Clinical Implication of Os subfibulare

Category: Ankle, Sports, Trauma Introduction/Purpose: Os subfibulare, defined as a separated ossicle of the distal fibular, has been linked to various clinical problems such as subfibulare pain and chronic lateral ankle instability. However, whether os subfibulare is congenital or traumatic remains unclear. The objectives of this study were: 1) to determine the incidence of os subfibulare development after ankle sprain in children and adolescents in a single primary care orthopedic clinic, and 2) to evaluate clinical implication of os subfibulare associated with ankle sprain in children and adolescents Methods: Among 896 pediatric patients (age ranging from 3 to 16 years) who visited a single primary care unit after sustaining ankle inversion injury, 627 patients who were followed up for over 2 weeks were included in this study. For each pediatric patient, physical examination and radiographic examination (anteroposterior, lateral, and mortise view of the bilateral ankle) were performed. The incidence of os subfibulare was evaluated based on initial radiographic examination. To analyze the incidence of new os subfibulare formation after ankle inversion injury, radiographs of 193 patients who were followed up for more than 6 months were evaluated according to the grade of injury. Results: At initial visit, 1% of examined ankles (13 from 1,254 ankles of 627 patients) showed well corticated ossicle not related to initial injuries. We cannot recognize the existence of accessory ossification center of the fibula in our study population. Overall incidence of os subfibulare at final follow up after ankle inversion injury was 23.9% (150/627). Os subfibulare at final follow up was correlated with initial injury grade (OR: 8.0, p = 0.001). In patients with initial avulsion fragment, 64.9% (61/94 cases) had residual ossicle at the final radiograph after being followed up for more than 6 months. As for the morphology of ossicle, 54 cases with wafer bone fragment at the time of initial injury showed oval or round shape ossicles at final radiograph. Conclusion: The incidence of os subfibulare at the initial radiograph was about 1%. The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. Based on the findings of our study, we carefully suggest that majority, if not all, of os subfibulare would be posttraumatic in pediatric period. Therefore, ankle inversion injury in children should be managed more actively to reduce the chance of posttraumatic os subfibulare formation

Changes of hindfoot alignment after high or low tibial osteotomy

Category: Hindfoot Introduction/Purpose: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively (P=0.03 and 0.001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change (P=0.001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased (P=0.001 for each), which represented a hindfoot alignment change to the valgus position. Conclusion: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO

Factors influencing medial sesamoid arthritis in patients with hallux valgus deformity

Category: Midfoot/Forefoot Introduction/Purpose: The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints. Methods: We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes. Results: The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P <0.001, 0.001. 0.006, respectively). Conclusion: Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis

A case of hemiparkinsonism with posterior cerebral artery giant aneurysm performing a FP-CIT PET study: Is it co-existing aneurysm or cause of hemiparkinsonism?

Rarely, it was reported the large aneurysm could be revealed a hemiparkinsonism in some case reports. We report the case of a patient who developed predominantly right-sided parkinsonism with giant aneurysm on posterior cerebral artery (PCA). The hemiparkinsonism by PCA aneurysm was not reported, from what we know. And, this is the first case that performing FP-CIT PET on hemiparkinsonism with giant aneurysm. Initially, we probably thought the parkinsonism was a result of giant aneurysm of the PCA, secondary to midbrain compression by aneurysm. However, it could not be excluded the idiopathic parkinsonian disease (IPD) by the result of FP-CIT PET. The levodopa was administrated and her gait disturbance and bradykinesia was improved. Keywords: Hemiparkinsonism, Giant aneurysm, PCA, CIT-PE

Image-Based Analysis of Tumor Localization After Intra-Arterial Delivery of Technetium-99m-Labeled SPIO Using SPECT/CT and MRI

The aim of this study is to evaluate the localization of 99m Tc-labeled dextran-coated superparamagnetic iron oxide (SPIO) nanoparticles to the liver tumor using image-based analysis. We delivered 99m Tc-SPIO intravenously or intra-arterially (IA) with/without Lipiodol to compare the tumor localization by gamma scintigraphy, single-photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) in a rabbit liver tumor. The gamma and SPECT image-based analysis shows that the uptake ratio of the tumor to the normal liver parenchyma is highest after delivery of 99m Tc-SPIO with Lipiodol IA and that well correlates with the trend of the signal decrease in the liver MRIs. Intra-arterial delivery of SPIO with Lipiodol might be a good drug delivery system targeting the hepatic tumors, as confirmed by image-based analysis

Reconstruction of Complex Maxillary Defects Using Patient-specific 3D-printed Biodegradable Scaffolds

