Atrophy patterns in isolated subscapularis lesions

Background!#!While supraspinatus atrophy can be described according to the system of Zanetti or Thomazeau there is still a lack of characterization of isolated subscapularis muscle atrophy. The aim of this study was to describe patterns of muscle atrophy following repair of isolated subscapularis (SSC) tendon.!##!Methods!#!Forty-nine control shoulder MRI scans, without rotator cuff pathology, atrophy or fatty infiltration, were prospectively evaluated and subscapularis diameters as well as cross sectional areas (complete and upper half) were assessed in a standardized oblique sagittal plane. Calculation of the ratio between the upper half of the cross sectional area (CSA) and the total CSA was performed. Eleven MRI scans of patients with subscapularis atrophy following isolated subscapularis tendon tears were analysed and cross sectional area ratio (upper half /total) determined. To guarantee reliable measurement of the CSA and its ratio, bony landmarks were also defined. All parameters were statistically compared for inter-rater reliability, reproducibility and capacity to quantify subscapularis atrophy.!##!Results!#!The mean age in the control group was 49.7 years (± 15.0). The mean cross sectional area (CSA) was 2367.0 mm!##!Conclusion!#!Analysis of typical atrophy patterns of the subscapularis muscle demonstrates that the CSA ratio represents a reliable and reproducible assessment tool in quantifying subscapularis atrophy. We propose the classification of subscapularis atrophy as Stage I (mild atrophy) in case of reduction of the cross sectional area ratio < 0.4, Stage II (moderate atrophy) in case of < 0.35 and Stage III (severe atrophy) if < 0.3

Atrophy patterns in isolated subscapularis lesions

BackgroundWhile supraspinatus atrophy can be described according to the system of Zanetti or Thomazeau there is still a lack of characterization of isolated subscapularis muscle atrophy. The aim of this study was to describe patterns of muscle atrophy following repair of isolated subscapularis (SSC) tendon.MethodsForty-nine control shoulder MRI scans, without rotator cuff pathology, atrophy or fatty infiltration, were prospectively evaluated and subscapularis diameters as well as cross sectional areas (complete and upper half) were assessed in a standardized oblique sagittal plane. Calculation of the ratio between the upper half of the cross sectional area (CSA) and the total CSA was performed. Eleven MRI scans of patients with subscapularis atrophy following isolated subscapularis tendon tears were analysed and cross sectional area ratio (upper half /total) determined. To guarantee reliable measurement of the CSA and its ratio, bony landmarks were also defined.All parameters were statistically compared for inter-rater reliability, reproducibility and capacity to quantify subscapularis atrophy.ResultsThe mean age in the control group was 49.7years ( 15.0).The mean cross sectional area (CSA) was 2367.0mm(2) ( 741.4) for the complete subscapularis muscle and 1048.2mm(2) (+/- 313.3) for the upper half, giving a mean ratio of 0.446 (+/- 0.046).In the subscapularis repair group the mean age was 56.7years (+/- 9.3). With a mean cross sectional area of 1554.7mm(2) (+/- 419.9) for the complete and of 422.9mm(2) (+/- 173.6) for the upper half of the subscapularis muscle, giving a mean CSA ratio of 0.269 (+/- 0.065) which was seen to be significantly lower than that of the control group (p<0.05).Conclusion SAnalysis of typical atrophy patterns of the subscapularis muscle demonstrates that the CSA ratio represents a reliable and reproducible assessment tool in quantifying subscapularis atrophy. We propose the classification of subscapularis atrophy as Stage I (mild atrophy) in case of reduction of the cross sectional area ratio<0.4, Stage II (moderate atrophy) in case of <0.35 and Stage III (severe atrophy) if <0.3

Differences in local population history at the finest level: the case of the Estonian population

Estonia geneticsSeveral recent studies detected fine-scale genetic structure in human populations. Hence, groups conventionally treated as single populations harbour significant variation in terms of allele frequencies and patterns of haplotype sharing. It has been shown that these findings should be considered when performing studies of genetic associations and natural selection, especially when dealing with polygenic phenotypes. However, there is little understanding of the practical effects of such genetic structure on demography reconstructions and selection scans when focusing on recent population history. Here we tested the impact of population structure on such inferences using high-coverage (~30×) genome sequences of 2305 Estonians. We show that different regions of Estonia differ in both effective population size dynamics and signatures of natural selection. By analyzing identity-by-descent segments we also reveal that some Estonian regions exhibit evidence of a bottleneck 10–15 generations ago reflecting sequential episodes of wars, plague and famine, although this signal is virtually undetected when treating Estonia as a single population. Besides that, we provide a framework for relating effective population size estimated from genetic data to actual census size and validate it on the Estonian population. This approach may be widely used both to cross-check estimates based on historical sources as well as to get insight into times and/or regions with no other information available. Our results suggest that the history of human populations within the last few millennia can be highly region specific and cannot be properly studied without taking local genetic structure into account

Pseudomalabsorption of thyroid hormones: case report and review of the literature.

Many causes of thyroxine malabsorption are described in the literature, but the most common cause of failure of thyroxine therapy is poor patient compliance, or pseudomalabsorption. We describe the case of a female patient who underwent total thyroidectomy for Basedow-Graves disease. Post-operatively, several treatment regimens were employed to achieve euthyroidism, but only injectable thyroxine was found to be effective. To exclude levothyroxine malabsorption, the patient was hospitalized in a hypothyroid state while a single oral test dose of levothyroxine (1000 microg) was administered. Within 4 hours a decrease of TSH level (from 59.7 to 55.6 microUI/ml) and a significant increase in free T4 levels (from 0.8 to 15.5 pg/ml) was observed, eliminating a malabsorption problem. The cause of resistance to thyroid hormone therapy was poor patient compliance, leading to the designation of this as a case of pseudomalabsorption.Plusieurs causes de malabsorption des hormones thyroïdiennes ont été décrites, mais la plus fréquente est le défaut de compliance du patient, décrit comme pseudomalabsorption. Nous rapportons le cas d'une femme traitée par thyroïdectomie totale pour maladie de Basedow-Graves. Après l'intervention chirurgicale, plusieurs schémas de substitution ont été essayés, mais seule la thyroxine injectable a permis la correction de l'hypothyroïdie. Pour écarter un problème d'absorption intestinale nous avons hospitalisé la patiente et nous avons réalisé un test avec une dose de 1000 μg de thyroxine administrée per os. Après quatre heures, la TSH a diminué (de 59,7 à 55,6 μUI/ml) et la T4 libre a augmenté (de 0,8 à 15,5 pg/ml), éliminant un syndrome de malabsorption. Nous avons ainsi démontré un défaut de compliance du patient et établi le diagnostic de pseudomalabsorption