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Sample records for litiasis fosa navicular

  1. The accessory navicular synchondrosis.

    PubMed

    Sella, E J; Lawson, J P; Ogden, J A

    1986-08-01

    The accessory navicular, which is considered an anatomic variant, may be the source of pain in athletes. There are three types of accessory naviculars: Type I is an ossicle in the substance of the posterior tibial tendon; Type II forms a synchondrosis with the navicular; and Type III, "the cornuate navicular," represents the possible end stage of Type II. Nine feet had Type II accessory naviculars. The pull of the posterior tibial tendon, the degree of foot pronation, and the location of the accessory navicular in relation to the undersurface of the navicular are factors that produce tension, shear, and/or compression forces on the synchondrosis of Type II accessory naviculars and cause microscopic changes of injury and repair similar to those observed with a physeal fracture. Such alterations are not always visible on roentgenograms but are usually detected by 99mTc methylene diphosphonate (99mTcMDP) scans. Initially, nonsurgical treatment with orthotics or casts should be attempted, but if this is unsuccessful, surgical treatment is recommended. Surgical treatment consists of excision of the accessory navicular with its synchondrosis, without transposition of the posterior tibial tendon.

  2. The painful accessory navicular.

    PubMed

    Lawson, J P; Ogden, J A; Sella, E; Barwick, K W

    1984-01-01

    The accessory navicular is usually considered a normal anatomic and roentgenographic variant. The term may refer to two distinct patterns. First, a sesamoid bone may be present within the posterior tibial tendon (Type 1); this is anatomically separate from the navicular. Second, an accessory ossification center may be medial to the navicular (Type 2). During postnatal development this is within a cartilaginous mass that is continuous with the cartilage of the navicular. At skeletal maturity the accessory center usually fuses with the navicular to form a curvilinear bone. The Type 2 pattern may be associated with a painful foot, particularly in the athletic adolescent, and should not be arbitrarily dismissed as a roentgenologic variant in the symptomatic patient. The clinical, radiologic, pathologic, and surgical findings in ten cases are reviewed. Roentgenographically the ossicle is triangular or heart-shaped. 99mTc MDP imaging may be of value when the significance of the ossicle is uncertain. Even when the roentgenographic variant is bilateral, increased radionuclide activity occurs only on the symptomatic side. Histologic examination of surgically excised specimens reveals inflammatory chondro-osseous changes in the navicular-accessory navicular synchondrosis compatible with chronic trauma and stress fracture. Nonsurgical treatment with orthotics or cast immobilization produces variable results and resection of the accessory navicular may be the treatment of choice.

  3. The accessory navicular.

    PubMed

    Ugolini, Peter A; Raikin, Steven M

    2004-03-01

    The accessory navicular is a common presence in the human foot and must be included in the differential diagnosis of medial foot pain in patients who are of appropriate age. Imaging modalities aid in diagnosis of a symptomatic ossicle and guide classification and treatment. Often, a combination of studies is needed to establish an accessory navicular as the source of foot pathology. Although conservative measures always are the first line of treatment, the benefits of surgical management are well-defined in the literature. Most foot surgeons rely on resection procedures with varied handling of the PTT insertion, although newer modifications that use bony fusion techniques are being investigated. As with any musculoskeletal condition, proper diagnosis and individually-tailored treatment plans are of the utmost importance to a satisfactory outcome. With meticulous patient selection and a thorough understanding of the condition, management of the painful accessory navicular often is successful in alleviating the disability it causes.

  4. Surgical treatment of the accessory navicular.

    PubMed

    Ray, S; Goldberg, V M

    1983-01-01

    Surgical management of the accessory navicular or navicular beak using the Kidner procedure was indicated in 29 feet. Pain was present in all feet; difficulty with shoe fit and flat feet were other complaints. The patients were followed up for two to ten years (mean, 4.5 years) after operation. Eleven results were excellent, 15 good, and 3 poor, all in boys with a navicular beak. Only one complication occurred. Excision of the accessory navicular or navicular beak, together with suturing the fibers of the posterior tibial tendon (inserting on the accessory navicular or navicular beak) to the inferior surface of the navicular, is effective treatment.

  5. Adolescent accessory navicular.

    PubMed

    Leonard, Zachary C; Fortin, Paul T

    2010-06-01

    Accessory tarsal navicular is a common anomaly in the human foot. It should be in the differential of medial foot pain. A proper history and physical, along with imaging modalities, can lead to the diagnosis. Often, classification of the ossicle and amount of morbidity guide treatment. Nonsurgical measures can provide relief. A variety of surgical procedures have been used with good results. Our preferred method is excision for small ossicles and segmental fusion after removal of the synchondrosis for large ossicles. In addition, pes planovalgus deformities need to be addressed concomitantly. Copyright 2010 Elsevier Inc. All rights reserved.

  6. Endoscopic Accessory Navicular Synchondrosis Fusion.

    PubMed

    Lui, Tun Hing

    2016-12-01

    The accessory navicular bone is one of the most common accessory ossicles of the foot. Fewer than 1% of accessory navicular bones are symptomatic, and most of these are type II accessory navicular bones. A separation of the synchondrosis is considered one of the main causes of pain. After an injury to the synchondrosis has resulted in a chondro-osseous disruption, the combined forces of tension and shear from the posterior tibial tendon and the foot aggravate the injury and prevent it from healing. Fusion of the synchondrosis is a logical surgical treatment option if the pain is recalcitrant to conservative measures. The purpose of this technical note is to report an endoscopic approach to achieve fusion. It has the advantages of better cosmesis, less scar pain, less risk of nonunion, and potential to examine the tibialis posterior tendon and the talonavicular joint.

  7. Magnetic resonance imaging of navicular bursa adhesions.

    PubMed

    Holowinski, Maureen E; Solano, Mauricio; Maranda, Louise; García-López, José M

    2012-01-01

    Adhesions occur in the navicular bursa between the deep digital flexor tendon (DDFT) and other structures. Our objectives were to describe the appearance of navicular bursa adhesions on high-field magnetic resonance (MR) images, to compare these findings to findings at navicular bursoscopy, and to determine the prevalence of lesions in the remainder of the podotrochlear apparatus. Sixteen forelimbs from 14 horses that underwent MR imaging and navicular bursoscopy were evaluated. Adhesions were considered type 1 when characterized by a discontinuity in the navicular bursa fluid signal between two structures, type 2 when the navicular bursa fluid signal was disrupted and ill-defined tissue was present between two structures, and type 3 when the fluid signal was disrupted and well-defined tissue was present between two structures. Twenty-six adhesions were suspected on MR images and nineteen were visualized at surgery. The positive predictive value was 50% for type 1 adhesions, 67% for type 2 adhesions, and 100% for type 3 adhesions. Additional lesions were detected in the navicular bursa in 15 limbs, the DDFT in 13, the navicular bone in 15, the collateral sesamoidean ligaments in 9, and the distal sesamoidean impar ligament in 8. A discontinuity in the navicular bursa fluid signal with well-defined tissue between two structures detected on high-field MR images is diagnostic for a navicular bursa adhesion. Additional lesions in the podotrochlear apparatus are common in horses with navicular bursa adhesions. © 2012 Veterinary Radiology & Ultrasound.

  8. Treating navicular syndrome in equine patients.

    PubMed

    Waguespack, R Wayne; Hanson, R Reid

    2011-01-01

    Navicular syndrome is a chronic, progressive condition affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. The treatment options for navicular syndrome are as varied as the proposed causes of the condition. The severity of clinical signs, intended use and workload of the horse, and owner compliance with therapy are important considerations in developing a treatment plan. Nonsurgical treatment of navicular syndrome consists of rest, hoof balance and corrective trimming/shoeing, and medical therapy, including administration of systemic antiinflammatories, hemorheologic medications, and intraarticular medications. While surgical therapy can include desmotomy of the collateral (suspensory) ligaments of the navicular bone, palmar digital neurectomy is more commonly performed when medical therapy is ineffective. Recently, adjunct therapies, such as acupuncture and extracorporeal shock wave therapy, have also been used to treat horses with navicular syndrome. Because of the wide range of pathologic changes and the lack of a definitive cure associated with navicular syndrome, treatment is directed toward the individual horse, focusing on the management of clinical signs to alleviate stress and retard degenerative changes of the navicular bursal and navicular regions.

  9. Outcome of fusion of a painful accessory navicular to the primary navicular.

    PubMed

    Chung, Jin-Wa; Chu, In-Tak

    2009-02-01

    An accessory navicular bone may cause pain due to continuous irritation at its interface with the navicular. The authors performed the fusion of the accessory navicular and navicular with screw(s) to relieve the symptoms while preserving the continuity of the posterior tibial tendon. We analyzed the clinical and radiological outcomes of 31 consecutive patients (34 feet) with a painful type II accessory navicular. Bone union was confirmed on plain radiography in 28 (82%) of 34 feet. Twenty-two patients (24 feet) were assessed as excellent, two (three feet) as good, and one (one foot) as fair. Nonunion developed in six patients (six feet) and was defined as poor. When conservative treatment fails to relieve pain in a type II accessory navicular, fusion of the accessory navicular to the navicular may successfully relieve pain without disrupting the tibialis posterior tendon insertion.

  10. Tarsal navicular stress fractures: radiographic evaluation

    SciTech Connect

    Pavlov, H.; Torg, J.S.; Freiberger, R.H.

    1983-09-01

    Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.

  11. CUBOID-NAVICULAR TARSAL COALITION

    PubMed Central

    Prado, Marcelo Pires; Mendes, Alberto Abussamara Moreira; Olivi, Rogério; Amodio, Daniel Tassetto

    2015-01-01

    The authors present the case of a nine-year-old female patient who presented with pain in her right foot associated with physical activities. After this case was diagnosed as cuboid-navicular tarsal coalition, the patient was treated surgically with resection of the coalition, thereby resolving the symptoms. The literature was reviewed and the importance of adequate physical examination and imaging assessment for investigating foot pain in children and adolescents was discussed. PMID:27047815

  12. CUBOID-NAVICULAR TARSAL COALITION.

    PubMed

    Prado, Marcelo Pires; Mendes, Alberto Abussamara Moreira; Olivi, Rogério; Amodio, Daniel Tassetto

    2010-01-01

    The authors present the case of a nine-year-old female patient who presented with pain in her right foot associated with physical activities. After this case was diagnosed as cuboid-navicular tarsal coalition, the patient was treated surgically with resection of the coalition, thereby resolving the symptoms. The literature was reviewed and the importance of adequate physical examination and imaging assessment for investigating foot pain in children and adolescents was discussed.

  13. Autosomal Dominant Transmission of Accessory Navicular

    PubMed Central

    Dobbs, Matthew B; Walton, Tim

    2004-01-01

    The accessory navicular bone is one of the most symptomatic bones of the foot. Although it has been reported to be present in various members of the same family, there is a lack of knowledge about its inheritance pattern. We report two large pedigrees in which accessory navicular is inherited in an autosomal dominant fashion with incomplete penetrance. PMID:15296212

  14. Autosomal dominant transmission of accessory navicular.

    PubMed

    Dobbs, Matthew B; Walton, Tim

    2004-01-01

    The accessory navicular bone is one of the most symptomatic bones of the foot. Although it has been reported to be present in various members of the same family, there is a lack of knowledge about its inheritance pattern. We report two large pedigrees in which accessory navicular is inherited in an autosomal dominant fashion with incomplete penetrance.

  15. Biochemical characterisation of navicular hyaline cartilage, navicular fibrocartilage and the deep digital flexor tendon in horses with navicular disease.

    PubMed

    Viitanen, M; Bird, J; Smith, R; Tulamo, R-M; May, S A

    2003-10-01

    The study hypothesis was that navicular disease is a process analogous to degenerative joint disease, which leads to changes in navicular fibrocartilage and in deep digital flexor tendon (DDFT) matrix composition and that the process extends to the adjacent distal interphalangeal joint. The objectives were to compare the biochemical composition of the navicular articular and palmar cartilages from 18 horses with navicular disease with 49 horses with no history of front limb lameness, and to compare navicular fibrocartilage with medial meniscus of the stifle and collateral cartilage of the hoof. Cartilage oligomeric matrix protein (COMP), deoxyribonucleic acid (DNA), total glycosaminoglycan (GAG), metalloproteinases MMP-2 and MMP-9 and water content in tissues were measured. Hyaline cartilage had the highest content of COMP and COMP content in hyaline cartilage and tendon was higher in lame horses than in sound horses (p<0.05). The concentration of MMP-2 amount in hyaline cartilage was higher in lame horses than in sound horses. The MMP-2 amounts were significantly higher in tendons compared to other tissue types. Overall, 79% of the lame horses with lesions had MMP-9 in their tendons and the amount was higher than in sound horses (p<0.05). In horses with navicular disease there were matrix changes in navicular hyaline and fibrocartilage as well as the DDFT with potential implications for the pathogenesis and management of the condition.

  16. Surgical treatment of symptomatic accessory tarsal navicular.

    PubMed

    Bennett, G L; Weiner, D S; Leighley, B

    1990-01-01

    We report a retrospective review of 50 consecutive patients (75 feet) with chronically symptomatic accessory tarsal naviculars that failed to improve with conservative treatment. Surgical treatment consisted of excision of the accessory tarsal navicular or medial protuberance of a prominent cornuate-shaped navicular combined with simple replication of the tibialis posterior tendon without altering its course. Good and excellent results were obtained in 45 (70 feet) of the 50 patients (90%). The procedure has a low rate of minor complications, is easy to perform, and is extremely well accepted by the patients.

  17. An unusual cause of medial foot pain: The cornuate navicular.

    PubMed

    Abourazzak, Fatima Ezzahra; Shimi, Mohammed; Azzouzi, Hamida; Mansouri, Samia; El Mrini, Abdelmajid; Harzy, Taoufik

    2015-03-01

    The accessory navicular bone (ANB) is a secondary ossification center of the navicular bone and is rarely observed. Three distinct types of accessory navicular bones have been described. The type III, known as the cornuate navicular, is a rare morphological entity of the accessory navicular bone. We report the case of a patient, 48 years old, who presented with chronic swelling and pain in her left foot. Radiological examination permitted the diagnosis and showed a conflict between the tibial posterior tendon and the cornuate navicular, responsible for the symptoms. Surgical treatment led to symptoms relief.

  18. An unusual cause of medial foot pain: The cornuate navicular

    PubMed Central

    Abourazzak, Fatima Ezzahra; Shimi, Mohammed; Azzouzi, Hamida; Mansouri, Samia; El Mrini, Abdelmajid; Harzy, Taoufik

    2015-01-01

    The accessory navicular bone (ANB) is a secondary ossification center of the navicular bone and is rarely observed. Three distinct types of accessory navicular bones have been described. The type III, known as the cornuate navicular, is a rare morphological entity of the accessory navicular bone. We report the case of a patient, 48 years old, who presented with chronic swelling and pain in her left foot. Radiological examination permitted the diagnosis and showed a conflict between the tibial posterior tendon and the cornuate navicular, responsible for the symptoms. Surgical treatment led to symptoms relief. PMID:27708918

  19. The adult tarsal navicular: why it matters.

    PubMed

    Scott-Moncrieff, Andrew; Forster, Bruce B; Andrews, Gordon; Khan, Karim

    2007-12-01

    The adult tarsal navicular is an integral part of the midfoot. Many unique pathological conditions affect its function, and while subtle in their presentation, they can be significant sources of pain and deformity. Recognition of these abnormalities in imaging is essential to obtaining prompt diagnoses and instigating early management interventions. In this pictorial essay, accessory ossicles, stress fractures, avascular necrosis, and tarsal coalitions involving the navicular will be discussed in terms of their characteristic imaging findings. Normal anatomy and biomechanical functional aspects of the navicular will be reviewed and multiple images from plain film, ultrasound, bone scan, computed tomography, and magnetic resonance imaging will be presented. Improved familiarity with the adult tarsal navicular and its various abnormalities will enable radiologists to recognize its importance in the differential diagnosis of midfoot pathology.

  20. Case report: fibrous dysplasia of the navicular bone treated with excision of navicular and talo-cuneiform arthrodesis.

    PubMed

    Siu, W; Ferguson, K B; Kumar, C S; Mahendra, A

    2015-03-01

    Fibrous dysplasia is an uncommon beningn disorder of bone. It usually affects the long bones, and is uncommon in the navicular. We describe a case of fibrous dysplasia of the navicular successfully treated with navicular excision and talo-cuneiform arthrodesis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Surgical treatment of symptomatic accessory navicular.

    PubMed

    Tan, S M; Chin, T W; Mitra, A K; Tan, S K

    1995-05-01

    The accessory navicular is a known cause of foot pain. When symptomatic and conservative measures have failed, surgical intervention may be required. Simple excision of the ossicle or the Kidner procedure with transplantation of tibialis posterior tendon to the undersurface of the navicular bone may be done. Eighteen patients with symptomatic accessory navicular were reviewed at the Singapore General Hospital, Department of Orthopaedic Surgery 'O' Unit. All 18 patients had foot pain and restriction of activities. Thirteen noticed a prominence on the medial side of the affected foot and 7 had difficulty with shoe fitting. Nine underwent simple excision of the ossicle while the other 9 had the Kidner procedure done. The average follow-up period was 3.1 years. Both the simple excision and the Kidner procedure were equally successful in relieving symptoms in 15 out of the 18 cases. The Kidner procedure did not confer any particular advantage over simple excision.

  2. Magnetic resonance imaging in adolescent symptomatic navicular tuberosity.

    PubMed

    Takahashi, Mitsuhiko; Sakai, Toshinori; Sairyo, Koichi; Takao, Shoichiro; Mima, Seiichi; Yasui, Natsuo

    2014-01-01

    The accessory navicular bone is one of the most common accessory ossicles, which sometimes become symptomatic. Abnormalities in magnetic resonance (MR) image, e. g. edema-like bone marrow pattern, have been reported for symptomatic accessory navicular. However, it has not been completely understood the edema-like bone marrow pattern correlates to the symptom of navicular tuberosity. We investigated the edema-like bone marrow pattern in correlation with alleviation of the symptom and the presence of accessory navicular bone. Ten adolescents with pain localized to the navicular tuberosity were recruited and seven cases were further examined with consecutive MR images. Edema-like bone marrow pattern was found in all symptomatic navicular but not in asymptomatic navicular. Intensity of the pattern diminished with alleviation of the symptom. Moreover, this correlation was recognized even in the patients who had no accessory navicular bones. MR images could be used not only for diagnosis but for monitor of healing in adolescent symptomatic navicular. There may be different pathologic mechanism for adolescent symptomatic navicular tuberosity, such as an osteitis, in adolescents.

  3. Inheritance of the accessory navicular bone.

    PubMed

    Kiter, E; Erduran, M; Günal, I

    2000-01-01

    The accessory navicular bone is one of the most symptomatic bones of the foot. Although it has been reported to be present in various members of the same family, there is a lack of knowledge about its inheritance in the literature. We examined three families and suggest that it has an autosomal dominant trait with incomplete penetrance.

  4. [Excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for treatment of flatfoot related with accessory navicular].

    PubMed

    Cao, Honghui; Tang, Kanglai; Deng, Yinshuan; Tan, Xiaokang; Zhou, Binghua; Tao, Xu; Chen, Lei; Chen, Qianbo

    2012-06-01

    To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 +/- 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. All patients got primary wound healing without any complication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain relief at 6 months after surgery and had good appearance of the feet. The AOFAS ankle-midfoot score was 90.4 +/- 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus inclination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P < 0.01). The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.

  5. Relationship of the dorsalis pedis artery to the tarsal navicular.

    PubMed

    Rimchala, Chakorn; Chuckpaiwong, Bavornrit

    2015-01-01

    When undertaking surgical maneuvers about the midfoot, caution must be used to avoid injury to the dorsalis pedis artery, which courses along the dorsum of the foot on the dorsolateral aspect of the tarsal navicular. In an effort to better understand the relationship of the course of the dorsalis pedis artery relative to the tarsal navicular, 128 embalmed feet (31 [48.4%] female and 33 [51.6%] male cadavers aged 15 to 91 years) were measured. The dorsalis pedis artery was dissected from its origin to its termination (i.e., the first dorsal metatarsal artery and the deep plantar perforating artery), and the distance from the medial cortex of the navicular tuberosity to the medial margin of the artery and the location of the artery as a percentage of the medial-to-lateral width of the navicular were measured. In the male cadaver specimens, the distance from the navicular tuberosity to the dorsalis pedis was 23.75 ± 3.1 mm, the width of the navicular was 37.41 ± 5.0 mm, and the location of the artery as a percentage of the width of the navicular was 64.34% ± 13.1%. In the female cadaver specimens, the distance from the navicular tuberosity to the dorsalis pedis was 22.81 ± 5.5 mm, the width of the navicular was 36.11 ± 4.0 mm, and the location of the artery as a percentage of the width of the navicular was 63.29% ± 9.9%. For the right foot specimens, the distance from the navicular tuberosity to the dorsalis pedis artery was 20.29 ± 3.3 mm, and the width of the navicular was 37.21 ± 4.4 mm. For the left foot specimens, the distance from the navicular tuberosity to the dorsalis pedis was 21.40 ± 2.5 mm, and the width of the navicular was 35.92 ± 4.4 mm. The statistical comparisons between the males and females showed no statistically significant differences. In contrast, those between the right and left feet showed significant differences in the distance from the navicular tuberosity to the dorsalis pedis artery and the location of the dorsalis pedis artery

  6. Accessory navicular bone: not such a normal variant.

    PubMed

    Bernaerts, A; Vanhoenacker, F M; Van de Perre, S; De Schepper, A M; Parizel, P M

    2004-01-01

    The accessory navicular is often erroneously considered as a normal anatomic and roentgenographic variant. Three distinct types of accessory navicular bones have been described. The type 2 and 3 variants have been associated with pathologic conditions such as posterior tibial tendon tear and painful navicular syndrome and therefore should not be arbitrarily dismissed as a roentgenologic variant in a symptomatic patient. The pathogenesis and radiologic findings are discussed and illustrated.

  7. The anatomy of the navicular and periarticular structures.

    PubMed

    Golano, Pau; Fariñas, Oscar; Sáenz, Ivan

    2004-03-01

    The navicular bone, located in the midfoot, articulates with the head of the talus, cuboid, and the three cuneiform bones that are involved in the acetabulum pedis. It gives attachment to the spring ligament (superomedial and inferior calcaneonavicular ligament)that can be injured in a failure of the posterior tibialis tendon and cause an adult acquired flatfoot deformity. The navicular bone provides insertion for the posterior tibialis tendon. Some pathologies can be related to the presence of an accessory navicular bone. Osteonecrosis or stress fractures can affect the navicular bone because of its poor vascularization, especially in its central portion.

  8. Fractures and Dislocations of the Tarsal Navicular.

    PubMed

    Ramadorai, Maj Uma E; Beuchel, Matthew W; Sangeorzan, Bruce J

    2016-06-01

    Fractures of the tarsal navicular are commonly the result of trauma or chronic overload. Because of its complex anatomy and blood supply, the tarsal navicular is susceptible to osteonecrosis, and injury to this bone can lead to posttraumatic arthrosis of the surrounding joints. Diagnosis of the injury, especially in patients with stress fractures, can require a high index of suspicion and the use of advanced imaging. The treatment of stress fracture is controversial and ranges from immobilization in a non-weight-bearing cast or boot to internal fixation with or without bone grafting. Traumatic fractures are treated with open reduction and internal fixation with or without external fixation for medial and lateral column stabilization. To avoid a poor outcome, concomitant injuries must be recognized and treated. Despite appropriate treatment, patients may ultimately require fusion procedures to address ongoing pain and disability.

  9. Acute fractures of the tarsal navicular.

    PubMed

    Rosenbaum, Andrew J; Uhl, Richard L; DiPreta, John A

    2014-08-01

    The tarsal navicular plays an integral role in hind-foot motion and gait, and is the keystone of the foot's medial longitudinal arch. As such, injuries to the navicular can be devastating. Acute avulsion, tuberosity, and body fractures have been described. Fractures of the body result from high-energy trauma and are often seen in conjunction with additional ipsilateral foot injuries. Plain radiographs are the gold standard for diagnosis, with computed tomography helpful in the presence of intra-articular fracture extension. Non-operative treatment is reserved for avulsion injuries and non-displaced body fractures. Open reduction and internal fixation must be performed for all other types, as failure to achieve an anatomic reduction can impede proper locomotion. Complications following operative intervention include pain, stiffness, posttraumatic arthritis, avascular necrosis, nonunion, and hindfoot deformity. Copyright 2014, SLACK Incorporated.

  10. Widespread Fosfomycin Resistance in Gram-Negative Bacteria Attributable to the Chromosomal fosA Gene

    PubMed Central

    Ito, Ryota; Tomich, Adam D.; Callaghan, Jake D.; McElheny, Christi L.; Mettus, Roberta T.; Sluis-Cremer, Nicolas

    2017-01-01

    ABSTRACT Fosfomycin is a decades-old antibiotic which is being revisited because of its perceived activity against many extensively drug-resistant Gram-negative pathogens. FosA proteins are Mn2+ and K+-dependent glutathione S-transferases which confer fosfomycin resistance in Gram-negative bacteria by conjugation of glutathione to the antibiotic. Plasmid-borne fosA variants have been reported in fosfomycin-resistant Escherichia coli strains. However, the prevalence and distribution of fosA in other Gram-negative bacteria are not known. We systematically surveyed the presence of fosA in Gram-negative bacteria in over 18,000 published genomes from 18 Gram-negative species and investigated their contribution to fosfomycin resistance. We show that FosA homologues are present in the majority of genomes in some species (e.g., Klebsiella spp., Enterobacter spp., Serratia marcescens, and Pseudomonas aeruginosa), whereas they are largely absent in others (e.g., E. coli, Acinetobacter baumannii, and Burkholderia cepacia). FosA proteins in different bacterial pathogens are highly divergent, but key amino acid residues in the active site are conserved. Chromosomal fosA genes conferred high-level fosfomycin resistance when expressed in E. coli, and deletion of chromosomal fosA in S. marcescens eliminated fosfomycin resistance. Our results indicate that FosA is encoded by clinically relevant Gram-negative species and contributes to intrinsic fosfomycin resistance. PMID:28851843

  11. Intraosseous and extraosseous arterial anatomy of the adult navicular.

    PubMed

    McKeon, Kathleen E; McCormick, Jeremy J; Johnson, Jeffrey E; Klein, Sandra E

    2012-10-01

    The etiology of navicular stress fractures is a topic of interest due to the implications in high-level athletes. Previous studies suggest an avascular zone in the central one-third of the bone as a potential causative factor. This study investigated the extraosseous and intraosseous arterial anatomy of the adult navicular. Sixty legs from 30 cadavers were amputated below the knee. India Ink and Wards Blue Latex were injected into the anterior tibial, peroneal, and posterior tibial arteries. The specimens were frozen, thawed to room temperature, and the skin was sharply dissected away. The soft tissues were chemically debrided, leaving the bones, interosseous ligaments, and casts of the extraosseous blood vessels. The vascular supply to the navicular was elucidated in 55 specimens. The navicular was then cleared using a modified Spälteholz technique; the intraosseous vascularity was reviewed in 54 specimens. Medial tarsal branches of the dorsalis pedis consistently supplied the dorsal navicular (96.4%). Lateral tarsal branches of varying size and distribution patterns also supplied the dorsal navicular. The medial plantar bone received small branches from the superficial branch of the medial plantar artery. Thirty of 54 specimens had a diffuse intraosseous vascular supply throughout the bone. Only six (11.8%) specimens had an avascular zone in the central third of the navicular extending to the dorsal cortex. The dorsalis pedis and posterior tibial arteries branch to supply blood flow to the navicular. In the majority of these specimens the navicular had a dense intraosseous vascular supply throughout it. If diminished vascular supply is a contributing factor to navicular stress fracture, our results suggest that a relatively small proportion of individuals is prone to their development. Biomechanical or other clinical factors may play a more prominent role in the development of navicular stress fractures than previously suspected.

  12. Percutaneous drilling of symptomatic accessory navicular in young athletes.

    PubMed

    Nakayama, Shoichiro; Sugimoto, Kazuya; Takakura, Yoshinori; Tanaka, Yasuhito; Kasanami, Ryoji

    2005-04-01

    Results of percutaneous drilling for symptomatic type II accessory tarsal navicular bone are not determined. Percutaneous drilling of accessory navicular synchondrosis will induce or accelerate bone union between the accessory and primary navicular bones. Bone union of the synchondrosis leads to symptomatic relief. Case series; Level of evidence, 4. Thirty-one feet of 29 patients with type II accessory tarsal navicular treated by percutaneous drilling were reviewed. Twenty-four feet (77.4%) were assessed as excellent, 6 (19.4%) as good, and 1 (3.2%) as fair. No feet were assessed as poor. Bone union was obtained in 16 (80%) of the 20 feet when the proximal phalanx of the great toe was immature and in 2 of the 11 feet when it was mature. Percutaneous drilling of the synchondrosis was effective for a symptomatic type II accessory navicular, especially in patients with immature proximal phalanx of the great toe.

  13. Tarsal navicular bone size in diabetics: radiographic assessment.

    PubMed

    Harmouche, Elie; Robertson, Douglas; Kogler, Geza; Xing, Minzhi; Terk, Michael

    2014-07-01

    To test the anecdotal observation that isolated navicular collapse is associated with diabetes mellitus, we quantified the size of the tarsal navicular bone in subjects with and without diabetes and tested for association of size with age, height, weight, body mass index (BMI), gender, smoking, bone mineral density (BMD), duration, and level of control of diabetes. Ankle radiographs of 200 patients (122 female; 78 male; mean age 58 years [27-89]), 100 with type II diabetes and 100 age- and gender-matched controls were selected and reviewed. The anteroposterior (AP) dimension of the mid-navicular bone was measured from lateral radiographs. For standardization, the supero-inferior (SI) dimension of the calcaneal was measured and the navicular-calcaneus ratio calculated. Statistical evaluation included independent sample t tests and linear regression analyses. Diabetic subjects had a significantly smaller navicular AP dimension and navicular-calcaneus ratio compared with controls (p = 0.02 and p = 0.0001 respectively). Age, gender, height and duration of diabetes had no association with the navicular-calcaneus ratio. The navicular-calcaneus ratio was inversely correlated with weight (p = 0.01) and BMI (p < 0.001) and directly correlated with smoking (p = 0.04). Reliability of the radiographic measurements was excellent (ICC 0.80-0.97; SEM 0.3-1.7 mm). The anteroposterior dimension of the navicular is smaller in type II diabetic subjects than in age- and gender-matched controls. We hypothesize that this might be due to navicular collapse of multifactorial causes.

  14. Outcome of horses undergoing navicular bursotomy for the treatment of contaminated or septic navicular bursitis: 19 cases (2002-2016).

    PubMed

    Suarez-Fuentes, D G; Caston, S S; Tatarniuk, D M; Kersh, K D; Ferrero, N R

    2017-08-05

    Contaminated or septic navicular bursitis has been reported to have a guarded prognosis after surgical treatment with navicular bursotomy only. In our experience, the use of navicular bursotomy for the treatment of this disease in combination with systemic and local delivery of antimicrobials can provide a good prognosis, even in horses with chronic disease. To report the outcome of horses undergoing navicular bursotomy for the treatment of contaminated or septic navicular bursitis. Descriptive case series. Navicular bursotomy was performed in combination with systemic and local antimicrobial therapies. Medical records (2002-2016) were reviewed. Follow-up information was obtained from owners or referring veterinarians. Horse outcome was divided into two groups. A successful outcome (Group 1) was assigned to horses that were able to return to the same level of use or performance as before contamination/infection. A satisfactory outcome (Group 2) was assigned to horses that survived but did not return to their previous function or level of performance. All horses survived to hospital discharge. Follow-up was obtained from 4 months to 12.75 years after surgery. Sixteen horses were able to return to their previous level of use (84.2%) and three horses were able to return to a lower level of performance or were pasture sound (15.8%). All 19 owners were satisfied with the outcome. Small sample size and retrospective nature of the study. Follow-up was limited to telephone contact with owners and referring veterinarians, and there is potential for recall bias. Navicular bursotomy in combination with systemic and local antimicrobial therapies is an effective treatment for contaminated or septic navicular bursitis. The success rate in this population makes navicular bursotomy worthy of consideration in cases of contaminated or septic navicular bursitis, especially with chronicity and/or where equipment or expertise for bursoscopy is unavailable. © 2017 EVJ Ltd.

  15. Management of dancers with symptomatic accessory navicular: 2 case reports.

    PubMed

    Smith, Teresa Riemer

    2012-05-01

    Case report. Symptomatic accessory navicular can be a source of pain and disability. The treatment considerations for accessory navicular in dancers may differ due to increased demands on the foot, the repetitive nature of the movements, and the specific footwear required. The purpose of this report is to describe the management (1 conservative and 1 postoperative) of 2 adolescent dancers with symptomatic accessory navicular. Case 1 was an 11-year-old female who underwent surgical excision of a symptomatic accessory navicular. Case 2 was a 15-year-old female who, following a traumatic injury that caused pain judged to be related to her accessory navicular, was managed nonsurgically. Treatment included pain management, range-of-motion exercises, trunk and lower extremity strengthening, balance and proprioception training, orthoses, crosstraining, and a guided return-to-dance progression. Both patients had improved pain, dance technique, strength, and patient-reported outcome scores that allowed a full return to dance. The 2 dancers presented here had foot pain believed to be related to a symptomatic accessory navicular. In both cases, treatment targeted specific impairments to improve function and disability. The guided progression of activities was intended to facilitate a return to dance that protected healing tissues and prevented a recurrence of symptoms. Clinicians should be aware of the effect of a symptomatic accessory navicular in the young dancer and potentially effective nonsurgical treatment options for this condition.

  16. Imaging of tarsal navicular disorders: a pictorial review.

    PubMed

    Tuthill, Heidi L; Finkelstein, Evan R; Sanchez, Allen M; Clifford, Paul D; Subhawong, Ty K; Jose, Jean

    2014-06-01

    The tarsal navicular is a bone within the midfoot that plays a critical role in maintaining the arch of the foot. This bone is clinically relevant because it may be affected by a wide array of pathologies. Our approach includes a detailed description of the imaging characteristics and disorders affecting the tarsal navicular. Organization includes (a) normal imaging, (b) accessory ossicles, (c) coalition, (d) fractures, (e) Kohler's disease, (f) osteonecrosis, (g) osteochondral lesions, (h) arthropathies, and (i) tumors. The purpose of this article is to discuss normal variants and pathological processes that can affect the tarsal navicular, with emphasis on the often-overlooked imaging findings.

  17. Reconstruction With β-Tricalcium Phosphate After Navicular Tumor Resection.

    PubMed

    Sakamoto, Akio

    Postresection reconstruction of the navicular bone is challenging. A composite hemangioendothelioma is an intermediate malignancy characterized by an admixture of differing vascular components. In the present report, a 40-year-old male with a composite hemangioendothelioma presented with multiple soft tissue lesions of the leg and sole and a navicular bone lesion. The navicular bone was resected and reconstructed using β-tricalcium phosphate of strong compression resistance with plating. The current reconstruction method can be applied, not only for tumors, but also for trauma. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. The association of hallux limitus with the accessory navicular.

    PubMed

    Evans, R D Lee; Averett, Ryan; Sanders, Stephanie

    2002-06-01

    Hallux limitus is one of the most prevalent, debilitating disorders of the first metatarsophalangeal joint, and it has many proposed etiologies. This article reviews these etiologies, focusing primarily on the pes planus foot. The pes planus foot type is often associated with symptomatic hallux limitus and the accessory navicular. This article discusses this correlation, although a causal relationship has not been proven. The prevalence and classification of the accessory navicular are also discussed. Clinical cases involving symptomatic hallux limitus occurring concomitantly with an accessory navicular are reviewed, including radiographic findings, symptoms, and surgical treatment.

  19. Osteomyelitis of the navicular bone: a case report.

    PubMed

    Kumahashi, Nobuyuki; Kuwata, Suguru; Imade, Shinji; Uchio, Yuji

    2017-01-17

    A 16-year-old boy developed left foot pain of unknown cause that was unresponsive to conservative treatment, associated with fever and difficulty walking. He was admitted to our hospital with osteomyelitis of the accessory and body of the navicular bone. Surgery could not be performed because the patient had been diagnosed with Wiskott-Aldrich syndrome. After antibiotic therapy, laboratory abnormalities and pain had resolved. One year after treatment, the patient had returned to his original level of sports activity. Both an accessory navicular and the body of the navicular bone may develop osteomyelitis in immunocompromised patients; early diagnosis is important for prescribing effective conservative treatment.

  20. The partition behavior of perfluorooctanesulfonate (PFOS) and perfluorooctanesulfonamide (FOSA) on microplastics.

    PubMed

    Wang, Fei; Shih, Kai Min; Li, Xiao Yan

    2015-01-01

    Microplastics have been recognized as transport vectors for heavy metals and organic pollutants to marine animals. Thus, the sorption behavior of contaminant on microplastic is crucial to their transport in marine system. In this study, the sorption behavior of PFOS and FOSA (two perfluorochemicals) on three kinds of microplastics (PE, PS, and PVC) are reported. The isotherm study showed that the sorption of PFOS and FOSA on microplastics is highly linear, and it indicated that partition by hydrophobic interaction is the predominant sorption mechanism. The Kd values of FOSA on three kinds of microplastics are all higher than those of PFOS, and the reason is attributed to their different functional groups. The Kd value of FOSA on three types of microplastics followed the order as: PE>PVC>PS. Such finding may indicate that the molecule composition and structure of microplastics play important roles in their sorption processes of organic pollutants. The PFOS sorption levels on PE and PS particles were increased with the increase of NaCl and CaCl2 concentrations, while the ion concentrations have no effect on FOSA sorption. The study on the pH effects on PFOS and FOSA sorption indicated FOSA could partition under various pH conditions on three types of microplastics while PFOS sorption on PE and PS were favored with lower pH.

  1. Widespread Fosfomycin Resistance in Gram-Negative Bacteria Attributable to the Chromosomal fosA Gene.

    PubMed

    Ito, Ryota; Mustapha, Mustapha M; Tomich, Adam D; Callaghan, Jake D; McElheny, Christi L; Mettus, Roberta T; Shanks, Robert M Q; Sluis-Cremer, Nicolas; Doi, Yohei

    2017-08-29

    Fosfomycin is a decades-old antibiotic which is being revisited because of its perceived activity against many extensively drug-resistant Gram-negative pathogens. FosA proteins are Mn(2+) and K(+)-dependent glutathione S-transferases which confer fosfomycin resistance in Gram-negative bacteria by conjugation of glutathione to the antibiotic. Plasmid-borne fosA variants have been reported in fosfomycin-resistant Escherichia coli strains. However, the prevalence and distribution of fosA in other Gram-negative bacteria are not known. We systematically surveyed the presence of fosA in Gram-negative bacteria in over 18,000 published genomes from 18 Gram-negative species and investigated their contribution to fosfomycin resistance. We show that FosA homologues are present in the majority of genomes in some species (e.g., Klebsiella spp., Enterobacter spp., Serratia marcescens, and Pseudomonas aeruginosa), whereas they are largely absent in others (e.g., E. coli, Acinetobacter baumannii, and Burkholderia cepacia). FosA proteins in different bacterial pathogens are highly divergent, but key amino acid residues in the active site are conserved. Chromosomal fosA genes conferred high-level fosfomycin resistance when expressed in E. coli, and deletion of chromosomal fosA in S. marcescens eliminated fosfomycin resistance. Our results indicate that FosA is encoded by clinically relevant Gram-negative species and contributes to intrinsic fosfomycin resistance.IMPORTANCE There is a critical need to identify alternate approaches to treat infections caused by extensively drug-resistant (XDR) Gram-negative bacteria. Fosfomycin is an old antibiotic which is routinely used for the treatment of urinary tract infections, although there is substantial interest in expanding its use to systemic infections caused by XDR Gram-negative bacteria. In this study, we show that fosA genes, which encode dimeric Mn(2+)- and K(+)-dependent glutathione S-transferase, are widely distributed in the

  2. [Surgical treatment strategy for flatfoot related with accessory navicular].

    PubMed

    Deng, Yin-shuan; Gao, Qiu-ming; Zhen, Ping; Tang, Kang-lai

    2015-02-01

    Accessory navicular source flatfoot is one of the foot deformity of clinical common disease,its treatment method is more controversial, differences in clinical efficacy of different surgical methods, according to accessory navicular source flatfoot symptoms of surgical treatment,there is no uniform standard, around a pair of accessory navicular excision how to reconstruct the arch produced a series of operation methods, the clinical curative effect of different operative methods produce also different, how to develop the operation strategy, choose operation method, and after acessory navicular excision whether to rebuild posterior tibial tendon, how to rebuild, the problems such as how to rebuild is the research hotspot and difficulty, looking forward to further research.

  3. Imaging of the symptomatic type II accessory navicular bone.

    PubMed

    Mosel, Leigh D; Kat, Evelyn; Voyvodic, Frank

    2004-06-01

    Accessory ossicles of the foot are commonly mistaken for fractures. The accessory navicular is one of the most common accessory ossicles of the foot. There is a higher incidence in women and the finding might be bilateral in 50-90%. This entity is usually asymptomatic, although populations with medial foot pain have a higher prevalence. Three types of accessory navicular bone have been described. The type II accessory navicular is the most commonly symptomatic variant with localized chronic or acute on chronic medial foot pain and tenderness with associated inflammation of overlying soft tissues. Plain radiographic identification of the accessory navicular is insufficient to attribute symptomatology. Ultrasound allows for comparison with the asymptomatic side and localization of pain. Bone scintigraphy has a high sensitivity but positive findings lack specificity. Magnetic resonance imaging is of high diagnostic value for demonstrating both bone marrow and soft tissue oedema.

  4. The painful accessory navicular: a clinical and histopathological study.

    PubMed

    Grogan, D P; Gasser, S I; Ogden, J A

    1989-12-01

    Twenty-two skeletally immature patients with 39 accessory tarsal navicular bones were seen over a 4-yr period. Twenty-five of the feet with accessory naviculars were symptomatic and, after failure of conservative treatment, were treated by excision of the accessory bone, the synchondrosis, and the prominent portion of the main navicular ossification process. No attempt was made to reroute the posterior tibial tendon. All 25 operative feet were completely relieved of the preoperative pain. The external oblique view was found to be the best radiographic view to demonstrate the accessory navicular. Histological findings in the surgical specimens included areas of micro-fracture through the cartilaginous synchondrosis, acute and chronic inflammation, and cellular proliferation indicative of attempted repair. These changes are consistent with the theory that chronic chondro-osseous tensile failure can occur in this condition and is responsible for the clinical findings.

  5. Complete open dislocation of the navicular: a case report.

    PubMed

    Rao, Harish

    2012-01-01

    Complete dislocation of the navicular is rare, and open dislocation even more so. We report a case of a 85-year-old female patient who experienced complete open dislocation of navicular, successfully treated by open reduction and arthrodesis of the naviculocuneiform and calcaneocuboid joints. At 2 years after treatment, the patient was symptom free and had nearly normal foot function. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Navicular index for differentiation of flatfoot from normal foot.

    PubMed

    Roth, Sandor; Roth, Aron; Jotanovic, Zdravko; Madarevic, Tomislav

    2013-06-01

    The height of navicular bone from the floor is in proportion with the height of longitudinal arch of the foot. The study was conducted to evaluate correlation of navicular bone height with most often used angles, heel valgus and a foot print in order to simplify the procedure for the diagnosis of flatfoot. A total of 218 operated children (436 feet) because of flexible flatfoot were evaluated clinically and radiologically. Meary angle, lateral talonavicular angle, talocalcaneal angle, calcaneal pitch, heel valgus and arch index (Staheli) were evaluated pre-operatively and postoperatively. In 121 (242 feet) chosen children (age eight to 15) with all clinical values and pre-operative angles corresponding flatfoot, all postoperatively measured values were within the normal range. We got the navicular index by dividing length of longitudinal arch with navicular height. Values of navicular index were then compared with pre-operatively and postoperatively measured values. Pearson correlation and ROC test were used for statistical analysis. Values of the navicular index for flatfeet were in the interval from 4.75 to 31.2 (median 8.98), and for normal-arched feet 3.58-22.6 (median 5.48). Pearson correlation of arch index and measured parameters were significant in majority, and degree according to Colton was good. Area under the ROC curve was 0.861 (p = 0.0001). The cut-off value with 86 % sensitivity and 75 % specificity was 6.7407. Navicular index can be used reliably, without measures of the other parameters, to differentiate flatfoot from normal-arched foot. Therefore, the navicular index has an ability to distinguish between the flatfoot and normal-arched foot.

  7. The incidence of accessory navicular bone types in Turkish subjects.

    PubMed

    Keles Coskun, Nigar; Arican, Ramazan Yavuz; Utuk, Arzu; Ozcanli, Haluk; Sindel, Timur

    2009-11-01

    Accessory ossicles are the skeletal variations of the ankle and foot that can cause painful syndromes. The accessory navicular bone is one of the most common accessory ossicle of the foot (4-21%) and is also known as os tibiale, os tibiale externum and os naviculare secundarium. This bone can be adjacent to the posteromedial tuberosity of the navicular bone or can be separated and may cause various diseases in the foot and mimic fractures of foot bones. The aim of this study was to document a detailed investigation of incidence and types of accessory navicular bones of Turkish subjects according to sex in both extremities. The accessory navicular bone was detected (11%) via the posterior-anterior radiographs of 650 subjects in the radiological examination. The incidences of accessory navicular bones were identified as 6.1-4.9% in female and male participants. Accessory navicular bones were classified into three groups as Type I, Type II and Type III and the incidences of these bones were determined as 3.3, 3.1, 4.6%, respectively. Each group was also divided into subgroups. The incidences of the subgroups are as Type Ia 0.6%, Type Ib 1.5%, Type Ic 1.2%, Type IIA/a 0.8%, Type IIA/b 0.4%, Type IIA/c 0%, Type IIB/a 1.1%, IIB/b 0.3%, IIB/c 0.5%, Type IIIa 1.5%, Type IIIb 1.4%, Type IIIc 1.7%. Finally, the types of accessory navicular bones were discussed and the imaging modalities for diagnosis were presented.

  8. Navicular bone position determined by positional MRI: a reproducibility study.

    PubMed

    Hansen, Philip; Johannsen, Finn E; Hangaard, Stine; Stallknecht, Sandra E; Hansen, Bjarke B; Nybing, Janus D; Boesen, Mikael

    2016-02-01

    To examine intraobserver, interobserver and between-day reproducibility of positional MRI for evaluation of navicular bone height (NVH) and medial navicular position (MNP). Positional MRI (pMRI) of the foot was performed on ten healthy participants (0.25 T G-scanner). Scanning was performed in supine and standing position, respectively. Two radiologists evaluated the images in a blinded manner. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC) and 95 % limits of agreement as a percentage of the mean (LOA%). Intraobserver and interobserver reliability was "substantial" in both supine and standing position (ICC 0.86-0.98) and showed good agreement (LOA% 4.9-14.7 %). Between-day reliability of navicular height and medial navicular position in standing position remained substantial (ICC 0.85-0.92) with adequate agreement (LOA% 8.3-19.8 %). In supine position between-day reliability was "moderate" for NVH (ICC 0.72) and "slight" for MNP (ICC 0.39). Agreement remained adequate between-days for MNP in supine position (LOA% 17.7 %), but it was less than adequate for NVH in supine position (LOA% 24.2 %). Navicular height and medial navicular position can be measured by pMRI in a very reproducible manner within and between observers. Increased measurement variation is observed between-days in supine position, which may be due to small positional differences or other unknown biomechanical factors.

  9. The symptomatic accessory tarsal navicular bone: assessment with MR imaging.

    PubMed

    Miller, T T; Staron, R B; Feldman, F; Parisien, M; Glucksman, W J; Gandolfo, L H

    1995-06-01

    To determine if a symptomatic accessory navicular bone, a normal variant, displays a pattern of altered signal intensity on magnetic resonance (MR) images indicative of an abnormality that could account for the patient's foot pain. Both feet were imaged in seven patients with an accessory navicular bone on radiographs and unilateral foot pain. Five patients had focal medial foot pain, and two had vague, diffuse pain. T1-weighted spin-echo and T2-weighted fat-suppressed sequences were used. A bone marrow edema pattern (BMEP) was noted in the accessory navicular bones of the five patients with focal pain and in the adjacent navicular tuberosities of three of them. The two patients with vague pain showed no osseous or soft-tissue abnormalities. Two patients with positive MR images underwent surgical excision of the accessory navicular bone, and histologic examination revealed osteonecrosis in one patient. The BMEP in a symptomatic accessory navicular bone is indicative of chronic stress and/or osteonecrosis. This information can furnish an objective basis for surgical or conservative management.

  10. Accessory Navicular is Associated With Wider and More Prominent Navicular Bone in Pediatric Patients by Radiographic Measurement.

    PubMed

    Seehausen, Derek A; Harris, Liam R; Kay, Robert M; Pace, J Lee

    2016-01-01

    Accessory navicular (AN) is a common anatomic variant that is known to cause medial foot pain. Surgery may be required for excision if conservative measures fail. Often, the medial border of the navicular is excised in addition to the AN during surgery. The purpose of this radiographic study is to determine if the presence of an AN is associated with a wider or more prominent navicular in pediatric patients compared with normal controls. This study included pediatric patients who received an initial plain anteroposterior foot radiograph between January 1, 2004 and December 31, 2012 and were between the ages of 10 and 20 years. Feet with an AN were compared with those without, while controlling for age. Male and female patients were analyzed independently. Feet with fractures, deformities, or previous surgeries were excluded. Radiographic measurements included the navicular width and the protrusion of the navicular bone medially. A total of 592 feet were included. An AN was identified in 73 feet. Male patients were analyzed separately from females. Cases with 1 AN bone had similar-sized native navicular bones in the contralateral normal foot compared with controls with 2 normal feet (P>0.05). The presence of an AN was associated with a larger navicular width (male: P=0.02, female: P=0.02) and a larger medial protrusion percent (male: P<0.01, female: P<0.01). Age was controlled for. On radiographic examination, feet with an AN had wider native navicular bones that protruded more medially than feet without an AN. Level IV-diagnostic.

  11. [Surgical treatment of the accessory navicular syndrome with simple excision].

    PubMed

    Chi, Lei-Ting; Li, Cheng; Zhang, Dong; Li, Zhi; Huang, Bo; Zhang, Ting-Jiu; Yu, Ming; Wang, Ping-Xi

    2009-12-01

    To observe and evaluate the clinical effects of surgical treatment for the accessory navicular syndrome with simple excision. From November 2006 to December 2008, 23 patients (twenty-five feet) with accessory navicular syndrome received simple excision of the accessory navicular bone. The chief complains were intermittent pain of feet after running or walking. Physical examination showed local tenderness on palpation in the region of the navicular bone. X-ray or CT showed there was an accessory navicular bone. The present history ranged from 6 months to 12 years. There were 14 males and 9 females. The mean age was 14.6 years, ranging from 8 to 35 years. About 2 cm long incision was made at the tip of the medial prominence of the navicular bone. After partial dissection of the posterior tibial tendon, the accesssory navicular bone was exposed and excisied. The prominence of the tuberosity of the navicular bone was cut and shaved. The posterior tibial tenden was repaired before closing the wound. The foot was immobilized with cast or brace in inversion position and no weight-bearing for 2 weeks. Strenuous jumping or dancing must be avoided in 3 months after surgery. The patients with residual symptoms and signs received physical therapy and an arch support for shoes without flatfoot deformity. The average clinical follow-up during was 12 month (ranged, 3 to 18 months). The excellent results in 21 feet and good in 4 feet (3 feet with mild flat deformity and 1 foot with old sprain injury). The average hospital stay was 5 days and no wound infection occurred. All patients resumed the normal life and study after operation. Surgical treatment of the accessory navicular syndrome with simple excision has the advantages of less invasive to the posterior tibial tenden and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results. This procedure is one of the best selective treatments for

  12. Reevaluating the functional implications of Australopithecus afarensis navicular morphology.

    PubMed

    Prang, Thomas C

    2016-08-01

    The longitudinal arch is a unique characteristic of the human foot, yet the timing and pattern of its evolution remain controversial, in part due to the disagreement among researchers over which skeletal traits are the best indicators of its presence or absence. The small size of the human navicular tuberosity has previously been linked to the presence of a longitudinal arch, implying that the large tuberosity of early hominins such as Australopithecus afarensis reflects a flat foot. However, this hypothesis is at odds with other evidence of pedal form and function, such as metatarsal, tarsal, and footprint morphology, which show that a longitudinal arch was probably present in A. afarensis. This study reevaluates the morphometric affinities of the A. afarensis naviculars among other Plio-Pleistocene fossil hominins and anthropoid primates (N = 170). Multivariate cluster analyses show that all fossil hominin naviculars, including those attributed to A. afarensis, are most similar to modern humans. A measure of navicular tuberosity size quantified as the ratio of the tuberosity volume to the surface area of the talar facet shows that Ateles has the largest navicular tuberosity among the anthropoid sample and that there is no difference between highly arboreal and terrestrial taxa in this metric (e.g., Hylobates and Gorilla beringei). Instead, a relatively large navicular tuberosity may reflect the development of leg musculature associated with ankle plantarflexion. The functional inferences derived from the morphology of the A. afarensis naviculars are consistent with the morphology of the Laetoli footprints. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Symptomatic and asymptomatic accessory navicular bones: findings of Tc-99m MDP bone scintigraphy.

    PubMed

    Chiu, N T; Jou, I M; Lee, B F; Yao, W J; Tu, D G; Wu, P S

    2000-05-01

    The accuracy of bone scintigraphy in diagnosing symptomatic accessory navicular bones has not been well studied. We conducted a retrospective study to explore the results and use of scintigraphy in symptomatic and asymptomatic accessory navicular bones. Thirteen patients with a total of 13 symptomatic and 10 asymptomatic accessory navicular bones were included in the study. We used a scoring system to grade the scintigraphic abnormalities. The patients' symptoms and scintigraphic findings were recorded. Though focally increased radiopharmaceutical uptake was observed in all symptomatic accessory naviculars, half of the asymptomatic accessory navicular bones had the same manifestations. The scoring system was of no value in differentiating symptomatic from asymptomatic accessory navicular bones. Bone scintigraphy is a sensitive but not a specific tool for diagnosing a symptomatic accessory navicular. Copyright 2000 The Royal College of Radiologists.

  14. Vascularized pedicle bone grafting for nonunions of the tarsal navicular.

    PubMed

    Fishman, Felicity G; Adams, Samuel B; Easley, Mark E; Nunley, James A

    2012-09-01

    Osteonecrosis and nonunions of the tarsal navicular remain a challenging clinical problem. This article presents a series of patients treated with local vascularized pedicle bone grafting to the navicular. The purpose of this study was to determine the early clinical and radiographic outcomes of this technique. Patients who underwent local vascularized pedicle bone grafting for osteonecrosis of the navicular from 2002 to 2007 were included in this study. The Ankle Osteoarthritis Scale (AOS), the Revised Foot Function Index (FFI-R), and the Short-Form 36 (SF-36) outcomes questionnaires were administered at most recent followup. Postoperative imaging was reviewed for evidence of healing. Eight patients with a mean age of 47.5 (range, 18 to 68) years were included in this study. The mean followup time was 61 (range, 32 to 72) months. Two patients underwent concomitant talonavicular arthrodesis. Two patients underwent additional procedures to address continued nonunion of the navicular. Neither patient elected to complete the outcomes questionnaires. The mean postoperative FFI score was 35.2 (range, 16.6 to 59). SF-36 subscales were as follows: bodily pain, 53; general health, 55; mental health, 75; physical function, 56; role emotional, 61; role physical, 37.5; social function, 71; and vitality, 56. The mean postoperative AOS pain score was 27.9 (range, 0 to 46.2) and the average disability score was 31.4 (range, 0 to 78.2). Postoperative imaging revealed consolidation and full healing in six of eight patients. Vascularized pedicle bone grafting is a treatment option for patients with chronic nonunion or osteonecrosis of the navicular. Additionally, it may serve as an adjunct procedure to provide increased vascularity to talonavicular arthrodesis in cases of navicular osteonecrosis and talonavicular arthritis.

  15. Vascular foramina of navicular bone: a morphometric study

    PubMed Central

    Ravichandran, Praveena; Shanmugasundaram, Jayanthi; Jayaraman, Anbalagan; Salem, Rajasekar Sivaprakasam

    2017-01-01

    The navicular bone is supplied by more than one artery. The knowledge about the vascular foramina is important to understand the pathogenesis and management of navicular fractures. The objective of the present study is to analyze the morphology and morphometry of vascular foramina of dried human navicular bone in Indian population. The study was carried out by using 100 navicular bones (50 right and 50 left) collected from our institute and other medical institutes in and around Puducherry. The bones were macroscopically studied for vascular foramina with respect to its location, number, size, and shape. The data collected were statistically analyzed. The vascular foramina were present on dorsal, plantar, medial, and lateral surfaces of navicular bone. Kruskal-Wallis test followed by series of Mann-Whitney test for post hoc analysis showed the number of nutrient foramina observed on dorsal surface were significantly greater than those observed on the plantar (U=2,755, P=0.001), medial (U=43, P=0.001), and lateral (U=626.5, P=0.001) surfaces of the navicle. About 97.6% of foramina were circular and 2.5% were oval in appearance. About 96.7% of vascular foramina were <1 mm in size and 3.3% were ≥1 mm in size. Spearman's rank correlation coefficient done showed a strong, positive correlation between vascular foramina of <1 mm size and circular shape, which was statistically significant (rs=0.981, P=0.001). We believe the present study has provided additional information on the vascular foramina of navicular bone and useful to surgeons in foot surgeries. PMID:28713611

  16. Osteochondritis dissecans of the tarsal navicular bone: a case report.

    PubMed

    Beil, Frank Timo; Bruns, Juergen; Habermann, Christian R; Rüther, Wolfgang; Niemeier, Andreas

    2012-01-01

    Osteochondritis dissecans most often affects the convex articular surfaces of the knee, the elbow, and the ankle joints; other sites of manifestation are very rare. Here we report a case of osteochondritis dissecans of the talonavicular joint affecting the concave part of the tarsal navicular bone in a 22-year-old woman, which was successfully treated by surgery, leading to complete recovery. Early diagnosis and surgery in stages of undamaged cartilage may help to prevent disease progression and the development of disabling osteoarthritis in the physiologically heavily loaded talo-navicular joint.

  17. Complete medial dislocation of the tarsal navicular without fracture: report of a rare injury.

    PubMed

    Davis, Adrian T; Dann, Adam; Kuldjanov, Djoldas

    2013-01-01

    Complete dislocation of the tarsal navicular, without fracture of the navicular, is an uncommon injury. A review of the published data revealed only 15 previous reported cases. The rarity of this injury can be attributed to the rigid bony and ligamentous support surrounding the navicular, which usually undergoes fracture and dislocation rather than pure dislocation of the navicular. The mechanism and appropriate treatment of this injury remains unclear. In the present report, we describe the case of a 29-year-old male who sustained complete dislocation of the tarsal navicular, without fracture of the navicular, along with fractures of the cuboid and calcaneus, when he was involved in a motor vehicle collision. The proposed mechanism of injury in this case was that of a pronation-abduction force applied to the midfoot, resulting in a transient midtarsal dislocation and disruption of the ligamentous support of the navicular, with medial dislocation of the navicular when the midtarsal dislocation was reduced. The anterolateral calcaneus and cuboid fractures were likely from an avulsion injury through the bifurcate ligament. The patient was treated successfully with closed reduction and Kirschner wire fixation of the navicular combined with application of a spanning external fixator. The pins and external fixator were removed at 7 weeks postoperatively, and the navicular was stable at that time. The patient was lost to follow-up shortly thereafter. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Longitudinal radiographic behavior of accessory navicular in pediatric patients.

    PubMed

    Knapik, Derrick M; Guraya, Sahejmeet S; Conry, Keegan T; Cooperman, Daniel R; Liu, Raymond W

    2016-12-01

    An accessory navicular is generally asymptomatic and discovered incidentally on radiographs. The natural history of an accessory navicular in the pediatric population is largely undescribed. The medical charts of 261 pediatric subjects undergoing 2620 annual unilateral radiographs of the foot and ankle (age range 0.25-7 years at enrollment) were reviewed. Radiographs were examined to determine the incidence of accessory navicular, with focus on the age at appearance and, if present, the age at fusion. Skeletal maturity was graded based on ossification pattern of the calcaneal apophysis. Accessory navicular was identified in 19 subjects (n = 12 males, n = 7 females, p = 0.43), appearing significantly earlier in the female subjects than in the male ones (p = 0.03). Fusion was documented in 42% (n = 8) of subjects, occurring at a mean (±standard deviation) age of 12.5 ± 1.0 years in females and 14.1 ± 2.7 years in males. Skeletal maturity grading demonstrated comparable stages of maturity at the time of fusion between male and female subjects (p = 0.5). Based on an analysis of 160 subjects with serial images extending at least one standard deviation past the mean age of appearance, the overall incidence was 12%. Our review of pediatric subjects showed that accessory navicular appeared earlier in females than in males. Fusion occurred in 42% of patients at comparable levels of skeletal maturity between the male and female subjects. No significant differences in overall incidence, skeletal maturity, fusion rate, or age of fusion were noted between the male and female subjects.

  19. [Outcome of accessory navicular fusion for the treatment of the painful accessory navicular bone of type II in adults].

    PubMed

    Xie, Bing; Tian, Jing; Liu, Xin-wei; Zhou, Da-peng; Xiang, Liang-bi

    2014-10-01

    To evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults. From June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS). Two patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01). For the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure

  20. Prognostic Value of the Radiologic Appearance of the Navicular Ossification Center in Congenital Talipes Equinovarus.

    PubMed

    Atanda, Abiola A; Oni, Julius K; Ramsden, David M; Yoon, Richard S; Ahmad, Alaa A; Otsuka, Norman Y

    2015-01-01

    Congenital talipes equinovarus (CTEV), more commonly known as clubfoot, is a deformity of the foot that is not well understood. The tarsal navicular is at the center of the disease process and exhibits abnormal development and delayed ossification. However, its role in the pathologic process is not clear. The aim of the present study was to better understand the role of the tarsal navicular in CTEV by correlating the presence of the navicular ossification center and relapse of clubfoot deformity after surgical treatment. The medical records and radiographs of 34 patients (41 feet) with surgically treated CTEV were reviewed for the presence of the navicular ossification center and the lateral talocalcaneal angles. Of the 41 feet, 17 (41.46%) did not have the tarsal navicular ossification center present before surgery, and 24 (58.54%) did have the ossification center present. The talocalcaneal angles were similar between those with and without the navicular ossification center present. No significant difference was found in the incidence of relapse between the nonossified navicular group (17.6%) and the ossified navicular group (16.7%; p = .63). The presence of the navicular ossification center before surgery does not appear to have prognostic value for the relapse of CTEV after surgical intervention.

  1. An isolated dorso-medial dislocation of navicular bone: A case report

    PubMed Central

    Singh, Varun Kumar; Kashyap, Abhishek; Vargaonkar, Gauresh; Kumar, Ramesh

    2014-01-01

    An isolated dislocation of tarsal navicular is extremely rare injury. Usually it is associated with fracture of navicular itself or other tarsal bones of foot along with disruption of medial or lateral column of foot. Mechanism of injury is complex but usually a severe abduction force is required to produce such injury in a planter flexed foot. A 30 year old male presented with isolated navicular dislocation. Management required open reduction and fixation with k-wires. These injuries have specific complications including avascular necrosis of navicular and post-traumatic arthritis. PMID:26549950

  2. Degeneration of the accessory navicular synchondrosis presenting as rupture of the posterior tibial tendon.

    PubMed

    Chen, Y J; Hsu, R W; Liang, S C

    1997-12-01

    Degeneration of the accessory navicular synchondrosis may be associated with decreased function of the posterior tibial tendon in patients who are middle-aged or older. We investigated the role of ultrasonography in differentiating between degeneration of the accessory navicular synchondrosis with separation of the accessory navicular from the navicular, which has not been previously reported to our knowledge, and a rupture of the posterior tibial tendon. We studied fourteen patients (mean age, fifty-five years; range, forty-one to seventy-two years) who had an operatively confirmed injury of the accessory navicular synchondrosis. The mean duration of follow-up was thirty-nine months (range, twenty-seven to fifty-four months). Preoperative radiographs demonstrated a type-II accessory navicular (an accessory navicular with a synchondrosis) in all fourteen patients. Ultrasonography, which was performed for twelve patients, demonstrated a defect in the synchondrosis in eleven patients and a normal posterior tibial tendon in all twelve. The operative findings included incomplete separation of the synchondrosis in four of the fourteen patients, complete separation of the synchondrosis and the periosteum in eight, and avulsion of the accessory navicular in two. On the basis of our findings, we concluded that post-traumatic degeneration of an accessory navicular synchondrosis may present clinically as a variant type of avulsion or rupture of the posterior tibial tendon in this age-group. Ultrasonography is useful for distinguishing between complete or partial separation through the synchondrosis and rupture or attenuation of the posterior tibial tendon.

  3. Endoscopic Fusion of the Accessory Navicular Synchondrosis That Has No Diastasis.

    PubMed

    Lui, Tun Hing

    2017-04-01

    Accessory navicular bone is a common accessory ossicle of the foot and is present in 10% to 14% of normal feet. Less than 1% of the accessory navicular bones are symptomatic. Degenerative or traumatic disruption of the accessory navicular synchondrosis is one of the main causes of symptomatic accessory navicular. The disrupted synchondrosis may or may not be associated with diastasis of the synchondrosis. Fusion of the synchondrosis is indicated if the pain fails to respond to conservative measures. The purpose of this Technical Note is to describe a minimally invasive approach for fusion of the synchondrosis that has no diastasis.

  4. Clinical outcome of surgical treatment of the symptomatic accessory navicular.

    PubMed

    Kopp, Franz J; Marcus, Randall E

    2004-01-01

    When conservative treatment fails to provide relief for a symptomatic accessory navicular, surgical intervention may be necessary. Numerous studies have been published, reporting the results of the traditional Kidner procedure and alternative surgical techniques, all of which produce mostly satisfactory clinical outcomes. The purpose of this study was to report the clinical results, utilizing the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, of surgical management for symptomatic accessory navicular with simple excision and anatomic repair of the tibialis posterior tendon. The authors retrospectively reviewed the results of 13 consecutive patients (14 feet) who underwent surgical treatment for symptomatic accessory navicular. The patients ranged in age from 16 to 64 years (average, 34.1 years; mean, 28.2 years) at the time of surgery. All patients had a type II accessory navicular. The average follow-up of the patients involved in the study was 103.4 months (range, 45-194 months). The AOFAS Midfoot Scale was utilized to determine both preoperative and postoperative clinical status of the 14 feet included in the study. The average preoperative AOFAS score was 48.2 (range, 20-75; mean, 38.8). The average postoperative AOFAS score was 94.5 (range, 83-100; mean, 94.3). At last follow-up, 13 of 14 feet were without any pain, no patients had activity limitations, and only two of 14 feet required shoe insert modification. Postoperatively, no patients had a clinically notable change in their preoperative midfoot longitudinal arch alignment. All of the patients in the study were satisfied with the outcome of their surgery and would undergo the same operation again under similar circumstances. When conservative measures fail to relieve the symptoms of a painful accessory navicular, simple excision of the accessory navicular and anatomic repair of the posterior tibialis tendon is a successful intervention. Overall, the procedure provides reliable pain

  5. Köhler's bone disease of the tarsal navicular.

    PubMed

    Borges, J L; Guille, J T; Bowen, J R

    1995-01-01

    Fourteen patients with Köhler's bone disease of the tarsal navicular in 16 feet were reviewed at an average follow-up of 31 years 6 months after diagnosis. The type and length of treatment did not affect the final outcome; however, short-leg cast immobilization did decrease the duration of symptoms. Two feet were symptomatic at the time of follow-up: one foot had a talocalcaneal coalition with degenerative changes, and the other foot had a large accessory navicular. Both of these feet were rated as having a fair result. The remaining 12 feet were classified as having a good result. Patients with Köhler's bone disease can be expected to have a normal foot at adulthood. Should the patient become symptomatic, other causes of foot pain should be investigated.

  6. Accessory Navicular Syndrome in Athlete vs General Population.

    PubMed

    Jegal, Hyuk; Park, Young Uk; Kim, Jin Su; Choo, Ho Sik; Seo, Young Uk; Lee, Kyung Tai

    2016-08-01

    Symptomatic accessory navicular syndrome (ANS) typically develops in young athletes. The symptoms are exacerbated during exercise or while walking, affecting the sports performance of athletes. The purpose of this study was to evaluate the radiologic findings and clinical course in athletes with accessory navicular syndrome (ANS) in comparison with a nonathletic population. Seventy-nine patients with ANS between August 2012 and August 2013 were included. Overall, 29 were athletes and 50 were not athletes, and 19 (2 athletes and 17 nonathletes) of them improved after at least 6 months of conservative treatment. The records of 60 patients (64 consecutive feet) of ANS treated by modified Kidner operation were evaluated retrospectively. The study population included 27 athletes (31 feet) and 33 nonathletes (33 feet). Clinical features and radiologic findings were compared between them. Overall, 34% of the nonathletes improved after conservative treatment, but only 6.9% of athletes improved (P < .001). Mean age at surgery in the athlete group was 16.1 years (range, 12-26), and 24.3 years (range, 12-52) in the nonathlete group (P < .001). There was a history of trauma in 23 feet (74%) of the athlete group and in 13 feet (39%) of the nonathlete group (P = .006). Eighteen feet (58%) in the athlete group and 11 feet (32%) in the nonathlete group showed movement between the 2 bones (P = .047). Bone marrow edema was observed in both navicular and accessory navicular in all of the athletes (27/27, 100%). But it was only present in 80% (16/20) for nonathletes (P = .012). The radiologic findings and clinical course of athletes were different from that of the general population. Their symptoms were more refractory to conservative treatment than the nonathletes group. Therefore, early operative treatment could be considered in cases of symptomatic ANS especially for athletes. Level III, retrospective comparative case series. © The Author(s) 2016.

  7. Tuberculosis around the tarsal navicular: A rare entity.

    PubMed

    Vijay, Vipul; Gupta, Nishint; Vaishya, Raju

    2016-08-01

    Osteoarticular TB around the tarsal navicular is a chronic, uncommon condition affecting the midfoot, which causes significant morbidity to the patient. Tuberculosis around the tarsal navicular is rarely described in the literature. A series of three cases - two involving the talo-navicular joint and one involving the naviculo-cuneiform joint is described. Biopsy was used in all the cases for achieving diagnosis. All patients had good to fair outcome following medical management with anti-tubercular therapy. Due to the pauci-bacillary nature of the disease, a positive culture of the disease is not always possible. The diagnosis depends on a positive histopathology finding. Once an early diagnosis is achieved, antitubercular therapy is usually the mainstay. Clinical awareness of the rare presentations of this disease can help in early detection, adequate treatment and good to fair outcomes. Due to the destruction of the midfoot joints, some patients report difficulty in walking on uneven surfaces and barefoot, for which triple arthrodesis may be offered. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The relationship of the accessory navicular to the development of the flat foot.

    PubMed

    Sullivan, J A; Miller, W A

    1979-10-01

    The Kidner procedure has been the most frequently recommended form of surgical treatment for the painful accessory navicular. This formal relocation of the posterior tibial tendon is said to restore the dynamic balance to the foot which is lost when the posterior tibial tendon gives an abnormal insertion into the accessory ossicle. The literature was reviewed to ascertain what is known or what is believed about the accessory navicular and the role of the posterior tibial tendon in the support of the longitudinal arch of the foot. Eighteen patients who had simple excision of the accessory navicular were reviewed to assess the success of such a procedure. In follow-up they all had very satisfactory results. A second group of 208 patients with non-traumatic foot complaints were reviewed to determine the incidence of accessory navicular and its association with the flat foot. Twenty-nine cases of previously undetected accessory navicular were identified in this group giving us a total of 179 patients without accessory navicular and 49 patients with accessory navicular available for study. There was no significant difference between the arch in these 2 groups of patients. Based on the findings in this study, the accessory navicular plays no role in the development of a flat foot. Simple excision of the prominent ossicle seems to be the surgical procedure of choice when conservative means of management fail.

  9. Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones.

    PubMed

    Jasiewicz, Barbara; Potaczek, Tomasz; Kacki, Wojciech; Tesiorowski, Maciej; Lipik, Ewa

    2008-01-01

    Accessory navicular bones might cause not only cosmetic problems but also be a reason of discomfort and pain. In case of inefficient conservative treatment symptomatic accessory naviculars are treated surgically. Presentation of results of simple excision of symptomatic accessory navicular. Material consists of 22 patients (34 feet), 17 women and 5 men, treated surgically between 1992 and 2006. Mean age at surgery was 14.1 years (9-22 years). Accessory navicular type I was present in 5 feet (14.7%), type II in 17 (50%) and type III-in 12 (35.3%). Main symptom was localized pain on the medial arch of the foot, in the height of navicular bone. Surgery consisted of simple accessory navicular excision and if needed partial resection of navicular bone. The mean follow-up period was 5.6 years (1-13 years). We analyzed: intensity of pain (VAS score system), daily and sport activity. Subjective results were analyzed using a questionnaire. The questionnaire was returned from 21 patients: 9 patients had total pain relief, 11 considerable and one patient had persistent pain. Mean VAS results before surgery was 5.9 and 1.7 after surgery. Only one patient required analgesics occasionally. Complications were present in two patients (6.1%). All active patients returned to their sport activities. Surgical treatment of symptomatic accessory navicular by simple excision technique gives satisfying results, surgery is minimally traumatic and risk of complications low.

  10. Osteomyelitis of the accessory navicular bone in the foot. A case report.

    PubMed

    Ali, Farhan; Fernandes, James A

    2004-06-01

    The accessory navicular is one of the most symptomatic bones of the foot. Osteonecrosis and fracture of this bone have been previously described. We report a case of osteomyelitis of an accessory navicular bone in a young girl, to make treating clinicians aware of this rare possibility.

  11. [Excessively long calcaneal spur. A rudimentary form of calcaneo-navicular synostosis].

    PubMed

    Hardy, J; Pouliquen, J C

    1983-01-01

    The authors have seen 5 children aged between 12 and 16 years suffering from a painful foot described as a recurrent sprain. Movements of the subtalar joint were limited and radiographs showed a hypertrophic calcaneal spur projecting towards the navicular but without fusion between the calcaneus and navicular. The calcaneal spurs were resected with good results and with an immediate symptomatic improvement.

  12. Image acquisitions, processing and analysis in the process of obtaining characteristics of horse navicular bone

    NASA Astrophysics Data System (ADS)

    Zaborowicz, M.; Włodarek, J.; Przybylak, A.; Przybył, K.; Wojcieszak, D.; Czekała, W.; Ludwiczak, A.; Boniecki, P.; Koszela, K.; Przybył, J.; Skwarcz, J.

    2015-07-01

    The aim of this study was investigate the possibility of using methods of computer image analysis for the assessment and classification of morphological variability and the state of health of horse navicular bone. Assumption was that the classification based on information contained in the graphical form two-dimensional digital images of navicular bone and information of horse health. The first step in the research was define the classes of analyzed bones, and then using methods of computer image analysis for obtaining characteristics from these images. This characteristics were correlated with data concerning the animal, such as: side of hooves, number of navicular syndrome (scale 0-3), type, sex, age, weight, information about lace, information about heel. This paper shows the introduction to the study of use the neural image analysis in the diagnosis of navicular bone syndrome. Prepared method can provide an introduction to the study of non-invasive way to assess the condition of the horse navicular bone.

  13. The Rare Cuboid-Navicular Coalition Presenting as Chronic Foot Pain

    PubMed Central

    Awan, Omer; Graham, James Allen

    2015-01-01

    Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought. PMID:25688320

  14. The rare cuboid-navicular coalition presenting as chronic foot pain.

    PubMed

    Awan, Omer; Graham, James Allen

    2015-01-01

    Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought.

  15. Spontaneous osteonecrosis of the tarsal navicular in an adult: Mueller-Weiss syndrome.

    PubMed

    Tosun, Bilgehan; Al, Firat; Tosun, Alptekin

    2011-01-01

    Spontaneous osteonecrosis of the navicular in the adult is known as Mueller-Weiss syndrome, which is a rare disease characterized by a collapse of the lateral portion of the tarsal navicular combined with a medial protrusion of the talar head and peri-navicular osteoarthritis. In this article, we describe a case of spontaneous osteonecrosis of tarsal navicular in a 43-year-old male. Chronic midfoot pain over the dorsomedial aspect of the right foot was resolved after complete removal of the necrotic bone from the tarsal navicular, followed by an autologous bone grafting of the resultant defect. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. An ultrasound-guided, tendon-sparing, lateral approach to injection of the navicular bursa.

