoma before and after treatment. Superior-lateral quadrant and extra-conal location were observed predominantly. Effective response after treatment was presented on follow-up imaging, although few local relapses were found. Further follow-up showed no changes of residual images.DiscussionLocation of orbital masses can help in the differential diagnosis. Moreover, imaging features of lymphoma at diagnosis can be useful in planning surgical biopsy. Pattern of follow-up described may be relevant on monitoring imaging.Teaching points• Orbital lymphoma involves mainly superior-lateral quadrant and the orbital structures inside.• Location of retrobulbar mass-like lesions are useful information in the differential diagnosis.• Satisfactory response is detected after treatment, however relapse is noted, so follow-up is needed.

Estudo descritivo dos casos de câncer de mama em Goiânia, entre 1989 e 2003

To describe cases of breast cancer in women living in Goiânia from 1989-2003. We conducted a retrospective, descriptive stud, which included all cases of breast cancer occurring in residents of Goiânia, identified by the Population-Based Cancer Registry of Goiânia (RCBPGO) in the period from 1989 to 2003. The variables were: age, method of diagnosis, topographic location, morphology and extent of breast cancer. We used frequencies and percentage rates, and Poisson regression to determine the annual percentage change (APC). We identified 3204 cases of breast cancer. The most frequent topographic location was the superior-lateral quadrant (53.7%). Infiltrating ductal carcinoma (IDC) was the most frequent, with 2582 cases (80.6%), followed by infiltrating lobular carcinoma (ILC), with 155 cases (4.8%). There was a significant increase of both the IDC and the ILC, with APCs of 11.0% and 15.4%, respectively. The ratio between IDC and ILC was not influenced by age (p = 0.98). As for tumor extent at diagnosis, 45.6% were located in the breast, and the APC was 16.1% (CI = 12.4 to 20.0, p <0.001). There was a trend of APC reduction of metastatic cases (-3.8, CI = -8.6 to 1.2, p = 0.12). The topographical location and histological type of breast cancer in the city of Goiania followed the pattern of other countries. The main morphological types were not influenced by age. There was a large increase in initial cases.

Venous drainage of the soleus muscle

Soleus veins have been implicated as the site for deep venous thrombosis initiation. Detailed anatomic knowledge is required for the early diagnosis using non-invasive ultrasound techniques. In the present work, we describe the anatomy of the veins that emerge from the ventral face of the soleus muscle. Twenty-eight soleus muscles were dissected and 543 veins were found. The number of veins per leg ranged from 7 to 38. The distribution of these veins per quadrant ranged from 0 to 12. The greatest number of veins occurred at the superior lateral quadrant. Most soleus veins mainly drained into the posterior tibial and fibular veins. The mean length of the soleus veins ranged from 0.907 to 2.804 cm. We conclude that there is a wide variability in the distribution of soleus veins through the soleus muscle and their quadrants. The majority of the soleus veins drain into the tibial and fibular veins.

Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine.

Knowledge of the relevant anatomy is important when developing a strategy for introducing screws into the lateral masses to secure internal fixation devices. This paper defines key bony landmarks and their relationship to critical neurovascular structures and identifies a location for safe placement of cervical articular pillar (lateral mass) screws. Measurements of anatomical landmarks in 10 spines from human cadavers aged 61 to 85 years were made by caliper and a metric ruler. Landmarks were the lateral facet line, rostrocaudal line, medial facet line, intrafacet line, and medial facet line-vertebral artery line. The average distances and ranges were recorded. Such great variance existed in measurements from spine to spine and within the same spine as to render averages clinically unreliable. Dissection revealed that division of the articular pillar into four quadrants leaves one, the superior lateral quadrant, under which there are no neurovascular structures; this may be considered the "safe quadrant" for placement of posterior screws and plates.

Congenital Cholesteatomas of the Middle Ear in Children: Origin and Management

Cholesteatomas (epidermoids) of the middle ear appearing medial to a normal tympanic membrane are identified in increasing numbers of young children. The evidence that these lesions are congenital in origin includes the young mean age of presentation, the normal appearance of the middle ear mucosa in almost all cases of small lesions, normal mastoid pneumatization documented by computerized tomography, the relatively large number of children with associated minor or major congenital malformations, and the consistent 3:1 ratio of males to females with the disorder in all of the large series reviewed. A direct relationship between congenital cholesteatomas (epidermoids) of the middle ear and the epidermoid formation is supported by the position of the epidermoid formation at a histologic transition zone in the anterior superior lateral quadrant of the tympanic cavity, which is also the site of greatest occurrence of congenital cholesteatomas. The epidermoid formation may not always involute and as it expands it would be expected to become visible medial to the tympanic membrane in the anterior superior quadrant. It seems evident that as the congenital cholesteatoma expands it can block the eustachian tube; during a bout of otitis media the tympanic membrane could perforate and the cholesteatoma could become secondarily infected. The congenital cholesteatoma in this situation would be difficult or impossible to distinguish from the more common acquired type.

Herniation pits of the femoral neck: appearance at MR imaging.

Herniation pits of the femoral neck are benign lesions recognized because of their characteristic appearance and location on plain radiographs. The appearance of this lesion in seven magnetic resonance (MR) examinations of the hips in five patients is described. MR revealed a well-marginated, round to oval defect in the superior lateral quadrant of the femoral neck with anterior cortical extension in all cases. With T1 weighting the signal intensity within each lesion was uniformly low. All but one case revealed a peripheral margin of absent signal intensity on T2-weighted and out-of-phase images. The MR appearance and location are sufficiently characteristic to allow identification of this lesion and aid in differentiating it from pathologic processes such as avascular necrosis, with which it may be confused.

The early roentgenographic changes in essential coxa plana: their significance in pathogenesis.

THE EARLY ROENTGENOGRAPHIC CHANGES IN ESSENTIAL COXA PLANA; THEIR SIGNIFICANCE IN PATHOGENESISJOHN CAFFEY, M.D.Audio Available | Share