Changes In angulation and phalangeal length of fingers and thumbs following surgical treatment for congenital clinodactyly

INTRODUCTION: Congenital clinodactyly is a condition characterized by the deviation of a digit or digits in the coronal plane. Angulation is often due to the presence of a delta phalanx. There is a scarcity of long-term data regarding the results of surgical treatment for clinodactyly, particularly with respect to postoperative phalangeal growth and risk factors for recurrent deformity. METHODS: Our retrospective study involved the analysis of data from medical records of patients who had corrective surgery for congenital clinodactyly. We also measured radiographs to quantify the angle of deviation and the longitudinal lengths of the surgically corrected phalanx and corresponding metacarpal. Clinodactyly was defined as radiographic angulation of 10° or greater in the coronal plane. Recurrence was defined as a final angulation of 10° or greater as well as an increase of at least 10° compared with the immediate postoperative measurement. The primary ratio was defined as the ratio of the length of the primary ossification center of the surgically corrected phalanx to the length of the primary ossification center of the corresponding metacarpal. The secondary ratio was the ratio of the length of the primary and secondary ossification centers together of the corrected phalanx to those of the metacarpal. Comparisons were made between preoperative, postoperative, and most-recent follow-up values. Postoperative data was restricted to radiographs taken within three months after surgery. Final follow-up data was initially permitted if radiographs were taken at least one year after surgery. Additional analysis was performed of patients with a minimum of two years clinical and radiographic follow-up. RESULTS: There was a significant decrease in angulation with surgery and a significant increase in angulation postoperatively (p<0.001; p<0.01). Overall, the mean preoperative and final digital angulation was 40.4° and 17.4°, respectively, when a two-year minimum between the time of surgery and final follow-up measurements was implemented. This resulted in a significant average correction of 23.3° (p<0.001). The postoperative change in angulation was found to be significantly different depending on the surgical technique used. Digits corrected with reverse wedge osteotomies showed little to no change in angulation during the postoperative period. However, digits corrected with closing wedge osteotomies showed a significant increase in angulation between the immediate postoperative and final follow-up measurements (p=0.007). The rate of recurrence was 43.2% (95% CI: 28.7-58.9% with a one year minimum for follow-up; 95% CI: 27.5-60.4% with a two year minimum for follow-up). Postoperative changes in angulation or recurrence were not significantly associated with gender, patient age at the time of surgery, the type of digit corrected, coexisting congenital syndromes, or the presence of additional hand abnormalities. The primary ratio decreased significantly with surgery, from 0.35 preoperatively to 0.27 postoperatively (p=0.03). The primary ratio then increased significantly over time to 0.40 when there was a two-year minimum between the time of surgery and final follow-up. There was an insignificant change in primary ratio from immediately after surgery to final follow-up when data as early as one year postoperatively was included. The secondary ratio did not change significantly with surgery or during the postoperative period regardless of whether one or two-year time restrictions were in place. The mean secondary ratio was 0.29 before surgery, 0.25 immediately after surgery, and 0.33 at the time of final follow-up at least two years after surgery. CONCLUSIONS: Surgery to correct clinodactyly effectively decreases angulation of the digit, despite the risk of recurrent deformity over time. Our study did not identify any factors associated with recurrence. However, there was a significant difference in the change in angulation between the immediate postoperative and final follow-up measurements depending on the surgical technique used. Surgery to correct clinodactyly does not hinder postoperative growth of the corrected phalanx

Computer-assisted radiographic calculation of spinal curvature in brachycephalic "screw-Tailed" dog breeds with congenital thoracic vertebral malformations: reliability and clinical evaluation