    PubMed

    Nottrott, K; De Guio, C; Khairoun, A; Schramme, M

    2017-09-01

    Navicular disease in the horse often requires injection of the navicular bursa. We have developed an ultrasound-guided, lateral needle approach to navicular bursocentesis, which avoids penetration of the deep digital flexor tendon (DDFT) and the need for radiographic control. To describe and evaluate the feasibility and efficacy of an ultrasound-guided, lateral bursocentesis technique. Cadaveric and in vivo experiments. The navicular bursa in 62 cadaveric forelimbs of 31 horses and in both forelimbs of 26 live horses, positioned with the foot flexed in a navicular block, were submitted to lateral, ultrasound-guided injection of 1.5 ml radiocontrast agent. Lateromedial radiographs were taken to locate the contrast. A second injection of 0.5 ml methylene blue was administered during needle withdrawal in cadaveric limbs to investigate the needle pathway during dissection. Contrast agent was successfully deposited in the navicular bursa in 104 of 114 (91%) limbs and in the navicular bursa alone in 89 of 114 (78%) limbs. Dissection showed no evidence of penetration of the DDFT in cadaver limbs. Failure to inject the navicular bursa was significantly associated with poor quality of the ultrasound image (P = 0.04) and resulted in aberrant injection of the distal interphalangeal joint in five of 114 (4%) limbs, the peribursal soft tissues in four of 114 (4%) limbs and the digital flexor tendon sheath in one of 114 (0.9%) limbs. Synovial fluid was observed at the needle hub in 58% of live horses. It is unknown whether injection results obtained in the limbs of horses without disease can be extrapolated to horses with clinical disease of the podotrochlear apparatus. The localisation of contrast medium on radiographs may not accurately reflect the behaviour of local anaesthetic solution or therapeutic medications injected in the navicular bursa. This lateral, ultrasound-guided technique for injecting the navicular bursa is effective, does not penetrate the DDFT and avoids

  17. Morphologic changes associated with functional adaptation of the navicular bone of horses

    PubMed Central

    Bentley, V A; Sample, S J; Livesey, M A; Scollay, M C; Radtke, C L; Frank, J D; Kalscheur, V L; Muir, P

    2007-01-01

    Failure of functional adaptation to protect the skeleton from damage is common and is often associated with targeted remodeling of bone microdamage. Horses provide a suitable model for studying loading-related skeletal disease because horses are physically active, their exercise is usually regulated, and adaptive failure of various skeletal sites is common. We performed a histologic study of the navicular bone of three groups of horses: (1) young racing Thoroughbreds (n = 10); (2) young unshod ponies (n = 10); and (3) older horses with navicular syndrome (n = 6). Navicular syndrome is a painful condition that is a common cause of lameness and is associated with extensive remodeling of the navicular bone; a sesamoid bone located within the hoof which articulates with the second and third phalanges dorsally. The following variables were quantified: volumetric bone mineral density; cortical thickness (Ct.Th); bone volume fraction, microcrack surface density; density of osteocytes and empty lacunae; and resorption space density. Birefringence of bone collagen was also determined using circularly polarized light microscopy and disruption of the lacunocanalicular network was examined using confocal microscopy. Remodeling of the navicular bone resulted in formation of transverse secondary osteons orientated in a lateral to medial direction; bone collagen was similarly orientated. In horses with navicular syndrome, remodeling often led to the formation of intracortical cysts and development of multiple tidemarks at the articular surface. These changes were associated with high microcrack surface density, low bone volume fraction, low density of osteocytes, and poor osteocyte connectivity. Empty lacunae were increased in Thoroughbreds. Resorption space density was not increased in horses with navicular syndrome. Taken together, these data suggest that the navicular bone may experience habitual bending across the sagittal plane. Consequences of cumulative cyclic loading in

  18. Navicular Stress Fracture Outcomes in Athletes: Analysis of 62 Injuries.

    PubMed

    Saxena, Amol; Behan, Shontal A; Valerio, Dallas L; Frosch, Dominick L

    The optimal treatment modalities for navicular stress fractures in athletes is currently unknown for this season-ending injury. The present study evaluated factors that might be significant and affect healing outcomes, specifically focusing on the return to activity (RTA) time and a decreased desired activity (DDA) after treatment in athletes. Such considerations included previous navicular stress fractures, patient demographic data and type of sport, and initiation time of treatment. The data from 59 patients with 62 fractures were prospectively analyzed from May 2005 through July 2016. The results showed a significant correlation between a previous navicular stress fracture and decreased desired activity. The average duration of symptoms before receiving definitive treatment was 8.8 months. Computed tomography as the initial imaging modality correlated positively with a correct diagnosis (1.00). In contrast, magnetic resonance imaging, when used initially, was only 71% accurate. Runners constituted most of the cohort at 38 (61.3%). Ten other athletes were involved in jumping sports. Of the 62 injuries, 21 (33.9%) were in elite or professional athletes, all of whom were able to RTA, with 1 patient, a 38-year-old world record holding runner, having a DDA. Seven refractures (11.2%) occurred an average >5 years after the initial injury, predominantly in those aged <21 years, none with previous surgery. Eight patients (12.9%) developed postinjury arthrosis, including 1 with DDA. Patients who underwent open reduction and internal fixation had a RTA of 4.56 months compared with those who had undergone nonoperative treatment, who had an average RTA of 3.97 months. Seven patients (11.2%) underwent screw removal and required a longer RTA. Overall, of the 62 injuries, the patients with 57 of the injuries (91.9%) were able to RTA at their preinjury level. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Treatment of painful accessory navicular: a modification to simple excision.

    PubMed

    Micheli, Lyle J; Nielson, Jason H; Ascani, Claudio; Matanky, Bryan K; Gerbino, Peter G

    2008-08-01

    An accessory tarsal navicular ossicle may produce pain and tenderness despite conservative treatment modalities. This condition causes pain along the medial arch and limitations of activities. This described modification of the Kidner procedure and simple excision technique keeps the tendon insertion intact while restoring some of the normal biomechanical relationships. In addition, this modification has the theoretical advantage of enhancing dynamic support of the longitudinal arch, and by maintaining the continuity of the posterior tibial tendon, a shorter period of immobilization is required. All patients at the most recent follow-up showed improvement, with 11 of 13 patients having excellent results with long-term follow-up.

  20. The relationship between the tibialis posterior tendon and the accessory navicular.

    PubMed

    Kiter, E; Günal, I; Karatosun, V; Korman, E

    2000-01-01

    Out of a total of 116 cadaver feet, 29 specimens were selected by means of palpation of the tuberosity of navicular for a possible presence of the accessory navicular. They were then radiographed and the accessory navicular was detected in ten. Also three fresh amputation specimens with an accessory navicular were added to the study. A total of 13 legs was dissected and in nine of them, the tibialis posterior tendon inserted directly into the accessory navicular without extending to the sole of the foot. In these feet, the second part of the tibialis posterior tendon originated from the accessory navicular, extending to the normal insertions. There was no connection between these two parts and when traction was applied to either one, no movement was observed in the other. Also a fibrocartilaginous mass was detected in four specimens, probably formed to resist the friction between the tendon and the bone. These results may explain the pronated foot in the presence of the navicular, due to the loss of the function of the tibialis posterior tendon.

  1. Response to injection of the navicular bursa with corticosteroid and hyaluronan following high-field magnetic resonance imaging in horses with signs of navicular syndrome: 101 cases (2000-2008).

    PubMed

    Marsh, Chad A; Schneider, Robert K; Sampson, Sarah N; Roberts, Greg D

    2012-11-15

    To determine treatment outcome on the basis of pathological changes identified on MRI and lameness duration in horses with navicular syndrome that underwent injection of corticosteroid and hyaluronan into the navicular bursa. Retrospective case series. 101 horses with navicular syndrome. Medical records of horses with signs of navicular syndrome evaluated between January 2000 and December 2008 were reviewed. Data on signalment, use of the horse, history, affected limbs, duration of lameness, findings on lameness examination, radiographic findings, MRI findings, treatment, and outcome were collected from the medical records. Follow-up information was obtained a minimum of 10 months after navicular bursa injection. Following navicular bursa injection, 76 of 101 (75%) horses returned to their intended use for a mean of 9.66 months, and 35 (35%) were sound at follow-up. Horses that had been lame for < 6 months before treatment were significantly more likely to return to their intended use, have a longer positive response to treatment, and be sound at follow-up, compared with horses that had a longer lameness history. Horses with primary deep digital flexor (DDF) tendonitis responded best to navicular bursa injection with rest and rehabilitation, followed by horses with navicular bursitis and horses with DDF tendonitis and adhesions to the collateral sesamoidean ligament of the distal sesamoid (navicular) bone. Horses with scar tissue in the proximal portion of the navicular bursa, adhesions from the navicular bone to the DDF tendon, or multiple abnormalities did not respond as well to treatment. Response to navicular bursa injection with corticosteroid and hyaluronan in horses with navicular syndrome was dependent on the disease process detected on MRI and duration of lameness.

  2. Endoscopically and Fluoroscopically Assisted Curettage and Bone Grafting of the Navicular Bone Cyst.

    PubMed

    Lui, Tun Hing

    2016-12-01

    Simple bone cyst is a common tumorlike lesion of the bone and can involve the bones of the foot. It is usually asymptomatic but can also present with pain or pathologic fracture. The purpose of this technical note is to describe the uni-osseous portal approach of endoscopic curettage and bone grafting of simple bone cyst of the navicular bone. The single-portal approach reduces the risk of iatrogenic fracture of the navicular bone. This is indicated for painful bone cyst of the navicular bone resistant to conservative treatment. It is contraindicated in multiple septated cysts, the presence of pathologic fracture, or the presence of aggressive cystic lesions.

  3. Dynamic in-vivo assessment of navicular drop while running in barefoot, minimalist, and motion control footwear conditions.

    PubMed

    Hoffman, Scott E; Peltz, Cathryn D; Haladik, Jeffrey A; Divine, George; Nurse, Matthew A; Bey, Michael J

    2015-03-01

    Running-related injuries are common and previous research has suggested that the magnitude and/or rate of pronation may contribute to the development of these injuries. Accurately and directly measuring pronation can be challenging, and therefore previous research has often relied on navicular drop (under both static and dynamic conditions) as an indirect assessment of pronation. The objectives of this study were to use dynamic, biplane X-ray imaging to assess the effects of three footwear conditions (barefoot, minimalist shoes, motion control shoes) on the magnitude and rate of navicular drop during running, and to determine the association between static and dynamic measures of navicular drop. Twelve healthy distance runners participated in this study. The magnitude and rate of navicular drop were determined by tracking the 3D position of the navicular from biplane radiographic images acquired at 60Hz during the stance phase of overground running. Static assessments of navicular drop and foot posture were also recorded in each subject. Footwear condition was not found to have a significant effect on the magnitude of navicular drop (p=0.22), but motion control shoes had a slower navicular drop rate than running barefoot (p=0.05) or in minimalist shoes (p=0.05). In an exploratory analysis, static assessments of navicular drop and foot posture were found to be poor predictors of dynamic navicular drop in all footwear conditions (p>0.18).

  4. Alterated talar and navicular bone morphology is associated with pes planus deformity: a CT-scan study.

    PubMed

    Peeters, Koen; Schreuer, Julien; Burg, Fien; Behets, Catherine; Van Bouwel, Saskia; Dereymaeker, Greta; Sloten, Jos Vander; Jonkers, Ilse

    2013-02-01

    We compared bone and articular morphology of the talus and navicular in clinically diagnosed flatfeet and evaluated their potential contribution to talo-navicular joint instability. We used CT images to develop 3D models of talus and navicular bones of 10 clinically diagnosed flatfeet and 15 non-flatfeet. We quantified their global bone dimensions, inclination and dimensions of the articular surfaces and their curvatures. Additionally, ratios of six talar and navicular dimensions were calculated. The values for these parameters were then compared between both groups. In flatfeet, the talar head faced more proximal and its width was larger compared to non-flatfeet. Also the navicular cup faced more proximal and its depth was significantly increased. Furthermore, we observed a more protruding talar head compared to the navicular cup in the control group with the articular surface depth being relatively larger for the navicular cups when compared to the talus in flatfeet. The ratio of the talar and navicular articular surface height was decreased in flatfeet, suggesting increased height of navicular cups relative to the articulating talar heads. Our results show that flatfoot deformity is associated with morphological changes of talar and navicular articular surfaces that can favor medial arch collapse and forefoot abduction. Copyright © 2012 Orthopaedic Research Society.

  5. Distal border fragments and shape of the navicular bone: radiological evaluation in lame horses and horses free from lameness.

    PubMed

    Biggi, M; Dyson, S

    2012-05-01

    The significance of distal border fragments of the navicular bone is not well understood. There are also no objective data about changes in thickness and proximal/distal extension of the palmar cortex of the navicular bone. To describe the distribution of distal border fragments and their association with other radiological abnormalities of the navicular bone and describe the shape of the navicular bone in sound horses and horses with foot-related lameness, including navicular pathology. Sound horses had radiographs acquired as part of a prepurchase examination. Lame horses had forelimb lameness abolished by palmar nerve blocks performed at the base of the proximal sesamoid bones. Diagnosis was assigned prospectively based on results of local analgesia and all imaging findings. The thickness of the palmar cortex of the navicular bone and size of proximal/distal extensions were measured objectively. Other radiological abnormalities were evaluated subjectively and each navicular bone graded. Fifty-five sound and 377 lame horses were included. All measurements were larger in lame compared with sound horses except the size of the distal extension of the palmar cortex. Fragments were observed in 3.6 and 8.7% of sound and lame horses respectively and in 24.1% of horses with a diagnosis of primary navicular pathology. There was an association between fragments and overall navicular bone grade, radiolucent areas at the angles of the distal border of the navicular bone and number and size of the synovial invaginations. The palmar cortex of the navicular bone was thicker in lame compared with sound horses. Distal border fragments were most frequent in horses with navicular pathology. Evaluation of changes in shape of the navicular bone may also be important for recognition of pathological abnormalities of the bone. © 2011 EVJ Ltd.

  6. Statistical shape models of cuboid, navicular and talus bones.

    PubMed

    Melinska, Aleksandra U; Romaszkiewicz, Patryk; Wagel, Justyna; Antosik, Bartlomiej; Sasiadek, Marek; Iskander, D Robert

    2017-01-01

    The aim was to develop statistical shape models of the main human tarsal bones that would result in novel representations of cuboid, navicular and talus. Fifteen right and 15 left retrospectively collected computed tomography data sets from male individuals, aged from 17 to 63 years, with no known foot pathology were collected. Data were gathered from 30 different subjects. A process of model building includes image segmentation, unifying feature position, mathematical shape description and obtaining statistical shape geometry. Orthogonal decomposition of bone shapes utilising spherical harmonics was employed providing means for unique parametric representation of each bone. Cross-validated classification results based on parametric spherical harmonics representation showed high sensitivity and high specificity greater than 0.98 for all considered bones. The statistical shape models of cuboid, navicular and talus created in this work correspond to anatomically accurate atlases that have not been previously considered. The study indicates high clinical potential of statistical shape modelling in the characterisation of tarsal bones. Those novel models can be applied in medical image analysis, orthopaedics and biomechanics in order to provide support for preoperative planning, better diagnosis or implant design.

  7. Radiographic measurement from the lateromedial projection of the equine foot with navicular disease.

    PubMed

    Verschooten, F; Roels, J; Lampo, P; Desmet, P; De Moor, A; Picavet, T

    1989-01-01

    Radiographic measurements from the lateromedial projection of the equine foot were compared in three groups of horses. Group 1 consisted of 143 normal horses, group 2 were 60 horses with clinical navicular disease and group 3 were 161 horses with clinical and radiographic navicular disease. Several measurements tended to be larger in group 3 than group 1. An enlargement of the navicular bone was observed in proximodistal and dorsopalmar directions. Partial enlargement of the pedal bone was observed in groups 2 and 3. Few differences were observed between age classes. All horses aged four years and over had an increased length of the hoof in the dorosopalmar direction and a decrease of the cranial angle of the hoof. Enlargement of the navicular bone fits well into the concept of osteoarthrosis. The pedal bone was partly engaged. These findings may be an expression of a regional acceleratory phenomenon.

  8. Stress fracture of the navicular bone in a patient with cerebral palsy: a case report.

    PubMed

    Yoshikawa, Mari; Nakanishi, Yoshitaka; Kawamura, Yoshika; Matsuo, Keisuke; Saeki, Mitsuru; Wada, Futoshi

    2015-03-01

    A 14-year-old girl with cerebral palsy (spastic diplegia) underwent examination due to a chief complaint of right foot pain, and was diagnosed with a stress fracture of the central one third of the navicular bone. The fracture was considered to have developed due to repeated loading on the navicular bone as a result of an equinus gait.Therefore, she underwent osteosynthesis and Achilles tendon lengthening to correct the equinus deformity. Following our review of the current literature, we did not identify any reports of stress fracture of the navicular bone in cerebral palsy. We believe that in cases where cerebral palsy patients with paralytic equinus complain of foot pain, the possibility of stress fracture of the navicular bone should be considered.

  9. Tibialis posterior tendon abnormalities in feet with accessory navicular bone and flatfoot.

    PubMed

    Kiter, E; Erdag, N; Karatosun, V; Günal, I

    1999-12-01

    To assess tibialis posterior tendon (TPT) pathology, we investigated 27 feet with the accessory navicular bone and 22 normal feet by MRI. We found two major anatomical differences in the feet with the accessory navicular bone; the TPT directly inserted in the accessory navicular bone, without any continuity to the sole of the foot or with a slip, less than 1 mm in thickness, and there was a mass with the density of fibrocartilage tissue, between the tendon and the bone in 20/27 feet. These abnormalities were not detected in the control group. 3 patients in the study group were operated on and the MRI findings were confirmed. These findings suggest that patients with the accessory navicular bone and flatfoot should be examined by MRI for insertion abnormalities of the TPT.

  10. Posterior tibial tendon tear combined with a fracture of the accessory navicular: a new subclassification?

    PubMed

    Chen, Y J; Shih, H N; Huang, T J; Hsu, R W

    1995-11-01

    A 58-year-old woman with a diagnosis of a tear of the posterior tibial tendon associated with the os accessory navicular fracture was treated surgically. We believe that the dysfunction of the posterior tibial tendon was associated with an os accessory navicular fracture. This case is proposed as a new subclassification that was separate from the traditional classification of the tear of the posterior tibial tendon.

  11. Evaluation of simple excision in the treatment of symptomatic accessory navicular associated with flat feet.

    PubMed

    Kiter, E; Günal, I; Turgut, A; Köse, N

    2000-01-01

    The results of 17 patients who had been treated by simple excision, for symptomatic accessory navicular were reviewed 2 to 5 years postoperatively. Although all patients had good or excellent results by subjective criteria, careful examination revealed difficulty in performing the "single-heel rise test" in 8 patients who also had preexisting flat feet. These results suggest the necessity for an objective evaluation system, as well as a different treatment approach, for the association of accessory navicular and flat foot.

  12. Evaluation of tarsal navicular stress fracture fixation using intraoperative O-arm computed tomography.

    PubMed

    Hsu, Andrew R; Lee, Simon

    2014-12-01

    Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Therapeutic, Level IV: Case Report. © 2014 The Author(s).

  13. MR Imaging Findings of Painful Type II Accessory Navicular Bone: Correlation with Surgical and Pathologic Studies

    PubMed Central

    Lee, Kyung Tai; Kang, Heung Sik; Kim, Eun Kyung

    2004-01-01

    Objective To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. Materials and Methods The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. Results The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. Conclusion The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients. PMID:15637478

  14. Kidner procedure for symptomatic accessory navicular and its relation to pes planus.

    PubMed

    Prichasuk, S; Sinphurmsukskul, O

    1995-08-01

    The role of relocation of tibialis posterior tendon insertion in the treatment of symptomatic accessory navicular and its relation to the pes planus was studied in 28 patients with symptomatic accessory navicular. Two hundred non-affected individuals were used as control. The calcaneal pitch angle measured radiographically, was used as an indicator of pes planus. All patients had had an excision of the accessory navicular and relocation of the tibialis posterior tendon insertion (Kidner procedure). The average follow-up was 3.2 years. The results were good in 27 patients, and fair in 1 patient, and there were no poor results. Most of the patients demonstrated that the pain and the fatigue signs of the foot and the leg have been improved. Only 3 of 25 patients clinically showed an improvement of the medial longitudinal arch. The calcaneal pitch angle in patients with symptomatic accessory navicular was significantly (14.8 degrees) lower than that in normal subjects (21.4 degrees). An association of pes planus and symptomatic accessory navicular was shown. The Kidner procedure gave good results in the relief of pain and fatigue in patients with symptomatic accessory navicular. The procedure did not significantly restore the height of the medial arch.

  15. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies.

    PubMed

    Choi, Yun Sun; Lee, Kyung Tai; Kang, Heung Sik; Kim, Eun Kyung

    2004-01-01

    To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients.

  16. Isolated tarsal navicular fracture dislocation: a case report.

    PubMed

    Mathesul, Ambarish A; Sonawane, Dhiraj V; Chouhan, Varun K

    2012-06-01

    Injuries to the midtarsal joints are rare. They occur in the form of various combinations such as fracture, fracture subluxation, and fracture dislocation. The largest series of 71 cases has been reported by Main and Jowett in 1975. Isolated tarsal navicular dislocations are rare injuries. Being rare, these injuries remain poorly understood. Only few case reports exist, which describe the probable mechanism of injury and optimal treatment. Of the few case reports, only one describes closed reduction with external fixator and percutaneous fixation as the treatment modality. This case report emphasizes the use of external fixation with pins in the calcaneum and not in talus as described by the earlier report. Therapeutic, Level IV.

  17. Clinicopathological findings in horses with a bi- or tripartite navicular bone.

    PubMed

    van der Zaag, Ellen J; Weerts, Erik A W S; van den Belt, Antoon J M; Back, Willem

    2016-04-09

    Navicular bone partition is a rare condition reported in horses, which is during the evaluation of a lameness or prepurchase examination often misinterpreted for a parasagittal fracture. In this report, the clinicopathological findings of three cases of navicular bone partition are evaluated. The possible pathomechanisms underlying the condition are hypothesised, focusing on a potential origin of foetal vascular disturbance. This study is furthermore aiming at a clearer and earlier recognition of navicular bone partition, since this condition would finally predispose for a clinical lameness with a poor prognosis. Case 1 was a 10-year-old Belgian Warmblood gelding with a Grade 3/5 chronic, recurrent left-forelimb lameness that had persisted for 4 months. Perineural palmar digital nerve block of the distal foot abolished the lameness. Radiographic examination revealed a bipartite navicular bone in the left forelimb. Unfortunately, the animal was lost to follow-up. Case 2 was a 7-year-old Quarter Horse stallion with a Grade 3/5 recurrent right forelimb lameness that had persisted for 2 years. The lameness switched to the contralateral left forelimb with a palmar digital nerve block. Radiographic examination identified a tripartite navicular bone in both forelimbs. Pathological examination additionally revealed chronic degenerative changes of the cartilage and subchondral bone with marked cystic changes. Case 3 was a 5-year-old Dutch Warmblood gelding with a Grade 3/5 recurrent left hindlimb lameness that had persisted for 6 months. Owing to the uncooperative behaviour of the horse, only a combined peroneal and tibial nerve block could be performed, which abolished the lameness. Radiographic examination revealed a bipartite navicular bone in the left hindlimb. Pathological examination showed a navicular bipartition in the left hindlimb, with microscopic changes comparable to those evident in Case 2; additionally, cartilage indentations were also found in the navicular

  18. Arch-Taping Techniques for Altering Navicular Height and Plantar Pressures During Activity

    PubMed Central

    Newell, Tim; Simon, Janet; Docherty, Carrie L.

    2015-01-01

    Context Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity. Objective To determine if taping techniques effectively support the arch during exercise. Design Crossover study. Setting Athletic training research laboratory. Patients or Other Participants Twenty-five individuals (13 men, 12 women; age = 20.0 ± 1.0 years, height = 172.3 ± 6.6 cm, mass = 70.1 ± 10.2 kg) with a navicular drop of more than 8 mm (12.9 ± 3.3 mm) volunteered. Intervention(s) All individuals participated in 3 days of testing, with 1 day for each tape condition: no tape, low dye, and navicular sling. On each testing day, navicular height and plantar pressures were measured at 5 intervals: baseline; posttape; and after 5, 10, and 15 minutes of running. The order of tape condition was counterbalanced. Main Outcome Measure(s) The dependent variables were navicular height in millimeters and plantar pressures in kilopascals. Plantar pressures were divided into 5 regions: medial forefoot, lateral forefoot, lateral midfoot, lateral rearfoot, and medial rearfoot. Separate repeated-measures analyses of variance were conducted for each dependent variable. Results Navicular height was higher immediately after application of the navicular-sling condition (P = .004) but was reduced after 5 minutes of treadmill running (P = .12). We observed no differences from baseline to posttape for navicular height for the low-dye (P = .30) and no-tape conditions (P = .25). Both the low-dye and navicular-sling conditions increased plantar pressures in the lateral midfoot region compared with the no-tape condition. The low-dye condition created decreased pressure in the medial and lateral forefoot regions compared with the no-tape condition. All changes were identified immediately after application and were maintained during running. No changes were noted in plantar pressures for the no

  19. Arch-Taping Techniques for Altering Navicular Height and Plantar Pressures During Activity.

    PubMed

    Newell, Tim; Simon, Janet; Docherty, Carrie L

    2015-08-01

    Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity. To determine if taping techniques effectively support the arch during exercise. Crossover study. Athletic training research laboratory. Twenty-five individuals (13 men, 12 women; age = 20.0 ± 1.0 years, height = 172.3 ± 6.6 cm, mass = 70.1 ± 10.2 kg) with a navicular drop of more than 8 mm (12.9 ± 3.3 mm) volunteered. All individuals participated in 3 days of testing, with 1 day for each tape condition: no tape, low dye, and navicular sling. On each testing day, navicular height and plantar pressures were measured at 5 intervals: baseline; posttape; and after 5, 10, and 15 minutes of running. The order of tape condition was counterbalanced. The dependent variables were navicular height in millimeters and plantar pressures in kilopascals. Plantar pressures were divided into 5 regions: medial forefoot, lateral forefoot, lateral midfoot, lateral rearfoot, and medial rearfoot. Separate repeated-measures analyses of variance were conducted for each dependent variable. Navicular height was higher immediately after application of the navicular-sling condition (P = .004) but was reduced after 5 minutes of treadmill running (P = .12). We observed no differences from baseline to posttape for navicular height for the low-dye (P = .30) and no-tape conditions (P = .25). Both the low-dye and navicular-sling conditions increased plantar pressures in the lateral midfoot region compared with the no-tape condition. The low-dye condition created decreased pressure in the medial and lateral forefoot regions compared with the no-tape condition. All changes were identified immediately after application and were maintained during running. No changes were noted in plantar pressures for the no-tape condition (P > .05). Both taping techniques effectively changed plantar pressures in the lateral midfoot, and these

  20. Reconstructive surgery using interference screw fixation for painful accessory navicular in adult athletes.

    PubMed

    Miyamoto, Wataru; Takao, Masato; Yamada, Kazuaki; Yasui, Youichi; Matsushita, Takashi

    2012-10-01

    To examine the effectiveness of a new technique for reattaching the posterior tibial tendon (PTT) using a bone tunnel and interference screw after resection of the accessory navicular for painful accessory navicular (type II) in adult athletes. Ten adult athletes (7 male, 3 female; mean age 30 years, range 23-45) underwent reconstruction using a bone tunnel with an interference screw for a painful accessory navicular. All patients complained of pain on the medial aspect of the foot after eversion sprain during sports activities and radiographs revealed type II accessory navicular. Clinical evaluation with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and visual analogue scale (VAS) before surgery was compared with that at most recent follow up (mean 30 months, range 24-39). Mean AOFAS score improved from a preoperative 62.8 ± 2.9 points (range 61-82) to a postoperative 92.1 ± 7.0 points (range 83-100; p < 0.01). Furthermore, mean VAS score improved from a preoperative 92.5 ± 5.4 points (range 85-100) to a postoperative 4.5 ± 3.8 points (range 0-10; p < 0.01). All patients could return to full sports activity at a mean of 14 weeks (range 12-18) after surgery. The presented technique reconstructs the bone-tendon interface of the PTT at the primary navicular with sufficient fixation after resection of the accessory navicular, which preserves the strength of the PTT in adult athletes with an intractably painful accessory navicular.

  1. Can orthoses and navicular drop affect foot motion patterns during running?

    PubMed

    Eslami, Mansour; Ferber, Reed

    2013-07-01

    The purpose of this study was to examine the influence of semi-rigid foot orthoses on forefoot-rearfoot joint coupling patterns in individuals with different navicular drop measures during heel-toe running. Ten trials were collected from twenty-three male subjects who ran slowly shod at 170 steps per minute (2.23m/s) with a semi-rigid orthoses and without. Forefoot-rearfoot coupling motions were assessed using a vector coding technique during four intervals across the first 50% of stance. Subjects were divided into two groups based on navicular drop measures. A three way ANOVA was performed to examine the interaction and main effects of stance interval, orthoses condition and navicular drop (p<0.05). There were no interaction effects among stance interval, orthoses condition, or navicular drop (p=0.14) whereas an interaction effect of orthoses condition and stance interval was observed (p=0.01; effect size=0.74). Forefoot-rearfoot coupling motion in the no-orthoses condition increased from heel-strike to foot-flat phase at a rate faster than the orthoses condition (p=0.02). Foot orthoses significantly decrease the forefoot-rearfoot joint coupling angle by reducing forefoot frontal plane motion relative to the rearfoot. Navicular drop measures did not influence joint coupling relationships between the forefoot and rearfoot during the first 50% of stance regardless of orthotic condition. Copyright © 2012 Sports Medicine Australia. All rights reserved.

  2. Core decompression of the equine navicular bone: an in vitro biomechanical study.

    PubMed

    Jenner, Florien; Kirker-Head, Carl

    2011-02-01

    To determine the effect of core decompression surgery and bone mineral density (BMD) on the mechanical properties of equine navicular bones. Experimental, in vitro study. Fore limb navicular bones (n=36 pairs) from sound 2-5-year-old horses with no radiographic abnormalities of the distal aspect of the forelimbs. Navicular BMD was measured using dual energy X-ray absorptiometry. One randomly assigned navicular bone from each pair served as control. The contralateral test specimen was allocated to 1 of 6 treatment groups defined by drill bit size (3.2 versus 2.5 mm diameter) and by the number of drill channels (1, 2, or 3) created in the proximal border of the bone. Bones were then tested until failure in 3-point bending. Data were statistically analyzed using ANOVA and regression analysis. There were significant (P<.001) positive correlations between BMD and biomechanical data. A significant (P<.001) reduction in breaking strength was noted between intact and drilled bone pairs; however, the diameter and number of decompression channels did not significantly (P>.05) influence the extent of the reduction in mechanical strength. In vitro core decompression significantly decreases the breaking strength of the equine navicular bone. © Copyright 2010 by The American College of Veterinary Surgeons.

  3. Surgical Treatment of the Accessory Navicular (Os Tibiale Externum) in Dancers: A Retrospective Case Series.

    PubMed

    Rietveld, A B M Boni; Diemer, Willemijn M

    2016-01-01

    This study is to draw attention to a relatively common anatomical anomaly and its possible operative treatment in dancers. The accessory navicular, or os tibiale externum, is an accessory bone on the medial side of the navicular of the foot at the insertion of the posterior tibial tendon (PTT). It can cause obvious hyperpronation, medial foot pain, and a limited and painful relevé in dancers. To the best of our knowledge, this is the first report on the operative treatment of the accessory navicular exclusively in dancers. Six dancers (10 feet) were treated in our clinic for a symptomatic accessory navicular Type II. Five of them (eight feet) underwent surgery, two unilaterally and three bilaterally (at the same time). All five had an excellent result at mean follow-up of 4.7 years, given that they fully resumed their professional dance activities without restriction, discomfort, or residual symptoms. One patient stopped dancing for unrelated reasons and became symptom free without further (surgical) treatment. Although no conclusions can be drawn from a retrospective case series and other treatment modalities were not considered, simple excision of a symptomatic accessory navicular Type II seems to be a good choice in dancers.

  4. Intra- and interobserver agreement in the interpretation of navicular bones on radiographs and computed tomography scans.

    PubMed

    Groth, A M; May, S A; Weaver, M P; Weller, R

    2009-02-01

    Criteria for the radiographic evaluation of navicular bones in horses have been published to standardise classification of radiographic signs. However, intra- and interobserver agreement have not been established. To determine intra- and interobserver agreement in the evaluation of radiographic and computed tomographic (CT) navicular changes. It was hypothesised that: 1) intraobserver agreement would be better than interobserver agreement; 2) agreement would be better for CT than for radiography; and 3) pathological changes would be recognised with greater certainty with CT. Radiographs and CT scans of 60 cadaver navicular bones were evaluated by 3 observers using published criteria. A subset of 30 studies was evaluated twice by one observer. Agreement was tested using the kappa statistic. Certainty about pathological changes was evaluated by giving the observers the option to choose 'not sure'. Agreement varied from poor to almost perfect for radiographic evaluation and from poor to substantial for CT evaluation. For radiographic evaluation mean interobserver agreement was fair, as it was for CT evaluation. For radiographic evaluation mean intraobserver agreement was moderate as it was for CT evaluation. Pathological changes were evaluated with greater certainty on CT scans compared to radiographs; however, this was not associated with improved agreement. Variations in classification of navicular lesions in radiographic and CT studies were considerable between and within observers and challenge the use of such studies for diagnostic and prognostic purposes. The results of this study allowed the identification of evaluation criteria with sufficient precision to be useful for navicular bone evaluation.

  5. Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete's Prospective NFL Career.

    PubMed

    Vopat, Bryan; Beaulieu-Jones, Brendin R; Waryasz, Gregory; McHale, Kevin J; Sanchez, George; Logan, Catherine A; Whalen, James M; DiGiovanni, Christopher W; Provencher, Matthew T

    2017-08-01

    Navicular injuries can result in persistent pain, posttraumatic osteoarthritis, and diminished performance and function. To determine the epidemiology of navicular fracture in players participating in the National Football League (NFL) Scouting Combine and evaluate the impact of a navicular injury on the NFL draft position and NFL game play compared with matched controls. Cohort study; Level of evidence, 3. Data were collected on players who previously sustained a navicular injury and participated in the NFL Combine between 2009 and 2015. The epidemiology of navicular injury was determined through an evaluation of the number of injuries, surgeries, and collegiate games missed as well as the position played, a physical examination, the surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared with a set of matched controls. NFL performance outcomes included the draft position, career length ≥2 years, and number of games played and started within the first 2 years. Between 2009 and 2015, 14 of 2285 (0.6%) players were identified as having sustained a navicular injury. A total of 11 of 14 (79%) athletes had sustained an overt navicular fracture, while 3 of 14 (21%) were diagnosed with stress reactions on magnetic resonance imaging. Eight patients who sustained a navicular fracture underwent surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (odds ratio, 1.3; P = .04). Fifty-seven percent of players with navicular injury (72.7% of fractures) were undrafted versus 30.9% in the control group (P = .001). Overall, 28.6% of players with navicular fracture played ≥2 years in the NFL compared with 69.6% in the control group (P = .02). A previous navicular fracture results in a greater risk of developing posttraumatic osteoarthritis. Although only a low prevalence of navicular injury in prospective NFL players was noted

  6. Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete’s Prospective NFL Career

    PubMed Central

    Vopat, Bryan; Beaulieu-Jones, Brendin R.; Waryasz, Gregory; McHale, Kevin J.; Sanchez, George; Logan, Catherine A.; Whalen, James M.; DiGiovanni, Christopher W.; Provencher, Matthew T.

    2017-01-01

    Background: Navicular injuries can result in persistent pain, posttraumatic osteoarthritis, and diminished performance and function. Purpose: To determine the epidemiology of navicular fracture in players participating in the National Football League (NFL) Scouting Combine and evaluate the impact of a navicular injury on the NFL draft position and NFL game play compared with matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on players who previously sustained a navicular injury and participated in the NFL Combine between 2009 and 2015. The epidemiology of navicular injury was determined through an evaluation of the number of injuries, surgeries, and collegiate games missed as well as the position played, a physical examination, the surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared with a set of matched controls. NFL performance outcomes included the draft position, career length ≥2 years, and number of games played and started within the first 2 years. Results: Between 2009 and 2015, 14 of 2285 (0.6%) players were identified as having sustained a navicular injury. A total of 11 of 14 (79%) athletes had sustained an overt navicular fracture, while 3 of 14 (21%) were diagnosed with stress reactions on magnetic resonance imaging. Eight patients who sustained a navicular fracture underwent surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (odds ratio, 1.3; P = .04). Fifty-seven percent of players with navicular injury (72.7% of fractures) were undrafted versus 30.9% in the control group (P = .001). Overall, 28.6% of players with navicular fracture played ≥2 years in the NFL compared with 69.6% in the control group (P = .02). Conclusion: A previous navicular fracture results in a greater risk of developing posttraumatic osteoarthritis. Although only a low

  7. Motion analysis to track navicular displacements in the pediatric foot: relationship with foot posture, body mass index, and flexibility.

    PubMed

    Kothari, Alpesh; Dixon, Philippe Courtney; Stebbins, Julie; Zavatsky, Amy Beth; Theologis, Tim

    2014-09-01

    Increased navicular drop (NDro) and navicular drift (NDri) are associated with musculoskeletal pathology in adults. The aim of this study was to investigate navicular motion in children, with respect to foot posture, and identify altered patterns of motion that demonstrate midfoot dysfunction. Navicular motion in different activities was evaluated as well as the role of flexibility and body mass index (BMI). Twenty-five children with flatfeet and 26 with neutral feet (age range, 8-15) underwent gait analysis using a 12-camera Vicon MX system (Vicon, UK). Navicular motion indices were calculated from marker coordinates. Student t tests and Pearson's correlation coefficient (R) were used to investigate navicular motion differences between groups. The relationship between NDRo, NDRi, and their dynamic counterparts was also assessed. Normalized NDri (NNDri) and normalized NDro (NNDro) correlated strongly in neutral feet (R = 0.56, P = .003) but not in flatfeet (R = 0.18, P > .05). Flatfeet demonstrated reduced NNDri compared to neutral footed children (0.7 vs 1.6, P = .007). No difference was observed in NNDro between groups. Standard and dynamic measures of NDri and NDRo were highly correlated. Navicular motion correlated poorly with BMI and flexibility. Motion of the navicular in the transverse and the sagittal plane is important when investigating foot function. Uncoupling of this motion in flatfeet may indicate impaired midfoot function. Reduced navicular medial translation in flatfeet may indicate altered alignment of the talonavicular joint. The measurement of dynamic navicular motion indices did not add information about dynamic foot function compared to measurement of static indices. © The Author(s) 2014.

  8. Radiographic evaluation of navicular position in the sagittal plane-correction following an extraosseous talotarsal stabilization procedure.

    PubMed

    Graham, Michael E; Jawrani, Nikhil T; Chikka, Avanthi

    2011-01-01

    The navicular drop in the sagittal plane on weight-bearing is a valid indicator of foot pronation. Dislocation of the talus on the tarsal mechanism results in hyperpronation, which can lead to excessive navicular drop. The purpose of the present study was to radiographically determine the efficacy of HyProCure(®) in realigning the navicular bone in hyperpronating feet. We hypothesized that following the placement of HyProCure(®), the navicular height would increase significantly compared to its preoperative value. Radiographs of 61 adult patients (86 feet) who received HyProCure(®) without adjunctive hindfoot or midfoot soft tissue or osseous procedures were analyzed. The distance of the navicular with respect to the cuboid was measured from the pre- and postoperative weight-bearing lateral radiographs. Additionally, we measured foot length to normalize the navicular to cuboid distance. The postoperative radiographs were taken at an average follow-up of 17 days. The mean preoperative true navicular to cuboid distance was 19 ± 6 mm as compared to a mean postoperative value of 24 ± 5 mm. The mean pre- and postoperative normalized navicular to cuboid distances were 0.098 ± 0.029 and 0.125 ± 0.027, respectively (± 1 SD). The postoperative increase in the true and normalized navicular to cuboid distance was statistically significant (p < .001). HyProCure(®) was effective in improving the anatomic alignment of the talonavicular joint by reducing excessive navicular drop. This indicates reduction of excessive abnormal pronation and stabilization of the medial column of the foot, which can also lead to reduction in the excessive forces placed on the supporting soft tissue structures. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Delayed healing of a navicular stress fracture, following limited weight-bearing activity

    PubMed Central

    Robinson, Matthew; Fulcher, Mark

    2014-01-01

    This report describes a 21-year-old man, a semiprofessional football (soccer) player, with a navicular stress fracture. It highlights the difficulty in diagnosing the condition and the complications arising from inadequate management. The case discusses the optimal management of these stress fractures and the detrimental role of weight-bearing recovery. The diagnosis of navicular stress fractures is challenging, and a high index of suspicion is required. The available literature indicates that limited weightbearing is not an appropriate treatment for navicular stress injuries. Non-weight-bearing (NWB) cast immobilisation for 6–8 weeks appears to be the gold standard treatment; however, open reduction with internal fixation (ORIF) has similar success rates and an equal return-to-play time but should also be followed by a period of NWB. NWB cast immobilisation for 6 weeks remains a good second option at any time following failed limited weight-bearing activity. PMID:24618870

  10. Navicular tuberculosis: A rare localization of bone tuberculosis.

    PubMed

    Lemnouer, Abdelhay; Frikh, Mohammed; Belfquih, Bouchra; Jaafar, Abdelwahab; Bouya, Ayoub; Jidal, Mohamed; Boussouga, Mustapha; Elouennass, Mostafa

    2015-01-01

    Tuberculosis (TB) is a global public health problem endemic to Morocco. While extrapulmonary TB uncommonly presents in osteoarticular anatomic locations, tarsal or metatarsal osteitis can occur when TB presents in the tarsal bones. Clinical symptoms are often insidious causing a delay in diagnosis that may lead to bone destruction. While diagnosis can be guided by X-ray imaging, bacteriologic and histologic examination of the tissue allows for pathogen isolation, identification of the bacillus and strain sensitivity to antibacillary treatment. We report a rare case of navicular osteitis associated with tarso-metatarsal arthritis caused by tuberculosis in a 68-year-old man. This case illustrates an exceptional location of osteoarticular TB and support diagnostic difficulties encountered: (i) imaging is not specific; (ii) lesions are paucibacillary which reduces conventional microbiological methods sensitivity and (iii) the peripheral location of the Koch bacillus within the lesion dictates surgical biopsy than percutaneous puncture. We recommend testing for tuberculosis in any case of chronic osteolysis and/or arthritis of the foot, especially in TB endemic countries.

  11. Results of the surgical treatment of calcaneo-navicular coalito.

    PubMed

    Jerosch, J; Lindner, N; Finnen, D A

    1997-01-01

    We present the results after surgical treatment in 15 patients who suffered from calcaneo-navicular coalitio. A total of 20 operations were performed on 19 feet (3 T-arthrodesis, 5 simple resections, 9 resections with fat interposition, 3 resections with muscle interposition). At the time of follow-up, the patients were examined clinically and radiologically. In addition, different functional tests were performed (heel-tip test, balance test, single-leg high jump, single-leg jumping course). Ten of 17 patients who underwent radiographic study at the follow-up had a successful result. Patients who had a coalitio showed a tibial rotation (heel-tip test) of 11.5 degrees, and those patients without a coalitio had a tibia rotation of 20.3 degrees. Concerning the functional outcome, 12 of 17 patients had a successful result. The range of motion of the subtalar joint did not correlate with the functional capacity of the ankle. Seven of 20 patients subjectively judged the outcome as a failure. The worst results were found in patients with pre-existing degenerative changes at the time of resection.

  12. Navicular tuberculosis: A rare localization of bone tuberculosis

    PubMed Central

    Lemnouer, Abdelhay; Frikh, Mohammed; Belfquih, Bouchra; Jaafar, Abdelwahab; Bouya, Ayoub; Jidal, Mohamed; Boussouga, Mustapha; Elouennass, Mostafa

    2015-01-01

    Tuberculosis (TB) is a global public health problem endemic to Morocco. While extrapulmonary TB uncommonly presents in osteoarticular anatomic locations, tarsal or metatarsal osteitis can occur when TB presents in the tarsal bones. Clinical symptoms are often insidious causing a delay in diagnosis that may lead to bone destruction. While diagnosis can be guided by X-ray imaging, bacteriologic and histologic examination of the tissue allows for pathogen isolation, identification of the bacillus and strain sensitivity to antibacillary treatment. We report a rare case of navicular osteitis associated with tarso-metatarsal arthritis caused by tuberculosis in a 68-year-old man. This case illustrates an exceptional location of osteoarticular TB and support diagnostic difficulties encountered: (i) imaging is not specific; (ii) lesions are paucibacillary which reduces conventional microbiological methods sensitivity and (iii) the peripheral location of the Koch bacillus within the lesion dictates surgical biopsy than percutaneous puncture. We recommend testing for tuberculosis in any case of chronic osteolysis and/or arthritis of the foot, especially in TB endemic countries. PMID:26793464

  13. Surgical treatment of symptomatic accessory navicular in children and adolescents.

    PubMed

    Pretell-Mazzini, Juan; Murphy, Robert F; Sawyer, Jeffrey R; Spence, David D; Warner, William C; Beaty, James H; Moisan, Alice; Kelly, Derek M

    2014-03-01

    Although an accessory navicular (AN) is present in approximately 10% of the population, it rarely is symptomatic, and few cases necessitate operative intervention. When symptoms require surgical treatment, excision of the AN, with or without advancement of the posterior tibial tendon, usually is successful. We reviewed our records to evaluate the outcomes and complications of surgical treatment of AN. Retrospective chart review identified patients younger than 18 who were treated surgically for a painful AN between 1991 and 2012. Medical records and digital images were reviewed to determine demographic information, duration of symptoms before surgery, type of AN, presence of flatfoot deformity, type of surgery, length of follow-up, outcomes, and complications. Twenty-seven patients (32 feet) had either isolated excision (14 feet) or excision plus tendon advancement (18 feet). Overall, 28 (87.5%) of feet had excellent or good functional outcomes. There was no significant difference in outcomes between the 2 procedures, though there was a trend toward more complications and more reoperations after tendon advancement.

  14. [The history of neurectomy in horses with navicular disease].

    PubMed

    Meier, H P

    1996-01-01

    The genetic predisposition to navicular disease is proven nowadays, but otherwise, etiology and pathogenesis are still unclear. Causal therapy isn't possible and because of the poor prognosis, neurectomy is still of bearing. This operation was performed already 200 years ago, but in the middle of the last century, critical voices have been raised in regard to the surgical procedure and its indication both for medical reasons and breeding. Clear instructions for exclusion of diseased animals from breeding are also older than one hundred years. These facts call for ethic considerations which concern both breeding and use of these animals. In earlier times, horses were used for basic human requirements mainly, but nowadays their employment occurs mainly for pleasure. Ethic reflections are our task, as our specialized knowledge forms their basis. Our philosophy has to be applicable in practice, what can be achieved best with utilitarianistic reasoning. The possibilities of our influence on the sport are limited, but in breeding our commitment has to be vigorous and unrestricted. Due to the development of immunogenetic studies, legal problems may arise in the near future as well.

  15. Imaging of tarsal navicular stress injury with a focus on MRI: A pictorial essay.

    PubMed

    Harris, Guy; Harris, Craig

    2016-06-01

    Predominantly diagnosed in athletes, stress fracture of the tarsal navicular is becoming increasingly recognised by clinicians as a cause of midfoot pain. Delayed diagnosis can increase the significant morbidity associated with this condition. Consequently the role of MRI is increasing, given the potential to identify a stress reaction in the navicular prior to the development of a discrete stress fracture. It is necessary for radiologists to be familiar with the typical and atypical appearances of this important condition. © 2016 The Royal Australian and New Zealand College of Radiologists.

  16. Vascularized scapular free bone graft after nonunion of a tarsal navicular stress fracture: a case report.

    PubMed

    Toren, Adam J; Hahn, David B; Brown, William C; Stone, Paul A; Ng, Alan

    2013-01-01

    Nonunion of a tarsal navicular stress fracture, although relatively uncommon, is often amenable to open reduction and internal fixation. Furthermore, avascular necrosis of the navicular whether intact or occurring after fracture is rare, secondary to the adequate blood supply it receives. However, persistent nonunion after primary surgical repair in conjunction with avascular necrosis often results in limited treatment options. Thus, the purpose of the present case report is to describe the surgical approach and complications of a vascularized scapular free bone graft for augmentation of revision talonavicular and naviculocuneiform arthrodesis. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Association of navicular drop and selected lower-limb biomechanical measures during the stance phase of running.

    PubMed

    Eslami, Mansour; Damavandi, Mohsen; Ferber, Reed

    2014-04-01

    There is evidence to suggest that navicular drop measures are associated with specific lower-extremity gait biomechanical parameters. The aim of this study was to examine the relationship between navicular drop and a) rearfoot eversion excursion, b) tibial internal rotation excursion, c) peak ankle inversion moment, and d) peak knee adduction moment during the stance phase of running. Sixteen able-bodied men having an average age of 28.1 (SD=5.30) years, weight of 81.5 (SD=10.40) kg, height of 179.1 (SD=5.42) cm volunteered and ran barefoot at 170 steps/minute over a force plate. Navicular drop measures were negatively correlated with tibial internal rotation excursion (r=-0.53, P=.01) but not with rearfoot eversion excursion (r=-0.19; P=.23). Significant positive correlations were found between navicular drop and peak knee adduction moment (r=.62, P<.01) and peak ankle inversion moment (r=.60, P<.01). These findings suggest that a low navicular drop measure could be associated with increasing tibial rotation excursion while high navicular drop measure could be associated with increased peak ankle and knee joint moments. These findings indicate that measures of navicular drop explained between 28% and 38% of the variability for measures of tibial internal rotation excursion, peak knee adduction moment and peak ankle inversion moments.

  18. Reliability and concurrent validity of a novel method allowing for in-shoe measurement of navicular drop

    PubMed Central

    2014-01-01

    Background Increased navicular drop is associated with increased risk of lower extremity overuse injuries and foot orthoses are often prescribed to reduce navicular drop. For laboratory studies, transparent shoes may be used to monitor the effect of orthoses but no clinically feasible methods exist. We have developed a stretch-sensor that allows for in-shoe measurement of navicular drop but the reliability and validity is unknown. The purpose of this study was to investigate: 1) the reliability of the stretch-sensor for measuring navicular drop, and 2) the concurrent validity of the stretch-sensor compared to the static navicular drop test. Methods Intra- and inter-rater reliability was tested on 27 participants walking on a treadmill on two separate days. The stretch-sensor was positioned 20 mm posterior to the tip of the medial malleolus and 20 mm posterior to the navicular tuberosity. The participants walked six minutes on the treadmill before navicular drop was measured. Reliability was quantified by the Intraclass Correlation Coefficient (ICC 2.1) and agreement was quantified by Limits of Agreement (LOA). To assess concurrent validity, static navicular drop was measured with the stretch-sensor and compared with static navicular drop measured with a ruler on 27 new participants. Linear regression was used to measure concurrent validity. Results The reliability of the stretch-sensor was acceptable for barefoot measurement (intra- and inter-rater ICC: 0.76-0.84) but lower for in-shoe measurement (ICC: 0.65). There was a significant association between static navicular drop measured with the stretch-sensor compared with a ruler (r = 0.745, p < 0.001). Conclusion This study suggests that the stretch-sensor has acceptable reliability for dynamic barefoot measurement of navicular drop. Furthermore, the stretch-sensor shows concurrent validity compared with the static navicular drop test as performed by Brody. This new simple method may hold promise for both

  19. Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone.

    PubMed

    Jain, Sachin; Karunanithi, Sellam; Agarwal, Krishan Kant; Kumar, Ganesh; Roy, Shambo Guha; Tripathi, Madhavi

    2014-07-01

    Accessory navicular bone is one of the supernumerary ossicles in the foot. Radiography is non diagnostic in symptomatic cases. Accessory navicular has been reported as a cause of foot pain and is usually associated with flat foot. Increased radio tracer uptake on bone scan is found to be more sensitive. We report a case highlighting the significance of single photon emission tomography/computed tomography in methylene diphosphonate bone scan in the evaluation of symptomatic accessory navicular bone where three phase bone scan is equivocal.

  20. Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone

    PubMed Central

    Jain, Sachin; Karunanithi, Sellam; Agarwal, Krishan Kant; Kumar, Ganesh; Roy, Shambo Guha; Tripathi, Madhavi

    2014-01-01

    Accessory navicular bone is one of the supernumerary ossicles in the foot. Radiography is non diagnostic in symptomatic cases. Accessory navicular has been reported as a cause of foot pain and is usually associated with flat foot. Increased radio tracer uptake on bone scan is found to be more sensitive. We report a case highlighting the significance of single photon emission tomography/computed tomography in methylene diphosphonate bone scan in the evaluation of symptomatic accessory navicular bone where three phase bone scan is equivocal. PMID:25210293

  1. A novel method for measuring in-shoe navicular drop during gait.

    PubMed

    Kappel, Simon L; Rathleff, Michael S; Hermann, Dan; Simonsen, Ole; Karstoft, Henrik; Ahrendt, Peter

    2012-01-01

    Analysis of foot movement is essential in the treatment and prevention of foot-related disorders. Measuring the in-shoe foot movement during everyday activities, such as sports, has the potential to become an important diagnostic tool in clinical practice. The current paper describes the development of a thin, flexible and robust capacitive strain sensor for the in-shoe measurement of the navicular drop. The navicular drop is a well-recognized measure of foot movement. The position of the strain sensor on the foot was analyzed to determine the optimal points of attachment. The sensor was evaluated against a state-of-the-art video-based system that tracks reflective markers on the bare foot. Preliminary experimental results show that the developed strain sensor is able to measure navicular drop on the bare foot with an accuracy on par with the video-based system and with a high reproducibility. Temporal comparison of video-based, barefoot and in-shoe measurements indicate that the developed sensor measures the navicular drop accurately in shoes and can be used without any discomfort for the user.

  2. Core decompression of the equine navicular bone: an in vivo study in healthy horses.

    PubMed

    Jenner, Florien; Kirker-Head, Carl

    2011-02-01

    To determine the physiologic response of the equine navicular bone to core decompression surgery in healthy horses. Experimental in vivo study. Healthy adult horses (n=6). Core decompression was completed by creating three 2.5-mm-diameter drill channels into the navicular bone under arthroscopic control. The venous (P(V)), arterial (P(A)), articular (P(DIPJ)), and intraosseous pressures (IOP) were recorded before and after decompression drilling. Each IOP measurement consisted of a baseline (IOP(B)) and a stress test (intramedullary injection of saline solution, IOP(S)) recording. Lameness was assessed subjectively and using force plate gait analysis. Fluorochrome bone labeling was performed. Horses were euthanatized at 12 weeks. Navicular bone mineral density (BMD) was measured, and bone histology evaluated. Peak IOP (IOP(max)) after stress testing was significantly (P<.05) reduced immediately after core decompression; however, the magnitude of these effects was decreased at 3 and 6 weeks after decompression. A significant (P<.05) correlation existed between IOP(max) and BMD. No lameness was observed beyond the first week after surgery. Substantial remodeling and neovascularization was evident adjacent the surgery sites. Navicular bone core decompression surgery reduced IOP(max), and, with the exception of a mild short-lived lameness, caused no other adverse effects in healthy horses during the 12-week study period. © Copyright 2011 by The American College of Veterinary Surgeons.

  3. A Novel Method for Measuring In-Shoe Navicular Drop during Gait

    PubMed Central

    Kappel, Simon L.; Rathleff, Michael S.; Hermann, Dan; Simonsen, Ole; Karstoft, Henrik; Ahrendt, Peter

    2012-01-01

    Analysis of foot movement is essential in the treatment and prevention of foot-related disorders. Measuring the in-shoe foot movement during everyday activities, such as sports, has the potential to become an important diagnostic tool in clinical practice. The current paper describes the development of a thin, flexible and robust capacitive strain sensor for the in-shoe measurement of the navicular drop. The navicular drop is a well-recognized measure of foot movement. The position of the strain sensor on the foot was analyzed to determine the optimal points of attachment. The sensor was evaluated against a state-of-the-art video-based system that tracks reflective markers on the bare foot. Preliminary experimental results show that the developed strain sensor is able to measure navicular drop on the bare foot with an accuracy on par with the video-based system and with a high reproducibility. Temporal comparison of video-based, barefoot and in-shoe measurements indicate that the developed sensor measures the navicular drop accurately in shoes and can be used without any discomfort for the user. PMID:23112678

  4. Accessory navicular bone: when ankle pain does not originate from the ankle.

    PubMed

    Issever, Ahi Sema; Minden, Kirsten; Eshed, Iris; Hermann, Kay-Geert A

    2007-12-01

    A young girl suffering from ankle pain occurring after gymnastics classes was referred to the rheumatology department by an orthopedic surgeon because a rheumatological condition was suspected to cause her symptoms. MRI was useful in pointing to the correct diagnosis of accessory navicular bone (AN). The morphological classification of ANs is discussed and the imaging modalities for diagnosis are presented.

  5. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study.

    PubMed

    Scott, Aaron T; Sabesan, Vani J; Saluta, Jonathan R; Wilson, Melanie A; Easley, Mark E

    2009-01-01

    Patients with symptomatic Type II accessory naviculars that fail nonoperative measures may be treated with excision, percutaneous drilling, a modified Kidner procedure, or a fourth option, arthrodesis of the accessory ossicle to the navicular body. There is little information in the literature on the relative merits of arthrodesis. A prospective evaluation of 20 patients undergoing surgical intervention for symptomatic Type II accessory naviculars was performed. The decision to perform either an arthrodesis (10 feet) or a modified Kidner (10 feet) was made intraoperatively based on the size of the accessory ossicle. Outcomes were measured using pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot scores, plain radiographs, and chart reviews. At an average followup of 35 months, the mean AOFAS score for the arthrodesis group improved from 50 to 93 points. There were two non-unions (20%) and one patient complained of painful hardware. At an average followup of 48 months, the mean AOFAS score for the modified Kidner group improved from 52 to 80 points. However, in this group, three of ten patients (30%) had persistent midfoot pain and radiographic evidence of progressive loss of the longitudinal arch. Although the methods do not represent a randomized comparison of treatments for the same condition, the results suggest that arthrodesis may be a reasonable treatment option in selected cases of patients with symptomatic recalcitrant Type II accessory naviculars that are large enough to accept small fragment screws.

  6. Sex estimation from the navicular bone in Spanish contemporary skeletal collections.

    PubMed

    Saldías, Eduardo; Malgosa, Assumpció; Jordana, Xavier; Isidro, Albert

    2016-10-01

    Sexual estimation is fundamental to reconstruct the biological profile of individuals, but postdepositional factors can alter the resistance of the bones, thereby preventing accurate diagnosis especially when the skull and the pelvis are absent. Navicular bones are usually well preserved in archeological and forensic contexts and can a good alternative to discriminate sex. On the basis of these aspects, the present investigation analyzed the sexual dimorphism in 231 pairs of navicular bones from documented contemporary collections from Spain. Receiver operating characteristic (ROC) curve analysis and binary logistic regressions were carried out in eight replicable linear measurements of the navicular bone. Each of the eight variables showed a significant sexual dimorphism in our sample. The ROC curve results indicate that at least five out of the eight variables used have high ability for sex diagnosis, among which the maximum length of the cuneiform surface (LMAXCUN) showed a better performance (area under the curve value=0.86). Moreover, we introduced regression equations with combination of measurements that correctly allocated the skeletons with 80% or greater accuracy. The equation with high allocation accuracy rate (83.4%) included a combination of the maximum height of the navicular (HMAX), maximum length of the cuneiform surface (LMAXCUN), and maximum length of the talar facet (LMAXTAL). The regression equations presented here are useful for the Western Mediterranean populations and offer better alternatives than formulas based on other population groups. Copyright © 2016. Published by Elsevier Ireland Ltd.

  7. Dissemination of a clone carrying a fosA3-harbouring plasmid mediates high fosfomycin resistance rate of KPC-producing Klebsiella pneumoniae in China.

    PubMed

    Jiang, Yan; Shen, Ping; Wei, Zeqing; Liu, Lilin; He, Fang; Shi, Keren; Wang, Yanfei; Wang, Haiping; Yu, Yunsong

    2015-01-01

    Fosfomycin has been proposed as an adjunct to other active agents for treating KPC-producing Klebsiella pneumoniae infections. This study aimed to investigate the prevalence of fosfomycin resistance and plasmid-mediated resistance determinants among KPC-producing K. pneumoniae isolates from clinical samples in China. In total, 278 KPC-producing and 80 extended-spectrum β-lactamase (ESBL)-producing (non-KPC-producing) clinical K. pneumoniae isolates were collected in 12 hospitals from 2010 to 2013. Fosfomycin susceptibility testing was carried out using the agar dilution method. Phylogenetic clonal patterns were revealed by pulsed-field gel electrophoresis (PFGE). Isolates were screened for plasmid-mediated fosfomycin resistance genes (fosA, fosA3 and fosC2) by PCR amplification. A plasmid was completely sequenced by next-generation sequencing. The fosfomycin resistance rate in KPC-producers (60.8%; 169/278) was significantly higher than in ESBL-producers (12.5%; 10/80). In addition, 94 KPC-producing isolates were positive for fosA3 and most of them were clonally related. A 23939-bp plasmid (pFOS18) co-harbouring fosA3 and bla(KPC-2) was completely sequenced, revealing that the fosA3 gene was flanked by two copies of IS26; however, bla(KPC-2) was located on a Tn3-Tn4401 integration structure. Although the fosA3 and blaKPC-2 genes are located on different transposon systems, they are able to spread together worldwide through plasmid transfer. Dissemination of the clone carrying the fosA3-harbouring plasmid mediates the high fosfomycin resistance rate of KPC-producing K. pneumoniae in China. Fosfomycin as an alternative option for treating infections caused by KPC-producing K. pneumoniae should not be recommended in hospitals in which fosfomycin-resistant clonal dissemination is emerging.

  8. Clinical and computed tomography evaluation of surgical outcomes in tarsal navicular stress fractures.

    PubMed

    McCormick, Jeremy J; Bray, Christopher C; Davis, W Hodges; Cohen, Bruce E; Jones, Carroll P; Anderson, Robert B

    2011-08-01

    As clinical suspicion increases and radiographic evaluation improves, navicular stress fractures are becoming a more recognized injury. To date, there is a small volume of literature examining these stress fractures, particularly as it pertains to outcomes of surgical management. To evaluate the clinical and computed tomography (CT) outcomes of surgically treated navicular stress fractures. Case series; Level of evidence, 4. Ten navicular stress fractures in 10 patients were available for follow-up at an average of 42.4 months postoperatively (range, 16.8-79.9). These patients underwent a clinical examination and a CT scan of their operatively treated foot. The American Orthopaedic Foot & Ankle Society (AOFAS) and SF-36 scores were completed for each fracture at the time of examination. The CT scans were blindly evaluated for bony union. According to the CT scan evaluation, 8 of 10 navicula (80%) had gone on to union. Clinical outcome scores on all patients were an average AOFAS hindfoot score of 88.5 and an average SF-36 score of 88.3. The feet with united fractures had an average AOFAS score of 92.1 (range, 83-100) and an average SF-36 score of 91.9 (range, 79-98). The 2 patients with nonunions had AOFAS scores of 74 and 74 and SF-36 scores of 70 and 78, respectively. Both nonunions were complete, displaced fractures on preoperative imaging. In our series of operatively treated navicular stress fractures, 80% went on to union, as verified by CT scan. Patients with united fractures had a clinically significant improvement in outcome, with higher AOFAS and SF-36 scores as compared with the 2 patients with nonunions. Patients with complete, displaced navicular stress fractures may be more likely to develop nonunions.

  9. Chromosomal location of the fosA3 and blaCTX-M genes in Proteus mirabilis and clonal spread of Escherichia coli ST117 carrying fosA3-positive IncHI2/ST3 or F2:A-:B- plasmids in a chicken farm.

    PubMed

    He, Dandan; Liu, Lanping; Guo, Baowei; Wu, Shengjun; Chen, Xiaojie; Wang, Jing; Zeng, Zhenling; Liu, Jian-Hua

    2017-04-01

    The aim of this study was to investigate the spread and location of the fosA3 gene among Enterobacteriaceae from diseased broiler chickens. Twenty-nine Escherichia coli and seven Proteus mirabilis isolates recovered from one chicken farm were screened for the presence of plasmid-mediated fosfomycin resistance genes by PCR. The clonal relatedness of fosA3-positive isolates, the transferability and location of fosA3, and the genetic context of the fosA3 gene were determined. Seven P. mirabilis isolates with three different pulsed-field gel electrophoresis (PFGE) patterns and five E. coli isolates belonging to sequence type 117 (ST117) and phylogenetic group D were positive for fosA3 and all carried the blaCTX-M gene. In E. coli, the genetic structures IS26-ISEcp1-blaCTX-M-65-IS26-fosA3-1758 bp-IS26 and IS26-ISEcp1-blaCTX-M-3-blaTEM-1-IS26-fosA3-1758 bp-IS26 were present on transferable IncHI2/ST3 and F2:A-:B- plasmids, respectively. However, fosA3 was located on the chromosome of the seven P. mirabilis isolates. IS26-ISEcp1-blaCTX-M-65-IS26-fosA3-1758 bp-IS26 and IS26-blaCTX-M-14-611 bp-fosA3-1222 bp-IS26 were detected in three and four P. mirabilis isolates, respectively. Minicircles that contained both fosA3 and blaCTX-M-65 were shared between E. coli and P. mirabilis. This is the first report of the fosA3 gene integrated into the chromosome of P. mirabilis isolates with the blaCTX-M gene. The emergence and clonal spread of avian pathogenic E. coli ST117 with the feature of multidrug resistance and high virulence are a serious problem. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  10. Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging.

    PubMed

    Burne, Scott G; Mahoney, Chris M; Forster, Bruce B; Koehle, Michael S; Taunton, Jack E; Khan, Karim M

    2005-12-01

    Tarsal navicular stress fracture is a condition that has curtailed many athletic careers. Management protocols remain varied and somewhat controversial. (1) Clinical practice does not mirror the recommendations reported from previous case series. (2) Clinical outcome is poor when navicular stress fracture is managed in a variety of ways. (3) Imaging does not correlate strongly with clinical status at long-term follow-up after navicular stress fracture. Case series (prognosis); Level of evidence, 4. From a computer registry, we identified patients who had attended a university sports medicine center between 1996 and 2002 and whose final diagnosis was navicular stress fracture (n = 11) or navicular stress reaction (n = 9). All patients had provided demographic and clinical data at their original evaluation, and all had undergone bone scans and computed tomographic imaging. These data were extracted by chart review. Follow-up clinical and imaging assessments took place a median of 3.7 years later (range, 1-15.7 years). At these assessments, we administered a questionnaire, performed a structured physician examination (blinded to other data), scanned both feet with computed tomography, and obtained magnetic resonance images of the affected foot. Only 2 of 11 patients (18%) with navicular stress fractures received the literature-recommended treatment of at least 6 weeks' nonweightbearing cast immobilization. Of these 11 patients, only 6 (55%) returned to sports at their previous level. Only 3 patients with navicular stress fractures regained normal imaging appearance at follow-up. Pain score, stiffness, sporting success, current sporting involvement, and recurrence/time to recurrence were not statistically associated with computed tomographic or magnetic resonance imaging parameters. Of 9 patients with navicular stress reactions, 7 developed clinical and radiological features of navicular stress fracture, but 6 of 9 patients (67%) returned successfully to sports

  11. Open reduction-internal fixation of a navicular body fracture with dorsal displacement of the first and second cuneiforms: a case report.

    PubMed

    Andersen, Robert C; Neiderer, Katherine; Martin, Billy; Dancho, James

    2013-01-01

    Body fractures of the tarsal navicular are relatively uncommon. To date, there is little literature discussing a navicular body fracture with dorsal subluxation of the first and second cuneiforms over the navicular. This case study presents a 30-year-old patient with this injury. He underwent open reduction internal fixation of the navicular body fracture successfully but failed adequate reduction of the navicular cuneiform joint after ligamentous reconstruction. After revisional surgery, he also failed 6 weeks of percutanous pinning with Kirschner-wire fixation. When comparing the literature of a similar injury, the Lisfranc fracture disclocation, the same principles may apply. One should consider rigid open reduction internal fixation or even primary fusion to treat disclocation of the naviculocuneiform joint following a navicular body fracture.

  12. Gross, histological and histomorphometric features of the navicular bone and related structures in the horse.

    PubMed

    Wright, I M; Kidd, L; Thorp, B H

    1998-05-01

    Forelimb navicular bones and associated soft tissues were collected from 3 groups of horses and subjected to pathological examinations. The groups consisted of 38 horses with clinical navicular disease (ND) and 2 control groups, with no history of forelimb lameness, consisting of 25 age-matched mature horses (A-MC) and 9 immature horses (IC). Histological and histomorphometric studies were performed on tissue samples from 10 ND, 10 A-MC and 5 IC horses. Gross changes seen only in ND horses included: full thickness defects in the palmar surface fibrocartilage, palmar cortex erosion, medullary lysis, flexor digitorum profundus tendon (FDPT) surface fibrillation, FDPT core lesions and adhesions between the FDPT and navicular bone. Palmar surface partial thickness fibrocartilage loss and distal border fragmentation were seen with a significantly greater incidence in ND than in A-MC and not observed in IC. Remodelling of the proximal border, FDPT surface colouration, palmar surface fibrocartilage colouration and proximal border entheseous bone were identified in ND and A-MC but not in IC. Mid-ridge synovial fossae and horizontal depressions in the palmar surface were identified in all groups. Histologically palmar fibrocartilage thinning and loss were associated with reduced palmar fibrocartilage cell density and chondrocyte cluster formation. Palmar fibrocartilage fibrillation, palmar cortical bone defects, fibromyxoid stromal change in the medulla, medullary pseudocyst formation and entheseous new bone formation were all seen in ND. The adjacent FDPT showed fibrillation, tag formation and degeneration of the dorsal surface. Necrotic foci were also present within the body of the tendon. Although not always present, medullary bone pseudocysts, separate mineralised foci and most changes on the dorsal surface of the FDPT were specific to ND. Bone histomorphometric parameters were compared among groups. Cross-sectional area reduced from the sagittal ridge to the medial and

  13. The non-surgical and surgical treatment of tarsal navicular stress fractures.

    PubMed

    Fowler, John R; Gaughan, John P; Boden, Barry P; Pavlov, Helene; Torg, Joseph S

    2011-08-01

    Stress fractures of the tarsal navicular, first described in 1970, were initially thought to be rare injuries. Heightened awareness and increased participation in athletics has resulted in more frequent diagnosis and more aggressive treatment. The vascular supply of the tarsal navicular results in a relatively avascular zone in the central one-third, which experiences severe compressive forces during explosive manoeuvers such as jumping and sprinting. Repetitive activities can result in stress reactions or even fracture. Patients often initially complain of vague midfoot pain localized to the medial border of the foot. The pain is usually exacerbated by activity and relieved with rest. The diagnosis of tarsal navicular stress fracture is challenging because of the high false negative rate of plain radiographs. Additional diagnostic testing with bone scan, CT and MRI are often required for diagnosis. The proper treatment of tarsal navicular stress fractures has become a topic of debate as surgical intervention for these injuries has increased. In a recent meta-analysis, Torg et al. found that 96% of tarsal navicular stress fractures treated with non-weight-bearing (NWB) conservative treatment for 5 weeks went on to successful outcomes. However, only 44% of patients treated with weight-bearing (WB) conservative treatment had successful outcomes. Surgical treatment resulted in successful outcome in 82% of patients. Interestingly, the meta-analysis also found that fracture type did not correlate with outcomes, regardless of treatment. The meta-analysis also found no difference in time to return to activity between patients treated surgically and those who underwent NWB conservative treatment. The recent literature indicates that patients are undergoing surgery or are receiving WB conservative management as a first-line treatment option with the expectation that they will return to their activity more quickly. Although surgical treatment seems increasingly common, the

  14. The symptomatic accessory navicular bone: a report and discussion of the clinical presentation.

    PubMed

    Fredrick, Lori A; Beall, Douglas P; Ly, Justin Q; Fish, Jon R

    2005-01-01

    An accessory navicular bone is a congenital anomaly caused by aberrant ossification. Usually asymptomatic, they are relatively common in our population. They can present in several different locations, which can have an impact on the clinical presentation and the degree of dysfunction. Occasionally, these can become symptomatic, which can manifest as chronic or acute on chronic foot pain. Diagnosis of this condition relies on radiographic evaluation. The 45-degree eversion oblique view of the foot is the most important view for identifying this condition, although several different imaging techniques can be used. Treatment of this condition includes both surgical and nonsurgical options. Ultimately, surgery yields the best outcome for young patients, though conservative management has relevance for less active patients. The following case demonstrates the presence of a symptomatic accessory navicular bone in a young athlete.

  15. Clinical use of high-resolution ultrasonography for the diagnosis of type II accessory navicular bone.

    PubMed

    Chuang, Yi-Wen; Tsai, Wen-San; Chen, Kai-Hua; Hsu, Hung-Chih

    2012-02-01

    Medial foot pain is a common complaint in rehabilitation clinics. The differential diagnoses include many musculoskeletal disorders like tendonitis and inflammation of ossicles. Posterior tibialis tendonitis is a common cause of foot pain in adults. The accessory navicular (AN) bone is occasionally observed and considered as a secondary ossification center of the navicular bone. Occasionally, posterior tibialis tendonitis and AN bone may cause acute or chronic medial foot pain with varying degrees of dysfunction. Previously, the diagnosis of an AN bone in a painful medial foot was based on clinical presentation and radiographic examinations such as plain radiography, bone scintigraphy, and magnetic resonance imaging. However, the application of soft-tissue ultrasonography for the diagnosis of posterior tibialis tendonitis associated with an AN bone has not been documented. Here, we report the case of a 60-yr-old woman with painful medial foot which had a diagnosis of posterior tibialis tendonitis associated with an AN bone by high-resolution ultrasonography.

  16. Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis.

    PubMed

    Torg, Joseph S; Moyer, James; Gaughan, John P; Boden, Barry P

    2010-05-01

    This study was conducted to provide a statistical analysis of previously reported tarsal navicular stress fracture studies regarding the outcomes and effectiveness of conservative and surgical management. Systematic review. A systematic review of the published literature was conducted utilizing MEDLINE through Ovid, PubMed, ScienceDirect, and EBSCOhost. Reports of studies that provided the type of tarsal navicular stress fracture (ie, complete or incomplete), type of treatment, result of that treatment, and the time required to return to full activity were selected for analysis. Using a mixed generalized linear model with study as a random effect and treatment as a fixed effect, cases were separated and compared based on 3 different types of treatment: conservative, weightbearing permitted (WBR); conservative, non-weightbearing (NWB); and surgical treatment. The outcome of the treatment was recorded as either successful or unsuccessful based on radiographic and/or clinical healing of the fracture and time from onset of treatment to return to activity. There was no statistically significant difference between NWB conservative treatment and surgical treatment regarding outcome (P = .6441). However, there is a statistical trend favoring NWB management (96% successful outcomes) over surgery (82% successful outcomes). Weightbearing as a conservative treatment was shown to be significantly less effective than either NWB (P = .0001) or surgical treatment (P <.0003). Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. The authors could find no advantage for surgical treatment compared with NWB immobilization. However, there is a statistical trend favoring NWB over surgery. Rest or immobilization with weightbearing was inferior to both other treatments analyzed. The authors concluded that conservative NWB management is the standard of care for initial treatment of both partial and complete stress

  17. Accessory navicular bone incidence in Chinese patients: a retrospective analysis of X-rays following trauma or progressive pain onset.

