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Sample records for partial medial meniscectomy

  1. Changes in articular cartilage following arthroscopic partial medial meniscectomy.

    PubMed

    Eichinger, Martin; Schocke, Michael; Hoser, Christian; Fink, Christian; Mayr, Raul; Rosenberger, Ralf E

    2016-05-01

    To examine degenerative changes in all cartilage surfaces of the knee following arthroscopic partial medial meniscectomy. For this prospective cohort study, 14 patients (five female) with a mean age of 47.9 ± 12.9 years who had undergone isolated arthroscopic partial medial meniscectomy were evaluated. Cartilage-sensitive magnetic resonance imaging (MRI) scans were acquired from the operated knees before the index operations, as well as at 6, 12, and 24 months after surgery. The MRI scans were assessed for the prevalence, severity, and size of cartilage degenerations. The clinical outcome was assessed using the SF-36 physical and mental component score and the International Knee Documentation Committee Knee Evaluation Form and was correlated with radiological findings. There was a significant increase in the severity of cartilage lesions in the medial tibial plateau (P = 0.019), as well as a trend towards an increase in the lateral tibial plateau. The size of the cartilage lesions increased significantly in the medial femoral condyle (P = 0.005) and lateral femoral condyle (P = 0.029), as well as in the patella (P = 0.019). Functional outcome scores improved significantly throughout the follow-up period. There was no correlation between cartilage wear and functional outcome. Arthroscopic partial medial meniscectomy is associated with adverse effects on articular cartilage and may lead to an increase in the severity and size of cartilage lesions. Post-operative cartilage wear predominantly affected the medial compartment and also affected the other compartments of the knee. Strategies to reduce subsequent osteoarthritic changes need to involve all compartments of the knee. IV.

  2. Joint space narrowing after partial medial meniscectomy in the anterior cruciate ligament-intact knee.

    PubMed

    Shelbourne, K Donald; Dickens, Jonathan F

    2007-09-01

    Osteoarthritis of the knee is common after total medial meniscectomy. In anterior cruciate ligament-intact knees, the reported outcomes of partial medial meniscectomy are variable. Radiographic assessment using a posteroanterior weight-bearing view is a reliable tool for detecting minor medial joint space narrowing, which may be an early sign of osteoarthritis. Studies that assessed the effect of partial medial meniscectomy found a low percentage of patients with >50% joint narrowing at 10 to 15 years after surgery. Digital radiography, using a posteroanterior weight-bearing view, is a highly sensitive method for observing minor joint space narrowing in the involved knee. A recent study showed that 88% of patients who underwent partial medial meniscectomy had joint space narrowing of <2 mm, and none had narrowing >or=2 mm, at a mean follow-up of 12 years. Subjective results after partial medial meniscectomy are favorable, with 88% to 95% of patients reporting good to excellent results.

  3. Effects of strength and neuromuscular training on functional performance in athletes after partial medial meniscectomy

    PubMed Central

    Zhang, Xiaohui; Hu, Min; Lou, Zhen; Liao, Bagen

    2017-01-01

    The aims of this study were to determine an effective knee function rehabilitation program for athletes undergoing partial medial meniscectomy. Participants were randomly assigned to neuromuscular training (NT) or strength training (ST) group and subjected to functional assessments before surgery and again at 4, and 8 weeks post hoc. Functional knee assessment, such as Lysholm knee scoring, star excursion balance, and BTE PrimusRS isokinetic performance tests were evaluated in each group. All postoperational symptoms were significantly improved after 4 and 8 weeks of NT and ST. Both NT and ST programs showed effective knee function recovery seen as an increase in muscular strength and endurance. However, the NT program showed the most significant functional improvement of dynamic balance and coordination. PMID:28349042

  4. Partial Meniscectomy Provides No Benefit for Symptomatic Degenerative Medial Meniscus Posterior Root Tears

    PubMed Central

    Krych, Aaron John; Johnson, Nick R.; Mohan, Rohith; Dahm, Diane L.; Levy, Bruce A.; Stuart, Michael J.

    2017-01-01

    Objectives: Medial meniscus posterior root tears (MMPRTs) are recognized as a source of pain and dysfunction, but treatment options remain a clinical challenge. Currently, outcomes are unknown following partial meniscectomy for these lesions. To determine (1) the efficacy of partial meniscectomy to treat MMPRTs compared to a matched group of non-operatively treated MMPRTs, and (2) risk factors for worse clinical and radiographic outcome. Methods: This retrospective comparative study was performed to include 27 patients with MMPRTs that were treated with arthroscopic partial meniscectomy (PMM) and a minimum 2-year follow-up. These patients were then matched by age, gender, and BMI to a group of 27 patients with MMPRTs treated non-operatively (control group). Demographic data, radiographic findings, final Tegner and IKDC scores were obtained and compared between the two groups. Risk factors for worse clinical and radiographic outcome in the PMM group alone, including age, sex, BMI, initial K-L grade, subchondral edema, and insufficiency fracture on MRI were determined. Results: Overall, 54 patients were included in the study. 27 patients (10M: 17F) with a mean age of 55±9 and a mean BMI of 32.8±5.3 were treated with PMM and followed for a mean of 5.5±2 years (range 2.3-9.3 years). In the PMM group, final median Tegner score was 3, mean IKDC scores were 67.8±20, median KL grades on weight-bearing AP films demonstrated progressive arthritis (median grade 1 to 2, p=0.001) and more patients had grade II or higher arthritis at final follow-up than baseline (91.3% vs. 36% p<0.01. Overall, 14 of the 27 patients (52%) treated operatively progressed to total knee arthroplasty at a mean of 54.3 months. When comparing the PMM and control groups, there was no significant difference in final median Tegner scores, mean IKDC, median K-L grades, progression to arthroplasty, or overall failure rate. Following PMM, female patients had lower final IKDC scores (74.6±16.7 vs. 44.00

  5. Effect of partial medial meniscectomy on anterior tibial translation in stable knees: a prospective controlled study on 32 patients

    PubMed Central

    2013-01-01

    Background Quantitative measurement of anterior translation of the tibia (ATT) by KT 1000 is used mainly to provide an objective assessment of knee laxity after anterior cruciate ligament (ACL) tears or ACL reconstructions. Only few papers described its use after menisectomies in knees with intact ACL. The objective of this paper is to determine whether partial medial meniscectomies could induce significant immediate post-operative ATT. Methods Thirty-two patients with a diagnosis of partial medial meniscal tear limited to the posterior horn and documented with magnetic resonance imaging (MRI) were assessed under anesthesia before and immediately after arthroscopic meniscectomy. The assessment was performed by the same examiner by means of the MEDmetric(R) KT-1000 instrument using manual maximum (MM) force. The opposite knees were also assessed. Results There is a significant difference between pre and post-operative KT MM mean values for the operated knees (CI: -3.933953 to −2.947297, p < 0.0001). No significance was found between the mean values for the contralateral knees before and after the completion of the menisectomy on the operated knees (p = 0.4). For the operated knees, 14 (43.75%) had a side-to-side difference between pre-and post-operative values of more than 3 mm, whereas for the contralateral knees, only 2 (6%) had the same. Conclusion Less than half of operated knees showed significant side-to-side difference values of ATT (>3 mm), immediately after meniscectomies in unconscious patients. Our values might reflect a temporarily increase of anterior laxity under specific conditions but whether a significant laxity remains in some knees, such changes may lead to higher cartilage loading and early osteoarthritis. PMID:24499538

  6. Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players.

    PubMed

    Nawabi, Danyal H; Cro, Suzie; Hamid, Imran P; Williams, Andy

    2014-09-01

    Meniscectomy is frequently performed in elite soccer athletes to allow return to a high level of performance as early as possible. Although lateral meniscectomy is known to have more serious long-term sequelae than medial meniscectomy, little is known about the effect of lateral meniscectomy on the time to return to play during the early recovery phase in professional soccer players. Lateral meniscectomy results in longer times to return to preinjury level of competition and a higher incidence of adverse outcomes compared with medial meniscectomy in elite professional soccer players. Cohort study; Level of evidence, 3. A single-surgeon database containing the injury history and operative details of elite soccer athletes from 2005 to 2009 was used to identify players who had undergone an isolated partial lateral or medial meniscectomy. The time to return to preinjury level of competition, the incidence of adverse events during early recovery, and the need for further arthroscopy were recorded. Time to return to play was analyzed by using the Kaplan-Meier method. A multivariate analysis was used to control for age, location of meniscectomy, percentage of meniscus excised, and type of tear. Ninety soccer players were identified, of which 42 had a lateral meniscectomy and 48 had a medial meniscectomy. The median time to return to play, to the nearest week, was longer in the lateral group than the medial group (7 vs 5; P < .001). At all time points after surgery, the cumulative probability of returning to play was 5.99 times greater (95% confidence interval, 3.34-10.74; P < .001) after medial meniscectomy. More lateral meniscectomy cases experienced adverse events related to pain/swelling-29 (69%) vs 4 (8%) (P < .001)-and required a second arthroscopy: 3 (7%) vs 0 (P = .098). The time to return to preinjury level of competition is significantly longer after lateral than medial meniscectomy in elite professional soccer athletes. Lateral meniscectomy has a higher

  7. The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol

    PubMed Central

    2012-01-01

    Background Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. Methods/design 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. Discussion The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist

  8. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study.

