Anatomy of the glenohumeral ligaments

For many years, there has been controversy regarding the presence of the glenohumeral ligaments; the aim of the present study was to evaluate the detailed anatomy of these ligaments. 140 shoulders were dissected and examined. The detailed anatomy of glenohumeral ligaments was recorded. Data were doubled-entered into the Statistical Package for Social Sciences version 21. Kruskal-Wallis and one way analysis for variance on ranks tests were used: statistical significance was set at p<0.05. The superior glenohumeral ligament was present in all specimens originating from the glenoid labrum anterosuperior aspect, inserting into the lesser tubercle (mean thickness 5.06 mm). The middle glenohumeral ligament was present in 98.57% of specimens arising from the glenoid labrum anterior aspect, inserting into the lesser tubercle (mean thickness 5.97 mm). The inferior glenohumeral ligament anterior band was present in all specimens arising from the glenoid labrum anteroinferior aspect, inserting into the humeral neck anteroinferior aspect (mean thickness 4.41 mm). The inferior glenohumeral ligament posterior band was observed in 79.28% of specimens arising from the posteroinferior aspect of the glenoid labrum, inserting into the humeral neck posteroinferior aspect: its mean thickness was 3.45 mm. this study concludes that the superior glenohumeral ligament was observed in all specimens. The middle glenohumeral ligament was seen in 98.57%. An anterior band of the inferior glenohumeral ligament was present in all specimens, while a posterior band was present in 79.28%. A tuberculohumeral ligament was seen in 54.83% of specimens. The present observations should encourage evaluation of the function of this ligament

What is the impact of diabetes mellitus on radiation induced acute proctitis after radical radiotherapy for adenocarcinoma prostate? A prospective longitudinal study

Background: Long-term complications of diabetes include cardiovascular disease, retinopathy, nephropathy, and neuropathy. Diabetic patients with prostate cancer could be at a high risk of radiation-induced acute proctitis following radical radiotherapy. Our aims were to analyse the incidence, severity, and duration of radiation proctitis in diabetic patients treated by radical radiotherapy and combined androgen deprivation for prostate cancer. Material and methods: On the bases of inclusion and exclusion criteria 716 patients with prostate cancer were retrospectively recruited. Patients were stratified into diabetic patients and non-diabetic patients. The incidence, severity, and duration of proctitis were the main outcomes. A polynomial ordered logistic regression was fitted to determine the influence of diabetes status, age, blood pressures medication, co-morbidities, Gleason score, PSA after treatment, and tumour stage on the grades of proctitis. Time to resolution per year was modelled as a negative binomial generalised linear model. Results: The overall mean age of patients was 67.44 (SD 6.77) years with a follow-up time of 3.36 (SD 2.05) years. Data exploratory analysis suggested that the only highly significant explanatory variable was the presence or absence of diabetes. Polynomial ordered logistic regression, however, showed that the presence (or not) of diabetes remained as the only significant predictor (t = −2.74; p = 0.0059) of severity of proctitis. A negative binomial generalised linear model showed that both grade of proctitis (z = −17.178; p < 0.001), and diabetes (z = −5.92; p < 0.001), were highly significant predictors of time to resolution. Conclusions: Diabetic patients were significantly more likely to have proctitis after radical radiation therapy for prostate cancer. Diabetes was significantly associated with an induced risk of radiation induced proctitis and also with deceleration of its resolution. Keywords: Prostate cancer, Diabetes mellitus, Proctitis, Radiotherap

Diagnostic accuracy of image guided biopsies in small (&lt;4cm) renal masses with implications for active surveillance:A systematic review of the evidence

The objective of this study was to determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only < 4cm using a 3 x 2 table intention-to-diagnose approach. The 3 x 2 table approach examines indeterminate results as a separate category, rather than pushing these through traditional a 2 x 2 table (four-cell matrix) approach. A highly sensitive search was performed in the Cochrane Library Database of Abstracts of Reviews of Effects, MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966 to 2016). The search sought the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM < 4cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using a conventional 2 x 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 x 2 table for pooled estimates of the sensitivity and specificity. A total of twenty studies were included, with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using a 2 x 2 table observed sensitivity 0.952 (confidence interval (CI) 0.908-0.979) and specificity 0.824 (CI 0.566-0.962). Using the 3 x 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. In conclusion, renal tumour biopsy in SRMs < 4cm is associated with a high diagnostic sensitivity, but poor specificity when non-diagnostic results are included by a 3 x 2 table for analysis (intention-to-diagnose approach). The risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study, appropriately powered for diagnostic accuracy using valid reference standards

BILATERAL FORAMINA ON THE POSTERIOR ARCH OF THE ATLAS. Foramina bilateral en el arco posterior del atlas