    PubMed

    Huang, Jiazhang; Zhang, Yijun; Ma, Xin; Wang, Xu; Zhang, Chao; Chen, Li

    2014-03-01

    Optimal treatment of symptomatic accessory navicular bones, generally asymptomatic 'extra' ossicles in the front interior ankle, remains debated. Incidence and type of accessory navicular bones in Chinese patients were examined as a basis for improving diagnostic and treatment standards. Accessory navicular bones were retrospectively examined in 1,625 (790 men and 835 women) patients with trauma-induced or progressive symptomatic ankle pain grouped by gender and age from August 2011 to May 2012. Anterior-posterior/oblique X-ray images; presence; type; affected side; modified Coughlin's classification types 1, 2A, 2B, and 3; and subgroups a-c were recorded. Accessory navicular bones were found in 329 (20.2%) patients (143 men and 186 women; mean age, 47.24 ± 18.34, ranging 14-96 years). Patients aged 51-60 exhibited most accessory navicular bones (29.7%), with risk slightly higher in women and generally increasing from minimal 10.9% at ages 11-20 to age 51 and thereafter declining to 0.4% by age 90. The incidence was 41.6% for Type 1 (Type 1a: 9.1%, Type 1b: 15.5%, and Type 1c: 19.4%), 36.8% for Type 2 (Type 2Aa: 2.1%, Type 2Ab: 13.7%, Type 2Ac: 5.1%, Type 2Ba: 2.1%, 2Bb: 2.1%, and 2Bc: 11.6%), and 21.6% for Type 3 (Type 3a: 4.5%, Type 3b: 14%, and Type 3c: 3.0%). Approximately one-fifth (20.3%) of ankle pain patients exhibited accessory navicular bones, with Type 2 most common and middle-aged patients most commonly affected. Thus, accessory navicular bones may be less rare than previously thought, underlying treatable symptomatic conditions of foot pain and deformity.

  18. Isolated complete dislocation of the tarsal navicular without fracture: A rare injury

    PubMed Central

    Ansari, M.A.Q.

    2016-01-01

    Injuries to the midtarsal joints usually occur in various combinations such as fracture, fracture subluxation, and fracture dislocation. Isolated dislocations of the navicular bone without fracture are rare injuries. The few existing case reports describe the probable mechanism of injury and optimal treatment. We present a 64-year-old diabetic man whose tarsal navicular was completely dislocated without fracture following a traffic accident. The most probable mechanism of injury was an abduction–pronation injury causing a midtarsal dislocation, and on spontaneous reduction, the navicular was dislocated medially. This mechanism is similar to perilunate dislocation. Computed tomography of the involved foot was done to accurately define the full extent of the bony injury and magnetic resonance imaging was required to determine if there was a ligamentous injury and to assess the attachment of soft tissues to the displaced bone to help assess the risk of avascular necrosis. The patient was treated successfully with open reduction and primary talonavicular arthrodesis with Kirschner wires. PMID:28757740

  19. Neglected Foreign Body, the Cause of Navicular Osteomyelitis in A Paediatric Foot: A Case Report

    PubMed Central

    Chandrashekara, C.M; George, M.A; Al-Marboi, Bader Said Khamis

    2013-01-01

    Introduction: Foreign body injuries with date thorns, metal and wooden splinters are common in Middle East region, as most of it is desert. Some of the injuries lead to cellulitis or abscess formation, if neglected or improperly managed results in osteomyelitis or septic arthritis of foot structures. This is the first report of isolated navicular osteomyelitis following neglected foreign body in a paediatric foot. Case Report: A 10 year old male patient presented with discharging sinus in left mid-foot 3 years after penetrating injury with wooden splinter. The diagnosis of navicular osteomelitis is confirmed with plain radio-graphs. The ultrasound of foot was done to localize the foreign bodies. Patient was treated with complete removal of foreign body (wooden splinters), surgical debridement and combination of IV and oral cloxacillin for period of 6 weeks. At 18 months follow up, patient had painless foot with no recurrence or collapse of navicular bone. Conclusion: The neglected foreign body can result in osteomyelitis of small bones of foot in pediatric patient. The ultrasound is more useful tool in localizing foreign bodies; those are not radio-opaque. Early and prompt diagnosis with adequate treatment of established osteomyelitis by complete removal of foreign body, curettage and antibiotics can give good results. PMID:27298914

  20. Hemangioblastomas de fosa posterior: Reporte de 16 casos y revisión de la literatura

    PubMed Central

    Campero, Alvaro; Ajler, Pablo; Fernandez, Julio; Isolan, Gustavo; Paiz, Martin; Rivadeneira, Conrado

    2016-01-01

    Resumen Objetivo: El propósito del presente trabajo es presentar los resultados de 16 pacientes con diagnóstico de hemangioblastoma de fosa posterior (HBFP), operados con técnicas microquirúrgicas. Método: Desde junio de 2005 a diciembre de 2015, 16 pacientes con diagnóstico de HBFP fueron intervenidos quirúrgicamente. Se evaluó: sexo, edad, tipo de lesión (quística con nódulo, quística sin nódulo, sólida y sólida-quística), sintomatología y resultados postoperatorios. Resultados: De los 16 pacientes intervenidos, 11 fueron varones y 5 mujeres. La edad promedio fue de 44 años. La forma más frecuente fue quística con nódulo (57%), seguida por forma sólida (31%). Un solo caso presentó la forma quística sin nódulo (6%), y uno solo la forma sólido-quística (6%). La sintomatología más frecuente fue cefalea acompañada de síndrome cerebeloso (43%), seguido de síndrome de hipertensión endocraneana (25%). En todos los casos la resección fue completa, siendo necesario en un caso una embolización previa. Como complicaciones postoperatorias, 2 pacientes presentaron ataxia (mejoró al cabo de 3 meses), y 1 paciente presentó una fístula de LCR (se solucionó con un drenaje espinal externo). Se registró un óbito por complicaciones postoperatorias. Conclusión: Lo más frecuente de ver en pacientes con HBFP es la forma quística con nódulo, siendo su sintomatología predominante la cefalea acompañada de síndrome cerebeloso. La resección quirúrgica completa es posible, con una baja tasa de morbimortalidad. PMID:27999708

  1. Ex Vivo Assessment of an Ultrasound-Guided Injection Technique of the Navicular Bursa in the Horse.

    PubMed

    Perrin, R; Diguet, A C; Cantet, P; Bailly, C; Brogniez, L; Dugdale, A; Nisolle, J F; Vandeweerd, J M

    2016-12-01

    Synovitis of the navicular bursa is common in performance horses. The objective of this study was to describe an ultrasound-guided technique to inject a distended navicular bursa and to evaluate its feasibility for use by a clinician not trained in the technique. Twenty distal limbs of horses of various breeds and sizes were used. To produce synovial distension, the navicular bursa of each limb was injected with contrast medium using a lateral approach and radiography was performed to confirm that the contrast medium was distending the bursa. The digit was positioned with the distal interphalangeal joint in hyperextension. A microconvex ultrasound probe was placed in the hollow of the pastern, palmar to the middle phalanx and the region was assessed in a transverse plane slightly oblique to the horizontal plane. The ultrasound probe was rotated to visualize both the lateral and medial recesses and to select which side was more distended to inject. A 21G 0.8 × 50 mm needle was inserted abaxially to the probe in the plane of the ultrasound beam into the proximal recess of this navicular bursa and a methylene blue solution was injected. Following injection, dissection was performed to assess whether the navicular bursa had been successfully injected. This ultrasound-guided technique was reliably performed with a success rate of 68%. The success of injection is influenced by hyperextension of the foot, quality of ultrasound images and degree of distension of the bursa. © 2015 Blackwell Verlag GmbH.

  2. Dissemination of plasmid-mediated fosfomycin resistance fosA3 among multidrug-resistant Escherichia coli from livestock and other animals.

    PubMed

    Ho, P L; Chan, J; Lo, W U; Law, P Y; Li, Z; Lai, E L; Chow, K H

    2013-03-01

    To investigate plasmid-mediated fosfomycin resistance related to fosA3 in Escherichia coli isolates collected from different animals in Hong Kong, China, 2008-2010. In total, 2106 faecal specimens from 210 cattle, 214 pigs, 460 chickens, 398 stray cats, 368 stray dogs and 456 wild rodents were cultured. The faecal colonization rates of fosfomycin-resistant E. coli were as follows: 11.2% in pigs, 8.6% in cattle, 7.3% in chickens, 2.4% in dogs, 0.8% in cats and 1.5% in rodents. The cultures yielded 1693 isolates of which 831 were extended-spectrum β-lactamases (ESBL) producers. Fosfomycin-resistant isolates were more likely than fosfomycin-susceptible isolates to be producers of ESBL and to have resistance to chloramphenicol, ciprofloxacin, cotrimoxazole, gentamicin and tetracycline. Of the 101 fosfomycin-resistant isolates, 97 (96.0%) isolates were fosA3 positive and 94 (93.1%) were bla(CTX) (-M) positive. PCR mapping showed that the fosA3-containing regions were flanked by IS26, both upstream and downstream in 81 (83.5%) isolates, and by an upstream bla(CTX-M-14) -containing transposon-like structure (ΔISEcp1-bla(CTX-M-14) -ΔIS903 or ISEcp1-IS10 -bla(CTX-M-14) -ΔIS903) and a downstream IS26 in 14 (14.4%) isolates. For the remaining two isolates, fosA3 was flanked by a downstream IS26 but the upstream part cannot be defined. In a random subset of 18 isolates, fosA3 was carried on transferable plasmids with sizes of 50-200 kb and the following replicons: F2:A-B- (n = 3), F16:A1:B- (n = 2), F24:A-B- (n = 1), N (n = 1), B/O (n = 1) and untypeable (n = 3). This study demonstrates the emergence of fosA3-mediated fosfomycin resistance among multidrug-resistant E. coli isolates from various animals. IS26 transposon-like structures might be the main vehicles for dissemination of fosA3. © 2012 The Society for Applied Microbiology.

  3. High prevalence of fosfomycin resistance gene fosA3 in bla CTX-M-harbouring Escherichia coli from urine in a Chinese tertiary hospital during 2010-2014.

    PubMed

    Cao, X-L; Shen, H; Xu, Y-Y; Xu, X-J; Zhang, Z-F; Cheng, L; Chen, J-H; Arakawa, Y

    2017-03-01

    Fosfomycin has become a therapeutic option in urinary tract infections. We identified 57 fosfomycin-resistant Escherichia coli from 465 urine-derived extended-spectrum β-lactamase (ESBL)-producing isolates from a Chinese hospital during 2010-2014. Of the 57 fosfomycin-resistant isolates, 51 (89·5%) carried fosA3, and one carried fosA1. Divergent pulsed-field gel electrophoresis profiles and multi-locus sequence typing results revealed high clonal diversity in the fosA3-positive isolates. Conjugation experiments showed that the fosA3 genes from 50 isolates were transferable, with IncFII or IncI1 being the most prevalent types of plasmids. The high prevalence of fosA3 was closely associated with that of bla CTX-M. Horizontal transfer, rather than clonal expansion, might play a central role in dissemination. Such strains may constitute an important reservoir of fosA3 and bla CTX-M, which may well be readily disseminated to other potential human pathogens. Since most ESBL-producing E. coli have acquired resistance to fluoroquinolones worldwide, further spread of fosA3 in such E. coli isolates should be monitored closely.

  4. Surgical treatment of an osteochondral lesion associated with stress fracture of the tarsal navicular: a case report.

    PubMed

    Kanazawa, Kazuki; Yoshimura, Ichiro; Shiokawa, Teruaki; Hagio, Tomonobu; Naito, Masatoshi

    2013-01-01

    We surgically treated an osteochondral lesion associated with a stress fracture of the tarsal navicular. The surgical procedure involved the confirmation and complete resection of the lesion under direct vision, followed by the transplantation of block-shaped iliac bone grafts. The postoperative computed tomography scan showed that the lesions had disappeared, the grafted bone had fused, and the stress fracture had healed. However, the tarsal navicular joint surface was slightly irregular. The patient was able to resume her sports activities 15 weeks after surgery. We have described a novel method to reconstruct the tarsal navicular after osteochondral lesion resection. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Dissemination of the Fosfomycin Resistance Gene fosA3 with CTX-M β-Lactamase Genes and rmtB Carried on IncFII Plasmids among Escherichia coli Isolates from Pets in China

    PubMed Central

    Hou, Jianxia; Huang, Xianhui; Deng, Yuting; He, Liangying; Yang, Tong; Zeng, Zhenling; Chen, Zhangliu

    2012-01-01

    The presence and characterization of plasmid-mediated fosfomycin resistance determinants among Escherichia coli isolates collected from pets in China between 2006 and 2010 were investigated. Twenty-nine isolates (9.0%) were positive for fosA3, and all of them were CTX-M producers. The fosA3 genes were flanked by IS26 and were localized on F2:A−:B− plasmids or on very similar F33:A−:B− plasmids carrying both blaCTX-M-65 and rmtB. These findings indicate that the fosA3 gene may be coselected by antimicrobials other than fosfomycin. PMID:22232290

  6. Medial displacement calcaneal osteotomy with posterior tibial tendon reconstruction for the flexible flatfoot with symptomatic accessory navicular.

    PubMed

    Cao, Hong-Hui; Tang, Kang-Lai; Lu, Wei-Zhong; Xu, Jian-Zhong

    2014-01-01

    We investigated the clinical outcomes after medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular, in patients with flexible flatfoot with accessory navicular symptoms. From December 2008 to July 2011, 16 patients (21 feet) with a flexible flatfoot, symptomatic accessory navicular, and obvious heel valgus underwent medial displacement calcaneal osteotomy and reconstruction with posterior tibial tendon insertion on the navicular bone. The patients were evaluated preoperatively, 6 weeks and 3, 6, and 12 months postoperatively, and every 6 months thereafter. The clinical examination was undertaken using the American Orthopaedic Foot and Ankle Society ankle and midfoot scores. The radiologic assessments included the arch height, calcaneus inclination angle, talocalcaneal angle, and talar first metatarsal angle on the lateral weightbearing radiograph. The talocalcaneal angle and talar first metatarsal angle was assessed on the anteroposterior view of the weightbearing foot. Heel valgus alignment was assessed on the axial hindfoot radiographs. The mean follow-up duration was 28.5 months (range 18 to 48). All patients were satisfied with the clinical results and were pain free 6 months postoperatively. No cases of wound infection or nerve injury developed. The mean American Orthopaedic Foot and Ankle Society score improved from 53.3 ± 6.5 to 90.8 ± 1.4 at the last follow-up visit (p < .01). The improvements in all radiographic parameters were statistically significant between the preoperative and last follow-up examinations (p < .01). The heel valgus of all patients was corrected. Our results have shown that medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular bone is an effective treatment of flexible flatfoot with symptomatic accessory navicular, associated with excellent clinical outcomes and correction of the deformity. Copyright © 2014

  7. Bilateral navicular-medial cuneiform synostosis manifesting as medial foot pain: a case report and review of the literature.

    PubMed

    Malone, Jason B; Raney, Ellen M

    2016-03-01

    Isolated navicular-medial cuneiform tarsal coalition is a rare condition. Very few case reports exist, with limited treatment recommendations. We present a case of an 11-year-old with bilateral isolated osseous navicular-medial cuneiform tarsal coalition. The patient was treated with bilateral coalition excision and soft tissue interposition, with excellent results at 2 years of follow-up. The current case is unusual in being an osseous coalition rather than the more commonly seen cartilaginous or fibrous condition. In addition, this case is uncommon as being in a patient of European rather than Asian descent.

  8. Development and validation of a method for the quantification of extractable perfluoroalkyl acids (PFAAs) and perfluorooctane sulfonamide (FOSA) in textiles.

    PubMed

    van der Veen, Ike; Weiss, Jana M; Hanning, Anne-Charlotte; de Boer, Jacob; Leonards, Pim E G

    2016-01-15

    In textiles, like outdoor clothing, per- and polyfluoroalkyl substances (PFASs) are often used for durable water repellency (DWR) of the final products. The analytical performance to determine the concentration of these chemicals available for exposure to humans and to the environment need to be established. Here a method for the extraction and analysis of one class of PFASs, namely perfluoroalkyl acids (PFAAs), in outdoor clothing was developed and validated. The PFAAs which were validated, included perfluoroalkyl carboxylic acids (PFCAs) (C4-C14), and perfluoroalkane sulfonic acids (PFSAs) (C4, C6, C7, C8). In addition, perfluorooctane sulfonamide (FOSA) was included in this study. The method was based on an organic solvent extraction and analysis by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). No further cleaning was needed. Two commonly used organic solvent compositions were evaluated for the optimal extraction, i.e. methanol and acetone/acetonitrile (80:20, v/v), and the number and duration of the sequential extractions were optimized. Results showed that two sequential extractions with 5mL methanol and an extraction time of 30min gave an optimal performance with an extraction efficiency of >90%. The influence of matrix on the quantification of PFAAs was studied. This indicated ion suppression due to different matrix effects or sorption behavior to specific textile samples. Validation of the entire method showed overall recoveries of>80% and relative standard deviations (RSDs) of<9% (n=3) for repeatability and <20% (n=3) for reproducibility. This is the first validation of an analytical method for the analysis of extractable PFCAs, PFSAs and FOSA associated to textiles, which is of high importance due to the regulation of PFAAs in textile.

  9. Peri-navicular arthrodesis for the Stage III Müller-Weiss disease.

    PubMed

    Cao, Hong-Hui; Tang, Kang-Lai; Xu, Jian-Zhong

    2012-06-01

    We aimed to report our results of peri-navicular arthrodesis with autologous iliac bone graft for Stage III Müller-Weiss disease. Nine cases of Stage III Müller-Weiss disease according to the Maceira classification (four male and five female) with average age of 48.2 (range, 41 to 58) years, had mild or severe midfoot pain with the longitudinal arch collapse. The patients, all of whom had failed conservative treatment for more than 6 months, underwent peri-navicular arthrodesis. All patients were followed up at 3, 6, 9, and 12 months, and then every 6 months with AOFAS ankle-hindfoot scores and radiographic measurements. Mean followup time for radiological and clinical evaluation was 22.4 (rangem 12 to 52) months. All patients were satisfied with their clinical results without pain 12 months after surgery. The mean AOFAS ankle-hindfoot scores improved from 40.1±8.3 preoperatively to 90.9±2.1 at the last followup (p<0.05). A solid fusion was found in all cases at 3 months after surgery by radiographic and clinical evaluation. The average longitudinal arch height increased from 46.1±2.1 mm preoperatively to 53.5±2.3 mm at the last followup (p<0.05) on the lateral weightbearing radiograph. The peri-navicular arthrodesis with autologous iliac bone graft resulted in a good outcome for Stage III Müller-Weiss disease with good clinical outcomes, high fusion rate, and obvious improvement of the longitudinal arch height.

  10. Müller-Weiss disease of the tarsal navicular: an idiopathic case.

    PubMed

    Nelson, Eric W; Rivello, George J

    2012-01-01

    Müller-Weiss disease of the tarsal navicular is a rare condition, the etiology of which remains unclear. We present the case of a 28-year-old woman with classic radiographic findings consistent with Müller-Weiss disease. The patient was successfully treated with a talonavicular-cuneiform arthrodesis of her right foot. Radiographs at 6 months postoperatively demonstrated a successful medial arch fusion. At 38 months follow-up, the patient was asymptomatic. The American Academy of Orthopaedic Surgeons ankle hindfoot score was 97, compared with a preoperative score of 32. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Arthroscopically Assisted Treatment of Navicular Osteochondral Defect Using Flowable Collagen, Iliac Crest Bone Marrow Aspirate and Fibrin Glue: A Case Report.

    PubMed

    Keller, Thomas C; Dempsey, Ian J; Park, Joseph S

    2015-10-01

    A 32-year-old male recreational athlete presented with activity-related chronic dorsal midfoot pain. Conservative treatment, including a prolonged period of immobilization, physical therapy, nonsteroidal anti-inflammatory drugs, and use of a bone stimulator, failed to resolve his symptoms. Computed tomography and magnetic resonance imaging demonstrated a cystic appearing focus within the navicular in conjunction with a osteochondral lesion within the proximal articular surface of the navicular. This case report presents an arthroscopically assisted treatment of a navicular osteochondral lesion using curettage and backfilling with fibrin glue, flowable collagen, and autogenous bone grafting. Therapeutic, Level IV. © 2014 The Author(s).

  12. Use of the medial femoral condyle vascularized bone flap in traumatic avascular necrosis of the navicular: a case report.

    PubMed

    Holm, Janson; Vangelisti, Garrett; Remmers, Jared

    2012-01-01

    The medial femoral condyle vascularized bone flap has a high success rate in published literature regarding its use in nonunions and avascular necrosis of the upper and lower extremities. It is reported to have minimal donor site morbidity and the ability to provide structural support and torsional strength to load-bearing areas. The flap has found particular success in the treatment of scaphoid nonunions. The tarsal navicular, similar to the scaphoid, is largely articular cancellous bone with little surface area for vascular inflow. These anatomic features make the navicular prone to nonunion and avascular necrosis in traumatic scenarios. We describe a case of nonunion and avascular necrosis of the tarsal navicular occurring as sequelae of a high-impact midfoot injury sustained in an automobile accident. After an initial attempt at open reduction and internal fixation with midfoot bridge plating, subsidence and nonunion resulted. An attempt at arthrodesis of the talonavicular and naviculocuneiform joints was then undertaken. This too failed, leading to the development of additional collapse and avascular necrosis. The site was treated with a medial femoral condyle vascularized bone flap. In this single case, the patient returned to pain-free ambulation and reported excellent outcomes and functional capacity. Although we present a successful case, a larger case series is necessary to establish the use of this flap as a reliable option for the treatment of nonunion and avascular necrosis of the tarsal navicular. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. A unique procedure for treatment of osteochondral lesions of the tarsal navicular: three cases in athletes.

    PubMed

    Saxena, Amol; Fullem, Brian W

    2013-01-01

    Surgery in the athlete can present unique challenges, particularly when articular damage and osteoarthritic changes are noted. To allow athletes to return to their desired activity level, an alternative to the traditional approach of fusion must be developed. We prospectively reviewed 3 cases of osteochondral lesions and degenerative changes of the tarsal navicular joint involving a unique surgical approach consisting of microfracture of the lesions with concomitant arthrodiastasis. All 3 patients were treated with a miniexternal fixator to provide distraction for 4 weeks. The patients were aged 15, 17, and 21 years, with follow-up ranging from 2 to 4 years, at which point each patient was competing at their desired activity level and pain free. Each patient was initially treated at different stages of a navicular injury with patient 3 having undergone 2 courses of casted non-weightbearing. This new treatment gives more options to a potentially athletic career-ending injury. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Morphometric study of the equine navicular bone: variations with breeds and types of horse and influence of exercise

    PubMed Central

    GABRIEL, ANNICK; JOLLY, SANDRA; DETILLEUX, JOHANN; DESSY-DOIZE, CÉCILE; COLLIN, BERNARD; REGINSTER, JEAN-YVES

    1998-01-01

    Navicular bones from the 4 limbs of 95 horses, classified in 9 categories, were studied. The anatomical bases were established for the morphometry of the navicular bone and its variations according to the category of horse, after corrections were made for front or rear limb, sex, weight, size and age. In ponies, navicular bone measurements were smallest for light ponies and regularly increased with body size, but in horses, navicular bone dimensions were smallest for the athletic halfbred, intermediate for draft horse, thoroughbreds and sedentary halfbreds and largest for heavy halfbreds. The athletic halfbred thus showed reduced bone dimensions when compared with other horse types. Navicular bones from 61 horses were studied histomorphometrically. Light horses and ponies possessed larger amounts of cancellous bone and less cortical bone. Draft horses and heavy ponies showed marked thickening of cortical bone with minimum intracortical porosity, and a decrease in marrow spaces associated with more trabecular bone. Two distinct zones were observed for the flexor surface cortex: an external zone composed mainly of poorly remodelled lamellar bone, disposed in a distoproximal oblique direction, and an internal zone composed mainly of secondary bone, with a lateromedial direction for haversian canals. Flexor cortex external zone tended to be smaller for heavy ponies than for the light ponies. It was the opposite for horses, with the largest amount of external zone registered for draft horses. In athletic horses, we observed an increase in the amount of cortical bone at the expense of cancellous bone which could be the result of reduced resorption and increased formation at the corticoendosteal junction. Cancellous bone was reduced for the athletic horses but the number of trabeculae and their specific surfaces were larger. Increased bone formation and reduced resorption could also account for these differences. PMID:10029187

  15. Internal fixation of complex fractures of the tarsal navicular with locking plates. A report of 10 cases.

    PubMed

    Cronier, P; Frin, J-M; Steiger, V; Bigorre, N; Talha, A

    2013-06-01

    Tarsal navicular fractures are rare and treatment of comminuted fractures is especially difficult. Since 2007, the authors have had access to 3D reconstruction from CT scan images and specific locking plates, and they decided to evaluate whether these elements improved management of these severe cases. Between 2007 and 2011, 10 comminuted tarsal navicular fractures were treated in a prospective study. All of the fractures were evaluated by 3D reconstruction from CT scan images, with suppression of the posterior tarsal bones. The surgical approach was chosen according to the type of lesion. Reduction was achieved with a mini-distractor when necessary, and stabilized by AO locking plate fixation (Synthes™). Patient follow-up included a clinical and radiological evaluation (Maryland Foot score, AOFAS score). Eight patients underwent postoperative CT scan. All patients were followed up after a mean 20.5 months. Union was obtained in all patients and arthrodesis was not necessary in any of them. The mean Maryland Foot score was 92.8/100, and the AOFAS score 90.6/100. One patient with an associated comminuted calcaneal fracture had minimal sequella from a compartment syndrome of the foot. The authors did not find any series in the literature that reported evaluating tarsal navicular fractures by 3D reconstruction from CT scan images. The images obtained after suppression of the posterior tarsal bones systematically showed a lateral plantar fragment attached to the plantar calcaneonavicular ligament, which is essential for stability, and which helped determine the reduction technique. Locking plate fixation of these fractures has never been reported. Comminuted fractures of the tarsal navicular were successfully treated with specific imaging techniques in particular 3D reconstructions of CT scan images to choose the surgical approach and the reduction technique. Locking plate fixation of the navicular seems to be a satisfactory solution for the treatment of these

  16. Calcific tendonitis of the tibialis posterior tendon at the navicular attachment

    PubMed Central

    Harries, Luke; Kempson, Susan; Watura, Roland

    2011-01-01

    Calcific tendinosis (tendonosis/tendonitis) is a condition which results from the deposition of calcium hydroxyapatite crystals in any tendon of the body. Calcific tendonitis usually presents with pain, which can be exacerbated by prolonged use of the affected tendon. We report a case of calcific tendinosis in the posterior tibialis tendon at the navicular insertion. The pathology is rare in the foot, and extremely rare in the tibialis posterior tendon, indeed there are only 2 reported in the published literature. This case report highlights the need to consider calcific tendinosis in the foot despite its rarity. If this diagnosis is considered early, appropriate investigations can then be requested and unnecessary biopsies, use of antibiotics and surgery can be avoided. We also discuss possible causes of calcific tendinosis in the tibialis posterior tendon, the role of imaging modalities and review treatment methods. PMID:22470798

  17. On the collateral sesamoidean (suspensory navicular) ligament of equines: topographic relations and sensitive innervation.

    PubMed

    Palmieri, G; Sanna, L; Asole, A; Farina, V; Bo Minelli, L

    1990-01-01

    The origin and course of the collateral sesamoidean (suspensory navicular) ligament of the horse and ass and its attachment to the distal sesamoid bone were studied by means of dissection. Particular attention was given to the topographic relations between this ligament and the deep digital flexor tendon. Numerous sensitive nerve endings are present in this anatomical district. The free and encapsulated nerve endings, displayed by impregnating techniques, are mostly concentrated in the ligament tract connected to the above-named tendon and close to its attachment to the distal sesamoid angle. The nerve endings are identified as typical Pacini, Pacini-like and Golgi-Mazzoni corpuscles on account of their morphological features and are found isolated, grouped to form flower-sprays, lined up along the course of a single nerve fibre or grouped to originate poikilomorphous fibres.

  18. Brachymetatarsia with accessory navicular in right foot: A rare coincidental finding.

    PubMed

    Pandey, Praveen-Kumar; Pawar, Inder; Beniwal, Sandeep-Kumar; Verma, Raaghav-R

    2016-01-01

    A 33 years old female patient presented with posttraumatic pain in the right foot for which radiographs of the right foot was advised. No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization. We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs. After 3 weeks of immobilization, she underwent mobilization of the right foot, weight bearing and intensive physio- therapy for 6 weeks. After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot. After surgery she was completely relieved of pain and could do activities well related to the right foot.

  19. An investigation of the dynamic relationship between navicular drop and first metatarsophalangeal joint dorsal excursion.

    PubMed

    Griffin, Nicole L; Miller, Charlotte; Schmitt, Daniel; D'Août, Kristiaan

    2013-06-01

    The modern human foot is a complex biomechanical structure that must act both as a shock absorber and as a propulsive strut during the stance phase of gait. Understanding the ways in which foot segments interact can illuminate the mechanics of foot function in healthy and pathological humans. It has been proposed that increased values of medial longitudinal arch deformation can limit metatarsophalangeal joint excursion via tension in the plantar aponeurosis. However, this model has not been tested directly in a dynamic setting. In this study, we tested the hypothesis that during the stance phase, subtalar pronation (stretching of the plantar aponeurosis and subsequent lowering of the medial longitudinal arch) will negatively affect the amount of first metatarsophalangeal joint excursion occurring at push-off. Vertical descent of the navicular (a proxy for subtalar pronation) and first metatarsophalangeal joint dorsal excursion were measured during steady locomotion over a flat substrate on a novel sample consisting of asymptomatic adult males and females, many of whom are habitually unshod. Least-squares regression analyses indicated that, contrary to the hypothesis, navicular drop did not explain a significant amount of variation in first metatarsophalangeal joint dorsal excursion. These results suggest that, in an asymptomatic subject, the plantar aponeurosis and the associated foot bones can function effectively within the normal range of subtalar pronation that takes place during walking gait. From a clinical standpoint, this study highlights the need for investigating the in vivo kinematic relationship between subtalar pronation and metatarsophalangeal joint dorsiflexion in symptomatic populations, and also the need to explore other factors that may affect the kinematics of asymptomatic feet.

  20. Operative Treatment of Acute Fractures of the Tarsal Navicular Body: Midterm Results With a New Classification.

    PubMed

    Schmid, Timo; Krause, Fabian; Gebel, Philippe; Weber, Martin

    2016-05-01

    Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity. We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman's coefficients tested this classification's correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months. Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = -0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = -.509, P = .011). At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome. Level IV, retrospective case series. © The Author(s) 2015.

  1. An investigation of the dynamic relationship between navicular drop and first metatarsophalangeal joint dorsal excursion

    PubMed Central

    Griffin, Nicole L; Miller, Charlotte; Schmitt, Daniel; D'Août, Kristiaan

    2013-01-01

    The modern human foot is a complex biomechanical structure that must act both as a shock absorber and as a propulsive strut during the stance phase of gait. Understanding the ways in which foot segments interact can illuminate the mechanics of foot function in healthy and pathological humans. It has been proposed that increased values of medial longitudinal arch deformation can limit metatarsophalangeal joint excursion via tension in the plantar aponeurosis. However, this model has not been tested directly in a dynamic setting. In this study, we tested the hypothesis that during the stance phase, subtalar pronation (stretching of the plantar aponeurosis and subsequent lowering of the medial longitudinal arch) will negatively affect the amount of first metatarsophalangeal joint excursion occurring at push-off. Vertical descent of the navicular (a proxy for subtalar pronation) and first metatarsophalangeal joint dorsal excursion were measured during steady locomotion over a flat substrate on a novel sample consisting of asymptomatic adult males and females, many of whom are habitually unshod. Least-squares regression analyses indicated that, contrary to the hypothesis, navicular drop did not explain a significant amount of variation in first metatarsophalangeal joint dorsal excursion. These results suggest that, in an asymptomatic subject, the plantar aponeurosis and the associated foot bones can function effectively within the normal range of subtalar pronation that takes place during walking gait. From a clinical standpoint, this study highlights the need for investigating the in vivo kinematic relationship between subtalar pronation and metatarsophalangeal joint dorsiflexion in symptomatic populations, and also the need to explore other factors that may affect the kinematics of asymptomatic feet. PMID:23600634

  2. Outcome of modified Kidner procedure with subtalar arthroereisis for painful accessory navicular associated with planovalgus deformity.

    PubMed

    Garras, David N; Hansen, Patricia L; Miller, Adam G; Raikin, Steven Mark

    2012-11-01

    Type II accessory naviculars are frequently associated with planovalgus deformity. Operative treatment for patients recalcitrant to nonoperative treatment involves resection, with or without takedown, and reattachment of the tibialis posterior tendon as described by Kidner. This does not address the planovalgus deformity. The authors hypothesized that adding a subtalar arthroereisis to the Kidner procedure would lead to improvement of pain and function and correction of the deformity. Institutional Review Board-approved, prospectively collected data were reviewed for 20 patients (23 feet), who underwent a combined modified Kidner and subtalar arthroereisis for painful type II accessory navicular with planovalgus deformity recalcitrant to nonoperative treatment. The average age at the time of surgery was 18 years. Patients were evaluated preoperatively and at final follow-up clinically, radiographically, and via the visual analog pain scale (VAPS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and a satisfaction rating. Mean follow-up was 53.9 months. The mean AOFAS scores improved from 53 preoperatively to 95 at final follow-up and the mean VAPS score decreased from 7.4 preoperatively to 1.7 at final follow-up. Radiographically, the average Meary's angle improved from 18.5° apex plantar preoperatively to 3° apex plantar on weight-bearing lateral radiographs, and the average talar head uncoverage percentage on weight-bearing anteroposterior radiographs improved from 24% preoperatively to 3%. Nineteen of 20 patients reported good or excellent results. Three patients required implant removal because of pain; no recurrence of planovalgus deformity occurred after implant removal. No patients developed subtalar arthritis. The modified Kidner procedure combined with a subtalar arthroereisis resulted in significant pain and functional improvement. The deformity correction obtained at surgery was maintained even if the arthroereisis plug

  3. Effects of 'navicular' shoeing on equine distal forelimb kinematics on different track surface.

    PubMed

    Scheffer, C J; Back, W

    2001-11-01

    Orthopaedic shoeing applied for disorders such as navicular disease is mostly evaluated on hard track surfaces, but very often horses are ridden only on soft tracks. To compare the effects of normal shoes, eggbar shoes, and shoes with heel wedges (5 degrees) on the kinematics of the distal forelimb on hard and soft track surfaces, eleven sound Dutch Warmblood horses were led across three different tracks (an asphalt, a fibre/sand mix (= Agterberg), and a pure sand track) with three different shoe types (a normal shoe, an eggbar shoe, and a shoe with heel wedges). The hoof rotation and the maximal extension of the fetlock joint at midstance period were recorded by an infrared-light based gait analysis system (ProReflex) at walk and at trot. Statistical analysis revealed significant effects of track and shoe type, and a shoe-track interaction (p<0.05). On soft track surfaces, the equilibrium of the distal forelimb dictated a 1.5-4 degrees forward rotation of the normal or eggbar shod foot, the most on a sand track. The wedge effect on hoof rotation, however, was always significantly greater, but similar to that on the hard track surface (5 degrees forward rotation). The maximal fetlock extension was less on a soft surface, in particular on the sand track (p<0.05). This decrease was most pronounced when the horses were shod with heel wedges and was least pronounced with normal shoes. In conclusion, in particular the sand track allows a forward rotation of the hoof and thus relief of pressure in the navicular area, and a decrease in maximal fetlock extension and thus unloading of the fetlock joint. The extra forward rotation of the hoof induced by heel wedges on hard tracks was almost the same on soft track surfaces. Eggbars and fibre/sand mix tracks have intermediate effects on unloading of the distal forelimb.

  4. Regenerative tissue matrix as an interpositional spacer following excision of a cuboid-navicular tarsal coalition: a case study.

    PubMed

    Hounshell, Charles R

    2011-01-01

    This article describes the use of an acellular human dermal regenerative tissue matrix as an interpositional spacer to maintain the distance between the cuboid and navicular, and to prevent recurrence, following surgical excision of a cuboid-navicular tarsal coalition in an adult female. The use of this acellular matrix as an interpositional spacer has previously been documented for use in association with arthroplasty for the treatment of hallux rigidus. After more than 3 years of follow-up, the patient was progressing well and there was no evidence of recurrent coalition or consolidation of the resection site. To the best of our knowledge, this is the first report of the use of this material for the treatment of tarsal coalition, published in the peer-reviewed literature. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Distal border fragments of the equine navicular bone: association between magnetic resonance imaging characteristics and clinical lameness

    USGS Publications Warehouse

    Yorke, Elizabeth H.; Judy, Carter E.; Saveraid, Travis C.; McGowan, Conor P.; Caldwell, Fred J.

    2014-01-01

    Distal border fragments of the navicular bone are increasingly being detected due to the improved capabilities of magnetic resonance imaging (MRI), but their clinical significance remains unclear. The purpose of this retrospective study was to describe the location, size, and frequency of fragments in a cohort of horses presented for MRI of the foot and to compare MRI findings with severity of lameness. Archived MRI studies and medical records were searched from March 2006 to June 2008. Horses were included if a distal border fragment of the navicular bone was visible in MRI scans. Confidence interval comparisons and linear regression analyses were used to test hypotheses that fragments were associated with lameness and lameness severity was positively correlated with fragment volume and biaxial location. A total of 453 horses (874 limbs) were included. Fragments were identified in 60 horses (13.25%) and 90 limbs (10.3%). Fifty percent of the horses had unilateral fragments and 50% had bilateral fragments. Fragments were located at the lateral (62.2%), medial (8.89%), or medial and lateral (28.9%) angles of the distal border of the navicular bone. There was no increased probability of being categorized as lame if a fragment was present. There was no significant difference in fragment volume across lameness severity categorizations. Confidence intervals indicated a slightly increased probability of being classified as lame if both medial and lateral fragments were present. Findings indicated that distal border fragments of the navicular bone in equine MRI studies are unlikely to be related to existing lameness.

  6. Cuboid-navicular tarsal coalition: report of a small case series with description of a surgical approach for resection.

    PubMed

    Sarage, Anthony L; Gambardella, Gabriel V; Fullem, Brian; Saxena, Amol; Caminear, David S

    2012-01-01

    Tarsal coalitions are an uncommon pathology, representing approximately a 1% occurrence in the general population, and most commonly diagnosed in the younger population. Coalitions between the cuboid and navicular are especially rare. In this case series, all patients were young (15-35 years of age), active patients with fibrous coalitions at the cuboid-navicular interface; 3 of the 4 patients related a past history of ankle sprains on the affected side. After conservative treatment was exhausted and a diagnostic injection was performed that eliminated the pain, surgical intervention was used that consisted of coalition resection and interposition of an adipose graft harvested from the lower leg. All patients were able to return to their previous level of activity and remain pain-free at the surgical site. Our series of 4 cases of this coalition suggests that, although rare, cuboid-navicular coalition should be included in the differential diagnosis when patients present with persistent foot pain and suspicion of tarsal coalition is high. We also demonstrate that surgical resection of this coalition with an interpositional adipose graft provides excellent results. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. The effects of prolonged running on foot posture: a repeated measures study of half marathon runners using the foot posture index and navicular height

    PubMed Central

    2013-01-01

    Background Different foot postures are associated with alterations in foot function, kinetics and the subsequent occurrence of injury. Little is known about changes in foot posture following prolonged weightbearing exercise. This study aimed to identify changes in foot posture after running a half marathon. Methods Foot posture was measured using the Foot Posture Index (FPI-6) and navicular height in thirty volunteer participants before and after running a half marathon. FPI-6 scores were converted to Rasch logit values and means compared for these and navicular height using an ANOVA. Results There was a 5 mm drop in navicular height in both feet when measured after the half marathon (P < 0.05). The FPI-6 showed a side x time interaction with an increase in score indicating a more ‘pronated’ position in the left foot of + 2 [Rasch value + 1.7] but no change in the right foot (+ 0.4 [+ 0.76]) following the half marathon. Conclusion The apparent differences between the FPI-6 and navicular height on the right foot may be because the FPI-6 takes soft tissue contour changes into consideration whilst the navicular height focuses on skeletal changes. The changes in foot posture towards a more pronated position may have implications for foot function, and therefore risk of injury; shoe fit and comfort and also the effect of therapeutic orthoses worn during prolonged running. PMID:23705863

  8. Tiludronate as a new therapeutic agent in the treatment of navicular disease: a double-blind placebo-controlled clinical trial.

    PubMed

    Denoix, J M; Thibaud, D; Riccio, B

    2003-06-01

    Bisphosphonates, such as tiludronate, are used to normalise bone metabolism via inhibition of bone resorption. Areas of increased bone resorption and formation are typical lesions in a diseased navicular bone. To determine if bone remodelling changes occurring in navicular disease may be corrected with therapies regulating bone metabolism. We designed a double-blind, placebo-controlled clinical trial to compare 2 doses of tiludronate, 0.5 mg/kg and 1 mg/kg bwt administered via daily i.v. injections over 10 days for the treatment of navicular disease. Seventy-three horses, split into 2 subpopulations of recent and chronic cases, were enrolled to be followed-up over 6 months. Of these, 33 recent and 17 chronic cases meeting the selection criteria were maintained in the final efficacy analyses. Clinical examinations were videorecorded and reviewed blindly by an independent expert. Horses treated with the higher dose showed optimal improvement of lameness and return to normal level of activity 2-6 months post treatment. The more recent the onset of clinical signs at the time of treatment, the greater the efficacy. The treatment did not modify the response to extension and flexion tests. The lower dose failed to significantly improve the condition. Tiludronate efficacy is demonstrated in the treatment of navicular disease at the dose of 1 mg/kg bwt. Our results support the clinical relevance of bone remodelling changes in the outcome of navicular disease.

  9. Molecular Characterization of Escherichia coli Strains Isolated from Retail Meat That Harbor blaCTX-M and fosA3 Genes

    PubMed Central

    Xie, Miaomiao; Lin, Dachuan; Chen, Kaichao; Chan, Edward Wai Chi

    2016-01-01

    A total of 55 cefotaxime-resistant Escherichia coli isolates were obtained from retail meat products purchased in Shenzhen, China, during the period November 2012 to May 2013. Thirty-seven of these 55 isolates were found to harbor a blaCTX-M gene, with the blaCTX-M-1 group being the most common type. blaCMY-2 was detected in 16 isolates, alone or in combination with other extended-spectrum β-lactamase (ESBL) determinants. Importantly, the fosA3 gene, which encodes fosfomycin resistance, was detected in 12 isolates, with several being found to reside in the conjugative plasmid that harbored the blaCTX-M gene. The insertion sequence IS26 was observed upstream of some of the blaCTX-M-55 and fosA3 genes. Conjugation experiments showed that blaCTX-M genes from 15 isolates were transferrable, with Inc I1 and Inc FII being the most prevalent replicons. High clonal diversity was observed among the blaCTX-M producers, suggesting that horizontal transfer of the blaCTX-M genes among E. coli strains in retail meats is a common event and that such strains may constitute an important reservoir of blaCTX-M genes, which may be readily disseminated to other potential human pathogens. PMID:26856843

  10. Coexistence of SFO-1 and NDM-1 β-lactamase genes and fosfomycin resistance gene fosA3 in an Escherichia coli clinical isolate.

    PubMed

    Zhao, Jing-yi; Zhu, Yuan-qi; Li, Yan-nian; Mu, Xiao-dong; You, Li-ping; Xu, Cha; Qin, Ping; Ma, Jin-long

    2015-01-01

    This study aims to characterize antimicrobial resistance and antimicrobial resistance genetic determinants of an Escherichia coli clinical isolate HD0149 from China in 2012. This strain displayed high-level resistance to cephalosporins, carbapenems, fluoroquinolones, aminoglycosides and fosfomycin. A range of antimicrobial resistance genes was detected responsible for its multiple antimicrobial resistances, involving the blaCMY-2, blaCTX-M-65, blaNDM-1, blaSFO-1, blaTEM-1, fosA3, rmtB, sul1 and sul2 genes. Four amino acid substitutions were detected in the quinolone resistance-determining regions (QRDRs) of GyrA (S83L and D87N), ParC (S80I) and ParE (S458A). Conjugation experiments revealed two multiresistance plasmids present in E. coli HD0149. The blaSFO-1 gene associated with blaNDM-1 gene was located in a 190 kb IncA/C plasmid and the blaCTX-M-65, fosA3 and rmtB genes were located in a 110 kb IncF plasmid. This is the first identification of the blaSFO-1 gene in an E. coli isolate and on a conjugative IncA/C plasmid. This may dramatically enhance the international prevalence and dissemination of blaSFO-1 among Enterobacteriaceae.

  11. Frequency of Penetration of the Digital Flexor Tendon Sheath and Distal Interphalangeal Joint Using a Direct Endoscopic Approach to the Navicular Bursa in Horses

    PubMed Central

    Taylor, Sarah Elizabeth; García, Eugenio Cillán; Reardon, Richard J.M.

    2016-01-01

    Objective To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa. Study Design Cadaveric study. Sample Population Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach). Methods Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons. Results Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10–80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach. Conclusion Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted. PMID:26971252

  12. An in vitro study comparing the use of suture anchors and drill hole fixation for flexor digitorum longus transfer to the navicular.

    PubMed

    Sullivan, Raymond J; Gladwell, Heather A; Aronow, Michael S; Nowak, Michael D

    2006-05-01

    The surgical management of posterior tibial tendon dysfunction often includes transfer of the flexor digitorum longus (FDL) tendon through a tunnel in the navicular. Fixation often is obtained by sewing the tendon back onto itself. The purpose of this study was to compare this standard method of fixation with suture anchor fixation, a technique that may be associated with less surgical morbidity, because it requires the harvesting of less tendon length. FDL tendon transfer to the navicular was done in 13 fresh-frozen cadaver specimens. In six feet comprising the standard group, the FDL tendon was transected distal to the master knot of Henry, placed through a drill hole into the navicular, and sutured back onto itself. In seven feet the FDL tendon was transected proximal to the master knot of Henry, placed into a drill hole into the navicular, and fixed with a suture anchor. Load was applied to the proximal FDL muscle and tendon using a materials testing system (MTS) machine and peak load to failure was measured. The mean load to failure was 142.48 N +/- 38.06 N for the standard group and 142.12 N +/- 59.26 N for the suture anchor group (p = 0.305 for the Student-t test and p = 0.945 for the Mann-Whitney test). Transfer of the FDL tendon to the navicular using suture anchor fixation requires less tendon length yet provides similar fixation strength as compared to sewing the tendon back onto itself. However, suture anchors are considerably more expensive than sutures. Suture anchors allow comparable fixation of FDL tendon transfer into a navicular without the need to disrupt the master knot of Henry. This technique may be associated with less morbidity including a shorter incision, decreased risk of medial plantar nerve injury, and decreased loss of lesser toe plantarflexion strength secondary to maintenance of the normal interconnections between the flexor hallucis longus (FHL) and FDL tendons.

  13. Frequency of Penetration of the Digital Flexor Tendon Sheath and Distal Interphalangeal Joint Using a Direct Endoscopic Approach to the Navicular Bursa in Horses.

    PubMed

    Kane-Smyth, Justine; Taylor, Sarah Elizabeth; García, Eugenio Cillán; Reardon, Richard J M

    2016-04-01

    To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa. Cadaveric study. Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach). Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons. Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10-80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach. Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted. © 2016 The Authors. Veterinary Surgery published by Wiley Periodicals Inc. on behalf of The American College of Veterinary Surgeons.

  14. Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents.

    PubMed

    Kim, Jung Ryul; Park, Chan Il; Moon, Young Jae; Wang, Sung Il; Kwon, Keun Sang

    2014-12-05

    Accessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch. Moreover, some severe, rigid flatfoot deformities are associated with an accessory navicular. We investigated the results of concomitant calcaneo-cuboid-cuneiform osteotomies (triple C) and the modified Kidner procedure for severe flatfoot associated with a symptomatic accessory navicular in children and adolescents. Twenty-one feet of 13 patients (nine boys, four girls; mean age 12.7 years) with severe flatfoot associated with a symptomatic accessory navicular who were treated with concomitant triple C and the modified Kidner procedure were evaluated based on clinical and radiographic examinations preoperatively and at a mean follow-up of 22.4 months (range, 12-36 months). We measured 12 variables on the anteroposterior (AP) and lateral weight-bearing radiographs, and we used the American College of Foot and Ankle Surgeons (ACFAS) score for clinical assessment. We found significant improvements (p < 0.001) in eight of the 12 radiographic measurements: the AP talo-first metatarsal (MTT) angle, AP talo-navicular coverage angle, AP talo-calcaneal angle, lateral talo-first MTT angle, calcaneal pitch, lateral talo-calcaneal angle, lateral talo-horizontal angle, and naviculo-cuboid overlap. Average ACFAS scores were significantly improved at the time of the last follow-up (p < 0.001). The only complication was overcorrection of the hindfoot in one patient. Concomitant triple C and the modified Kidner procedure result in favorable radiographic and clinical outcomes in the treatment of severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.

  15. Bilateral osteonecrosis of the navicular and medial cuneiform in a patient with systemic lupus erythematosus: a case report.

    PubMed

    Greenhagen, Robert M; Crim, Brandon E; Shinabarger, Andrew B; Burns, Patrick R

    2012-06-01

    Atraumatic avascular necrosis (AVN) is an unusual pathology to the foot. Risk factors include the use of corticosteroids, smoking, alcohol, rheumatologic disorders, hematologic disorders, and metabolic disorders. To the authors' knowledge, this study presents the first case of bilateral atraumatic AVN to the navicular and medial cuneiform in a patient with systemic lupus erythamatosus (SLE). A 40-year-old man presented with a past medical history of SLE in which he developed AVN of the tarsal navicular and medial cuneiform. This occurred first on the subject's right foot and then while recovering from surgical intervention, on his left foot. Talonaviculocuneiform arthrodesis was performed with the use of distal tibial autograft on both extremities. The subject's American Orthopaedic Foot and Ankle Society midfoot score improved from 34 to 80 at 21 months on the right and 37 to 90 at 15 months to the left. Patients with SLE carry a significant risk of developing AVN. Comorbidities such as vasculitis, corticosteroid use, cytotoxic medication, and peripheral neuropathy are known risk factors in the development of AVN. Unusual features such as multifocal AVN and unusual anatomic locations can occur with SLE. AVN of the foot is generally treated with surgical intervention. Treatments such as core decompression, open reduction and internal fixation, and arthrodesis have been recommended based on the symptoms and presentation. The authors present a very rare presentation of bilateral osteonecrosis of the tarsal navicular and first cuneiform in a patient with SLE. The patient was treated with bilateral talonaviculocuneiform arthrodesis. The patient demonstrated considerable improvement to both extremities. Therapeutic, Level IV.

  16. Simple excision vs the Kidner procedure for type 2 accessory navicular associated with flatfoot in pediatric population.

    PubMed

    Cha, Soo-Min; Shin, Hyun-Dae; Kim, Kyung-Cheon; Lee, Jeong-Kil

    2013-02-01

    Recently, many studies have argued against the Kidner procedure and its several modifications, with the accessory navicular considered an irritant rather than a hindrance to foot function, and simple excision has been advocated. We designed this prospective, comparative study of simple excision and the Kidner procedure in children and adolescents with flatfoot and evaluated functional and radiographic outcomes. From February 2004 to March 2009, we followed 50 consecutive feet of symptomatic type 2 accessory navicular. Simple excision and the Kidner procedure were performed in 25 feet each, respectively. The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, the visual analogue scale (VAS), and the talo-first metatarsal, talocalcaneal, and calcaneal pitch angles were evaluated preoperatively and postoperatively for a minimum of 3 years. Patient satisfaction was assessed. The preoperative AOFAS midfoot scale and VAS of each group were improved at final follow-up. The talo-first metatarsal and talocalcaneal angles were not significantly different pre- and postoperatively. However, the calcaneal pitch angle of both groups was improved at the final follow-up. At the final follow-up, we observed no significant differences between the 2 groups in the AOFAS midfoot scale, the VAS, and the talo-first metatarsal, talocalcaneal, and calcaneal pitch angles. The satisfaction frequencies were 86% and 82% in groups 1 and 2, respectively. We found that in children and adolescents with accessory navicular and flatfoot, simple excision and the Kidner procedure both gave satisfactory results and both minimally restored the medial longitudinal arch similarly. Level II, prospective therapeutic study.

  17. Incidence and anatomical variations of accessory navicular bone in patients with foot pain: A retrospective radiographic analysis.

    PubMed

    Kalbouneh, Heba; Alajoulin, Omar; Alsalem, Mohammad; Humoud, Noor; Shawaqfeh, Jamil; Alkhoujah, Mohammad; Abu-Hassan, Hana; Mahafza, Waleed; Badran, Darwish

    2017-05-01

    The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patient's symptoms and prevent misinterpreting them as fractures. Foot radiographs from 1,240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender. The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2 A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development. Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. Clin. Anat. 30:436-444, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system.

    PubMed

    Kanatli, Ulunay; Yetkin, Haluk; Yalcin, Nadir

    2003-06-01

    This study included 92 patients with an accessory navicular (AN) noted on an anteroposterior roentgenography. This group was selected from 860 patients admitted to the authors' gait analysis laboratory. The medial longitudinal arch was evaluated by using an "arch index" calculated from the pressure picture obtained from a pressure distribution measurement system. The average arch index was 0.15 and there was no significant correlation between AN types and arch index. The study concluded that the presence and type of AN are not correlated with the height of the medial longitudinal arch of the foot and that AN is not associated with pes planus.

  19. The Relationship Between Accessory Navicular and Flat Foot: A Radiologic Study.

    PubMed

    Park, Hoon; Hwang, Jin Ho; Seo, Joon Oh; Kim, Hyun Woo

    2015-01-01

    The aim of this study was to investigate the relationship between accessory navicular (AN) and flat foot and to evaluate the association between flat foot and the symptoms of patients with AN. We enrolled 196 patients with painful or asymptomatic AN in this study. Patients who were older than 18 years or who had no weight-bearing radiographs of the feet were not included. Another 46 normal participants were used as a control group. The AN group was divided into 3 subgroups: a group with asymptomatic AN; a symptomatic group that had not undergone excision; and a symptomatic group that had undergone surgery. Seven radiographic indices were measured including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo-first metatarsal angle, and AP talo-first metatarsal angle. Groups were compared regarding age, sex, presence of pain at the time of surgery, and radiographic parameters. The calcaneal pitch angle in the AN group was significantly smaller than that of controls (P=0.004). Naviculocuboid overlap (P=0.001), talonavicular coverage angle (P<0.001), lateral talo-first metatarsal angle (P=0.014), and AP talo-first metatarsal angle (P<0.001) were significantly larger in the AN group than in controls. No significant radiologic differences were seen between patients with symptomatic and asymptomatic AN. No significant radiographic differences were found between the groups of patients who had and who had not had bone excised. AN associated with radiographic parameters felt to be representative of a flat foot; however, the degree of flat foot was not associated with the development and severity of symptoms in patients with AN.

  20. Clinical Meaning of Hot Uptake on Bone Scan in Symptomatic Accessory Navicular Bones.

    PubMed

    Chong, Ari; Ha, Jung-Min; Lee, Jun-Young

    2016-12-01

    We analyzed clinical factors related to uptake on a Tc-99 m HDP bone scan of the accessory navicular (AN). We retrospectively reviewed patients who had been examined by an orthopedic surgeon and underwent bone scan due to suspected symptomatic AN. A three-point grading system was used to evaluate uptake on bone scan. Relationships between grade, symptoms, age, gender, symptom duration, and bone size were analyzed. In total, 73 ANs (30 asymptomatic, 43 symptomatic) were enrolled. The majority of asymptomatic ANs had no uptake but some had grade 1 (n = 8) or 2 (n = 2) uptake. All asymptomatic ANs with uptake remained asymptomatic during follow-up. For the asymptomatic ANs, larger bones showed a higher grade. With a cut-off value of size ≤6.8 mm, there is no chance of uptake. All symptomatic ANs showed uptake on bone scan. For symptomatic ANs, larger size and shorter pain duration were related to a higher grade. Age, gender, and left-/right-sideness were not related to grade. Multiple regressions revealed that only uptake grade, not size or symptom duration, was the significant risk factor for a symptomatic AN. With a cut-off value of grade <1, a symptomatic AN could be ruled out with a negative predictive value of 100 %. Bone scanning is useful for symptomatic ANs with a high negative predictive value. Higher grade is related to larger size and shorter pain duration. For asymptomatic ANs, grade was related to size but did not predict symptom development.

  1. Genetic Influence on Accessory Navicular Bone in the Foot: A Korean Twin and Family Study.

    PubMed

    Cheong, In Yae; Kang, Hyo Jeong; Ko, Hyeonyoung; Sung, Joohon; Song, Yun-Mi; Hwang, Ji Hye

    2017-06-01

    An accessory navicular bone (AN) is the most common accessory ossicle in the foot. The presence of an AN bone can trigger various foot problems, such as posterior tibial tendon pathology, flattening of the medial longitudinal arch, and medial foot pain. Despite the clinical influence of presence of an AN in foot disease, the research regarding its inheritance is still insufficient. A total of 135 pairs of monozygotic (MZ) twins, 25 pairs of dizygotic (DZ) twins, and 676 singletons from families were enrolled in order to estimate genetic influences on AN. After confirmation of zygosity and family relationship with a tandem repeat marker kit and questionnaires, the presence and type of the AN was classified through bilateral feet radiographic examination. The heritability of an AN was estimated using quantitative genetic analysis based on a variance decomposition model considering various types of family relationships: father-offspring pair, mother-offspring pair, and pooled DZ twin and sibling pairs. As a result, approximately 40.96% of the participants in this study had an AN in either foot, with type II being the most common type. The heritability for the presence of any type of an AN in any foot was estimated as 0.88 (95% CI [0.82, 0.94]) after adjusting for age and sex. Specifically, type II AN showed the highest heritability of 0.82 (95% CI [0.71-0.93]). The high heritability of an AN found in this large twin and family study suggests that an AN is determined by the substantial influence of genetic factor.

  2. F33: A-: B-, IncHI2/ST3, and IncI1/ST71 plasmids drive the dissemination of fosA3 and blaCTX−M−55/−14/−65 in Escherichia coli from chickens in China

    PubMed Central

    Yang, Xiaoyun; Liu, Wuling; Liu, Yiyun; Wang, Jing; Lv, Luchao; Chen, Xiaojie; He, Dandan; Yang, Tong; Hou, Jianxia; Tan, Yinjuan; Xing, Li; Zeng, Zhenling; Liu, Jian-Hua

    2014-01-01

    The purpose of this study was to examine the occurrence of fosfomycin-resistant Escherichia coli from chickens and to characterize the plasmids carrying fosA3. A total of 661 E. coli isolates of chicken origin collected from 2009 to 2011 were screened for plasmid-mediated fosfomycin resistance determinants by PCR. Plasmids were characterized using PCR-based replicon typing, plasmid multilocus sequence typing, and restriction fragment length polymorphisms. Associated addiction systems and resistance genes were identified by PCR. PCR-mapping was used for analysis of the genetic context of fosA3. Fosfomycin resistance was detected in 58 isolates that also carried the fosA3 gene. Fifty-seven, 17, and 52 FosA3-producers also harbored blaCTX−M, rmtB, and floR genes, respectively. Most of the 58 fosA3-carrying isolates were clonally unrelated, and all fosA3 genes were located on plasmids belonged to F33:A-:B- (n = 18), IncN-F33:A-:B- (n = 7), IncHI2/ST3 (n = 10), IncI1/ST71 (n = 3), IncI1/ST108 (n = 3), and others. The genetic structures, IS26-ISEcp1-blaCTX−M−55-orf477-blaTEM-1-IS26-fosA3-1758bp-IS26 and ISEcp1-blaCTX−M−65-IS903-iroN-IS26-fosA3-536bp-IS26 were located on highly similar F33:A-:B- plasmids. In addition, blaCTX−M−14-fosA3-IS26 was frequently present on similar IncHI2/ST3 plasmids. IncFII plasmids had a significantly higher frequency of addiction systems (mean 3.5) than other plasmids. Our results showed a surprisingly high prevalence of fosA3 gene in E. coli isolates recovered from chicken in China. The spread of fosA3 can be attributed to horizontal dissemination of several epidemic plasmids, especially F33:A-:B- plasmids. Since coselection by other antimicrobials is the major driving force for the diffusion of the fosA3 gene, a strict antibiotic use policy is urgently needed in China. PMID:25566207

  3. Failure of Internal Fixation for Painful Bipartite Navicular in Two Adolescent Soccer Players: A Report of Two Cases.

    PubMed

    Yamaguchi, Satoshi; Niki, Hisateru; Akagi, Ryuichiro; Yamamoto, Yohei; Sasho, Takahisa

    Bipartite navicular bone is an uncommon condition that can cause midfoot pain in children and adolescents. No treatment methods, other than conservative management, have been reported. We report the cases of 2 adolescent soccer players who underwent internal fixation of the painful bipartite fragments, resulting in nonunion. After failure of conservative management, the patients underwent surgery. Curettage of the junction between the 2 bone fragments was performed, and autologous cancellous bone was grafted. Next, the fragments were fixed with variable-threaded screws. Bone union of the bipartite fragments was once achieved on computed tomography in both cases at 3 and 5 months after surgery, respectively. However, separation of the fragment occurred in both cases after the patients had returned to sports. Although the patients were able to return to sports activities, they still had mild midfoot pain 3 and 2 years after surgery, respectively. Internal fixation using screws and an autologous bone graft for painful bipartite navicular bone in adolescent athletes is not recommended, and other surgeries should be considered to achieve bony union. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Results and complications of operative and non-operative navicular fracture treatment.

    PubMed

    Coulibaly, Marlon O; Jones, Clifford B; Sietsema, Debra L; Schildhauer, Thomas A

    2015-08-01

    Navicular fractures (NF) are uncommon. The purpose of this study was to compare results of operative (ORIF) and non-operative (NOT) treatment in NF. A retrospective analysis was undertaken on patients diagnosed with NF between March 2002 and June 2007 at a Level I teaching trauma centre. Clinical outcome consisted of functional ability and complications. Eighty-eight patients with 90 fractures were identified including 56 males and 32 females with a mean age of 38 (range 17-72) and body mass index of 28.2 (range 18.7-48.9). Twenty-one of 90 (23.3%) injuries were isolated. Ten of 90 (11.1%) injuries were open. Treatment was 49/90 (55%) NOT and 41/90 (45.6%) ORIF. 11/41 (30%) ORIF required bone grafting. Complications included one ipsilateral deep vein thrombosis, one avascular necrosis, one nonunion, seven infections (two deep and five superficial), and 56 cases of secondary osteoarthrosis (SOA). ORIF had significantly more SOA (χ(2)=0.000). Secondary surgery was 25 hardware removals (16 for irritation, five for prominent or broken plates), nine arthrodeses/-plasties, two debridements for infection, and one tarsal tunnel release. Pain was present at final follow up in 39/90 (43.3%) feet. Work status was 64 without restrictions, 17 with restrictions, and 5 did not return to work. Sixty-two of 88 (69%) patients were able to wear normal shoes, which were related to return to work without restrictions (ρ=-0.508, p=0.000). Inability to return to previous work was related to pain (ρ=-0.394), SOA (ρ=-0.280), and poor reduction quality (ρ=-0.384) with significance at p<0.01. Increased BMI (>35) related to pain (ρ=0.250) and poor reduction quality (ρ=0.326) at a σ<0.05. Despite modern surgical techniques, operative treatment of displaced fractures is at high risk for complications. Obesity, pain, and secondary osteoarthrosis determine shoe wear, return to function, and employment status. Level III. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Complete Sequence of a Novel IncR-F33:A-:B- Plasmid, pKP1034, Harboring fosA3, blaKPC-2, blaCTX-M-65, blaSHV-12, and rmtB from an Epidemic Klebsiella pneumoniae Sequence Type 11 Strain in China.

    PubMed

    Xiang, Dai-Rong; Li, Jun-Jie; Sheng, Zi-Ke; Yu, Hai-Ying; Deng, Mei; Bi, Sheng; Hu, Fei-Shu; Chen, Wei; Xue, Xiao-Wei; Zhou, Zhi-Bo; Doi, Yohei; Sheng, Ji-Fang; Li, Lan-Juan

    2015-12-14

    A high fosfomycin resistance rate was observed in Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) in our previous study, but little is known about its mechanisms. In this study, we explored the prevalence of plasmid-mediated fosfomycin resistance determinants among fosfomycin-resistant KPC-KP strains from a Chinese university hospital and determined the complete sequence of a novel fosA3-carrying plasmid isolated from an epidemic K. pneumoniae sequence type (ST) 11 strain. A total of 97 KPC-KP strains were studied, of which 57 (58.8%) were resistant to fosfomycin, including 44 (45.4%) harboring fosA3 and 1 harboring fosA. All fosA3-positive strains belonged to the dominant ST11-pulse type (PT) A clone according to multilocus sequence typing and pulsed-field gel electrophoresis, suggesting clonal dissemination. The fosA-positive isolate belonged to ST11-PTE. The fosA3-carrying plasmid pKP1034 is 136,848 bp in length and is not self-transmissible. It is a multireplicon plasmid belonging to IncR-F33:A-: B-. Besides fosA3, a variety of other resistance determinants, including blaKPC-2, rmtB, blaCTX-M-65, and blaSHV-12, are identified in pKP1034, which would allow for coselection of fosA3 by most β-lactams and/or aminoglycosides and facilitate its dissemination despite limited use of fosfomycin in China. Detailed comparisons with related plasmids revealed that pKP1034 is highly mosaic and might have evolved from alarming recombination of the blaKPC-2-carrying plasmid pKPC-LK30 from Taiwan and the epidemic fosA3-carrying plasmid pHN7A8 from mainland China.

  6. Complete Sequence of a Novel IncR-F33:A–:B– Plasmid, pKP1034, Harboring fosA3, blaKPC-2, blaCTX-M-65, blaSHV-12, and rmtB from an Epidemic Klebsiella pneumoniae Sequence Type 11 Strain in China

    PubMed Central

    Xiang, Dai-Rong; Li, Jun-Jie; Sheng, Zi-Ke; Yu, Hai-Ying; Deng, Mei; Bi, Sheng; Hu, Fei-Shu; Chen, Wei; Xue, Xiao-Wei; Zhou, Zhi-Bo; Doi, Yohei; Li, Lan-Juan

    2015-01-01

    A high fosfomycin resistance rate was observed in Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) in our previous study, but little is known about its mechanisms. In this study, we explored the prevalence of plasmid-mediated fosfomycin resistance determinants among fosfomycin-resistant KPC-KP strains from a Chinese university hospital and determined the complete sequence of a novel fosA3-carrying plasmid isolated from an epidemic K. pneumoniae sequence type (ST) 11 strain. A total of 97 KPC-KP strains were studied, of which 57 (58.8%) were resistant to fosfomycin, including 44 (45.4%) harboring fosA3 and 1 harboring fosA. All fosA3-positive strains belonged to the dominant ST11-pulse type (PT) A clone according to multilocus sequence typing and pulsed-field gel electrophoresis, suggesting clonal dissemination. The fosA-positive isolate belonged to ST11-PTE. The fosA3-carrying plasmid pKP1034 is 136,848 bp in length and is not self-transmissible. It is a multireplicon plasmid belonging to IncR-F33:A−: B−. Besides fosA3, a variety of other resistance determinants, including blaKPC-2, rmtB, blaCTX-M-65, and blaSHV-12, are identified in pKP1034, which would allow for coselection of fosA3 by most β-lactams and/or aminoglycosides and facilitate its dissemination despite limited use of fosfomycin in China. Detailed comparisons with related plasmids revealed that pKP1034 is highly mosaic and might have evolved from alarming recombination of the blaKPC-2-carrying plasmid pKPC-LK30 from Taiwan and the epidemic fosA3-carrying plasmid pHN7A8 from mainland China. PMID:26666939

  7. The Independent and Interactive Effects of Navicular Drop and Quadriceps Angle on Neuromuscular Responses to a Weight-Bearing Perturbation

    PubMed Central

    Shultz, Sandra J; Carcia, Christopher R; Gansneder, Bruce M; Perrin, David H

    2006-01-01

    Context: Little is known about the effects of static alignment on neuromuscular control of the knee during dynamic motion. Objective: To evaluate the isolated and combined effects of quadriceps angle (QA) and navicular drop (ND) on neuromuscular responses to a weight-bearing perturbation. Design: Mixed-model, repeated-measures design. Setting: Sports medicine and athletic training research laboratory. Patients or Other Participants: Seventy-nine National Collegiate Athletic Association Division I collegiate female athletes, classified with below-average ND and QA (LND-LQA); below-average ND and above-average QA (LND-HQA); above-average ND and below-average QA (HND-LQA); or above-average ND and QA (HND-HQA). Intervention(s): A lower extremity perturbation device produced a forward and either internal or external rotation of the trunk and femur on the weight-bearing tibia to evoke a reflex response. Main Outcome Measure(s): Neuromuscular responses were examined in the quadriceps, hamstrings, and gastrocnemius muscles: preperturbation amplitude 50 milliseconds before the perturbation, reflex time, and postperturbation amplitude 150 milliseconds immediately postperturbation. Results: Navicular drop had the greatest effect on preperturbation amplitude of the lateral hamstrings and postperturbation amplitude of all muscles, with greater activation amplitude noted in subjects in the HND classifications. Quadriceps angle primarily affected reflex time of the quadriceps; in subjects with LQA, reflex time was faster for internal rotation than external rotation perturbations. The interaction between ND and QA had the greatest effect on reflex time of the lateral hamstrings. For internal rotation perturbations, subjects in the LND classifications had faster reflex times in the lateral hamstrings if they had HQA values rather than LQA values. With external rotation perturbations, HND-LQA subjects had slower reflex times than those in all other alignment classifications

  8. Revision Surgery for Recurrent Pain after Excision of the Accessory Navicular and Relocation of the Tibialis Posterior Tendon

    PubMed Central

    Lee, Woo Chun

    2017-01-01

    Background The results of operative treatments for symptomatic accessory navicular are debatable. In some cases, recurrent pain may develop after the Kidner procedure. The purpose of this study is to review the reasons for recurrent pain after the Kidner procedure and to suggest possible options for revision surgery. Methods We reviewed the clinical and radiological outcomes in 9 patients who underwent revision surgery for recurrent pain after the Kidner procedure. During the revision surgery, the tibialis posterior tendon was reattached to the navicular either by advancing the tendon in 4 patients or by lengthening the tendon in another 4 patients. In the other 1 patient, the flexor digitorum longus tendon was transferred. Surgeries for the accompanying deformities were performed simultaneously in all patients. The results were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and a visual analog scale. The mean follow-up was 2.3 years (range, 1 to 5 years). Results The mean American Orthopedic Foot and Ankle Society ankle-hindfoot score improved from 71.25 to 81.50 in the advancement group, and 71.75 to 90.00 in the lengthening group. The mean visual analog scale improved from 7.75 to 4.25 in the advancement group and from 7.50 to 1.75 in the lengthening group. Conclusions Recurrent pain after the Kidner procedure was associated with pes planovalgus or hindfoot valgus deformity. In revision surgery, correction of the associated deformities and reattachment of the tibialis posterior tendon after lengthening may need to be considered. PMID:28567228

  9. Revision Surgery for Recurrent Pain after Excision of the Accessory Navicular and Relocation of the Tibialis Posterior Tendon.

    PubMed

    Choi, Hong Joon; Lee, Woo Chun

    2017-06-01

    The results of operative treatments for symptomatic accessory navicular are debatable. In some cases, recurrent pain may develop after the Kidner procedure. The purpose of this study is to review the reasons for recurrent pain after the Kidner procedure and to suggest possible options for revision surgery. We reviewed the clinical and radiological outcomes in 9 patients who underwent revision surgery for recurrent pain after the Kidner procedure. During the revision surgery, the tibialis posterior tendon was reattached to the navicular either by advancing the tendon in 4 patients or by lengthening the tendon in another 4 patients. In the other 1 patient, the flexor digitorum longus tendon was transferred. Surgeries for the accompanying deformities were performed simultaneously in all patients. The results were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and a visual analog scale. The mean follow-up was 2.3 years (range, 1 to 5 years). The mean American Orthopedic Foot and Ankle Society ankle-hindfoot score improved from 71.25 to 81.50 in the advancement group, and 71.75 to 90.00 in the lengthening group. The mean visual analog scale improved from 7.75 to 4.25 in the advancement group and from 7.50 to 1.75 in the lengthening group. Recurrent pain after the Kidner procedure was associated with pes planovalgus or hindfoot valgus deformity. In revision surgery, correction of the associated deformities and reattachment of the tibialis posterior tendon after lengthening may need to be considered.

  10. Antimicrobial susceptibility and emerging resistance determinants (blaCTX-M, rmtB, fosA3) in clinical isolates from urinary tract infections in the Bolivian Chaco.

    PubMed

    Bartoloni, Alessandro; Sennati, Samanta; Di Maggio, Tiziana; Mantella, Antonia; Riccobono, Eleonora; Strohmeyer, Marianne; Revollo, Carmen; Villagran, Ana Liz; Pallecchi, Lucia; Rossolini, Gian Maria

    2016-02-01

    Bolivia is among the lowest-resourced South American countries, with very few data available on antibiotic resistance in bacterial pathogens. The phenotypic and molecular characterization of bacterial isolates responsible for urinary tract infections (UTIs) in the Bolivian Chaco are reported here. All clinical isolates from UTIs collected in the Hospital Basico Villa Montes between June 2010 and January 2014 were analyzed (N=213). Characterization included susceptibility testing, extended-spectrum beta-lactamase (ESBL) detection, identification of relevant resistance determinants (e.g., CTX-M-type ESBLs, 16S rRNA methyltransferases, glutathione S-transferases), and genotyping of CTX-M producers. Very high resistance rates were observed. Overall, the lowest susceptibility was observed for trimethoprim-sulphamethoxazole, tetracycline, nalidixic acid, amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin. Of E. coli and K. pneumoniae, 11.6% were ESBL producers. Resistance to nitrofurantoin, amikacin, and fosfomycin remained low, and susceptibility to carbapenems was fully preserved. CTX-M-15 was the dominant CTX-M variant. Four E. coli ST131 (two being H30-Rx) were identified. Of note, isolates harbouring rmtB and fosA3 were detected. Bolivia is not an exception to the very high resistance burden affecting many South American countries. Optimization of alternative approaches to monitor local antibiotic resistance trends in resource-limited settings is strongly encouraged to support the implementation of effective empiric treatment guidelines. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Use of force plate analysis to compare the analgesic effects of intravenous administration of phenylbutazone and flunixin meglumine in horses with navicular syndrome.

    PubMed

    Erkert, Ronald S; MacAllister, Charles G; Payton, Mark E; Clarke, Cyril R

    2005-02-01

    To use force plate analysis to evaluate the analgesic efficacies of flunixin meglumine and phenylbutazone administered i.v. at typical clinical doses in horses with navicular syndrome. 12 horses with navicular syndrome that were otherwise clinically normal. Horses received flunixin (1.1 mg/kg), phenylbutazone (4.4 mg/kg), or physiologic saline (0.9% NaCI; 1 mL/45 kg) solution administered IV once daily for 4 days with a 14-day washout period between treatments (3 treatments/horse). Before beginning treatment (baseline) and 6, 12, 24, and 30 hours after the fourth dose of each treatment, horses were evaluated by use of the American Association of Equine Practitioners lameness scoring system (half scores permitted) and peak vertical force of the forelimbs was measured via a force plate. At 6, 12, and 24 hours after the fourth treatment, subjective lameness evaluations and force plate data indicated significant improvement in lameness from baseline values in horses treated with flunixin or phenylbutazone, compared with control horses; at those time points, the assessed variables in flunixin- or phenylbutazone-treated horses were not significantly different. In horses with navicular syndrome treated once daily for 4 days, typical clinical doses of flunixin and phenylbutazone resulted in similar significant improvement in lameness at 6, 12, and 24 hours after the final dose, compared with findings in horses treated with saline solution. The effect of flunixin or phenylbutazone was maintained for at least 24 hours. Flunixin meglumine and phenylbutazone appear to have similar analgesic effects in horses with navicular syndrome.

  12. Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review.

