Hallux valgus and fusion of the middle phalange of V ray

Hallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Its prevalence in the adult population is in 23% in adults (18-65 years) and 35.7% in elderly people (over 65 years) and is higher in females (30% compared to males 13%). The anatomical variation of the lateral rays has been ascribed to the process of involution of the feet and of its functions and actions. The intermediate phalanges of the V ray can be fused or also reduced in volume. The aim of the study was to evaluate a possible association between HV and anatomical variation of V ray. The standard radiographs of 100 patients (M 21, F 79, mean age 53y) with clinical diagnosis of HV were analysed. The HV angle was 29.84 (range 16.9 - 62,5), the 1-2 intermetatarsal angle was 10.92 (range 6.93-16.63) and the hallux interphalangeal angle was 10.55 (range 1,8 – 35.3). In 98% of cases there was the presence of fusion of the phalanges. A series of 100 consecutive patients (M 25, F 75, mean age 48y) were also analysed and basing on the review of the standard radiographs the fusion of the middle phalange was found in 42% of cases. There are conflicting notions about aetiology of HV as well. Occupation, shoe wear, genetic predisposition, and pes planus have been implicated. Our study show a strong association between the HV and fusion of the middle phalange. The presence of an anatomical variation of the V ray could modify the biodynamic of the walk and consequently influence the development and progression of the HV

Anatomical study and clinical implication of perivascular fascia of the radial artery

The characteristics of the fascial tissue that surround a vascular bundle are rarely described in any anatomical textbook and often neglected in the histological description of a vascular structure. The ability of a vascular structure to adapt to any body movement, to maintain its calibre against external pressure preserving its functional role is guarantee by this perivascular fascia. Wrist ganglions are the most common masses localized on the dorsal and volar aspect of the wrist. The herniation of the synovial sac or a split in the synovial epithelium of the volar wrist joint produce a ganglion that is able to distort and compress the radial artery. Authors present the case of 24 years old man with a mucinous cyst originated from the volar wrist joint that was grown inside the vascular fascia of the radial artery and extended up to the middle portion of the forearm. Clinical sintomatology of pain and tenderness was justify by the temporary partial decrease of the arterial lumen and occlusion of the satellite veins. To better understand the clinical relevance of these fascial tissue a microscopical study of serial sections of the radial artery in 20 cadaveric upper limbs was performed (EE, Azan-Mallory, Weigert). The mean area of the perivascular fascia was 13596,3 mm, the mean minimum and maximum thickness of this area was 73 and 389 micron. The mean thickness of the fibrous tissue of the perivascular fascia was 26,21 micron. During the raising of a forearm pedicled radial artery flap or during the surgical excision of volar wrist ganglions the surgeon has to mobilize the radial artery thanks to the integrity of its perivascular fascia. The fascia surrounding the radial artery and satellite veins represented a inestensive sleeve that compelled the mucinous cyst to grow flattened proximally until its complete erniation and superficial radial nerve dislocation in the middle of the forearm. Other clinical implications of the alteration of the radial perivascular fascia are described

A fuzzy feature fusion method for auto-segmentation of gliomas with multi-modality diffusion and perfusion magnetic resonance images in radiotherapy

The difusion and perfusion magnetic resonance (MR) images can provide functional information about tumour and enable more sensitive detection of the tumour extent. We aimed to develop a fuzzy feature fusion method for auto-segmentation of gliomas in radiotherapy planning using multi-parametric functional MR images including apparent difusion coefcient (ADC), fractional anisotropy (FA) and relative cerebral blood volume (rCBV). For each functional modality, one histogram-based fuzzy model was created to transform image volume into a fuzzy feature space. Based on the fuzzy fusion result of the three fuzzy feature spaces, regions with high possibility belonging to tumour were generated automatically. The auto-segmentations of tumour in structural MR images were added in fnal autosegmented gross tumour volume (GTV). For evaluation, one radiation oncologist delineated GTVs for nine patients with all modalities. Comparisons between manually delineated and auto-segmented GTVs showed that, the mean volume diference was 8.69% (±5.62%); the mean Dice’s similarity coefcient (DSC) was 0.88 (±0.02); the mean sensitivity and specifcity of auto-segmentation was 0.87 (±0.04) and 0.98 (±0.01) respectively. High accuracy and efciency can be achieved with the new method, which shows potential of utilizing functional multi-parametric MR images for target defnition in precision radiation treatment planning for patients with gliomas