The objectives of this study were: To investigate computer-assisted digital radiographic measurement of Cobb angles in dogs with congenital thoracic vertebral malformations, to determine its intra- and inter-observer reliability and its association with the presence of neurological deficits. Medical records were reviewed (2009–2013) to identify brachycephalic screw-tailed dog breeds with radiographic studies of the thoracic vertebral column and with at least one vertebral malformation present. Twenty-eight dogs were included in the study. The end vertebrae were defined as the cranial end plate of the vertebra cranial to the malformed vertebra and the caudal end plate of the vertebra caudal to the malformed vertebra. Three observers performed the measurements twice. Intraclass correlation coefficients were used to calculate the intra- and inter-observer reliabilities. The intraclass correlation coefficient was excellent for all intra- and inter-observer measurements using this method. There was a significant difference in the kyphotic Cobb angle between dogs with and without associated neurological deficits. The majority of dogs with neurological deficits had a kyphotic Cobb angle higher than 35°. No significant difference in the scoliotic Cobb angle was observed. We concluded that the computer assisted digital radiographic measurement of the Cobb angle for kyphosis and scoliosis is a valid, reproducible and reliable method to quantify the degree of spinal curvature in brachycephalic screw-tailed dog breeds with congenital thoracic vertebral malformations

Knowledge, attitude and perception on radiation imaging among children's caregivers in the pediatric dental clinic

OBJECTIVE: Nuclear medicine provides important clinical information for diagnostic and therapeutic purposes. Use of medical imaging has gradually increased in the United States and this has raised health concerns about the potential future risks associated with radiation exposure in children. While studies have evaluated the adverse effects of imaging procedures, there is insufficient evidence about communicating radiation risks. The overall purpose of this paper is to review radiation risks in pediatric imaging using published evidence by the World Health Organization and to evaluate the knowledge and attitude of caregivers towards radiation risks in pediatric imaging. Specifically, we aim to determine whether an educational brochure improves parental knowledge of radiation and/or changes in attitude and perception to allow their children to undergo dental radiographs. METHODS: A prospective sample survey was performed of caregivers who presented with their child to the Boston University Pediatric Oral Healthcare Center. Parents or legal guardians (18 years or older) who accompanied a child were eligible for inclusion and approached for enrollment. Pre- and post-survey questionnaires were used to evaluate parents’ or guardians’ level of knowledge and attitude about the risks and benefits of dental radiographs. Parents were also asked their comfort level to allow their child to undergo dental radiographs. After completing the pre-survey questionnaire, parents were asked to read the English-language informational handout. Statistical analysis was performed through Microsoft Excel 2013. Descriptive analysis was conducted to summarize the survey responses. RESULTS: Among 30 parents who were surveyed, a small proportion (30%) of parents were very comfortable with dentist using dental radiographs on their child, versus 57% after reading the handout. Results showed that the informational handout improved the parental knowledge of risks and benefits of ionizing radiation. Most parents indicated that the handout was helpful and they reported increased level of comfort and willingness in their children receiving radiation imaging during dental treatment procedures. DISCUSSION: Educating parents or caregivers through an informational handout is a helpful resource in improving their knowledge and in relieving their concerns. Informing parents about the risks of ionizing radiation does not change parental willingness for their children to undergo dental radiographs

Retrospective study of the association between neutering status and changes secondary to degenerative mitral valve disease