    PubMed

    Mallee, Wouter H; Weel, Hanneke; van Dijk, C Niek; van Tulder, Maurits W; Kerkhoffs, Gino M; Lin, Chung-Wei Christine

    2015-03-01

    To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. Systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and retrospective studies. Two reviewers independently extracted data and assessed methodological quality. Main outcomes were return to sport and complication rate. 18 studies were included (2 anterior tibia (N=31), 8 navicular (N=200) and 8 fifth metatarsal (N=246)). For anterior tibial fracture, no studies on initial surgery were eligible. Conservative treatment resulted in high complication rates and few cases returned to sport. For navicular fracture, a weighted mean return to sport of 22 for conservative and 16 weeks for surgical treatment was found. Six weeks of non-weightbearing cast was mostly used as conservative treatment. Surgical procedures varied widely. For the fifth metatarsal fracture, weighted mean return to sport was 19 for conservative and 14 weeks for surgical treatment. Surgery consisted of intramedullary screw fixation or tension band wiring. For conservative methods, insufficient details were reported. Overall, there was a high risk of bias; sample sizes were small and GRADE level of evidence was low. Strong conclusions for surgical or conservative therapy for these high-risk stress fractures cannot be drawn; quality of evidence is low and subjected to a high risk of bias. However, there are unsatisfying outcomes of conservative therapy in the anterior tibia. The role of initial surgery is unknown. For the navicular, surgery provided an earlier return to sport; and when treated conservatively, weightbearing should be avoided. For the fifth metatarsal, surgery provided the best results. Treatment decision-making would greatly benefit from further prospective research. PROSPERO database of systematic reviews: CRD42013004201. Published by the BMJ Publishing Group Limited

  13. Is there an association between clinical features, response to diagnostic analgesia and radiological findings in horses with a magnetic resonance imaging diagnosis of navicular disease or other injuries of the podotrochlear apparatus?

    PubMed

    Parkes, Rebecca; Newton, Richard; Dyson, Sue

    2015-04-01

    Previous descriptions of the clinical features of navicular disease occurred before the widespread use of magnetic resonance imaging (MRI) allowed a more definitive diagnosis of foot pain. The objective of this study was to compare the clinical features of horses with lesions of the podotrochlear apparatus with those with other causes of foot pain. It was hypothesised that primary navicular bone disease would be associated with more advanced radiological findings than other diagnoses. A retrospective study was performed of all horses examined at a referral centre with a definitive diagnosis of foot pain based on MRI ± post-mortem examination. Clinical examination findings, response to diagnostic analgesia and radiological grading of the navicular bone were compared among five diagnosis groups: (1) primary navicular bone pathology (NB); (2) lesions of the collateral sesamoidean ligament and/or distal sesamoidean impar ligament (CSL + DSIL); (3) primary deep digital flexor tendon injury (DDFT); (4) navicular bone pathology and other lesions of the podotrochlear apparatus ± DDFT (PTA) and (5) Other. There were 702 horses (NB, 62; CSL + DSIL, 180; DDFT, 69; PTA, 92; Other, 299). Horses with PTA injuries were more frequently unilaterally lame than other groups (P = 0.04). Horses with DDFT injury were more likely to exhibit pain on turning than other groups (P <0.01). There were no associations between response to diagnostic analgesia and diagnostic group, and no association between radiological grade and diagnostic group. Clinical examination findings generally did not discriminate between diseases of the PTA and other causes of foot pain. Overall radiological scores of the navicular bone did not accurately predict navicular bone pathology.

  14. First report of a clinical, multidrug-resistant Enterobacteriaceae isolate coharboring fosfomycin resistance gene fosA3 and carbapenemase gene blaKPC-2 on the same transposon, Tn1721.

    PubMed

    Li, Gang; Zhang, Ying; Bi, Dexi; Shen, Pinghua; Ai, Fuqi; Liu, Hong; Tian, Yueru; Ma, Yiming; Wang, Bei; Rajakumar, Kumar; Ou, Hong-Yu; Jiang, Xiaofei

    2015-01-01

    In order to understand the genetic background and dissemination mechanism of carbapenem resistance and fosfomycin resistance in Enterobacteriaceae isolates, we studied a clinical Escherichia coli strain HS102707 isolate and an Enterobacter aerogenes strain HS112625 isolate, both of which were resistant to carbapenem and fosfomycin and positive for the bla(KPC-2) and fosA3 genes. In addition, a clinical Klebsiella pneumoniae strain HS092839 isolate which was resistant to carbapenem was also studied. A 70-kb plasmid was successfully transferred to recipient E. coli J53 by a conjugation test. PCR and Southern blot analysis showed that bla(KPC-2) was located on this plasmid. The complete sequence of pHS102707 showed that this plasmid belongs to the P11 subfamily (IncP1) and has a replication gene, several plasmid-stable genes, an intact type IV secretion system gene cluster, and a composite transposon Tn1721-Tn3 that harbored bla(KPC-2). Interestingly, a composite IS26 transposon carrying fosA3 was inserted in the Tn1721-tnpA gene in pHS102707 and pHS112625, leading to the disruption of Tn1721-tnpA and the deletion of Tn1721-tnpR. However, only IS26 with a truncated Tn21-tnpR was inserted in pHS092839 at the same position. To our knowledge, this is the first report of fosA3 and bla(KPC-2) colocated in the same Tn1721-Tn3-like composite transposon on a novel IncP group plasmid.

  15. First Report of a Clinical, Multidrug-Resistant Enterobacteriaceae Isolate Coharboring Fosfomycin Resistance Gene fosA3 and Carbapenemase Gene blaKPC-2 on the Same Transposon, Tn1721

    PubMed Central

    Li, Gang; Zhang, Ying; Bi, Dexi; Shen, Pinghua; Ai, Fuqi; Liu, Hong; Tian, Yueru; Ma, Yiming; Wang, Bei; Rajakumar, Kumar

    2014-01-01

    In order to understand the genetic background and dissemination mechanism of carbapenem resistance and fosfomycin resistance in Enterobacteriaceae isolates, we studied a clinical Escherichia coli strain HS102707 isolate and an Enterobacter aerogenes strain HS112625 isolate, both of which were resistant to carbapenem and fosfomycin and positive for the blaKPC-2 and fosA3 genes. In addition, a clinical Klebsiella pneumoniae strain HS092839 isolate which was resistant to carbapenem was also studied. A 70-kb plasmid was successfully transferred to recipient E. coli J53 by a conjugation test. PCR and Southern blot analysis showed that blaKPC-2 was located on this plasmid. The complete sequence of pHS102707 showed that this plasmid belongs to the P11 subfamily (IncP1) and has a replication gene, several plasmid-stable genes, an intact type IV secretion system gene cluster, and a composite transposon Tn1721-Tn3 that harbored blaKPC-2. Interestingly, a composite IS26 transposon carrying fosA3 was inserted in the Tn1721-tnpA gene in pHS102707 and pHS112625, leading to the disruption of Tn1721-tnpA and the deletion of Tn1721-tnpR. However, only IS26 with a truncated Tn21-tnpR was inserted in pHS092839 at the same position. To our knowledge, this is the first report of fosA3 and blaKPC-2 colocated in the same Tn1721-Tn3–like composite transposon on a novel IncP group plasmid. PMID:25367902

  16. Effects of analgesia of the distal interphalangeal joint and navicular bursa on experimental lameness caused by solar pain in horses.

    PubMed

    Sardari, K; Kazemi, H; Mohri, M

    2002-11-01

    It has been hypothesized that pain originating from the dorsal margin of the sole of the hoof in horses can be attenuated by analgesia of either the distal interphalangeal (DIP) joint, or of the navicular bursa (NB). To test this hypothesis, an experimental lameness was induced in the toe region of the left forelimb in six adult horses. After this, both synovial structures were blocked and the effects on the lameness were semi-quantitatively scored. Lameness was induced by creating pressure on the dorsal margin of the sole with the help of set-screws that were screwed into a nut, welded to the inside of each branch of the shoe. Gaits were recorded on a videotape before and after application of the screws, and after application of either a local anaesthetic or saline into the DIP joint or NB. The gaits were independently evaluated by two blinded clinicians and scored. Lameness scores were high after application of the screws and remained high after the administration of saline, but decreased significantly (P < 0.05) after administration of the local anaesthetic. Analgesia of the DIP joint as well as the NB appeared to be able to desensitize a portion of the sole. It was concluded that pain arising from the toe region of the sole should not be excluded as a cause of lameness when lameness is attenuated by analgesia of the DIP joint, or of the NB.

  17. The structure and histopathology of the "enthesis organ" at the navicular insertion of the tendon of tibialis posterior.

    PubMed

    Moriggl, Bernhard; Kumai, Tsukasa; Milz, Stefan; Benjamin, Michael

    2003-03-01

    To investigate the structure, histopathology, and molecular composition of tissue specializations of the tibialis posterior enthesis. They collectively reduce stress concentration at the insertion site and are part of an "enthesis organ." This has implications for understanding the basis of enthesopathy. Fifty-two specimens of tibialis posterior and the associated superomedial part of the calcaneonavicular ligament taken from cadavers were sectioned longitudinally and examined by routine histology (42 samples) or immunohistochemistry (10 samples). Serial sections of formalin fixed material were stained with Masson's trichrome, toluidine blue, or hematoxylin, eosin and alcian blue. A panel of antibodies against collagens, glycosaminoglycans, and proteoglycans was used to immunolabel methanol fixed material. The enthesis organ consists of the enthesis itself, the superomedial part of the calcaneonavicular ligament (which may fuse with the tendon), the tendon sheath, and associated accessory bones. The accessory bones lay in a region of fibrocartilage that was present even in specimens where the bones themselves were absent. Degenerative changes were seen at the enthesis, around the accessory bones, and in the walls of the tendon sheath. The navicular and accessory bone entheses, together with the calcaneonavicular ligament, were all rich in fibrocartilage. This immunolabeled for aggrecan, link protein, type II collagen, and versican. The complexity of the enthesis organ, and the diversity of sites showing histopathological changes, suggest that enthesopathy may not be located precisely at the osteotendinous junction. It could target a number of adjacent locations, in accord with what happens at other entheses; e.g., in patients with spondyloarthropathy. The prominence of fibrocartilage in the enthesis organ, and the degenerative changes to which it is subject, support the view that spondyloarthropathy has an underlying biomechanical basis.

  18. Complete Sequence of a F33:A-:B- Conjugative Plasmid Carrying the oqxAB, fosA3, and blaCTX-M-55 Elements from a Foodborne Escherichia coli Strain

    PubMed Central

    Xie, Miaomiao; Xie, Liqi; Lin, Dachuan; Li, Ruichao; Zhou, Yuanjie; Chan, Edward W.; Chen, Sheng

    2016-01-01

    This study reports the complete sequence of pE80, a conjugative IncFII plasmid recovered from an Escherichia coli strain isolated from chicken meat. This plasmid harbors multiple resistance determinants including oqxAB, fosA3, blaCTX-M-55, and blaTEM-1, and is a close variant of the recently reported p42-2 element, which was recovered from E. coli of veterinary source. Recovery of pE80 constitutes evidence that evolution or genetic re-arrangement of IncFII type plasmids residing in animal-borne organisms is an active event, which involves acquisition and integration of foreign resistance elements into the plasmid backbone. Dissemination of these plasmids may further compromise the effectiveness of current antimicrobial strategies. PMID:27833607

  19. Complete Sequence of the FII Plasmid p42-2, Carrying blaCTX-M-55, oqxAB, fosA3, and floR from Escherichia coli.

    PubMed

    Yang, Qiu E; Walsh, Timothy Rutland; Liu, Bao Tao; Zou, Meng Ting; Deng, Hui; Fang, Liang Xing; Liao, Xiao Ping; Sun, Jian; Liu, Ya Hong

    2016-07-01

    We sequenced a novel conjugative multidrug resistance IncF plasmid, p42-2, isolated from Escherichia coli strain 42-2, previously identified in China. p42-2 is 106,886 bp long, composed of a typical IncFII-type backbone (∼54 kb) and one distinct acquired DNA region spanning ∼53 kb, harboring 12 antibiotic resistance genes [blaCTX-M-55, oqxA, oqxB, fosA3, floR, tetA(A), tetA(R), strA, strB, sul2, aph(3')-II, and ΔblaTEM-1]. The spread of these multidrug resistance determinants on the same plasmid is of great concern and, because of coresistance to antibiotics from different classes, is therapeutically challenging.

  20. IncA/C Plasmid Carrying bla(NDM-1), bla(CMY-16), and fosA3 in a Salmonella enterica Serovar Corvallis Strain Isolated from a Migratory Wild Bird in Germany.

    PubMed

    Villa, L; Guerra, B; Schmoger, S; Fischer, J; Helmuth, R; Zong, Z; García-Fernández, A; Carattoli, A

    2015-10-01

    A Salmonella enterica serovar Corvallis strain was isolated from a wild bird in Germany. This strain carried the IncA/C2 pRH-1238 plasmid. Complete sequencing of the plasmid was performed, identifying the blaNDM-1, blaCMY-16, fosA3, sul1, sul2, strA, strB, aac(6')-Ib, aadA5, aphA6, tetA(A), mphA, floR, dfrA7, and merA genes, which confer clinically relevant resistance to most of the antimicrobial classes, including β-lactams with carbapenems, fosfomycin, aminoglycosides, co-trimoxazole, tetracyclines, and macrolides. The strain likely originated from the Asiatic region and was transferred to Germany through the Milvus migrans migratory route.

  1. Posterior talar fracture with dislocation of both talo-navicular and subtalar joints: a variant type II of the Sneppens classification

    PubMed Central

    Galanopoulos, Ilias; Fogg, Quentin; Ashwood, Neil

    2012-01-01

    A 63-year-old man fell from a ladder, thus causing an axial compression injury to the right ankle. Severe deformity was evident and the ankle could not be reduced by simple manipulation. The skin was tented and appearing critically contused. Radiographs revealed an oblique fracture of the posterior aspect of the talar body with dislocation of both the talo-navicular and subtalar joints, an injury previously not described in the literature. The fracture–dislocation was anatomically reduced within 3 h of presentation and stability achieved with two headless buried compression screws. CT scan confirmed anatomical reduction and the patient remained non-weight bearing in a cast for 6 weeks. One year postoperatively, the patient remains pain-free with no radiological signs of avascular necrosis of the talus. This injury is unique and despite its severity and soft tissue compromise good quality reduction and internal fixation resulted in an excellent clinical outcome. PMID:22847568

  2. A rare case of an osteochondral lesion of the tarsal navicular with a subacute stress fracture in a high level athlete.

    PubMed

    Nunag, Perrico; Quah, Colin; Pillai, Anand

    2014-12-01

    In this report, an osteochondral lesion of the tarsal navicular associated with a subacute stress fracture in a professional basketball player surgical treatment is presented. The surgical technique involved extra-articular curettage, bone grafting and plate stabilisation. Postoperative CT scan confirmed that both the osteochondral lesion and the stress fracture healed. The talonavicular joint showed no signs of arthritis on imaging. Clinical foot scores showed marked improvement after surgery. At 6 months patient managed to return to competitive play without pain in the foot and ankle. The outcome of this case indicates that the combination of curettage, bone grating and plate stabilisation works well for this rare and potentially career ending dual lesions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. The relationship between isotonic plantar flexor endurance, navicular drop, and exercise-related leg pain in a cohort of collegiate cross-country runners.

    PubMed

    Bennett, Jason E; Reinking, Mark F; Rauh, Mitchell J

    2012-06-01

    The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP). Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries. Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP. While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2-38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1-48.9) more likely to develop an in-season occurrence of ERLP. While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP. 2b.

  4. THE RELATIONSHIP BETWEEN ISOTONIC PLANTAR FLEXOR ENDURANCE, NAVICULAR DROP, AND EXERCISE-RELATED LEG PAIN IN A COHORT OF COLLEGIATE CROSS-COUNTRY RUNNERS

    PubMed Central

    Reinking, Mark F.; Rauh, Mitchell J.

    2012-01-01

    Purpose: The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP). Background: Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries. Methods: Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP. Results: While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2–38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1–48.9) more likely to develop an in-season occurrence of ERLP. Conclusion: While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP. Level of Evidence: 2b. PMID:22666641

  5. The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot.

    PubMed

    Goo, Young-Mi; Kim, Tae-Ho; Lim, Jin-Yong

    2016-03-01

    [Purpose] The purpose of the present study is to examine the effects of abductor hallucis and gluteus maximus strengthening exercises on pronated feet. [Subjects and Methods] The present study was conducted with 18 adults without no history of surgery on the foot or ankle. One group performed both gluteus maximus strengthening exercises and abductor hallucis strengthening exercises, while the other group performed only abductor hallucis strengthening exercises five times per week for four weeks. [Results] The group that performed both gluteus maximus and abductor hallucis strengthening exercises showed smaller values in the height of navicular drop than the group that performed only abductor hallucis strengthening exercises. The muscle activity of the gluteus maximus and the vastus medialis increased during heel-strike in the group that added gluteus maximus exercises, and the muscle activity of the abductor hallucis significantly increased in both groups. [Conclusion] Given the results of the present study, it can be suggested that strengthening the gluteus maximus while also performing exercises to correct the pronated foot is an effective method for achieving normal gait.

  6. Complete Sequence of pEC012, a Multidrug-Resistant IncI1 ST71 Plasmid Carrying bla CTX-M-65, rmtB, fosA3, floR, and oqxAB in an Avian Escherichia coli ST117 Strain.

    PubMed

    Pan, Yu-Shan; Zong, Zhi-Yong; Yuan, Li; Du, Xiang-Dang; Huang, Hui; Zhong, Xing-Hao; Hu, Gong-Zheng

    2016-01-01

    A 139,622-bp IncI1 ST71 conjugative plasmid pEC012 from an avian Escherichia coli D-ST117 strain was sequenced, which carried five IS26-bracketed resistance modules: IS26-fosA3-orf1-orf2-Δorf3-IS26, IS26-fip-ΔISEcp1-bla CTX-M-65-IS903D-iroN-IS26, IS26-ΔtnpR-bla TEM-1-rmtB-IS26, IS26-oqxAB-IS26, and IS26-floR-aac(3)-IV-IS26. The backbone of pEC012 was similar to that of several other IncI1 ST71 plasmids: pV408, pM105, and pC271, but these plasmids had different arrangements of multidrug resistance region. In addition, the novel ISEc57 element was identified, which is in the IS21 family. The stepwise emergence of multi-resistance regions demonstrated the accumulation of different resistance determinants through homologous recombination. To the best of our knowledge, this is the first study to identify a multidrug-resistant IncI1 ST71 plasmid carrying bla CTX-M-65, rmtB, fosA3, floR, and oqxAB in an avian E. coli ST117 strain.

  7. Complete Sequence of pEC012, a Multidrug-Resistant IncI1 ST71 Plasmid Carrying blaCTX-M-65, rmtB, fosA3, floR, and oqxAB in an Avian Escherichia coli ST117 Strain

    PubMed Central

    Pan, Yu-Shan; Zong, Zhi-Yong; Yuan, Li; Du, Xiang-Dang; Huang, Hui; Zhong, Xing-Hao; Hu, Gong-Zheng

    2016-01-01

    A 139,622-bp IncI1 ST71 conjugative plasmid pEC012 from an avian Escherichia coli D-ST117 strain was sequenced, which carried five IS26-bracketed resistance modules: IS26-fosA3-orf1-orf2-Δorf3-IS26, IS26-fip-ΔISEcp1-blaCTX-M-65-IS903D-iroN-IS26, IS26-ΔtnpR-blaTEM-1-rmtB-IS26, IS26-oqxAB-IS26, and IS26-floR-aac(3)-IV-IS26. The backbone of pEC012 was similar to that of several other IncI1 ST71 plasmids: pV408, pM105, and pC271, but these plasmids had different arrangements of multidrug resistance region. In addition, the novel ISEc57 element was identified, which is in the IS21 family. The stepwise emergence of multi-resistance regions demonstrated the accumulation of different resistance determinants through homologous recombination. To the best of our knowledge, this is the first study to identify a multidrug-resistant IncI1 ST71 plasmid carrying blaCTX-M-65, rmtB, fosA3, floR, and oqxAB in an avian E. coli ST117 strain. PMID:27486449

  8. [Etiopathogenic factors of the different types of urinary litiasis.

    PubMed

    Arrabal-Martín, Miguel; Cano-García, María Carmen; Arrabal-Polo, Miguel Ángel; Domínguez-Amillo, Alejandro; Canales-Casco, Nelson; de la Torre-Trillo, Javier; Cózar-Olmo, José Manuel

    2017-01-01

    In this review, we analyze the etiopathogenic principles of urinary lithiasis formation. In the kidney, calcifications that may cause renal lithiasis are produced as a consequence of processes that injury the urothelium at the papilla and Bellini's ducts. With the improvement of imaging techniques, mainly micro CT scan, it is possible to detect them and we may be able to anticipate to the formation of lithiasis. As we well know, there are different factors that influence the formation of the calculi depending on their composition. In calcium lithiasis it is key to review the modification of the categories of hypercalciuria, we currently distinguish two types instead of three, thanks to the fasting calcium/ creatinine ratio, differentiating absorptive hypercalciuria and fasting hypercalciuria. In the fasting hypercalciuria, it is important to emphasize the relationship between this factor and the loss of bone mineral density in patients with recurrent renal calcic lithiasis, so that in this kind of patients it is compulsory the study of bone metabolism by bone remodelling markers and bone densitometry. Regarding the other factors that participate in the formation of calcium lithiasis we should specially emphasize on hypercalciuria and its growing increase because of its relationship with obesity and metabolic syndrome, as well as hipocitraturia, present in an important percentage of patients and related in some cases with metabolic acidosis and osteopenia-osteoporosis too. In relation to uric acid lithiasis it should be highlighted that urinary pH is the most determinant factor and, therefore, its control and modifications would be paramount for prevention of this type of lithiasis. In the infectious lithiasis, the presence of germs that split urea is mandatory. They generate ammonia ions with the ability to injure the urothelium and to form magnesium ammonium phosphate lithiasis mainly. Regarding cystine lithiasis, rare, it was classically divided in three types and now passed to be classified in type A and B depending on the muted gene, and it is more useful to perform direct 24-hour urine measurement than screening tests which have low sensitivity. In general, we tried to give a comprehensive view of the various types of lithiasis emphasizing the most interesting clinical points for the urologist.

  9. Quiz case. Symptomatic type II accessory navicular.

    PubMed

    Demeyere, N; De Maeseneer, M; Osteaux, M

    2001-01-01

    A 17 year old boy, who twisted his left foot while playing soccer a few days earlier, presented with pain and swelling along the medial aspect of the left foot. Clinical examination revealed an area of swelling and tenderness anteroinferiorly to the medial malleolus. Radiographs were considered normal and the patient was treated with a topical anti-inflammatory agent. During the following seven months the patient continued to experience pain on the medial side of the left foot, especially after a prolonged activity and when putting on shoes. Focal redness and tenderness was also evident.

  10. Analytical (mathematical) predictive modeling in fiber optics structural analysis (FOSA): review and extension

    NASA Astrophysics Data System (ADS)

    Suhir, Ephraim

    2015-03-01

    An updated version of the paper with revised references has been published The review part of the paper addresses analytical (mathematical) modeling in structural analysis in fiber optics engineering, mostly fiber optics interconnects, and deals with optical fibers subjected to thermal and/or mechanical loading (stresses) in bending, tension, compression, or to the combinations of such loadings. Attributes and significance of predictive modeling are indicated and discussed. The review is based mostly on the author's research conducted at Bell Laboratories, Physical Sciences and Engineering Research Division, Murray Hill, NJ, USA, during his tenure with this company, and, to a lesser extent, on his recent work in the field. The addressed structures include, but are not limited to, optical fibers of finite length: bare fibers; jacketed and dual-coated fibers; fibers experiencing thermal loading; fibers soldered into ferrules or adhesively bonded into capillaries; as well as the roles of geometric and material non-linearity; dynamic response to shocks and vibrations; and possible applications of nano-materials in new generations of coating and cladding systems. The extension part is concerned with a novel, fruitful and challenging directionprobabilistic design for reliability (PDfR) of opto-electronic and photonic products, including optical fibers and interconnects. The rationale behind the PDfR concept is that there is no such thing as zero probability of failure, that the difference between a highly reliable product and an insufficiently reliable product is "merely" in the level of the never zero probability of its failure and that when the operational performance of the product is imperative, the ability to predict, quantify, assure and, if possible and appropriate, even specify its reliability is highly desirable. Accordingly, the objective of the PDfR effort is to quantify the likelihood of an operational failure of a material, device or a system, including the field of fiber optics.

  11. Ongoing pain and deformity after an excision of the accessory navicular.

    PubMed

    Vaughan, Philip; Singh, Dishan

    2014-09-01

    Although a painful accessory navicula and a pes planus often coexist, they are not necessarily causally related, and each condition should be assessed and treated individually. A child or adolescent will notice the rubbing of an accessory navicula against footwear as the foot and boney swelling grows. The cause of persistent local pain such as inadequate bony resection, scar pain, irritation of the tibialis posterior tendon, and so forth should be sought and addressed; management will depend on the specific presentation and previous procedure performed. The cause of the ongoing pain should be investigated. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Complete bony coalition of the talus and navicular: decades of discomfort

    PubMed Central

    Bryson, David; Uzoigwe, Chika Edward; Bhagat, Shaishav B; Menon, Dipen K

    2011-01-01

    Tarsal coalition is a congenital disturbance of hindfoot development. Talonavicular coalition is among the rarest forms of aberrant bony union of the tarsus. It frequently occurs bilaterally and in association with a number of skeletal deformities. Some patients are asymptomatic and the anomaly is discovered incidentally on plain radiographs. For others, a troublesome bony prominence will be the principle complaint and in a small proportion of patients marked foot and ankle pain with activity will prove debilitating. The authors describe the case of a 54-year-old male with bilateral foot pain spanning for nearly two decades. Symptom onset was insidious and at the time of presentation, he was limited to 10–15 min of mobilisation on flat ground. PMID:22691945

  13. The Relationship of Static Anthropometric Measurements to Lower Leg, Ankle, and Foot Injuries in Air Force Academy Cadets: A Prospective Longitudinal Study

    DTIC Science & Technology

    2001-01-01

    for all variables demonstrated a significant relationship between navicular drop, total talocrural range of motion, total supination, fitness level... navicular drop results and r square of 0.031 for talocrural range of motion, fitness level, and total supination results.

  14. Characterization of a Novel IncHI2 Plasmid Carrying Tandem Copies of blaCTX-M-2 in a fosA6-Harboring Escherichia coli Sequence Type 410 Strain.

    PubMed

    Guo, Qinglan; Ding, Baixing; Jové, Thomas; Stoesser, Nicole; Cooper, Vaughn S; Wang, Minggui; Doi, Yohei

    2016-11-01

    The extended-spectrum β-lactamase gene blaCTX-M-2 is mainly associated with ISCR1 embedded in complex sul1-type integrons, but information on the genetic context of plasmids harboring the ISCR1-blaCTX-M-2 module remains limited. In this study, a blaCTX-M-2-harboring plasmid (pYD786-1) belonging to the sequence type 2 (ST2)-IncHI2 plasmid type and isolated from an Escherichia coli ST410 clinical strain was sequenced and analyzed. pYD786-1 belongs to the APEC-O1-R-type IncHI2 plasmids, which are widely distributed in human, poultry, and livestock strains. It contains a multidrug resistance mosaic region (MRR) consisting of a Tn21::In2 transposon backbone augmented by acquisition of duplicate ISCR1-blaCTX-M-2 modules. Tn2411, a Tn21::In2 precursor, likely played a role in the generation of the MRR in pN13-01290_23, the putative progenitor plasmid of pYD786-1, found in a foodborne Salmonella strain. Tn21/Tn2411::In::ISCR1-blaCTX-M-2 derivatives, including pYD786-1, have been identified in strains from Europe, South America, and the United States, suggesting potential global dissemination of the blaCTX-M-2 modules mediated by this vehicle.

  15. Comparative hepatic in vitro depletion and metabolite formation of major perfluorooctane sulfonate precursors in Arctic polar bear, beluga whale, and ringed seal.

    PubMed

    Letcher, Robert J; Chu, Shaogang; McKinney, Melissa A; Tomy, Gregg T; Sonne, Christian; Dietz, Rune

    2014-10-01

    Perfluorooctane sulfonate (PFOS) has been reported to be among the most concentrated persistent organic pollutants in Arctic marine wildlife. The present study examined the in vitro depletion of major PFOS precursors, N-ethyl-perfluorooctane sulfonamide (N-EtFOSA) and perfluorooctane sulfonamide (FOSA), as well as metabolite formation using an assay based on enzymatically viable liver microsomes for three top Arctic marine mammalian predators, polar bear (Ursus maritimus), beluga whale (Delphinapterus leucas), and ringed seal (Pusa hispida), and in laboratory rat (Rattus rattus) serving as a general mammalian model and positive control. Rat assays showed that N-EtFOSA (38 nM or 150 ng mL(-1)) to FOSA metabolism was >90% complete after 10 min, and at a rate of 23 pmol min(-1) mg(-1) protein. Examining all species in a full 90 min incubation assay, there was >95% N-EtFOSA depletion for the rat active control and polar bear microsomes, ∼65% for ringed seals, and negligible depletion of N-EtFOSA for beluga whale. Concomitantly, the corresponding in vitro formation of FOSA from N-EtFOSA was also quantitatively rat≈polar bear>ringed seal>beluga whale. A lack of enzymatic ability and/or a rate too slow to be detected likely explains the lack of N-EtFOSA to FOSA transformation for beluga whale. In the same assays, the depletion of the FOSA metabolite was insignificant (p>0.01) and with no concomitant formation of PFOS metabolite. This suggests that, in part, a source of FOSA is the biotransformation of accumulated N-EtFOSA in free-ranging Arctic ringed seal and polar bear. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  16. [Synthesis and characterization of novel associating water-soluble copolymers]: Annual progress report, November 15, 1993-November 15, 1994

    SciTech Connect

    1994-12-31

    A large number of hydrophobically associating copolymers of N-vinylpyrrolidone (NVP) or N,N-dimethyl acrylamide (DMA) with perfluoroalkyl acrylates (FOSA) containing between .01 and 1.0 mole % FOSA (with respect to DMA) were synthesized by emulsion and by bulk copolymerization. In contrast with the acrylamide (AM) FOSA copolymers the corresponding NVP and DMA copolymers are soluble in THF and CH{sub 3}OH in addition to water. This is expected to be of help in the characterization. This report discusses the synthesis, the kinetics of AM-FOSA copolymerization, and characterization.

  17. Application of the Ottawa Ankle Rules to Evaluate Ankle and Foot Injuries by Army Nurse Practitioners

    DTIC Science & Technology

    1999-05-01

    tenderness at the base of the fifth metatarsal; b) bone tenderness at the navicular ; c) inability to bear weight both immediately and in the...following findings: a) bone tenderness at the base of the fifth metatarsal; b) bone tenderness at the navicular ; c) inability to bear weight both...cuboid, or the navicular . Stiell et al., (1993) performed the second study in two emergency departments in two university hospitals. The objective of

  18. Application of the Ottawa Ankle Rules to Evaluate Ankle and Foot Injuries By Army Nurse Practitioners

    DTIC Science & Technology

    1999-05-01

    bone tenderness at the navicular ; c) inability to bear weight both immediately and in the provider s presence (Stiell et al., 1994). Findings of this...fifth metatarsal; b) bone tenderness at the navicular ; c) inability to bear weight both immediately and in the provider s presence. Ottawa Ankle...among patients with pain in the midfoot and bone tenderness at the base of the fifth metatarsal, the cuboid, or the navicular . Stiell et al., (1993

  19. Is Ongoing Sulfluramid Use in South America a Significant Source of Perfluorooctanesulfonate (PFOS)? Production Inventories, Environmental Fate, and Local Occurrence.

    PubMed

    Löfstedt Gilljam, John; Leonel, Juliana; Cousins, Ian T; Benskin, Jonathan P

    2016-01-19

    Despite international phase-out initiatives, production and use of perfluorooctanesulfonate (PFOS) and related substances continues in some countries. In Brazil, the PFOS-precursor N-ethyl perfluorooctane sulfonamide (EtFOSA) is used in Sulfluramid, a pesticide for controlling leaf-cutting ants. New data on production, environmental fate, and occurrence of Brazilian Sulfluramid are reported herein. From 2003 to 2013, Brazilian Sulfluramid manufacturing increased from 30 to 60 tonnes yr(-1) EtFOSA. During this time <1.3 tonnes yr(-1) were imported, while exports increased from ∼0.3 to 2 tonnes yr(-1). From 2004 to 2015, most EtFOSA was exported to Argentina (7.2 tonnes), Colombia (2.07 tonnes), Costa Rica (1.13 tonnes), Equador (2.16 tonnes), and Venezuela (2.4 tonnes). Within Brazil, sales occurred primarily in the states of Minas Gerais, São Paulo, Mato Grosso do Sul, Espírito Santo, and Bahia. Model simulations predict EtFOSA will partition to soils, while transformation products perfluorooctane sulfonamide (FOSA) and PFOS are sufficiently mobile to leach into surface waters. In support of these predictions, up to 3400 pg L(-1) of FOSA and up to 1100 pg L(-1) of PFOS were measured in Brazilian surface water, while EtFOSA was not detected. The high FOSA/PFOS ratio observed here (up to 14:1) is unprecedented in the scientific literature to our knowledge. Depending on the extent of conversion of EtFOSA, cumulative Brazilian Sulfluramid production and import from 2004 to 2015 may contribute between 167 and 487 tonnes of PFOS/FOSA to the environment. These levels are clearly nontrivial and of concern since production is continuing unabated.

  20. [Characteristics of pediatric patients with biliary lithiasis. Immediate post-operative evolution].

    PubMed

    Espinosa-Saavedra, David; Flores-Calderón, Judith; González-Ortiz, Beatriz; Rodríguez-González, Perla

    2014-01-01

    INTRODUCCIÓN: la litiasis biliar es una enfermedad poco diagnosticada en los niños; en México, la prevalencia es inferior a 1 %. Dada la escasez de investigaciones que aborden la epidemiologia y resultados de la cirugía en los pacientes pediátricos, nuestro objetivo fue conocer la epidemiologia y evolución posoperatoria de los pacientes pediátricos con litiasis biliar. MÉTODOS: se llevó a cabo un estudio descriptivo trasversal. Se incluyeron todos los pacientes pediátricos con diagnóstico de litiasis biliar atendidos durante un periodo de seis años, cuyos datos estuvieran completos en los expedientes clínicos.

  1. Peritalar destabilisation syndrome (adult flatfoot with degenerative glenopathy).

    PubMed

    Pisani, Giacomo

    2010-12-01

    In cases of adult acquired flatfoot associated with peritalar destabilisation, special reference is made to the plantar calcaneo-navicular (spring) ligament's degenerative disease (degenerative glenopathy) and to the presence of the accessory navicular bone as a possible pathogenic cause. Peritalar destabilization syndrome is proposed for the articular (subtalar and talo-navicular joints) or tendinosis (tibialis posterior tendon) separately or in association with degenerative glenopathy of the coxa pedis. In degenerative glenopathy surgical reconstruction of the glenoid also makes use of a posterior tibial split to create a new tibial-navicular ligament. The concept of pronatory syndrome deemed as the root the pathological subtalar pronation, which is an entirely secondary factor in peritalar destabilisation, must be questioned. We must keep in mind that subtalar pronation and supination are respectively subsequent to opening and closing of the coxa pedis (talo-calcaneo-navicular joint) kinetic chain.

  2. Temporal Shifts in Poly- and Perfluoroalkyl Substances (PFASs) in North Atlantic Pilot Whales Indicate Large Contribution of Atmospheric Precursors.

    PubMed

    Dassuncao, Clifton; Hu, Xindi C; Zhang, Xianming; Bossi, Rossana; Dam, Maria; Mikkelsen, Bjarni; Sunderland, Elsie M

    2017-03-28

    Poly- and perfluoroalkyl substances (PFASs) are persistent, bioaccumulative anthropogenic compounds associated with adverse health impacts on humans and wildlife. PFAS production changed in North America and Europe around the year 2000, but impacts on wildlife appear to vary across species and location. Unlike other mammal species, cetaceans lack the enzyme for transforming an important intermediate precursor (perfluorooctane sulfonamide: FOSA), into a prevalent compound in most wildlife (perfluorooctanesulfonate: PFOS). Thus, their tissue burden differentiates these two compounds while other mammals contain PFOS from both direct exposure and precursor degradation. Here we report temporal trends in 15 PFASs measured in muscle from juvenile male North Atlantic pilot whales (Globicephala melas) harvested between 1986 and 2013. FOSA accounted for a peak of 84% of the 15 PFASs around 2000 but declined to 34% in recent years. PFOS and long-chained PFCAs (C9-C13) increased significantly over the whole period (2.8% yr(-1) to 8.3% yr(-1)), but FOSA declined by 13% yr(-1) after 2006. Results from FOSA partitioning and bioaccumulation modeling forced by changes in atmospheric inputs reasonably capture magnitudes and temporal patterns in FOSA concentrations measured in pilot whales. Rapid changes in atmospheric FOSA in polar and subpolar regions around 2000 helps to explain large declines in PFOS exposure for species that metabolize FOSA, including seafood consuming human populations. This work reinforces the importance of accounting for biological exposures to PFAS precursors.

  3. Characterization of Extended-Spectrum β-Lactamase Genes of Shigella flexneri Isolates With Fosfomycin Resistance From Patients in China.

    PubMed

    Liu, Yanyan; Cheng, Yue; Yang, Haifei; Hu, Lifen; Cheng, Jun; Ye, Ying; Li, Jiabin

    2017-09-01

    The emergence of fosfomycin resistance and extended-spectrum β-lactamase (ESBL) genes is a serious threat to public health and a new challenge in shigellosis treatment. The purpose of this study was to identify fosfomycin resistance and characterize β-lactamase genes in fos-carrying isolates of Shigella flexneri from patients in China. A total of 263 S. flexneri isolates were collected from 34 hospitals in the Anhui Province of China during September 2012-September 2015 and screened for fosA3, fosA, and fosC2 by PCR amplification and sequencing. The fos-carrying isolates were then screened for β-lactamase genes. The clonal relationships between fosA3-carrying isolates, the transmissibility of fosfomycin resistance, replicon types of plasmids carrying fosfomycin resistance genes and other associated resistance genes were investigated. Twenty-five of the 263 isolates (9.5%) showed resistance to fosfomycin, and 18 (6.8%) were positive for fosA3. None of the isolates was positive for fosA or fosC2. Seventeen of the isolates carrying fosA3 (94%) were CTX-M producers (seven CTX-M-55, five CTX-M-14, and five CTX-M-123), while three (16.7%) were TEM producers (TEM-1).Sixteen (88.9%) fosA3-carrying isolates exhibited multi-drug resistance. The replicon types of the 13 fosA3-carrying plasmids were IncF (n=13), IncHI2 (n=3), IncIl-Ir (n=2), and IncN (n=1). Our results indicated that fosA3 could spread through plasmids in S. flexneri isolates, along with the bla(CTX-M) and bla(TEM), which facilitate its quick dispersal. To the best of our knowledge, this is the first report of CTX-M-123-type ESBLs in S. flexneri isolates from patients in China.

  4. Magnetic resonance imaging in adolescent painful flexible flatfoot.

    PubMed

    Wong, Margaret W N; Griffith, James F

    2009-04-01

    The cause of navicular tuberosity pain in adolescents with flexible flatfeet is not well understood. We hypothesized that some of the navicular tuberosity pain may be related to insertional enthesopathy of the posterior tibial tendon at the navicular. Magnetic resonance imaging was performed to look for abnormal signal changes in a series of patients. Consecutive adolescent patients presenting with flexible flatfeet and navicular tuberosity pain were prospectively recruited. A detailed foot examination and body fat analysis was performed. Standing radiographs and Tekscan pedobarograph of both feet were obtained. Magnetic resonance examinations were performed on a 1.5-T whole-body magnetic resonance imaging system utilizing a standard extremity coil. MRI abnormality was detected in 15 of the 36 feet in 18 adolescents examined. Abnormalities detected included thickening of the posterior tibial tendon insertion, marrow edema in the accessory navicular, marrow edema in the navicular tuberosity, and contrast enhancement at the posterior tibial tendon insertion site. Patients with MRI abnormalities were significantly taller, had a lower body mass index and a lower body fat percentage than those without MRI abnormality. Forward stepwise logistic regression analysis identified low body fat percentage and presence of an accessory navicular as independent predictors for abnormality on MRI. MRI abnormality was frequently detected in adolescents with painful flexible flatfeet. The MRI signal changes indicated an enthesopathy like process occurring at the posterior tibial tendon insertion to the navicular which could explain the origin of pain in flexible flatfeet patients without an accessory navicular. Early identification and appropriate treatment to prevent progression may be helpful.

  5. Analysis of Perfluorinated Chemicals and Their Fluorinated Precursors in Sludge: Method Development and Initial Results

    EPA Science Inventory

    A rigorous method was developed to maximize the extraction efficacy for perfluorocarboxylic acids (PFCAs), perfluorosulfonates (PFSAs), fluorotelomer alcohols (FTOHs), fluorotelomer acrylates (FTAc), perfluorosulfonamides (FOSAs), and perfluorosulfonamidoethanols (FOSEs) from was...

  6. Analysis of Perfluorinated Chemicals and Their Fluorinated Precursors in Sludge: Method Development and Initial Results

    EPA Science Inventory

    A rigorous method was developed to maximize the extraction efficacy for perfluorocarboxylic acids (PFCAs), perfluorosulfonates (PFSAs), fluorotelomer alcohols (FTOHs), fluorotelomer acrylates (FTAc), perfluorosulfonamides (FOSAs), and perfluorosulfonamidoethanols (FOSEs) from was...

  7. Symptomatic os infranaviculare.

    PubMed

    Kim, Jae Kwang; Roh, Kwon Jae

    2013-06-01

    The author observed a new accessory bone of the foot in the distal portion of navicular, which articulated with the medial cuneiform and the intermediate cuneiform, and named it os infranaviculare. A degenerative change was observed between the accessory bone and the navicular; this caused midfoot pain to the patient during weight-bearing. Thus, the patient was treated by excision of the accessory bone. The symptom was relieved at one-year postoperative.

  8. Symptomatic Os Infranaviculare

    PubMed Central

    Roh, Kwon Jae

    2013-01-01

    The author observed a new accessory bone of the foot in the distal portion of navicular, which articulated with the medial cuneiform and the intermediate cuneiform, and named it os infranaviculare. A degenerative change was observed between the accessory bone and the navicular; this caused midfoot pain to the patient during weight-bearing. Thus, the patient was treated by excision of the accessory bone. The symptom was relieved at one-year postoperative. PMID:23730481

  9. The detection of fosfomycin resistance genes in Enterobacteriaceae from pets and their owners.

    PubMed

    Yao, Hong; Wu, Dongfang; Lei, Lei; Shen, Zhangqi; Wang, Yang; Liao, Kang

    2016-09-25

    The aim of this study was to investigate the prevalence of fosfomycin resistance and molecular characteristic of fosfomycin-resistant strains isolated from companion animals and their owners. A total of 171 samples collected from pets and pet owners in a Chinese veterinary teaching hospital were screened for the presence of phenotype and genotype of fosfomycin-resistance by selective media containing fosfomycin and PCR & sequencing. Among 171 samples tested, nineteen isolates were resistant to fosfomycin. Sixteen and three of these fosfomycin-resistant isolates were positive for fosA3 and fosA genes, respectively. The fosA3 gene was detected both in chromosomes and plasmids in bacteria. All of the fosA3 gene-positive isolates except one were CTX-M producers and nearly half (7/16) of them also harbored the rmtB gene. The fosA3 gene-carrying plasmids, which were readily transferrable to recipient E. coli J53 by conjugation, conferred resistance to multiple antimicrobial agents. Genetic structures were IS26-385bp-fosA3-1810bp-IS26 (n=11) and IS26-385bp-fosA3-588bp-IS26 (n=5). Molecular typing indicated that two fosA3-positive isolates from dogs were genetically identical to the isolates from the pet owners. Our results indicated that active transmission of fosA3-mediated fosfomycin resistance has occurred among Enterobacteriaceae isolated from pets and their owners by both horizontal transfer and clonal expansion. Copyright © 2016. Published by Elsevier B.V.

  10. Microstructure of Hydrophobically Modified Alkyl Acrylamide Polymers

    NASA Astrophysics Data System (ADS)

    Tian, Jun; Seery, T. A. P.; Weiss, R. A.

    2002-03-01

    Hydrophobically modified water soluble polymers of poly(N,N-dimethylacrylamide-co-2-(N-ethylfluorooctanesulfonamido)ethyl acrylate) (polyDMA/FOSA) with different compositions were prepared by solution free radical polymerization. The molecular weights ranged from Mw/Mn=53000/23000 to 95000/40000. The intrinsic viscosity decreased with the increasing FOSA content. The glass transition temperature of the copolymer decreased with FOSA content, and exhibited positive deviation from that predicted by the Fox equation. Small angle X-ray scattering (SAXS) curves exhibited a peak that indicated the copolymer had a microphase separated structure, presumably due to hydrophobic association of FOSA groups. The SAXS peak position shifted to higher q value with the increasing FOSA content in the dry polymers, while for the water swollen gel, it shifted to lower q value with the increasing water uptake in the gels. These results suggested that the origin of the peak was related to the spacing between hydrophobic microdomains. The failure of time-temperature superposition of the dynamic shear moduli supported the conclusion of a microphase separated structure in the copolymer.

  11. Antimicrobial susceptibility and mechanisms of fosfomycin resistance in extended-spectrum β-lactamase-producing Escherichia coli strains from urinary tract infections in Wenzhou, China.

    PubMed

    Bi, Wenzi; Li, Bin; Song, Jiangning; Hong, Youliang; Zhang, Xiaoxiao; Liu, Haiyang; Lu, Hong; Zhou, Tieli; Cao, Jianming

    2017-07-01

    Fosfomycin in combination with various antibiotics represents an excellent clinically efficacious regimen for the treatment of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Underlying mechanisms of fosfomycin resistance remain largely uncharacterised. To investigate the antibacterial efficacy of fosfomycin against ESBL-producing E. coli, 356 non-repetitive ESBL-producing E. coli clinical isolates were collected from urine specimens from patients with UTI in Wenzhou, China, from January 2011 to December 2015. Antimicrobial sensitivity testing indicated that 6.7% (24/356) of the ESBL-producing E. coli strains were resistant to fosfomycin. The fosA3 gene encoding a fosfomycin-modifying enzyme was detected in 20 isolates by PCR and sequencing, alone or in combination with other ESBL determinants. Conjugation experiments and Southern blotting demonstrated that 70% (14/20) of the fosA3-positive isolates possessed transferable plasmids (ca. 54.2 kb) co-harbouring the ESBL resistance gene blaCTX-M and the fosfomycin resistance gene fosA3. Among the four fosfomycin-resistant fosA3-negative E. coli isolates, three contained amino acid substitutions (Ile28Asn and Phe30Leu in MurA and Leu297Phe in GlpT). The results indicate that presence of the fosA3 gene is the primary mechanism of fosfomycin resistance in ESBL-producing E. coli isolates in Wenzhou, China. In addition, a plasmid (ca. 54.2 kb) co-harbouring fosA3 and blaCTX-M genes is horizontally transferable. Furthermore, a low degree of homology in the fosfomycin-resistant E. coli was confirmed using multilocus sequence typing (MLST), suggesting that there is no obvious phenomenon of clonal dissemination. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  12. Repeatability of sonographic measurements in clubfeet.

    PubMed

    Aurell, Y; Adlercreutz, C; Andriesse, H; Jonsson, K

    2004-10-01

    To assess the intra- and interobserver agreement of ultrasound assessment of clubfoot patho-anatomy in early childhood. Seventeen clubfeet in 12 children were sequentially scanned by 2 examiners and repeat assessments were carried out independently. Three well-defined imaging planes were chosen to evaluate navicular displacement: the medial malleolus-navicular (MM-N) distance, soft tissue thickness, talar deformity and the calcaneo-cuboid (C-C) distance. Intra- and interobserver agreement was analysed using Cohen's kappa for the discrete variables and by Bland-Altman's graphic technique for measurements. Kappa values for intra-observer agreement were 0.82 for navicular displacement, 0.93 for "talar head pointing laterally", and 0.70 for medial deviation of the talar neck. The corresponding interobserver kappa values were 0.70, 0.68, and 0.36. The mean difference between the two observers for the MM-N distance was 0.42 +/- 3.0 mm and for the soft tissue thickness 0.35 +/- 2.0 mm; the C-C distance showed a mean interobserver distance of 0.0 +/- 2.8 mm. The imaging planes used to study the talo-navicular and calcaneo-cuboid relationships are reproducible and relatively easy to learn. Intra- and interobserver assessments were acceptable for MM-N distance, soft tissue thickness, navicular displacement and "talar head pointing laterally", but questionable for the C-C distance and medial deviation of the talar neck.

  13. Focused dynamic sonographic examination of the congenital clubfoot.

    PubMed

    Shiels, William E; Coley, Brian D; Kean, John; Adler, Brent H

    2007-11-01

    US readily demonstrates cartilaginous structures, and static sonography has shown potential in evaluating clubfoot deformity. To investigate the potential of dynamic sonography in the evaluation of the congenital clubfoot. Sonography was used for static and dynamic stress evaluation of 13 clubfeet and 35 normal feet in 24 patients (ages 0-32 weeks). Dynamic foot sonography was performed using a single-operator bimanual scanning technique. The examination involved coronal oblique evaluation of the medial malleolar-navicular (MMN) distance and the calcaneocuboid relationship, sagittal evaluation of the talonavicular relationship, and transverse evaluation of navicular subluxation, rotation, and deformation. Dynamic abduction/adduction stress maneuvers were performed, measured by the MMN. The clubfoot "gristle" is a consistent, measurable soft-tissue landmark in clubfeet, connecting the medial malleolus to the medial navicular and talus. Mean MMN distances in clubfeet in the neutral position and abduction were significantly different from these distances in the normal paired foot (differences of 8.7 mm neutral position and 7.94 mm abduction), as compared to bilateral normal feet (differences of 0.98 mm neutral position and 1.43 mm abduction). Navicular subluxation showed good correlation between highly deformed and subluxated navicular bones and a tight medial clubfoot complex. Focused dynamic foot sonography is useful in providing a specific and detailed functional preoperative and/or postoperative assessment of the congenital clubfoot.

  14. Emergence of Colistin Resistance Gene mcr-1 in Cronobacter sakazakii Producing NDM-9 and in Escherichia coli from the Same Animal

    PubMed Central

    Song, Feng-Jing; Zou, Ming; Hao, Zhi-Hui

    2016-01-01

    ABSTRACT We report the presence of mcr-1 in Escherichia coli and carbapenem-resistant Cronobacter sakazakii from the same diseased chicken. The mcr-1 gene linked with ISApl1 was located on two different IncI2 plasmids, including one multidrug plasmid in E. coli, whereas fosA3-blaNDM-9 was on an IncB/O plasmid in C. sakazakii. The development of the fosA3-blaNDM-9 resistance region was mediated by IS26. The colocation of mcr-1 or blaNDM-9 with other resistance genes will accelerate the dissemination of the two genes. PMID:27855074

  15. Bilateral Foot Pain in a Collegiate Distance Runner

    PubMed Central

    Denegar, Craig R.; Siple, Bonnie J.

    1996-01-01

    A 19-year-old, white female, college freshman cross-country runner presented to the athletic training center complaining of bilateral plantar foot pain 1 week into the cross-country season. She had been treated for bilateral plantar fasciitis twice in the previous 3 years, and initial evaluation suggested a recurrence. A failure to respond to treatment led us to suspect other causes. Subsequent diagnostic imaging (bone scan, CT scan) revealed bilateral navicular stress fractures. Navicular stress fractures are probably more common than once believed. This case study describes the course of evaluation and treatment in relation to the common presentation, etiology, problems of diagnosis, and treatment of navicular stress fractures. ImagesFig 1.Fig 2.Fig 3.Fig 4. PMID:16558375

  16. Medial foot pain in a runner: a case presentation.

    PubMed

    Miller, Levi K; Harrast, Mark A

    2013-09-01

    A 27-year-old runner presented to our sports medicine clinic with 4 months of medial foot pain after an eversion ankle sprain. Initial radiographs were negative for fracture. Her symptoms improved but plateaued after 1 month. She was unable to continue running and noticed a new prominence at her right medial foot. Results of a physical examination showed pes planus, a prominent navicular in her right foot and mild weakness of inversion at the right ankle. Magnetic resonance imaging showed bone edema adjacent to a navicular synchondrosis, which confirmed a diagnosis of type 2 accessory navicular with synchondrosis injury. The patient was treated conservatively with a progressive rehabilitation course. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  17. Correlation of radiographic measurements of structures of the equine foot with lesions detected on magnetic resonance imaging.

    PubMed

    de Zani, D; Polidori, C; di Giancamillo, M; Zani, D D

    2016-03-01

    There are few studies on the correlations between radiographic measurements of the foot and abnormalities of specific structures found with magnetic resonance imaging (MRI). To document the relationship between radiographic measurements of the equine foot and the presence of lesions in the foot on MRI. We hypothesised that different radiographic measurements would be associated with specific lesions detected by MRI. Retrospective analysis of radiographs and MRI studies. Seventy-four feet from 52 lame horses were included. Twenty parameters were measured on radiographs, whereas the signal intensity, homogeneity and size of each structure in the foot were evaluated on magnetic resonance images. The data were analysed using simple linear correlation analysis and classification and regression trees (CARTs). Linear correlations were found between the navicular bone compacta thickness and injuries of the deep digital flexor tendon, collateral sesamoidean ligament, navicular spongiosa and navicular bone proximal border. Long-toed horses had a high incidence of lesions involving the spongiosa and proximal border of the navicular bone. Elongation of the navicular bone was associated with proximal and distal border injuries. A reduced palmar angle and increased angle between the middle and distal phalanx were observed in horses with alterations of collateral ligaments of the distal interphalangeal joint and navicular bone spongiosa, respectively. For each structure under investigation, CARTs predicting the presence of MRI pathology based on radiographic measurements had excellent performance, with >80% correct classification of cases, when using one of 3 data sources. This study demonstrated a relationship between radiographic measurements of the foot and the presence of lesions detected on MRI, while CARTs illustrated that different radiographic measurements were associated with different MRI lesions. © 2015 EVJ Ltd.

  18. Microstructure of Hydrophobically Modified Alkyl Acrylamide Hydrogels

    NASA Astrophysics Data System (ADS)

    Tian, Jun; Seery, Thomas A. P.; Ho, Derek L.; Weiss, R. A.

    2004-03-01

    Hydrophobically modified water-soluble acrylamide polymers have a variety of applications, including viscosity thickeners, microencapsulation, biosensors and controlled drug delivery systems. The microstructure of copolymer hydrogels of N,N-dimethylacrylamide (DMA) or N-isopropylacrylamide(NIPA) modified with 2-(N-ethylfluorooctanesulfonamido)ethyl acrylate, FOSA, was studied by small angle x-ray (SAXS) and neutron scattering (SANS). Swelling and DSC measurements showed that FOSA/NIPA gels exhibited a volume phase transition (VPT), but that FOSA/DMA gels did not. A modified interacting core-shell model was used to explain the SAXS and SANS data for both gels. The crosslink junctions of the gel consisted of nanophase-separated FOSA domains as the core surrounded by a water-poor layer of the alkyl acrylamide. These nanodomains were dispersed in a matrix of water-swollen alkyl acrylamide that had large scale heterogeneities. The average spherical core radius ranged from 1 to 3 nm and the average shell thickness ranged from 1 to 1.5 nm; the aggregation number ranged from 10 to 200.

  19. Neutral polyfluorinated compounds in indoor air in Germany--the LUPE 4 study.

    PubMed

    Fromme, Hermann; Dreyer, Annekatrin; Dietrich, Silvio; Fembacher, Ludwig; Lahrz, Thomas; Völkel, Wolfgang

    2015-11-01

    Perfluoroalkyl- and polyfluoroalkyl-substances (PFAS) have been detected in many types of environmental media and biota including humans. We determined volatile PFAS, including fluorotelomer alcohols (FTOHs), fluorotelomer acrylates (FTACs), perfluorooctane sulfonamides (FOSAs), and perfluorooctane sulfonamidoethanols (FOSEs), in indoor air of residences and schools in Germany. FTOHs, FTACs, FOSEs, and FOSAs were quantified with median levels in schools (in residences) of 11,783pg/m(3) (13,198pg/m(3)), 737pg/m(3) (450pg/m(3)), 130pg/m(3) (278pg/m(3)), and 243pg/m(3) (110pg/m(3)), respectively. Using our data and previously published results in a simplified model based on the medians and 95th percentiles, the "typical" and "high" daily non-dietary exposures were calculated to be 4.2ng/kg body weight (9.9ng/kgb.w.) for Σ-FTOHs and 0.1ng/kgb.w. (0.8ng/kgb.w.) for Σ-FOSEs/FOSAs in children. Inhalation was the dominant intake pathway for FTOHs; however, dust ingestion contributed significantly to the total intake of FOSEs/FOSAs. In organisms, 8:2 FTOH is degraded to perfluorooctanoate (PFOA). Assuming that 1% of 8:2 FTOH is converted to PFOA, 8:2 FTOH exposure in Germany has a negligible contribution to the total daily PFOA exposure, which is mainly driven by dietary intake.

  20. 78 FR 27372 - Combined Notice of Filings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... 2013 Filing to be effective 8/ 1/2013. Filed Date: 5/1/13. Accession Number: 20130501-5062. Comments Due: 5 p.m. ET 5/13/13. Docket Numbers: RP13-863-000. Applicants: Big Sandy Pipeline, LLC. Description: FOSA Modifications May 2013 Filing to be effective 8/ 1/2013. Filed Date: 5/1/13. Accession...

  1. 78 FR 49493 - Combined Notice of Filings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-14

    ... following Natural Gas Pipeline Rate and Refund Report filings: Filings Instituting Proceedings Docket Numbers: RP13-1119-000. Applicants: East Tennessee Natural Gas, LLC. Description: FOSA Clean-up to be...: Central New York Oil And Gas, L.L.C. Description: Central New York Oil And Gas Company LLC--Order No. 776...

  2. Postural adjustments in young ballet dancers compared to age matched controls.

    PubMed

    Iunes, Denise H; Elias, Iara F; Carvalho, Leonardo C; Dionísio, Valdeci C

    2016-01-01

    The purpose of the study was to use photogrammetry to evaluate the posture of ballet practitioners compared to an age-matched control group. One hundred and eleven 7- to 24-year-old female volunteers were evaluated and were divided into two groups: the ballet practising group (n = 52) and the control group (n = 59), divided into three subgroups according to age and years of ballet experience. Dancers with 1-3 years experience compared to controls of the same age shows alterations in External Rotation Angle (P < 0.05). Dancers 4-9 years experience show alterations in Lumbar Lordosis, Pelvis Tilt Angle and Navicular Angle Right and Left (P < 0.05). Dancers with over 9 years experience show alterations in External Rotation and Navicular Angle Left (P < 0.05). Research shows there are differences between dancers and controls. In the groups 1-3 years and over 9 years of experience, the External Rotation Angle is greater. In the group 4-9 years of experience the Lumbar Lordosis Angle is greater and Pelvis Tilt, Navicular Angle Left and Right are smaller. In more than 9 years of ballet experience, the Navicular Angle Left is smaller. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Technical innovation changes standard radiographic protocols in veterinary medicine: is it necessary to obtain two dorsoproximal-palmarodistal oblique views of the equine foot when using computerised radiography systems?

    PubMed

    Whitlock, J; Dixon, J; Sherlock, C; Tucker, R; Bolt, D M; Weller, R

    2016-05-21

    Since the 1950s, veterinary practitioners have included two separate dorsoproximal-palmarodistal oblique (DPr-PaDiO) radiographs as part of a standard series of the equine foot. One image is obtained to visualise the distal phalanx and the other to visualise the navicular bone. However, rapid development of computed radiography and digital radiography and their post-processing capabilities could mean that this practice is no longer required. The aim of this study was to determine differences in perceived image quality between DPr-PaDiO radiographs that were acquired with a computerised radiography system with exposures, centring and collimation recommended for the navicular bone versus images acquired for the distal phalanx but were subsequently manipulated post-acquisition to highlight the navicular bone. Thirty images were presented to four clinicians for quality assessment and graded using a 1-3 scale (1=textbook quality, 2=diagnostic quality, 3=non-diagnostic image). No significant difference in diagnostic quality was found between the original navicular bone images and the manipulated distal phalanx images. This finding suggests that a single DPr-PaDiO image of the distal phalanx is sufficient for an equine foot radiographic series, with appropriate post-processing and manipulation. This change in protocol will result in reduced radiographic study time and decreased patient/personnel radiation exposure. British Veterinary Association.

  4. Isoxsuprine hydrochloride in the horse: a review.

    PubMed

    Erkert, R S; Macallister, C G

    2002-04-01

    Isoxsuprine hydrochloride has been suggested for use in horses for treatment of navicular syndrome and laminitis. The drug has been shown to be a beta-adrenoreceptor antagonist with beta-adrenoreceptor agonistic properties, with both characteristics contributing to vasodilation and uterine relaxation. In addition, the drug is capable of decreasing blood viscosity and platelet aggregation. Studies have shown i.v. isoxsuprine to have a plasma half-life of <3 h with a large apparent volume of distribution. Cardiovascular effects resolve rapidly following i.v. administration, but are absent with oral dosing. Oral bioavailability is 2.2% with a high first pass effect. Isoxsuprine has an apparent affinity for melanin that may contribute to extended renal excretion. Clinical trials appear to support the use of isoxsuprine for treatment of navicular disease. However, poor bioavailability, lack of cardiovascular effects following oral administration, superficial support in clinical trials, and new evidence regarding the pathogenesis of navicular syndrome indicate that the use of isoxsuprine for treatment of navicular syndrome or laminitis is questionable at best.

  5. Traumatic foot injuries in horses: surgical management.

    PubMed

    Burba, Daniel J

    2013-01-01

    Managing traumatic foot wounds in horses may require surgical intervention. These wounds include coronary-band and heel-bulb lacerations, septic pedal osteitis, septic navicular bursitis, sepsis of the collateral cartilages, and hoof-wall injuries. This article provides a practical overview of the surgical management of these types of wounds.

  6. A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome. The Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) Cohort

    DTIC Science & Technology

    2009-09-24

    angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased...quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of...age, sex, history of participation in athletic activity, mental health, knee and lower limb injury history, and recent exercise and weight training

  7. 21 CFR 522.2473 - Tiludronate.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ....600(c) of this chapter. (c) Conditions of use in horses—(1) Amount. Administer a single dose of 1 mg... control of clinical signs associated with navicular syndrome. (3) Limitations. Do not use in horses intended for human consumption. Federal law restricts this drug to use by or on the order of a licensed...

  8. Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities.

    PubMed

    Aurell, Y; Johansson, A; Hansson, G; Wallander, H; Jonsson, K

    2002-09-01

    The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and inter-observer reliability was assessed and found to be acceptable ( r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.

  9. Chopart fractures.

    PubMed

    Klaue, Kaj

    2004-09-01

    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  10. Treatment of Chopart Fracture-Dislocations.

    PubMed

    Klaue, Kaj

    2010-06-01

    The Chopart articular space was used by François Chopart (1743-1795) as a practical space for amputation in cases of distal foot tumor. It corresponds to the center of the foot and allows for essential articulation by means of the talo-calcaneo-navicular joint (coxa pedis). Chopart fracture-dislocations may therefore include fractures of the navicular, the cuboid, the talus, and calcaneus. The treatment priorities should therefore include addressing all of the injured soft tissues by immediate joint reduction or restoring bony alignment, including the avoidance of threatening compartment syndromes. Subsequent anatomical bone and joint reconstruction, if possible, should first address the talar head and the navicular. The anterior process of the calcaneus and the cuboid should be aligned to preserve foot alignment in the sagittal and horizontal planes. In severe joint destructions, isolated fusion of the calcaneo-cuboidal joint may help preserve functional mobility of the foot. Isolated or associated talo-navicular fusion considerably limits functional mobility of the foot.

  11. Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

    ERIC Educational Resources Information Center

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

    Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

  12. Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

    ERIC Educational Resources Information Center

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

    Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

  13. Destructive wrist arthropathy of pseudogout

    SciTech Connect

    Smathers, R.L.; Keats, T.E.; Stelling, C.B.

    1982-01-01

    The wrist is a frequent site of arthropathy in the pseudogout syndrome (calcium pyrophosphate dihydrate crystal deposition disease). Three cases of severe wrist arthropathy are presented to emphasize the destructive changes which may occur, including necrosis or collapse of the lunate and navicular bones. The roentgenographic findings characteristic of pseudogout in the wrist are discussed.

  14. Bone density comparison of selected carpal and tarsal bones: validation for their use in compression fracture fixation studies of scaphoid screws.

    PubMed

    Brutus, J P; Rajkumar, J S; Rust, E; Harley, B J; Palmer, A K; Werner, F W

    2006-06-01

    To determine if trabecular, total and cortical bone densities of the capitate, navicular, cuboid, and first cuneiform were equivalent to those of the scaphoid, such that these bones could be used in place of the scaphoid in evaluating new headless scaphoid compression screws. Fifty scaphoids, capitates, naviculars, cuboids, and first cuneiforms were harvested from fresh frozen cadavers. The trabecular, total and cortical bone densities were measured using pQCT technology and statistically compared. A paired t comparison between paired scaphoids and capitates showed no difference between the trabecular bone densities. However, their total bone and cortical densities were found to be different. An independent measures ANOVA comparison of the five bones, showed no significant difference in mean trabecular density between the capitates, naviculars and first cuneiforms when compared to the scaphoids. However, the mean total and cortical densities of the first cuneiforms were less than the scaphoids and the mean trabecular, total and cortical bone densities of the cuboids were all less than the scaphoids. Compression fracture fixation studies of headless compression screws could be conducted using the capitate, navicular, and first cuneiform as models of the scaphoid when the supply of scaphoids is limited.

  15. Correction of neglected vertical talus deformity in an adult.

    PubMed

    Lui, Tun Hing

    2015-02-18

    Congenital vertical talus is an uncommon foot deformity that is characterised by a fixed dorsal dislocation of the navicular on the talar head and neck. Left untreated, a congenital vertical talus causes significant long-term disability. We present a case of neglected vertical talus in a middle-aged woman who was successfully treated with resection of the talar head and tendon transfers.

  16. [Clinical course and prognosis of patients with urolithiasis in a pediatric hospital].

    PubMed

    Ubillo-Sánchez, José Manuel; Bonilla-Rojas, Jesús; Peña, Luis Alberto; Zurita-Cruz, Jessie Nallely; Cárdenas-Navarrete, Rocío; Serret-Montoya, Juana; Villasís-Keever, Miguel Angel

    2014-01-01

    INTRODUCCIÓN: la litiasis renal se considera poco frecuente en pediatría. La información disponible no es suficiente para determinar con certeza su pronóstico. El objetivo de esta investigación fue describir los signos, síntomas, complicaciones y recurrencia que presentaron los pacientes pediátricos con urolitiasis. MÉTODOS: se identificaron los expedientes de pacientes pediátricos con urolitiasis atendidos en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, en el periodo de 2003 a 2009.

  17. [Stress reactions and stress fractures in the high performance athlete. Causes, diagnosis and therapy].

    PubMed

    Geyer, M; Sander-Beuermann, A; Wegner, U; Wirth, C J

    1993-02-01

    From 1987 until July 1991 70 athletes with stress reactions or stress fractures were treated in the orthopaedic department of the Hannover Medical School. The average age of the 42 male and 28 female athletes was 22.6 years. The number of athletes involved in track and field sports was 29 (41.4%), in gymnastics 9 (12.9%) and in soccer 5 (7.1%). The most common bone injured was the tibia in 29 (41.4%), followed by the tarsal navicular in 21 (30.0%), the midfoot in 17 (24.3%) and the fibula in 4 (5.7%) athletes. In three cases double stress fractures were found in adjacent locations; in one case a stress fracture of the opposite navicular occurred after the initial tarsal navicular stress fracture had healed, and in another case the tarsal navicular was found to be fractured again. Thirty-seven percent of the athletes claimed sudden increase in training intensity was the cause; 33% felt that the increased sprinting and jump activities were the reason for their complaints. In some athletes pain started after an ankle sprain. Standard diagnostic procedure consisted in X-rays in two planes and three-phase bone scanning. In tarsal navicular or tibial locations additional tomograms were performed. MRI and CT scans were reserved for unclear findings and to exclude the possibility of a tumorous or inflammatory process. A new grading system was introduced that covers all forms of stress reactions from periostitis to pseudarthrosis. Clinical symptoms, sport disabilities, radiological and bone scan findings were graded from A to D. Using a modified Wilson classification, all radiologically recognizable stress reactions could be classified.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. The role of ultrasound in clubfoot treatment: correlation with the Pirani score and assessment of the Ponseti method.

    PubMed

    El-Adwar, Khaled Loutfy; Taha Kotb, Hesham

    2010-09-01

    To evaluate neonates and infants with clubfoot, clinical and imaging modalities are required. Conventional radiography is of limited value because the studied bones are not fully ossified. We attempted to (1) evaluate clinically and sonographically the reliability of the Ponseti method in correcting clubfeet; and (2) determine whether various ultrasound (US) variables correlated with each other and with the Pirani score before and after treatment. We prospectively followed 17 infants (25 clubfeet) assessed using the Pirani score and US variables (medial malleolus navicular distance, navicular alignment in relation to the talar head, medial soft tissue thickness, talar length, and calcaneocuboid distance) and treated with the Ponseti method. The mean age of the patients at first casting was 30 days, and repeat assessment after treatment was performed at a mean age of 6.3 months. Patients were followed for a minimum of 0.75 months (mean, 14.1 months; range, 0.75-38 months). The Ponseti method corrected all feet. We found three clinical/US correlations. Before treatment, we observed a negative correlation between the clinical midfoot score and the sonographic medial malleolus navicular distance. After treatment we observed two negative correlations: one between the midfoot score and the sonographic talar length and the other between the hindfoot score and medial malleolus navicular distance. Four feet had recurrence of varus, two of which had an increased calcaneocuboid distance despite full restoration of navicular alignment in one foot. US can play a role in clubfoot assessment and may alert the surgeon to feet that may be prone to recurrence. Level II, prospective study. See Guidelines for Authors for a complete description of levels of evidence.

  19. Practical agar-based disk potentiation test for detection of fosfomycin-nonsusceptible Escherichia coli clinical isolates producing glutathione S-transferases.

    PubMed

    Nakamura, Genki; Wachino, Jun-Ichi; Sato, Natsumi; Kimura, Kouji; Yamada, Keiko; Jin, Wanchun; Shibayama, Keigo; Yagi, Tetsuya; Kawamura, Kumiko; Arakawa, Yoshichika

    2014-09-01

    The number of reports concerning Escherichia coli clinical isolates that produce glutathione S-transferases responsible for fosfomycin resistance (FR-GSTs) has been increasing. We have developed a disk-based potentiation test in which FR-GST producers expand the growth inhibition zone around a Kirby-Bauer disk containing fosfomycin in combination with sodium phosphonoformate (PPF). PPF, an analog of fosfomycin, is a transition-state inhibitor of FosA(PA), a type of FR-GST from Pseudomonas aeruginosa. Considering its mechanism of action, PPF was expected to inhibit a variety of FR-GSTs. In the presence of PPF, zone enlargement around the disk containing fosfomycin was observed for FosA3-, FosA4-, and FosC2-producing E. coli clinical isolates. Moreover, the growth inhibition zone was remarkably enlarged when the Mueller-Hinton (MH) agar plate contained 25 μg/ml glucose-6-phosphate (G6P). When we retrospectively tested 12 fosfomycin-resistant (MIC, ≥256 μg/ml) E. coli clinical isolates from our hospital with the potentiation test, 6 FR-GST producers were positive phenotypically by potentiation disk and were positive for FR-GST genes: 5 harbored fosA3 and 1 harbored fosA4. To identify the production of FR-GSTs, we set the provisional cutoff value, 5-mm enlargement, by adding PPF to a fosfomycin disk on the MH agar plates containing G6P. Our disk-based potentiation test reliably identifies FR-GST producers and can be performed easily; therefore, it will be advantageous in epidemiological surveys and infection control of fosfomycin-resistant bacteria in clinical settings.

  20. Uptake of perfluorooctanoic acid, perfluorooctane sulfonate and perfluorooctane sulfonamide by carrot and lettuce from compost amended soil.

    PubMed

    Bizkarguenaga, E; Zabaleta, I; Mijangos, L; Iparraguirre, A; Fernández, L A; Prieto, A; Zuloaga, O

    2016-11-15

    Sewage sludge, which acts like a sink for many pollutants, including metals, pathogens and organic pollutants, that are not completely removed in waste water treatment plants (WWTPs), is applied as a nutrient rich organic fertilizer in many agricultural applications. In the present work, carrot and lettuce crops were grown in two different compost amended soils fortified with perfluorooctanoic acid (PFOA), perfluorosulfonate acid (PFOS) and perfluorosulfonamide (FOSA) and cultivated in a greenhouse. The plants were harvested and divided into root core, root peel and leaves in the case of carrots and into heart and leaves for lettuces. Concentrations for all the different compartments were determined to assess the bioconcentration factors (BCFs) and the plant distribution of the target analytes. The highest carrot BCFs for PFOA and PFOS were determined in the leaves (0.6-3.4), while lower values were calculated in the core (0.05-0.6) and the peel (0.05-1.9) compartments. However, PFOA was taken up in the translocation stream and accumulated more than PFOS in the edible part of lettuce. FOSA was totally degraded in the presence of carrot; however, a lower FOSA degradation was observed in presence of the lettuce, which was dependent on the total organic carbon (TOC) content of the soil. The higher the TOC value, the higher the FOSA degradation observed. No degradation was observed in the crop absence. In the case of the carrot experiments, different polymeric materials (polyethersulfone, PES, polyoxymethylene, and silicone rod) were tested to predict the concentration in the cultivation media. A high correlation (r(2)>0.63) was observed for the BCFs in the PES and in the carrot core and peel for PFOA and PFOS. It could be, concluded that the PES can be used as a first approach for the determination of the uptake of compounds such as PFOS and PFOA in carrot. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. In vitro metabolic formation of perfluoroalkyl sulfonamides from copolymer surfactants of pre- and post-2002 scotchgard fabric protector products.

    PubMed

    Chu, Shaogang; Letcher, Robert J

    2014-06-03

    Currently there is a scientific debate on whether fluorinated polymers (or copolymers) are a source, as a result of their degradation and subsequent formation, of perfluorinated carboxylic acids (PFCAs) and perfluorinated alkanesulfonates (PFSAs). The present study investigated whether commercially available fluorinated surfactants, such as Scotchgard fabric protector (3M Company), can be metabolically degraded, using a model microsomal in vitro assay (Wistar-Han rats liver microsomes), and with concomitant formation of PFCAs, PFASs, and/or their precursors. The results showed that the main in vitro metabolite from the pre-2002 product was perfluorooctane sulfonamide (FOSA), and coincident with the detection of the major fabric protector components, which contains the N-ethyl-perfluorooctanesulfonyl chemical moiety (C8F17SO2N(C2H5)-); the main in vitro metabolite of the post-2002 product was perfluorobutane sulfonamide (FBSA), which was coincident with the detection of the major fabric protector components, and contains the N-methyl-perfluorobutanesulfonyl chemical moiety (C4F9SO2N(CH3)-). FOSA or FBSA metabolite concentrations increased over the 0-60 min microsomal incubation period. However, concentrations of their small molecule precursors such as alkylated FOSAs or FBSAs were not detectable (FOSA or FBSA metabolites were derived from the copolymer product itself rather than nonreacted reagents in the Scotchgard products. This result is consistent with reports of high concentrations of PFASs detected in the plasma of persons in households where Scotchgard products are heavily used.

  2. Aerobic biotransformation and fate of N-ethyl perfluorooctane sulfonamidoethanol (N-EtFOSE) in activated sludge.

    PubMed

    Rhoads, Kurt R; Janssen, Elisabeth M L; Luthy, Richard G; Criddle, Craig S

    2008-04-15

    Processes affecting the fate of perfluorinated organics are of increasing concern due to the global dispersal, persistence, and bioaccumulation of these contaminants. The volatile compound N-ethyl perfluorooctane sulfonamidoethanol (N-EtFOSE) and its phosphate esters have been used in protective surface coatings. In this report, we describe the fate of N-EtFOSE in aerobic batch assays. These assays were performed using undiluted activated sludge in serum bottles that were sealed to prevent the escape of N-EtFOSE and volatile transformation products. Separate assays were performed with N-EtFOSE and reported transformation products. N-EtFOSE degraded to N-ethyl perfluorooctane sulfonamido acetic acid (N-EtFOSAA) with an observed first-order rate of 0.99 +/- 0.08 day(-1) and a pseudosecond order rate of 0.26 +/- 0.02 L/mg VSS day(-1). N-EtFOSAA underwent further transformation at a slower rate (0.093 +/- 0.012 day(-1)) to N-ethylperfluorooctane sulfonamide (N-EtFOSA). N-EtFOSA then transformed to perfluorooctane sulfonamide (FOSA). FOSA transformed to perfluorooctane sulfinate (PFOSI), and PFOSI transformed to perfluorooctane sulfonate (PFOS). Perfluorooctanoic acid (PFOA) was not detected as a transformation product of any compound. Using the measured rate of N-EtFOSE biotransformation and literature values for phase partitioning and mass transfer in aeration basins, we modeled the fate of N-EtFOSE in a typical activated sludge aeration basin open to the atmosphere. The model predicts that 76% of the N-EtFOSE is stripped into the atmosphere, 5% sorbs to waste solids, 13% undergoes transformation to N-EtFOSAA, and 6% is discharged in the wastewater effluent.