    PubMed

    Vangsness, C Thomas; Farr, Jack; Boyd, Joel; Dellaero, David T; Mills, C Randal; LeRoux-Williams, Michelle

    2014-01-15

    There are limited treatment options for tissue restoration and the prevention of degenerative changes in the knee. Stem cells have been a focus of intense preclinical research into tissue regeneration but limited clinical investigation. In a randomized, double-blind, controlled study, the safety of the intra-articular injection of human mesenchymal stem cells into the knee, the ability of mesenchymal stem cells to promote meniscus regeneration following partial meniscectomy, and the effects of mesenchymal stem cells on osteoarthritic changes in the knee were investigated. A total of fifty-five patients at seven institutions underwent a partial medial meniscectomy. A single superolateral knee injection was given within seven to ten days after the meniscectomy. Patients were randomized to one of three treatment groups: Group A, in which patients received an injection of 50 × 10⁶ allogeneic mesenchymal stem cells; Group B, 150 × 10⁶ allogeneic mesenchymal stem cells; and the control group, a sodium hyaluronate (hyaluronic acid/hyaluronan) vehicle control. Patients were followed to evaluate safety, meniscus regeneration, the overall condition of the knee joint, and clinical outcomes at intervals through two years. Evaluations included sequential magnetic resonance imaging (MRI). No ectopic tissue formation or clinically important safety issues were identified. There was significantly increased meniscal volume (defined a priori as a 15% threshold) determined by quantitative MRI in 24% of patients in Group A and 6% in Group B at twelve months post meniscectomy (p = 0.022). No patients in the control group met the 15% threshold for increased meniscal volume. Patients with osteoarthritic changes who received mesenchymal stem cells experienced a significant reduction in pain compared with those who received the control, on the basis of visual analog scale assessments. There was evidence of meniscus regeneration and improvement in knee pain following treatment with

  9. Protective effects of calcium gluconate on osteoarthritis induced by anterior cruciate ligament transection and partial medial meniscectomy in Sprague–Dawley rats

    PubMed Central

    2014-01-01

    Background This study aimed to determine whether calcium gluconate exerts protective effects on osteoarthritis (OA) induced by anterior cruciate ligament (ACL) transection and partial medial meniscectomy. Methods Calcium gluconate was administered by mouth daily for 84 days to male ACL transected and partial medial meniscectomized Sprague–Dawley rats 1 week after operation. Results Eighty-four days of treatment with 50 mg/kg calcium gluconate led to a lower degree of articular stiffness and cartilage damage compared to the OA control, possibly through inhibition of overexpressed cyclooxygenase (COX)-2 and related chondrocyte apoptosis. Similar favorable effects on stiffness and cartilage were detected in calcium gluconate-administered rats. Additionally, calcium gluconate increased 5-bromo-2′-deoxyuridine (BrdU) uptake based on observation of BrdU-immunoreactive cells on both the femur and tibia articular surface cartilages 84 days after intra-joint treatment with calcium gluconate. Conclusions Taken together, our results demonstrate that calcium gluconate has a protective effect against OA through inhibition of COX-2 and related chondrocyte apoptosis. PMID:24602500

  10. Forward lunge knee biomechanics before and after partial meniscectomy.

    PubMed

    Hall, Michelle; Nielsen, Jonas Høberg; Holsgaard-Larsen, Anders; Nielsen, Dennis Brandborg; Creaby, Mark W; Thorlund, Jonas Bloch

    2015-12-01

    Patients following meniscectomy are at increased risk of developing knee osteoarthritis in the tibiofemoral compartment and at the patellofemoral joint. As osteoarthritis is widely considered a mechanical disease, it is important to understand the potential effect of arthroscopic partial meniscectomy (APM) on knee joint mechanics. The purpose of this study was to evaluate changes in knee joint biomechanics during a forward lunge in patients with a suspected degenerative meniscal tear from before to three months after APM. Twenty-two patients (35-55 years old) with a suspected degenerative medial meniscal tear participated in this study. Three dimensional knee biomechanics were assessed on the injured and contralateral leg before and three months after APM. The visual analogue scale was used to assess knee pain and the Knee Injury Osteoarthritis Outcome Score was used to assess sport/recreation function and knee-related confidence before and after APM. The external peak knee flexion moment reduced in the APM leg compared to the contralateral leg (mean difference (95% CI)) -1.08 (-1.80 to -0.35) (Nm/(BW × HT)%), p = 0.004. Peak knee flexion angle also reduced in the APM leg compared to the contralateral leg -3.94 (-6.27 to -1.60) degrees, p = 0.001. There was no change in knee pain between the APM leg and contralateral leg (p=0.118). Self-reported sport/recreation function improved (p = 0.004). Although patients self-reported less difficulty during strenuous tasks following APM, patients used less knee flexion, a strategy that may limit excessive patellar loads during forward lunge in the recently operated leg. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. MRI Evaluation of Isolated Arthroscopic Partial Meniscectomy Patients at a Minimum Five-Year Follow-up

    PubMed Central

    Warner, Kristin K.; Petrigliano, Frank A.; Potter, Hollis G.; Hatch, Joshua; Cordasco, Frank A.

    2006-01-01

    Background The risk of radiographic knee degeneration after partial or total meniscectomy is well documented, but no prior study has employed cartilage-sensitive MRI technology to assess degenerative changes after meniscectomy. Hypothesis Arthroscopic partial meniscectomy results in early articular cartilage wear and subchondral bony degeneration, even in the absence of clinical symptoms, and these findings can be evaluated with cartilage-sensitive MRI. Study design Retrospective cohort. Methods Twenty-nine patients (ages: 15–40) who had undergone isolated arthroscopic partial medial or lateral meniscectomy with at least 5-year follow-up were evaluated. All patients had arthroscopically normal articular cartilage at the time of initial meniscectomy. Seventeen patients (18 knees) underwent partial medial meniscectomy (MM) and 12 patients underwent partial lateral meniscectomy (LM) with mean follow-up of 8.4 and 7.1 years, respectively. Follow-up evaluation included physical examination, outcome questionnaires, and cartilage-sensitive MRI examination with modified Outerbridge grading of articular surfaces. Results Outerbridge grades II–IV were noted in 64% of medial compartment joint surfaces in group MM knees versus 33% of lateral compartment joint surfaces in group LM knees. Abnormal cartilage surfaces (grades II–IV), subchondral sclerosis, and condylar squaring were all significantly more frequent after medial meniscectomy (p < 0.05). Groups MM and LM had no significant differences among outcome scores, which remained excellent in both groups. A significant negative correlation was found between the severity of cartilage wear and functional scoring in the MM group, suggesting that functional disability lags behind early MRI evidence of degeneration. Conclusions Despite optimal preoperative prognostic factors and excellent functional outcomes, MRI evidence of early articular cartilage degeneration was present in both partial medial and lateral

  12. Arthroscopic Meniscectomy and Meniscoplasty for a Torn Discoid Medial Meniscus: Case Report, Surgical Technique, and Literature Review

    PubMed Central

    Abhay, Gokhale Nikhil; Ashwin, Samant; Sunil, Shahane; Hardik, Kapopara

    2016-01-01

    Introduction: Normal menisci of the knee are semilunar structures. Sometimes, a meniscus may be found to be thickened and disc like and is called a discoid meniscus. Such a discoid variant is usually found in the lateral meniscus. Its occurrence in the medial meniscus is extremely rare. Case Report: We report a case of an 18-year-old female, who presented to us with knee pain and was found to have a discoid medial meniscus with a tear. We operated on her arthroscopically and performed meniscectomy and meniscoplasty. Postoperatively, the patient was free of her knee pain. Conclusion: Discoid medial meniscus is a rare phenomenon which can present as a cause of knee pain. If discoid meniscus is symptomatic, the management includes arthroscopic meniscectomy and meniscoplasty. PMID:28164061

  13. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year.

    PubMed

    Roemer, Frank W; Kwoh, C Kent; Hannon, Michael J; Hunter, David J; Eckstein, Felix; Grago, Jason; Boudreau, Robert M; Englund, Martin; Guermazi, Ali

    2017-01-01

    To assess whether partial meniscectomy is associated with increased risk of radiographic osteoarthritis (ROA) and worsening cartilage damage in the following year. We studied 355 knees from the Osteoarthritis Initiative that developed ROA (Kellgren-Lawrence grade ≥ 2), which were matched with control knees. The MR images were assessed using the semi-quantitative MOAKS system. Conditional logistic regression was applied to estimate risk of incident ROA. Logistic regression was used to assess the risk of worsening cartilage damage in knees with partial meniscectomy that developed ROA. In the group with incident ROA, 4.4 % underwent partial meniscectomy during the year prior to the case-defining visit, compared with none of the knees that did not develop ROA. All (n = 31) knees that had partial meniscectomy and 58.9 % (n = 165) of the knees with prevalent meniscal damage developed ROA (OR = 2.51, 95 % CI [1.73, 3.64]). In knees that developed ROA, partial meniscectomy was associated with an increased risk of worsening cartilage damage (OR = 4.51, 95 % CI [1.53, 13.33]). The probability of having had partial meniscectomy was higher in knees that developed ROA. When looking only at knees that developed ROA, partial meniscectomy was associated with greater risk of worsening cartilage damage. • Partial meniscectomy is a controversial treatment option for degenerative meniscal tears. • Partial meniscectomy is strongly associated with incident osteoarthritis within 1 year. • Partial meniscectomy is associated with increased risk of worsening cartilage damage.