Evaluation of fascial manipulation in carpal tunnel syndrome: A pilot randomized clinical trial

peer reviewed[No abstract available

Pediatric primary intramedullary spinal cord glioblastoma

Spinal cord tumors in pediatric patients are rare, representing less than 1% of all central nervous system tumors. Two cases of pediatric primary intramedullary spinal cord glioblastoma at ages 14 and 8 years are reported. Both patients presented with rapid onset paraparesis and quadraparesis. Magnetic resonance imaging in both showed heterogeneously enhancing solitary mass lesions localized to lower cervical and upper thoracic spinal cord parenchyma. Histopathologic diagnosis was glioblastoma. Case #1 had a small cell component (primitive neuroectodermal tumor-like areas), higher Ki67, and p53 labeling indices, and a relatively stable karyotype with only minimal single copy losses involving regions: Chr8;pter-30480019, Chr16;pter-29754532, Chr16;56160245–88668979, and Chr19;32848902-qter on retrospective comparative genomic hybridization using formalin-fixed, paraffin-embedded samples. Case #2 had relatively bland histomorphology and negligible p53 immunoreactivity. Both underwent multimodal therapy including gross total resection, postoperative radiation and chemotherapy. However, there was no significant improvement in neurological deficits, and overall survival in both cases was 14 months.This report highlights the broad histological spectrum and poor overall survival despite multi modality therapy. The finding of relatively unique genotypic abnormalities resembling pediatric embryonal tumors in one case may highlight the value of genome-wide profiling in development of effective therapy. The differences in management with intracranial and low-grade spinal cord gliomas and current management issues are discussed

Impact of leg lengthening on viscoelastic properties of the deep fascia

<p>Abstract</p> <p>Background</p> <p>Despite the morphological alterations of the deep fascia subjected to leg lengthening have been investigated in cellular and extracellular aspects, the impact of leg lengthening on viscoelastic properties of the deep fascia remains largely unknown. This study aimed to address the changes of viscoelastic properties of the deep fascia during leg lengthening using uniaxial tensile test.</p> <p>Methods</p> <p>Animal model of leg lengthening was established in New Zealand white rabbits. Distraction was initiated at a rate of 1 mm/day and 2 mm/day in two steps, and preceded until increases of 10% and 20% in the initial length of tibia had been achieved. The deep fascia specimens of 30 mm × 10 mm were clamped with the Instron 1122 tensile tester at room temperature with a constant tensile rate of 5 mm/min. After 5 load-download tensile tests had been performed, the specimens were elongated until rupture. The load-displacement curves were automatically generated.</p> <p>Results</p> <p>The normal deep fascia showed typical viscoelastic rule of collagenous tissues. Each experimental group of the deep fascia after leg lengthening kept the properties. The curves of the deep fascia at a rate of 1 mm/day with 20% increase in tibia length were the closest to those of normal deep fascia. The ultimate tension strength and the strain at rupture on average of normal deep fascia were 2.69 N (8.97 mN/mm²) and 14.11%, respectively. The increases in ultimate tension strength and strain at rupture of the deep fascia after leg lengthening were statistically significant.</p> <p>Conclusion</p> <p>The deep fascia subjected to leg lengthening exhibits viscoelastic properties as collagenous tissues without lengthening other than increased strain and strength. Notwithstanding different lengthening schemes result in varied viscoelastic properties changes, the most comparable viscoelastic properties to be demonstrated are under the scheme of a distraction rate of 1 mm/day and 20% increase in tibia length.</p

3D-MRI rendering of the anatomical structures related to acupuncture points of the Dai mai, Yin qiao mai and Yang qiao mai meridians within the context of the WOMED concept of lateral tension: implications for musculoskeletal disease

BACKGROUND: A conceptual model of lateral muscular tension in patients presenting thyroid associated ophthalmopathy (TAO) has been recently described. Clinical improvement has been achieved by using acupuncture on points belonging to the so-called extraordinary meridians. The aim of this study was to characterize the anatomical structures related to these acupuncture points by means of 3D MRI image rendering relying on external markers. METHODS: The investigation was carried out the index case patient of the lateral tension model. A licensed medical acupuncture practitioner located the following acupuncture points: 1) Yin qiao mai meridian (medial ankle): Kidney 3, Kidney 6, the plantar Kidney 6 (Nan jing description); 2) Yang qiao mai meridian (lateral ankle): Bladder 62, Bladder 59, Bladder 61, and the plantar Bladder 62 (Nan jing description); 3) Dai mai meridian (wait): Liver 13, Gall bladder 26, Gall bladder 27, Gall bladder 28, and Gall bladder 29. The points were marked by taping a nitro-glycerin capsule on the skin. Imaging was done on a Siemens Magnetom Avanto MR scanner using an array head and body coil. Mainly T1-weighted imaging sequences, as routinely used for patient exams, were used to obtain multi-slice images. The image data were rendered in 3D modus using dedicated software (Leonardo, Siemens). RESULTS: Points of the Dai mai meridian – at the level of the waist – corresponded to the obliquus externus abdominis and the obliquus internus abdominis. Points of the Yin qiao mai meridian – at the medial side of the ankle – corresponded to tendinous structures of the flexor digitorum longus as well as to muscular structures of the abductor hallucis on the foot sole. Points of the Yang qiao mai meridian – at the lateral side of the ankle – corresponded to tendinous structures of the peroneus brevis, the peroneous longus, and the lateral surface of the calcaneus and close to the foot sole to the abductor digiti minimi. CONCLUSION: This non-invasive MRI investigation has revealed the anatomical relations of acupuncture points belonging to 3 of the so-called extraordinary meridians. We conclude that the clinically developed "WOMED concept of lateral tension" is related to tendino-muscular structures