  3. Synthesis, antidepressant evaluation and QSAR studies of novel 2-(5H-[1,2,4]triazino[5,6-b]indol-3-ylthio)-N-(substituted phenyl)acetamides.

    PubMed

    Shelke, Suhas M; Bhosale, Sharad H

    2010-08-01

    In search for novel antidepressants, a series of 2-(5H-[1,2,4]triazino[5,6-b]indol-3-ylthio)-N-(substituted phenyl)acetamides was synthesized and screened for potential antidepressant activity by tail suspension test (TST) in mice. Number of synthesized compounds exhibited impressive antidepressant activity, measured in terms of percentage decrease in immobility duration (%DID). QSAR analysis was also undertaken which correlated three parameters FOSA, PISA, and glob with biological activity.

  4. Observation of emerging per- and polyfluoroalkyl substances (PFASs) in Greenland marine mammals.

    PubMed

    Gebbink, Wouter A; Bossi, Rossana; Rigét, Frank F; Rosing-Asvid, Aqqalu; Sonne, Christian; Dietz, Rune

    2016-02-01

    The present pilot study examined emerging per- and polyfluoroalkyl substances (PFASs), i.e., a suite of short chain perfluoroalkyl acids (PFAAs), PFAA precursors and replacement chemicals, and legacy PFASs (long chain length PFAAs) in livers from ringed seals, polar bears and, for the first time, killer whales from East Greenland collected in 2012-2013. Among the emerging PFASs, perfluorobutanesulfonic acid (PFBS) and F-53B (a chlorinated polyfluorinated ether sulfonic acid) were detected in Arctic wildlife, albeit at concentrations approximately four orders of magnitude lower compared to perfluorooctanesulfonic acid (PFOS). PFOS was positively correlated with F-53B, but not PFBS in all three species. A total of 17 PFASs were detected in killer whales, including in a mother-fetus pair, demonstrating maternal transfer. ∑PFAS concentrations in killer whales (269 ± 90 ng/g) were comparable to concentrations found in ringed seals (138 ± 7 ng/g), however, an order of magnitude lower compared to concentrations found in polar bear livers (2336 ± 263 ng/g). Patterns of long chain PFAAs in killer whales differed from the pattern in ringed seals and polar bears. Of the monitored PFAA precursors, only perfluorooctanesulfonamide (FOSA) was detected in all three species, and FOSA/PFOS ratios and isomer patterns indicated that killer whales have a potential lower metabolic capacity to degrade FOSA compared to polar bears and ringed seals. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Longitudinal and latitudinal distribution of perfluoroalkyl compounds in the surface water of the Atlantic Ocean.

    PubMed

    Ahrens, Lutz; Barber, Jonathan L; Xie, Zhiyong; Ebinghaus, Ralf

    2009-05-01

    Perfluoroalkyl compounds (PFCs) were determined in 2 L surface water samples collected in the Atlantic Ocean onboard the research vessels Maria S. Merian along the longitudinal gradient from Las Palmas (Spain) to St. Johns (Canada) (15 degrees W to 52 degrees W) and Polarstern along the latitudinal gradient from the Bay of Biscay to the South Atlantic Ocean (46 degrees N to 26 degrees S) in spring and fall 2007, respectively. After filtration the dissolved and particulate phases were extracted separately, and PFC concentrationswere determined using high-performance liquid chromatography interfaced to tandem mass spectrometry. No PFCs were detected in the particulate phase. This study provides the first concentration data of perfluorooctanesulfonamide (FOSA), perfluorohexanoic acid, and perfluoroheptanoic acid from the Atlantic Ocean. Results indicate that trans-Atlantic Ocean currents caused the decreasing concentration gradient from the Bay of Biscay to the South Atlantic Ocean and the concentration drop-off close to the Labrador Sea. Maximum concentrations were found for FOSA, perfluorooctanesulfonate, and perfluorooctanoic acid at 302, 291, and 229 pg L(-1), respectively. However, the concentration of each single compound was usually in the tens of picograms per liter range. South of the equator only FOSA and below 4 degrees S no PFCs could be detected.

  6. Nanofiltration for trace organic contaminant removal: structure, solution, and membrane fouling effects on the rejection of perfluorochemicals.

    PubMed

    Steinle-Darling, Eva; Reinhard, Martin

    2008-07-15

    The use of nanofiltration (NF) membranes for water recycling requires an improved understanding of the factors that govern rejection of potentially harmful organic trace contaminants. Rejections of 15 perfluorochemicals (PFCs)--5 perfluorinated sulfonates, 9 perfluorinated carboxylates, and perfluorooctane sulfonamide (FOSA)--by four nanofiltration membranes (NF270, NF200, DK, and DL) were measured. Rejections for anionic species were >95% for MW >300 g/mol. FOSA (MW = 499 g/mol), which is uncharged at the pH of deionized water (5.6), was rejected as little as 42% (DL membrane). Decreasing the pH to less than 3 decreases rejection by up to 35%, effectively increasing the MWCO of NF270 by >200 g/mol, while a 2500 mg/L NaCl equivalent increase in ionic strength reduces rejections <1%. An alginate fouling layer increases transmission, where quantifiable, by factors of 4-8. Accumulation of PFCs on membranes was measured after the completion of rejection experiments. Based on rejection kinetics and the extent of sorption, we infer that two different sorption processes are significant: charged species adsorb quickly to the membrane surface, whereas the uncharged FOSA absorbs within the membrane matrix in a much slower process.

  7. Perfluoroalkyl Acids (PFAAs) and Selected Precursors in the Baltic Sea Environment: Do Precursors Play a Role in Food Web Accumulation of PFAAs?

    PubMed

    Gebbink, Wouter A; Bignert, Anders; Berger, Urs

    2016-06-21

    The present study examined the presence of perfluoroalkyl acids (PFAAs) and selected precursors in the Baltic Sea abiotic environment and guillemot food web, and investigated the relative importance of precursors in food web accumulation of PFAAs. Sediment, water, zooplankton, herring, sprat, and guillemot eggs were analyzed for perfluoroalkane sulfonic acids (PFSAs; C4,6,8,10) and perfluoroalkyl carboxylic acids (PFCAs; C6-15) along with six perfluoro-octane sulfonic acid (PFOS) precursors and 11 polyfluoroalkyl phosphoric acid diesters (diPAPs). FOSA, FOSAA and its methyl and ethyl derivatives (Me- and EtFOSAA), and 6:2/6:2 diPAP were detected in sediment and water. While FOSA and the three FOSAAs were detected in all biota, a total of nine diPAPs were only detected in zooplankton. Concentrations of PFOS precursors and diPAPs exceeded PFOS and PFCA concentrations, respectively, in zooplankton, but not in fish and guillemot eggs. Although PFOS precursors were present at all trophic levels, they appear to play a minor role in food web accumulation of PFOS based on PFOS precursor/PFOS ratios and PFOS and FOSA isomer patterns. The PFCA pattern in fish could not be explained by the intake pattern based on PFCAs and analyzed precursors, that is, diPAPs. Exposure to additional precursors might therefore be a dominant exposure pathway compared to direct PFCA exposure for fish.

  8. Vascularised pisiform bone graft. Indications, technique and long-term results.

    PubMed

    Kuhlmann, J Norbert; Kron, Cédric; Boabighi, André; Baux, Serge; Mimou, Maurice

    2003-08-01

    The authors report their experience with the use of a vascularised pisiform bone graft based on the dorsal branch of the ulnar artery to provide osseous support and an efficient vascular aid especially in non-unions of the carpal navicular bone with avascular necrosis of its proximal pole and in stage III Kienböck's disease. The pisiform can replace the proximal pole of the navicular bone in totality. When implanted into the lunate, it stops its collapse and helps to revascularize it. The authors present the results achieved in 14 patients (12 male, 2 female), of which eight had a follow-up longer than 5 years The technique appears as an interesting alternative to carpectomies and partial intracarpal fusions which are usually proposed in advanced cases of these conditions.

  9. [The anterior tarsal tunnel syndrome: a case report].

    PubMed

    Milants, C; Wang, F C; Gomulinski, L; Ledon, F; Petrover, D; Bonnet, R; Crielaard, J M; Kaux, J F

    2015-01-01

    The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is frequently unrecognized and may lead to misdiagnosis and delayed treatment. We report the case of a 77 year old patient complaining of symptoms of an anterior tarsal tunnel syndrome with neuropathic pain located at the dorsal part of the foot, without any sensorimotor loss. The ENMG was in favour of a motor impairment of the deep peroneal nerve. MRI exploration of the ankle showed a millimetric bony overgrowth of the upper pole of the navicular bone, irritative to the deep peroneal nerve. Infiltration at overgrowth of the navicular provided a partial and temporary decrease in pain symptoms. Surgical nerve decompression was then considered.

  10. Jackson-Weiss syndrome: Clinical and radiological findings in a large kindred and exclusion of the gene from 7p21 and 5qter

    SciTech Connect

    Ades, L.C.; Haan, E.A.; Mulley, J.C.; Senga, I.P.; Morris, L.L.; David, D.J.

    1994-06-01

    We describe the clinical and radiological manifestations of the Jackson-Weiss syndrome (JWS) in a large South Australian kindred. Radiological abnormalities not previously described in the hands include coned epiphyses, distal and middle phalangeal hypoplasia, and carpal bone malsegmentation. New radiological findings in the feet include coned epiphyses, hallux valgus, phalangeal, tarso-navicular and calcaneo-navicular fusions, and uniform absence of metatarsal fusions. Absence of linkage to eight markers along the short arm of chromosome 7 excluded allelian between JWS and Saethre-Chotzen syndrome at 7p21. No linkage was detected to D5S211, excluding allelism to another recently described cephalosyndactyly syndrome mapping to 5qter. 35 refs., 5 figs., 4 tabs.

  11. Fate and transport of perfluoro- and polyfluoroalkyl substances including perfluorooctane sulfonamides in a managed urban water body.

    PubMed

    Nguyen, Tung V; Reinhard, Martin; Chen, Huiting; Gin, Karina Y-H

    2016-06-01

    Transport and fate of perfluoro- and polyfluoroalkyl substances (PFASs) in an urban water body that receives mainly urban runoff was investigated. Water, suspended solids, and sediment samples were collected during the monsoon (wet) and inter-monsoon (dry) season at different sites and depths. Samples were analyzed for C7 to C12 perfluoroalkyl carboxylate homologues (PFCAs) (PFHpA, PFOA, PFNA, PFDA, PFUnA, PFDoA), perfluorohexane, perfluorooctane, and 6:2-fluorotelomer sulfonate (PFHxS, PFOS, and 6:2FtS, respectively), perfluorooctane sulfonamide (FOSA), N-ethyl FOSA (sulfluramid), N-ethyl sulfonamidoethanol (N-EtFOSE), and N-methyl and N-ethyl sulfonamidoacetic acid (N-EtFOSAA and N-MeFOSAA, respectively). Concentrations in wet samples were only slightly higher. The sum total PFAS (ΣPFAS) concentrations dissolved in the aqueous phase and sorbed to suspended solids (SS) ranged from 107 to 253 ng/L and 11 to 158 ng/L, respectively. PFOA, PFOS, PFNA, PFHxS, and PFDA contributed most (approximately 90 %) to the dissolved ΣPFASs. N-EtFOSA dominated the particulate PFAS burden in wet samples. K D values of PFOA and PFOS calculated from paired SS and water concentrations varied widely (1.4 to 13.7 and 1.9 to 98.9 for PFOA and PFOS, respectively). Field derived K D was significantly higher than laboratory K D suggesting hydrophobic PFASs sorbed to SS resist desorption. The ΣPFAS concentrations in the top sedimentary layer ranged from 8 to 42 μg/kg and indicated preferential accumulation of the strongly sorbing long-chain PFASs. The occurrence of the metabolites N-MeFOSAA, N-EtFOSAA and FOSA in the water column and sediments may have resulted from biological or photochemical transformations of perfluorooctane sulfonamide precursors while the absence of FOSA, N-EtFOSA and 6:2FtS in sediments was consistent with biotransformation.

  12. Foot Structure and Muscle Reaction Time to a Simulated Ankle Sprain

    PubMed Central

    Denyer, Joanna R.; Hewitt, Naomi L. A.; Mitchell, Andrew C. S.

    2013-01-01

    Context: Foot structure has been shown to affect aspects of neuromuscular control, including postural stability and proprioception. However, despite an association between pronated and supinated foot structures and the incidence of lateral ankle sprains, no one to our knowledge has measured muscle reaction time to a simulated ankle-sprain mechanism in participants with different foot structures. Objective: To determine whether pronated or supinated foot structures contribute to neuromuscular deficits as measured by muscle reaction time to a simulated ankle-sprain mechanism. Design: Cross-sectional study. Setting: University biomechanics laboratory. Patients or Other Participants: Thirty volunteers were categorized into 3 groups according to navicular-drop–height measures. Ten participants (4 men, 6 women) had neutral feet (navicular-drop height = 5–9 mm), 10 participants (4 men, 6 women) had pronated feet (navicular-drop height ≥ 10 mm), and 10 participants (4 men, 6 women) had supinated feet (navicular-drop height ≤ 4 mm). Intervention(s): Three perturbations on a standing tilt platform simulating the mechanics of an inversion and plantar-flexion ankle sprain. Main Outcome Measure(s): Muscle reaction time in milliseconds of the peroneus longus, tibialis anterior, and gluteus medius to the tilt-platform perturbation. Results: Participants with pronated or supinated foot structures had slower peroneus longus reaction times than participants with neutral feet (P = .01 and P = .04, respectively). We found no differences for the tibialis anterior or gluteus medius. Conclusions: Foot structure influenced peroneus longus reaction time. Further research is required to establish the consequences of slower peroneal reaction times in pronated and supinated foot structures. Researchers investigating lower limb muscle reaction time should control for foot structure because it may influence results. PMID:23675791

  13. Foot structure and muscle reaction time to a simulated ankle sprain.

    PubMed

    Denyer, Joanna R; Hewitt, Naomi L A; Mitchell, Andrew C S

    2013-01-01

    Foot structure has been shown to affect aspects of neuromuscular control, including postural stability and proprioception. However, despite an association between pronated and supinated foot structures and the incidence of lateral ankle sprains, no one to our knowledge has measured muscle reaction time to a simulated ankle-sprain mechanism in participants with different foot structures. To determine whether pronated or supinated foot structures contribute to neuromuscular deficits as measured by muscle reaction time to a simulated ankle-sprain mechanism. Cross-sectional study. University biomechanics laboratory. Thirty volunteers were categorized into 3 groups according to navicular-drop-height measures. Ten participants (4 men, 6 women) had neutral feet (navicular-drop height = 5-9 mm), 10 participants (4 men, 6 women) had pronated feet (navicular-drop height ≥ 10 mm), and 10 participants (4 men, 6 women) had supinated feet (navicular-drop height ≤ 4 mm). Three perturbations on a standing tilt platform simulating the mechanics of an inversion and plantar-flexion ankle sprain. Muscle reaction time in milliseconds of the peroneus longus, tibialis anterior, and gluteus medius to the tilt-platform perturbation. Participants with pronated or supinated foot structures had slower peroneus longus reaction times than participants with neutral feet (P = .01 and P = .04, respectively). We found no differences for the tibialis anterior or gluteus medius. Foot structure influenced peroneus longus reaction time. Further research is required to establish the consequences of slower peroneal reaction times in pronated and supinated foot structures. Researchers investigating lower limb muscle reaction time should control for foot structure because it may influence results.

  14. Foot kinematics during walking measured using bone and surface mounted markers.

    PubMed

    Nester, C; Jones, R K; Liu, A; Howard, D; Lundberg, A; Arndt, A; Lundgren, P; Stacoff, A; Wolf, P

    2007-01-01

    The aim was to compare kinematic data from an experimental foot model comprising four segments ((i) heel, (ii) navicular/cuboid (iii) medial forefoot, (iv) lateral forefoot), to the kinematics of the individual bones comprising each segment. The foot model was represented using two different marker attachment protocols: (a) markers attached directly to the skin; (b) markers attached to rigid plates mounted on the skin. Bone data were collected for the tibia, talus, calcaneus, navicular, cuboid, medial cuneiform and first and fifth metatarsals (n=6). Based on the mean differences between the three data sets during stance, the differences between any two of the three kinematic protocols (i.e. bone vs skin, bone vs plate, skin vs plate) were >3 degrees in only 35% of the data and >5 degrees in only 3.5% of the data. However, the maximum difference between any two of the three protocols during stance was >3 degrees in 100% of the data, >5 degrees in 73% of the data and >8 degrees in 23% of the data. Differences were greatest for motion of the combined navicular/cuboid relative to the calcaneus and the medial forefoot segment relative to the navicular/cuboid. The differences between the data from the skin and plate protocols were consistently smaller than differences between either protocol and the kinematic data for each bone comprising the segment. The pattern of differences between skin and plate protocols and the actual bone motion showed no systematic pattern. It is unlikely that one rigid body foot model and marker attachment approach is always preferable over another.

  15. Blast Performance of Commercially Available Demining Footwear: A Summary of Experimental Trials on Surrogate Legs

    DTIC Science & Technology

    2008-10-01

    of definitions NAVICULAR SECOND CUNEIFORM FIRST CUNEIFORM PHALANGES The lower limb (left) and the foot/ankle complex anatomy [ Tortora . 1984. 2003...talus, which is the only bone to articulate with the tibia and the fibula, transmits all the forces from the foot to the leg. References Tortora , G...Anagnostakos. N. (1984), Principles of Anatomy and Physiology, Fourth Edition, Harper & Row, Publishers, Inc.. New York, NY. Tortora G.J. and

  16. Arch Height and Maximum Rearfoot Eversion During Jogging in 2 Static Neutral Positions

    PubMed Central

    Lee, Sae Yong; Hertel, Jay

    2012-01-01

    Context: Clinically, lowering of the medial longitudinal arch is believed to be closely related to rearfoot eversion. However, the relationship between arch height and rearfoot eversion during gait is unclear. Objectives: (1) To examine the influence of 2 reference positions (weight-bearing neutral position [WBNP] and subtalar neutral position [STNP]) on maximum rearfoot eversion, tibial internal rotation, knee flexion, knee internal rotation, and dorsiflexion-plantar flexion of ankle joint measures during jogging and (2) to compare the relationships among static arch height, navicular drop, and the 2 maximum rearfoot eversion measures. Design: Crossover study. Setting: Gait laboratory. Patients or Other Participants: Thirty-three volunteers between 18 and 40 years of age. Intervention(s): Each participant stood on the treadmill in 2 static positions: WBNP and STNP. Kinematic data were obtained using a 10-camera motion analysis system (120 Hz) when participants jogged at 2.65 m/s on the treadmill in bare feet. Main Outcome Measure(s): Rearfoot and shank angular kinematics, navicular drop, and static arch height. Results: Maximum rearfoot eversion was greater (WBNP: 4.03° ± 2.58°, STNP: 10.91° ± 5.34°) when STNP was the static reference (P < .001). A strong correlation was seen between maximum STNP eversion and navicular drop (r = 0.842) but not between WBNP and navicular drop (r = 0.216). Differences were noted in dorsiflexion and knee kinematics during gait between the static references; however, the effect sizes were low, and the mean differences were smaller than 2°, which was less than 5% of total excursion during gait. Conclusions: Using STNP rather than WBNP as the reference position affects estimates of frontal-plane rearfoot movement but not other ankle or knee motions in jogging. PMID:22488234

  17. Tarsal Coalitions--Calcaneonavicular Coalitions.

    PubMed

    Swensen, Stephanie J; Otsuka, Norman Y

    2015-12-01

    Calcaneonavicular coalitions are an important cause of adolescent foot pain and deformity. The congenital condition is characterized by an aberrant osseous, cartilaginous, or fibrinous union of the calcaneal and navicular bones. Calcaneonavicular coalitions are the most common form of tarsal coalitions identified within epidemiologic studies. A thorough understanding of this clinically significant entity is important for restoring joint motion and preventing long-term disability. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Diagnostic dilemmas in foot and ankle injuries

    SciTech Connect

    Keene, J.S.; Lange, R.H.

    1986-07-11

    Differential diagnosis of foot and ankle injuries should include (1) stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; (2) transchondral talar-dome fractures; (3) fractures of the os trigonum; and (4) dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required.

  19. In vitro study of foot kinematics using a dynamic walking cadaver model.

    PubMed

    Nester, C J; Liu, A M; Ward, E; Howard, D; Cocheba, J; Derrick, T; Patterson, P

    2007-01-01

    There is a dearth of information on navicular, cuboid, cuneiform and metatarsal kinematics during walking and our objective was to study the kinematic contributions these bones might make to foot function. A dynamic cadaver model of walking was used to apply forces to cadaver feet and mobilise them in a manner similar to in vivo. Kinematic data were recorded from 13 cadaver feet. Given limitations to the simulation, the data describe what the cadaver feet were capable of in response to the forces applied, rather than exactly how they performed in vivo. The talonavicular joint was more mobile than the calcaneocuboid joint. The range of motion between cuneiforms and navicular was similar to that between talus and navicular. Metatarsals four and five were more mobile relative to the cuboid than metatarsals one, two and three relative to the cuneiforms. This work has confirmed the complexity of rear, mid and forefoot kinematics. The data demonstrate the potential for often-ignored foot joints to contribute significantly to the overall kinematic function of the foot. Previous emphasis on the ankle and sub talar joints as the principal articulating components of the foot has neglected more distal articulations. The results also demonstrate the extent to which the rigid segment assumptions of previous foot kinematics research have over simplified the foot.

  20. The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients

    PubMed Central

    Kim, Eun-Kyung; Kim, Jin Seop

    2016-01-01

    [Purpose] The purpose of the present study is to apply short foot exercises and arch support insoles in order to improve the medial longitudinal arch of flatfoot and compare the results to identify the effects of the foregoing exercises on the dynamic balance of the feet and the lower limbs. [Subjects and Methods] Fourteen university students with flexible flatfoot were selected by conducting navicular drop tests and randomly assigned to a short foot exercise group of seven subjects and an arch support insoles group of seven subjects. The intervention in the experiment was implemented for 30 minutes per time, three times per week for five weeks in total. [Results] In inter-group comparison conducted through navicular drop tests and Y-balance tests, the short foot exercise group showed significant differences. Among intra-group comparisons, in navicular drop tests, the short foot exercise group showed significant decreases. In Y-balance tests, both the short foot exercise group and the arch support insoles group showed significant increases. [Conclusion] In the present study, it could be seen that to improve flatfoot, applying short foot exercises was more effective than applying arch support insoles in terms of medial longitudinal arch improvement and dynamic balance ability. PMID:27942135

  1. An in vitro and finite element study of load redistribution in the midfoot.

    PubMed

    Niu, WenXin; Tang, TingTing; Zhang, Ming; Jiang, ChengHua; Fan, YuBo

    2014-12-01

    A good knowledge of midfoot biomechanics is important in understanding the biomechanics of the entire foot, but it has never been investigated thoroughly in the literature. This study carried out in vitro experiments and finite element analysis to investigate the midfoot biomechanics. A foot-ankle finite element model simulating the mid-stance phase of the normal gait was developed and the model validated in in vitro experimental tests. Experiments used seven in vitro samples of fresh human cadavers. The simulation found that the first principal stress peaks of all midfoot bones occurred at the navicular bone and that the tensile force of the spring ligament was greater than that of any other ligament. The experiments showed that the longitudinal strain acting on the medial cuneiform bone was -26.2±10.8 μ-strain, and the navicular strain was -240.0±169.1 μ-strain along the longitudinal direction and 65.1±25.8 μ-strain along the transverse direction. The anatomical position and the spring ligament both result in higher shear stress in the navicular bone. The load from the ankle joint to five branches of the forefoot is redistributed among the cuneiforms and cuboid bones. Further studies on the mechanism of loading redistribution will be helpful in understanding the biomechanics of the entire foot.

  2. Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method.

    PubMed

    Aurell, Ylva; Andriesse, Hanneke; Johansson, Arne; Jonsson, Kjell

    2005-09-01

    The purpose of this study was to sonographically compare the early anatomical outcome of a group of clubfeet treated with the Ponseti method (group A, nine clubfeet) with a group treated with an adjustable plexidur splint, the Copenhagen method (group B, 19 feet). The clinical severity was assessed using the Diméglio-Bensahel classification. The need for complementary surgery was clinically assessed at the age of about 2 months. Ultrasound investigation was made in the neonatal period, after 2-3 months of non-surgical treatment and 1-2 months post-surgically. After 2 months of non-surgical treatment the correction obtained at the talo-navicular joint, expressed as the distance between the medial malleolus and the navicular (MM-N distance), was significantly greater in group A. After surgery, tenotomy of the Achilles tendon for all group A feet, and posterior or posteriomedial release for 13 feet in group B, the correction at the talo-navicular and calcaneo-cuboid joints was similar for the two groups. Anatomical correction of the displacement in these joints can be achieved without extensive interventional procedures. Ultrasound may be a valuable tool to assess the effects of different treatment protocols quantitatively.

  3. A study of structural foot deformity in stroke patients

    PubMed Central

    Jang, Gwon Uk; Kweon, Mi Gyoug; Park, Seol; Kim, Ji Young; Park, Ji Won

    2015-01-01

    [Purpose] The aim of this study was to evaluate the structural deformity of the foot joint on the affected side in hemiplegic patients to examine factors that affect this kind of structural deformity. [Subjects and Methods] Thirty-one hemiplegic patients and 32 normal adults participated. The foot posture index (FPI) was used to examine the shape of the foot, the modified Ashworth scale test was used to examine the degree of ankle joint rigidity, the navicular drop test was used to investigate the degree of navicular change, and the resting calcaneal stance position test was used to identify location change of the heel bone. [Results] The FPIs of the paretic side of the hemiplegic patients, the non-paretic side of the hemiplegic patients, and normal participants were −0.25 ± 2.1, 1.74 ± 2.3, and 2.12 ± 3.4 respectively. [Conclusion] Our findings indicated that in stroke-related hemiplegic patients, the more severe the spasticity, the more supinated the foot. Further, the smaller the degree of change in the navicular height of hemiplegic patients is, the more supinated the paretic side foot is. Additionally, a greater change in the location of the calcaneus was associated with greater supination of the overall foot. PMID:25642071

  4. [Management of ureteric colic with ketorolac and nifedipin vs. ketorolac and tamsulosin in the emergency room].

    PubMed

    Montiel-Jarquín, Álvaro J; Rocha-Rocha, Valeria M; Solís-Mendoza, Hugo A; Romero-Figueroa, María S; Etchegaray-Morales, Ivet; Alvarado-Ortega, Ivan

    2017-01-01

    Introducción: el cólico renoureteral es la manifestación más común de la litiasis. Se trata de la presencia de cálculos en las papilas renales que frecuentemente migran hacia el uréter, ocasionando un cólico renoureteral, caracterizado por un dolor intenso en la región lumbar o en sus flancos. Se buscó comparar el uso del ketorolaco y nifedipino frente a ketorolaco y tamsulosina para el manejo del dolor ocasionado por litiasis en el tercio inferior del uréter. Métodos: estudio longitudinal en 150 pacientes mayores de 21 años con litiasis en tercio inferior del uréter. Al 50% se le administró ketorolaco y nifedipino y al otro 50% ketorolaco y tamsulosina. Se utilizó la escala numérica de dolor (END) al ingreso, a las 4 y a las 12 horas. La estadística fue descriptiva e inferencial (U de Mann-Whitney-Wilcoxon, chi cuadrada y regresión de Poisson). Resultados: la edad promedio fue 38.17 años y 54.7% de los pacientes fueron hombres. Inicialmente la END tuvo una media de 9.69, de 7.42 a las 4 horas y de 2.05 a las 12 horas. En la medición inicial del dolor no hubo diferencias significativas entre ambos grupos (p > 0.005); 4 y 12 horas después el dolor disminuyó más en los pacientes manejados con ketorolaco y nifedipino: p = 0.0041 y p = 0.000, respectivamente. No hubo complicaciones ni efectos secundarios en ambos tratamientos. Conclusión: la mancuerna ketorolaco y nifedipino es más efectiva que la del ketorolaco y la tamsulosina para el manejo del dolor del cólico renoureteral inferior durante las primeras 12 horas de tratamiento.

  5. [The Somovillas: a family of lithiasis surgeons from Rioja. Chronology of their trajectory in Arnedillo, 16th Century].

    PubMed

    Fernández Fernández, A

    2001-01-01

    In the second middle of the XVI century lived in Arnedillo Juan and Francisco Somovilla, booths "maesse". The names of his wives were Anna Garcia and Iomar de Oña. The brothers of Juan and Anna were Mardia, Diego baptised on 20 of june of 1566, and Iñigo. Juan Somovilla passes away on 22 of December of 1574. His brother made the testament. We think that Juan was the surgeon that we contracted by Felipe II, instead of Francisco. Francisco Díaz talked about Arnedillo, as an important thermal baths in the treatment of the kidney diseases, in his text. If Arnedillo was a centre of treatment of urinary disease, the Somovilla family could learn here the surgery of bladder litiasis.

  6. [Cystinic lithiasis. Current aspects of the urologic treatment].

    PubMed

    Dore, B; Irani, J; Marroncle, M; Aubert, J

    1990-01-01

    On the basis of a series of 9 patients (12 renal units) gathered over 19 years, the authors analyze the current possibilities of treatment of cystine lithiasis. They first describe the characteristics of this litiasis, which is rare but serious, being naturally prone to recurrence because it is caused by a genetic defect. The development of extracorporeal lithotripsy raised great hopes for the treatment of this lithiasis, but it was soon realized that cystine strones were hard to break. However, even the mere fragmentation of the stones improves the dissolving action of the various drugs proposed to modify the pH of urine. The authors consider that open surgery by means of posterior vertical lumbar section still is indicated for larger stones, and percutaneous nephrolithotomy seems to be a very useful technique, either exclusively or as a complement of extracorporeal lithotrity.

  7. [Epidemiology of urinary lithiasis in Spain: New scenarios.

    PubMed

    Carrasco Valiente, Julia; Gómez Gómez, Enrique; Requena Tapia, María José

    2017-01-01

    Renal lithiasis is one of the most common disorders in modern society, constituting an important health problem that associates a great economic burden. The nature of stone disease varies according to age and sex, being also influenced by dietary and lifestyle factors, and climatic variations among others. In spite of the advances made in the management of this pathology, it continues being a disease with a high recurrence rate. In recent years, several studies have pointed out that its prevalence is rising especially in developed countries. This increase seems to be fundamentally due to changes in dietary habits and lifestyle, although other factors such as migratory flows from rural areas to major cities, and a rise in global temperatures may also be involved. In the present article, we discuss the main factors that seem to influence today the epidemiology of urinary litiasis, as well as the aforementioned increase of prevalence.

  8. [Long-term follow up of patients surgically treated for pyelo-ureteral disease by the Anderson-Hynes technique].

    PubMed

    Polito, M; Galosi, A B; Minardi, D; Nonni, M; Cinti, P; Riccardi, A

    1997-02-01

    A series of 48 patients with hydronephrosis (mean age 31 yrs.) underwent on Anderson-Hynes pyeloplasty. Assessment was carried out in 30 pts. after a mean observation time of 90 months, with a minimum 5 years follow-up. Clinical examination, laboratory investigations, renal ultrasonography, urography and renal scan were performed pre-operatively and at follow-up. There was one patient with evidence of stenosis in the ureteropelvic junction; one patient developed urinary leakage post-operatively and required surgical correction. All patients had symptoms pre-operatively and no one had symptoms post-operatively. Four patients had calcolosis associated, postoperatively all pts. were stone free; four years later one patient developed litiasis. We observed that the results of surgical intervention in hydronephrosis are excellent especially in patients aged less than 30 years.

  9. Temporal trends of polyfluoroalkyl compounds (PFCs) in liver tissue of grey seals (Halichoerus grypus) from the Baltic Sea, 1974-2008.

    PubMed

    Kratzer, Johanna; Ahrens, Lutz; Roos, Anna; Bäcklin, Britt-Marie; Ebinghaus, Ralf

    2011-09-01

    Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypus) liver from the Baltic Sea over a period of 35 years (1974-2008). In total, 17 of 43 PFCs were found, including the perfluoroalkyl sulfonates (C(4)-C(10) PFSAs), perfluorooctanesulfinate (PFOSi), long chain perfluoroalkyl carboxylates (C(7)-C(14) PFCAs), and perfluoroalkyl sulfonamides (i.e., perfluorooctane sulfonamide (FOSA) and N-ethyl perfluorooctane sulfonamide (EtFOSA)), whereas saturated and unsaturated fluorotelomer carboxylates, shorter chain PFCAs and perfluoroalkyl phosphonic acids were not detected. Perfluorooctane sulfonate (PFOS) was the predominant compound (9.57-1,444 ng g(-1) wet weight (ww)), followed by perfluorononanoate (PFNA, 0.47-109 ng g(-1) ww). C(6)-C(8) PFSAs, PFOSi and C(7)-C(13) PFCAs showed statistically significant increasing concentrations between 1974 and 1997, with a peak in 1997 and then decreased or levelled off (except for C(12) and C(13) PFCAs). FOSA had a different temporal trend with a maximum in 1989 followed by significant decreasing concentrations until 2008. Toxicological implications for grey seals are limited, but the maximal PFOS concentration found in this study was about 40 times lower than the predicted lowest observed effect concentrations (LOEC). The statistically significant decreasing concentrations or levelling off for several PFCs in the relative closed marine ecosystem of the Baltic Sea indicate a rapidly responding to reduced emissions to the marine environment. However, the high concentrations of PFOS and continuing increasing concentrations of the longer chain PFCAs (C(12)-C(14)) shows that further work on the reduction of environmental emissions of PFCs are necessary.

  10. In situ air-water and particle-water partitioning of perfluorocarboxylic acids, perfluorosulfonic acids and perfluorooctyl sulfonamide at a wastewater treatment plant.

    PubMed

    Vierke, Lena; Ahrens, Lutz; Shoeib, Mahiba; Palm, Wolf-Ulrich; Webster, Eva M; Ellis, David A; Ebinghaus, Ralf; Harner, Tom

    2013-08-01

    In situ measurements of air and water phases at a wastewater treatment plant (WWTP) were used to investigate the partitioning behavior of perfluorocarboxylic acids (PFCAs), perfluorosulfonic acids (PFSAs) and perfluorooctyl sulfonamide (HFOSA) and their conjugate bases (PFC(-)s, PFS(-)s, and FOSA(-), respectively). Particle-dissolved (Rd) and air-water (QAW) concentration ratios were determined at different tanks of a WWTP. Sum of concentrations of C4-12,14 PFC(A)s, C4,6,8,10 PFS(A)s and (H)FOSA were as high as 50 pg m(-3) (atmospheric gas phase), 2300 ng L(-1) (aqueous dissolved phase) and 2500 ng L(-1) (aqueous particle phase). Particle-dissolved concentration ratios of total species, log Rd, ranged from -2.9 to 1.3 for PFS(A)s, from -1.9 to 1.1 for PFC(A)s and was 0.71 for (H)FOSA. These field-based values agree well with equilibrium partitioning data reported in the literature, suggesting that any in situ generation from precursors, if they are present in this system, occurs at a slower rate than the rate of approach to equilibrium. Acid QAW were also estimated. Good agreement between the QAW and the air-water equilibrium partition coefficient for C8PFCA suggests that the air above the WWTP tanks is at or near equilibrium with the water. Uncertainties in these QAW values are attributed mainly to variability in pKa values reported in the literature. The WWTP provides a unique environment for investigating environmental fate processes of the PFCAs and PFSAs under 'real' conditions in order to better understand and predict their fate in the environment.

  11. Investigation on per- and polyfluorinated compounds in paired samples of house dust and indoor air from Norwegian homes.

    PubMed

    Haug, Line S; Huber, Sandra; Schlabach, Martin; Becher, Georg; Thomsen, Cathrine

    2011-10-01

    Per- and polyfluorinated compounds (PFCs) have been found to be ubiquitously distributed in human populations, however the sources of human exposure are not fully characterized. A wide range of PFCs were determined in paired samples of indoor air and dust from 41 Norwegian households. Up to 18 ionic and 9 neutral PFCs were detected. The concentrations found are comparable to or lower than what has previously been reported in North America, Europe, and Asia. The highest median concentrations in dust were observed for perfluorohexanoic acid (28 ng/g), perfluorononanoic acid (23 ng/g), perfluorododecanoic acid (19 ng/g), and perfluorooctanoic acid (18 ng/g). However, perfluoroalkyl sulfonic acids (PFSAs) were also frequently detected. Fluortelomer alcohols were the most prominent compounds found in indoor air, with median concentrations for 8:2 fluortelomer alcohol, 10:2 fluortelomer alcohol, and 6:2 fluortelomer alcohol of 5173, 2822, and 933 pg/m(3) air, respectively. All perfluoroalkyl sulfonamides and sulfonamidoethanols (FOSA/FOSEs) were detected in more than 40% of the air samples. For the first time, significant positive correlations (p < 0.05) between PFSAs in house dust and FOSA/FOSEs in the indoor air have been shown, supporting the hypothesis that FOSA/FOSEs may be transformed to PFSAs. Further, we found the age of the residence to be a predictor of PFC concentrations in both indoor air and house dust. These results are important for estimating the exposure to PFCs from the indoor environment and for characterization of exposure pathways.

  12. A novel multidrug resistance plasmid isolated from an Escherichia coli strain resistant to aminoglycosides.

    PubMed

    Sun, Hui; Li, Shasha; Xie, Zhijing; Yang, Fangfang; Sun, Yani; Zhu, Yanli; Zhao, Xiaomin; Jiang, Shijin

    2012-07-01

    Previous studies have reported several different plasmids that confer multidrug resistance (MDR) including resistance to aminoglycosides. In this study, we investigated the aminoglycoside resistance patterns for 224 Escherichia coli isolates from diseased chickens and ducks in China, characterized a novel MDR plasmid, and collected prevalence data on similar resistance plasmids. Antibiotic susceptibilities were determined using disc diffusion and the microdilution method. The plasmid pXZ was analysed by restriction fragment length polymorphism (RFLP) with EcoRI and SalI, and sequenced. The prevalence of similar resistance plasmids was assessed by multiplex PCR and by RFLP analysis. Among the 224 E. coli isolates, 189 (84.4%) were resistant to streptomycin, 125 (55.8%) were resistant to kanamycin, 116 (51.8%) were resistant to gentamicin, 106 (47.3%) were resistant to neomycin and 98 (43.8%) were resistant to amikacin. Among the 224 E. coli isolates, 17 contained a plasmid with the MDR-encoding region of pXZ, which showed high-level resistance to aminoglycosides (MICs of gentamicin and amikacin ≥ 512 mg/L). The plasmid pXZ was digested into five fragments by EcoRI and six fragments by SalI. The plasmid pXZ was a circular DNA molecule of 76635 bp with a 51.65% guanine + cytosine content and included four resistance genes (rmtB, fosA3, bla(TEM-1) and bla(CTX-M-24)). A novel MDR plasmid, pXZ, harbouring four resistance genes (rmtB, fosA3, bla(TEM-1) and bla(CTX-M)) was identified. To our knowledge, this is the first report of an aminoglycoside resistance plasmid harbouring the fosA3 gene.

  13. Leishmaniasis

    DTIC Science & Technology

    1993-01-01

    44 F GEoms Ap ovod-lAD-A269 094 AGE I______0__" 1 no w", . m ~a. *%*to" U. Cro ,4 f o *"uU0 oM. I.w e Mm 4O¢ m fosa. 1 . AGENCY 3j. REPORT TYPIE ANb...vectors, cutaneous disease, 19 mucosal disease, visceral disease 1 . PRICE COOE 17. SECURITY CLASSIPICATION I. SECURITY CLASSWICATION 1T. SECURITY...317 References.................................................... 318 DTIC QA~iTY 1 JSPI~?ED Det’iuion Fo NTS CAvalbltM oe DT AvBi anjr Dist, i

  14. Does supplemental 18:0 alleviate fish oil-induced milk fat depression in dairy ewes?

    PubMed

    Toral, P G; Hervás, G; Carreño, D; Frutos, P

    2016-02-01

    Supplementation of dairy ewe diet with marine lipids may be an effective strategy for modulating milk fatty acid composition but induces milk fat depression (MFD). This syndrome has been associated with a shortage of 18:0 for uptake and Δ(9)-desaturation that may impair the capacity of the mammary gland to achieve an adequate fluidity for milk fat secretion. On this basis, it was suggested that supplemental 18:0 may contribute to alleviate marine lipid-induced MFD in sheep. To test this hypothesis, 12 lactating ewes were allocated to 1 of 3 lots and used in a 3×3 Latin square design with 3 periods of 28 d each and 3 experimental treatments: a total mixed ration without lipid supplementation (control) or supplemented with 20 g/kg of DM of fish oil alone (FO) or in combination with 20 g/kg of DM of 18:0 (FOSA). Diets were offered ad libitum, and animal performance and rumen and milk fatty acid composition were studied at the end of each period. After completing the Latin square trial and following a change-over design, the in vivo digestibility of supplemental 18:0 was estimated using 6 lactating sheep. As expected, diet supplementation with fish oil increased the milk content of some potentially health-promoting fatty acids (e.g., cis-9,trans-11 18:2, trans-11 18:1, 20:5n-3, 22:5n-3, and 22:6n-3), but reduced milk fat concentration and yield (-20% in both FO and FOSA treatments). Thus, although reductions in milk 18:0 and cis-9 18:1 output caused by FO (-81 and -51%, respectively) were partially reversed with FOSA diet (-49 and -27%, respectively), the addition of 18:0 to the diet did not prove useful to alleviate MFD. This response, which could not be fully accounted for by the low digestibility coefficient of supplemental 18:0, may challenge the theory of a shortage of this fatty acid as a mechanism to explain fish oil-induced MFD in sheep. Effects of FO and FOSA on rumen and milk fatty acid composition would support that increases in the concentration of some

  15. Temporal trends of perfluoroalkane sulfonic acids and their sulfonamide-based precursors in herring from the Swedish west coast 1991-2011 including isomer-specific considerations.

    PubMed

    Ullah, Shahid; Huber, Sandra; Bignert, Anders; Berger, Urs

    2014-04-01

    A method was developed for simultaneous analysis of perfluoroalkane sulfonic acids (PFSAs) and their sulfonamide-based precursors (perfluoroalkane sulfonamidoacetic acids (FASAAs), sulfonamides (FASAs), and sulfonamidoethanols (FASEs)) in fish muscle. Extraction was performed with acetonitrile followed by a clean-up and fractionation step and instrumental analysis by UPLC/MS/MS and GC/MS. Time trends of PFSAs and their precursors in herring muscle samples originating from the Kattegat at the west coast of Sweden were investigated covering the years 1991-2011. The following analytes were detected, all with decreasing or unchanged trends between 1991 and 2011: Perfluorobutane sulfonic acid (PFBS, below the method detection limit (FOSA, 78-920pg/g). The highest concentrations were found for PFOS and FOSA around the turn of the century. Shorter disappearance half-lives were observed for precursors compared to PFSAs. Assuming that these trend differences are representative for fish consumed by the general Swedish population, this observation suggests that the relative contribution of precursors to total human exposure to PFOS via fish intake has decreased in Sweden over the study period. PFOS precursors in fish may have constituted a significant indirect exposure pathway for PFOS in the 1990s. Isomer-specific analysis of PFOS and FOSA revealed <10% relative contributions of branched isomers to total PFOS and total FOSA. Furthermore, the percentage branched isomers decreased over time for both compounds. These findings are contrary to patterns and temporal trends of PFOS isomers commonly found in human serum. In combination with literature data on isomer patterns

  16. Partition of perfluoroalkyl substances (PFASs) in whole blood and plasma, assessed in maternal and umbilical cord samples from inhabitants of arctic Russia and Uzbekistan.

    PubMed

    Hanssen, Linda; Dudarev, Alexey A; Huber, Sandra; Odland, Jon Øyvind; Nieboer, Evert; Sandanger, Torkjel M

    2013-03-01

    Perfluoroalkyl substances (PFASs) are ubiquitous in the environment world-wide. Our overall objective was to assess the exposure to PFASs experienced by delivering women and their new-borns in the industrial city of Norilsk (arctic Russia) and the rural Aral Sea region of Uzbekistan, with the secondary objective of evaluating the distribution of PFASs between blood cell and plasma fractions. Six PFASs were detected in every sample from Norilsk city with the plasma concentration sequence of: PFOS≫PFOA>PFNA>FOSA>PFHxS>PFUnDA. In the Uzbekistani samples, only PFOS was reported above the MDL (0.08 ng/mL). The median plasma concentrations of PFOS of 11.0 ng/mL for the Norilsk mothers was comparable to that reported for western countries, while that for Uzbekistan was considerably lower (0.23 ng/mL). Apparent increases in the maternal-cord concentration ratios for both whole blood and plasma were evident with the length of the carbon chain for both the carboxylate and the sulfonate PFASs. The median value of this ratio for FOSA in plasma was the lowest, while that for whole blood was the highest. Other than for FOSA, the observed plasma-whole blood concentration ratios for maternal and umbilical cord blood were consistent with a priori calculations using appropriate packed cell and plasma volumes for neonates and pregnant women at term. Clearly FOSA favored whole blood, and acid-base equilibrium calculations suggested that the resonance-stabilized sulfonamidate ion resides in the blood cell fraction. Thus for PFASs and related compounds with pK values with magnitudes comparable to physiological pH, it is pertinent to measure the cell-associated fraction (separately or as whole blood). Our study illustrates that consideration of both the physico-chemical properties of the contaminants and the physiological attributes of blood matrices were helpful in the interpretation of our findings. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. [Correlation of clinical and radiologic results of complete subtalar release in congenital clubfoot].

    PubMed

    Kalenderer, Onder; Ağuş, Haluk; Ak, Mümtaz; Ozlük, Serkan

    2003-01-01

    We evaluated the mid-term results in patients who underwent complete subtalar release with the use of the Cincinnati incision for congenital clubfoot. Complete subtalar release was performed in 30 feet of 23 patients (16 boys, 7 girls; 7 bilateral cases). The mean age at surgery was 17.5 months (range 2 to 84 months). Clinically, cosmetic appearance, adduction of the forefoot, the range of motion of the ankle joint, and muscle strength were evaluated. Radiologic evaluations included talocalcaneal angles on antero-posterior and lateral views, talocalcaneal index, talar-first metatarsal angles, calcaneal-fifth metatarsal angles, and Bohler angles. Talar and navicular bone lengths were compared with the other side in unilateral patients. The results were evaluated according to the Simons' criteria. The mean follow-up was 9 years and 8 months (range 7 years to 14 years). The mean range of motion of the ankle joint was measured as 47 degrees (range 10 degrees to 60 degrees ). The parents of three patients were not satisfied with the clinical results. Clinically, six patients had metatarsus adductus. Radiologically, flattening of the talar head (7 patients) and the talar dome (2 patients) were detected in unilateral patients. Navicular dorsal subluxation was found in seven feet. Compared to the normal side, the mean navicular shortening was 2.6 mm (range 0 to 4 mm), the mean talar shortening was 4.8 mm (range 2 to 11 mm). According to the Simons' criteria, the results were satisfactory in 27 feet (90%) and unsatisfactory in three feet (10%). Our results suggest that complete subtalar release for the treatment of clubfoot enables correction of all components of the deformity at a single session, and that its clinical results are more favorable than radiologic results, without requiring a close cooperation of the parents.

  18. Anatomical Localization of Motor Points of the Abductor Hallucis Muscle: A Cadaveric Study.

    PubMed

    Choi, Asayeon; Kwon, Na Yeon; Kim, Kyeongwon; Kim, Youngkook; Oh, Jeehae; Oh, Hyun Mi; Park, Joo Hyun

    2017-08-01

    To identify the anatomical motor points of the abductor hallucis muscle in cadavers. Motor nerve branches to the abductor hallucis muscles were examined in eight Korean cadaver feet. The motor point was defined as the site where the intramuscular nerve penetrates the muscle belly. The reference line connects the metatarsal base of the hallux (H) to the medial tubercle of the calcaneus (C). The x coordinate was the horizontal distance from the motor point to the point where the perpendicular line from the navicular tuberosity crossed the reference line. The y coordinate was the perpendicular distance from the motor point to the navicular tuberosity. Most of the medial plantar nerves to the abductor hallucis muscles divide into multiple branches before entering the muscles. One, two, and three motor branches were observed in 37.5%, 37.5%, and 25% of the feet, respectively. The ratios of the main motor point from the H with respect to the H-C line were: main motor point, 68.79%±5.69%; second motor point, 73.45%±3.25%. The mean x coordinate value from the main motor point was 0.65±0.49 cm. The mean value of the y coordinate was 1.43±0.35 cm. All of the motor points of the abductor hallucis were consistently found inferior and posterior to the navicular tuberosity. This study identified accurate locations of anatomical motor points of the abductor hallucis muscle by means of cadaveric dissection, which can be helpful for electrophysiological studies in order to correctly diagnose the various neuropathies associated with tibial nerve components.

  19. Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.

    PubMed

    Potenza, V; Caterini, R; Farsetti, P; Bisicchia, S; Ippolito, E

    2010-07-01

    We report the short- and mid-term results in six patients (seven feet) affected by markedly comminuted intra-articular calcaneal fractures (Sanders type IV), treated by primary subtalar arthrodesis. The average age at surgery was 40 years. In all patients, arthrodesis of the subtalar joint was performed using a limited lateral approach to the calcaneus; it was stabilised with two or three cannulated screws. No patient had a preliminary reduction and internal fixation of the fracture. The time from injury to surgery averaged 20 days because all of the patients had associated visceral and/or other skeletal injuries. All of the patients were followed up clinically and radiographically 2 times, at an average of 12 months and 53 months after surgery. At the short-term follow-up, the mean AOFAS score was 70 points; the X-rays showed a complete fusion of the subtalar joint in all seven feet, without any sign of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints. In all cases, an altered shape of the calcaneus was present. At the mid-term follow-up, the mean AOFAS score increased to 85 points; in one patient, radiographic signs of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints were present and, in another patient, only talo-navicular joint was present, although both patients were free from pain. The difference between the two AOFAS scores was statistically significant. We believe that primary subtalar arthrodesis performed for markedly comminuted Sanders type IV calcaneal fractures yielded good mid-term results, and it is especially indicated when surgical treatment is delayed for whatever reason. A preliminary open reduction and internal fixation to restore the normal height of the calcaneus before performing the subtalar arthrodesis, as suggested by several authors, does not seem indispensable to obtain good clinical results. 2009 Elsevier Ltd. All rights reserved.

  20. Windlass Mechanism in Individuals With Diabetes Mellitus, Peripheral Neuropathy, and Low Medial Longitudinal Arch Height.

    PubMed

    Gelber, Judith R; Sinacore, David R; Strube, Michael J; Mueller, Michael J; Johnson, Jeffrey E; Prior, Fred W; Hastings, Mary K

    2014-08-01

    The windlass mechanism, acting through the plantar fascia, stabilizes the arches of the foot during stance phase of gait. The purpose of this study was to compare changes in radiographic measurements of the medial longitudinal arch (MLA) between toe-flat and -extended positions in participants with and without diabetes mellitus (DM), peripheral neuropathy (PN), and a low MLA. Twelve participants with DMPN and low MLA and 12 controls received weightbearing radiographs in a toe-flat and toe-extended position. DMPN participants were subcategorized from radiographs into DMPN severe, evidence of severe joint changes, and DMPN low, absence of joint changes. Primary measurements of MLA were determined in each position and included Meary's angle, talar declination angle, first metatarsal declination angle, and navicular height. The DMPN severe group had no difference between toe-flat and -extended positions for Meary's, talar declination, and first metatarsal declination angles (P > .35) while navicular height elevated (P < .05). The DMPN low group had no difference between toe-flat and -extended positions for talar declination angle (P = .38), while Meary's angle, first metatarsal declination angle, and navicular height elevated (P < .05). All measurements in the control group changed, consistent with arch height elevation, when toes were extended (P < .05). The DMPN severe and low groups showed impaired ability to raise the arch from the toe-flat to -extended position. Further research is needed to examine the contribution of specific windlass mechanism components (ie, plantar fascia, ligament, foot joint integrity, and mobility) as they relate to progressive foot deformity in adults with DMPN. Level III, comparative series. © The Author(s) 2014.

  1. Windlass mechanism in individuals with diabetes mellitus, peripheral neuropathy and low medial longitudinal arch height

    PubMed Central

    Gelber, Judith R.; Sinacore, David R.; Strube, Michael J; Mueller, Michael J.; Johnson, Jeffrey E.; Prior, Fred W.; Hastings, Mary K.

    2014-01-01

    Background The windlass mechanism, acting through the plantar fascia, stabilizes the arches of the foot during stance phase of gait. The purpose of this study was to compare changes in radiographic measurements of the medial longitudinal arch (MLA) between toe-flat and- extended positions in participants with and without diabetes mellitus (DM), peripheral neuropathy (PN) and a low MLA. Methods Twelve participants with DMPN and low MLA and 12 controls received weightbearing radiographs in a toe-flat and toe-extended position. DMPN participants were subcategorized from radiographs into DMPN severe, evidence of severe joint changes, and DMPN low, absence of joint changes. Primary measurements of MLA were determined in each position and included Meary's angle, talar declination angle, first metatarsal declination angle, and navicular height. Results The DMPN severe group had no difference between toe-flat and -extended positions for Meary's, talar declination and first metatarsal declination angles (p>0.35) while navicular height elevated (p<0.05). The DMPN low group had no difference between toe-flat and -extended positions for talar declination angle (p=0.38), while Meary's angle, first metatarsal declination angle and navicular height elevated (p<0.05). All measurements in the control group changed, consistent with arch height elevation, when toes were extended (p<0.05). Conclusion The DMPN severe and low groups showed impaired ability to raise the arch from the toe-flat to -extended position. Further research is needed to examine the contribution of specific windlass mechanism components (i.e. plantar fascia, ligament, foot joint integrity and mobility) as they relate to progressive foot deformity in adults with DMPN. PMID:24917647

  2. Acute Orthotic Intervention Does Not Affect Muscular Response Times and Activation Patterns at the Knee

    PubMed Central

    Rose, Holly M.; Shultz, Sandra J.; Arnold, Brent L.; Gansneder, Bruce M.; Perrin, David H.

    2002-01-01

    Objective: To evaluate the short-term effect of a semirigid foot orthotic device on response times and activation patterns of knee musculature in individuals with hyperpronation after a lower extremity perturbation in a single-leg, weight-bearing stance. Design and Setting: We used a lower extremity perturbation device designed to produce a forward and either internal or external rotation of the trunk and femur on the weight-bearing tibia to evoke a reflex response. Subjects were tested both with and without orthotic devices. Subjects: Seventeen (13 male, 4 female) volunteers (age, 20.6 ± 1.8 years; height, 181.0 ± 8.1 cm; weight, 87.4 ± 19.5 kg; navicular drop, 12.1 ± 1.8 mm) with a navicular drop greater than 10 mm volunteered for this study. Measurements: Long latency reflex times were recorded via surface electromyography for the medial and lateral hamstrings, gastrocnemius, and quadriceps muscles. Results: A dependent-sample t test revealed a significant decrease in navicular drop with orthotic intervention (P < .0001). With that confirmed, separate repeated-measures analyses of variance with 2 within factors (orthotic condition and muscle) revealed no significant difference in muscle response time between orthotic and nonorthotic conditions for either internal or external rotation perturbation. Although we found a main effect for muscle for both internal (P < .0001) and external (P < .0001) rotation, indicating a preferred muscle activation order, this activation order did not differ between orthotic and nonorthotic conditions (internal rotation P = .674, external rotation P = .829). Conclusions: Our findings suggest that a short-term application of a semirigid orthotic device does not alter muscle response times or activation patterns of the muscles that stabilize the knee. Further research is needed to determine whether changes in activation patterns may occur over time since mechanical adaptations occur with long-term wear. PMID:12937425

  3. Juvenile onset ankylosing spondylitis with ankylosing tarsitis: a rare combination.

    PubMed

    Siddiq, A B; Hasan, S A; Abdullah, A M; Azad, S A; Khan, E H; Khasru, M R

    2012-01-01

    Ankylosing spondylitis is the most common whereas ankylosing tarsitis is the least common subgroup of juvenile onset spondyloarthritides. In our recent study a male presented with ankle joint pain and swelling with limited movements and characteristic radiological changes including; periarticular swelling, thickened heel pad, hyperostosis and reduced ankle, calcaneo-cuboid and talo-navicular joint space for ankylosing tarsitis. He also had persistent inflammatory low back pain with radiological sacroilitis satisfying the clinical features for ankylosing spondylitis. The patient was treated with different anti-inflammatory agents including intra-articular methyl-prednisolone with short-term relief. Associated back pain was improved with spine mobilizing exercise.

  4. Subtalar coalition in pediatrics.

    PubMed

    Mosca, Vincent S

    2015-06-01

    Subtalar tarsal coalition is an autosomal dominant developmental maldeformation that affects between 2% and 13% of the population. The most common locations are between the calcaneus and navicular and between the talus and calcaneus. If prolonged attempts at nonoperative management do not relieve the pain, surgery is indicated. The exact surgical technique(s) should be based on the location of the pain, the size and histology of the coalition, the health of the other joints and facets, the degree of foot deformity, and the excursion of the heel cord.

  5. Hoof wall surgery in the horse: approaches to and underlying disorders.

    PubMed

    Honnas, Clifford M; Dabareiner, Robin M; McCauley, Betsy H

    2003-08-01

    Because of the hoof capsule, surgery of the equine foot is often perceived to be quite difficult. Knowledge of the specific disease entities that require surgical intervention as well as an in-depth understanding of the anatomy of the tissues beneath the hoof capsule is a definite prerequisite to successful surgical treatment. This article details the surgical approaches used to treat septic navicular bursitis, septic pedal osteitis, infection of the collateral cartilages, and keratomas. The principles used to treat these conditions can be applied to a variety of other conditions for which access through the hoof wall is required.

  6. Novel COL1A1 gene mutation (R1026X) of type I osteogenesis imperfecta: A first case report.

    PubMed

    Niramitmahapanya, Sathit; Anusornvongchai, Thitinun; Pingsuthiwong, Sarinee; Sarinnapakorn, Veerasak; Deerochanawong, Chaicharn; Sunthornthepvarakul, Thongkum

    2013-03-01

    A 22-year-old Thai man with blue sclera, normal height and absence of deformity sustained an open fracture at the right talus and talo-navicular dislocation while playing in a volleyball match. The patient had a history of several fractures of his elbows, wrists and ankles from minor impacts. Novel COL1A1 nonsense mutation (c. 3202 C-->T), a C to T transition at position 3,203, resulting in arginine to stop codon at codon 1026 (R102 6X) mutation in exon 42 was found, and this is the first case reported in the literature.

  7. Anterior tarsal tunnel syndrome secondary to missed talus fracture: a case report.

    PubMed

    Cetinkal, Ahmet; Topuz, Kivanc; Kaya, Serdar; Colak, Ahmet; Demircan, Mehmet Nusret

    2011-01-01

    The anterior tarsal tunnel syndrome (ATTS) has first been described by Kopell and Thompson in 1963. The anterior tarsal tunnel is formed by the fascia lining the inferior extensor retinaculum and talus as well as the navicular bone. Many ATTS cases with various etiologies have been reported since the first description. We report here an ATSS case resulting from a fibro-osseous structure that occurred after a missed talus fracture. The ATTS diagnosis can be made with a comprehensive clinical neurological examination and electrophysiological study. The treatment is based on the underlying etiology, while surgery is the most common treatment providing successful outcomes in the long term.

  8. Cancellous structure of tarsal bones.

    PubMed Central

    Sinha, D N

    1985-01-01

    The internal structure of the tarsal bones has been studied to investigate their cancellous architecture. It is revealed that these bones have fine and coarse meshworks and even a tendency for obliteration of the trabecular pattern in the bones lying distal to this midtarsal joint. Internal structure of the talus does not show an arched pattern of bony lamellae. An increased density of bony lamellae in the internal structure of the navicular bone could result from excessive stress, enforced by its close relationship to the three cuneiform bones. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:4066465

  9. Management of foot pain associated with accessory bones of the foot: two clinical case reports.

    PubMed

    Requejo, S M; Kulig, K; Thordarson, D B

    2000-10-01

    Case study. To discuss the differential diagnosis, the nonsurgical and postoperative management of common accessory bones of the foot. Accessory bones of the foot that are formed during abnormal ossification are commonly found in asymptomatic feet. Two of the most common accessory bones are the accessory navicular and the os peroneum. Their painful presence must be considered in the differential diagnosis of any acute or chronic foot pain. The optimal treatment for the conservative and postoperative management of painful os peroneum and accessory navicular bones remains undefined. Therapeutic management of the fractured os peroneum included bracing, taping, and foot orthotics to allow healing of involved tissues, and stretching. The focus of the postoperative management of the accessory navicular was joint mobilization and progressive strengthening. Dependent variables included level of pain with provocation and alleviation tests of joint and soft tissue; girth and sensory tests of the foot and ankle; goniometric measures of foot and ankle; strength of ankle and hip muscles; functional tests; and patient's self-reported pain status. The patient with the fractured os peroneum was treated in 13 visits for 10 weeks. At discharge from physical therapy, the patient had the following outcomes relative to the noninvolved side: 100% return of normal sensation tested by light touch and vibration; pain decreased from 6/10 to 1/10; 100% reduction of swelling with ankle girth to normal; 100% range of motion of ankle and subtalar joints. Strength in plantar flexion and eversion remained 20% impaired (80% return to normal) secondary to pain. Upon discharge, he still reported mild pain when walking but was able to return to previous leisure activities. The second patient with the accessory navicular was treated in 18 visits over 9 weeks. Relative to the uninvolved side, she was discharged with the following: 70% return of range of motion in the foot and ankle, 100% of strength in

  10. Long term follow-up of medial column fusion and tibialis anterior transposition for adolescent flatfoot deformity.

    PubMed Central

    Sekiya, J. K.; Saltzman, C. L.

    1997-01-01

    We report the results of three patients (four feet) who had surgical correction of adolescent flatfeet performed over fifty years ago. The surgery involved medial column stabilization with fusion procedures and tibialis anterior transposition into the navicular (Young's tenosuspension procedure). In this small sample, we found a high rate of painful arthrosis that developed over time in the contiguous joints of the foot. Images Figure 1A Figure 1B Figure 1C Figure 1D Figures 2A Figures 2B Figures 2C Figure 3 Figure 3B Figure 4 PMID:9234984

  11. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis

    PubMed Central

    Newman, Phil; Witchalls, Jeremy; Waddington, Gordon; Adams, Roger

    2013-01-01

    Background Medial tibial stress syndrome (MTSS) affects 5%–35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Methods Medical research databases were searched for relevant literature, using the terms “MTSS AND prevention OR risk OR prediction OR incidence”. Results A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29–1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56–3.43, P<0.001); fewer years of running experience (SMD −0.74, 95% CI −1.26 to −0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15–2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17–11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08–0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02–0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00–3.96, P=0.05). Conclusion Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly

  12. [2 new species of gregarines parasites of annelides: Pleurocystis eiseniellae of Eiseniella tetraedra Sav.)Oligochaeta), Pterospora petaloprocti of Petaloproctus terricola Quatr. (Polychaeta)].

    PubMed

    Ormieres, R

    1977-01-01

    The first species belongs to the genus Pleurocystis (in the Oligocheta host, Eiseniella tetraedra). It is characterized by early syzygies with lateral connection and navicular sporocysts with similar poles. It differs from the only species already described of the genus and is named Pleurocystis eiseniellae n. sp. The second one is related to the genus Pterospora (in the Polychaeta host, Petaloproctus terricola) but differs from the three species already known by its size and number of terminal digitations in specimens always found in syzygy. The sporocysts with dissimilar poles (one rounded, the other neck-shaped) show a loose epispore. This Gregarine in named Pterospora petaloprocti n. sp.

  13. Foot and ankle fractures in dancers.

    PubMed

    Goulart, Megan; O'Malley, Martin J; Hodgkins, Christopher W; Charlton, Timothy P

    2008-04-01

    Fractures in the dance population are common. Radiography, CT, MRI, and bone scan should be used as necessary to arrive at the correct diagnosis after meticulous physical examination. Treatment should address the fracture itself and any surrounding problems such as nutritional/hormonal issues and training/performance techniques and regimens. Compliance issues in this population are a concern, so treatment strategies should be tailored accordingly. Stress fractures in particular can present difficulties to the treating physician and may require prolonged treatment periods. This article addresses stress fractures of the fibula, calcaneus, navicular, and second metatarsal; fractures of the fifth metatarsal, sesamoids, and phalanges; and dislocation of toes.

  14. Arthroscopic Resection of Too-Long Anterior Process of the Calcaneus.

    PubMed

    Lui, Tun Hing

    2016-10-01

    A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.

  15. Increasing concentrations of perfluoroalkyl acids in Scandinavian otters (Lutra lutra) between 1972 and 2011: a new threat to the otter population?

    PubMed

    Roos, Anna; Berger, Urs; Järnberg, Ulf; van Dijk, Jiska; Bignert, Anders

    2013-10-15

    Liver samples from 140 otters (Lutra lutra) from Sweden and Norway were analyzed for 10 perfluoroalkyl carboxylic acids (PFCAs; C6-C15), 4 perfluoroalkane sulfonic acids (PFSAs; C4,C6,C8,C10) and perfluorooctane sulfonamide (FOSA). Perfluorooctane sulfonic acid (PFOS) was the dominant compound accounting for approximately 80% of the fluorinated contaminants and showing concentrations up to 16 μg/g wet weight. Perfluorononanoic acid (PFNA) was the dominant PFCA (up to 640 ng/g wet weight) closely followed by the C10 and C11 homologues. A spatial comparison between otters from southwestern Norway, southern and northern Sweden sampled between 2005 and 2011 revealed that the samples from southern Sweden had generally the largest contaminant load, but two PFCAs and FOSA were higher concentrated in the Norwegian samples. A temporal trend study was performed on otters from southern Sweden collected between 1972 and 2011. Seven PFCAs (C8-C14), PFOS and perfluorodecane sulfonic acid (PFDS) showed significantly increasing trends with doubling times between 5.5 and 13 years. The PFCAs also showed significantly increasing trends over the period 2002 to 2011. These findings together with the exceptionally high liver concentrations of PFOS are of great concern for the Scandinavian otter populations.

  16. Latitudinal gradient of airborne polyfluorinated alkyl substances in the marine atmosphere between Germany and South Africa (53 degrees N-33 degrees S).

    PubMed

    Jahnke, Annika; Berger, Urs; Ebinghaus, Ralf; Temme, Christian

    2007-05-01

    Neutral, volatile polyfluorinated alkyl substances (PFAS) were determined in high-volume air samples collected onboard the German research vessel Polarstern during cruise ANTXXIII-1 between Bremerhaven, Germany (53 degrees N) and Capetown, Republic of South Africa (33 degrees S) in fall 2005. An optimized and validated analytical protocol was used for the determination of several fluorotelomer alcohols (FTOHs) as well as N-alkylated fluorooctane sulfonamides and sulfonamidoethanols (FOSAs/FOSEs). Quantitative analyses were done by gas chromatography-mass spectrometry. This study provides the first concentration data of airborne PFAS from the Southern Hemisphere. Results indicate a strongly decreasing concentration gradient from the European continent toward less industrialized regions. The study confirms that airborne PFAS are mainly restricted to the Northern Hemisphere with a maximum concentration of 190 pg/m3 (8:2 FTOH) in the first sample collected in the channel between the European mainland and the UK. However, south of the equator, trace amounts of several FTOHs and FOSAs with a maximum of 14 pg/m3 (8:2 FTOH) could still be detected. Furthermore, a selection of ionic PFAS including perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) were determined in the particulate phase of high-volume air samples by liquid chromatography-mass spectrometry. Levels of ionic PFAS were almost 2 orders of magnitude lower than those of neutral PFAS, with maximum concentrations in the first sample of 2.5 pg/m3 (PFOS) and 2.0 pg/m3 (PFOA).

  17. Perfluoroalkyl substances and extractable organic fluorine in surface sediments and cores from Lake Ontario.

    PubMed

    Yeung, Leo W Y; De Silva, Amila O; Loi, Eva I H; Marvin, Chris H; Taniyasu, Sachi; Yamashita, Nobuyoshi; Mabury, Scott A; Muir, Derek C G; Lam, Paul K S

    2013-09-01

    Fourteen perfluoroalkyl substances (PFASs) including short-chain perfluorocarboxylates (PFCAs, C4-C6) and perfluoroalkane sulfonates (PFSAs, C4 and C6) were measured in surface sediment samples from 26 stations collected in 2008 and sediment core samples from three stations (Niagara, Mississauga, and Rochester basins) collected in 2006 in Lake Ontario. Perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorodecanoate (PFDA), and perfluoroundecanoate (PFUnDA) were detected in all 26 surface sediment samples, whereas perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonamide (FOSA), perfluorododecanoate (PFDoDA) and perfluorobutanoate (PFBA) were detected in over 70% of the surface sediment samples. PFOS was detected in all of the sediment core samples (range: 0.492-30.1ngg(-1) d.w.) over the period 1952-2005. The C8 to C11 PFCAs, FOSA, and PFBA increased in early 1970s. An overall increasing trend in sediment PFAS concentrations/fluxes from older to more recently deposited sediments was evident in the three sediment cores. The known PFCAs and PFSAs accounted for 2-44% of the anionic fraction of the extractable organic fluorine in surface sediment, suggesting that a large proportion of fluorine in this fraction remained unknown. Sediment core samples collected from Niagara basin showed an increase in unidentified organic fluorine in recent years (1995-2006). These results suggest that the use and manufacture of fluorinated organic compounds other than known PFCAs and PFSAs has diversified and increased.

  18. Characterization of two passive air samplers for per- and polyfluoroalkyl substances.

    PubMed

    Ahrens, Lutz; Harner, Tom; Shoeib, Mahiba; Koblizkova, Martina; Reiner, Eric J

    2013-12-17

    Two passive air sampler (PAS) media were characterized under field conditions for the measurement of per- and polyfluoroalkyl substances (PFASs) in the atmosphere. The PASs, consisting of polyurethane foam (PUF) and sorbent-impregnated PUF (SIP) disks, were deployed for over one year in parallel with high volume active air samplers (HV-AAS) and low volume active air samplers (LV-AAS). Samples were analyzed for perfluoroalkyl carboxylic acids (PFCAs), perfluoroalkane sulfonic acids (PFSAs), fluorotelomer alcohols (FTOHs), fluorotelomer methacrylates (FTMACs), fluorotelomer acrylates (FTACs), perfluorooctane sulfonamides (FOSAs), and perfluorooctane sulfonamidoethanols (FOSEs). Sampling rates and the passive sampler medium (PSM)-air partition coefficient (KPSM-A) were calculated for individual PFASs. Sampling rates were similar for PFASs present in the gas phase and particle phase, and the linear sampling rate of 4 m(-3) d(-1) is recommended for calculating effective air sample volumes in the SIP-PAS and PUF-PAS for PFASs except for the FOSAs and FOSEs in the PUF-PAS. SIP disks showed very good performance for all tested PFASs while PUF disks were suitable only for the PFSAs and their precursors. Experiments evaluating the suitability of different isotopically labeled fluorinated depuration compounds (DCs) revealed that (13)C8-perfluorooctanoic acid (PFOA) was suitable for the calculation of site-specific sampling rates. Ambient temperature was the dominant factor influencing the seasonal trend of PFASs.

  19. Polyfluorinated Compounds in Serum Linked to Indoor Air in Office Environments

    PubMed Central

    Fraser, Alicia J; Webster, Thomas F; Watkins, Deborah J; Nelson, Jessica W; Stapleton, Heather M; Calafat, Antonia M; Kato, Kayoko; Shoeib, Mahiba; Vieira, Verónica M; McClean, Michael D

    2011-01-01

    We aimed to investigate the role of indoor office air on exposure to polyfluorinated compounds (PFCs) among office workers. Week-long, active air sampling was conducted during the winter of 2009 in 31 offices in Boston, MA. Air samples were analyzed for fluorotelomer alcohols (FTOHs), sulfonamides (FOSAs), and sulfonamidoethanols (FOSEs). Serum was collected from each participant (n=31) and analyzed for twelve PFCs including PFOA and PFOS. In air, FTOHs were present in the highest concentrations, particularly 8:2-FTOH (GM=9,920 pg/m3). FTOHs varied significantly by building with the highest levels observed in a newly constructed building. PFOA in serum was significantly correlated with air levels of 6:2-FTOH (r=0.43), 8:2-FTOH (r=0.60), and 10:2-FTOH (r=0.62). Collectively, FTOHs in air significantly predicted PFOA in serum (p < 0.001) and explained approximately 36% of the variation in serum PFOA concentrations. PFOS in serum was not associated with air levels of FOSAs/FOSEs. In conclusion, FTOH concentrations in office air significantly predict serum PFOA concentrations in office workers. Variation in PFC air concentrations by building is likely due to differences in the number, type, and age of potential sources such as carpeting, furniture and/or paint. PMID:22148395

  20. Perfluorinated alkyl substances (PFASs) in household dust in Central Europe and North America.

    PubMed

    Karásková, Pavlína; Venier, Marta; Melymuk, Lisa; Bečanová, Jitka; Vojta, Šimon; Prokeš, Roman; Diamond, Miriam L; Klánová, Jana

    2016-09-01

    Concentrations of 20 perfluorinated alkyl substances (PFASs) were measured in dust samples from 41 homes in Canada, the Czech Republic, and United States in the spring-summer of 2013. The most frequently detected compounds were perfluorohexanoic acid (PFHxA) and perfluorooctane sulfonate (PFOS). PFOS and perfluorooctanoic acid (PFOA) had the highest concentrations of PFASs in all countries. PFOS median concentrations for the three countries were between 9.1 and 14.1ng/g, and PFOA medians ranged between 8.2 and 9.3ng/g. In general, concentrations in North America were higher than in the Czech Republic, which is consistent with usage patterns. No differences were found for perfluorooctane sulfonamides/sulfonamidoethanols (FOSA/Es) levels due to the low number of detections. Homologue profiles suggest that the shift from longer to shorter chain PFASs is more advanced in North America than in Europe. Significant relationships were found among individual homologues and between PFAS concentrations in dust and type of floor, number of people living in the house, and building age.

  1. Effect of body condition on tissue distribution of perfluoroalkyl substances (PFASs) in Arctic fox (Vulpes lagopus).

    PubMed

    Aas, Camilla Bakken; Fuglei, Eva; Herzke, Dorte; Yoccoz, Nigel G; Routti, Heli

    2014-10-07

    Arctic animals undergo large seasonal fluctuations in body weight. The effect of body condition on the distribution and composition of 16 perfluoroalkyl substances (PFASs) was investigated in liver, blood, kidney, adipose tissue, and muscle of Arctic foxes (Vulpes lagopus) from Svalbard (n = 18, age 1-3 years). PFAS concentrations were generally highest in liver, followed by blood and kidney, while lowest concentrations were found in adipose tissue and muscle. Concentrations of summed perfluorocarboxylic acids and perfluoroalkyl sulfonates were five and seven times higher, respectively, in adipose tissue of lean compared to fat foxes. In addition, perfluorodecanoate (PFDA) and perfluoroheptanesulfonate (PFHpS) concentrations in liver, kidney, and blood, and, perfluorononanoate (PFNA) in liver and blood, were twice as high in the lean compared to the fat foxes. The ratio between perfluorooctane sulfonamide (FOSA) and its metabolite perfluorooctanesulfonate (PFOS) was lowest in liver, muscle, and kidney, while significantly higher proportions of FOSA were found in adipose tissue and blood. The results of the present study suggest that toxic potential of exposure to PFAS among other pollutants in Arctic mammals may increase during seasonal emaciation. The results also suggest that body condition should be taken into account when assessing temporal trends of PFASs.

  2. Distribution profiles of per- and poly fluoroalkyl substances (PFASs) and their re-regulation by ocean currents in the East and South China Sea.