  14. The Effect of ACL Reconstruction on Kinematics of the Knee with Combined ACL Injury and Subtotal Medial Meniscectomy - an in-vitro robotic investigation

    PubMed Central

    Seon, Jong Keun; Gadikota, Hemanth R.; Kozanek, Michal; Oh, Luke S.; Gill, Thomas J.; Li, Guoan

    2009-01-01

    Purpose The aims of this study were to determine: 1) the kinematic effect of subtotal medial meniscectomy on ACL deficient knee and 2) the effect of ACL reconstruction on kinematics of the knee with combined ACL deficiency and subtotal medial meniscectomy under an anterior tibial and a simulated quadriceps loads. Methods Eight human cadaveric knees were sequentially tested using a robotic testing system under 4 conditions: intact, ACL deficiency, ACL deficiency with subtotal medial meniscectomy, and single bundle ACL reconstruction using a bone-patellar tendon-bone graft. Knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flex ion under an anterior tibial load of 130 N and a quadriceps muscle load of 400 N. Results Subtotal medial meniscectomy in ACL deficient knee significantly increased anterior and lateral tibial translations under the anterior tibial and quadriceps loads (P < 0.05). These kinematic changes were larger at high flexion (≥ 60°) than at low flexion angles. ACL reconstructio n in knees with ACL deficiency and subtotal medial meniscectomy significantly reduced the increased anterior tibial translation, but could not restore anterior translation to the intact level with differences ranging from 2.6 mm at 0° to 5.5 mm at 30° of flexion. ACL reconstruction did not significantly affect the medial-lateral translation and internal-external tibial rotation in the presence of subtotal meniscectomy. Conclusions Subtotal medial meniscectomy in knees with ACL deficiency altered knee kinematics, especially at high flexion angles. ACL reconstruction significantly reduced the increased tibial translation in knees with combined ACL deficiency and subtotal medial meniscectomy, but could not restore the knee kinematics to the intact knee level. Clinical Relevance This study suggests that meniscus is an important secondary stabilizer against anterior and lateral tibial translations and should be preserved in the setting of ACL reconstruction for

  15. The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation.

    PubMed

    Seon, Jong Keun; Gadikota, Hemanth R; Kozanek, Michal; Oh, Luke S; Gill, Thomas J; Li, Guoan

    2009-02-01

    The aims of this study were to determine: (1) the kinematic effect of subtotal medial meniscectomy on the anterior cruciate ligament (ACL)-deficient knee and (2) the effect of ACL reconstruction on kinematics of the knee with combined ACL deficiency and subtotal medial meniscectomy under anterior tibial and simulated quadriceps loads. Eight human cadaveric knees were sequentially tested using a robotic testing system under 4 conditions: intact, ACL deficiency, ACL deficiency with subtotal medial meniscectomy, and single-bundle ACL reconstruction using a bone-patellar tendon-bone graft. Knee kinematics were measured at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion under an anterior tibial load of 130 N and a quadriceps muscle load of 400 N. Subtotal medial meniscectomy in the ACL-deficient knee significantly increased anterior and lateral tibial translations under the anterior tibial and quadriceps loads (P < .05). These kinematic changes were larger at high flexion (>or=60 degrees) than at low flexion angles. ACL reconstruction in knees with ACL deficiency and subtotal medial meniscectomy significantly reduced the increased anterior tibial translation, but could not restore anterior translation to the intact level with differences ranging from 2.6 mm at 0 degrees to 5.5 mm at 30 degrees of flexion. ACL reconstruction did not significantly affect the medial-lateral translation and internal-external tibial rotation in the presence of subtotal meniscectomy. Subtotal medial meniscectomy in knees with ACL deficiency altered knee kinematics, especially at high flexion angles. ACL reconstruction significantly reduced the increased tibial translation in knees with combined ACL deficiency and subtotal medial meniscectomy, but could not restore the knee kinematics to the intact knee level. This study suggests that meniscus is an important secondary stabilizer against anterior and lateral tibial translations and should be preserved in the setting of

  16. Mechanisms underpinning the peak knee flexion moment increase over 2-years following arthroscopic partial meniscectomy.

    PubMed

    Hall, Michelle; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Cicuttini, Flavia M; Dempsey, Alasdair R; Mills, Peter M; Lloyd, David G; Bennell, Kim L

    2015-12-01

    Knee osteoarthritis is common in people who have undergone partial meniscectomy, and a higher external knee flexion moment during gait may be a potential contributor. Although the peak external knee flexion moment has been shown to increase from 3 months to 2 years following partial meniscectomy, mechanisms underpinning the increase in the peak knee flexion moment are unknown. Sixty-six participants with partial meniscectomy completed three-dimensional gait (normal and fast pace) and quadriceps strength assessment at baseline (3 months following partial meniscectomy) and again 2 years later. Variables included external knee flexion moment, vertical ground reaction force, knee flexion kinematics, and quadriceps peak torque. For normal pace walking, the main significant predictors of change in peak knee flexion moment were an increase in peak vertical ground reaction force (R(2)=0.55), mostly due to an increase in walking speed, and increase in peak knee flexion angle (R(2)=0.19). For fast pace walking, the main significant predictors of change in peak knee flexion moment were an in increase in peak vertical ground reaction force (R(2)=0.51) and increase in knee flexion angle at initial contact (R(2)=0.17). Change in peak vertical force was mostly due to an increase in walking speed. Findings suggest that increases in vertical ground reaction force and peak knee flexion angle during stance are predominant contributors to the 2-year change in peak knee flexion moment. Future studies are necessary to refine our understanding of joint loading and its determinants following meniscectomy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. The Role of Arthroscopic Partial Meniscectomy in the Management of Degenerative Meniscus Tears: A Review of the Recent Literature

    PubMed Central

    Azam, Mohsin; Shenoy, Ravi

    2016-01-01

    Background: The use of arthroscopic partial meniscectomy for middle aged to older adults with knee pain is one of the most common surgical procedures with approximately 150,000 knee arthroscopies being carried out in the United Kingdom each year, and about five times that number in the United States. Despite this, the procedure remains controversial. The aim of this paper is to provide a comprehensive review of the role of arthroscopic meniscectomy in patients with degenerative meniscus tears and suggest recommendations for clinical practice. Methods: A thorough literature search was performed using available databases, including Pubmed, Medline, EMBASE and the Cochrane Library to cover important randomised control trials surrounding the use of arthroscopic partial meniscectomy. Results: The majority of randomised control trials suggest that arthroscopic partial meniscectomy is not superior to conservative measures such as exercise programmes. Furthermore, one randomised control trial found that arthroscopic partial meniscectomy was not even superior to sham surgery. Conclusion: There is significant overtreatment of knee pain with arthroscopic partial meniscectomy when alternative, less invasive and less expensive treatment options are equally effective. First-line treatment of degenerative meniscus tears should be non-operative therapy focused on analgesia and physical therapy to provide pain relief as well as improve mechanical function of the knee joint. Arthroscopic partial meniscectomy should be considered as a last resort when extensive exercise programmes and physiotherapy have been tried and failed. PMID:28217206

  18. Simple arthroscopic partial meniscectomy associated with anterior cruciate-deficient knees.

    PubMed

    Marshall, S; Levas, M G; Harrah, A

    1985-01-01

    Twenty-five patients with combined tears of the meniscus and anterior cruciate ligament in the same knee were evaluated for the results of a simple arthroscopic meniscectomy that preserved the meniscal rim. These patients, classified as "recreational athletes," were analyzed to determine their postoperative functional capabilities. Using the presence or absence of the pivot shift sign as the most important indicator of functional capability, we found that partial meniscectomy was effective in allowing patients to regain a high degree of normal functional ability and in permitting forward motion activities. However, all patients were left with an anterior cruciate-deficient knee that caused laxity in the anterior plane and frequently in the rotatory plane. Rotatory laxity markedly limits activities, and those patients unable to adjust to their instability are considering further surgery.

  19. Knee Biomechanics During Jogging After Arthroscopic Partial Meniscectomy: A Longitudinal Study.

    PubMed

    Hall, Michelle; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Cicuttini, Flavia M; Dempsey, Alasdair R; Lloyd, David G; Bennell, Kim L

    2017-07-01

    Altered knee joint biomechanics is thought to play a role in the pathogenesis of knee osteoarthritis and has been reported in patients after arthroscopic partial meniscectomy (APM) while performing various activities. Longitudinally, understanding knee joint biomechanics during jogging may assist future studies to assess the implications of jogging on knee joint health in this population. To investigate knee joint biomechanics during jogging in patients 3 months after APM and a healthy control group at baseline and 2 years later at follow-up. Controlled laboratory study. Seventy-eight patients who underwent medial APM and 38 healthy controls underwent a 3-dimensional motion analysis during barefoot overground jogging at baseline. Sixty-four patients who underwent APM and 23 controls returned at follow-up. External peak moments (flexion and adduction) and the peak knee flexion angle during stance were evaluated for the APM leg, non-APM leg (nonoperated leg), and control leg. At baseline, the peak knee flexion angle was 1.4° lower in the APM leg compared with the non-APM leg ( P = .03). No differences were found between the moments in the APM leg compared with the control leg (all P > .05). However, the normalized peak knee adduction moment was 35% higher in the non-APM leg compared with the control leg ( P = .008). In the non-APM leg, the normalized peak knee adduction and flexion moments were higher compared with the APM leg by 16% and 10%, respectively, at baseline ( P ≤ .004). Despite the increase in the peak knee flexion moment in the APM leg compared with the non-APM leg ( P < .001), there were no differences in the peak knee flexion moment or any other parameter assessed at 2-year follow-up between the legs ( P > .05). Comparing the APM leg and control leg, no differences in knee joint biomechanics during jogging for the variables assessed were observed. Higher knee moments in the non-APM leg may have clinical implications for the noninvolved leg. Kinematic

