Sonography of the Lateral Antebrachial Cutaneous Nerve With Magnetic Resonance Imaging and Anatomic Correlation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135544/1/jum20143381475.pd

The orbitofrontal cortex : sulcal anatomy and cytoarchitectonic correlations

The sulcal patterns of the human orbitofrontal cortex have not been adequately characterized. Classical authors, as well as more recent investigators, have attempted to identify and label the sulci of this part of the brain. Nevertheless, there is considerable confusion regarding the orbital sulcal patterns with inconsistencies in the naming of orbitofrontal sulci in many modern texts. Moreover, a correlation between specific landmarks and architectonic areas has not been demonstrated.A clarification of the patterns of the orbitofrontal sulci and their relationship to architectonic subregions is necessary if the results of functional neuroimaging and other physiological and anatomical findings are to be properly interpreted. Although studies have reported altered activity in the orbitofrontal cortex in relation to various sensory processes and pathological states it has been difficult to relate these changes to specific orbitofrontal regions because of a limited understanding of the anatomical landmarks. The absence of reliable reference markers forces the use of vague terminology (e.g., "orbital frontal activation") in describing the location of functional changes in the orbital frontal cortex.The aim of this doctoral thesis was to gain a better understanding of the sulcal pattern of the human orbitofrontal cortex and its relation to the underlying cytoarchitecture. The first study resolved the confusion associated with the orbitofrontal sulci by identifying, quantifying, and precisely localizing the various orbital sulci from fifty human magnetic resonance scans that were transformed into the standardized stereotaxic space of Talairach and Tournoux (1988). The second study compared the individual sulci and sulcal patterns of these fifty human brains with the brains of fifty adult rhesus monkeys. Having examined the orbitofrontal sulci in these two species, a nomenclature for the human orbitofrontal sulci was established which was based on comparable sulci in the less convoluted macaque monkey brain while trying to preserve many of the familiar labels associated with this region in the human brain. The final part of this thesis examined the orbitofrontal cytoarchitecture of 10 human adult cerebral hemispheres to determine if a correlation exists between the different orbital sulci and the borders of the architectonic subregions

Radial Collateral Ligament of the Elbow

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135312/1/jum20143361041.pd

Radiographic union score for hip substantially improves agreement between surgeons and radiologists

Abstract Background Despite the prominence of hip fractures in orthopedic trauma, the assessment of fracture healing using radiographs remains subjective. The variability in the assessment of fracture healing has important implications for both clinical research and patient care. With little existing literature regarding reliable consensus on hip fracture healing, this study was conducted to determine inter-rater reliability between orthopedic surgeons and radiologists on healing assessments using sequential radiographs in patients with hip fractures. Secondary objectives included evaluating a checklist designed to assess hip fracture healing and determining whether agreement improved when reviewers were aware of the timing of the x-rays in relation to the patients’ surgery. Methods A panel of six reviewers (three orthopedic surgeons and three radiologists) independently assessed fracture healing using sequential radiographs from 100 patients with femoral neck fractures and 100 patients with intertrochanteric fractures. During their independent review they also completed a previously developed radiographic checklist (Radiographic Union Score for Hip (RUSH)). Inter and intra-rater reliability scores were calculated. Data from the current study was compared to the findings from a previously conducted study where the same reviewers, unaware of the timing of the x-rays, completed the RUSH score. Results The agreement between surgeons and radiologists for fracture healing was moderate for “general impression of fracture healing” in both femoral neck (ICC = 0.60, 95% CI: 0.42-0.71) and intertrochanteric fractures (0.50, 95% CI: 0.33-0.62). Using a standardized checklist (RUSH), agreement was almost perfect in both femoral neck (ICC = 0.85, 95% CI: 0.82-0.87) and intertrochanteric fractures (0.88, 95% CI: 0.86-0.90). We also found a high degree of correlation between healing and the total RUSH score using a Receiver Operating Characteristic (ROC) analysis, there was an area under the curve of 0.993 for femoral neck cases and 0.989 for intertrochanteric cases. Agreement within the radiologist group and within the surgeon group did not significantly differ in our analyses. In all cases, radiographs in which the time from surgery was known resulted in higher agreement scores compared to those from the previous study in which reviewers were unaware of the time the radiograph was obtained. Conclusions Agreement in hip fracture radiographic healing may be improved with the use of a standardized checklist and appears highly influenced by the timing of the radiograph. These findings should be considered when evaluating patient outcomes and in clinical studies involving patients with hip fractures. Future research initiatives are required to further evaluate the RUSH checklist