    PubMed

    Zheng, Hongyuan; Wang, Feng; Zhao, Zhen; Ma, Yuxin; Yang, Haizhen; Lu, Zhibo; Cai, Minggang; Cai, Minghong

    2017-08-09

    We investigated the distribution of 17 individual per- and polyfluoroalkyl substances (PFASs) in 42 surface water samples collected from the East and South China Seas (7.0-36.0°N, 110.0°N-123.0°E). Concentrations of 7 individual PFASs, including perfluorobutane sulfonate (PFBS), perfluorohexane sulfonate (PFHxS), perfluoropentanoic acid (PFPA), perfluorohexanoate (PFHxA), perfluoroheptanoate (PFHpA), perfluorooctanoic acid (PFOA), and perfluorooctane sulfonamide (FOSA), were quantified in the East China Sea, but only concentrations of PFOA and FOSA were quantified in the South China Sea. The total concentrations of the 17 PFASs ranged from 181 to 2658pg/L in the East China Sea and from 62 to 494pg/L in the South China Sea. We also show that river fluxes and ocean currents had a strong influence on the distribution of PFASs in the East China Sea. Using ArcGIS 10.1, we show how ocean currents control the spatial distribution of PFOA in the central South China Sea. Copyright © 2017. Published by Elsevier Ltd.

  3. Behaviors of N-ethyl perfluorooctane sulfonamide ethanol (N-EtFOSE) in a soil-earthworm system: Transformation and bioaccumulation.

    PubMed

    Zhao, Shuyan; Ma, Xinxin; Fang, Shuhong; Zhu, Lingyan

    2016-06-01

    N-ethyl perfluorooctane sulfonamido ethanol (N-EtFOSE) is a typical precursor of perfluorooctane sulfonate (PFOS). In this study, the behaviors of N-EtFOSE in a soil-earthworm system, including biodegradation in soil and bioaccumulation and biotransformation in earthworms (Eisenia fetida) were investigated. N-EtFOSE could be biodegraded in soil and biotransformed in earthworms to several metabolites, including n-ethylperfluorooctane sulfonamide acetate (N-EtFOSAA), perfluorooctane sulfonamide acetate (FOSAA), perfluorooctane sulfonamide (FOSA) and PFOS, with N-EtFOSAA as the predominant intermediate and PFOS as the terminal product in both soil and earthworm. The uptake rate coefficients (ku, 0.746 goc gdw(-1)d(-1)), degradation rate constant in soil (k0, 0.138 d(-1)) and the biota-to-soil accumulation factor (BSAF, 0.523 goc gdw(-1)) of N-EtFOSE were estimated. For N-EtFOSE, N-EtFOSAA, FOSAA, FOSA and PFOS, their loss rate constants in earthworms were in the range of 0.467-30.2 (α) and 0.006-0.415 (β) d(-1), respectively. The results provided important information about the behaviors of N-EtFOSE in the soil-earthworm system.

  4. Relationships Between Lower Extremity Alignment and the Quadriceps Angle

    PubMed Central

    Nguyen, Anh-Dung; Boling, Michelle C.; Levine, Beverly; Shultz, Sandra J.

    2010-01-01

    Objective To determine the extent to which select lower extremity alignment characteristics of the pelvis, hip, knee, and foot are related to the Q angle. Design Descriptive cohort study design. Setting Applied Neuromechanics Research Laboratory. Participants Two hundred eighteen participants (102 males, 116 females). Assessment of Risk Factors Eight clinical measures of static alignment of the left lower extremity were measured by a single examiner to determine the impact of lower extremity alignment on the magnitude of Q angle. Main Outcome Measures Q angle, pelvic angle, hip anteversion, tibiofemoral angle, genu recurvatum, tibial torsion, navicular drop, and femur and tibia length. Results Once all alignment variables were accounted for, greater tibiofemoral angle and femoral anteversion were significant predictors of greater Q angle in both males and females. Pelvic angle, genu recurvatum, tibial torsion, navicular drop, and femur to tibia length ratio were not significant independent predictors of Q angle in males or females. Conclusions Greater femoral anteversion and tibiofemoral angle result in greater Q angle, with changes in tibiofemoral angle having a substantially greater impact on the magnitude of the Q angle compared with femoral anteversion. As such, the Q angle seems to largely represent a frontal plane alignment measure. As many knee injuries seem to result from a combination of both frontal and transverse plane motions and forces, this may in part explain why Q angle has been found to be a poor independent predictor of lower extremity injury risk. PMID:19423972

  5. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

    PubMed

    Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

    2017-03-25

    Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

  6. [A Combination of Young's and Grice's Operation in Pes Planovalgus in Children with Cerebral Palsy.].

    PubMed

    Smetana, V; Schejbalová, A

    1997-01-01

    The authors describe a combination of operations according to Young and Grice, i.e. a combination of suspension of the os naviculare on the anterior tibial muscle for modelling the longitudinal arch of the foot with extraarticular talocalcanear arthrodesis, when dealing with neurogenic deformities of the sole in cerebral palsy in children, and evaluate the results of the operation. In general the authors draw attention to certain changes in the clinical picture of cerebral palsy, in particular a more frequent incidence of deformities of the soles which in recent years shifted from the original age of 6-8 years to the age 4-3 years. The combination of the mentioned operations improves the reposition of the soles and thus the general results of Grice's operation which is basic in deformities of the sole in surgery of celebral palsy. Young's operation can be performed in young children also separately. However, it does not produce permanent results without a secondary Grice's operation. It can be implemented in a second stage. Young's operation cannot be made unless there is a sufficiently strong anterior tibial muscle (at least grade 4 in the muscle test). Thus it cannot be performed in weak pareses. The achieved results (64,9 % excellent, 27,0 % good) fully justify the combination of the above operations. Key words: cerebral palsy (CP), extraarticular talocalcanear arthrodesis, Grice's operation, Young's operation, transposition of the tendon of the anterior tibial muscle across the os naviculare.

  7. Clinical measures of static foot posture do not agree.

    PubMed

    Langley, Ben; Cramp, Mary; Morrison, Stewart C

    2016-01-01

    The aim of this study was to determine the level of agreement between common clinical foot classification measures. Static foot assessment was undertaken using the Foot Posture Index (FPI-6), rearfoot angle (RFA), medial longitudinal arch angle (MLAA) and navicular drop (ND) in 30 participants (29 ± 6 years, 1.72 ± 0.08 m, 75 ± 18 kg). The right foot was measured on two occasions by one rater within the same test environment. Agreement between the test sessions was initially determined for each measure using the Weighted Kappa. Agreement between the measures was determined using Fleiss Kappa. Foot classification across the two test occasions was almost perfect for MLAA (Kw = .92) and FPI-6 (Kw = .92), moderate for RFA (Kw = .60) and fair for ND (Kw = .40) for comparison within the measures. Overall agreement between the measures for foot classification was moderate (Kf = .58). The findings reported in this study highlight discrepancies between the chosen foot classification measures. The FPI-6 was a reliable multi-planar measure whereas navicular drop emerged as an unreliable measure with only fair agreement across test sessions. The use of this measure for foot assessment is discouraged. The lack of strong consensus between measures for foot classification underpins the need for a consensus on appropriate clinical measures of foot structure.

  8. Sonographic assessment of clubfoot.

    PubMed

    Gigante, Cosimo; Talenti, E; Turra, S

    2004-06-01

    This study was performed to develop a standardized methodology for the sonographic assessment of clubfoot at birth and at the end of both conservative treatment and surgical correction. Forty-two congenital clubfeet and 42 normal feet were examined sonographically in the position of spontaneous alignment and during passive manual correction. Scans along 4 planes provided information relevant to the assessment: sagittal posterior, sagittal anterior, coronal lateral, and transverse. Sagittal posterior sonograms demonstrated the progressive gain of dorsiflexion ability during the different steps of treatment for clubfoot. Sagittal anterior sonograms could not demonstrate the normal alignment of the navicular in clubfeet because of the bone's medial displacement. On transverse sonograms, the talar head and the medially displaced navicular may lie on the same plane, depending on the severity of the deformity. Coronal lateral sonograms provided for estimation of the relationships between the calcaneus and cuboid, which were described by the calcaneal-cuboid angle. Sonography is a promising technique for assessment and monitoring of clubfoot during treatment. The method described here yields accurate and reproducible information about the anatomy of the nonossified clubfoot, helping the orthopedic team decide on appropriate treatment steps. Copyright 2004 Wiley Periodicals, Inc.

  9. Assessment of talus deformity by three-dimensional MRI in congenital clubfoot.

    PubMed

    Itohara, T; Sugamoto, K; Shimizu, N; Ohno, I; Tanaka, H; Nakajima, Y; Sato, Y; Yoshikawa, H

    2005-01-01

    To evaluate the morphological deformity of talus in congenital clubfoot by three-dimensional MRI. Subjects were five patients (two male, three female, mean age 5 months) with unilateral congenital clubfoot. Magnetic resonance imaging was performed of both feet using 1.5 T magnet. Based on the resulting magnetic resonance imaging volume data, a three-dimensional surface bone model was reconstructed by the Marching Cubes method. The long axis of the reconstructed model was determined, and in relation to the standard planes including this axis, the degree of talar head and neck deviation, and the relative positioning of the talus and navicular in the talonavicular joint were compared between normal foot and clubfoot. The talar head and neck angle in relation to the talus exhibited significant medial deviation in the clubfoot, but the degree of plantar deviation of the talar head and neck did not show significance. The navicular was located more medially in clubfoot than in normal foot. The volume of the total talar and of the ossific nucleus for the clubfoot was smaller than that for the normal foot. The assessment technique presented herein was shown to be useful in ascertaining the various pathological characteristics associated with clubfoot.

  10. Tarsal shape, size, and articulating surface morphology in adolescent surgically treated clubfoot and their contralateral normal foot.

    PubMed

    Roche, Christopher; Mattingly, Brian; Talwalkar, Vishwas; Tylkowski, Chester; Stevens, David B; Hardy, Peter A; Pienkowski, David

    2006-01-01

    Despite the inability of radiographic measurements to quantify the 3-dimensional (3D) shape and size of the hindfoot bones affected by the clubfoot pathology, radiographs continue to be used to evaluate treatment efficacy. Advancements in imaging and image analysis allow new quantitative insights to be obtained into bone shape and size. Therefore, this study sought to quantify and compare the 3D size, shape, and articulating surface morphology of the tibia, talus, calcaneus, navicular, and cuboid bones in the adolescent surgically treated unilateral clubfoot and the contralateral normal foot. Anatomic measurements were obtained by geometrically modeling 3D reconstructed magnetic resonance images of the hindfoot tarsals in the feet of 7 adolescents (mean age, 13.0+/-2.8 years). The results showed that the tarsal bones in the surgically treated clubfoot were smaller in volume (20%-36%) and smaller in surface area (16%-28%) than those in the contralateral normal foot. Correspondingly, the size and shape of the articulating surfaces of these bones in the surgically treated clubfoot were also smaller and flatter than those in the contralateral normal foot. Specifically, the mean talar articular surface area was 25% to 40% smaller, the mean talar-tibiotalar articular surface length was 26% smaller, the mean tibiotalar articular surface length difference was 78% smaller, and the mean navicular "flattening index" was 86% larger in the surgically treated clubfoot. These data offer an objective standard that will advance the knowledge of the clubfoot pathology and aid treatment efficacy evaluation.

  11. Load response of the medial longitudinal arch in patients with flatfoot deformity: in vivo 3D study

    PubMed Central

    Kido, Masamitsu; Ikoma, Kazuya; Imai, Kan; Tokunaga, Daisaku; Inoue, Nozomu; Kubo, Toshikazu

    2014-01-01

    Background The acquisition of flatfoot by an adult is thought to primarily be caused by posterior tibial tendon dysfunction, although some other causes, such as congenital flexible flatfoot or an accessory navicular, may also be responsible. The objective of this study was to evaluate the bone rotation of each joint in the medial longitudinal arch (MLA) and compare the response in healthy feet with that in flat feet by analyzing the reconstructive three-dimensional (3D) CT image data during weightbearing. Methods CT scans of 20 healthy feet and 24 feet with flatfoot deformity were taken in non-load condition followed by full-body weightbearing condition. Images of the tibia and MLA bones (first metatarsal bone, cuneiforms, navicular, talus, and calcaneus) were reconstructed into 3D models. The volume merge method in three planes was used to calculate the bone-to-bone relative rotations. Findings Under loading conditions, the flatfoot dorsiflexed more in the first tarsometatarsal joint, and everted more in the talonavicular and talocalcaneal joints compared with the healthy foot. The total relative rotation was larger in the flatfoot compared with the healthy foot only in the first tarsometatarsal joint. Interpretation Supporting the MLA in the sagittal direction and the subtalar joint in the coronal direction may be useful for treating flatfoot deformity. The first tarsometatarsal joint may play an important role in diagnosing or treating flatfoot deformity. PMID:23643289

  12. Load response of the medial longitudinal arch in patients with flatfoot deformity: in vivo 3D study.

    PubMed

    Kido, Masamitsu; Ikoma, Kazuya; Imai, Kan; Tokunaga, Daisaku; Inoue, Nozomu; Kubo, Toshikazu

    2013-06-01

    The acquisition of flatfoot by an adult is thought to primarily be caused by posterior tibial tendon dysfunction, although some other causes, such as congenital flexible flatfoot or an accessory navicular, may also be responsible. The objective of this study was to evaluate the bone rotation of each joint in the medial longitudinal arch (MLA) and compare the response in healthy feet with that in flat feet by analyzing the reconstructive three-dimensional (3D) CT image data during weightbearing. CT scans of 20 healthy feet and 24 feet with flatfoot deformity were taken in non-load condition followed by full-body weightbearing condition. Images of the tibia and MLA bones (first metatarsal bone, cuneiforms, navicular, talus, and calcaneus) were reconstructed into 3D models. The volume merge method in three planes was used to calculate the bone-to-bone relative rotations. Under loading conditions, the flatfoot dorsiflexed more in the first tarsometatarsal joint, and everted more in the talonavicular and talocalcaneal joints compared with the healthy foot. The total relative rotation was larger in the flatfoot compared with the healthy foot only in the first tarsometatarsal joint. Supporting the MLA in the sagittal direction and the subtalar joint in the coronal direction may be useful for treating flatfoot deformity. The first tarsometatarsal joint may play an important role in diagnosing or treating flatfoot deformity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Functional motion of the medial column joints of the foot during propulsion.

    PubMed

    Phillips, R D; Law, E A; Ward, E D

    1996-10-01

    Motion in the ankle, subtalar, midtarsal, and first metatarsophalangeal joints has been well documented. However, motion in the first metatarsocuneiform, the first cuneonavicular, and the first interphalangeal joint has not been addressed. Motion in these joints has not been documented because many believe that little motion occurs at these joints, and because of the difficulty in assessing motion at these joints. Using two-dimensional motion analysis, the authors present sagittal plane ranges of motion occurring in the first metatarsophalangeal joint, the first metatarsocuneiform joint, the medial cuneonavicular joint, and the first interphalangeal joint during the propulsive period of gait. This pilot study indicates that sagittal plane motion between the navicular and calcaneus and between the first metatarsal and first cuneiform are very mild and inconsistent. However, plantarflexion motion between the first cuneiform and the navicular is significant and comprises most of the plantarflexion motion of the first ray during propulsion. Motion in the first interphalangeal joint is slight during the first 80% of the propulsive period but shows slight-to-moderate dorsiflexion during the last 20% of the propulsive period of gait.

  14. Effect of the Intrinsic Foot Muscle Exercise Combined with Interphalangeal Flexion Exercise on Metatarsalgia with Morton’s Toe

    PubMed Central

    Yoo, Won-gyu

    2014-01-01

    [Purpose] This study examined the effects of the intrinsic foot muscle exercise combined with interphalangeal flexion exercise on metatarsalgia with Morton’s toe. [Subject] A 38-year-old male with Morton’s toe, who complained of pain in his left metatarsophalangeal joints was the subject. [Methods] The pressure pain threshold, peak contact pressure of the metatarsophalangeal region during gait, and the navicular drop were measured before and after the intrinsic foot muscles exercises combined with interphalangeal flexion exercise. [Results] After exercising for 2 weeks, the pressure pain threshold increased from 1 to 1.5 kg, while the peak contact pressure decreased from 0.63 to 0.50 kg/cm2, and the navicular drop improved from 5 to 8 mm. [Conclusion] The results show that the combined exercises alleviated the pain while walking by reducing the excessive pressure on the metatarsophalangeal region, and the improvement of gait with Morton’s toe. PMID:25540516

  15. [Mirizzi syndrome: experience at Spanish Hospital of Veracruz].

    PubMed

    Roesch-Dietlen, Federico; Pérez-Morales, Alfonso Gerardo; Martínez-Fernández, Silvia; Remes-Troche, José María; Jiménez-García, Victoria Alejandra; Romero-Sierra, Graciela

    2013-01-01

    Antecedentes: el síndrome de Mirizzi es una complicación de la litiasis vesicular por cálculos impactados en la bolsa de Hartmann o conducto cístico que comprimen la vía biliar principal; el diagnóstico se establece mediante estudios de imagen, aunque la mayor parte son hallazgos transoperatorios; su tratamiento es la colecistectomía con restauración de la vía biliar. Objetivo: analizar una serie de casos de síndrome de Mirizzi y comparar los resultados con lo publicado en la bibliografía mundial. Casos clínicos: se comunican cuatro casos con síndrome de Mirizzi de una cohorte de 1,034 casos con enfermedad litiásica vesicular del Hospital Español de Veracruz, en 21 años. La frecuencia en esta muestra es de 0.38%, con edad promedio de 32.1 ± 58.4 años; 50% son hombres y 25% tuvo ictericia y coluria con perfil hepático demostrativo. En un caso el ultrasonido sugirió síndrome de Mirizzi; el diagnóstico se corroboró por colangiografía percutánea y tomografía computada. A todos los pacientes se les realizó colecistectomía laparoscópica, y en dos se efectuó colangiografía transcística. Un caso correspondió al tipo I-A y 3 al tipo I-B según la Clasificación de Beltrán y Csendes. La evolución postoperatoria fue satisfactoria y no hubo mortalidad. Conclusiones: el síndrome de Mirizzi debe sospecharse en pacientes con litiasis vesicular con ictericia obstructiva. El cirujano debe extremar las precauciones para evitar lesionar la vía biliar.

  16. [Pseudomyxoma peritonei. Two-case-report].

    PubMed

    Carranza-Martínez, Ixchel; Cornejo-López, Gilberto; Monroy-Argumedo, Montserrat; Villanueva-Sáenz, Eduardo

    2014-01-01

    Antecedentes: el pseudomixoma peritoneal se caracteriza por la diseminación celular intraperitoneal de un tumor adenomucinoso; el apéndice cecal es la etiología más frecuente. Objetivo: reportar la experiencia de un grupo de Cirugía General y revisar la bibliografía. Casos clínicos: 1: paciente femenina de 74 años de edad, que cuatro días previos inició con dolor abdominal tipo cólico en el mesogastrio y fosa iliaca derecha, evacuaciones diarreicas y fiebre. A su ingreso al hospital se la encontró con datos de irritacion peritoneal y resistencia muscular, leucocitosis de 14,500 células por mm3, neutrófilos 89%, bandas 1%. Se diagnosticó: apendicitis aguda y se programó para laparoscopia diagnóstica, con distensión importante de asas, por lo que se decidió convertir a laparotomía. Caso 2: paciente masculino de 73 años de edad; el padecimiento actual se inició con dolor intermitente en la fosa iliaca derecha e hipogastrio, de un año de evolución. Al cuadro se agregaron: disnea, estreñimiento alternado con periodos de diarrea, plenitud gástrica, y pirosis. A la exploración física se encontró un tumor palpable en el mesogastrio y ambas fosas iliacas. Por eso se le realizó la laparotomía exploradora. En ambos casos el diagnóstico se estableció en el transoperatorio con el hallazgo de múltiples implantes tumorales mucinosos multilobulados diseminados en la cavidad peritoneal, el diagnóstico se confirmó con el reporte histopatológico de pseudomixoma peritoneal. Conclusiones: el pseudomixoma peritoneal es una neoplasia poco frecuente y de difícil diagnóstico, caracterizada por producción copiosa de ascitis mucinosa y de múltiples implantes tumorales en la serosa de las vísceras intracavitarias. El tratamiento ideal es la cirugía citorreductiva y la quimioterapia intraperitoneal perioperatoria o la quimioterapia postoperatoria, o ambas.

  17. Atmospheric concentrations and gas/particle partitioning of neutral poly- and perfluoroalkyl substances in northern German coast

    NASA Astrophysics Data System (ADS)

    Wang, Zhen; Xie, Zhiyong; Möller, Axel; Mi, Wenying; Wolschke, Hendrik; Ebinghaus, Ralf

    2014-10-01

    Total 58 high volume air samples were collected in Büsum, Germany, from August 2011 to October 2012 to investigate air concentrations of 12 per- and polyfluoroalkyl substances (PFASs) and their gas/particle partitioning. The total concentration (vapor plus particle phases) of the 12 PFASs (ΣPFASs) ranged from 8.6 to 155 pg/m3 (mean: 41 pg/m3) while fluorotelomer alcohols 8:2 (8:2 FTOH) dominated all samples accounting for 61.9% of ΣPFASs and the next most species were 10:2 FTOH (12.7%). Air mass back trajectory analysis showed that atmospheric PFASs in most samples were from long range atmospheric transport processes and had higher ratios of 8:2 to 6:2 FTOH compared to the data obtained from urban/industrial sources. Small portion of particle PFASs in the atmosphere was observed and the average percent to ΣPFASs was 2.0%. The particle-associated fractions of different PFASs decreased from perfluorooctane sulfonamidoethanols (FOSEs) (15.5%) to fluorotelomer acrylates (FTAs) (7.6%) to perfluorooctane sulfonamides (FOSAs) (3.1%) and FTOHs (1.8%), indicating the functional group obviously influenced their gas/particle partitioning. For neutral compounds with acid dissociation constant (pKa) > 7.0 (i.e., FTOHs, FOSEs and FOSAs), a significant log-linear relationship was observed between their gas/particle partition coefficients (KSP) and vapor pressures (pºL), suggesting the gas/particle partitioning of neutral PFASs agreed with the classical logKSP-logpºL relation. Due to the pKa values of 6:2 and 8:2 FTA below the typical environmental pH conditions, they mainly exist as ionic form in aerosols, and the corrected logKSP (neutral form) were considerably lower than those of FTOHs, FOSEs and FOSAs with similar vapor pressures. Considering the strong partitioning potential to aqueous phases for ionic PFASs at higher pH values, a need exists to develop a model taking account of the ad/absorption mechanism to the condensed phase of aerosols for ionizable PFASs (e

  18. [Adolescent idiopathic scoliosis].

    PubMed

    2016-12-01

    Adolescent idiopathic scoliosis is a 3D spinal deformity in frontal, sagittal and axial planes, with high relevance in the pediatric population especially in adolescents and females between 10 years of age and the end of growth spurt and skeletal maturity. The radiographic manifestation is a curve greater than 10° measured by Cobb method associated with vertebral rotation. "Idiopathic" diagnosis has to be done after neuroanatomical anomalies of the posterior cerebral fosa and spinal canal have been ruled out. The physical finding of a thoracic or lumbar hump is the clinical manifestation of vertebral rotation seen in a forward bending test (Adam's Test). It is recommended that all curves with a magnitude greater than 20° have to be controlled and treated by a spinal surgeon being observation, bracing and surgery the different treatment options based on the extent, progression of deformity and basically the clinical condition of the patient.

  19. Emergence of NDM-5- and MCR-1-Producing Escherichia coli Clones ST648 and ST156 from a Single Muscovy Duck (Cairina moschata)

    PubMed Central

    Yang, Run-Shi; Feng, Youjun; Lv, Xiao-Yue; Duan, Jia-Hong; Chen, Jing; Fang, Liang-Xing; Xia, Jing; Liao, Xiao-Ping

    2016-01-01

    Two Escherichia coli clones (sequence type 648 [ST648] and ST156) that coproduce NDM-5 and MCR-1 were detected from a single fowl in China. The blaNDM-5 gene was found on the two indistinguishable IncX3 plasmids from the two different E. coli isolates, whereas the mcr-1 gene was located on IncHI2 and IncI2 plasmids, respectively, suggesting that blaNDM-5 and mcr-1 have spread in avian intestinal flora. Also, the two strains harbor blaTEM-1, blaCTX-M-55, fosA3, and aac(6′)-Ib. The multiresistant E. coli strains (especially the epidemic clone ST648) might raise a potential threat to human health via food chain transmission. PMID:27550364

  20. Multiple evaluations of the removal of pollutants in road runoff by soil infiltration.

    PubMed

    Murakami, Michio; Sato, Nobuyuki; Anegawa, Aya; Nakada, Norihide; Harada, Arata; Komatsu, Toshiya; Takada, Hideshige; Tanaka, Hiroaki; Ono, Yoshiro; Furumai, Hiroaki

    2008-05-01

    Groundwater replenishment by infiltration of road runoff is expected to be a promising option for ensuring a sustainable urban water cycle. In this study, we performed a soil infiltration column test using artificial road runoff equivalent to approximately 11-12 years of rainfall to evaluate the removal of pollutants by using various chemical analyses and bioassay tests. These results indicated that soil infiltration treatment works effectively to remove most of the pollutants such as organic matter (chemical oxygen demand (CODMn) and dissolved organic carbon (DOC)), P species, polycyclic aromatic hydrocarbons (PAHs), numerous heavy metals and oestrogenic activities. Bioassay tests, including algal growth inhibition test, Microtox and mutagen formation potential (MFP) test, also revealed effective removal of toxicities by the soils. However, limited amounts of NO3, Mn, Ni, alkaline earth metals, perfluorooctane sulphonate (PFOS) and perfluorooctane sulphonamide (FOSA) were removed by the soils and they possibly reach the groundwater and cause contamination.

  1. Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children

    PubMed Central

    Cezarino, Bruno Nicolino; Park, Rubens; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Denes, Francisco T.; Srougi, Miguel

    2016-01-01

    ABSTRACT Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with an increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. Patient and Methods: A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria, with previous history of urinary infections‥ Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. Results: The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Conclusions: Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. PMID:27813386

  2. [Obesity as a risk factor for metabolic disorders in adults with urolithiasis].

    PubMed

    Medina-Escobedo, Martha; Alcocer-Dzul, Rogelio; López-López, José; Salha-Villanueva, Jorge

    2015-01-01

    Introducción: Yucatán ocupa el primer lugar en la prevalencia de litiasis urinaria (LU), y supera la media nacional de obesidad (OB). El objetivo del estudio fue conocer si existe una asociación entre la obesidad y las alteraciones metabólicas (AM) en pacientes con LU. Métodos: mediante un diseño de casos y controles, se estudiaron 197 pacientes con y sin LU. Se midió peso y talla; en orina se cuantificó calcio, fosfato, magnesio, ácido úrico, oxalatos, citratos y sodio. Resultados: se estudiaron 197 sujetos, 62 hombres y 135 mujeres; 114 sujetos con LU y 83 sin LU. La hiperuricosuria fue más frecuente en pacientes obesos sin LU. La hipocitraturia fue la AM de mayor frecuencia tanto en pacientes con, como sin OB, con y sin LU. Existió una tendencia positiva a un mayor número de AM en función del incremento de peso. Fue significativa la excreción de sodio urinario en los pacientes con OB. Conclusiones: la obesidad es factor de riesgo para AM en pacientes con LU. Deben implementarse estrategias que concienticen sobre la influencia de la obesidad en la LU, y como ésta puede ser modificada por la alimentación.

  3. Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children.

    PubMed

    Cezarino, Bruno Nicolino; Park, Rubens; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Denes, Francisco T; Srougi, Miguel

    2016-01-01

    Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with na increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria,with previous history of urinary infections.. Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. Copyright® by the International Brazilian Journal of Urology.

  4. [Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000].

    PubMed

    Torres Solis, José; Celis, J; Ruiz, E; Payet, E; Chavez, I; Berrospi, F; Young, F; Luque, C

    2011-01-01

    To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. A total de 148 patients were involved in this study. 29 of them (19.6%) develop gallbladder stones during the (x years of) follow up vs 119 (80.9%) . The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male.\\The mean time of develop gallbladder stones was 3.1 years.According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. The frecuency of gallbladder stones post gastrectomy in this study was 19.6%. The mean time of the develop and diagnosis of litiasis was 3.1 years.To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer.We need furthermore studies to have conclusions about the risk factors.

  5. Weightbearing CT scan of severe flexible pes planus deformities.

    PubMed

    Ferri, Melanie; Scharfenberger, Angela V; Goplen, Gord; Daniels, Timothy R; Pearce, Dawn

    2008-02-01

    The three-dimensional relationships of the bones in the foot in a flatfoot deformity are difficult to assess with standard radiographs. CT scans demonstrate these relationships but are typically made in a nonweightbearing mode. Our objective was to assess the use of a weightbearing CT apparatus to image the feet in patients with severe flexible pes planus deformities and to better define the anatomical changes that occur. A specialized device was designed and constructed to simulate weightbearing to the feet during CT examination. Eighteen normal feet and 30 painful severe and flexible pes planus feet were imaged in both the non weightbearing and weightbearing states, set at 50% of body weight. Several measurements of intertarsal relationships were made of the pes planus and normal feet. Navicular floor to skin distance, forefoot arch angle, and subtalar joint subluxation were measured in the coronal plane in both the weightbearing and nonweightbearing states. T-tests were used to analyze measurements of navicular floor to skin distance and forefoot arch angle. The weightbearing device had a significant effect on foot configuration for both normal and pes planus feet (p = 0.0008) and (p < 0.0001) respectively for both floor to skin distance and forefoot arch angle. There was a significant difference between normal feet and pes planus feet with regard to the forefoot arch angle in the nonweightbearing (p = 0.02) and weightbearing states (p = 0.01). Four of the pes planus patients had evidence of subtalar joint subluxation which was more pronounced in the weightbearing state. There was no significant difference between the navicular floor to skin distance in the normal versus pes planus feet in either the non weightbearing (p = 0.05) or the weightbearing states (p = 0.07). A device was designed and constructed to apply a weightbearing load equal to that of 50% body weight with minimal to no patient discomfort. The resultant effects on foot configuration were

  6. Biomechanical investigation of two plating systems for medial column fusion in foot

    PubMed Central

    Simons, Paul; Sommerer, Theresia; Zderic, Ivan; Wahl, Dieter; Lenz, Mark; Skulev, Hristo; Knobe, Matthias; Gueorguiev, Boyko; Richards, R. Geoff; Klos, Kajetan

    2017-01-01

    Background Arthrodesis of the medial column (navicular, cuneiform I and metatarsal I) is performed for reasons such as Charcot arthropathy, arthritis, posttraumatic reconstruction or severe pes planus. However, the complication rate is still high and mainly resulting from inadequate fixation. Special plates, designed for medial column arthrodesis, seem to offer potential to reduce the complication rate. The aim of this study was to investigate biomechanically plantar and dorsomedial fusion of the medial column using two new plating systems. Methods Eight matched pairs of human cadaveric lower legs were randomized in two groups and medial column fusion was performed using either plantar or dorsomedial variable-angle locking compression plates. The specimens were biomechanically tested under cyclic progressively increasing axial loading with physiological profile of each cycle. In addition to the machine data, mediolateral x-rays were taken every 250 cycles and motion tracking was performed to determine movements at the arthrodesis site. Statistical analysis of the parameters of interest was performed at a level of significance p = 0.05. Results Displacement of the talo-navicular joint after 1000, 2000 and 4000 cycles was significantly lower for plantar plating (p≤0.039) while there was significantly less movement in the naviculo-cuneiform I joint for dorsal plating post these cycle numbers (p<0.001). Displacements in all three joints of the medial column, as well as angular and torsional deformations between the navicular and metatarsal I increased significantly for each plating technique between 1000, 2000 and 4000 cycles (p≤0.021). The two plating systems did not differ significantly with regard to stiffness and cycles to failure (p≥0.171). Conclusion From biomechanical point of view, although dorsomedial plating showed less movement than plantar plating in the current setup under dynamic loading, there was no significant difference between the two plating

  7. Survey of polyfluorinated chemicals (PFCs) in the atmosphere over the northeast Atlantic Ocean

    NASA Astrophysics Data System (ADS)

    Shoeib, Mahiba; Vlahos, Penny; Harner, Tom; Peters, Andrew; Graustein, Margaret; Narayan, Julie

    2010-08-01

    High volume air sampling in Bermuda, Sable Island (Nova Scotia) and along a cruise track from the Gulf of Mexico to northeast coast of the USA, was carried out to assess air concentrations, particle-gas partitioning and transport of polyfluorinated chemicals (PFCs) in this region. Samples were collected in the summer of 2007. Targeted compounds included the neutral PFCs: fluorotelomer alcohols (FTOHs), perfluoroalkyl sulfonamides (FOSAs) and perfluoroalkyl sulfonamido ethanols (FOSEs). Among the FTOHs, 8:2 FTOH was dominant in all samples. Sum of the concentration of FTOHs (gas+particle phase) were higher in Bermuda (mean, 34 pg m -3) compared to Sable Island (mean, 16 pg m -3). In cruise samples, sum of FTOHs were highly variable (mean, 81 pg m -3) reflecting contributions from land-based sources in the northeast USA with concentrations reaching as high as 156 pg m -3. Among the FOSAs and FOSEs, MeFOSE was dominant in all samples. In Bermuda, levels of MeFOSE were exceptionally high (mean, 62 pg m -3), exceeding the FTOHs. Sable Island samples also exhibited the dominance of MeFOSE but at a lower concentration (mean, 15 pg m -3). MeFOSE air concentrations (pg m -3) in cruise samples ranged from 1.6 to 73 and were not linked to land-based sources. In fact high concentrations of MeFOSE observed in Bermuda were associated with air masses that originated over the Atlantic Ocean. The partitioning to particles for 8:2 FTOH, 10:2 FTOH, MeFOSE and EtFOSE ranged from as high as 15 to 42% for cruise samples to 0.9 to 14% in Bermuda. This study provides key information for validating and developing partitioning and transport models for the PFCs.

  8. Improved characterization of gas-particle partitioning for per- and polyfluoroalkyl substances in the atmosphere using annular diffusion denuder samplers.

    PubMed

    Ahrens, Lutz; Harner, Tom; Shoeib, Mahiba; Lane, Douglas A; Murphy, Jennifer G

    2012-07-03

    Gas-phase perfluoroalkyl carboxylic acids (PFCAs) sorb strongly on filter material (i.e., GFF, QFF) used in conventional high volume air samplers, which results in an overestimation of the particle-phase concentration. In this study, we investigated an improved technique for measuring the gas-particle partitioning of per- and polyfluoroalkyl substances (PFASs) using an annular diffusion denuder sampler. Samples were analyzed for 7 PFAS classes [i.e., PFCAs, perfluoroalkane sulfonic acids (PFSAs), fluorotelomer alcohols (FTOHs), fluorotelomer methacrylates (FTMACs), fluorotelomer acrylates (FTACs), perfluorooctane sulfonamides (FOSAs), and perfluorooctane sulfonamidoethanols (FOSEs)]. The measured particulate associated fraction (Φ') using the diffusion denuder sampler generally followed the trend FTACs (0%) < FTOHs (~8%) < FOSAs (~21%) < PFSAs (~29%) < FOSEs (~66%), whereas the Φ' of the C(8)-C(18) PFCAs increased with carbon chain length, and ranged from 6% to 100%. The ionizability of some PFASs, when associated with particles, is an important consideration when calculating the gas-particle partitioning coefficient as both ionic and neutral forms can be present in the particles. Here we differentiate between a gas-particle partitioning coefficient for neutral species, K(p), and one that accounts for both ionic and neutral species of a compound, K(p)'. The measured K(p)' for PFSAs and PFCAs was 4-5 log units higher compared to the interpolated K(p) for the neutral form only. The measured K(p)' can be corrected (to apply to the neutral form only) with knowledge of the pK(a) of the chemical and the pH of the condensed medium ("wet" particle or aqueous aerosol). The denuder-based sampling of PFASs has yielded a robust data set that demonstrates the importance of atmospheric pH and chemical pK(a) values in determining gas-particle partitioning of PFASs.

  9. Relationship between peroxisome proliferator-activated receptor alpha activity and cellular concentration of 14 perfluoroalkyl substances in HepG2 cells.

    PubMed

    Rosenmai, Anna Kjerstine; Ahrens, Lutz; le Godec, Théo; Lundqvist, Johan; Oskarsson, Agneta

    2017-08-31

    Peroxisome proliferator-activated receptor alpha (PPARα) is a molecular target for perfluoroalkyl substances (PFASs). Little is known about the cellular uptake of PFASs and how it affects the PPARα activity. We investigated the relationship between PPARα activity and cellular concentration in HepG2 cells of 14 PFASs, including perfluoroalkyl carboxylates (PFCAs), perfluoroalkyl sulfonates and perfluorooctane sulfonamide (FOSA). Cellular concentrations were determined by high-performance liquid chromatography-tandem mass spectrometry and PPARα activity was determined in transiently transfected cells by reporter gene assay. Cellular uptake of the PFASs was low (0.04-4.1%) with absolute cellular concentrations in the range 4-2500 ng mg(-1) protein. Cellular concentration of PFCAs increased with perfluorocarbon chain length up to perfluorododecanoate. PPARα activity of PFCAs increased with chain length up to perfluorooctanoate. The maximum induction of PPARα activity was similar for short-chain (perfluorobutanoate and perfluoropentanoate) and long-chain PFCAs (perfluorododecanoate and perfluorotetradecanoate) (approximately twofold). However, PPARα activities were induced at lower cellular concentrations for the short-chain homologs compared to the long-chain homologs. Perfluorohexanoate, perfluoroheptanoate, perfluorooctanoate, perfluorononanoate (PFNA) and perfluorodecanoate induced PPARα activities >2.5-fold compared to controls. The concentration-response relationships were positive for all the tested compounds, except perfluorooctane sulfonate PFOS and FOSA, and were compound-specific, as demonstrated by differences in the estimated slopes. The relationships were steeper for PFCAs with chain lengths up to and including PFNA than for the other studied PFASs. To our knowledge, this is the first report establishing relationships between PPARα activity and cellular concentration of a broad range of PFASs. Copyright © 2017 John Wiley & Sons, Ltd.

  10. [Locally administered ropivacaine vs. standard analgesia for laparoscopic cholecystectomy].

    PubMed

    Chavarría-Pérez, Teresa; Cabrera-Leal, Carlos Fernando; Ramírez-Vargas, Susana; Reynada, José Luis; Arce-Salinas, César Alejandro

    2015-01-01

    Introducción: se desconoce qué modalidad analgésica brinda mejores resultados después de una colecistectomía laparoscópica. El objetivo de este estudio consistió en valuar la eficacia analgésica de la ropivacaína usada localmente contra la dipirona por vía intravenosa en colecistectomía laparoscópica. Métodos: ensayo clínico al azar, de no inferioridad, en 50 pacientes con colecistectomía laparoscópica para comparar el uso de ropivacaína al 0.75 % infiltrada en el lugar de inserción de los trócares y en la fosa vesicular frente a dipirona por vía intravenosa. El desenlace primario fue dolor evaluado mediante escala visual análoga (EVA) en las primeras 24 horas. Resultados: el promedio de las EVA de dolor al término de la cirugía fue de 3.8 frente a 3.56 en el grupo de ropivacaína o de dipirona, mientras que a las 6, 12 y 24 horas fueron 2.64 frente a 2.6, 1.92 frente a 1.88 y 1.28 frente a 1.2, respectivamente. No hubo efectos adversos en ningún grupo y la necesidad de rescates analgésicos con tramadol fue similar entre ambos grupos. Conclusiones: la ropivacaína al 0.75 % infiltrada en el lugar de inserción de los trócares y la fosa vesicular muestra una analgesia similar a la dipirona por vía intravenosa en las primeras 24 horas después de una colecistectomía laparoscópica, sin efectos adversos.

  11. Lateral subtalar dislocation.

    PubMed

    Sharda, Praveen; DuFosse, Julian

    2008-07-01

    Subtalar dislocations are rare in routine orthopedic practice. While many of these dislocations are a result of high-energy injuries such as fall from a height or traffic accidents, it is not uncommon for patients to present after slipping down a few stairs. Two types of dislocation have been described, medial and lateral. The type of dislocation is described according to the position of the foot. In lateral subtalar dislocation the head of talus is found medially and the calcaneus is dislocated laterally. The navicular may lie dorsolateral to the talus. The reverse is true of lateral dislocation. Medial dislocation has been referred to as "basketball foot" due to its preponderance in basketball players.4 The deciding factor is the inverted or everted position of the foot when the force is dissipated through the weak talonavicular and talocalcaneal ligaments. This article presents a case of an adult with lateral subtalar dislocation following a fall.

  12. Bilateral osteochondrosis of the primary patellar ossification centers in a young athlete: a case report.

    PubMed

    Dharamsi, Aisha S; Carl, Rebecca L

    2014-01-01

    : Osteochondroses are a group of idiopathic self-limited conditions seen in skeletally immature individuals. The term describes disturbances in endochondral ossification affecting either the primary or secondary ossification centers. Osteochondrosis of the tarsal navicular was first described by Köhler in 1908; the eponym "Köhler's disease" is commonly used to refer to this condition. In his original paper, Köhler also described one instance of an osteochondrosis of the primary patellar ossification center, a clinical entity that has since rarely been reported. We present a case of isolated bilateral "Köhler's disease of the patellae" in an approximately 7-year-old male athlete demonstrated clinically and radiographically by both plain radiographs and magnetic resonance imaging.

  13. Monocystis apporectodae sp. nov. (Protozoa: Apicomplexa: Eugregarinida), from an Indian earthworm Apporectodea trapezoides Duges.

    PubMed

    Bandyopadhyay, Probir K; Mallik, Partha; Göçmen, Bayram; Mitra, Amlan Kumar

    2006-01-01

    A survey aimed at exploring the endoparasitic acephaline gregarine diversity in South-western Bengal, detected a new species of the genus Monocystis Stein, 1848, that resides in the seminal vesicles of the earthworm, Apporectodea trapezoides Duges collected in the district of Bankura from alluvial soil. Monocystis apporectodae sp. nov. is a ribbon-like organism with one or more prominent constric-tions especially in some mature forms and measures 178.0-224.0 (203.0+/-5.0) microm x 37.0-58.0 (46.0+/-1.5) microm. The extreme ends are pointed. Its gametocysts are ovoid and measure 108.0-118.0 microm (113.0+/-1.1) x 79.0-89.0 (83.0+/-1.1) microm. Oocysts are navicular in shape. The length of the oocysts ranges from 10.0-14.6 and the width, from 5.5-8.1 microm.

  14. Clubfoot posteromedial release: advantages of tibialis anterior tendon lengthening.

    PubMed

    Wicart, Philippe R; Barthes, Xavier; Ghanem, Ismat; Seringe, Raphaël

    2002-01-01

    The aim of this study is to evaluate the eventual advantages of tibialis anterior (TA) tendon lengthening during clubfoot posteromedial release. A continuous series of 60 idiopathic clubfeet has been retrospectively studied. Tibialis anterior lengthening (TAL) began to be performed in 1984. Two groups of 30 feet have been distinguished: without TAL (before 1984) and with TAL (after 1984). There was no significant difference between the 2 groups concerning mean age at surgery, preoperative clinical and radiologic data. Mean postoperative follow-up was 10 years and minimal follow-up required was 5 years. TAL decreased Triceps surae relative insufficiency and improved monopodal jump. TAL balanced TA and peroneus longus, decreased dynamic supination and balanced forefoot pronation and supination. The feet without TAL presented lack of anteromedial support (20% without TAL, 0% with TAL) and medial arch cavus with dorsal talo-navicular subluxation (20% without TAL, 3,3% with TAL). TAL decreased the rate of recurrence and surgical revision.

  15. Hydatid disease of the tarsal bones. A case report.

    PubMed

    Papanikolaou, A; Antoniou, N; Pavlakis, D; Garas, G

    2005-01-01

    Hydatid disease is caused by the larval form of the tapeworm Echinococcus. Osseous cysts are rare and very few cases of foot infestation have been reported. We present the case of a 51-year-old woman who developed a palpable mass at the medial dorsal aspect of the right midfoot. Radiological examination showed cystic lesions in the cuneiforms and the navicular. The lesion was explored and several small cysts containing clear fluid were found. They were evacuated and the bone was curetted. The diagnosis of E. granulosus infestation was made histologically. After 15 years' follow-up there were no signs of recurrence. Osseous echinococcosis is a rare disease that may present as infective or neoplastic pathology. A high index of suspicion is necessary for its diagnosis, especially in patients who live in or travel to sheep-raising areas where hydatid disease is endemic.

  16. Peculiar chondroblastoma involving multiple tarsal bones.

    PubMed

    Fukunaga, Masaharu; Asanuma, Kazuo; Irie, Takeo

    2010-07-01

    A case of peculiar chondroblastoma involving multiple tarsal bones in a 49-year-old woman is described. The patient presented with pain and swelling of the right foot. Radiographs revealed a lytic expansile lesion of medial, intermediate, and lateral cuneiform bones, navicular, cuboid, and tarsal bones of the right foot, indicating a malignant tumor. Biopsies demonstrated a diffuse proliferation of round cells with eccentric and indented nuclei with longitudinal grooves and eosinophilic cytoplasm. Atypia was prominent, but mitotic figures were rare. The stroma was chondroid with focal chicken-wire calcification. On electron microscopy, the tumor exhibited chondroblastic features. The patient is alive with the tumor 7 years after radiotherapy. The tumor is considered a chondroblastoma with low malignant potential.

  17. Histopathological study of nonosseous tarsal coalition.

    PubMed

    Kumai, T; Takakura, Y; Akiyama, K; Higashiyama, I; Tamai, S

    1998-08-01

    Histopathological analysis was performed on 55 feet in 48 patients with nonosseous tarsal coalitions. Histological findings were similar to those observed at the tendinous attachment site of Osgood-Schlatter disease, accessory navicular, and bipartite patellae. No nerve elements were observed in the fibrocartilaginous tissue at the coalition. Nerve elements were present only in periosteum and articular capsule surrounding the coalition. Pain in the tarsal coalition is not mediated by nerve elements at the coalition site itself. It is assumed that the pain is caused by mechanical abnormality that results from incomplete coalition. Incomplete coalition produces microfractures and remodelings on the boundaries between bone and the coalition, which then lead to degenerative changes. This mechanical abnormality seems to induce pain via free nerve endings in the periosteum and in the articular capsule surrounding the coalition.

  18. Differential diagnosis in a professional basketball player with foot pain: is it an avulsion fracture or an os supranaviculare?

    PubMed

    Bayramoğlu, Alp; Demiryürek, Deniz; Firat, Ayşegül; Oznur, Ali; Ozsoy, M Hakan

    2009-01-01

    The os supranaviculare is an accessory bone located on the dorsal aspect of the talonavicular joint close to the midpoint. This rare incidental skeletal variant has an estimated prevalence of 1%. It may rarely become symptomatic and should not be confused with cortical avulsion fractures of navicular or talar head. We present the case of a 25-year-old professional basketball player with pain on the dorsum of his right foot after twisting his ankle during a regular season match. Magnetic resonance imaging findings of the player's foot represented a flake of bone on the superior part of the talar head. The differential diagnosis and clinical outcome of this unusual case are briefly discussed.

  19. An accessory flexor of the fifth toe.

    PubMed

    Asomugha, A L; Chukwuanukwu, T O G; Nwajagu, G I; Ukoha, U

    2005-12-01

    The presence of accessory muscles and other organs on the lower limbs of some individuals have variously been reported in the literature. We report an unusual muscle located on the plantar surface of the left foot of a cadaver, which had not been previously described. This muscle originated from the tendon of tibialis posterior and inserted into the middle phalanx of the fifth toe. It differed from the 'expansions' of the tibialis posterior tendon, which usually pass from its insertion on the navicular bone to other tarsal bones and are ligamentous in nature. The muscle produced flexion of the fifth toe and is innervated by the medial plantar nerve. Awareness of this is important to Anatomists and surgeons, especially those working on the foot.

  20. Deformity of talus and calcaneous in congenital clubfoot: an anatomical study.

    PubMed

    Epeldegui, Tomas

    2012-01-01

    Clubfoot is a complex congenital deformity. Midtarsal joint is a key point to understand the deformity in clubfoot as a consequence of the malalignment of the osseous columns. Talar and calcaneal deformities affecting the normal alignment of the medial and lateral osseous columns in the foot can be the factors that determine the difficulty in the management of clubfoot. We report observations of two clubfeet of one stillborn. Our observations in the head of the talus report two different articular areas: the histological section of medial area facing the navicular shows active articular cartilage and the lateral area shows an atrophic articular cartilage suggesting a difference between the anatomical declination angles of the talus from a functional declination angle. Observing the calcaneous, we report a twisting rotational deformity along the longitudinal axis of the calcaneous. These observations may contribute to a better understanding of the clubfoot relapse, and also the treatment of complicated cases of clubfeet.

  1. Observation on Monocystis constricta n. sp. (Protozoa: Apicomplexa: Monocystidae) from an Indian earthworm, Eutyphoeus quaripapillatus Michelsen, 1907.

    PubMed

    Bandyopadhyay, Probir K; Mitra, Amlan Kumar; Göçmen, Bayram

    2009-01-01

    A biodiversity survey of aseptate gregarines in earthworm hosts in the Calcutta district of West Bengal State revealed the existence of a new species of aseptate gregarine under the genus Monocystis Stein, 1848. The monocystid gregarines obtained from the earthworm host, Eutyphoeus quaripapillatus Michelsen, 1907 have been identified as a new species. The mucron was indistinct. The gamonts are elongated, ovoid, have a hood like structure at the anterior end and measure 150.1-212.4 (188.1+/-2.1) micromx66.1-112.1 (72.3+/-1.1) microm. The gametocysts are ellipsoid and measure 92.3-136.3 microm (111.2+/-2.1)x78.3-114.4 microm (82.6+/-3.6) microm. Prominent syzygy was apparent. Oocysts are navicular, measuring 14.1-22.3 (18.1+/-3.2) micromx9.1-15.2 (11.9+/-1.1) microm.

  2. Management of hand injuries in a professional football team. Review of 15 years of experience with one team.

    PubMed

    Ellsasser, J C; Stein, A H

    1979-01-01

    Thirty-eight players from one professional football team suffered 46 major hand and wrist injuries during a 15-year period. Twenty-one of the injuries occurred in offensive players and 25 occurred in defensive players. The injuries included fractures, dislocations, fracture dislocations, and soft tissue injuries of the phalanges, metacarpals, carpals (particularly the navicular), and distal radius/ulna, including intra-articular injuries. Twelve surgical procedures were performed. Open reduction, internal fixation, and Lightcast immobilization devices (3M Company, Atlanta, Georgia) allowed the players to return to active participation with a minimum loss of practice time and virtually no loss of Sunday game availability. Early aggressive surgery for intra-articular and certain metacarpal fractures is the correct course of treatment, according to our analysis, in order to achieve the best possible functional results.

  3. Perspectives for clinical measures of dynamic foot function-reference data and methodological considerations.

    PubMed

    Rathleff, M S; Nielsen, R G; Simonsen, O; Olesen, C G; Kersting, U G

    2010-02-01

    Several studies have investigated if static posture assessments qualify to predict dynamic function of the foot showing diverse outcomes. However, it was suggested that dynamic measures may be better suited to predict foot-related overuse problems. The purpose of this study was to establish the reliability for dynamic measures of longitudinal arch angle (LAA) and navicular height (NH) and to examine to what extent static and dynamic measures thereof are related. Intra-rater reliability of LAA and NH measures was tested on a sample of 17 control subjects. Subsequently, 79 subjects were tested while walking on a treadmill. The ranges and minimum values for LAA and NH during ground contact were identified over 20 consecutive steps. A geometric error model was used to simulate effects of marker placement uncertainty and skin movement artifacts. Results demonstrated the highest reliability for the minimum NH (MinNH), followed by the minimum LAA (MinLAA), the dynamic range of navicular height (DeltaNH) and the range of LAA (DeltaLAA) while all measures were highly reliable. Marker location uncertainty and skin movement artifacts had the smallest effects on measures of NH. The use of an alignment device for marker placement was shown to reduce error ranges for NH measures. Therefore, DeltaNH and MinNH were recommended for functional dynamic foot characterization in the sagittal plane. There is potential for such measures to be a suitable predictor for overuse injuries while being obtainable in clinical settings. Future research needs to include such dynamic but simple foot assessments in large-scale clinical studies.

  4. The Relationships between Foot Arch Volumes and Dynamic Plantar Pressure during Midstance of Walking in Preschool Children

    PubMed Central

    Chang, Hsun-Wen; Chieh, Hsiao-Feng; Lin, Chien-Ju; Su, Fong-Chin; Tsai, Ming-June

    2014-01-01

    Objectives The purpose of this study was to examine the correlation between the foot arch volume measured from static positions and the plantar pressure distribution during walking. Methods A total of 27 children, two to six years of age, were included in this study. Measurements of static foot posture were obtained, including navicular height and foot arch volume in sitting and standing positions. Plantar pressure, force and contact areas under ten different regions of the foot were obtained during walking. Results The foot arch index was correlated (r = 0.32) with the pressure difference under the midfoot during the foot flat phase. The navicular heights and foot arch volumes in sitting and standing positions were correlated with the mean forces and pressures under the first (r = −0.296∼−0.355) and second metatarsals (r = −0.335∼−0.504) and midfoot (r = −0.331∼−0.496) during the stance phase of walking. The contact areas under the foot were correlated with the foot arch parameters, except for the area under the midfoot. Conclusions The foot arch index measured in a static position could be a functional index to predict the dynamic foot functions when walking. The foot arch is a factor which will influence the pressure distribution under the foot. Children with a lower foot arch demonstrated higher mean pressure and force under the medial forefoot and midfoot, and lower contact areas under the foot, except for the midfoot region. Therefore, children with flatfoot may shift their body weight to a more medial foot position when walking, and could be at a higher risk of soft tissue injury in this area. PMID:24736650

  5. Accuracy of open magnetic resonance imaging for guiding injection of the equine deep digital flexor tendon within the hoof.

    PubMed

    Groom, Lauren M; White, Nathaniel A; Adams, M Norris; Barrett, Jennifer G

    2017-07-06

    Lesions of the distal deep digital flexor tendon (DDFT) are frequently diagnosed using MRI in horses with foot pain. Intralesional injection of biologic therapeutics shows promise in tendon healing; however, accurate injection of distal deep digital flexor tendon lesions within the hoof is difficult. The aim of this experimental study was to evaluate accuracy of a technique for injection of the deep digital flexor tendon within the hoof using MRI-guidance, which could be performed in standing patients. We hypothesized that injection of the distal deep digital flexor tendon within the hoof could be accurately guided using open low-field MRI to target either the lateral or medial lobe at a specific location. Ten cadaver limbs were positioned in an open, low-field MRI unit. Each distal deep digital flexor tendon lobe was assigned to have a proximal (adjacent to the proximal aspect of the navicular bursa) or distal (adjacent to the navicular bone) injection. A titanium needle was inserted into each tendon lobe, guided by T1-weighted transverse images acquired simultaneously during injection. Colored dye was injected as a marker and postinjection MRI and gross sections were assessed. The success of injection as evaluated on gross section was 85% (70% proximal, 100% distal). The success of injection as evaluated by MRI was 65% (60% proximal, 70% distal). There was no significant difference between the success of injecting the medial versus lateral lobe. The major limitation of this study was the use of cadaver limbs with normal tendons. The authors conclude that injection of the distal deep digital flexor tendon within the hoof is possible using MRI guidance. © 2017 American College of Veterinary Radiology.

  6. An Innovative Anchoring Technique for Anterior Transfer of the Tibialis Posterior Tendon.

    PubMed

    Shen, Po-Chih; Chou, Shih-Hsiang; Chen, Jian-Chih; Chen, Shu-Jung; Tien, Yin-Chun

    Favorable results have been reported for tibialis posterior tendon transfers, which can effectively restore the dorsiflexion of the ankle and normal heel-to-toe gait. However, the commonly used methods for anchoring the transplanted tendon have some drawbacks. Therefore, we developed a new tendon-anchoring method to improve fixation of the transferred tendon and reduce the related complications. The new method entails tying the anchoring suture to the navicular bone instead of the button on the plantar foot to avoid wound complications. It requires no additional skin incisions or special equipment. We retrospectively evaluated 24 feet of 19 pediatric patients (13 [68.4%] females and 6 [31.6%] males) who had undergone anterior transfer of the tibialis posterior tendon with our new method from 2000 to 2013. All patients were clinically followed up. At the final follow-up visit, they were evaluated while standing and walking, and the range of motion of the foot was evaluated. The mean age at surgery was 7.8 (range 2 to 16) years. At the longest follow-up point, all the patients exhibited improved gait, except for 1 patient who required a secondary procedure. All the transferred tibialis posterior tendons could be palpated with certainty during active dorsiflexion or withdrawal of the foot. No tendon displacements, wound infections, or postoperative complications were observed. Fixation of a transferred tibialis posterior tendon by tying the suture to the navicular bone is simple and reliable. This technique can efficiently prevent the plantar ulcers that can develop with the traditional pull-out button method and provides a solution when appropriate-size bioabsorbable interference screws are unavailable. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome. The joint undertaking to monitor and prevent ACL injury (JUMP-ACL) cohort

    PubMed Central

    Boling, Michelle C.; Padua, Darin A; Marshall, Stephen W.; Guskiewicz, Kevin; Pyne, Scott; Beutler, Anthony

    2010-01-01

    Background Patellofemoral pain syndrome (PFPS) is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury. Hypothesis Altered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors. Study Design Prospective cohort. Methods 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included three-dimensional motion analysis during a jump-landing task, six lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q-angle). Participants were prospectively followed from their date of enrollment to January 2008 (maximum of 2.5 years of follow up). Results Risk factors for the development of PFPS included decreased knee flexion angle, decreased vertical ground reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of PFPS. Conclusions Multiple modifiable risk factors for PFPS pain have been identified in this investigation. In order to decrease the incidence of this chronic injury, the risk factors for PFPS need to be targeted in injury prevention programs. Clinical Relevance Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements in order to decrease the incidence of PFPS. PMID:19797162

  8. Diffusion of mepivacaine to adjacent synovial structures after intrasynovial analgesia of the digital flexor tendon sheath.

    PubMed

    Jordana, M; Martens, A; Duchateau, L; Haspeslagh, M; Vanderperren, K; Oosterlinck, M; Pille, F

    2016-05-01

    Controversy exists about the specificity of diagnostic analgesia of the digital flexor tendon sheath (DFTS) in horses. To evaluate the degree of diffusion of mepivacaine from the equine DFTS to adjacent synovial structures. Crossover experiment. Under general anaesthesia, the DFTS of one front and one hindlimb of 8 horses were injected simultaneously with mepivacaine. Synovial fluid samples of the injected DFTS, the adjacent metacarpo-/metatarsophalangeal (MCP/MTP) joint, proximal interphalangeal joint, distal interphalangeal joint, navicular bursa and contralateral MCP/MTP joint were collected 15 min post injection (T15) from one of the injected limbs and 60 min post injection (T60) from the other limb. Venous blood samples were obtained at T0, T15 and T60 to evaluate systemic distribution of mepivacaine. After a 2-week washout period, the procedure was repeated using the same limbs but reversing the time of sampling (front vs. hindlimbs). The concentration of mepivacaine in samples was measured with a commercial ELISA kit. Mepivacaine concentrations in the DFTS samples, at both T15 (5077 mg/l) and T60 (3503 mg/l), exceeded those estimated sufficient to produce synovial analgesia (100 mg/l or 300 mg/l). Mepivacaine was found in all synovial structures adjacent to the injected DFTS and in the contralateral MCP/MTP joints, but concentrations were low, with a maximum value of only 3.2 mg/l. With the exception of the navicular bursa samples, the mepivacaine concentrations in the adjacent synovial structures were significantly higher at T60 than at T15 (P<0.03). Significantly higher mepivacaine concentrations were found in the ipsilateral than the contralateral MCP/MTP joints at T60 (P<0.001). Blood samples had significantly higher mepivacaine concentrations at T15 and T60 than at T0 (P<0.001). Mepivacaine injected into the DFTS of horses diffuses towards adjacent synovial structures without achieving clinically relevant concentrations. © 2015 EVJ Ltd.

  9. Injury rates in martial art athletes: anthropometric parameters and training volume, but not foot morphology indexes, are predictive risk factors for lower limb injuries.

    PubMed

    Vitale, Jacopo A; Bassani, Tito; Galbusera, Fabio; Bianchi, Alberto; Martinelli, Nicolò

    2017-09-22

    Previous studies attempted to identify possible risk factors for acute and overuse injuries in several sports disciplines such as running, gymnastics or team sports. Given the lack of scientific works focused on risk factors for lower limb injuries in martial arts, the present study was aimed to investigate foot anatomy, anthropometric measures, and other background information as possible risk factors of injury in barefoot athletes practicing judo, karate, kung fu, thai boxe, or aikido. In addition, the injury rates were evaluated in relation with the different martial art styles. One group of 130 martial artists was retrospectively evaluated. Data of three foot morphological variables were collected: navicular height (NH), navicular drop (ND) and the rear foot (RF). In addition, each participant filled an interview questionnaire providing the following information: age, sex, body weight, height, BMI, hours of training per week, the kind of injury occurred to the lower limbs in the preceding year. Of 130 subjects, 70 (53.8%) did not sustain injuries, 35 (27.0%) suffered an acute injury and the remaining 25 (19.2%) reported an overuse injury. No significant differences were observed in the injury rates in relation to style and kind of martial art. Age, training volume and BMI were found as significant predictors of injury, while NH, ND and RF were not able to predict acute or overuse injury at lower limbs. The injury rates were similar in karate, judo, kung fu, aikido, and thai boxe. The foot morphology variables were not related with the presence or absence of acute and overuse injuries. Conversely, older and heavier martial artists, performing more hours of barefoot training, are at higher risk of acute and overuse injury. Athletic trainers should strongly take into account the present information in order to develop more accurate and specific injury prevention programs for martial artists.

  10. Load response of the tarsal bones in patients with flatfoot deformity: in vivo 3D study.

    PubMed

    Kido, Masamitsu; Ikoma, Kazuya; Imai, Kan; Maki, Masahiro; Takatori, Ryota; Tokunaga, Daisaku; Inoue, Nozomu; Kubo, Toshikazu

    2011-11-01

    The objective of this study was to evaluate the bone rotation of each joint in the hindfoot and compare the load response in healthy feet with that in flatfeet by analyzing the reconstructive three-dimensional (3D) CT image data during weightbearing. CT scans of 21 healthy feet and 21 feet with flatfoot deformity were taken in non-load condition followed by full-body weightbearing load condition. The images of the hindfoot bones were reconstructed into 3D models. The volume merge method in three planes was used to calculate the position of the talus relative to the tibia in the tibiotalar joint, the navicular relative to the talus in talonavicular joint, and the calcaneus relative to the talus in the talocalcaneal joint. The talar position difference to the load response relative to the tibia in the tibiotalar joint in a flatfoot was 1.7 degrees more plantarflexed in comparison to that in a healthy foot (p = 0.031). The navicular position difference to the load response relative to the talus in the talonavicular joint was 2.3 degrees more everted (p = 0.0034). The calcaneal position difference to the load response relative to the talus in the talocalcaneal joint was 1.1 degrees more dorsiflexed (p = 0.0060) and 1.7 degrees more everted (p = 0.0018). Referring to previous cadaver study, regarding not only the cadaveric foot, but also the live foot, joint instability occurred in the hindfoot with load in patients with flatfoot. The method used in this study might be applied to clinical analysis of foot diseases such as the staging of flatfoot and to biomechanical analysis to evaluate the effects of foot surgery in the future.

  11. [Prognostic factors of morbimortality in patients with emphysematous pyelonephritis].

    PubMed

    Torres-Mercado, León Octavio; García-Padilla, Miguel Ángel; Serrano-Brambila, Eduardo; Maldonado-Alcaraz, Efraín; López-Sámano, Virgilio Augusto; Montoya-Martínez, Guillermo; Moreno-Palacios, Jorge

    2016-01-01

    Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 μL (RM 43.65, IC 95 % 2.36-805, p < 0.001), la trombocitopenia ≤ 120 000 μL (RM 363, IC 95 % 9.2-14208, p < 0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p < 0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

  12. [Mini-laparoscopy vs. laparoscopy for the gallblader stone treatment. Prospective and comparative study].

    PubMed

    Lada, Paul Eduardo; Forez, Francisco; Janikov, Christian; Mariot, Daniela; Sanchez Tassone, Carlos; Massa, Martin

    2015-01-01

    Antecedentes: La colecistectomía por video-laparoscópica es considerada como el gold-standard del tratamiento de la colecistolitiasis. No obstante, en la literatura internacional sigue teniendo presencia las incisiones pequeñas adaptadas como procedimiento alternativo. Objetivos: El objetivo de este estudio es evaluar los resultados obtenidos con la video-laparoscopia (CVL) y las incisiones pequeñas adaptadas (IPA) en el tratamiento de la colecistolitiasis. Diseño: Prospectivo y comparativo protocolizado. Lugar de aplicación: Servicio de Cirugía General “Pablo Luis Mirizzi” del Hospital Nacional de Clínicas. Material y Métodos: Entre enero del 1994 y diciembre del 2011, hemos tratado quirúrgicamente 3822 pacientes con colélitiasis. En 1735 pacientes se práctico una CVL y en 2087 por IPA, configurando dos grupos, que en lo relacionado a la edad, sexo, operaciones previas y diagnóstico preoperatorio constituyen dos grupos comparables. Resultados: Ninguno de los procedimientos tuvo mortalidad. 115 casos (6,62%) fueron convertidos a cirugía abierta en la CVL. Las complicaciones postoperatorias quirúrgicas fueron del 2,40 % para la CVL y del 6,37 % para las IPA. Las causas de bilirragias fueron superiores y de mayor gravedad en la CVL, cuya incidencia fue del 0,55 % en contraposición del 0,23 % de los operados por IPA. Conclusiones: Sin duda en manos experimentadas la CVL constituye el procedimiento de elección o gold standard en el tratamiento de la colecistolitiasis. No obstante, sobretodo en ambientes o regiones con restricciones presupuestarias las IPA representa una excelente gold estándar alternativo, por ser un procedimiento seguro, muy económico y complejidad razonable con menor índice de lesiones quirúrgicas graves.

  13. Removal efficiency of multiple poly- and perfluoroalkyl substances (PFASs) in drinking water using granular activated carbon (GAC) and anion exchange (AE) column tests.

    PubMed

    McCleaf, Philip; Englund, Sophie; Östlund, Anna; Lindegren, Klara; Wiberg, Karin; Ahrens, Lutz

    2017-09-01

    Poly- and perfluoroalkyl substances (PFASs) have been detected in drinking water at relatively high concentrations throughout the world which has led to implementation of regulatory guidelines for specific PFASs in drinking water in several European countries and in the U.S. The Swedish National Food Agency has determined that the drinking water of over one third of the country's municipal consumers is at risk or already affected by PFAS contamination. The present study investigated the effects of perfluorocarbon chain length, functional group and isomer structure (branched or linear) on removal of multiple PFASs using granular activated carbon (GAC, Filtrasorb(®) 400) and anion exchange (AE, Purolite(®) A600) column experiments. The removal of 14 different PFASs, i.e. the C3C11, C14 perfluoroalkyl carboxylic acids (PFCAs) (PFBA, PFPeA, PFHxA, PFHpA, PFOA, PFNA, PFDA, PFUnDA, PFDoDA, PFTeDA), perfluorooctane sulfonamide (FOSA), and the C4, C6, C8 perfluoroalkyl sulfonic acids (PFSAs) (PFBS, PFHxS, PFOS), was monitored for a 217 day period. The results indicate the selective nature of PFAS removal as the absorbents are loaded with PFASs and dissolved organic carbon (DOC). A clear relationship between perfluorocarbon chain length and removal efficiency of PFASs using GAC and AE was found while PFASs with sulfonate functional groups displayed greater removal efficiency than those with carboxylate groups. Similarly, time to column breakthrough increased with increasing perfluorocarbon chain length and was greater for the PFSAs than the PFCAs for both GAC and AE. Shorter carbon chained PFASs such as PFBA, PFPeA, PFHxA showed desorption behavior and long-chained PFASs showed increased removal towards the end of the experiment indicating agglomeration or micelle development. Linear isomers of PFOS, PFHxS, and perfluorooctane sulfonamide (FOSA) had greater column removal efficiencies using GAC (and also for AE at greater bed volume throughput) than the branched and this

  14. Radiography and sonography of clubfoot: A comparative study

    PubMed Central

    Bhargava, Satish Kumar; Tandon, Anupama; Prakash, Meenakshi; Arora, Shobha S; Bhatt, Shuchi; Bhargava, Sumeet

    2012-01-01

    Background: Congenital talipes equinovarus is a common foot deformity afflicting children with reported incidence varying from 0.9/1000 to 7/1000 in various populations. The success reported with Ponseti method when started at an early age requires an imaging modality to quantitate the deformity. Sonography being a radiation free, easily available non-invasive imaging has been investigated for this purpose. Various studies have described the sonographic anatomy of normal neonatal foot and clubfoot and correlated the degree of severity with trends in sonographic measurements. However, none of these studies have correlated clinical, radiographic and sonographic parameters of all the component deformities in clubfoot. The present study aims to compare the radiographic and sonographic parameters in various grades of clubfoot. Materials and Methods: Thirty-one children with unilateral clubfoot were examined clinically and graded according to the Demeglio system of classification of clubfoot severity. Antero-posterior (AP) and lateral radiographs of both normal and affected feet were obtained in maximum correction and AP talo-calcaneal (T-C), AP talo-first metatarsal (TMT) and lateral T-C angles were measured. Sonographic examination was done in medial, lateral, dorsal and posterior projections of both feet in static neutral position and after Ponseti manouever in the position of maximum correctability in dynamic sonography. Normal foot was taken as control in all cases. The sonographic parameters measured were as follows : Medial malleolar- navicular distance (MMN) and medial soft tissue thickness (STT) on medial projection, calcaneo-cuboid (C-C) distance, calcaneo-cuboid (C-C) angle and maximum length of calcaneus on lateral projection, length of talus on dorsal projection; and tibiocalcaneal (T-C) distance, posterior soft tissue thickness and length of tendoachilles on posterior projection. Also, medial displacement of navicular relative to talus, mobility of

  15. Asymmetric adaptive modeling of central tarsal bones in racing greyhounds.

    PubMed

    Johnson, K A; Muir, P; Nicoll, R G; Roush, J K

    2000-08-01

    Fatigue fracture of the cuboidal bones of the foot, especially the navicular tarsal bone, is common in athletes and dancers. The racing greyhound is a naturally occurring animal model of this injury because both microcracking and complete fracture occur in the right central (navicular) tarsal bone (CTB). The right limb is on the outside when racing in a counter-clockwise direction on circular tracks, and is subjected to asymmetric cyclic compressive loading. We wished to study in more detail adaptive modeling in the right CTB in racing greyhounds. We hypothesized that cyclic asymmetric loading of a cuboidal bone induced by racing on a circular track would induce site-specific bone adaptation. We also hypothesized that such an adaptive response would be attenuated in greyhounds that were retired from racing and no longer subjected to cyclic asymmetric loading. Central tarsal bones from racing greyhounds (racing group, n = 6) and retired greyhounds being used for breeding (nonracing group, n = 4) were examined using quantitative computed tomography (CT). Bone mineral density (BMD) was determined in a 3-mm diameter region-of-interest (ROI) in six contiguous 1-mm-thick sagittal CT slices of each CTB. Bones were subsequently examined histomorphometrically and percentage bone area (B.Ar./T.Ar., %) was determined in 10 ROI from dorsal to plantar in a transverse plane, mid-way between the proximal and distal articular surfaces. The BMD of the right CTB was greater than the left in all greyhounds (p < 0. 001). In comparing ipsilateral limbs between groups, BMD of the racing group was greater than the nonracing group for each side (p < 0.005). In sagittal plane histologic sections, bone in the dorsal region of the right CTB had undergone adaptive modeling, through thickening and compaction of trabeculae. B.Ar./T.Ar., % in the right CTB of the racing group was greater than in the contralateral CTB (p < 0.001), and the ipsilateral CTB of the nonracing group (p < 0.001). In the

  16. Arterial anatomy of the tibialis posterior tendon.

    PubMed

    Manske, Mary Claire; McKeon, Kathleen E; Johnson, Jeffrey E; McCormick, Jeremy J; Klein, Sandra E

    2015-04-01

    Tibialis posterior tendon dysfunction is a common disorder leading to pain, deformity, and disability, although its pathogenesis is unclear. A vascular etiology has been proposed, but there is controversy regarding the existence of a hypovascular region that may render the tendon vulnerable. The purpose of this study was to provide a description of the arterial anatomy supplying the tibialis posterior tendon. Sixty adult cadaveric lower extremities were obtained from a university-affiliated body donation program. Thirty specimens obtained within 72 hours of death were used for microscopic analysis. Thirty specimens were previously frozen and used for macroscopic analysis. The tibialis anterior, tibialis posterior, and peroneal arteries were injected with India Ink and Ward's Blue Latex. The specimens used for macroscopic analysis were debrided with sodium hypochlorite to expose the extratendinous anatomy. For the microscopic analysis, the tendon was cleared using a modified Spälteholz technique to expose the intratendinous vascular anatomy. Macroscopically, an average of 2.5 ± 0.7 vessels entered the tendon proximal to the navicular insertion. In all, 28/30 (93.3%) specimens had a vessel entering 4.1 ± 0.6 cm proximal to the medial malleolus and 24/30 (80.0%) specimens had a vessel entering 1.7 ± 0.9 cm distal to the medial malleolus. Microscopically, an average of 1.9 ± 0.3 vessels entered each tendon proximal to the navicular insertion. In total, 27/30 (90%) specimens had a vessel entering the tendon 4.8 ± 0.8 cm proximal to the medial malleolus and 30/30 (100%) specimens had a vessel entering the tendon 1.9 ± 0.8 cm distal to the medial malleolus. In all specimens, a hypovascular region was observed, starting 2.2 ± 0.8 cm proximal to the medial malleolus and ending 0.6 ± 0.6 cm proximal to the medial malleolus with an average length of 1.5 ± 1.0 cm. The insertion of the tendon was well vascularized both on microscopic and macroscopic specimens. The

  17. Reliability of clinically relevant 3D foot bone angles from quantitative computed tomography

    PubMed Central

    2013-01-01

    Background Surgical treatment and clinical management of foot pathology requires accurate, reliable assessment of foot deformities. Foot and ankle deformities are multi-planar and therefore difficult to quantify by standard radiographs. Three-dimensional (3D) imaging modalities have been used to define bone orientations using inertial axes based on bone shape, but these inertial axes can fail to mimic established bone angles used in orthopaedics and clinical biomechanics. To provide improved clinical relevance of 3D bone angles, we developed techniques to define bone axes using landmarks on quantitative computed tomography (QCT) bone surface meshes. We aimed to assess measurement precision of landmark-based, 3D bone-to-bone orientations of hind foot and lesser tarsal bones for expert raters and a template-based automated method. Methods Two raters completed two repetitions each for twenty feet (10 right, 10 left), placing anatomic landmarks on the surfaces of calcaneus, talus, cuboid, and navicular. Landmarks were also recorded using the automated, template-based method. For each method, 3D bone axes were computed from landmark positions, and Cardan sequences produced sagittal, frontal, and transverse plane angles of bone-to-bone orientations. Angular reliability was assessed using intraclass correlation coefficients (ICCs) and the root mean square standard deviation (RMS-SD) for intra-rater and inter-rater precision, and rater versus automated agreement. Results Intra- and inter-rater ICCs were generally high (≥ 0.80), and the ICCs for each rater compared to the automated method were similarly high. RMS-SD intra-rater precision ranged from 1.4 to 3.6° and 2.4 to 6.1°, respectively, for the two raters, which compares favorably to uni-planar radiographic precision. Greatest variability was in Navicular: Talus sagittal plane angle and Cuboid: Calcaneus frontal plane angle. Precision of the automated, atlas-based template method versus the raters was comparable to

  18. Individual headless compression screws fixed with three-dimensional image processing technology improves fusion rates of isolated talonavicular arthrodesis.