  20. Return to Play After Partial Lateral Meniscectomy in National Football League Athletes.

    PubMed

    Aune, Kyle T; Andrews, James R; Dugas, Jeffrey R; Cain, E Lyle

    2014-08-01

    Lateral meniscal injury is a common and possibly career-threatening injury among players in the National Football League (NFL). The rate of return to play (RTP) and factors that affect RTP after lateral meniscal injury in NFL players are currently not defined. The aims of this study were to determine the rate of RTP to regular-season NFL game play of NFL players after arthroscopic partial lateral meniscectomy and to identify factors that can predict the ability to return to play. Case series; Level of evidence, 4. Seventy-two patients undergoing 77 arthroscopic lateral partial meniscectomies were followed to determine the rate of RTP (defined as successful RTP in at least 1 regular-season NFL game after meniscectomy) and factors predicting players' ability to return to play. Perioperative variables were recorded using retrospective chart review. Players' heights and weights, dates of return, draft rounds, and counts of games, starts, and seasons both before and after meniscectomy were all collected from statistical databases maintained by the NFL. Chi-square and Student t tests were performed to assess differences among covariates with respect to an athlete's ability to return to play, and odds ratios were calculated as appropriate. All percentages were calculated as percent of total procedures performed (n = 77). Of the 77 partial lateral meniscectomies performed, 61% (n = 47) resulted in the athlete returning to play at his previous level of competition with an average length of time to RTP of 8.5 months; 19 (40%) of those who returned were still active in the NFL at the time of follow-up. Age at time of surgery, games and seasons played before surgery, and individual position were not significantly different between those who did and did not return to play. Undergoing a concomitant procedure did not affect an athlete's ability to return to play, nor did concurrent arthroscopic anterior cruciate ligament reconstruction affect a player's likelihood to return to

  1. Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy: a prospective cohort study.

    PubMed

    Thorlund, J B; Holsgaard-Larsen, A; Creaby, M W; Jørgensen, G M; Nissen, N; Englund, M; Lohmander, L S

    2016-07-01

    Patients undergoing arthroscopic partial meniscectomy (APM) are at increased risk of knee osteoarthritis (OA). Meniscal damage and/or surgery may alter knee joint loading to increase OA risk. We investigated changes in knee joint loading following medial APM surgery, compared with the contra-lateral leg. We estimated indices of knee joint loading (external peak knee adduction moment (KAM), KAM impulse and peak knee flexion moment (KFM)) normalized to body size (i.e., body mass (BM) and height (HT)) using 3D gait analysis in 23 patients (17 men, mean (SD) 46.2 (6.4) years, BMI 25.8 (3.4) kg/m(2)) without radiographic knee OA before and 12 months after medial APM. Static alignment was assessed by radiography and self-reported outcomes by Knee injury and Osteoarthritis Outcome Score (KOOS). Peak KAM and KAM impulse increased in the APM leg compared to the contra-lateral leg from before to 12 months after surgery (change difference: 0.38 Nm/BM*HT% 95% CI 0.01 to 0.76 (P = 0.049) and 0.20 Nm*s/BM*HT% 95% CI 0.10 to 0.30 (P < 0.001)). Patients self-reported improvements on all KOOS subscales (KOOS pain improvement: 22.8 95% CI 14.5 to 31.0 (P < 0.01)). A relative increase in indices of medial compartment loading was observed in the leg undergoing APM compared with the contra-lateral leg from before to 12 months after surgery. This increase may contribute to the elevated risk of knee OA in these patients. Randomized trials including a non-surgical control group are needed to determine if changes in joint loading following APM are caused by surgery or by changes in symptoms. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  2. A multi-scale finite element model for investigation of chondrocyte mechanics in normal and medial meniscectomy human knee joint during walking.

    PubMed

    Tanska, Petri; Mononen, Mika E; Korhonen, Rami K

    2015-06-01

    Mechanical signals experienced by chondrocytes (articular cartilage cells) modulate cell synthesis and cartilage health. Multi-scale modeling can be used to study how forces are transferred from joint surfaces through tissues to chondrocytes. Therefore, estimation of chondrocyte behavior during certain physical activities, such as walking, could provide information about how cells respond to normal and abnormal loading in joints. In this study, a 3D multi-scale model was developed for evaluating chondrocyte and surrounding peri- and extracellular matrix responses during gait loading within healthy and medial meniscectomy knee joints. The knee joint geometry was based on MRI, whereas the input used for gait loading was obtained from the literature. Femoral and tibial cartilages were modeled as fibril-reinforced poroviscoelastic materials, whereas menisci were considered as transversely isotropic. Fluid pressures in the chondrocyte and cartilage tissue increased up to 2MPa (an increase of 30%) in the meniscectomy joint compared to the normal, healthy joint. The elevated level of fluid pressure was observed during the entire stance phase of gait. A medial meniscectomy caused substantially larger (up to 60%) changes in maximum principal strains in the chondrocyte compared to those in the peri- or extracellular matrices. Chondrocyte volume or morphology did not change substantially due to a medial meniscectomy. Current findings suggest that during walking chondrocyte deformations are not substantially altered due to a medial meniscectomy, while abnormal joint loading exposes chondrocytes to elevated levels of fluid pressure and maximum principal strains (compared to strains in the peri- or extracellular matrices). These might contribute to cell viability and the onset of osteoarthritis.

  3. Arthroscopic partial meniscectomy is superior to physical rehabilitation in the management of symptomatic unstable meniscal tears.

    PubMed

    El Ghazaly, Sherif A; Rahman, Amr A Abdul; Yusry, Ahmed H; Fathalla, Mahmoud M

    2015-04-01

    Meniscus injuries are the most commonly reported in athletes. Meniscectomy is the most common treatment. Stable peripheral tears may heal, while degenerative tears do well with physical therapy. However, the exact role of physical therapy in treating symptomatic unstable meniscal tears is not known. We aimed to identify the role of physical therapy in treating such patients and clarify the role of arthroscopic partial meniscectomy in treating unstable meniscal tears. Seventy patients with unstable meniscal tear met the inclusion criteria according to Vande Berg and co-workers. Clinical examination, McMurray test and magnetic resonance imaging were done. Age ranged from 18-67 years (average 39.87). Mild osteoarthritis was seen in 20 cases. Physical therapy thrice a week for eight weeks was offered (faradic quadriceps stimulation and neuromuscular strengthening exercises). After physical therapy, patients still complaining or unsatisfied were offered arthroscopic partial menisectomy (APM). Outcomes were evaluated using the VAS pain score and the Lysholm knee score. Mean VAS before interventions was 7.4, significantly improved to 5.16 after rehabilitation and to 1.9 after APM (p = 0.001). Mean Lysholm score before rehabilitation was 65.1 and improved to 69.6 after rehabilitation, the difference was non-significant. However, Lysholm score difference before and after APM showed a highly significant difference (p = 0.001). Pain and swelling improved after physical therapy. However, patients were not satisfied as limited range of knee motion persisted. APM was superior to physical therapy in treating symptomatic unstable meniscal tears, with high patient satisfaction and restored knee function.

  4. The effects of Rumalon, a glycosaminoglycan peptide complex, in a partial meniscectomy model of osteoarthritis in rabbits.

    PubMed

    Moskowitz, R W; Reese, J H; Young, R G; Fein-Krantz, D; Malemud, C J; Caplan, A I

    1991-02-01

    The effects of Rumalon, a glycosaminoglycan peptide complex (GP-C), were evaluated in a partial meniscectomy model of osteoarthritis (OA). When rabbits were treated with Rumalon, 0.25 ml/kg 3 times/week for 12 weeks after partial meniscectomy, the proportion of animals that developed cartilage ulceration was lower than that in untreated meniscectomized rabbits (p less than 0.05). At 6 weeks sacrifice, the same dose of Rumalon was associated with a trend toward reduction in the number of animals with ulcerations. Rumalon administered at a dose of 0.5 ml/kg for 12 weeks reduced the number of animals with ulcers, although not at the p less than 0.05 level of significance. Semiquantitative histologic evaluations revealed no differences between control and treatment groups either in the thickness of articular cartilage, density of cells present, safranin-O stain or ratio of DNA/protein. Increased proteoglycan synthesis characteristic of OA was modulated toward normal in association with Rumalon therapy. Diminished OA changes in response to Rumalon are consistent with an ameliorative response to this agent in the partial meniscectomy model in the rabbit.

  5. Combined Effect of Bilateral Ovariectomy and Anterior Cruciate Ligament Transection With Medial Meniscectomy on the Development of Osteoarthritis Model

    PubMed Central

    2016-01-01

    Objective To investigate the combined effect of bilateral ovariectomy (OVX) and anterior cruciate ligament transection (ACLT) with medial meniscectomy (MM) on the development of osteoarthritis (OA). Methods Twenty female 15-week-old Sprague-Dawley rats were used. Five rats in each group underwent bilateral OVX (OVX group), bilateral ACLT with MM (ACLT with MM group), bilateral OVX plus ACLT with MM (OVX plus ACLT with MM group), and sham surgery (SHAM group). All the rats were subjected to treadmill running for 4 weeks. The behavioral evaluation for induction of OA used the number of rears method, and this was conducted at 1, 2, and 4 weeks post-surgery. Bone mineral density (BMD) was calculated with micro-computerized tomography images and the modified Mankin's scoring was used for the histological changes. Results The number of rears in the OVX plus ACLT with MM group decreased gradually and more rapidly in the ACLT with MM group. Histologically, the OVX plus ACLT with MM group had a significantly higher modified Mankin's score than the OVX group (p=0.008) and the SHAM group (p=0.008). BMDs of the OVX plus ACLT with MM group were significantly lower than the SHAM group (p=0.002), and the ACLT with MM group (p=0.003). Conclusion We found that bilateral OVX plus ACLT with MM induced definite OA change in terms of histology and BMD compared to bilateral OVX and ACLT with MM alone. Therefore, OVX and ACLT with MM was an appropriate degenerative OA rat model. PMID:27606264

  6. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

    PubMed Central

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje; Ranstam, Jonas; Engebretsen, Lars; Roos, Ewa M

    2016-01-01

    Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7–59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised

  7. Quantitative Magnetic Resonance Imaging Detects Changes in Meniscal Volume in Vivo After Partial Meniscectomy

    PubMed Central

    Bowers, Megan E.; Tung, Glenn A.; Oksendahl, Heidi L.; Hulstyn, Michael J.; Fadale, Paul D.; Machan, Jason T.; Fleming, Braden C.