Dissertação de Mestrado Integrado em Medicina VeterináriaMyxomatous mitral valve disease is the most common cardiovascular disease reported in dogs. Although many patients may remain asymptomatic, some of them progress to left-sided congestive heart failure and develop clinical signs. Little has yet been published regarding the possible influence of the neutering status on changes secondary to myxomatous mitral valve disease. This study aims to assess a possible correlation between neutering status and myxomatous mitral valve disease. A retrospective study was conducted and included all the cases diagnosed with myxomatous mitral valve disease, consulted at the Cardiology service of the University of Liverpool. To help assess the association between neutering status and cardiac remodelling, dogs were categorized into four groups: FE (female entire), FN (female neutered), ME (male entire) and MN (male neutered). Retrospective review of echocardiographic data, signalment, and underlying diseases were performed. Echocardiographic measurements were made through offline analysis. Echocardiographic measurements were then compared between groups. Five hundred and eighty-two dogs (n = 582) were included: female entire (n = 24), female neutered (n = 235), male entire (n = 115) and male neutered (n = 208). Left ventricular internal diameter at end diastole (LVIDd), left atrial dimension to the aortic root diameter (LA:Ao) and left atrium maximal dimension to the aortic root dimension (LAmax:Ao) were significantly different between ME and MN, with ME dogs presenting higher mean values for LVIDd and higher median LA:Ao and LAmax:Ao measurements. Left ventricular internal diameter at end systole (LVIDs) was not significantly different between ME and MN. There were no significant differences between FE and FN groups. This study shows that neutering status may influence the development of myxomatous mitral valve disease in male dogs and that entire male dogs could be at higher risk of developing cardiac remodelling secondary to myxomatous mitral valve disease. On the other hand, neutering status doesn’t seem to have an influence on disease progression in female dogs.RESUMO - Estudo retrospetivo da associação entre a esterilização e alterações secundárias à doença mixomatosa da válvula mitral - A doença mixomatosa da válvula mitral é a doença cardiovascular mais prevalente em cães. Apesar da maior parte dos pacientes permanecerem assintomáticos, alguns podem progredir para insuficiência cardíaca esquerda e desenvolver sinais clínicos. Até hoje, existem poucas publicações sobre o possível efeito que a esterilização possa ter no desenvolvimento da doença mixomatosa da válvula mitral. O objetivo deste estudo é avaliar se existe de facto uma relação entre a esterilização e a doença mixomatosa da válvula mitral. Foi realizado um estudo retrospetivo que incluiu todos os casos diagnosticados com doença mixomatosa da válvula mitral consultados no serviço de Cardiologia da Universidade de Liverpool. Para avaliar a relação entre a esterilização e a presença de remodelação cardíaca, os cães foram categorizados em quatro grupos: FE (fêmeas inteiras), FN (fêmeas esterilizadas), ME (machos inteiros) e MN (machos castrados). A história pregressa e os dados ecocardiográficos dos animais foram revistos retrospetivamente e as medidas ecocardiográficas foram obtidas por medição offline. Estas medições foram depois comparadas entre os diferentes grupos. Quinhentos e oitenta e dois cães (n = 582) foram incluídos: fêmeas inteiras (n = 24), fêmeas esterilizadas (n = 235), machos inteiros (n = 115) e machos castrados (n = 208). Nos resultados obtidos, o diâmetro interno do ventrículo esquerdo no final da diástole (LVIDd), o rácio átrio esquerdo-aorta (LA:Ao) e o rácio diâmetro máximo do átrio esquerdo-aorta (LAmax:Ao) foram estatisticamente significativos entre machos inteiros e machos castrados. Os machos inteiros apresentaram não só um LVIDd médio superior, como também uma mediana de LA:Ao e LAmax:Ao superior aos machos castrados. Ao mesmo tempo, o diâmetro interno do ventrículo esquerdo no final da sístole (LVIDs) não mostrou ser estatisticamente significativo entre machos inteiros e machos castrados e nenhum dos parâmetros ecocardiográficos anteriormente referidos revelou ser estatisticamente significativo entre fêmeas inteiras e fêmeas esterilizadas. Este estudo demonstra que a esterilização poderá influenciar o desenvolvimento da doença mixomatosa da válvula mitral e que os cães machos inteiros poderão apresentar um maior risco de desenvolver remodelação cardíaca secundária a esta doença. No entanto, a esterilização não aparenta influenciar a progressão desta doença em cadelas.N/

Therapeutic ultrasound as an aid in tibial fracture management in a dog

A six-year-old, male, neutered Bernese mountain dog was presented with acute left hind limb lameness. Based on the symptoms, orthopedic examination and radiographic evaluation, a cranial cruciate ligament rupture was diagnosed. Surgical treatment with TTA Rapid was performed with good result. At two weeks postoperatively, the dog developed a fracture of the proximal tibia, due to excessive activity. Conservative treatment consisting of a splint and rest was advised. Physiotherapeutic ultrasonography and exercises were started to stimulate bone healing. After eight sessions, the dog was clinically much better, and radiographs showed a good evolution with a clear callus. Follow-up controls confirmed the progressive evolution