    PubMed

    Xie, Mei-Ming; Xia, Kang; Zhang, Hong-Xin; Cao, Hong-Hui; Yang, Zhi-Jin; Cui, Hai-Feng; Gao, Shang; Tang, Kang-Lai

    2017-01-23

    Screw fixation is a typical technique for isolated talonavicular arthrodesis (TNA), however, no consensus has been reached on how to select most suitable inserted position and direction. The study aimed to present a new fixation technique and to evaluate the clinical outcome of individual headless compression screws (HCSs) applied with three-dimensional (3D) image processing technology to isolated TNA. From 2007 to 2014, 69 patients underwent isolated TNA by using double Acutrak HCSs. The preoperative three-dimensional (3D) insertion model of double HCSs was applied by Mimics, Catia, and SolidWorks reconstruction software. One HCS oriented antegradely from the edge of dorsal navicular tail where intersected interspace between the first and the second cuneiform into the talus body along the talus axis, and the other one paralleled the first screw oriented from the dorsal-medial navicular where intersected at the medial plane of the first cuneiform. The anteroposterior and lateral X-ray examinations certified that the double HCSs were placed along the longitudinal axis of the talus. Postoperative assessment included the American Orthopaedic Foot & Ankle Society hindfoot (AOFAS), the visual analogue scale (VAS) score, satisfaction score, imaging assessments, and complications. At the mean 44-months follow-up, all patients exhibited good articular congruity and solid bone fusion at an average of 11.26 ± 0.85 weeks (range, 10 ~ 13 weeks) without screw loosening, shifting, or breakage. The overall fusion rates were 100%. The average AOFAS score increased from 46.62 ± 4.6 (range, 37 ~ 56) preoperatively to 74.77 ± 5.4 (range, 64-88) at the final follow-up (95% CI: -30.86 ~ -27.34; p < 0.001). The mean VAS score decreased from 7.01 ± 1.2 (range, 4 ~ 9) to 1.93 ± 1.3 (range, 0 ~ 4) (95% CI: 4.69 ~ 5.48; p < 0.001). One cases (1.45%) and three cases (4.35%) experienced wound infection and adjacent arthritis

  19. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis.

    PubMed

    Hamstra-Wright, Karrie L; Bliven, Kellie C Huxel; Bay, Curt

    2015-03-01

    Medial tibial stress syndrome (MTSS) is a common injury in runners and military personnel. There is a lack of agreement on the aetiological factors contributing to MTSS, making treatment challenging and highlighting the importance of preventive efforts. Understanding the risk factors for MTSS is critical for developing preventive measures. The purpose of this systematic review and meta-analysis was to assess what factors put physically active individuals at risk to develop MTSS. Selected electronic databases were searched. Studies were included if they contained original research that investigated risk factors associated with MTSS, compared physically active individuals with MTSS and physically active individuals without MTSS, were in the English language and were full papers in peer-reviewed journals. Data on research design, study duration, participant selection, population, groups, MTSS diagnosis, investigated risk factors and risk factor definitions were extracted. The methodological quality of the studies was assessed. When the means and SDs of a particular risk factor were reported three or more times, that risk factor was included in the meta-analysis. There were 21 studies included in the systematic review and nine risk factors qualified for inclusion in the meta-analysis. Increased BMI (weighted mean difference (MD)=0.79, 95% CI 0.38 to 1.20, p<0.001), navicular drop (MD=1.19 mm, 95% CI 0.54 to 1.84, p<0.001), ankle plantarflexion range of motion (ROM; MD=5.94°, 95% CI 3.65 to 8.24, p<0.001) and hip external rotation ROM (MD=3.95°, 95% CI 1.78 to 6.13, p<0.001) were risk factors for MTSS. Dorsiflexion and quadriceps-angle were clearly not risk factors for MTSS. There is a need for high-quality, prospective studies using consistent methodology evaluating MTSS risk factors. Our findings suggest that interventions focused on addressing increased BMI, navicular drop, ankle plantarflexion ROM and hip external rotation ROM may be a good starting point for

  20. Reproducibility of and sex differences in common orthopaedic ankle and foot tests in runners

    PubMed Central

    2014-01-01

    Background For future etiologic cohort studies in runners it is important to identify whether (hyper)pronation of the foot, decreased ankle joint dorsiflexion (AJD) and the degree of the extension of the first Metatarsophalangeal joint (MTP1) are risk factors for running injuries and to determine possible sex differences. These parameters are frequently determined with the navicular drop test (NDT) Stance and Single Limb-Stance, the Ankle Joint Dorsiflexion-test, and the extension MTP1-test in a healthy population. The aim of this clinimetric study was to determine the reproducibility of these three orthopaedic tests in runners, using minimal equipment in order to make them applicable in large cohort studies. Furthermore, we aimed to determine possible sex differences of these tests. Methods The three orthopaedic tests were administered by two sports physiotherapists in a group of 42 (22 male and 20 female) recreational runners. The intra-class correlation (ICC) for interrater and intrarater reliability and the standard error of measurement (SEM) were calculated. Bland and Altman plots were used to determine the 95% limits of agreements (LOAs). Furthermore, the difference between female and male runners was determined. Results The ICC’s of the NDT were in the range of 0.37 to 0.45, with a SEM in the range of 2.5 to 5 mm. The AJD-test had an ICC of 0.88 and 0.86 (SEM 2.4° and 8.7°), with a 95% LOA of -6.0° to 6.3° and -5.3° to 7.9°, and the MTP1-test had an ICC of 0.42 and 0.62 (SEM 34.4° and 9.9°), with a 95% LOA of -30.9° to 20.7° and -20° to 17.8° for the interrater and intrarater reproducibility, respectively. Females had a significantly (p < 0.05) lower navicular drop score and higher range of motion in extension of the MTP1, but no sex differences were found for ankle dorsiflexion (p ≥ 0.05). Conclusion The reproducibility for the AJD test in runners is good, whereas that of the NDT and extension MTP1 was moderate or low. We found a

  1. Determination of perfluorinated compounds in fish fillet homogenates: method validation and application to fillet homogenates from the Mississippi River.

    PubMed

    Malinsky, Michelle Duval; Jacoby, Cliffton B; Reagen, William K

    2011-01-10

    We report herein a simple protein precipitation extraction-liquid chromatography tandem mass spectrometry (LC/MS/MS) method, validation, and application for the analysis of perfluorinated carboxylic acids (C7-C12), perfluorinated sulfonic acids (C4, C6, and C8), and perfluorooctane sulfonamide (FOSA) in fish fillet tissue. The method combines a rapid homogenization and protein precipitation tissue extraction procedure using stable-isotope internal standard (IS) calibration. Method validation in bluegill (Lepomis macrochirus) fillet tissue evaluated the following: (1) method accuracy and precision in both extracted matrix-matched calibration and solvent (unextracted) calibration, (2) quantitation of mixed branched and linear isomers of perfluorooctanoate (PFOA) and perfluorooctanesulfonate (PFOS) with linear isomer calibration, (3) quantitation of low level (ppb) perfluorinated compounds (PFCs) in the presence of high level (ppm) PFOS, and (4) specificity from matrix interferences. Both calibration techniques produced method accuracy of at least 100±13% with a precision (%RSD) ≤18% for all target analytes. Method accuracy and precision results for fillet samples from nine different fish species taken from the Mississippi River in 2008 and 2009 are also presented. Copyright © 2010 Elsevier B.V. All rights reserved.

  2. World-Wide Indoor Exposure to Polyfluoroalkyl Phosphate Esters (PAPs) and other PFASs in Household Dust.

    PubMed

    Eriksson, Ulrika; Kärrman, Anna

    2015-12-15

    Human exposure to perfluorooctanoic acid (PFOA) and other per- and polyfluoroalkyl substances (PFASs) is ongoing and in some cases increasing, despite efforts made to reduce emissions. The role of precursor compounds such as polyfluorinated phosphate esters (PAPs) has received increasing attention, but there are knowledge gaps regarding their occurrence and impact on human exposure. In this study, mono-, di-, and triPAPs, perfluorinated alkyl acids (PFAAs), saturated, and unsaturated fluorotelomer carboxylic acids (FTCA/FTUCAs), perfluoroalkane sulfonamides, and sulfonamidethanols (FOSA/FOSEs), and one fluorotelomer sulfonic acid (FTSA)) were compared in household dust samples from Canada, the Faroe Islands, Sweden, Greece, Spain, Nepal, Japan, and Australia. Mono-, di-, and triPAPs, including several diPAP homologues, were frequently detected in dust from all countries, revealing an ubiquitous spread in private households from diverse geographic areas, with significant differences between countries. The median levels of monoPAPs and diPAPs ranged from 3.7 ng/g to 1 023 ng/g and 3.6 ng/g to 692 ng/g, respectively, with the lowest levels found in Nepal and the highest in Japan. The levels of PAPs exceeded those of the other PFAS classes. These findings reveal the importance of PAPs as a source of PFAS exposure worldwide.

  3. Quantitative trace analysis of polyfluorinated alkyl substances (PFAS) in ambient air samples from Mace Head (Ireland): A method intercomparison

    NASA Astrophysics Data System (ADS)

    Jahnke, Annika; Barber, Jonathan L.; Jones, Kevin C.; Temme, Christian

    A method intercomparison study of analytical methods for the determination of neutral, volatile polyfluorinated alkyl substances (PFAS) was carried out in March, 2006. Environmental air samples were collected in triplicate at the European background site Mace Head on the west coast of Ireland, a site dominated by 'clean' westerly winds coming across the Atlantic. Extraction and analysis were performed at two laboratories active in PFAS research using their in-house methods. Airborne polyfluorinated telomer alcohols (FTOHs), fluorooctane sulfonamides and sulfonamidoethanols (FOSAs/FOSEs) as well as additional polyfluorinated compounds were investigated. Different native and isotope-labelled internal standards (IS) were applied at various steps in the analytical procedure to evaluate the different quantification strategies. Field blanks revealed no major blank problems. European background concentrations observed at Mace Head were found to be in a similar range to Arctic data reported in the literature. Due to trace-levels at the remote site, only FTOH data sets were complete and could therefore be compared between the laboratories. Additionally, FOSEs could partly be included. Data comparison revealed that despite the challenges inherent in analysis of airborne PFAS and the low concentrations, all methods applied in this study obtained similar results. However, application of isotope-labelled IS early in the analytical procedure leads to more precise results and is therefore recommended.

  4. Emerging investigator series: a 14-year depositional ice record of perfluoroalkyl substances in the High Arctic.

    PubMed

    MacInnis, John J; French, Katherine; Muir, Derek C G; Spencer, Christine; Criscitiello, Alison; De Silva, Amila O; Young, Cora J

    2017-01-25

    To improve understanding of long-range transport of perfluoroalkyl substances to the High Arctic, samples were collected from a snow pit on the Devon Ice Cap in spring 2008. Snow was analyzed for perfluoroalkyl acids (PFAAs), including perfluoroalkyl carboxylic acids (PFCAs) and perfluoroalkyl sulfonic acids (PFSAs), as well as perfluorooctane sulfonamide (FOSA). PFAAs were detected in all samples dated from 1993 to 2007. PFAA fluxes ranged from <1 to hundreds of ng per m(2) per year. Flux ratios of even-odd PFCA homologues were mostly between 0.5 and 2, corresponding to molar ratios expected from atmospheric oxidation of fluorotelomer compounds. Concentrations of perfluorobutanoic acid (PFBA) were much higher than other PFCAs, suggesting PFBA loading on the Devon Ice Cap is influenced by additional sources, such as the oxidation of heat transfer fluids. All PFCA fluxes increased with time, while PFSA fluxes generally decreased with time. No correlations were observed between PFAAs and the marine aerosol tracer, sodium. Perfluoro-4-ethylcyclohexanesulfonate (PFECHS) was detected for the first time in an atmospherically - derived sample, and its presence may be attributed to aircraft hydraulic system leakage. Observations of PFAAs from these samples provide further evidence that atmospheric oxidation of volatile precursors is an important source of PFAAs to the Arctic environment.

  5. Adjoint based sensitivity analysis of a reacting jet in crossflow

    NASA Astrophysics Data System (ADS)

    Sashittal, Palash; Sayadi, Taraneh; Schmid, Peter

    2016-11-01

    With current advances in computational resources, high fidelity simulations of reactive flows are increasingly being used as predictive tools in various industrial applications. In order to capture the combustion process accurately, detailed/reduced chemical mechanisms are employed, which in turn rely on various model parameters. Therefore, it would be of great interest to quantify the sensitivities of the predictions with respect to the introduced models. Due to the high dimensionality of the parameter space, methods such as finite differences which rely on multiple forward simulations prove to be very costly and adjoint based techniques are a suitable alternative. The complex nature of the governing equations, however, renders an efficient strategy in finding the adjoint equations a challenging task. In this study, we employ the modular approach of Fosas de Pando et al. (2012), to build a discrete adjoint framework applied to a reacting jet in crossflow. The developed framework is then used to extract the sensitivity of the integrated heat release with respect to the existing combustion parameters. Analyzing the sensitivities in the three-dimensional domain provides insight towards the specific regions of the flow that are more susceptible to the choice of the model.

  6. Perfluorooctane sulfonate: a review of human exposure, biomonitoring and the environmental forensics utility of its chirality and isomer distribution.

    PubMed

    Miralles-Marco, Ana; Harrad, Stuart

    2015-04-01

    Perfluorooctane sulfonate (PFOS) found extensive use for over 60 years up until its restriction in the early 2000s, culminating in its listing under the Stockholm Convention on Persistent Organic Pollutants (POPs) in 2009. Efforts to minimise human body burdens are hindered by uncertainty over their precise origins. While diet appears the principal source for the majority of western populations (with other pathways like dust ingestion, drinking water and inhalation also important contributors); the role played by exposure to PFOS-precursor compounds followed by in vivo metabolism to PFOS as the ultimate highly stable end-product is unclear. Such PFOS-precursor compounds include perfluorooctane sulfonamide derivates, e.g., perfluorooctane sulfonamides (FOSAs) and sulfonamidoethanols (FOSEs). Understanding the indirect contribution of such precursors to human body burdens of PFOS is important as a significant contribution from this pathway would render the margin of safety between the current exposure limits and estimates of external exposure to PFOS alone, narrower than hitherto appreciated. Estimates derived from mathematical modelling studies, put the contribution of so-called "precursor exposure" at between 10% and 40% of total PFOS body burdens. However, there are substantial uncertainties associated with such approaches. This paper reviews current understanding of human exposure to PFOS, with particular reference to recent research highlighting the potential of environmental forensics approaches based on the relative abundance and chiral signatures of branched chain PFOS isomers to provide definitive insights into the role played by "precursor exposure".

  7. Airborne Precursors Predict Maternal Serum Perfluoroalkyl Acid Concentrations.

    PubMed

    Makey, Colleen M; Webster, Thomas F; Martin, Jonathan W; Shoeib, Mahiba; Harner, Tom; Dix-Cooper, Linda; Webster, Glenys M

    2017-07-05

    Human exposure to persistent perfluoroalkyl acids (PFAAs), including perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorooctanesulfonate (PFOS), can occur directly from contaminated food, water, air, and dust. However, precursors to PFAAs (PreFAAs), such as dipolyfluoroalkyl phosphates (diPAPs), fluorotelomer alcohols (FTOHs), perfluorooctyl sulfonamides (FOSAs), and sulfonamidoethanols (FOSEs), which can be biotransformed to PFAAs, may also be a source of exposure. PFAAs were analyzed in 50 maternal sera samples collected in 2007-2008 from participants in Vancouver, Canada, while PFAAs and PreFAAs were measured in matching samples of residential bedroom air collected by passive sampler and in sieved vacuum dust (<150 μm). Concentrations of PreFAAs were higher than for PFAAs in air and dust. Positive associations were discovered between airborne 10:2 FTOH and serum PFOA and PFNA and between airborne MeFOSE and serum PFOS. On average, serum PFOS concentrations were 2.3 ng/mL (95%CI: 0.40, 4.3) higher in participants with airborne MeFOSE concentrations in the highest tertile relative to the lowest tertile. Among all PFAAs, only PFNA in air and vacuum dust predicted serum PFNA. Results suggest that airborne PFAA precursors were a source of PFOA, PFNA, and PFOS exposure in this population.

  8. Generation of Perfluoroalkyl Acids from Aerobic Biotransformation of Quaternary Ammonium Polyfluoroalkyl Surfactants.

    PubMed

    Mejia-Avendaño, Sandra; Vo Duy, Sung; Sauvé, Sébastien; Liu, Jinxia

    2016-09-20

    The aerobic biotransformation over 180 days of two cationic quaternary ammonium compounds (QACs) with perfluoroalkyl chains was determined in soil microcosms, and biotransformation pathways were proposed. This is the first time that polyfluoroalkyl cationic surfactants used in aqueous film-forming foam (AFFF) formulations were studied for their environmental fate. The biotransformation of perfluorooctaneamido quaternary ammonium salt (PFOAAmS) was characterized by a DT50 value (time necessary to consume half of the initial mass) of 142 days and significant generation of perfluoroalkyl carboxylic acid (PFOA) at a yield of 30 mol % by day 180. The biotransformation of perfluorooctane sulfonamide quaternary ammonium salt (PFOSAmS) was very slow with unobservable change of the spiked mass; yet the generation of perfluorooctanesulfonate (PFOS) at a yield of 0.3 mol % confirmed the biotransformation of PFOSAmS. Three novel biotransformation intermediates were identified for PFOAAmS and three products including perfluorooctane sulfonamide (FOSA) for PFOSAmS through high-resolution mass spectrometry (MS) analysis and t-MS(2) fragmentation. The significantly slower PFOSAmS biotransformation is hypothesized to be due to its stronger sorption to soil owing to a longer perfluoroalkyl chain and a bulkier sulfonyl group, when compared to PFOAAmS. This study has demonstrated that despite overall high stability of QACs and their biocide nature, the ones with perfluoroalkyl chains can be substantially biotransformed into perfluoroalkyl acids in aerobic soil.

  9. Spatial and temporal trends in perfluoroalkyl substances (PFASs) in ringed seals (Pusa hispida) from Svalbard.

    PubMed

    Routti, Heli; Gabrielsen, Geir Wing; Herzke, Dorte; Kovacs, Kit M; Lydersen, Christian

    2016-07-01

    This study investigates concentrations of perfluoroalkyl carboxylates (PFCAs), perfluoroalkyl sulfonates (PFSAs) and perfluoroalkane sulfonamides (FASA) in plasma from ringed seals sampled in the period 1990-2010 (n = 71) in Svalbard, Norway. Perfluorooctane sulfonate was dominant among the perfluoroalkyl substances. PFCAs were dominated by perfluoroundecanoate followed by perfluorononanoate. C4C8 PFCAs and perfluorooctane sulfonamide (FOSA) were detected in ≤42% of the samples. PFSA and PFCA concentrations were higher in seals sampled from Kongsfjorden, a fjord influenced by strong inflows of Atlantic Water compared to seals from fjords dominated by Arctic Water (e.g. Billefjorden). Sex, age and body condition of the seals did not influence PFAS concentrations. Due to the confounding effect of year and sampling area, temporal trends were assessed only in seals sampled from Kongsfjorden (5 years, n = 51). PFHxS and PFOS concentrations did not show significant linear trends during the whole study period, but a decrease was observed since 2004. Concentrations of all of the detected PFCAs (C9C13 PFCAs) increased until 2004 after which they have declined or stabilized. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. [Aicardi syndrome with Dandy-Walker type malformation].

    PubMed

    Laguado-Herrera, Yuly V; Manrique-Hernández, Edgar F; Peñaloza-Mantilla, Camilo A; Quintero-Gómez, David A; Contreras-García, Gustavo A; Sandoval-Martínez, Diana K

    2015-07-16

    Introduccion. El sindrome de Aicardi (OMIM 304050) fue descrito en 1965. Su triada clasica esta compuesta por espasmos infantiles, agenesia parcial o total del cuerpo calloso y alteraciones oculares, como lagunas coriorretinianas. Se postula un mecanismo de herencia ligado a X dominante. Caso clinico. Niña nacida a termino, sin antecedentes familiares patologicos ni consanguinidad parental, con diagnostico prenatal de malformacion tipo Dandy-Walker, quien presento episodios convulsivos, coloboma del nervio optico, bloque vertebral toracico con presencia de escoliosis, ecografia transfontanelar con agenesia del cuerpo calloso y cariotipo 46,XX. Se diagnostico de sindrome de Aicardi y fallecio con mes y medio de edad. En la autopsia se evidencio hidrocefalia supratentorial con presencia de papiloma de los plexos coroideos, quiste en la fosa posterior (cuarto ventriculo), hipoplasia del vermis cerebeloso, agenesia del hemisferio del cuerpo calloso y cerebeloso izquierdo, rasgos faciales caracteristicos del sindrome, paladar ojival, pectus excavatum, escoliosis, quiste paraovarico y hepatomegalia. Conclusiones. Pocos casos han descrito la asociacion de la patologia y la presencia de malformacion de Dandy-Walker. Se comunica un nuevo caso con esta asociacion, teniendo en cuenta que las alteraciones relacionadas, principalmente agenesia o hipoplasia del cuerpo calloso, sugieren que tiene un componente genetico de base. El estudio de busqueda de la etiologia de centrarse en evaluar aquellos genes que tengan relacion con el neurodesarrollo y su activacion en la etapa de organogenia. El diagnostico definitivo establece el pronostico, manejo y asesoria genetica a la familia.

  11. [Treatment of syringomyelia in patients with Chiari malformation and craniosynostosis. A case report and review of the literature].

    PubMed

    Aransay-Garcia, A; Villarejo-Ortega, F J

    2016-11-16

    Introduccion. Los pacientes con craneosinostosis complejas o unisuturales presentan frecuentemente malformacion de Chiari y siringomielia. El tratamiento quirurgico de la siringomielia en estos pacientes es controvertido. Caso clinico. Niña de 3 años con craneosinostosis compleja no corregida quirurgicamente. Permanecio asintomatica a pesar de que en la resonancia magnetica craneal se evidencio una malformacion de Chiari y un año despues desarrollo una siringomielia cervicodorsolumbar. Se le realizo una craniectomia suboccipital descompresiva, pero posteriormente sufrio un empeoramiento de la siringomielia. El registro de presion intracraneal resulto patologico, por lo que se decidio realizar una craneotomia descompresiva frontoparietotemporal bilateral y remodelacion de la boveda craneal, con lo que se consiguio una disminucion significativa de la siringomielia. Conclusiones. Tras la revision de la bibliografia, se observa que actualmente no existe un consenso sobre el tratamiento de la siringomielia en los pacientes con craneosinostosis y malformacion de Chiari. Algunos autores recomiendan la simultanea descompresion quirurgica suboccipital y de la boveda craneal, otros solo la descompresion de la boveda craneal, y otros la ampliacion de la fosa posterior con distractores. En los casos en los que se realizo primero la descompresion suboccipital no se consiguio resolver ni estabilizar la siringomielia. Concluimos que el tratamiento mas eficaz para los pacientes con siringomielia y craneosinostosis es la remodelacion descompresiva de la boveda craneal, ya que el principal factor causante de la siringomielia es la hipertension intracraneal y la falta de distensibilidad del craneo.

  12. MALDI-TOF "fingerprint" phospholipid mass spectra allow the differentiation between ruminantia and feloideae spermatozoa.

    PubMed

    Fuchs, B; Jakop, U; Göritz, F; Hermes, R; Hildebrandt, T; Schiller, J; Müller, K

    2009-03-01

    The detailed comparative analysis of sperm lipids could essentially contribute to a better understanding of membrane function in the context of fertilization and, moreover, of sperm preservation. The application of sensitive analytical methods is particularly necessary for endangered species as the available amount of spermatozoa (and, accordingly, extractable lipids) is strongly limited. It will be shown that matrix-assisted laser desorption and ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) is a fast, simple and sensitive method for the determination of the phospholipid composition of spermatozoa from several ruminantia (cattle, roe deer, Klipspringer) and feloideae species (domestic cat, Siberian tiger, fosa). Characteristic "fingerprints" are obtained from the positive ion spectra that allow the differentiation between both animal groups. In contrast to the lipid extracts of ruminantia spermatozoa which predominantly contain ether lipids including essential amounts of plasmalogens, the more complex phospholipid composition of feloideae spermatozoa is clearly dominated by diacyl phospholipids and contains only marginal amounts of plasmalogens. It will also be shown that the lipid compositions of ejaculated, electroejaculated and cauda epididymal spermatozoa of the same species are very similar and give comparable data. Therefore, the analysis of ejaculated spermatozoa is not an absolute must.

  13. [Syringomyelias in paediatrics: a retrospective study of 25 cases].

    PubMed

    Martinez-Albaladejo, I; Prochazkova, M; Perez-Sebastian, I; Bernardino-Cuesta, B; Martinez-Ferrandez, C; Suarez-Traba, O M; Budke, M; Garcia-Penas, J J

    2016-09-01

    Introduccion. Se define siringomielia como una cavidad que contiene liquido cefalorraquideo dispuesta en el interior de la medula espinal. Objetivo. Describir las caracteristicas clinicas de una serie de pacientes con siringomielia, su diagnostico y tratamiento. Pacientes y metodos. Estudio descriptivo retrospectivo realizado mediante la revision de historias clinicas en nuestro centro. Resultados. Se revisaron 25 pacientes diagnosticados de siringomielia. En cinco el diagnostico fue casual y ocho presentaban una patologia grave previa (tumoral, osea o vascular). Dos pacientes comenzaron con hidrocefalia y clinica de hipertension intracraneal y unicamente dos destacaban cefalea como unico sintoma. Cuatro presentaron escoliosis progresiva, dos de ellos como queja inicial, y precisaron cirugia con artrodesis y uso de corse, respectivamente. Destaca la precocidad del diagnostico. La mayoria presentaba unicamente perdida de fuerza leve, con potenciales somatosensoriales y electromiograma normales. En todos se hicieron controles con resonancia magnetica. Ocho pacientes precisaron craniectomia descompresiva con laminectomia posterior C1-C2, con drenaje de la cavidad siringomielica en cuatro. Nueve requirieron valvula de derivacion y dos precisaron, ademas, ventriculostomia. Conclusiones. La presencia de siringomielia en pediatria es rara, y se asocia generalmente a malformaciones en la fosa posterior y antecedentes de disrafismo espinal. Destaca la escoliosis progresiva como posible manifestacion aislada. Un abordaje multidisciplinar con controles radiologicos seriados y la valoracion por servicios de neurologia y neurocirugia pediatricos son mandatorios para su seguimiento.

  14. Flexor Digitorum Longus (FDL) or Flexor Hallucis Longus (FHL) Harvesting: Technical Tip and Case Studies.

    PubMed

    Lehnert, Bruce; Nyska, Meir; Ip, Wing; Huynh, Em; Palmanovich, Ezequiel

    2017-09-01

    Harvesting of the flexor digitorum longus (FDL) or the flexor hallucis longus (FHL) is a procedure used when tendon transfer is needed. It is commonly used in tibialis posterior reconstruction and Achilles tendon reconstruction. Harvesting of these tendons is sometimes difficult and time-consuming. It is important to obtain sufficient length to make a loop around the navicular bone or anchor it in the calcaneus. We describe a technique in which a loop is passed from proximal identification of the FDL or FHL through the tendon sheath, harvesting it from a minimal plantar approach. After using this technique, we evaluated 10 consecutive patients for neurovascular damage. We found no postoperative neurovascular injuries. The technique described enables the surgeon to find the FDL/FHL tendon through the medial approach and obtain sufficient length for the procedure by cutting the distal portion of the tendon through an additional plantar incision. Our technical tip for passing the loop facilitates harvest of the tendon easily and safely using the plantar approach. IV, case series.

  15. Annealing condition influences thermal hysteresis of fungal type ice-binding proteins.

    PubMed

    Xiao, Nan; Hanada, Yuichi; Seki, Haruhiko; Kondo, Hidemasa; Tsuda, Sakae; Hoshino, Tamotsu

    2014-02-01

    The Antarctic sea ice diatom Navicular glaciei produced ice-binding protein (NagIBP) that is similar to the antifreeze protein (TisAFP) from snow mold Typhula ishikariensis. In the thermal hysteresis range of NagIBP, ice growth was completely inhibited. At the freezing point, the ice grew in a burst to 6 direction perdicular to the c-axis of ice crystal. This burst pattern is similar to TisAFP and other hyperactive AFPs. The thermal hysteresis of NagIBP and TisAFP could be increased by decreasing a cooling rate to allow more time for the proteins to bind ice. This suggests the possible second binding of proteins occurs on the ice surface, which might increase the hysteresises to a sufficient level to prevent freezing of the brine pockets which habitat of N. glaciei. The secondary ice binding was described as that after AFP molecules bind onto the flat ice plane irreversibly, which was based on adsorption-inhibition mechanism model at the ice-water interface, convex ice front was formed and overgrew during normal TH measurement (no annealing) until uncontrolled growth at the nonequilibrium freezing point. The results suggested that NagIBP is a hyperactive AFP that is expressed for freezing avoidance. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Pharmacokinetics of gallium nitrate after oral administration in adult horses--pilot study.

    PubMed

    Pollina, G F; Zagotto, G; Maritan, P; Iacopetti, I; Busetto, R

    2012-10-01

    Gallium (Ga), a metal in group IIIA of the periodic table, has shown a remarkable activity against bone resorption and could therefore possibly prove useful in the treatment of certain diseases in sport horses, for example navicular disease. The aim of this study was to gain more information concerning the kinetics of Ga after oral administration of gallium nitrate (GaN) in adult horses. Six horses received a single dose of 10 mg/kg of GaN mixed with the food ration. Absorption was slow (T(max) = 10 ± 3 h, T(½abs) = 2 ± 0.8 h), and a C(max) of 26 ± 11 μg/L was achieved. Excretion followed a one-phase elimination model, with a long half-life (T(½el) = 52 ± 14 h). By means of a mathematical model, we estimated that the plasmatic levels should reach 93 μg/L (1.33 μm) at steady state, following the repeated daily administration of 10 mg/kg of GaN. A three times lower concentration has been demonstrated as effective in inhibiting the osteolytic activity of osteoclasts in vitro. The results of this study suggest that the administration of oral GaN at a rate of 10 mg/kg per day may be considered for future clinical studies. © 2011 Blackwell Publishing Ltd.

  17. Osteolytic Cystic Lesion of Naviculum: The Great Mimicker

    PubMed Central

    Saindane, K A; Ghodke, Aashish B; Patil, Sameer S; Godghate, Neha N; Kelkar, Sagar

    2016-01-01

    Introduction: Children show a higher predisposition to the development of extrapulmonary tuberculosis. Osteoarticular tuberculosis, especially in the foot is uncommon therefore it has remained a diagnostic enigma. The non-specific, often indolent, clinical presentation of foot (navicular) tuberculosis, whose low prevalence and low index of suspicion among clinicians may convert a purely osseous lesion into one involving a joint with more local destruction and functional disability. However, prompt diagnosis and treatment of this curable disease remains critical for initiation of proper management, prevention of joint deformity and permanent bone destruction. Case Presentation: A 6-year-old female child with pain and swelling over the mid-foot was the subject of this study. Clinical, haematological, radiological examination and FNAC was done which revealed it to be of tuberculous pathology. Treatment consisted of anti-tubercular regimen for a period of 15 months. Within 4 months of starting anti tubercular therapy the patient was pain free and fully weight bearing on the affected foot. Conclusion: To make a diagnosis of tuberculosis one must consider it as a possibility. Long standing pain and swelling of the midfoot should include TB in the differential diagnosis of destructive osteoarticular lesions. Since the radiological features are non-specific, so a high degree of suspicion is required to avoid permanent articular disability, to obtain a supple, painless and weight bearing foot. PMID:27299123

  18. The effects of hip external rotator exercises and toe-spread exercises on lower extremity muscle activities during stair-walking in subjects with pronated foot

    PubMed Central

    Goo, Young-Mi; Kim, Da-Yeon; Kim, Tae-Ho

    2016-01-01

    [Purpose] The purpose of the present study was to examine the effects of toe-spread (TS) exercises and hip external rotator strengthening exercises for pronated feet on lower extremity muscle activities during stair-walking. [Subjects and Methods] The participants were 20 healthy adults with no present or previous pain, no past history of surgery on the foot or the ankle, and no foot deformities. Ten subjects performed hip external rotator strengthening exercises and TS exercises and the remaining ten subjects performed only TS exercises five times per week for four weeks. [Results] Less change in navicular drop height occurred in the group that performed hip external rotator exercises than in the group that performed only TS exercises. The group that performed only TS exercises showed increased abductor hallucis muscle activity during both stair-climbing and -descending, and the group that performed hip external rotator exercises showed increased muscle activities of the vastus medialis and abductor hallucis during stair-climbing and increased muscle activity of only the abductor hallucis during stair-descending after exercise. [Conclusion] Stair-walking can be more effectively performed if the hip external rotator muscle is strengthened when TS exercises are performed for the pronated foot. PMID:27134364

  19. The effects of hip external rotator exercises and toe-spread exercises on lower extremity muscle activities during stair-walking in subjects with pronated foot.

    PubMed

    Goo, Young-Mi; Kim, Da-Yeon; Kim, Tae-Ho

    2016-03-01

    [Purpose] The purpose of the present study was to examine the effects of toe-spread (TS) exercises and hip external rotator strengthening exercises for pronated feet on lower extremity muscle activities during stair-walking. [Subjects and Methods] The participants were 20 healthy adults with no present or previous pain, no past history of surgery on the foot or the ankle, and no foot deformities. Ten subjects performed hip external rotator strengthening exercises and TS exercises and the remaining ten subjects performed only TS exercises five times per week for four weeks. [Results] Less change in navicular drop height occurred in the group that performed hip external rotator exercises than in the group that performed only TS exercises. The group that performed only TS exercises showed increased abductor hallucis muscle activity during both stair-climbing and -descending, and the group that performed hip external rotator exercises showed increased muscle activities of the vastus medialis and abductor hallucis during stair-climbing and increased muscle activity of only the abductor hallucis during stair-descending after exercise. [Conclusion] Stair-walking can be more effectively performed if the hip external rotator muscle is strengthened when TS exercises are performed for the pronated foot.

  20. [Stress fractures in athletes. role of magnetic resonance imaging in predicting injury morbidity].

    PubMed

    Maquirriain, Javier; Ghisi, Juan Pablo

    2007-01-01

    Magnetic resonance imaging is a useful tool for stress fractures (SF) diagnosis, allowing the estimation of injury severity. The aim of this study was to determine the relation between the severity of SF in athletes determined by magnetic resonance imaging and the morbidity estimated as the time to return to sport. Thirty-four cases of stress fractures, (29 athletes; 12 female, 17 male; age 26.3 +/- 12.5), were studied by radiographs and magnetic resonance imaging. Injuries were classified according to Arendt's scale and they were analyzed according to site, activity level, delay in diagnosis and time needed to return to sports. The tibia was the most affected bone (n=12; 35.2%), followed by the tarsal navicular (n=5; 14.7%), and the metatarsals (n=4; 11.7%). Injury severity according to magnetic resonance imaging appearance was: grade 1=14.7%; grade 2=14.7%; grade 3=38.2%; grade 4=32.4%. The main finding was the positive significant correlation between injury severity and recovery time (r=0.66, p=0.0002). In conclusion, significant correlation exists between stress fracture injury severity determined by magnetic resonance image and recovery time in athletes. The use of a systematic graded magnetic resonance image evaluation may assist the physician to define clinical management, supervise the rehabilitation program and estimate the return to sport activity.

  1. Astragalar Morphology of Selected Giraffidae

    PubMed Central

    2016-01-01

    The artiodactyl astragalus has been modified to exhibit two trochleae, creating a double pullied structure allowing for significant dorso-plantar motion, and limited mediolateral motion. The astragalus structure is partly influenced by environmental substrates, and correspondingly, morphometric studies can yield paleohabitat information. The present study establishes terminology and describes detailed morphological features on giraffid astragali. Each giraffid astragalus exhibits a unique combination of anatomical characteristics. The giraffid astragalar morphologies reinforce previously established phylogenetic relationships. We find that the enlargement of the navicular head is a feature shared by all giraffids, and that the primitive giraffids possess exceptionally tall astragalar heads in relation to the total astragalar height. The sivatheres and the okapi share a reduced notch on the lateral edge of the astragalus. We find that Samotherium is more primitive in astragalar morphologies than Palaeotragus, which is reinforced by tooth characteristics and ossicone position. Diagnostic anatomical characters on the astragalus allow for giraffid species identifications and a better understanding of Giraffidae. PMID:27028515

  2. Benign intestinal glandular lesions in the vagina: a possible correlation with implantation.

    PubMed

    Lu, Weiwei; Zhang, Xiaofei; Lu, Bingjian

    2016-06-17

    Enteric-type glandular lesions are extremely rare in the vagina. Their histological origin remains a matter of speculation at present. We review two rectal mucosal prolapse-like polyps and one intestinal-type adenosis in the vagina. Case 1, a 64-year-old woman, presented with a vaginal polypoid lesion with a size of 4 × 3 × 3 cm. Case 2, an 8-year-old girl, had a 1.5 × 1.5 × 0.8-cm pedunculated polyp in the vaginal navicular fossa and a clinically suspected rectovaginal fistula. Case 1 and 3 had an obsolete severe perineal laceration. On histopathological examination, cases 1 and 2 resembled rectal mucosal prolapse or inflammatory cloacogenic polyp (rectal mucosal prolapse-like polyp). Case 3 had an incidental intestinal-type adenosis in the removed vaginal wall. Immunohistochemistry confirmed the intestinal differentiation in all 3 lesions by showing diffuse CDX2-positive, CK20-positive, and scattered chromogranin A-positive neuroendocrinal cells in the lower compartment of the crypt. In summary, we report herein three unusual cases of benign intestinal-type glandular lesions in the vagina including two rectal mucosal prolapse-like polyps and one case of intestinal-type adenosis, and discuss possibilities for their histogenetic basis.

  3. Impact of foot pronation on postural stability: An observational study.

    PubMed

    Koura, Ghada Mohamed; Elimy, Doaa Ayoub; Hamada, Hamada Ahmed; Fawaz, Hossam Eddien; Elgendy, Mohamed Hussein; Saab, Ibtissam M

    2017-09-15

    To investigate the effect of foot pronation on the dynamic balance including overall stability index (OAI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI). Forty participants from both sexes were selected from the Faculty of Physical Therapy, Cairo University, with a mean age of 23.55 ± 1.74 years. Subjects were divided into two groups: group A (8 males and 12 females) with foot pronation, and group B (9 males and 11 females) with normal feet. The Navicular Drop Test (NDT) was used to determine if the feet were pronated and Biodex Balance System was used to assess dynamic balance at level 8 and level 4 for both groups. No significant difference was found in dynamic balance, including OAI, APSI and MLSI at stability level 8 (p> 0.05) but, there was a significant difference at stability level 4 (p< 0.05) between the two groups with lower stability in group A. Foot pronation or flat feet influences the dynamic balance at stability level four using the Biodex Balance System compared with those in the control group.

  4. Talus measurements as a diagnostic tool for sexual dimorphism in Egyptian population.

    PubMed

    Abd-elaleem, Shereen Abd-elhakim; Abd-elhameed, Mostafa; Ewis, Ashraf Abd-elazeem

    2012-02-01

    Measurements of talus have been shown to be sexually dimorphic in South African blacks and whites and Prehistoric New Zealand Polynesians. Since several studies have demonstrated that discriminant function equations used to determine the sex of a skeleton are population specific, the purpose of the present study was to derive similar equation for the tali of Egyptians. The sample consisted of 110 tali (67 male & 43 female) whose age at death ranged between 20 and 60 years. The tali were obtained from Anatomy departments of Minia and Cairo Universities and also from Forensic Medicine department of Justice Office in Minia governates - Egypt. Twelve measurements were taken for every talus. Data were analyzed by SPSS version 16. All measurements showed significant sexual differences (P < 0.05) except calcaneus articular surface width and navicular articular surfaced width. Talar length was found to be the most sexual dimorphic (90.9%). Combination of talar length, talar width and neck width gave a percentage of accuracy of 85.5%. Finally, it is concluded that the talus of Egyptian population is useful for sex estimation.

  5. Septic osteitis of the distal phalanx: findings and surgical treatment in 18 cases.

    PubMed

    Cauvin, E R; Munroe, G A

    1998-11-01

    Eighteen cases of septic osteitis of the distal phalanx were diagnosed clinically and confirmed at surgery over a 6 year period (1990-1996). Focal bone lysis was the most common radiographic finding. Sequestra were identified in 4 horses, one of which was associated with a fractured plantar process. All the horses were treated surgically with open debridement. The septic process recurred in 4 horses: one was subjected to euthanasia due to navicular bursa infection, secondary to a pathological fracture, the other 3 horses responded to further debridement. A pathological fracture occurred in another horse. All the survivors were not lame 3 months post operatively, although complete healing took 1-12 months. Long term follow up was available in 14 cases. One was retired, all the other horses were back in work at a similar level of performance. This series indicates that surgical treatment of septic pedal osteitis carries a fair to good prognosis despite a high rate of post operative complications and convalescence period of up to 12 months.

  6. [Tuberculous osteitis of the tarsal bones: a case report].

    PubMed

    Kotevoğlu, Nurdan; Tezer, Mehmet; Kabukçuoğlu, Fevziye

    2003-01-01

    A thirty-year old woman presented with complaints of pain, swelling in her right ankle, and difficulty in walking that had a history of six months. The range of motion of the joint was limited. She did not get any benefit from various non-steroidal anti-inflammatory drugs. She had undergone surgery three years ago for pain in her right hip, difficulty in walking, and a swelling in the right inguinal area. She had an elevated erythrocyte sedimentation rate. Foot radiographs showed degeneration of the navicular and cuneiform bones. Hyperintensity in the same area on magnetic resonance scans was interpreted in favor of a chronic infection. Arthrotomy of the calcaneocuboid joint and the 3rd, 4th, and 5th tarsometatarsal joints was performed, with curettage of the cuboid and lateral cuneiform bones. Tissue samples were obtained from the synovium, joint capsule, and bone, among which Mycobacterium tuberculosis was recovered only in bone cultures. The patient manifested rapid improvement with antituberculous therapy. This case demonstrates the need to obtain cultures from the bone as well as those from the synovial fluid or tissues to identify tuberculosis of a very rare site of involvement.

  7. New experiences in treating postburn talipes equinovarus associated with bone and joint pathologic changes.

    PubMed

    Liu, Tianyi; Wang, Danru; Qian, Yunliang; Shi, Yaoming; Guan, Wenxiang

    2009-09-01

    This article aims to solve the problem of postburn talipes equinovarus associated with bone and joint pathologic changes by simplified and modified techniques. In addition to lengthening the shortened Achilles tendon and the contracted scar above it, we performed triple arthrodesis directly on the densely scarred, deformed foot without replacing the scar tissue with normal tissue tube or flap. Only the proximal scar-periosteum wound edge of the curved incision, 2 cm distal to the conventional one, was elevated to expose the bones to be excised. The two excised wedge-shaped bone blocks, one on the dorsum and the other on the lateral side of the deformed foot, were composed of a larger part of the talus and lesser parts of the navicular, cuboid and calcaneus bones. All the patients who could not stand or walk without crutches pre-operatively obtained a good operative result, which enabled them to do so without crutches postoperatively. We conclude that the scar tissue can be elevated without risk of necrosis if it is still attached firmly to the underlying periosteum, and arthrodesis can be done under it. Incision wound healing and bone union is not exclusively a problem.

  8. Kwoniella mangroviensis gen. nov., sp.nov. (Tremellales, Basidiomycota), a teleomorphic yeast from mangrove habitats in the Florida Everglades and Bahamas.

    PubMed

    Statzell-Tallman, Adele; Belloch, Carmela; Fell, Jack W

    2008-02-01

    Mangrove forests inhabit the shoreline regions of tropical and subtropical marine habitats, where they are the basis of a multi-trophic level food web that drives the shellfish and fisheries industries. Yeasts, and other fungi, have significant roles in these ecosystems as they decompose plant organic material and serve as a food source for small invertebrates. Studies designed to examine yeast communities of mangrove regions of the Florida Everglades and the Bahamas demonstrated the repeated presence of an undescribed teleomorphic basidiomycetous yeast. The yeast is heterothallic, with a sexual cycle that can be observed on artificial media. Mating between compatible pairs produces polymorphic basidia. Some basidia are globose, ovoid or lageniform, with longitudinal to oblique and transverse septa, whereas other basidia are navicular with one to three transverse septa. Basidiocarps and ballistoconidia are absent. Molecular sequence analysis of a partial region (D1/D2 domains) of the large subunit rRNA demonstrated that the yeast is phylogenetically distinct from other teleomorphic Tremellales with close relationships to the anamorphic species Cryptococcus dejecticola, Cryptococcus bestiolae and Bullera dendrophila. The molecular and phenotypic data indicate that this teleomorph should be classified in a novel genus. Therefore, Kwoniella mangroviensis gen. nov., sp. nov. (Type strain CBS 8507), is proposed.

  9. Template-based automatic extraction of the joint space of foot bones from CT scan

    NASA Astrophysics Data System (ADS)

    Park, Eunbi; Kim, Taeho; Park, Jinah

    2016-03-01

    Clean bone segmentation is critical in studying the joint anatomy for measuring the spacing between the bones. However, separation of the coupled bones in CT images is sometimes difficult due to ambiguous gray values coming from the noise and the heterogeneity of bone materials as well as narrowing of the joint space. For fine reconstruction of the individual local boundaries, manual operation is a common practice where the segmentation remains to be a bottleneck. In this paper, we present an automatic method for extracting the joint space by applying graph cut on Markov random field model to the region of interest (ROI) which is identified by a template of 3D bone structures. The template includes encoded articular surface which identifies the tight region of the high-intensity bone boundaries together with the fuzzy joint area of interest. The localized shape information from the template model within the ROI effectively separates the bones nearby. By narrowing the ROI down to the region including two types of tissue, the object extraction problem was reduced to binary segmentation and solved via graph cut. Based on the shape of a joint space marked by the template, the hard constraint was set by the initial seeds which were automatically generated from thresholding and morphological operations. The performance and the robustness of the proposed method are evaluated on 12 volumes of ankle CT data, where each volume includes a set of 4 tarsal bones (calcaneus, talus, navicular and cuboid).

  10. The Tarsal Bone Test: A Basic Test of Health Sciences Students' Knowledge of Lower Limb Anatomy

    PubMed Central

    Castillo-López, José Manuel; Díaz-Mancha, Juan Antonio; Heredia-Rizo, Alberto Marcos; Fernández-Seguín, Lourdes María; Polo-Padillo, Juan; Domínguez-Maldonado, Gabriel; Munuera, Pedro V.

    2014-01-01

    Objectives. The aim of the present study was to design an easy-to-use tool, the tarsal bone test (TBT), to provide a snapshot of podiatry students' basic anatomical knowledge of the bones of the lower limb. Methods. The study included 254 podiatry students from three different universities, 145 of them were first-year students and 109 were in their fourth and final years. The TBT was administered without prior notice to the participants and was to be completed in 5 minutes. Results. The results show that 97.2% of the subjects (n = 247) correctly labelled all tarsal bones, while the other 2.8% (n = 7) incorrectly labelled at least one bone, that was either the cuboid (7 times) or the navicular (6 times). Although only one fourth-year student inaccurately identified one bone, no significant differences in the distribution of the correct and incorrect responses were found between first and fourth-year students. Conclusions. The TBT seems to be a straightforward and easy-to-apply instrument, and provides an objective view of the level of knowledge acquired at different stages of podiatry studies. PMID:25110712

  11. Effect of therapeutic insoles on the medial longitudinal arch in patients with flatfoot deformity: a three-dimensional loading computed tomography study

    PubMed Central

    Kido, Masamitsu; Ikoma, Kazuya; Hara, Yusuke; Imai, Kan; Maki, Masahiro; Ikeda, Takumi; Fujiwara, Hiroyoshi; Tokunaga, Daisaku; Inoue, Nozomu; Kubo, Toshikazu

    2014-01-01

    Background Insoles are frequently used in orthotic therapy as the standard conservative treatment for symptomatic flatfoot deformity to rebuild the arch and stabilize the foot. However, the effectiveness of therapeutic insoles remains unclear. In this study, we assessed the effectiveness of therapeutic insoles for flatfoot deformity using subject-based three-dimensional (3D) computed tomography (CT) models by evaluating the load responses of the bones in the medial longitudinal arch in vivo in 3D. Methods We studied eight individuals (16 feet) with mild flatfoot deformity. CT scans were performed on both feet under non-loaded and full-body-loaded conditions, first with accessory insoles and then with therapeutic insoles under the same conditions. Three-dimensional CT models were constructed for the tibia and the tarsal and metatarsal bones of the medial longitudinal arch (i.e., first metatarsal bone, cuneiforms, navicular, talus, and calcaneus). The rotational angles between the tarsal bones were calculated under loading with accessory insoles or therapeutic insoles and compared. Findings Compared with the accessory insoles, the therapeutic insoles significantly suppressed the eversion of the talocalcaneal joint. Interpretation This is the first study to precisely verify the usefulness of therapeutic insoles (arch support and inner wedges) in vivo. PMID:25457972

  12. Correlates of knee anterior laxity in sportswomen.

    PubMed

    Vauhnik, Renata; Morrissey, Matthew C; Rutherford, Olga M; Turk, Zmago; Pilih, Iztok A; Perme, Maja Pohar

    2009-12-01

    The purpose of this study was to evaluate whether any of the following factors are related to knee anterior laxity in healthy sportswomen: anthropometric characteristics, lower limb alignment characteristics, hormone-related factors and sport history. Six hundred and sixteen sportswomen were tested in the pre-season. The data have been analysed using linear regression for possible association of knee anterior laxity with other variables. Univariate linear regression indicated a positive association of knee anterior laxity with knee extension and navicular drop and a negative association with body height. Multivariate linear regression analysis showed statistically significant associations between knee anterior laxity and the combination of passive knee extension and the chosen sport (R(2)=0.089; p<0.05). The combination of passive knee extension and sport type was found to be related to the amount of knee anterior laxity, although the association was weak with this combination of factors able to explain only about 9% of the variability in laxity. Knowing which factors influence the amount of knee anterior laxity will help us to better interpret the results of knee anterior laxity testing and help us to understand the possible role of knee anterior laxity as a risk factor for knee injury.

  13. Stress distribution comparisons of foot bones in patient with tibia vara: a finite element study.

    PubMed

    Ozkan, Arif; Atmaca, Halil; Mutlu, Ibrahim; Celik, Talip; Uğur, Levent; Kişioğlu, Yasin

    2013-01-01

    Blount's disease, or tibia vara, is the most common cause of pathologic genu varum in children and adolescents. Changes in the loading of knee structures such as tibial articular cartilage, menisci and subcondral bone are well documented in case of genu varum. But the mechanical effects of this condition on foot bones are still questionable. In this study, the authors hypothesized that stress distributions on foot bones might increase in patients with tibia vara when compared with patients who had normal lower extremity mechanical axis. Three-dimensional (3D) finite element analyses of human lower limb were used to investigate and compare the loading on foot bones in normal population and patient with tibia vara. The segmentation software, MIMICS was used to generate the 3D images of the bony structures of normal and varus malalignment lower extremity. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones were independently developed to form foot and ankle complex. Also femur, tibia and fibula were modeled utilizing mechanical axis. ANSYS version 14 was used for mechanical tests and maximum equivalent stresses (MES) were examined. As a result of the loading conditions, in varus model MES on talus, calcaneus and cuboid were found higher than in normal model. And stress distributions changed through laterally on middle and fore foot in varus deformity model.

  14. Observation on Monocystis kuidongae sp. nov. (Apicomplexa: Eugregarinida) from an Indian earthworm Perionyx excavatus Perrier (Annelida: Oligochaeta).

    PubMed

    Mallik, Partha; Bandyopadhyay, Probir K

    2017-06-01

    A survey to know the diversity of endoparasitic protozoan parasites of the earthworms of West Bengal, revealed a new species of the genus Monocystis Stein, 1848, that resides in the seminal vesicle of the earthworm Perionyx excavatus Perrier. Monocystis kuidongae sp. nov. is characterized by ovoidal gamonts (trophozoites) with inconspicuous mucron and measure 69.53-102.25 (86.29 ± 11.48) μm × 24.54-61.35 (35.17 ± 12.82) μm. Shape of the gametocysts are almost rounded and measure 81.80-110.43 (96.11 ± 8.85) μm in diameter. Oocysts are navicular with pointed ends and measure 11.55-12.32 (11.78 ± 0.36) µm × 5.00-5.77 (5.39 ± 0.25) µm.

  15. Observation on Nematocystis kailashi sp. nov. (Apicomplexa: Eugregarinida) from an Indian earthworm Glyphidrilus tuberosus Stephenson (Annelida: Oligochaeta)

    PubMed

    Mallik, Partha; Bandyopadhyay, Prabir K

    Surveys on aseptate gregarines in earthworm hosts in different districts of West Bengal state of India revealed the existence of one new species of aseptate gregarine of the genus Nematocystis Hesse, 1909 have been identified from the seminal vesicles of the earthworm, Glyphidrilus tuberosus Stephenson, 1916 in the district of Purba Midnapur, West Bengal of India. Gamonts of the organism are very much elongated, cylindrical, nematoid and without mucron. The terminal end adjacent to the nucleus rounded and the distal end pointed. The gamonts measure 846.45-1031.13 (931.86±70.48) μm in length and 18.40-20.45 (19.43±1.05) μm in width. Nucleus elongated or depressed elliptoid, measures 53.17-63.39 (60.33±3.28) μm in length and 13.29-16.36 (14.15±0.89) μm in width. The gametocysts are slightly ovoid, measuring 110.43-120.65 (114.31±3.44) μm in diameter. Oocysts navicular and measure 9.24-10.39 (9.78±0.40) μm×5.77-6.16 (6.04±0.18) μm. Based on critical analysis and comparison with earlier reported species, the species under discussion established as new one.

  16. Clinico-radiological improvement in an immunocompetent patient presented with scedosporium apiospermum osteomyelitis.

    PubMed

    Mohan, Rahul; Gopakumar, T S

    2016-01-01

    Scedosporium apiospermum is frequently found as a saprophyte in soil, sewage and contaminated water. Its manifestations in immunocompetent patients are usually localised and in immunodeficient patients, it causes invasive systemic diseases. We are reporting the case of a 40-year-old male, who presented with pain, oedema and multiple discharging sinuses over the lateral aspect of the left foot with history of thorn prick. On examination, there were multiple active sinuses with tenderness and local rise in temperature. Calcaneum on palpation showed a thickened and irregular surface with limitation of ankle and subtalar movements. Blood investigations showed a moderate rise in ESR and CRP. X-rays showed typical features of chronic osteomyelitis with sclerosis, cavities and irregular bone contour. CT report showed features of osteomyelitis involving calcaneum, talus, cuneiforms and navicular bone with periarticular soft tissue involvement and mild focal collection in the calcaneum. On repeated culture, it was found to be scedosporium apiospermum fungus. We managed the case with voriconazole therapy and it responded with excellent clinical and radiological improvement by 9 months.

  17. Effects of hallux valgus deformity on rear foot position, pain, function, and quality of life of women

    PubMed Central

    Coşkun, Gürsoy; Talu, Burcu; Bek, Nilgün; Bayramlar, Kezban Yigiter

    2016-01-01

    [Purpose] To investigate the relationship between hallux valgus (HV) deformity and the position of rearfoot joints, and its effects on the quality of life, pain, and related functional status of women with bilateral hallux valgus (HV). [Subjects and Methods] The subjects were 27 right-dominant women. Demographic data, HV angle, weight-bearing and non-weight-bearing subtalar pronation (SP), and navicular height were recorded. Visual Analog Pain Scale, Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) first metatarsophalangeal- interphalangeal (MTP-IP) and AOFAS Mid foot (MF) Scales, and SF-36 were also used. [Results] HV angle, weight-bearing SP, and pain intensity of the left foot were higher. HV angle of left foot was correlated with all sub-scales of FFI, the pain parameter of AOFAS MTP-IP, and pain and total scores of AOFAS-MF Scale. HV angle of the left foot correlated with physical role, pain, and social function sub-domains of SF-36. Right HV angles were correlated with right foot pain and non-weight-bearing SP. [Conclusion] Increasing HV angle and pathomechanical changes in the rear foot are correlated, resulting in increasing pain and thus decreasing functional status as well as decreasing quality of life. Although all the participants were right-dominant, their left foot problems were more prominent. PMID:27134358

  18. Magnetic resonance imaging of the congenital clubfoot treated with the French functional (physical therapy) method.

    PubMed

    Richards, B Stephens; Dempsey, Molly

    2007-03-01

    The purpose of this study was to assess magnetic resonance imaging (MRI) changes that occur in clubfeet after nonoperative treatment with the French functional method, specifically pertaining to the chondro-osseous anatomy and the joint relationships. The magnetic resonance images were obtained in 6 infants before treatment and 3 months later. The MRI protocol described previously for clubfeet which were treated by the Ponseti method (J Pediatr Orthop. 2001;21:719) was closely adhered to, except that no sedation was allowed by our institutional review board. The severity of the clubfoot deformities before treatment made assessment of the tibiotalar, talonavicular, and talocalcaneal joint relationships difficult in some feet. Despite this, improvements were noted after treatment in tibiotalar plantarflexion, the talonavicular relationship, the calcaneocuboid relationship, and the varus position of the calcaneus. The wedge shape of both the navicular and distal end of the calcaneus that occasionally was noted on the MRI before treatment improved after therapy. Although improved clinically, persistent equinus of the calcaneus on MRI was significant in 2 feet and was associated with slight dorsal displacement of the cuboid on the calcaneus (MRI evidence of rocker bottom). As noted with use of the Ponseti nonoperative treatment method, the chondro-osseous abnormalities seen on MRI studies in congenital clubfoot improve after treatment with the French functional (physical therapy) method, with the exception of equinus.

  19. Clinico-radiological assessment and their correlation in clubfeet treated with postero-medial soft-tissue release.

    PubMed

    Prasad, Prabhudev; Sen, Ramesh K; Gill, Shivender S; Wardak, Emal; Saini, Raghav

    2009-02-01

    The controversy regarding the radiographic parameter which best represents the various deformities of clubfoot continues. The aim of our study was to clear up this controversy. Fifty surgically treated (soft-tissue release) congenital clubfeet were studied clinically using Laaveg and Ponseti score and radiologically using twelve different radiographic parameters in weight-bearing AP and lateral views. The talo-calcaneal angle (TCA) in AP and lateral view showed statistically significant correlation with the functional rating, but significant variation in the dimension of the angles among the different functional groups was found with AP angle only. The talo-first metatarsal angle in AP and lateral view averaged 10 degrees and 19 degrees respectively, and showed significant correlation with the functional rating. The talo-navicular subluxation in AP, the calcaneo-fifth metatarsal angle and the first-fifth metatarsal angle in lateral view did not show any significant correlation with function. Talo-calcaneal index averaged 44 degrees in the clubfeet and showed significant correlation. The wide range of parameters representing each of the deformities gives a better radiological assessment of the clubfoot than any single parameter.

  20. Characterization of the magic angle effect in the equine deep digital flexor tendon using a low-field magnetic resonance system.

    PubMed

    Spriet, Mathieu; McKnight, Alexia

    2009-01-01

    Three isolated equine limbs were imaged with a low-field magnetic resonance system with a vertical magnetic field. Each limb was scanned in multiple positions with mild variation of the angle between the magnetic field and the long axis of the limb. When the long axis of the limb was not perpendicular to the magnetic field, a linear hyperintense signal was present at the palmar aspect of one of the deep digital flexor tendon lobes, at the level of the navicular bone and collateral sesamoidean ligaments, in proton density and T1-weighted pulse sequences. With increased angulation of the limb, the palmar hyperintense signal extended farther distally and proximally and additional signal hyperintensity was present at the dorsal aspect of the distal part of the other lobe of the deep digital flexor tendon. Increased signal intensity was also present in the collateral ligament of the distal interphalangeal joint on the same side as the palmar hyperintense signal in the tendon. The changes in the deep digital flexor tendon are due to the specific orientation of fibers at the palmar and dorsal aspect of the tendon, which is responsible for focal manifestation of the magic angle effect. Careful positioning of the limb perpendicular to the magnetic field can prevent this phenomenon. The association of palmar increased signal intensity in the deep digital flexor tendon with increased signal in the collateral ligament of the distal interphalangeal joint on the same side should be recognized as manifestations of the magic angle effect.

  1. Microstructure of a commercial W-1% La2O3 alloy

    NASA Astrophysics Data System (ADS)

    Shen, Yinzhong; Xu, Zhiqiang; Cui, Kai; Yu, Jie

    2014-12-01

    W-1% La2O3 alloy is considered as the most promising material for plasma-facing components of fusion reactors. The microstructure of a commercial W-1% La2O3 alloy was investigated using optical and transmission electron microscopes. The microstructure of pure tungsten can be improved significantly by fabrication of W-1% La2O3 alloys. W-1% La2O3 alloys can be produced with no porosities and cracks, and with various oxide phases dispersed in alloy matrix. La2O3 with different crystal structures, La6W2O15, WO2, WO3 and W3O8 phases were identified in as-forged W-1% La2O3 alloy. Long strip-like La2O3 has a very large size, whereas spherical La6W2O15, navicular WO3, hexagonal W3O8 and short rod-like La2O3 are smaller particles. Most identified phases have a heterogeneous distribution. Forging leads to a more dispersive distribution of large-sized La2O3 particles but not of fine WO3 particles compared with rolling. The mechanical properties of the alloys are also discussed.

  2. Does Pulsed Low Intensity Ultrasound Allow Early Return to Normal Activities When Treating Stress Fractures?

    PubMed Central

    Brand, Jeff C; Brindle, Tim; Nyland, John; Caborn, David NM; Johnson, Darren L

    1999-01-01

    We sought to evaluate the efficacy of daily pulsed low intensity ultrasound (LIUS) with early return to activities for the treatment of lower extremity stress fractures. Eight patients (2 males, 6 females) with radiographic and bone scan confirmed tibial stress fractures participated in this study. Additionally, a case report of a tarsal navicular stress fracture is described. All patients except one were involved in athletics. Prior to the study, subjects completed a 5 question, 10 cm visual analog scale (VAS) regarding pain level (10 = extreme pain, 1 = no pain) and were assessed for functional performance. Subjects received 20-minute LIUS treatments 5 times a week for 4 weeks. Subjects maintained all functional activities during the treatment period. Seven patients with posterior-medial stress fractures participated without a brace. Subjects were re-tested after 4 weeks of treatment. Mann-Whitney U tests (VAS data) and paired t-tests (functional tests) assessed statistical significance (p<0.05). Although the intensity of practice was diminished in some instances, no time off from competitive sports was prescribed for the patients with the tibial stress fractures. The patient with the anterior tibial stress fracture underwent tibial intramedullary nailing at the conclusion of a season of play. In this uncontrolled experience, treatment of tibial stress fractures with daily pulsed LIUS was effective in pain relief and early return to vigorous activity without bracing for the patients with posterior-medial stress fractures. PMID:10847513

  3. 3D morphology of the rear foot from MRI data: technical validation and clinical description

    NASA Astrophysics Data System (ADS)

    Stindel, Eric; Udupa, Jayaram K.; Hirsch, Bruce E.; Odhner, Dewey; Couture, Christine

    1998-06-01

    The purpose of this work is to characterize the 3D morphology of the bones of the rear foot using MR data. This work has two subaims: (1) to study the variability of the various computed architectural measures as a result of the subjectivity and variations in the various processing operations; (2) to study the morphology of the bones included in the peritalar complex. Each image data set utilized in this study consists of 60 longitudinal slices of the foot acquired on a 1.5 T commercial GE MR system. Our description of the rear foot morphology is based mainly on the principal axes, which represent the inertia axes of the bones, as well as on the bone surfaces. We use the live-wire method for segmenting and forming the surfaces of the bones. In the first part of this work, we focus on the dependence of the principal axes system on segmentation and on scan orientation. In the second part, we describe the normal morphology of the rear foot considering the four bones (calcaneus, cuboid, navicular, talus) and compare them to a population from the Upper Pleistocene. We conclude that this non-invasive method can be used in live patients to characterize the bone morphology or as a comparative method to classify population of bones. in spite of the variations involved in the various processing operations.

  4. Effect of therapeutic insoles on the medial longitudinal arch in patients with flatfoot deformity: a three-dimensional loading computed tomography study.

    PubMed

    Kido, Masamitsu; Ikoma, Kazuya; Hara, Yusuke; Imai, Kan; Maki, Masahiro; Ikeda, Takumi; Fujiwara, Hiroyoshi; Tokunaga, Daisaku; Inoue, Nozomu; Kubo, Toshikazu

    2014-12-01

    Insoles are frequently used in orthotic therapy as the standard conservative treatment for symptomatic flatfoot deformity to rebuild the arch and stabilize the foot. However, the effectiveness of therapeutic insoles remains unclear. In this study, we assessed the effectiveness of therapeutic insoles for flatfoot deformity using subject-based three-dimensional (3D) computed tomography (CT) models by evaluating the load responses of the bones in the medial longitudinal arch in vivo in 3D. We studied eight individuals (16 feet) with mild flatfoot deformity. CT scans were performed on both feet under non-loaded and full-body-loaded conditions, first with accessory insoles and then with therapeutic insoles under the same conditions. Three-dimensional CT models were constructed for the tibia and the tarsal and metatarsal bones of the medial longitudinal arch (i.e., first metatarsal bone, cuneiforms, navicular, talus, and calcaneus). The rotational angles between the tarsal bones were calculated under loading with accessory insoles or therapeutic insoles and compared. Compared with the accessory insoles, the therapeutic insoles significantly suppressed the eversion of the talocalcaneal joint. This is the first study to precisely verify the usefulness of therapeutic insoles (arch support and inner wedges) in vivo. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Monocystis metaphirae sp. nov. (Protista: Apicomplexa: Monocystidae) from the earthworm Metaphire houlleti (Perrier).

    PubMed

    Bandyopadhyay, Probir K; Mallik, Partha; Göçmen, Bayram; Mitra, Amlan Kumar

    2006-01-01

    Biodiversity studies in search of endoparasitic acephaline gregarines revealed a new species of the genus Monocystis Stein, 1848 in the seminal vesicles of the earthworm Metaphire houlleti (Perrier) residing in alluvial soil of the district of North 24 Parganas. The new species is characterized by having bean-shaped gamonts measuring 94.0-151.0 (119.0+/-16.0) microm x 53.0-81.0(66.0+/-8.0) microm. The anterior end of the gamont is always wider than the posterior end. The mucron is always present at the wider end. The occurrence of syzygy (end to end, cauda-frontal) is a very rare feature which has been observed in the life cycle of the new species. The gametocyst is ovoid consisting of two unequal gamonts, measuring 85.0-102.0 microm (93.0+/-6.0). Oocysts are navicular in shape, measuring 6.5-11.0 (9.0+/-1.1) microm x 4.0-7.5 (5.5+/-1.9) microm.

  6. Monocystis julkae sp.nov., (Protista: Apicomplexa: Monocystidae) a new aseptate gregarine species of the genus Monocystis Stein, 1848 obtain from an Indian Earthworm, Eutyphoeus kherai, Julka, 1978.

    PubMed

    Bhowmik, Biplab; Bandyopadhyay, P K

    2017-03-01

    During the course of a biodiversity survey of the endoparasitic aseptate gregarines in the Malda district of West Bengal, India, seminal vesicles of the earthworm, Eutyphoeus kherai, Julka 1978 were found to be infested with a new species, Monocystis julkae sp.nov., of the genus, Monocystis Stein (Arch Anat Phys Med 181-223, 1848). The trophozoite is elongated but slightly constricted posteriorly. A tail like protrusion appears in the posterior end. Anterior end is rather wider than the posterior one. The whole body size of the trophozoite measures 102.2-184.0 (126.7 ± 19.9) µm × 40.9-81.8 (58.2 ± 10.0) µm. Size of the nucleus ranges from 10.2 to 16.3 (11.9 ± 1.9) µm × 8.1-12.2 (8.8 ± 1.2) µm. The gametocysts are ovoidal containing two unequal gametocytes. Diameter of it measures 61.3-98.1 (75.8 ± 8.6) µm. Oocysts are navicular and measures 6.9-10.0 (8.7 ± 0.9) µm × 3.0-4.6 (4.3 ± 0.4) µm.

  7. High-Risk Stress Fractures: Diagnosis and Management.

    PubMed

    McInnis, Kelly C; Ramey, Lindsay N

    2016-03-01

    Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures.

  8. Reconstruction of large defect of foot with extensive bone loss exclusively using a latissimus dorsi muscle free flap: a potential new indication for this flap.

    PubMed

    Gomez, Manuel Macemino; Casal, Diogo

    2012-01-01

    In cases of extensive damage to the foot, with significant bone loss, it is generally accepted that reconstruction must include bone flaps or grafts either in the emergency setting or subsequently. In this report, we describe the case of an 18-year-old student with an avulsion injury of the dorsum of his right foot. Consequently, he lost most of the soft tissue over the dorsum of the foot and the cuboid, navicular, and cuneiform bones. A latissimus dorsi free flap was used to reconstruct the defect. A functional pseudoarthrosis developed between the remaining bones of the foot, and the patient experienced satisfactory foot function after rehabilitation. For this reason, no additional reconstructive procedure was undertaken. This case suggests that it might be adequate to use the latissimus dorsi muscle flap more liberally than previously reported in the reconstruction of extensive defects of the dorsum of the foot, including cases with significant bone loss. This option could avoid the morbidity and inconvenience of a second surgery and the need to harvest a bone flap or graft.

  9. May bone cement be used to treat benign aggressive bone tumors of the feet with confidence?

    PubMed

    Özer, Devrim; Er, Turgay; Aycan, Osman Emre; Öke, Ramadan; Coşkun, Mehmet; Kabukçuoğlu, Yavuz Selim

    2014-03-01

    Using bone cement for the reconstruction of defects created after curettage of benign aggressive bone tumors is among acceptable methods. The study aimed to assess the effect of bone cement used in aggressive bone tumors in the feet on the function of the feet. Five patients were reviewed. They were treated between 2004 and 2010. Three cases were female and two male. Their age ranged from 16 to 55 with an average of 34.8. Follow up period ranged from 14 to 86 months with an average of 34. Two cases were giant cell tumor of bone located in calcaneus and 3 were solid variant aneurysmal bone cyst located in talus, navicular and first proximal phalanx. None had any previous treatment. A biopsy was done in all cases. Treatment was curettage, high speed burring (except phalanx case), and filling the cavity with bone cement. The case located in talus recurred and re-operated 1 year later doing the same procedure. Final evaluation included physical examination, X-ray and Maryland Foot Score. No recurrence was present in the final evaluation. No problems were detected related to bone cement. Maryland Foot Scores ranged 84-100, average of 94. Cement integrity was not disturbed. The procedure is found not to effect foot functions adversely.

  10. Studying the Relation Between Medial Tibial Stress Syndrome and Anatomic and Anthropometric Characteristics of Military Male Personnel.

    PubMed

    Sobhani, Vahid; Shakibaee, Abolfazl; Khatibi Aghda, Amidoddin; Emami Meybodi, Mohammad Kazem; Delavari, Abbasali; Jahandideh, Dariush

    2015-06-01

    Medial Tibial Stress Syndrome (MTSS) is common among military recruits and to our knowledge; the factors that might put the military recruits at higher risk of incidence of MTSS are not well known. This study was done to investigate the association between some anthropometric and anatomical factors and the prevalence of MTSS among military recruits. One hundred and eighty one randomly selected military recruits were included in this cross sectional study. Using history taking and physical examinations they were tested for MTSS. Accordingly the subjects were assigned to the case (those with MTSS) and control groups (normal healthy subjects). Using standard guidelines, the anthropometric and anatomical criteria of the subjects were measured. The correlation between the measurements and the prevalence of MTSS was tested using statistical analysis. Data of all the 181 subjects with the mean age of 30.7 ± 4.68 years were Included in the final analysis. The prevalence of MTSS was found to be 16.6% (30 people). Internal and external rotation range of motion, iliospinale height, the score of navicular drop test, and the trochanteric tibial lateral length were significantly different between healthy subjects and patients with MTSS (P < 0.05). The prevalence of MTSS was relatively lower in this study comparing to other studies on military personnel. It was not probably due to type of military shoes or exercise area surface (none of them were standardized); it could be due to low intensity trainings and the long intervals between training sessions.

  11. Neanderthal hand and foot remains from Moula-Guercy, Ardèche, France.

    PubMed

    Mersey, Ben; Jabbour, Rebecca S; Brudvik, Kyle; Defleur, Alban

    2013-12-01

    The hand and foot remains from Moula-Guercy cave (Ardèche, France) comprise 24 specimens of Eemian age (ca. 120 ka). The specimens include primarily complete elements, which are rare among the Moula-Guercy postcrania. The hand remains have several characteristic Neanderthal traits including a laterally facing (parasagittally oriented) second metacarpal-capitate articulation, a short styloid process, a wide proximal articular surface on the third metacarpal, and absolutely expanded apical tuberosities on the distal hand phalanges relative to modern humans. The foot remains include several incomplete elements along with an antimeric pair of naviculars, a medial cuneiform and cuboid, and a single complete element from each of the distal segments (one each: metatarsal, proximal foot phalanx, intermediate foot phalanx, distal foot phalanx). Consistent among the specimens are relatively wide diaphyses for length in the metatarsals and phalanges and large and prominent muscle attachments, both consistent with previously published Neanderthal morphology. The hand and foot collection from Moula-Guercy is an important dataset for future studies of Neanderthal functional morphology, dexterity, and behavior as it represents a previously undersampled time period for European Neanderthals.

  12. Comparison of isometric ankle strength between females with and without patellofemoral pain syndrome.

    PubMed

    de Moura Campos Carvalho E Silva, Ana Paula; Magalhães, Eduardo; Bryk, Flavio Fernandes; Fukuda, Thiago Yukio

    2014-10-01

    Proximal and distal influences on the knee may be related as etiological factors of patellofemoral pain syndrome (PFPS). The distal factors include subtalar excessive pronation as well as medial tibia rotation, but no study has investigated whether ankle weakness could lead to alterations that influence the patellofemoral joint. Thus, the purpose of this study was to compare the ankle dorsiflexor and invertor muscles strength, as well as rearfoot eversion and the Navicular Drop Test (NDT) in females with PFPS to a control group of females of similar demographics without PFPS. Forty females, between 20 and 40 years of age (control group: n=20; PFPS group: n=20) participated. Rearfoot eversion range of motion and the NDT were assessed for both groups. The Numeric Pain Rating Scale and the Anterior Knee Pain Scale were used to evaluate the level of pain and the functional capacity of the knee during activities, respectively. Isometric ankle dorsiflexor and invertor strength was measured using a handheld dynamometer as the dependent variable. The isometric strength of the dorsiflexor and invertor muscle groups in females with PFPS was not statistically different (P>0.05) than that of the control group. There was no statistically significant difference between groups for rearfoot eversion and NDT (p>0.05). These results suggest that there is no difference between isometric ankle dorsiflexion and inversion strength, the NDT, and rearfoot eversion range of motion in females with and without PFPS. 3-b.

  13. Management of High-Energy Foot and Ankle Injuries in the Geriatric Population

    PubMed Central

    Herscovici, Dolfi; Scaduto, Julia M.

    2012-01-01

    By the year 2035 almost 20% of the US population of 389 million people will be 65 years and older. What this group has, compared with aged populations in the past, is better health, more mobility, and more active lifestyles. From January 1989 through December 2010, a total of 494 elderly patients with 536 foot and ankle injuries were identified. Within this group, 237 (48%) patients with 294 injuries were sustained as a result of a high-energy mechanism. These mechanisms consisted of 170 motor vehicle accidents, 30 as a result of high (not ground level) energy falls, 2 from industrial accidents, and 35 classified as other, which included sports, blunt trauma, bicycle, airplane or boating accidents, crush injuries, and injuries resulting from a lawn mower. The injuries produced were 17 metatarsal fractures, 9 Lisfranc injuries, 10 midfoot (navicular, cuneiform, or cuboid) fractures, 23 talus fractures, 63 calcaneal fractures, 73 unimalleolar, bimalleolar, or trimalleolar ankle fractures, 45 pilon fractures, and 3 pure dislocations of the foot or ankle. Overall, 243 (83%) of these injuries underwent surgical fixation and data have shown that when surgery is used to manage high-energy injuries of the foot and ankle in the elderly individuals, the complications and outcomes are similar to those seen in younger patients. Therefore, the decision for surgical intervention for high-energy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient. PMID:23569695

  14. A new species of Monocystis stein, 1848 (Protista: Apicomplexa: Eugregarinida) from the Indian earthworm, Amynthas Hawayanus Rosa, 1891 (Annelida: Oligochaeta).