    2010-01-01

    Background Quantifying changes in meniscal volume in vivo before and after partial meniscectomy (PM) could help elucidate the mechanisms involved in osteoarthritis development after meniscal injury and its surgical treatment. Purpose/Hypothesis To determine whether quantitative MRI (qMRI) could detect the immediate reduction in meniscal volume created by PM, while ruling out changes in unresected structures. We hypothesized that qMRI would be reliable for determining meniscal volume within the repeated images of unresected menisci. Additionally, we expected no significant difference in volume between the uninjured menisci of the injured knees and the same menisci of the uninjured knees. Study Design Controlled laboratory study. Methods Ten subjects with meniscal tears were evaluated with 3T MRI before and after arthroscopic PM. Manual segmentation was used to create models of the menisci and to determine the pre- and post-operative meniscal volumes for each subject. The responsiveness and reliability of qMRI for determining meniscal volume in vivo were evaluated using these measurements. We expected a decrease in volume of the resected menisci, but not in the uninjured menisci, after surgery. Results The mean pre-operative volume of the injured menisci was significantly greater than the mean post-operative volume (2896±277mm3 vs. 2480±277mm3; p=0.000). There was no significant difference between the mean pre- and post-operative volumes of the uninjured menisci (2687±256mm3 vs. 2694±256mm3; p=1.000). Conclusions Manual segmentation demonstrated a significant reduction in the volume of the surgically resected menisci after PM, but no significant change in the volume of unresected meniscal tissue, indicating that the manual segmentation method is responsive. Clinical Relevance This approach offers a novel, reliable method to study the relationship between the volume of meniscal tissue removed during PM and subsequent patient outcomes during long-term clinical

  8. Quantitative magnetic resonance imaging detects changes in meniscal volume in vivo after partial meniscectomy.

    PubMed

    Bowers, Megan E; Tung, Glenn A; Oksendahl, Heidi L; Hulstyn, Michael J; Fadale, Paul D; Machan, Jason T; Fleming, Braden C

    2010-08-01

    Quantifying changes in meniscal volume in vivo before and after partial meniscectomy (PM) could help elucidate the mechanisms involved in osteoarthritis development after meniscal injury and its surgical treatment. Purpose/ To determine whether quantitative magnetic resonance imaging (qMRI) can detect the immediate reduction in meniscal volume created by PM, while ruling out changes in unresected structures. We hypothesized that qMRI would be reliable for determining meniscal volume within the repeated images of unresected menisci. Additionally, we expected no significant difference in volume between the uninjured menisci of the injured knees and the same menisci of the uninjured knees. Cohort study (Diagnosis); Level of evidence, 2. Ten subjects with meniscal tears were evaluated with 3-T MRI before and after arthroscopic PM. Manual segmentation was used to create models of the menisci and to determine the preoperative and postoperative meniscal volumes for each subject. The responsiveness and reliability of qMRI for determining meniscal volume in vivo were evaluated using these measurements. We expected a decrease in volume of the resected menisci, but not in the uninjured menisci, after surgery. The mean preoperative volume of the injured menisci was significantly greater than the mean postoperative volume (2896 +/- 277 vs 2480 +/- 277 mm(3); P = .000). There was no significant difference between the mean preoperative and postoperative volumes of the uninjured menisci (2687 +/- 256 vs 2694 +/- 256 mm(3); P = 1.000). Manual segmentation demonstrated a significant reduction in the volume of the surgically resected menisci after PM, but no significant change in the volume of unresected meniscal tissue, indicating that the manual segmentation method is responsive. This approach offers a novel, reliable method to study the relationship between the volume of meniscal tissue removed during PM and subsequent patient outcomes during long-term clinical studies.

  9. Intraarticular tramadol plus pericapsular incisional bupivacaine provides better analgesia than intraarticular plus pericapsular incisional bupivacaine after outpatient arthroscopic partial meniscectomy.

    PubMed

    Beyzadeoglu, Tahsin; Yilmaz, Cemil; Bekler, Halil; Gokce, Alper; Sayin, Murat M

    2007-05-01

    Postoperative analgesic effects of intraarticular tramadol plus periarticular bupivacaine, and intraarticular plus periarticular bupivacaine injections after day-case arthroscopic partial meniscectomy were compared. Seventy-four ASA I/II patients undergoing arthroscopic partial meniscectomy, performed by a single surgeon under general anesthesia were assigned in a randomized, double-blinded manner into two groups: Group TB (n = 41) received intraarticular 100 mg of tramadol in 20 ml normal saline and periarticular incisional injection of 10 ml bupivacaine 0.5%. Group BB (n = 33) received intraarticular 20 ml 0.25% and periarticular incisional 10 ml 0.5% bupivacaine injections. The injections were performed immediately after the portal closures. Pain was assessed with visual analog scale (VAS) at 0, 15, 30 min and at 1, 2, 4 h at rest and active 90 degrees knee flexion by a blinded observer. The first additional analgesic requirement time was recorded. The patients were discharged the same day with a prescription for paracetamol as required, up to six tablets a day and questioned for analgesic use and pain score at 24 h. VAS scores at rest at 15, 30 min and at movement at 0, 15, 30 min were lower in group TB (P < 0.05). First time requiring additional analgesia was lower in group TB (17.1 +/- 21.9, 33.8 +/- 26.6) (P < 0.05) and total paracetamol dose at the end of 24 h was 1.2 +/- 1.5 g in group BB and 0.9 +/- 1.3 g in group TB (P < 0.05). Intraarticular tramadol plus periarticular bupivacaine combination provides better pain relief and less analgesic requirement following arthroscopic outpatient partial meniscectomy surgery.

  10. Editorial Commentary: Book? … Book Report? … or Just a New Chapter in an Ongoing Story?: Knee Partial Meniscectomy Has Limited Benefit for "Nonobstructive" Meniscal Tears, but We Need to Know if Patients Have Osteoarthritis.

    PubMed

    Whelan, Daniel B

    2016-09-01

    Knee partial meniscectomy has limited benefit for "nonobstructive" meniscal tears, but we need to know if included patients have osteoarthritis. Research on outcomes of arthroscopic partial meniscectomy versus nonsurgical treatment must consider not only signs and symptoms but also imaging findings, to determine the indications for surgical versus nonsurgical in a selected patient. Copyright © 2016. Published by Elsevier Inc.

  11. Intra-articular injection of hyaluronic acid following arthroscopic partial meniscectomy of the knee.

    PubMed

    Thein, Rafael; Haviv, Barak; Kidron, Amos; Bronak, Shlomo

    2010-10-11

    The short-term recovery period post-arthroscopic meniscectomy is characterized by pain and impaired function most likely related to the irrigation of synovial fluid from the knee intraoperatively. Consequently, along with removal of harmful debris, the irrigation fluid dilutes the hyaluronic acid layer covering the joint tissues. Hyaluronic acid contributes to the homeostasis of the joint environment and is an important component of synovial fluid and cartilage matrix. Hence, the instillation of hyaluronic acid after the procedure may relieve symptoms. This prospective, single-blind, randomized, controlled study evaluated clinical outcome after hyaluronic acid injection to patients who underwent arthroscopic meniscectomy of the knee. Patients with ligamentous injuries or severe chondral damage were excluded. Fifty-six patients with a mean age of 34 years (range, 17-44 years) were injected with Viscoseal (TRB Chemedica International S.A., Geneva, Switzerland) or normal saline immediately post-arthroscopy and divided into the Viscoseal group or control group, respectively. Patients were evaluated for pain, swelling, and function at 1, 4, and 12 weeks postoperatively. Patients in the control group reported more pain at week 1, with a mean visual analog score (VAS) of 43, than did patients in the Viscoseal group, with a mean VAS of 28 (P=.006). At 4 weeks postoperatively, none of the Viscoseal patients had consumed analgesics, where 9 (of 28) in the control group reported acetaminophen intake (P=.039). No significant difference in knee function was found between groups. Intra-articular injection of Viscoseal after arthroscopic meniscectomy reduced pain in the short-term recovery period. Copyright 2010, SLACK Incorporated.