Medical imaging analysis with artificial neural networks

Given that neural networks have been widely reported in the research community of medical imaging, we provide a focused literature survey on recent neural network developments in computer-aided diagnosis, medical image segmentation and edge detection towards visual content analysis, and medical image registration for its pre-processing and post-processing, with the aims of increasing awareness of how neural networks can be applied to these areas and to provide a foundation for further research and practical development. Representative techniques and algorithms are explained in detail to provide inspiring examples illustrating: (i) how a known neural network with fixed structure and training procedure could be applied to resolve a medical imaging problem; (ii) how medical images could be analysed, processed, and characterised by neural networks; and (iii) how neural networks could be expanded further to resolve problems relevant to medical imaging. In the concluding section, a highlight of comparisons among many neural network applications is included to provide a global view on computational intelligence with neural networks in medical imaging

A Technique for Standardized Evaluation of Soft and Hard Peri-Implant Tissues in Partially Edentulous Patients

Background: There is a growing need to evaluate the esthetics of implant-supported crowns and bridges. An important tool for such an evaluation is standardized assessment of the soft and hard peri-implant tissue levels. Methods: A simple acrylic device has been developed for reliable and reproducible assessment of soft and hard peri-implant tissues using standardized color slides and standardized dental x-rays. With this device, changes in both the soft and hard tissues around implant-supported crowns can be evaluated as a function of time. The reproducibility of the technique was tested on color slides as well as on dental x-rays in a series of implant-supported crowns and their neighboring teeth. Results: The reproducibility of this technique was excellent. The measuring errors for repeated measurements of the soft and hard tissues were 0.14 +/- 0.02 mm and 0.13 +/- 0.01 mm, respectively. Conclusions: The device is a reliable tool to assess changes in both soft and hard tissues around crowns and implants over time. Likewise, it is suggested that this technique also can be used to objectively assess soft and hard tissue changes around natural teeth with or without prosthetic restorations

Diagnosis and Treatment of Children with a Radiological Fat Pad Sign without Visible Elbow Fracture Vary Widely:An International Online Survey and Development of an Objective Definition

Children often present at the emergency department with a suspected elbow fracture. Sometimes, the only radiological finding is a ‘fat pad sign’ (FPS) as a result of hydrops or haemarthros. This sign could either be the result of a fracture, or be due to an intra-articular haematoma without a concomitant fracture. There are no uniform treatment guidelines for this common population. The aims of this study were (1) to obtain insight into FPS definition, diagnosis, and treatment amongst international colleagues, and (2) to identify a uniform definition based on radiographic measurements with optimal cut-off points via a receiver operating characteristic (ROC) curve. An online international survey was set up to assess the diagnostic and treatment strategies, criteria, and definitions of the FPS, the probability of an occult fracture, and the presence of an anterior and/or posterior FPS on 20 radiographs. Additionally, the research team performed radiographic measurements to identify cut-off values for a positive FPS, as well as test–retest reliability and inter-rater reliability via intraclass correlation coefficients (ICC). A total of 133 (paediatric) orthopaedic surgeons completed the survey. Definitions, further diagnostics, and treatments varied considerably amongst respondents. Angle measurements of the fat pad as related to the humeral axis line showed the highest reliability (test–retest ICC, 0.95 (95% CI 0.88–0.98); inter-rater ICC, 0.95 (95% CI 0.91–0.98)). A cut-off angle of 16° was defined a positive anterior FPS (sensitivity, 1.00; specificity, 0.87; accuracy, 99%), based on the respondents’ assessment of the radiographs in combination with the research team’s measurements. Any visible posterior fat pad was defined as a positive posterior FPS. This study provides insight into the current diagnosis and treatment of children with a radiological fat pad sign of the elbow. A clear, objective definition of a positive anterior FPS was identified as a ≥16° angle with respect to the anterior humeral line