    PubMed

    Bandyopadhyay, Probir K; Göçmen, Bayram; Bhowmik, Biplab; Mitra, Amlan Kumar

    2006-01-01

    As a part of an ongoing biodiversity survey of aseptate gregarine fauna of oligochaete hosts of West Bengal, an expedition was carried out in the Darjeeling district of West Bengal and most of the earthworms collected were found to be infested with a species of Monocystis Stein, 1848. The monocystid species was collected from the seminal vesicles of the earthworm and was identified as a new species, Monocystis amynthae sp. nov. The gamont of the new species is characterized by having an elongated body with broad anterior end, separated from the narrow posterior end by a prominent constriction measuring 49.0-77.0 (66.0+/-1.3) microm x 32.0-41.0 (37.0+/-2.8) microm. The gametocysts are oval-shaped, measuring 40.0-65.0 (58.0+/-2.1) microm. The oocysts are navicular, measuring 8.0-12.0 (10.5+/-1.1) microm x 4.0-6.0 (5.5+/-1.1) microm.

  15. [Endoscopic treatment of primary vesicoureteral reflux in childhood. Review of 989 cases in a 9 years period].

    PubMed

    Nortes Cano, L; Zambudio Carmona, G; Guirao Piñera, M J; Ruiz Jiménez, J I

    2008-07-01

    The primary vesicoureteral reflux (PVUR) is the most common urologic pathology during childhood and affects from 1 to 3% of newborn. It causes acute pyelonephritis (APN) and renal damage in addition to hospital visits with high economic and social costs. Nowadays the endoscopic treatment (ETR) seems to be the most suitable one for the reflux, due to its lower biological cost and its good results. We report our experience in the endoscopic treatment of the primary vesicoureteral reflux (ETR) in Murcia Pediatric Hospital from 1998 to 2007. We present a retrospective study describing 989 patients (1498 ureters) treated by means of ETR. All patients were treated with chemoprophylaxis since the moment of the diagnosis. ETR was fulfilled by the surgeon in an ambulatory way and with Sevofluorano. Deflux, Macroplastique and Coaptite were used. Age, stade, number of ETR, material, chemoprophylaxis, ureterocistoneostomy and ETR costs were evaluated. One-thousand four-hundred and ninty-eight ureteral units, corresponding to 989 patients, (51,2% males), at ages from 4 months to 21-years-old, have been treated by means of ETR. The average age was 4-years-old. Grade III reflux was the most common of all, with 801 ureters affected. Deflux was used in 777 patients, Macroplastique in 203 and Coaptite in 9. No problems in early post-operation happened and the average length was shorter than 2 hours. Forty-eight hours after, 7 patients had to be treated due to APN. Four patients showed late litiasis related to ETR. Two suffered litotomy. The 89.9% of the patients were cured at first ETR. The 11.2% needed a second ETR, with 2.12% of failure (21 patients). Six cured with the third injection and 2 needed a fourth ETR. Thirteen children were treated with ureterocistoneostomy. Radiological correction have not relation with PVUR level and does not show significant differences. Failure regarding the used material was around 9% for Deflux, 11.8% for Macroplastique and 66.6% for Coaptite. The

  16. Occurrence and source characterization of perfluorochemicals in an urban watershed.

    PubMed

    Nguyen, Viet Tung; Reinhard, Martin; Karina, Gin Yew-Hoong

    2011-02-01

    Perfluorochemicals (PFCs) are used in numerous applications, mainly as surfactants, and occur ubiquitously in the environment as complex mixtures. This study was undertaken to characterize the occurrence and sources of commonly detected PFC compounds in surface waters of the Marina catchment, a watershed that drains an urbanized section of Singapore. Of the 19 target PFCs, 13 were detected with perfluorooctanoic acid (PFOA) (5-31 ng L(-1)) and perfluorooctane sulfonate (PFOS) (1-156 ng L(-1)) being the dominant components. Other compounds detected included perfluoroalkyl carboxylates (C7-C12) and perfluoroalkyl sulfonates (C6 and C8). Sulfonamide compounds detected 2-(N-ethylperfluorooctanesulfonamido) acetic acid (N-EtFOSAA), 2-(N-methylperfluorooctanesulfonamido) acetic acid (N-MeFOSAA), perfluorooctanesulfonamido acetic acid (FOSAA) and perfluorooctanesulfonamide (FOSA) were putative transformation products of N-EtFOSE and N-MeFOSE, the N-ethylated and N-methylated ethyl alcohol derivatives, respectively. Surface water concentrations were generally higher during dry weather than during storm water flow: the median concentrations of total PFCs in dry and wet weather were 57 and 138 ng L(-1) compared to 42 and 79 ng L(-1), respectively, at Stamford and Alexandra canal, suggesting the presence of a continuous source(s) which is subject to dilution during storm events. In rain water, median concentrations were 6.4 ng L(-1), suggesting rain contributed from 12-25% to the total PFC load for non-point source sites. The longitudinal concentration profile along one of the canals revealed a point source of sulfonated PFCs (PFOS), believed to originate from aqueous film-forming foam (AFFF). Sources were characterized using principal component analysis (PCA) and by plotting PFHxS/PFOA against PFOS/PFOA. Typical surface waters exhibit PFOS/PFOA and PFHxS/PFOA ratios below 0.9 and 0.5, respectively. PCA plots reveal waters impacted by "non-typical" PFC sources in Alexandra

  17. New Delhi Metallo-β-Lactamase 1(NDM-1), the Dominant Carbapenemase Detected in Carbapenem-Resistant Enterobacter cloacae from Henan Province, China

    PubMed Central

    Liu, Xuchun; Lang, Shaolei; Feng, Xianju; Liu, Hong-Min

    2015-01-01

    The emergence of New Delhi metallo-β-lactamase 1 (NDM-1) has become established as a major public health threat and represents a new challenge in the treatment of infectious diseases. In this study, we report a high incidence and endemic spread of NDM-1-producing carbapenem-resistant Enterobacter cloacae isolates in Henan province, China. Eight (72.7%) out of eleven non-duplicated carbapenem-resistant E. cloacae isolates collected between June 2011 and May 2013 were identified as NDM-1 positive. The blaNDM-1 gene surrounded by an entire ISAba125 element and a bleomycin resistance gene bleMBL in these isolates were carried by diverse conjugatable plasmids (IncA/C, IncN, IncHI2 and untypeable) ranging from ~55 to ~360 kb. Molecular epidemiology analysis revealed that three NDM-1-producing E. cloacae belonged to the same multilocus sequence type (ST), ST120, two of which were classified as extensively drug-resistant (XDR) isolates susceptible only to tigecycline and colistin. The two XDR ST120 E. cloacae isolates co-harbored blaNDM-1, armA and fosA3 genes and could transfer resistance to carbapenems, fosfomycin and aminoglycosides simultaneously via a conjugation experiment. Our study demonstrated NDM-1 was the most prevalent metallo-β-lactamase (MBL) among carbapenem-resistant E.cloacae isolates and identified a potential endemic clone of ST120 in Henan province. These findings highlight the need for enhanced efforts to monitor the further spread of NDM-1 and XDR ST120 E. cloacae in this region. PMID:26263489

  18. High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

    PubMed Central

    Qin, Shangshang; Fu, Ying; Zhang, Qijing; Qi, Hui; Wen, Jian Guo; Xu, Hui; Xu, Lijuan; Zeng, Li; Tian, Hao; Rong, Lijuan; Li, Yonghong; Shan, Lihong; Xu, Hongde; Yu, Yunsong

    2014-01-01

    The emergence and spread of New Delhi metallo-β-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the blaNDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for blaNDM-1, and the gene was found to be carried on plasmids of various sizes (∼55 to ∼360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The blaNDM-1-positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each blaNDM-1-positive CRE isolate, the blaNDM-1 gene was downstream of an intact ISAba125 element and upstream of the bleMBL gene. Furthermore, gene environment analysis suggested the possible transmission of blaNDM-1-containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread. PMID:24777095

  19. Global pilot study of legacy and emerging persistent organic pollutants using sorbent-impregnated polyurethane foam disk passive air samplers.

    PubMed

    Genualdi, Susie; Lee, Sum Chi; Shoeib, Mahiba; Gawor, Anya; Ahrens, Lutz; Harner, Tom

    2010-07-15

    Sorbent-impregnated polyurethane foam (SIP) disk passive air samplers were deployed alongside polyurethane foam (PUF) disk samplers at 20 sites during the 2009 spring sampling period of the Global Atmospheric Passive Sampling (GAPS) Network. The SIP disk samplers consisted of PUF disks impregnated with finely ground XAD-4 resin. The addition of XAD-4 greatly improves the sorptive capacity of the PUF disk samplers for more volatile and polar chemicals, and allows for linear-phase sampling over several weeks for these compounds. The SIP and PUF disks were analyzed for polychlorinated biphenyls (PCBs), neutral polyfluoroalkyl compounds (PFCs), and ionic PFCs. Correlations between sampler-derived air concentrations for PCBs in the PUF and SIP disks samplers were significant (p < 0.05). The SIP disks effectively captured 4-50% more of the low molecular weight PCBs than the PUF disks samplers, and the PUF disks also had limitations for time-weighted passive sampling of neutral PFCs in air. Theoretical uptake curves for PUF disks showed rapid equilibration occurring in just hours for 8:2 FTOH and in a few days for MeFOSE, while theoretical curves for SIP disks showed superior sampling profiles for the neutral PFCs. PFCs were measured on SIP disks at all sites with 8:2 FTOH being the dominant compound detected and urban centers (n = 3) having the highest total neutral PFC concentrations ranging from 51.7 to 248 pg/m(3). A positive correlation was found between the FTOHs and FOSAs/FOSEs (p < 0.001, Pearson correlation) indicating similar contamination sources. The SIP disk appears to be a promising passive air sampler for measuring both emerging and legacy POPs on a global scale. They can also be used as a complement to the PUF disk sampler for capturing broader classes of compounds, or as a replacement for PUF disks entirely, especially when longer than quarterly deployment periods are desired.

  20. Simple, high throughput ultra-high performance liquid chromatography/tandem mass spectrometry trace analysis of perfluorinated alkylated substances in food of animal origin: milk and fish.

    PubMed

    Lacina, Ondrej; Hradkova, Petra; Pulkrabova, Jana; Hajslova, Jana

    2011-07-15

    The present study documents development and validation of a novel approach for determination of 23 perfluorinated alkylated substances (PFASs) in food of animal origin represented by milk and fish. The list of target analytes comprises four classes of PFASs, both ionic and non-ionic: 11 perfluorocarboxylic acids (PFCAs), 4 perfluorosulphonic acids (PFSAs), 5 perfluorosulphonamides (FOSAs) and 3 perfluorophosphonic acids (PFPAs). Fast sample preparation procedure is based on an extraction of target analytes with acetonitrile (MeCN) and their transfer (supported by inorganic salts and acidification) into the organic phase. Removing of matrix co-extracts by a simple dispersive solid phase extraction (SPE) employing ENVI-Carb and C18 sorbents is followed by an efficient sample pre-concentration performed by acetonitrile evaporation and subsequent dilution of residue in a small volume of methanol (matrix equivalent in the final extracts was 16 and 8 g mL(-1), for milk and fish respectively). Using modern instrumentation consisting of ultra-high performance liquid chromatography (UHPLC) hyphenated with a tandem mass spectrometer (MS/MS), limits of quantification (LOQs) as low as 0.001-0.006 μg kg(-1) for milk and 0.002-0.013 μg kg(-1) for fish can be achieved. Under these conditions, a wide spectrum of PFASs, including minor representatives, can be determined which enables collecting data required for human exposure studies. The pilot study employing the new method for examination of milk and canned fish samples was realized. Whereas in majority of canned fish products a wide spectrum of PFCAs, perfluorooctanesulphonic acid (PFOS) and perfluoro-1-octanesulphonamide (PFOSA) was detected, only in a few milk samples very low concentrations (LOQ levels) of PFOS and perfluorooctansulphonic acid (PFDS) were found.

  1. Occurrence and sources of perfluorinated surfactants in rivers in Japan.

    PubMed

    Murakami, Michio; Imamura, Eiji; Shinohara, Hiroyuki; Kiri, Kentaro; Muramatsu, Yuki; Harada, Arata; Takada, Hideshige

    2008-09-01

    We analyzed perfluorinated surfactants (PFSs) in 20 river samples and 5 wastewater secondary effluent samples in Japan to reveal their occurrence and sources. Nine PFS species were determined: perfluorooctanesulfonate (PFOS), perfluorooctane sulfonamide (FOSA), perfluoroheptanoate (PFHpA), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorodecanoate (PFDA), perfluoroundecanoate (PFUA), perfluorododecanoate (PFDDA), and perfluorotridecanoate (PFTDA). PFSs were detected in all rivers, revealing nationwide contamination of rivers. In particular, 11 out of 20 river samples exceeded New Jersey guidance for PFOA in drinking water (40 ng/L). PFOS, PFHpA, PFOA, and PFNA were major species in Japan. Concentrations of PFOS, PFHpA, and PFNA in rivers were strongly correlated with population density, suggesting that the chemicals were derived from urban activities. PFOA showed a significant but weak correlation. We used crotamiton, a marker of sewage effluent, for further source analysis. Concentrations of PFOS, PFHpA, and PFNAwere strongly correlated with those of crotamiton, and plots of secondary effluents fell near the regression lines of rivers, indicating that the PFOS, PFHpA, and PFNA in rivers were derived from sewage effluent. On the other hand, PFOA was found at remarkably high levels (54-192 ng/L) in seven river samples containing low levels of crotamiton, suggesting that it was derived from nonsewage point sources, as well as sewage effluent. The total fluxes of sewage-derived PFOS, PFHpA, PFOA, and PFNA from Japan were estimated to be 3.6, 2.6, 5.6, and 2.6 t/year, respectively. This is the first report to identify PFOA in several rivers, derived from nonsewage point sources, by using a marker of sewage effluent.

  2. Concentrations of organochlorine pesticides, polybrominated diphenyl ethers and perfluorinated compounds in the atmosphere of North Greenland.

    PubMed

    Bossi, Rossana; Vorkamp, Katrin; Skov, Henrik

    2016-10-01

    Atmospheric concentrations of organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs) and neutral per- and polyfluoroalkyl substances (PFAS) have been measured at Villum Research Station, Station Nord (North Greenland) in the period 2008-2013. Atmospheric concentrations of OCPs at the same site have been previously reported for the years 2008-2010. The detection frequency and the average concentrations of OCPs have not significantly changed since the previous study. PBDE congeners (∑13PBDEs) were measured for the first time in North Greenland at concentrations similar to those observed for other remote sites, confirming that these compounds are ubiquitous in the Northern Hemisphere. The ∑13PBDEs concentration ranged from not detected (n.d.) to 6.26 pg m(-3). The BDE congeners found in more than 30% of the samples were BDE-17, BDE-28, BDE-47, BDE-71, BDE-99 and BDE-100. Also for neutral PFAS we present for the first time a multiyear series of measurements for North Greenland. The average sum of the seven measured neutral PFAS (∑7PFAS) ranged from 1.82 to 32.1 pg m(-3). The most abundant compound was 8:2 FTOH (44% of ∑7PFAS), followed by 6:2 FTOH and 10:2 FTOH. Perfluoroalkyl sulfonamides (FOSA) and perfluoroalkyl sulfonamidoethanols (FOSE) were also detected but at much lower concentrations than FTOHs. Temporal trends were investigated for all measured compounds but no significant trend in concentration was observed. Monthly average concentrations for the six years were calculated for each compound and the seasonal variation was investigated. Some OCPs and FTOHs showed seasonal variations, and in most cases a maximum was found during summer. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. [Prevalence of sensitization to allergens in school children with asthma residents from Guadalajara metropolitan area].

    PubMed

    Alcalá-Padilla, Guadalupe; Bedolla-Barajas, Martín; Kestler-Gramajo, Amanda; Valdez-López, Francisco

    2016-01-01

    Antecedentes: la prevalencia de rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable (IDCV) es de 52%. Los pacientes con esta enfermedad tienen mayor frecuencia de rinosinusitis crónica, enfermedad inflamatoria que afecta a la mucosa de uno o más senos paranasales y la cavidad nasal. Objetivo: identificar los microorganismos de secreción del meato medio obtenida por endoscopia asociados con rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable (IDCV). Material y método: estudio descriptivo, transversal, que incluyó a pacientes adultos con inmunodeficiencia común variable, de quienes se obtuvo una muestra vía endoscópica de secreción del meato medio de ambas fosas nasales, que se envió a cultivo para bacterias aerobias, anaerobias y hongos. Se obtuvo consentimiento informado de todos los pacientes. Resultados: se estudiaron 29 pacientes: 18 mujeres y 11 hombres, con edad promedio de 40±13 años. Los resultados obtenidos fueron: 2 muestras de pacientes no tuvieron desarrollo microbiano, 24 tuvieron desarrollo de bacterias aerobias, en 3 casos hubo crecimiento fúngico sin desarrollo de bacterias anaerobias. Conclusiones: nuestros resultados muestran que los microorganismos asociados con rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable más comunes son: Moraxella catarrhalis, Staphylococcus, Sphingomonas paucimobilis y Citrobacter koseri; los agentes micóticos asociados fueron: Candida albicans y Aspergillus fumigatus.

  4. Neutral polyfluoroalkyl substances in the atmosphere over the northern South China Sea.

    PubMed

    Lai, Senchao; Song, Junwei; Song, Tianli; Huang, Zhijiong; Zhang, Yingyi; Zhao, Yan; Liu, Guicheng; Zheng, Junyu; Mi, Wenying; Tang, Jianhui; Zou, Shichun; Ebinghaus, Ralf; Xie, Zhiyong

    2016-07-01

    Neutral Polyfluoroalkyl substances (PFASs) in the atmosphere were measured during a cruise campaign over the northern South China Sea (SCS) from September to October 2013. Four groups of PFASs, i.e., fluorotelomer alcohols (FTOHs), fluorotelomer acrylates (FTAs), fluorooctane sulfonamides (FOSAs) and fluorooctane sulfonamidoethanols (FASEs), were detected in gas samples. FTOHs was the predominant PFAS group, accounting for 95.2-99.3% of total PFASs (ΣPFASs), while the other PFASs accounted for a small fraction of ΣPFASs. The concentrations of ΣPFASs ranged from 18.0 to 109.9 pg m(-3) with an average of 54.5 pg m(-3). The concentrations are comparable to those reported in other marine atmosphere. Higher concentrations of ΣPFASs were observed in the continental-influenced samples than those in other samples, pointing to the substantial contribution of anthropogenic sources. Long-range transport is suggested to be a major pathway for introducing gaseous PFASs into the atmosphere over the northern SCS. In order to further understand the fate of gaseous PFASs during transport, the atmospheric decay of neutral PFASs under the influence of reaction with OH radicals and atmospheric physical processes were estimated. Concentrations of 8:2 FTOH, 6:2 FTOH and MeFBSE from selected source region to the atmosphere over the SCS after long-range transport were predicted and compared with the observed concentrations. It suggests that the reaction with OH radicals may play an important role in the atmospheric decay of PFAS during long-range transport, especially for shorted-lived species. Moreover, the influence of atmospheric physical processes on the decay of PFAS should be further considered.

  5. Perfluoroalkyl acids and their precursors in indoor air sampled in children's bedrooms.

    PubMed

    Winkens, Kerstin; Koponen, Jani; Schuster, Jasmin; Shoeib, Mahiba; Vestergren, Robin; Berger, Urs; Karvonen, Anne M; Pekkanen, Juha; Kiviranta, Hannu; Cousins, Ian T

    2017-03-01

    The contamination levels and patterns of perfluoroalkyl acids (PFAAs) and their precursors in indoor air of children's bedrooms in Finland, Northern Europe, were investigated. Our study is among the most comprehensive indoor air monitoring studies (n = 57) and to our knowledge the first one to analyse air in children's bedrooms for PFASs (17 PFAAs and 9 precursors, including two acrylates, 6:2 FTAC and 6:2 FTMAC). The most frequently detected compound was 8:2 fluorotelomer alcohol (8:2 FTOH) with the highest median concentration (3570 pg/m(3)). FTOH concentrations were generally similar to previous studies, indicating that in 2014/2015 the impact of the industrial transition had been minor on FTOH levels in indoor air. However, in contrast to earlier studies (with one exception), median concentrations of 6:2 FTOH were higher than 10:2 FTOH. The C8 PFAAs are still the most abundant acids, even though they have now been phased out by major manufacturers. The mean concentrations of FOSE/As, especially MeFOSE (89.9 pg/m(3)), were at least an order of magnitude lower compared to previous studies. Collectively the comparison of FTOHs, PFAAs and FOSE/FOSAs with previous studies indicates that indoor air levels of PFASs display a time lag to changes in production of several years. This is the first indoor air study investigating 6:2 FTMAC, which was frequently detected (58%) and displayed some of the highest maximum concentrations (13 000 pg/m(3)). There were several statistically significant correlations between particular house and room characteristics and PFAS concentrations, most interestingly higher EtFOSE air concentrations in rooms with plastic floors compared to wood or laminate.

  6. Emission of poly and perfluoroalkyl substances, UV-filters and siloxanes to air from wastewater treatment plants.

    PubMed

    Shoeib, Mahiba; Schuster, Jasmin; Rauert, Cassandra; Su, Ky; Smyth, Shirley-Anne; Harner, Tom

    2016-11-01

    The potential of wastewater treatment plants (WWTPs) to act as sources of poly and perfluoroalkyl substances (PFASs), volatile methyl siloxanes (VMSs) and organic UV-filters to the atmosphere was investigated. Target compounds included: PFASs (fluorotelomer alcohols (FTOHs), perfluorooctane sulfonamides/sulfonamidoethanols (FOSAs/FOSEs), perfluroalkyl sulfonic acids (PFSAs) and perfluroalkyl carboxylic acids (PFCAs)), cyclic VMSs (D3 to D6), linear VMSs (L3 to L5) and eight UV-filters. Emissions to air were assessed at eight WWTPs using paired sorbent-impregnated polyurethane foam passive air samplers, deployed during summer 2013 and winter 2014. Samplers were deployed on-site above the active tank and off-site as a reference. Several types of WWTPs were investigated: secondary activated sludge in urban areas (UR-AS), secondary extended aeration in towns (TW-EA) and facultative lagoons in rural areas (RU-LG). The concentrations of target compounds in air were ∼1.7-35 times higher on-site compared to the corresponding off-site location. Highest concentrations in air were observed at UR-AS sites while the lowest were at RU-LG. Higher air concentrations (∼2-9 times) were observed on-site during summer compared to winter, possibly reflecting enhanced volatilization due to higher wastewater temperatures or differences in influent wastewater concentrations. A significant positive correlation was obtained between concentrations in air and WWTP characteristics (influent flow rate and population in the catchment of the WWTP); whereas a weak negative correlation was obtained with hydraulic retention time. Emissions to air were estimated using a simplified dispersion model. Highest emissions to air were seen at the UR-AS locations. Emissions to air (g/year/tank) were highest for VMSs (5000-112,000) followed by UV-filters (16-2000) then ΣPFASs (10-110). Copyright © 2016. Published by Elsevier Ltd.

  7. Prevalence and Antimicrobial Susceptibility of Enterobacteriaceae Isolated from Retail Pepper in Vietnam.

    PubMed

    Harada, Tetsuya; Yamane, Ryoko; Dang, Van Chinh; Nguyen, Do Phuc; Nguyen, Thi Anh Dao; Jinnai, Michio; Yonogi, Shinya; Kawahara, Ryuji; Kanki, Masashi; Kawai, Takao; Kawatsu, Kentaro; Kumeda, Yuko; Isegawa, Yuji; Yamamoto, Yoshimasa

    2017-03-28

    To investigate the microbial quality of retail pepper in Vietnam, the enumeration and detection of Enterobacteriaceae and the screening of cefotaxime (CTX)-resistant coliforms were performed by using 84 commercial samples. Although Enterobacteriaceae were isolated from 78 samples, the number of Enterobacteriaceae was lower than 1.0 log CFU/g in 46 samples. For the detection of Enterobacteriaceae with the International Organization for Standardization methods, Salmonella spp., Escherichia coli , Klebsiella pneumoniae , Cronobacter sakazakii , and Enterobacter cloacae complex were isolated from 5, 12, 36, 19, and 30 samples, respectively. During screening of CTX-resistant coliforms, K. pneumoniae , C. sakazakii , and E. cloacae complex were isolated from 8, 1, and 21 samples, respectively. Seven K. pneumoniae and seven E. cloacae complex isolates obtained in the screening of CTX-resistant coliforms were resistant to at least one of the three third-generation cephalosporins (CTX, ceftazidime, and cefpodoxime). Moreover, one E. cloacae complex cluster IV and all K. pneumoniae isolates were positive for extended-spectrum β-lactamase genes or plasmid-mediated AmpC β-lactamase genes or both. Additionally, two extended-spectrum β-lactamase-producing K. pneumoniae isolates and one AmpC β-lactamase-producing E. cloacae complex cluster IV isolate were positive for the plasmid-mediated quinolone resistance determinants and also had amino acid alterations in the quinolone resistance-determining regions of GyrA and ParC. Furthermore, 10 E. cloacae complex isolates were positive for the plasmid-mediated fosfomycin resistance gene fosA. As pepper is often consumed without a heating process, the possible spread to humans of foodborne, opportunistic, and nosocomial infection pathogens or resistance genes from foods prepared or seasoned with pepper cannot be excluded. Therefore, it is necessary to handle pepper by using hygienic conditions during the cultivation, harvesting and

  8. [Visceral leishmaniasis in an HIV positive patient].

    PubMed

    Rossiere-Echazarreta, Natalia Lorena; Rodríguez-Campos, Esther Alicia; Morales-Esponda, Mario; Domínguez-Moreno, Rogelio; Cruz-Ortiz, Margarita; Rodríguez-Guzmán, Leoncio Miguel

    2013-01-01

    Introducción: la leishmaniasis visceral o kala azar es la presentación clínica más grave. En México, es una enfermedad rara por lo que su diagnóstico es tardío y generalmente culmina en la muerte del paciente. Se describe a un paciente VIH positivo que desarrolló leishmaniasis visceral. El objetivo es explicar sus características fisiopatológicas y de su tratamiento. Caso clínico: hombre de 45 años de edad, quien ingresó al hospital por cuadro crónico de diarrea sanguinolenta, distensión abdominal, dolor tipo cólico, pérdida de peso y fiebre. A la exploración física se identificó paciente febril con dolor en fosa iliaca derecha y hepatoesplenomegalia. La prueba ELISA para VIH resultó positiva y el ultrasonido hizo evidente una tumoración en ciego, por lo que se realizó biopsia. El informe histopatológico indicó que se trataba de leishmaniasis. Conclusiones: en los pacientes con leishmaniasis e infección por VIH existe pobre respuesta al tratamiento y la mortalidad es alta, causada por la menor respuesta inmune del huésped. En la literatura especializada se sugiere el tratamiento establecido para la infección por VIH combinado con miltefosine y anfotericina B liposomal para la leishmaniasis.

  9. Per- and polyfluoroalkyl substances in snow, lake, surface runoff water and coastal seawater in Fildes Peninsula, King George Island, Antarctica.

    PubMed

    Cai, Minghong; Yang, Haizhen; Xie, Zhiyong; Zhao, Zhen; Wang, Feng; Lu, Zhibo; Sturm, Renate; Ebinghaus, Ralf

    2012-03-30

    The multi-matrices samples from snow (n=4), lake water (n=4), surface runoff water (SRW) (n=1) and coastal seawater (n=10) were collected to investigate the spatial distribution and the composition profiles of per- and polyfluoroalkyl substances (PFASs) in Fildes Peninsula, King George Island, Antarctica in 2011. All samples were prepared by solid-phase extraction and analyzed by using high performance liquid chromatography/negative electrospray ionization-tandem mass spectrometry (HPLC/(-)ESI-MS/MS). 14 PFASs in snow, 12 PFASs in lake water, 9 PFASs in SRW and 13 PFASs in coastal seawater were quantified, including C(4), C(7), C(8), C(10) PFSAs, C(4)-C(9), C(11)-C(14), C(16) PFCAs, and FOSA. PFOA was detected in all samples with the highest concentration (15,096 pg/L) in coastal seawater indicating a possible influence of local sewage effluent. High concentration and mostly frequency of PFBA occurred in snow (up to 1112 pg/L), lake water (up to 2670 pg/L) and SRW (1431 pg/L) while detected in the range of method detection limited (MDL) in the coastal seawaters indicate that PFBA is mainly originated from atmospheric dust contamination and also affected by the degradation of their precursors. No geographical differences in PFOS concentrations (n=8, 18 ± 3 pg/L) were measured in all snow and lake water samples also suggests that PFOS could be originated from the degradation of their precursors which can transported by long-range atmospheric route, but in a very low level.

  10. Emergence of Klebsiella variicola positive for NDM-9, a variant of New Delhi metallo-β-lactamase, in an urban river in South Korea.

    PubMed

    Di, Doris Y W; Jang, Jeonghwan; Unno, Tatsuya; Hur, Hor-Gil

    2017-04-01

    To examine the presence of pathogenic bacteria carrying New Delhi metallo-β-lactamase in the environment and to characterize the genome structures of these strains. Phenotypic screening of antimicrobial susceptibility and WGS were conducted on three Klebsiella variicola strains possessing NDM-9 isolated from an urban river. Three carbapenem-resistant K. variicola isolated from Gwangju tributary were found to possess bla NDM-9 genes. Antimicrobial susceptibility testing indicated resistance of these strains to aminoglycosides, carbapenems, cephems, folate pathway inhibitors, fosfomycin and penicillins, but susceptibility to fluoroquinolones, phenicols, tetracyclines and miscellaneous agents. WGS revealed that the 108 kb IncFII(Y)-like plasmids carry bla NDM-9 sandwiched between IS 15 for the GJ1 strain, IS 26 for the GJ2 strain, IS 15D1 for the GJ3 strain and IS Vsa3 , and further bracketed by IS 26 and Tn AS3 along with the mercury resistance operon upstream and the class 1 integron composed of gene cassettes of aadA2 , dfrA12 and sul1 downstream. An aph(3')-Ia gene conferring resistance to aminoglycosides is located after the integrons. Chromosomally encoded bla LEN-13 , fosA , aqxA and oqxB genes, as well as plasmid-mediated bla TEM-1B and bla CTX-M-65 encoding ESBL, ant(3')-Ia and mph (A) genes, were also identified. The findings of the present study provide us with the information that NDM-9 has been spreading into the environment. Dissemination of NDM-9 in the environment has raised a health risk alarm as this variant of NDM carries MDR genes with highly transferable mobile genetic elements, increasing the possibility of resistance gene transfer among microorganisms in the environment.

  11. Hunting, Exotic Carnivores, and Habitat Loss: Anthropogenic Effects on a Native Carnivore Community, Madagascar.

    PubMed

    Farris, Zach J; Golden, Christopher D; Karpanty, Sarah; Murphy, Asia; Stauffer, Dean; Ratelolahy, Felix; Andrianjakarivelo, Vonjy; Holmes, Christopher M; Kelly, Marcella J

    2015-01-01

    The wide-ranging, cumulative, negative effects of anthropogenic disturbance, including habitat degradation, exotic species, and hunting, on native wildlife has been well documented across a range of habitats worldwide with carnivores potentially being the most vulnerable due to their more extinction prone characteristics. Investigating the effects of anthropogenic pressures on sympatric carnivores is needed to improve our ability to develop targeted, effective management plans for carnivore conservation worldwide. Utilizing photographic, line-transect, and habitat sampling, as well as landscape analyses and village-based bushmeat hunting surveys, we provide the first investigation of how multiple forms of habitat degradation (fragmentation, exotic carnivores, human encroachment, and hunting) affect carnivore occupancy across Madagascar's largest protected area: the Masoala-Makira landscape. We found that as degradation increased, native carnivore occupancy and encounter rates decreased while exotic carnivore occupancy and encounter rates increased. Feral cats (Felis species) and domestic dogs (Canis familiaris) had higher occupancy than half of the native carnivore species across Madagascar's largest protected landscape. Bird and small mammal encounter rates were negatively associated with exotic carnivore occupancy, but positively associated with the occupancy of four native carnivore species. Spotted fanaloka (Fossa fossana) occupancy was constrained by the presence of exotic feral cats and exotic small Indian civet (Viverricula indica). Hunting was intense across the four study sites where hunting was studied, with the highest rates for the small Indian civet (mean=90 individuals consumed/year), the ring-tailed vontsira (Galidia elegans) (mean=58 consumed/year), and the fosa (Cryptoprocta ferox) (mean=31 consumed/year). Our modeling results suggest hunters target intact forest where carnivore occupancy, abundance, and species richness, are highest. These various

  12. High incidence and endemic spread of NDM-1-positive Enterobacteriaceae in Henan Province, China.

    PubMed

    Qin, Shangshang; Fu, Ying; Zhang, Qijing; Qi, Hui; Wen, Jian Guo; Xu, Hui; Xu, Lijuan; Zeng, Li; Tian, Hao; Rong, Lijuan; Li, Yonghong; Shan, Lihong; Xu, Hongde; Yu, Yunsong; Feng, Xianju; Liu, Hong-Min

    2014-08-01

    The emergence and spread of New Delhi metallo-β-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla(NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla(NDM-1), and the gene was found to be carried on plasmids of various sizes (∼ 55 to ∼ 360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla(NDM-1)-positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla(NDM-1)-positive CRE isolate, the bla(NDM-1) gene was downstream of an intact ISAba125 element and upstream of the bleMBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla(NDM-1)-containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.

  13. New Delhi Metallo-β-Lactamase 1(NDM-1), the Dominant Carbapenemase Detected in Carbapenem-Resistant Enterobacter cloacae from Henan Province, China.

    PubMed

    Liu, Cailin; Qin, Shangshang; Xu, Hui; Xu, Lijuan; Zhao, Di; Liu, Xuchun; Lang, Shaolei; Feng, Xianju; Liu, Hong-Min

    2015-01-01

    The emergence of New Delhi metallo-β-lactamase 1 (NDM-1) has become established as a major public health threat and represents a new challenge in the treatment of infectious diseases. In this study, we report a high incidence and endemic spread of NDM-1-producing carbapenem-resistant Enterobacter cloacae isolates in Henan province, China. Eight (72.7%) out of eleven non-duplicated carbapenem-resistant E. cloacae isolates collected between June 2011 and May 2013 were identified as NDM-1 positive. The blaNDM-1 gene surrounded by an entire ISAba125 element and a bleomycin resistance gene bleMBL in these isolates were carried by diverse conjugatable plasmids (IncA/C, IncN, IncHI2 and untypeable) ranging from ~55 to ~360 kb. Molecular epidemiology analysis revealed that three NDM-1-producing E. cloacae belonged to the same multilocus sequence type (ST), ST120, two of which were classified as extensively drug-resistant (XDR) isolates susceptible only to tigecycline and colistin. The two XDR ST120 E. cloacae isolates co-harbored blaNDM-1, armA and fosA3 genes and could transfer resistance to carbapenems, fosfomycin and aminoglycosides simultaneously via a conjugation experiment. Our study demonstrated NDM-1 was the most prevalent metallo-β-lactamase (MBL) among carbapenem-resistant E.cloacae isolates and identified a potential endemic clone of ST120 in Henan province. These findings highlight the need for enhanced efforts to monitor the further spread of NDM-1 and XDR ST120 E. cloacae in this region.

  14. Simultaneous characterization of perfluoroalkyl carboxylate, sulfonate, and sulfonamide isomers by liquid chromatography-tandem mass spectrometry.

    PubMed

    Benskin, Jonathan P; Bataineh, Mahmoud; Martin, Jonathan W

    2007-09-01

    A comprehensive method was developed to simultaneously separate and detect perfluorinated acid (PFA) and PFA-precursor isomers using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A linear perfluorooctyl stationary phase and acidified mobile phase increased separation efficiency, relative to alkyl stationary phases, for the many perfluoroalkyl carboxylate (PFCA), perfluoroalkyl sulfonate (PFSA), and perfluorooctyl sulfonamide (PFOSA) isomers and in combination with their distinct MS/MS transitions allowed full resolution of most isomers in standards. Utilizing the absence of the "9-series" and "0-series" product ions, several perfluorooctane sulfonate (C8F17SO3-, PFOS) isomers were structurally elucidated. In human serum, only perfluorooctane sulfonamide (C8F17SO2NH2, FOSA) and PFOS consisted of significant quantities of branched isomers, whereas PFCAs were predominantly linear. Interferences that coelute with the m/z 499 --> 80 transition of PFOS on alkyl stationary phases were simultaneously separated and identified as taurodeoxycholate isomers, removal of which permitted the use of the more sensitive m/z 80 product ion and a resulting 20-fold decrease in PFOS detection limits compared to the m/z 499 --> 99 transition (0.8 pg versus 20 pg using m/z 80 and 99, respectively). Interferences in human serum which caused a 10-20-fold over-reporting of perfluorohexane sulfonate (C6F13SO3-, PFHxS) concentrations on alkyl stationary phases were also simultaneously separated from linear PFHxS and identified as endogenous steroid sulfates. PFOSA isomers, generated with human microsomes, had different rates of metabolism, suggesting that the perfluoroalkyl branching pattern may affect the biological properties of individual isomers. This fact, and for reasons of improved accuracy and sensitivity, investigators are urged to utilize more efficient separation methods capable of isomer characterization in perfluoroalkyl research.

  15. [Cross-reactivity in allergic fungal sinusitis. Case report].

    PubMed

    González-Díaz, Sandra Nora; Arias-Cruz, Alfredo; Rivero-Arias, Dulce María; Partida-Ortega, Alma Belén; Elizondo-Villarreal, Bárbara; Ibarra-Chávez, Jesús Arturo; Ramos-Valencia, Lissette; Monge-Ortega, Olga Patricia; Macouzet-Sánchez, Carlos; Salinas-Díaz, María Rocío

    2016-01-01

    Antecedentes: La presencia de mucina alérgica en la rinosinusitis alérgica fúngica (RAF) es una manifestación que la identifica como un proceso de hipersensibilidad. En la RAF existe un fenómeno de reactividad cruzada entre proteínas unidas a IgE que tienen al menos dos epítopes compartidos. Caso clínico: Varón de 13 años de edad con síntomas obstructivos nasales de tres años de evolución. Por exploración física y tomografía se identificó masa obstructiva en los senos paranasales. En la cirugía endoscópica, en la fosa nasal izquierda se identificó pólipo con aspecto macroscópico de mucina alérgica; el pólipo fue resecado. El examen histopatológico final mediante tinciones con ácido peryódico de Schiff y metenamina plata de Grocott indicó Aspergillus. Dos semanas después de la cirugía, las pruebas percutáneas mostraron sensibilización a Alternaria alternata, Helminthosporium sativum y Deramatophagoides farianae, con negatividad a Aspergillus fumigatus. Conclusiones: La ausencia de títulos significativos de anticuerpos IgE específicos para Aspergillus fumigatus constituyó la evidencia de que la respuesta de hipersensibilidad fue desencadenada por un patógeno distinto del aislado en el estudio histopatológico, que aunada a las pruebas positivas para otros hongos puede explicarse por el fenómeno de reactividad cruzada en un probable fenómeno de hipersensibilidad.

  16. [Pollution levels of perfluorochemicals in chicken eggs and duck eggs from the markets in Beijing].

    PubMed

    Qi, Yan-Jie; Zhou, Zhen; Shi, Ya-Li; Meng, Zhao-Fu

    2013-01-01

    Pollution levels of perfluorochemicals in eggs purchased from the markets in Beijing had been investigated. The egg samples of chicken and duck were collected from the 59 stalls of 14 main eggs wholesale markets in Beijing, respectively. Systematic analyses were made for seventeen kinds of perfluorochemicals (11 perfluorinated carboxylates (PFCAs), 3 perfluorinated sulfonates (PFSAs), perfluorooctane sulfonamide (FOSA), 2-perfluorooctylethanoic acid (FOEA) and 2H-perfluoro-2-decenoic acid (FOUEA) by a high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The results showed that there was a certain perfluorochemical contamination in all egg samples. Nine kinds of perfluorochemicals were detected in chicken eggs, perfluorononanoic acid (PFNA), perfluoroheptanoic acid (PFHpA) and perfluorooctanoate acid (PFOA) are dominant, and their average concentrations were 0.105, 0.073 and 0.069 ng x g(-1), respectively. Ten kinds of perfluorochemicals were detected in the duck eggs, perfluorooctane sulfonate (PFOS) and PFOA are dominant, and their average concentrations were 0.378 and 0.296 ng x g(-1), respectively. Perfluoropentanoic acid ( PFPeA), perfluorotetradecanoic acid (PFTA), perfluorobutane sulfonate (PFBS) and 2-perfluorooctylethanoic acid (FOEA) were not detected in all samples. The total concentration of PFCs in the duck eggs was 3.4 times of that in the chicken eggs. A strong positive correlation (r = 0.954) was not only observed between of PFNA and PFHpA in chicken eggs, but also found between perfluoroundecanoic acid (PFUnDA) and perfluorotridecanoic acid (PFTrDA) in duck eggs (r = 0.915). The results of health-based risk assessment showed that there was little immediate risk of exposure to PFOS and PFOA via the consumption of chicken eggs and duck eggs purchased from the markets in Beijing.

  17. The 2013 seismic sequence close to gas injection platform of the Castor project, offshore Spain

    NASA Astrophysics Data System (ADS)

    Cesca, Simone; Grigoli, Francesco; Heimann, Sebastian; Gonzalez, Alvaro; Buforn, Elisa; Maghsoudi, Samira; Blanch, Estefania; Dahm, Torsten

    2014-05-01

    A spatially localized seismic sequence has originated few tens of kilometres offshore the Mediterranean coast of Spain, starting on September 5, 2013, and lasting at least until October 2013. The sequence culminated in a maximal moment magnitude Mw 4.3 earthquake, on October 1, 2013. The epicentral region is located near the offshore platform of the Castor project, where gas is conducted through a pipeline from mainland and where it was recently injected in a depleted oil reservoir, at about 2 km depth. We analyse the temporal evolution of the seismic sequence and use full waveform techniques to derive absolute and relative locations, estimate depths and focal mechanisms for the largest events in the sequence (with magnitude mbLg larger than 3), and compare them to a previous event (April 8, 2012, mbLg 3.3) taking place in the same region prior to the gas injection. Moment tensor inversion results show that the overall seismicity in this sequence is characterized by oblique mechanisms with a normal fault component, with a 30° low-dip angle plane oriented NNE-SSW and a sub- vertical plane oriented NW-SE. The combined analysis of hypocentral location and focal mechanisms could indicate that the seismic sequence corresponds to rupture processes along sub- horizontal shallow surfaces, which could have been triggered by the gas injection in the reservoir,. An alternative scenario includes the iterated triggering of a system of steep faults oriented NW-SE, which were identified by prior marine seismics investigations. The most relevant seismogenic feature in the area is the Fosa de Amposta fault system, which includes different strands mapped at different distances to the coast, with a general NE-SW orientation, roughly parallel to the coastline. No significant known historical seismicity has involved this fault in the past. Our both scenarios exclude its activation, as its known orientation is inconsistent with focal mechanism results.

  18. The 2013 September-October seismic sequence offshore Spain: a case of seismicity triggered by gas injection?

    NASA Astrophysics Data System (ADS)

    Cesca, Simone; Grigoli, Francesco; Heimann, Sebastian; González, Álvaro; Buforn, Elisa; Maghsoudi, Samira; Blanch, Estefania; Dahm, Torsten

    2014-08-01

    A spatially localized seismic sequence originated few tens of kilometres offshore the Mediterranean coast of Spain, close to the Ebro river delta, starting on 2013 September 5, and lasting at least until 2013 October. The sequence culminated in a maximal moment magnitude Mw 4.3 earthquake, on 2013 October 1. The most relevant seismogenic feature in the area is the Fosa de Amposta fault system, which includes different strands mapped at different distances to the coast, with a general NE-SW orientation, roughly parallel to the coastline. However, no significant known historical seismicity has involved this fault system in the past. The epicentral region is also located near the offshore platform of the Castor project, where gas is conducted through a pipeline from mainland and where it was recently injected in a depleted oil reservoir, at about 2 km depth. We analyse the temporal evolution of the seismic sequence and use full waveform techniques to derive absolute and relative locations, estimate depths and focal mechanisms for the largest events in the sequence (with magnitude mbLg larger than 3), and compare them to a previous event (2012 April 8, mbLg 3.3) taking place in the same region prior to the gas injection. Moment tensor inversion results show that the overall seismicity in this sequence is characterized by oblique mechanisms with a normal fault component, with a 30° low-dip angle plane oriented NNE-SSW and a subvertical plane oriented NW-SE. The combined analysis of hypocentral location and focal mechanisms could indicate that the seismic sequence corresponds to rupture processes along shallow low-dip surfaces, which could have been triggered by the gas injection in the reservoir, and excludes the activation of the Amposta fault, as its known orientation is inconsistent with focal mechanism results. An alternative scenario includes the iterated triggering of a system of steep faults oriented NW-SE, which were identified by prior marine seismics

  19. Comparative Analysis of Extended-Spectrum-β-Lactamase CTX-M-65-Producing Salmonella enterica Serovar Infantis Isolates from Humans, Food Animals, and Retail Chickens in the United States.

    PubMed

    Tate, Heather; Folster, Jason P; Hsu, Chih-Hao; Chen, Jessica; Hoffmann, Maria; Li, Cong; Morales, Cesar; Tyson, Gregory H; Mukherjee, Sampa; Brown, Allison C; Green, Alice; Wilson, Wanda; Dessai, Uday; Abbott, Jason; Joseph, Lavin; Haro, Jovita; Ayers, Sherry; McDermott, Patrick F; Zhao, Shaohua

    2017-07-01

    We sequenced the genomes of 10 Salmonella enterica serovar Infantis isolates containing blaCTX-M-65 obtained from chicken, cattle, and human sources collected between 2012 and 2015 in the United States through routine National Antimicrobial Resistance Monitoring System (NARMS) surveillance and product sampling programs. We also completely assembled the plasmids from four of the isolates. All isolates had a D87Y mutation in the gyrA gene and harbored between 7 and 10 resistance genes [aph(4)-Ia, aac(3)-IVa, aph(3')-Ic, blaCTX-M-65, fosA3, floR, dfrA14, sul1, tetA, aadA1] located in two distinct sites of a megaplasmid (∼316 to 323 kb) similar to that described in a blaCTX-M-65-positive S Infantis isolate from a patient in Italy. High-quality single nucleotide polymorphism (hqSNP) analysis revealed that all U.S. isolates were closely related, separated by only 1 to 38 pairwise high-quality SNPs, indicating a high likelihood that strains from humans, chickens, and cattle recently evolved from a common ancestor. The U.S. isolates were genetically similar to the blaCTX-M-65-positive S Infantis isolate from Italy, with a separation of 34 to 47 SNPs. This is the first report of the blaCTX-M-65 gene and the pESI (plasmid for emerging S Infantis)-like megaplasmid from S Infantis in the United States, and it illustrates the importance of applying a global One Health human and animal perspective to combat antimicrobial resistance. Copyright © 2017 American Society for Microbiology.

  20. Co-spread of metal and antibiotic resistance within ST3-IncHI2 plasmids from E. coli isolates of food-producing animals

    PubMed Central

    Fang, Liangxing; Li, Xingping; Li, Liang; Li, Shumin; Liao, Xiaoping; Sun, Jian; Liu, Yahong

    2016-01-01

    Concerns have been raised in recent years regarding co-selection for antibiotic resistance among bacteria exposed to heavy metals, particularly copper and zinc, used as growth promoters for some livestock species. In this study, 25 IncHI2 plasmids harboring oqxAB (20/25)/blaCTX-M (18/25) were found with sizes ranging from ∼260 to ∼350 kb and 22 belonged to the ST3-IncHI2 group. In addition to blaCTX-M and oqxAB, pcoA-E (5/25) and silE-P (5/25), as well as aac(6′)-Ib-cr (18/25), floR (16/25), rmtB (6/25), qnrS1(3/25) and fosA3 (2/25), were also identified on these IncHI2 plasmids. The plasmids carried pco and sil contributed to increasing in the MICs of CuSO4 and AgNO3. The genetic context surrounding the two operons was well conserved except some variations within the pco operon. The ~32 kb region containing the two operons identified in the IncHI2 plasmids was also found in chromosomes of different Enterobacteriaceae species. Further, phylogenetic analysis of this structure showed that Tn7-like transposon might play an important role in cross-genus transfer of the sil and pco operons among Enterobacteriaceae. In conclusion, co-existence of the pco and sil operons, and oqxAB/blaCTX-M as well as other antibiotic resistance genes on IncHI2 plasmids may promote the development of multidrug-resistant bacteria. PMID:27143648

  1. Landing biomechanics in participants with different static lower extremity alignment profiles.

    PubMed

    Nguyen, Anh-Dung; Shultz, Sandra J; Schmitz, Randy J

    2015-05-01

    Whereas static lower extremity alignment (LEA) has been identified as a risk factor for anterior cruciate ligament injury, little is known about its influence on joint motion and moments commonly associated with anterior cruciate ligament injury. To cluster participants according to combinations of LEA variables and compare these clusters in hip- and knee-joint kinematics and kinetics during the landing phase of a drop-jump task. Descriptive laboratory study. Research laboratory. A total of 141 participants (50 men: age = 22.2 ± 2.8 years, height = 177.9 ± 9.3 cm, weight = 80.9 ± 13.3 kg; 91 women: age = 21.2 ± 2.6 years, height = 163.9 ± 6.6 cm, weight = 61.1 ± 8.7 kg). Static LEA included pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, tibial torsion, and navicular drop. Cluster analysis grouped participants according to their static LEA profiles, and these groups were compared on their hip- and knee-joint kinematics and external moments during the landing phase of a double-legged drop jump. Three distinct clusters (C1-C3) were identified based on their static LEAs. Participants in clusters characterized with static internally rotated hip and valgus knee posture (C1) and externally rotated knee and valgus knee posture (C3) alignments demonstrated greater knee-valgus motion and smaller hip-flexion moments than the cluster with more neutral static alignment (C2). Participants in C1 also experienced greater hip internal-rotation and knee external-rotation moments than those in C2 and C3. Static LEA clusters that are positioned anatomically with a more rotated and valgus knee posture experienced greater dynamic valgus along with hip and knee moments during landing. Whereas static LEA contributes to differences in hip and knee rotational moments, sex may influence the differences in frontal-plane knee kinematics and sagittal-plane hip moments.

  2. Foot posture and function have only minor effects on knee function during barefoot walking in healthy individuals.

    PubMed

    Buldt, Andrew K; Levinger, Pazit; Murley, George S; Menz, Hylton B; Nester, Christopher J; Landorf, Karl B

    2015-06-01

    Foot posture has been postulated as a risk factor for overuse injuries of the knee, however the link between foot posture and knee joint function is unclear. The aims of this study were to: (i) compare knee adduction moment and knee joint rotations between normal, planus and cavus foot posture groups, and (ii) to determine the relationship between rearfoot and midfoot joint rotations and knee adduction moment magnitude. Rotation of the knee, rearfoot and midfoot was evaluated in 97 healthy adults that were classified as normal (n=37), cavus (n=30) or planus (n=30) for the Foot Posture Index, Arch Index and normalised navicular height. One way analyses of variance were used to compare tri-planar knee joint rotation, knee adduction moment peak variables and knee adduction angular impulse between foot posture groups. Pearson's correlation coefficient was used to investigate the association between rearfoot and midfoot joint rotation during initial contact phase and the magnitude of 1st knee adduction moment peak. The planus group displayed significantly greater external rotation angle at heel contact compared to both normal and cavus groups. The planus groups also displayed greater extension at heel contact and sagittal plane flexion range of motion during propulsion and early swing compared to the cavus group. Otherwise, differences between groups were characterised by small effect sizes. There was no association between rearfoot or midfoot joint rotations and knee adduction moment. These findings suggest that in healthy individuals, foot posture and foot joint rotations do not substantially influence knee joint rotations and knee adduction moment while walking at a comfortable pace. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Prospective Predictors of Patellofemoral Pain Syndrome

    PubMed Central

    Pappas, Evangelos; Wong-Tom, Wing M.

    2012-01-01

    Context: Patellofemoral pain syndrome (PFPS) is one of the most common overuse injuries. Objective: To assess the collective evidence of predisposing factors to PFPS. Data Sources: MEDLINE (1960–June 2010), EMBASE (1980–June 2010), and CINAHL (1982–June 2010). Study Selection: Studies were included if patients were asymptomatic at baseline testing (free of PFPS) and were prospectively followed for the development of the disorder. Only studies that assessed at least 1 variable that can be measured at a typical clinic were included. After duplicates were removed, 973 studies were assessed from their titles or abstracts, 20 from the full text, and from these, 7 met the inclusion criteria. Data Extraction: Data were extracted for age, weight, height, sample size, patient type (military vs civilian), follow-up periods, diagnostic methods, and diagnostic criteria. Means and standard deviations were extracted for all outcome variables. Results: Meta-analyses were performed for height, weight, leanness, Q angle, number of sit-ups, knee extension strength, and peak knee valgus angle during landing. Lower knee extension strength was the only variable that was predictive of PFPS (P < 0.01). Other variables that were identified as predictive of PFPS by single studies were vertical jump, push-ups, knee flexion and hip abduction strength, thumb-to-forearm flexibility, quadriceps and gastrocnemius flexibility, genu varum, navicular drop, knee valgus moment at initial contact during landing, social support, and palliative reaction. Conclusions: It appears that anthropometric variables are not associated with PFPS, while knee extension strength deficits appear to be predictors of PFPS. PMID:23016077

  4. Differences in plantar loading between flat and normal feet during different athletic tasks.

    PubMed

    Queen, Robin M; Mall, Nathan A; Nunley, James A; Chuckpaiwong, Bavornrit

    2009-06-01

    The purpose of this study was to determine if foot type (flat or normal) resulted in loading differences during four sport-specific tasks (cross-cut, side-cut, shuttle run, and landing from a simulated lay-up). Twenty-two healthy subjects (12 normal feet and 10 flat feet) completed five trials in each condition, while in-shoe pressure data was collected at 50 Hz. Contact area, maximum force, and the force time integral were analyzed under the entire foot and in eight-foot regions. Foot type was determined by examining navicular height, arch angle, rearfoot angle, and a clinical score. A series of independent sample t-tests were used to determine statistical differences (alpha<0.05). During the cross-cut, flat feet demonstrated an increase in medial midfoot contact area. During the side-cut, flat feet demonstrated an increase in contact area, force time integral and maximum force in both the medial and lateral midfoot. During the shuttle run, flat feet demonstrated an increase in force time integral in the lateral midfoot and increases in maximum force in both the medial and lateral midfoot. During the landing task, flat feet demonstrated an increase in maximum force in the medial midfoot. However, flat feet demonstrate a decrease in middle forefoot maximum force. All results were statistically significant (p<0.05). Therefore, individuals with a normal foot could be at a lower risk for medial and lateral midfoot injuries such as metatarsal stress fractures, indicating that foot type should be assessed when determining an individual's risk for metatarsal stress fractures.

  5. Tibialis posterior tenosynovitis and associated pes plano valgus in rheumatoid arthritis: electromyography, multisegment foot kinematics, and ultrasound features.

    PubMed

    Barn, Ruth; Turner, Deborah E; Rafferty, Daniel; Sturrock, Roger D; Woodburn, James

    2013-04-01

    To compare electromyographic (EMG), kinematic, kinetic, and ultrasound (US) features of pes plano valgus associated with US-confirmed tibialis posterior (TP) tenosynovitis in rheumatoid arthritis (RA) and healthy control subjects. In this cross-sectional study, patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including 3-dimensional kinematics, kinetics, and intramuscular EMG of TP, and findings were compared with a group of healthy individuals. The RA group also underwent B mode and power Doppler US scanning of the TP tendon to assess and score levels of pathology. Ten patients with RA, median (range) disease duration of 3 years (1-18 years), and 5 control subjects were recruited. Compared to control subjects, the RA patients walked slower and presented with moderate levels of foot-related disability. The mean ± SD Disease Activity Score in 28 joints was 4.6 ± 1.6. Increased magnitude of TP activity was recorded in the RA group compared to controls in the contact period of stance (P = 0.007), in conjunction with reduced ankle joint power (P = 0.005), reduced navicular height in the medial arch (P = 0.023), and increased forefoot dorsiflexion (P = 0.027). TP tendon thickening, fluid, and power Doppler signal were observed in the majority of patients. This study has demonstrated, for the first time, increased TP EMG activity in the presence of US-confirmed TP tenosynovitis in RA. Altered muscle function occurred in conjunction with suboptimal mechanics, moderate levels of tendon pathology, and active disease. Targeted therapy may be warranted to reduce inflammation and mechanically off-load diseased tendon states. Copyright © 2013 by the American College of Rheumatology.

  6. The incidence and distribution of stress fractures in elite tennis players

    PubMed Central

    Maquirriain, J; Ghisi, J P

    2006-01-01

    Background Modern professional tennis involves powerful movements repeatedly subjecting the musculoskeletal system to heavy mechanical load. Thus tennis players are exposed to high risk of overuse injuries including stress fractures. Objective To determine the incidence and distribution of stress fractures in elite tennis players. Study design Retrospective cohort study. Methods The cohort study population consisted of 139 elite players (mean (SD) age, 20.0 (5.0) years; 48 female, 91 male). Stress fractures were identified and confirmed radiologically from medical records during a two year period. Injuries were analysed according to age, sex, site, severity, delay in diagnosis, and time needed to return to sports. Results 15 players sustained 18 stress fractures, corresponding to an overall case incidence of 12.9% (95% confidence interval (CI), 8.1 to 20.0). The tarsal navicular was most affected (n = 5; 27%), followed by the pars interarticularis (n = 3; 16%), the metatarsals (n = 3; 16%), the tibia (n = 2; 11%) and the lunate (n = 2; 11%). Magnetic resonance imaging showed a greater incidence of “high grade” lesions (94.4%). Stress fracture incidence was significantly higher in juniors (20.3% (95% CI, 11.4 to 33.2)) than in professional players (7.5% (2.8 to 15.6)) (p = 0.045). Conclusions There was a high absolute risk (12.9%) of stress fractures in elite tennis players over a two year period. Junior players were at highest risk. The lesions are a major cause of disruption both of training and of competition. Risk factors should therefore be identified and prevention emphasised. PMID:16632579

  7. Preliminary gait analysis results after posterior tibial tendon reconstruction: a prospective study.

    PubMed

    Brodsky, James W

    2004-02-01

    The purpose of this study was to investigate the effect on gait in patients who underwent reconstruction for stage II posterior tibial tendon (PTT) dysfunction. Twelve patients with stage II PTT dysfunction underwent surgical reconstruction consisting of debridement of the posterior tibial tendon, flexor digitorum longus tendon transfer to the navicular tuberosity, medial displacement calcaneal osteotomy, and spring ligament reconstruction. Midfoot arthrodesis was performed in six patients and gastrocnemius recession in three. Gait analysis was performed 2 weeks prior to surgery and 1 year postoperatively. Preoperative and postoperative data were compared to determine differences in temporal-spatial parameters, lower limb kinematics, and ankle push-off power. Step length for the operated side increased from 52.6 +/- 9.6 cm before the surgery to 57.5 +/- 7.1 cm after the surgery (p =.048). Cadence improved from 100.2 +/- 10.7 steps/min to 109.1 +/- 8.5 steps/min (p =.05), thus increasing velocity from 87.6 +/- 22.6 cm/s to 103.4 +/- 15.9 cm/s (p =.042). Single support percentage was unchanged. Maximum sagittal ankle joint power at push-off increased from 0.79 +/- 0.35 W before surgery to 1.2 +/- 0.5 W after surgery (p =.042). There were statistically significant improvements in all radiographic parameters studied. This is the first prospective study to evaluate the in vivo effects on gait in patients undergoing this common surgical procedure. Analysis demonstrated statistically significant improvement in kinetic and kinematic parameters of gait function.

  8. Reliable measurement of 3D foot bone angles based on the frame-of-reference derived from a sole of the foot

    NASA Astrophysics Data System (ADS)

    Kim, Taeho; Lee, Dong Yeon; Park, Jinah

    2016-03-01

    Clinical management of foot pathology requires accurate and robust measurement of the anatomical angles. In order to measure a 3D angle, recent approaches have adopted a landmark-based local coordinate system to establish bone angles used in orthopedics. These measurement methods mainly assess the relative angle between bones using a representative axis derived from the morphological feature of the bone and therefore, the results can be affected by bone deformities. In this study, we propose a method of deriving a global frame-of-reference to acquire consistent direction of the foot by extracting the undersurface of the foot from the CT image data. The two lowest positions of the foot skin are identified from the surface to define the base plane, and the direction from the hallux to the fourth toe is defined together to construct the global coordinate system. We performed the experiment on 10 volumes of foot CT images of healthy subjects to verify that the proposed method provides reliable measurements. We measured 3D angles for talus-calcaneus and talus-navicular using facing articular surfaces of paired bones. The angle was reported in 3 projection angles based on both coordinate systems defined by proposed global frame-of-reference and by CT image planes (saggital, frontal, and transverse). The result shows that the quantified angle using the proposed method considerably reduced the standard deviation (SD) against the angle using the conventional projection planes, and it was also comparable with the measured angles obtained from local coordinate systems of the bones. Since our method is independent from any individual local shape of a bone, unlike the measurement method using the local coordinate system, it is suitable for inter-subject comparison studies.

  9. Custom-Made Total Talonavicular Replacement in a Professional Rock Climber.

    PubMed

    Giannini, Sandro; Cadossi, Matteo; Mazzotti, Antonio; Ramponi, Laura; Belvedere, Claudio; Leardini, Alberto

    Professional athletes are often eager to resume sporting activities at preinjury levels. When facing the challenge of restoring joint function after a complex articular fracture, innovative solutions must be explored. We describe the results of what we believe to be the first custom-made talonavicular prosthesis implanted in a professional rock climber who had developed post-traumatic ankle and talonavicular arthritis as sequelae of a complex talar and navicular fracture. Using computed tomography scan reconstruction of the contralateral healthy ankle and direct metal laser sintering, a custom-made talonavicular prosthesis was obtained and implanted using an anteromedial approach. The patient was clinically and radiographically evaluated every 6 months after surgery for 30 months. A 3-dimensional videofluoroscopic analysis was performed to assess the range of motion about the prosthesis. At the last follow-up visit, the functional scores were excellent (Tegner activity scale score of 9 of 10), and he had completely resumed his sporting activity. The American Orthopaedic Foot and Ankle Society score had increased from 36 to 81 points, and no signs of radiolucency were observed on the radiographs. The 3-dimensional videofluoroscopic analysis showed 15° of dorsiflexion and 4° of plantar flexion at the ankle. A customized solution is an option when the patient's expectations are not likely to be met by standard treatment, such as arthrodesis. A custom-made talonavicular prosthesis can be an effective solution for complex ankle injury sequelae in patients demanding high functionality. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Functional anatomy of the limbs of erethizontidae (Rodentia, Caviomorpha): Indicators of locomotor behavior in Miocene porcupines.

    PubMed

    Candela, Adriana M; Picasso, Mariana B J

    2008-05-01

    Functional analysis of the limb bones of the erethizontid Steiromys duplicatus, one of the most abundant Miocene porcupines from Patagonia, provides evidence to infer their locomotor behavior. Remains of the giant Neosteiromys pattoni (Late Miocene of Northeast Argentina) are also analyzed. Osteological and myological features of extant porcupines were evaluated and used as a model to interpret the functional significance of Miocene species' limbs. Several features in erethizontids are compatible with the ability to climb: the low humeral tuberosities indicate a mobile gleno-humeral joint; the prominent and distally extended deltopectoral crest indicates a powerful pectoral muscle, which is particularly active when climbing; the humero-ulnar and humero-radial joints are indicative of pronation-supination movements; the well-developed lateral epicondylar ridge and the medially protruding entepicondyle are in agreement with an important development of the brachioradialis, supinator, flexor digitorum profundus, and pronator teres muscles, acting in climbing and grasping functions; the mechanical advantage of the biceps brachii would be emphasized because of its distal attachment on the bicipital tuberosity. As with extant porcupines, in Miocene species, the large femoral head would have permitted a broad range of abduction of the femur, and the medially protruding lesser trochanter would have emphasized the abduction and outward rotation of the femur by the action of the ilio-psoas complex. In S. duplicatus, the shape of the hip, knee, and cruro-astragalar, calcaneo-astragalar, and astragalo-navicular joints would have allowed lateral and rotational movements, although probably to a lesser degree than in extant porcupines. Foot features of S. duplicatus (e.g., great medial sesamoid bone, medial astragalar head, complete hallux) indicate that this species would have had grasping ability, but would not have achieved the high degree of specialization of Coendou

  11. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures.

    PubMed

    Ramlee, Muhammad Hanif; Kadir, Mohammed Rafiq Abdul; Murali, Malliga Raman; Kamarul, Tunku

    2014-10-01

    Pilon fractures are commonly caused by high energy trauma and can result in long-term immobilization of patients. The use of an external fixator i.e. the (1) Delta, (2) Mitkovic or (3) Unilateral frame for treating type III pilon fractures is generally recommended by many experts owing to the stability provided by these constructs. This allows this type of fracture to heal quickly whilst permitting early mobilization. However, the stability of one fixator over the other has not been previously demonstrated. This study was conducted to determine the biomechanical stability of these external fixators in type III pilon fractures using finite element modelling. Three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones were reconstructed from previously obtained CT datasets. Bones were assigned with isotropic material properties, while the cartilage was assigned as hyperelastic springs with Mooney-Rivlin properties. Axial loads of 350 N and 70 N were applied at the tibia to simulate the stance and the swing phase of a gait cycle. To prevent rigid body motion, the calcaneus and metatarsals were fixed distally in all degrees of freedom. The results indicate that the model with the Delta frame produced the lowest relative micromovement (0.03 mm) compared to the Mitkovic (0.05 mm) and Unilateral (0.42 mm) fixators during the stance phase. The highest stress concentrations were found at the pin of the Unilateral external fixator (509.2 MPa) compared to the Mitkovic (286.0 MPa) and the Delta (266.7 MPa) frames. In conclusion, the Delta external fixator was found to be the most stable external fixator for treating type III pilon fractures. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  12. The First Complete 3D Reconstruction of a Spanish Fly Primary Larva (Lytta vesicatoria, Meloidae, Coleoptera)

    PubMed Central

    Ge, Si-Qin; Wipfler, Benjamin; Pohl, Hans; Hua, Yi; Ślipiński, Adam; Yang, Xing-Ke; Beutel, Rolf Georg

    2012-01-01

    The first detailed anatomical study of a primary larva of Meloidae is presented. Thereby techniques such as three-dimensional reconstructions, microtome sections, SEM (scanning electronic microscopy) and CLSM (confocal laser scanning microscopy) are applied. The structural features are discussed in the context of phylogeny, but also possible correlations with parasitism, phoresy and miniaturisation. The triungulin first instar larva is likely an apomorphy of Meloidae excl. Eleticinae and linked with a specialisation on acridoid eggs or larvae and provisions of bees. The campodeid body shape of Lytta and Meloinae is a groundplan feature of Meloidae, whereas a navicular body is an autapomorphy of the generally phoretic larvae of Nemognathinae. Head structures of Lytta and features of the postcephalic body are largely plesiomorphic. The musculature of the head is only moderately simplified while the one of the postcephalic body is well developed. Its thorax is largely characterised by plesiomorphies. The characteristics of the legs suggest phoretic habits, even though this does not apply to larvae of Lytta. It is conceivable that a phoretic behaviour is secondarily lost, together with some but not all morphological modifications related to it. Derived features of the abdomen of Meloidae are the complete loss of the fixed urogomphi (also missing in Rhipiphoridae and other related groups) and the presence of one or two conspicuous caudal bristles. Only few features of Lytta are shared with the parasitic larvae of Rhipiphoridae and Strepsiptera. These characteristics, which are possibly linked with specialised life habits, have obviously evolved independently. Miniaturisation effects are minimal in the larvae of Lytta. PMID:23300692

  13. The first complete 3D reconstruction of a Spanish fly primary larva (Lytta vesicatoria, Meloidae, Coleoptera).

    PubMed

    Ge, Si-Qin; Wipfler, Benjamin; Pohl, Hans; Hua, Yi; Slipiński, Adam; Yang, Xing-Ke; Beutel, Rolf Georg

    2012-01-01

    The first detailed anatomical study of a primary larva of Meloidae is presented. Thereby techniques such as three-dimensional reconstructions, microtome sections, SEM (scanning electronic microscopy) and CLSM (confocal laser scanning microscopy) are applied. The structural features are discussed in the context of phylogeny, but also possible correlations with parasitism, phoresy and miniaturisation. The triungulin first instar larva is likely an apomorphy of Meloidae excl. Eleticinae and linked with a specialisation on acridoid eggs or larvae and provisions of bees. The campodeid body shape of Lytta and Meloinae is a groundplan feature of Meloidae, whereas a navicular body is an autapomorphy of the generally phoretic larvae of Nemognathinae. Head structures of Lytta and features of the postcephalic body are largely plesiomorphic. The musculature of the head is only moderately simplified while the one of the postcephalic body is well developed. Its thorax is largely characterised by plesiomorphies. The characteristics of the legs suggest phoretic habits, even though this does not apply to larvae of Lytta. It is conceivable that a phoretic behaviour is secondarily lost, together with some but not all morphological modifications related to it. Derived features of the abdomen of Meloidae are the complete loss of the fixed urogomphi (also missing in Rhipiphoridae and other related groups) and the presence of one or two conspicuous caudal bristles. Only few features of Lytta are shared with the parasitic larvae of Rhipiphoridae and Strepsiptera. These characteristics, which are possibly linked with specialised life habits, have obviously evolved independently. Miniaturisation effects are minimal in the larvae of Lytta.

  14. Sex Differences and Representative Values for 6 Lower Extremity Alignment Measures

    PubMed Central

    Medina McKeon, Jennifer M; Hertel, Jay

    2009-01-01

    Context: A discrepancy in anterior cruciate ligament (ACL) injury rates exists between men and women. Structural differences between the sexes often are implicated as a factor in this discrepancy. Researchers anecdotally assume that men and women tend to display different normative values for certain lower extremity alignments, but published information about these values is limited. Objective: To evaluate the effect of sex on 6 measures of lower extremity alignment and to report representative values of these measures from a sample of active adults and elite athletes. Design: Descriptive cohort design. Setting: University research laboratory. Patients or Other Participants: A total of 118 healthy adults (57 men: age  =  21.1 ± 3.0 years, height  =  179.1 ± 7.3 cm, mass  =  79.8 ± 13.0 kg; 61 women: age  =  20.0 ± 1.6 years, height  =  167.7 ± 6.7 cm, mass  =  62.7 ± 5.5 kg) volunteered. Main Outcome Measure(s): Six common measures of lower extremity posture (navicular drop, tibial varum, quadriceps angle, genu recurvatum, anterior pelvic tilt, femoral anteversion) were collected using established methods. One measurement was taken for each participant for each lower extremity alignment. We measured the right lower extremity only. Results: Compared with men, women demonstrated larger quadriceps angles, more genu recurvatum, greater anterior pelvic tilt, and more femoral anteversion. Conclusions: We observed differences between men and women for 4 of the 6 lower extremity alignments that we measured. Future researchers should focus on identifying how sex and skeletal alignment affect biomechanical performance of functional tasks and what these differences specifically mean regarding the discrepancy in anterior cruciate ligament injury rates between the sexes. PMID:19478840

  15. Exercise-related leg pain in female collegiate athletes: the influence of intrinsic and extrinsic factors.

    PubMed

    Reinking, Mark F

    2006-09-01

    Exercise-related leg pain is a common complaint among athletes, but there is little evidence regarding risk factors for this condition in female collegiate athletes. To examine prospectively the effect of selected extrinsic and intrinsic factors on the development of exercise-related leg pain in female collegiate athletes. Cohort study; Level of evidence, 2. Subjects were 76 female collegiate athletes participating in fall season sports, including cross-country running, field hockey, soccer, and volleyball. Athletes were seen for a pre-season examination that included measures of height, weight, foot pronation, and calf muscle length as well as a questionnaire for disordered eating behaviors. Body mass index was calculated from height and weight (kg/m(2)). Those athletes who developed exercise-related leg pain during the season were seen for follow-up. All athletes who developed the condition and a matched group without such leg pain underwent bone mineral density and body composition testing. Statistical analyses of differences and relationships were conducted. Of the 76 athletes, 58 (76%) reported a history of exercise-related leg pain, and 20 (26%) reported occurrence of exercise-related leg pain during the season. A history of this condition was strongly associated with its occurrence during the season (odds ratio, 13.2). Exercise-related leg pain was most common among field hockey and cross-country athletes and least common among soccer players. There were no differences between athletes with and without such leg pain regarding age, muscle length, self-reported eating behaviors, body mass index, menstrual function, or bone mineral density. Athletes with exercise-related leg pain had significantly (P < .05) greater navicular drop compared with those without. Exercise-related leg pain was common among this group of female athletes. The results suggest that there are certain factors, including foot pronation, sport, and a history of this condition, that are

  16. Ankle and foot contributions to extreme plantar- and dorsiflexion in female ballet dancers.

    PubMed

    Russell, Jeffrey A; Shave, Ruth M; Kruse, David W; Koutedakis, Yiannis; Wyon, Matthew A

    2011-02-01

    Female ballet dancers require extreme ankle motion. The objective of this study was to quantify the relative contributions of the ankle and various foot joints to extreme plantarflexion (PF) and dorsiflexion (DF) in female ballet dancers using an X-ray superimposition technique and digital graphics software. One asymptomatic ankle was studied in each of seven experienced female ballet dancers. Three lateral weightbearing X-rays were taken of each ballet dancer's ankle: en pointe (maximum PF), in neutral position, and in demi-plié (maximum DF). Using graphics software, a subject's three X-ray images were superimposed and the tali were aligned. On each image the tibia, navicular, intermediate cuneiform, and first metatarsal were marked. Positional differences of a bone's line among the three images demonstrated angular movement of the bone in degrees. The neutral position was the reference from which PF and DF of the bones were calculated. The talocrural joint contributed the most motion of any pair of bones evaluated for both PF and DF, with mean movements of 57.6 ± 5.2 degrees en pointe and 24.6 ± 9.6 degrees in demi-plié. Approximately 70% of total PF and DF were attributable to the talocrural joint, with the remaining 30% coming from motion between adjacent pairs of the studied foot bones. Superimposed X-rays for assessing ankle and foot contributions to the extreme positions required of female ballet dancers offer insight into how these positions are attained that is not available via goniometry. Functional information gained from this study may assist clinicians in assessing ankle and foot pain in these individuals.

  17. Clinical diagnosis of symptomatic midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot

    PubMed Central

    Thomas, M.J.; Roddy, E.; Rathod, T.; Marshall, M.; Moore, A.; Menz, H.B.; Peat, G.

    2015-01-01

    Summary Objective To derive a multivariable diagnostic model for symptomatic midfoot osteoarthritis (OA). Methods Information on potential risk factors and clinical manifestations of symptomatic midfoot OA was collected using a health survey and standardised clinical examination of a population-based sample of 274 adults aged ≥50 years with midfoot pain. Following univariable analysis, random intercept multi-level logistic regression modelling that accounted for clustered data was used to identify the presence of midfoot OA independently scored on plain radiographs (dorso-plantar and lateral views), and defined as a score of ≥2 for osteophytes or joint space narrowing in at least one of four joints (first and second cuneometatarsal, navicular-first cuneiform and talonavicular joints). Model performance was summarised using the calibration slope and area under the curve (AUC). Internal validation and sensitivity analyses explored model over-fitting and certain assumptions. Results Compared to persons with midfoot pain only, symptomatic midfoot OA was associated with measures of static foot posture and range-of-motion at subtalar and ankle joints. Arch Index was the only retained clinical variable in a model containing age, gender and body mass index. The final model was poorly calibrated (calibration slope, 0.64, 95% CI: 0.39, 0.89) and discrimination was fair-to-poor (AUC, 0.64, 95% CI: 0.58, 0.70). Final model sensitivity and specificity were 29.9% (95% CI: 22.7, 38.0) and 87.5% (95% CI: 82.9, 91.3), respectively. Bootstrapping revealed the model to be over-optimistic and performance was not improved using continuous predictors. Conclusions Brief clinical assessments provided only marginal information for identifying the presence of radiographic midfoot OA among community-dwelling persons with midfoot pain. PMID:26093213

  18. Lower limb stress fractures in sport: Optimising their management and outcome

    PubMed Central

    Robertson, Greg A J; Wood, Alexander M

    2017-01-01

    Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting. PMID:28361017

  19. Newly discovered Neanderthal remains from Shanidar Cave, Iraqi Kurdistan, and their attribution to Shanidar 5.

    PubMed

    Pomeroy, Emma; Mirazón Lahr, Marta; Crivellaro, Federica;