  12. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

    PubMed Central

    Risberg, May Arna; Stensrud, Silje; Ranstam, Jonas; Engebretsen, Lars; Roos, Ewa M

    2016-01-01

    Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial’s inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider

  13. The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: systematic review with meta-analysis.

    PubMed

    Dias, Josilainne Marcelino; Mazuquin, Bruno Fles; Mostagi, Fernanda Queiroz Ribeiro Cerci; Lima, Tarcísio Brandão; Silva, Mônica Angélica Cardoso; Resende, Bruna Nogueira; Borges da Silva, Rodrigo Matsuoka; Lavado, Edson Lopes; Cardoso, Jefferson Rosa

    2013-08-01

    Systematic review with meta-analysis. To evaluate the effectiveness of postoperative physical therapy treatment for patients who have undergone arthroscopic partial meniscectomy. There is no consensus on which treatment is best for patients post meniscectomy. A search for articles published from 1950 to March 2013 was conducted in the MEDLINE, Embase, CINAHL, LILACS, SciELO, IBECS, Scopus, Web of Science, PEDro, Academic Search Premier, and Cochrane Central Register of Controlled Trials databases. The key words were physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis. Eighteen randomized controlled trials were included in the review, 6 of which were included in the meta-analysis. Outpatient physical therapy plus a home exercise program, compared to a home program alone, improved function compared to a home program alone (mean difference, 10.3; 95% confidence interval: 1.3, 19.3; P = .02) and knee flexion range of motion (mean difference, 9.1; 95% confidence interval: 3.7, 14.5; P = .0009). Inpatient physical therapy alone compared to inpatient plus outpatient physical therapy reduced the likelihood of effusion (odds ratio = 0.25; 95% confidence interval: 0.10, 0.61; P = .003). Physical therapy associated with home exercises seems to be effective in improving patient-reported knee function and range of motion in patients post-arthroscopic meniscectomy, although the included randomized controlled trials were classified from moderate to high risk of bias and should be interpreted with caution. Therapy, level 1a-.

  14. The Effect of Body Mass Index on Clinical Outcomes in Patients Without Radiographic Evidence of Degenerative Joint Disease After Arthroscopic Partial Meniscectomy.

    PubMed

    Kluczynski, Melissa A; Marzo, John M; Wind, William M; Fineberg, Marc S; Bernas, Geoffrey A; Rauh, Michael A; Zhou, Zehua; Zhao, Jiwei; Bisson, Leslie J

    2017-09-29

    To examine the effect of obesity on clinical outcomes at 1 year after arthroscopic partial meniscectomy. We conducted a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial (N = 256). The visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and presence of effusion were assessed preoperatively and at 1 year after arthroscopic partial meniscectomy. Body mass index was categorized as normal weight, 24.99 or less; overweight, 25 to 29.99; or obese, 30 or greater. Analysis of variance or the Cochran-Mantel-Haenszel test was used to examine differences in clinical outcomes between body mass index categories, and mean ± standard deviation or number (percentage) is reported. Preoperatively, obese patients had worse WOMAC pain (56.2 ± 17.2 vs 61.3 ± 17.2, P = .02), WOMAC physical function (55.8 ± 17.1 vs 62.8 ± 17.1, P = .004), pain visual analog scale (4.9 ± 2.1 vs 4.2 ± 1.9, P = .01), KOOS pain (49.5 ± 14.9 vs 54.0 ± 15.1, P = .02), and KOOS quality-of-life (27.9 ± 18.3 vs 36.9 ± 17.0, P = .001) scores, as well as decreased flexion (121.8° ± 22.6° vs 132.3° ± 16.5°, P = .003), compared with normal-weight patients. Overweight patients (n = 51 [51.5%], P = .03) and obese patients (n = 56 [52.8%], P = .002) were more likely to have knee effusion before surgery than normal-weight patients (n = 17 [34%]). At 1 year after surgery, overweight (130.2° ± 7.7°, P = .03) and obese (128.1° ± 7.1°, P = .003) patients had decreased flexion compared with normal-weight patients (134.5° ± 8.3°). Obese patients had worse pain, physical functioning, and quality-of-life scores, as well as decreased flexion, compared with normal-weight patients before arthroscopic partial meniscectomy. At 1 year after arthroscopic partial meniscectomy, there were no statistically significant

  15. A New Surgical Technique of Arthroscopic Partial Meniscectomy for Unstable Inferior Leaf of the Anterior Horn in a Horizontal Tear of Lateral Meniscus

    PubMed Central

    Na, Suk In; Woo, Min Su; Lee, Jong Min

    2013-01-01

    We introduce a new arthroscopic partial meniscectomy technique using a three portals and a small skin hook retractor to remove unstable inferior leaf in horizontal meniscal tear that involved the anterior portion of the lateral meniscus. The patient is positioned for a standard knee arthroscopy. After careful estimation of the depth and extent of the cleft and stability of the superior and inferior leaves is done through the standard anteromedial portal, a small skin hook retractor is inserted through the standard anterolateral portal to raise the dominant superior leaf of anterior horn, then the unstable inferior leaf is excised with a 90° rotary punch and a motorized shaver through the extreme far anteromedial portal. This technique is useful method to remove unstable inferior leaf of anterior horn of lateral meniscus which is difficult to remove with a standard technique. PMID:24032104

  16. A new surgical technique of arthroscopic partial meniscectomy for unstable inferior leaf of the anterior horn in a horizontal tear of lateral meniscus.

    PubMed

    Na, Suk In; Woo, Min Su; Lee, Jong Min; Kim, Myung Ku

    2013-09-01

    We introduce a new arthroscopic partial meniscectomy technique using a three portals and a small skin hook retractor to remove unstable inferior leaf in horizontal meniscal tear that involved the anterior portion of the lateral meniscus. The patient is positioned for a standard knee arthroscopy. After careful estimation of the depth and extent of the cleft and stability of the superior and inferior leaves is done through the standard anteromedial portal, a small skin hook retractor is inserted through the standard anterolateral portal to raise the dominant superior leaf of anterior horn, then the unstable inferior leaf is excised with a 90° rotary punch and a motorized shaver through the extreme far anteromedial portal. This technique is useful method to remove unstable inferior leaf of anterior horn of lateral meniscus which is difficult to remove with a standard technique.

  17. [Results of polyurethane implant for persistent knee pain after partial meniscectomy with a minimum of two years follow-up].

    PubMed

    Martín-Hernández, C; Ranera-García, M; Díaz-Martínez, J V; Muniesa-Herrero, M P; Floría-Arnal, L J; Osca-Guadalajara, M; García-Aguilera, D

    2015-01-01

    To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy. Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al. Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p=.001), one year (83.3 points) (p<.001) and final follow-up (84.4 points) (p<.001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p=.001), one year (81.39 points) (p<.001) and final follow-up (83.34 points) (p<.001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p<.001), 1.9 points at one year (p<.001), and 1.9 points at final follow-up (p<.001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus. A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus. The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  18. Percutaneous Partial Medial Collateral Ligament Release (PPMCLR) Does Not Result in Residual Medial Collateral Laxity (MCL)

    PubMed Central

    Hinton, M. Alan

    2015-01-01

    Objectives: The intra-articular posterior medial knee can be difficult to approach during arthroscopy. This is especially true for medial meniscal tears, medial meniscal repairs or medial meniscal transplantation. Various methods and instruments have been proposed to help with this approach. PPMCLR is one of these methods. This study found that this is a safe technique and does not result in measurable laxity of the MCL. Methods: 50 consecutive patients took part in the study. The patients were then randomized into a control or partial percutaneous release group (25 in each group). Prior to arthroscopy each patient had standardized 30 degree valgus stress radiograph performed. The MCL was stressed with the Telos Stress Device GA/III at 30 degrees of flexion; utilizing 150 Newton's of stress. The stress radiographs were measured independently for the maximal separation at the medial compartment. At six weeks the stress radiographs were repeated and the results again recorded. The postoperative care for each group was the same. Results: The results were then statistically evaluated using the, finding no radiographic evidence of residual laxity P<.005. There was also no difference in the control and PPMCLR group p<.0005. No patient complained of residual laxity. Patient follow up will be discussed. Conclusion: PPMCLR is an effective and safe method to reach the intra-articular posterior aspect of the knee during arthroscopy. PPMCLR does not result in measurable laxity of the MCL.

  19. Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel ‘RCT within-a-cohort’ study design

    PubMed Central

    Sihvonen, Raine; Paavola, Mika; Malmivaara, Antti; Järvinen, Teppo L N

    2013-01-01

    Introduction Arthroscopic partial meniscectomy (APM) to treat degenerative meniscus injury is the most common orthopaedic procedure. However, valid evidence of the efficacy of APM is lacking. Controlling for the placebo effect of any medical intervention is important, but seems particularly pertinent for the assessment of APM, as the symptoms commonly attributed to a degenerative meniscal injury (medial joint line symptoms and perceived disability) are subjective and display considerable fluctuation, and accordingly difficult to gauge objectively. Methods and analysis A multicentre, parallel randomised, placebo surgery controlled trial is being carried out to assess the efficacy of APM for patients from 35 to 65 years of age with a degenerative meniscus injury. Patients with degenerative medial meniscus tear and medial joint line symptoms, without clinical or radiographic osteoarthritis of the index knee, were enrolled and then randomly assigned (1 : 1) to either APM or diagnostic arthroscopy (placebo surgery). Patients are followed up for 12 months. According to the prior power calculation, 140 patients were randomised. The two randomised patient groups will be compared at 12 months with intention-to-treat analysis. To safeguard against bias, patients, healthcare providers, data collectors, data analysts, outcome adjudicators and the researchers interpreting the findings will be blind to the patients’ interventions (APM/placebo). Primary outcomes are Lysholm knee score (a generic knee instrument), knee pain (using a numerical rating scale), and WOMET score (a disease-specific, health-related quality of life index). The secondary outcome is 15D (a generic quality of life instrument). Further, in one of the five centres recruiting patients for the randomised controlled trial (RCT), all patients scheduled for knee arthroscopy due to a degenerative meniscus injury are prospectively followed up using the same protocol as in the RCT to provide an external

  20. Changes in Joint Contact Mechanics in a Large Quadrupedal Animal Model After Partial Meniscectomy and a Focal Cartilage Injury.