Summary:. Reconstruction of maxilla defects has remained one of the most challenging problems in craniomaxillofacial reconstruction because it typically requires harvesting and grafting of autologous bone, which poses limitations related to the difficulties in accurately reconstructing the defected bone and the highly prolonged duration of surgery. We employed tissue-engineered, patient-specific, 3-dimensional (3D)-printed biodegradable scaffolds for maxillofacial bone reconstruction in patients with complex maxillary defects after surgical removal of cancer. A customized polycaprolactone (PCL) scaffold was designed and fabricated for each patient. For this purpose, we used computer-aided design and manufacturing combined with 3D printing technology. The patients implanted with the PCL scaffolds were followed up for up to 2 years with careful evaluation of morphological changes in the face. We confirmed that the patient-specific 3D-printed PCL scaffold effectively filled the maxillary defect and promoted regeneration of the deficient tissue while remaining stable in the body for a relatively long period. Employing customized tissue-engineered scaffolds built using the patient’s computed tomography data and an extrusion-based 3D printing system is safe and clinically feasible, helping create and maintain improved morphological features of the face, which represents the most important aspect from the perspective of the patients

Practice Patterns Among Korean Urologists for Glans Penis Augmentation Using Hyaluronic Acid Filler in the Management of Premature Ejaculation

Introduction: Glans penis augmentation (GPA) using hyaluronic acid (HA) gel has been developed for treating premature ejaculation (PE) with penile hypersensitivity. The injected HA filler creates a barrier that reduces the tactile stimuli to the hypersensitive dorsal nerve. Although the HA filler is biodegradable and is believed to not cause permanent loss of sexual function, the current International Society for Sexual Medicine guideline for PE does not recommend this procedure owing to concerns regarding sexual dysfunction. Aim: To investigate the practice patterns for GPA using HA filler among Korean urologists, and to identify whether urologist experienced patient reports of sexual dysfunction post-treatment. Methods: Between March 2016 and July 2016, a specially designed questionnaire was mailed to 86 selected Korean urologists who had used injectable materials to treat PE. Main Outcome Measures: The prevalence and awareness of sexual dysfunction after GPA using HA filler were evaluated. Results: Overall, 56 urologists completed the survey (response rate: 69.2%), of which 36 (64.3%) had performed GPA using HA filler. They reported having performed a combined total of 4,344 such GPA procedures. Most urologists (72.7%) performed GPA using HA filler in patients who benefit from topical anesthetics. Patients with a history of failed pharmacotherapy (59.1%) and selective dorsal nerve neurotomy (45.5%) were selected for GPA using HA filler. The respondents (44.4%) encountered overall 206 (4.7%) cases of patients reports of recurrence of PE. Interestingly, only 36 (0.8%) cases of glans pain or paresthesia and no cases of erectile dysfunction post-treatment were reported. Conclusion: Korean urologists performed GPA using HA filler when pharmacotherapy failed or if there was a response to topical treatment. Paresthesia and hypoesthesia after GPA using HA filler are rare, and no cases of erectile dysfunction were encountered by Korean urologists.Jeong HG, Ahn ST, Kim JW, et al. Practice Patterns Among Korean Urologists for Glans Penis Augmentation Using Hyaluronic Acid Filler in the Management of Premature Ejaculation. Sex Med 2018;6:297–301. Key Words: Pre-Mature Ejaculation, Glans Penis Augmentation, Hyaluronic Acid Gel, Sexual Function Los

Asian Subgroup Analysis of the Randomized Phase 3 CROWN Study of First-Line Lorlatinib Versus Crizotinib in Advanced ALK-Positive NSCLC

Introduction: Lorlatinib is a potent, third-generation inhibitor of ALK. In the planned interim analysis of the ongoing, phase 3, randomized, global CROWN trial (NCT03052608), lorlatinib resulted in significantly longer progression-free survival than crizotinib in patients with previously untreated, advanced, ALK-positive NSCLC. Here, we present a subgroup analysis of Asian patients in the CROWN study. Methods: Patients received lorlatinib 100 mg once daily or crizotinib 250 mg twice daily. The primary end point was progression-free survival assessed by blinded independent central review. Objective response rate (ORR), intracranial ORR, safety, and select biomarkers were secondary end points. Results: At data cutoff (September 20, 2021), 120 patients were included in the Asian intention-to-treat subgroup (lorlatinib n = 59; crizotinib n = 61). At 36 months, 61% (95% confidence interval [CI]: 47–72) and 25% (95% CI: 12–41) of patients in the lorlatinib and crizotinib groups, respectively, were alive without disease progression (hazard ratio for disease progression by blinded independent central review or death: 0.40; 95% CI: 0.23–0.71). ORR was 78% (95% CI: 65–88) versus 57% (95% CI: 44–70) for patients treated with lorlatinib and crizotinib, respectively. In patients with measurable, nonmeasurable, or both measurable and nonmeasurable brain metastases at baseline, intracranial ORR was 73% (95% CI: 39–94) versus 20% (95% CI: 4–48) for patients treated with lorlatinib and crizotinib, respectively. The definition of nonmeasurable brain metastases is: a brain lesion less than 10 mm in MRI scan is defined as nonmeasurable brain metastasi based on RECIST criteria (Clinical trial evaluation criteria). Hypercholesterolemia, hypertriglyceridemia, and edema were the most frequently reported adverse events with lorlatinib. Conclusions: Lorlatinib efficacy and safety in the Asian subgroup of CROWN were consistent with those in the overall population