Durante la disección de la región cervical de diez cadáveres (5 varones y 5 mujeres, con edad media de 81,66 años) de una población de Escocia, se observaron dos especímenes con canales bilaterales de las arterias vertebrales y otro ejemplar con un canal vertebral unilateral en el arco posterior del atlas (C1). En estas muestras, se observó que la tercera parte de las arterias vertebrales pasan a través del foramen accesorio ubicado en el arco posterior del atlas. Anomalías del atlas y la arteria vertebral no son comúnmente reportadas en la literatura; sin embargo, son importantes debido a su importancia en el diagnóstico y tratamiento clínico. Forámenes bilate-rales en el arco posterior de C1 no se han informado anteriormente en una población escocesa. Para los neurocirujanos y radiólogos la presencia de este rasgo no métrico es importante a la hora de realizar operaciones o en la interpretación de esta zona de la anatomía. During dissection of the cervical region of ten cadavers (5 males, 5 females: mean age 81.66 years) from a Scottish population, two specimens were observed to have bilateral vertebral artery canals and a further specimen had a unilateral vertebral canal on the posterior arch of the atlas (C1): in these specimens the third part of the vertebral artery passed through the accessory foramen. Anomalies of the atlas and vertebral artery are not commonly reported in the literature; however they are important due to their significance in clinical diagnosis and treatment. Bilateral foramina in the posterior arch of C1 have not been previously reported in a Scottish population. The presence of this non-metric trait is important for neurosurgeons and radiologists who may be operating on or interpreting this area of anatomy

THE COEXISTENCE OF ILIACUS MUSCLE VARIATION AND FEMORAL NERVE SPLIT: A CASE REPORT AND POSSIBLE CLINICAL IMPLICATIONS La coexistencia de la variación del músculo ilíaco y de la división del nervio femoral: Reporte de caso y posibles repercusiones clínic

The iliacus muscle variation and coexisting femoral nerve split were discovered during routine anatomical dissection of iliac fossae in an embalmed cadaver. Careful dissection revealed abnormal branching of the femoral nerve around a muscular slip of iliacus, named iliacus minimus. We reason that the coexistence of a femoral nerve split with aberrant muscular slips increases the chance of nerve compression. The findings reported here support many other cases of unusual femoral nerve branching and highlight the impact on diagnostic testing, imaging, and treatment of pathology within the iliac compartment. Understanding and recognising anatomical variation is critical for medical specialists and educators, particularly anatomists, radiologists, and surgeons in order to improve medical practice;La variación de músculo del ilíaco coexistiendo con la división del nervio femoral fueron descubiertos durante la disección anatómica rutinaria de la Fosa ilíaca en un cadáver fijado. La disección cuidadosa reveló una ramificación anormal del nervio femoral alrededor de una división accesoria del musculo iliaco, llamado iliacus minimus. Razonamos que la coexistencia de una ramificación del nervio femoral con divisiones musculares aberrantes aumenta la posibilidad de compresión del nervio. Los resultados publicados aquí apoyan muchos otros casos de ramificación del nervio femoral inusuales y destacan la relevancia en las pruebas diagnósticas, los métodos por imágenes y el tratamiento de la patología dentro de la fosa iliaca. Comprender y reconocer las variaciones anatómicas son fundamentales para médicos especialistas y docentes, particularmente anatomistas, radiólogos y cirujanos con el fin de mejorar la práctica médica

THE GLENOID NOTCH AND ITS CLINICAL IMPLICATIONS. La muesca glenoidea y sus implicaciones clínicas.

A notch is often observed on the anterosuperior aspect of the glenoid fossa, however its association with gender remains unexplored. The aims of this study were to: (i) investigate the incidence and type of glenoid notch, and (ii) its association with gender, age and side. A total of 140 shoulders from 30 male and 40 female cadavers were examined. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were removed to expose the glenoid fossa: the presence of a notch was classified as type I (mild), type II (moderate) or type III (severe). The mean age of specimens was 81.5 years (±9.8 years). A type III notch was the most commonly observed (32 male, 21 female specimens), followed by type I (14 male, 34 female specimens) and finally type II (14 male, 25 female specimens). Multivariate analysis showed that the type of glenoid notch was significantly associated with gender (?2 (2, n=140) = 11.088, p = 0.004). Females are significantly more likely to have a type I or II glenoid notch, while males are significantly more likely to have a type III notch. This difference could explain the higher incidence of shoulder dislocation in males compared to females.  A menudo se observa una muesca en el lado anterosuperior de la fosa glenoidea, sin embargo su relación con el sexo sigue siendo inexplorada. Los objetivos de este estudio fueron: (i) investigar la incidencia y el tipo de muesca glenoidea, y (ii) su relación con el sexo, la edad y el lado en el que se observa. Se examinaron un total de 140 hombros de entre 30 cadáveres masculinos y 40 femeninos. Todos los músculos y vasos sanguíneos que rodean la articulación glenohumeral, así como la cápsula fibrosa, fueron retirados para permitir el acceso a la fosa glenoidea: la presencia de la muesca fue clasificada como tipo I (leve), tipo II (moderado) o tipo III (grave). La edad media de los especímenes examinados fue de 81,5 años (± 9,8 años). La muesca de tipo III fue la más comúnmente observada (32 varones, 21 hembras), seguida por la muesca de tipo I (14 varones, 34 hembras) y finalmente seguida de la de tipo II (14 varones, 25 hembras). El análisis multivariado mostró que el tipo de muesca glenoidea está significativamente relacionado con el sexo (?2 (2, n = 140) = 11.088, p = 0.004). Las mujeres son significativamente más propensas a presentar una muesca glenoidea de tipo I o II, mientras que los varones son significativamente más propensos a presentar una muesca de tipo III. Esta diferencia podría explicar la mayor incidencia de luxación de hombro que se produce en los varones en comparación con la que se produce en las mujeres.