    PubMed

    Heckelsmiller, David J; James Rudert, M; Baer, Thomas E; Pedersen, Douglas R; Fredericks, Douglas C; Goetz, Jessica E

    2017-05-01

    Acute mechanical damage and the resulting joint contact abnormalities are central to the initiation and progression of post-traumatic osteoarthritis (PTOA). Study of PTOA is typically performed in vivo with replicate animals using artificially induced injury features. The goal of this work was to measure changes in a joint contact stress in the knee of a large quadruped after creation of a clinically realistic overload injury and a focal cartilage defect. Whole-joint overload was achieved by excising a 5-mm wedge of the anterior medial meniscus. Focal cartilage defects were created using a custom pneumatic impact gun specifically developed and mechanically characterized for this work. To evaluate the effect of these injuries on joint contact mechanics, Tekscan (Tekscan, Inc., South Boston, MA) measurements were obtained pre-operatively, postmeniscectomy, and postimpact (1.2-J) in a nonrandomized group of axially loaded cadaveric sheep knees. Postmeniscectomy, peak contact stress in the medial compartment is increased by 71% (p = 0.03) and contact area is decreased by 35% (p = 0.001); the center of pressure (CoP) shifted toward the cruciate ligaments in both the medial (p = 0.004) and lateral (p = 0.03) compartments. The creation of a cartilage defect did not significantly change any aspect of contact mechanics measured in the meniscectomized knee. This work characterizes the mechanical environment present in a quadrupedal animal knee joint after two methods to reproducibly induce joint injury features that lead to PTOA.

  1. Medial and Lateral Discoid Menisci of Both Knees

    PubMed Central

    Kan, Hiroyuki; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Minami, Ginjiro; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared. PMID:27894182

  2. Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial.

    PubMed

    Bisson, Leslie J; Kluczynski, Melissa A; Wind, William M; Fineberg, Marc S; Bernas, Geoffrey A; Rauh, Michael A; Marzo, John M; Zhou, Zehua; Zhao, Jiwei

    2017-07-05

    It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM. Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported. There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02). Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ. Therapeutic Level I. See Instructions

  3. Editorial Commentary: Chondrocytes Trump Ligaments! Partial Release of the Medial Collateral Ligament During Knee Arthroscopy Protects Chondrocytes.

    PubMed

    Leland, J Martin

    2016-10-01

    With knee arthroscopy being the most common orthopaedic procedure performed in the United States, it is crucial to be able to access the entire knee without iatrogenic injury. Frequently orthopaedic surgeons encounter tight medial compartments, creating difficulty in accessing the posterior horn of the medial meniscus without damaging the articular cartilage. Partial release of the medial collateral ligament during knee arthroscopy protects chondrocytes.

  4. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial.

    PubMed

    Herrlin, Sylvia; Hållander, Maria; Wange, Peter; Weidenhielm, Lars; Werner, Suzanne

    2007-04-01

    In this prospective randomised study two treatments after non-traumatic medial meniscal tear diagnosed with radiological examination and magnetic resonance imaging were compared; arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone. The aim was to evaluate knee function and physical activity. Ninety patients (mean age 56 years) were evaluated using the Knee Injury and Osteoarthritis Outcome Score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and a Visual Analogue Scale for knee pain prior to the intervention, after 8 weeks of exercise and after 6 months. According to the outcome scores arthroscopic partial medial meniscectomy combined with exercise did not lead to greater improvement than exercise alone. After the intervention both groups reported decreased knee pain, improved knee function and a high satisfaction (P<0.0001). Forty-one per cent of the patients returned to their pre-injury activity level after 6 months. In conclusion, when evaluated with outcome scores, arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function and improved quality of life.

  5. Patellofemoral osteoarthritis coexistent with tibiofemoral osteoarthritis in a meniscectomy population

    PubMed Central

    Englund, M; Lohmander, L

    2005-01-01

    Objectives: To evaluate the frequency of patellofemoral osteoarthritis and its relevance to symptoms and function in a meniscectomy population. Methods: 317 patients with no cruciate ligament injury were evaluated (mean (SD) age, 54 (11) years). They had undergone meniscal resection 15 to 22 years earlier (follow up rate 70%). Standing tibiofemoral and skyline patellofemoral radiographs were graded according to the OARSI atlas. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to quantify symptoms and function. Controls were 68 unoperated subjects identified from national population records. Results: Patellofemoral osteoarthritis (isolated or coexisting with tibiofemoral osteoarthritis) was present in 66 of 317 index knees (21%) and 21 of 263 unoperated contralateral knees (8%, p<0.001). In 57/66 (86%) of these index knees, tibiofemoral osteoarthritis was present (mixed osteoarthritis). In a model adjusted for age, sex, and body mass index, the odds ratio for patellofemoral osteoarthritis (alone or in combination with tibiofemoral osteoarthritis) was 2.6 (95% confidence interval, 1.1 to 6.6) after medial meniscectomy and 5.3 (1.9 to 15.0) after lateral meniscectomy, using controls as the reference. Individuals with a mixed knee osteoarthritis pattern had more symptoms, lower function in sports and recreation, and worse knee related quality of life than subjects with isolated tibiofemoral osteoarthritis. Conclusions: Mixed patellofemoral and tibiofemoral osteoarthritis is common in a meniscectomy population. Patellofemoral osteoarthritis is a contributing cause of knee symptoms and reduced knee related quality of life and is relevant to the management of knee complaints of this group of patients. PMID:15843446

  6. Medial Rectus Bridge Faden Operations in Accommodative and Partially Accommodative Esotropia With Convergence Excess.

    PubMed

    Inal, Asli; Ocak, Osman Bulut; Aygit, Ebru Demet; Celik, Selcen; Ozturk Karabulut, Gamze; Inal, Berkay; Taskapili, Muhittin; Gokyigit, Birsen

    2017-10-09

    To evaluate the results of the bilateral bridge Faden operation on the medial rectus muscles with and without recession in the treatment of accommodative and partially accommodative esotropia with convergence excess. A retrospective analysis was performed on the medical records of 103 patients who underwent the bridge Faden operation on both medial rectus muscles, with or without recession, for the treatment of accommodative and partially accommodative esotropia with convergence excess. Preoperative and postoperative near and distance deviations and near-distance disparities were evaluated. The study population consisted of 38 (37%) girls and 65 (63%) boys. The mean age was 9.32 ± 5.83 years (range: 1 to 18 years) and the mean follow-up period was 14.49 ± 2.78 months. Fifty-one patients underwent the bridge Faden operation on both medial rectus muscles with recession (recession group) and 52 patients underwent the bridge Faden operation on both medial rectus muscles without recession (no recession group). The mean preoperative amount of esotropia at near was 43.51 ± 7.00 and 24.24 ± 3.56 prism diopters (PD) for the recession and no recession groups, respectively. The mean preoperative amount of esotropia at distance was 26.63 ± 6.86 and 9.22 ± 2.09 PD for both groups, respectively. The mean preoperative near-distance disparity was 17.14 ± 3.00 and 14.05 ± 4.14 PD for both groups, respectively. In both groups, there was a statistically significant difference in the near and distance deviations and the near-distance disparity between preoperative and postoperative values (P < .05). Postoperatively, there was no significant difference between 1 month, 6 months, and 1 year and between 6 months and 1 year (P > .05). The bridge Faden operation on both medial rectus muscles either with or without recession was a successful surgical procedure in patients with accommodative and partially accommodative esotropia. During the follow-up period, the success rates did not

  7. A modified surgical procedure for cubital tunnel syndrome: partial medial epicondylectomy.

    PubMed

    Kaempffe, F A; Farbach, J

    1998-05-01

    Cubital tunnel release with partial medial epicondylectomy was performed in 32 patients with cubital tunnel syndrome unresponsive to conservative management. Twenty-seven patients were available for examination an average follow-up of 13 months. Ninety-three percent were subjectively improved, with results being excellent in 8, good in 10, fair in 8, and poor in 1. Regression analyses showed a statistically significant correlation between outcome and slow ulnar nerve conduction velocity across the elbow, abnormal preoperative 2-point discrimination, abnormal preoperative terminal sensory latency of the ulnar nerve, and abnormal preoperative electromyographic studies. The results suggest that the procedure is an acceptable alternative for treatment of cubital tunnel syndrome.

  8. Evaluation of electrosurgical meniscectomy in rabbits.

    PubMed

    Schosheim, P M; Caspari, R B

    1986-01-01

    Recently, electrosurgical cutting instruments utilizing radiofrequency energy have been designed as arthroscopic devices for cutting meniscal tissue. This study attempted to determine the in vivo gross and microscopic effects of radiofrequency energy on meniscal tissue in rabbits. Twelve adult New Zealand white rabbits (48 menisci) underwent bilateral knee arthrotomies. Ten rabbits (40 menisci) underwent partial meniscectomies in which one half of each meniscus in the longitudinal plane was removed with the electrosurgical generator. Two control rabbits underwent arthrotomy without resection of meniscal tissue. At specific time intervals, the rabbits were killed, and the menisci were removed. The gross specimens were photographed, and microscopic sections of each meniscus were fixed and stained. Specimens were evaluated to determine the cellular and vascular response to the electrosurgical cut edge of each meniscus. The microscopic specimens revealed that the radiofrequency cutting instruments produced a small degree of direct thermal damage to the cut meniscus. A tissue response producing a hypercellular dense collagen matrix was present for approximately 3 months. The spontaneous repair of tissue was complete by 6 months, and the histologic 6-month specimens could not be distinguished from the 6-month control specimens except with respect to the overall width of the specimens.

  9. A randomized trial of isokinetic versus isotonic rehabilitation program after arthroscopic meniscectomy.

    PubMed

    Koutras, Georgios; Letsi, Magdalini; Papadopoulos, Pericles; Gigis, Ioannis; Pappas, Evangelos

    2012-02-01

    Although both isotonic and isokinetic exercises are commonly used in the rehabilitation of patients after arthroscopic meniscectomy no studies have compared their effect on strength recovery and functional outcomes. The purpose of this study was to investigate the effects of two rehabilitation programs (isotonic and isokinetic) on muscle strength and functional performance after partial knee meniscectomy. A secondary purpose was to assess the correlation between isokinetic strength deficits and hop test performance deficits. Twenty male patients who underwent arthroscopic partial meniscectomy volunteered for the study. Both isotonic and isokinetic training were performed with the same equipment thereby blinding subjects to the mode of exercise. Main outcome measures were collected on the 14th and 33rd postoperative days and included isokinetic strength of the knee extensors and flexors, functional performance (single, triple, and vertical hopping) and the Lysholm questionnaire. Multivariate and univariate analyses of variance were used to assess the effects of the independent variables on the isokinetic variables, functional tests, and Lysholm score. Pearson's correlation was used to assess the relationship between isokinetic strength deficits and functional performance deficits. Isokinetic measures, functional tests, and the Lysholm score all increased between initial and final assessment (p≤0.003). However, there were no group or group*time effects on any of the outcome variables (p≥0.33). Functional tests were better predictors of isokinetic deficits in the 14(th) compared to the 33(rd) postoperative day. No differences were found in the outcomes of patients treated using an isokinetic and an isotonic protocol for rehabilitation after arthroscopic meniscectomy. More than half of patients did not meet the 90% criterion in the hop tests for safe return to sports five weeks after meniscectomy. There were correlations between the hop tests and isokinetic

  10. A RANDOMIZED TRIAL OF ISOKINETIC VERSUS ISOTONIC REHABILITATION PROGRAM AFTER ARTHROSCOPIC MENISCECTOMY

    PubMed Central

    Koutras, Georgios; Letsi, Magdalini; Papadopoulos, Pericles; Gigis, Ioannis

    2012-01-01

    Background: Although both isotonic and isokinetic exercises are commonly used in the rehabilitation of patients after arthroscopic meniscectomy no studies have compared their effect on strength recovery and functional outcomes. Purpose: The purpose of this study was to investigate the effects of two rehabilitation programs (isotonic and isokinetic) on muscle strength and functional performance after partial knee meniscectomy. A secondary purpose was to assess the correlation between isokinetic strength deficits and hop test performance deficits. Methods: Twenty male patients who underwent arthroscopic partial meniscectomy volunteered for the study. Both isotonic and isokinetic training were performed with the same equipment thereby blinding subjects to the mode of exercise. Main outcome measures were collected on the 14th and 33rd postoperative days and included isokinetic strength of the knee extensors and flexors, functional performance (single, triple, and vertical hopping) and the Lysholm questionnaire. Multivariate and univariate analyses of variance were used to assess the effects of the independent variables on the isokinetic variables, functional tests, and Lysholm score. Pearson's correlation was used to assess the relationship between isokinetic strength deficits and functional performance deficits. Results: Isokinetic measures, functional tests, and the Lysholm score all increased between initial and final assessment (p≤0.003). However, there were no group or group*time effects on any of the outcome variables (p≥0.33). Functional tests were better predictors of isokinetic deficits in the 14th compared to the 33rd postoperative day. Conclusion: No differences were found in the outcomes of patients treated using an isokinetic and an isotonic protocol for rehabilitation after arthroscopic meniscectomy. More than half of patients did not meet the 90% criterion in the hop tests for safe return to sports five weeks after meniscectomy. There were

  11. Partial Amelioration of Medial Visceromotor Network Dysfunction in Major Depression by Sertraline.

    PubMed

    Schafer, Scott M; Wager, Tor D; Mercado, Ramon A; Thayer, Julian F; Allen, John J B; Lane, Richard D

    2015-09-01

    Major depression is associated with reduced cardiac vagal control, most commonly indexed by heart rate variability. To examine the dynamics of this abnormality, we examined within-participant covariation over time between brain activity, cardiac vagal control, and depressive symptoms in depressed patients treated with sertraline and in healthy volunteers. Patients with depression and nondepressed control participants were enrolled in a 12-week protocol. After Week 0 assessment, patients began treatment with sertraline. Neural activity and vagal control were measured for all participants at Weeks 0, 2, 6, and 12 using functional magnetic resonance imaging and synchronized electrocardiographic recordings. At each of the four assessments, a moving window analysis was used to estimate vagal control as assessed by respiratory sinus arrhythmia (RSA) from the electrocardiographic data, which was then regressed onto functional magnetic resonance imaging activity. At baseline, patients showed reduced blood oxygen level-dependent RSA covariation compared with controls within multiple a priori brain regions associated with vagal control, collectively described as the medial visceromotor network (MVN). Sertraline treatment led to a significant increase in brain-RSA covariation for patients compared with controls, despite a lack of improvement in mean RSA. These data suggest a partial normalization of MVN dysfunction in depression during sertraline treatment. Specifically, results indicate a partial recovery of MVN function. However, this recovery was insufficient to cause a significant change in RSA levels. These results may help to explain both improvements with and limitations of sertraline treatment of depression.

  12. The Oxford Medial Partial Knee Replacement. The rationale for a femur first technique.

    PubMed

    Shakespeare, David; Waite, Jon

    2012-12-01

    The Oxford Medial Partial Knee Replacement (PKR) has been in clinical use for more than 20 years. The current surgical technique requires a number of judgements to be made, and even in the most experienced hands surgery can be challenging. We present an alternative surgical technique, which we believe addresses the unpredictability of the current method. The technique is based on precise femoral positioning prior to tibial resection. A prospective series of 125 Oxford Medial PKRs was performed using this new technique and a radiographical analysis was performed. We used meniscal thickness, meniscal position and femoral position as measures of reproducibility of the procedure. Variability in meniscal thickness has been minimised with a 3mm meniscal bearing used in 21 knees (15%), 4mm (the target thickness) in 73 knees (59%) and 5mm in 30 knees (24%). The mean meniscal position relative to the tibial tray upright was 2mm (SD 1mm). Femoral component position relative to the tibial tray, which defines the excursion of the meniscus was also assessed. Mean coronal plane alignment was 2° of valgus (SD 2.8). Mean flexion/extension was 3.8° (SD 3.1). The mean rotation was 10° internal (SD 5°). We believe this new technique makes this procedure more reproducible, and should be considered as a viable alternative to the current recommended technique. It may be a better technique for those surgeons who are relatively inexperienced with this prosthesis. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Endoscopic Resection of Medial Extra-articular Cysts of the Knee.

    PubMed

    Lui, Tun Hing

    2017-04-01

    Although most of the parameniscal cysts are very small and asymptomatic, some of them can present with a painful mass or snapping knee. Because parameniscal cysts are almost always associated with horizontal meniscal tears, arthroscopic partial meniscectomy of the involved part of meniscus and intra-articular cyst drainage has become the most accepted procedure. However, arthroscopic cyst decompression through partial meniscectomy to the meniscocapsular junction to expose the communication between the cyst and the knee joint may sacrifice some of the healthy parts of the meniscus especially when meniscal tear is peripheral. Moreover, internal drainage may not be an adequate treatment for a cyst larger than 5 cm in size or a multiloculated cyst. The excision of the cyst is a more appropriate treatment option in these situations. The purpose of this Technical Note is to describe the details of endoscopic resection of medial extra-articular cysts of the knee. This technique is indicated in symptomatic medial extra-articular cysts of the knee with peripheral or no tear of the medial meniscus, especially if the cysts are large and multiloculated.

  14. Protease inhibitors decrease rabbit cartilage degradation after meniscectomy

    SciTech Connect

    Caputo, C.B.; Sygowski, L.A.; Patton, S.P.; Wolanin, D.J.; Shaw, A.; Roberts, R.A.; DiPasquale, G.

    1988-01-01

    In vitro proteoglycan (PG) synthesis and release were measured on cartilage removed from rabbit knees within 1 week of meniscectomy. Three days following partial lateral meniscectomy, 72% of the femurs and 82% of the tibias had visible ulcers. Cartilage from the weight-bearing areas incorporated 2.0-2.9 times more /sup 35/S-sulfate in vitro than cartilage from the opposite, unoperated knees. /sup 3/H-thymidine incorporation was 2.5-3.4 times higher for surgical than control groups. /sup 35/S-sulfate incorporation by the surgical group was inhibited by 22% in the presence of 10(-4) M U24522, an inhibitor of rabbit chondrocyte metalloprotease (CMP). /sup 3/H-thymidine incorporation by the surgical group was inhibited by 28% by 10(-4) M U24522. In vitro PG release from cartilage removed 2 days after surgery was 1.6-3.7 times higher for the surgical than the control group. PG release by the surgical group after 22 h of incubation was reduced to the control level by three CMP inhibitors, U24278, U24279, and U24522. PG release by cartilage from the nonsurgical group was also reduced by these compounds at 22 h. These results suggest that both the anabolic and catabolic processes that are stimulated by surgery can be isolated in vitro and that CMP may be involved in the catabolic process.

  15. New England journal of medicine article evaluating the usefulness of meniscectomy is flawed.

    PubMed

    Elattrache, Neal; Lattermann, Christian; Hannon, Michael; Cole, Brian

    2014-05-01

    A controversial article was recently published in the New England Journal of Medicine titled "Arthroscopic Partial Meniscectomy Versus Sham Surgery for a Degenerative Meniscal Tear" by Sihvonen et al. We believe that readers of this article should be careful about making sweeping generalizations regarding the study findings given several methodologic flaws inherent in the population studied. There are significant concerns regarding the generalizability of these data. The actual study sample group is exceedingly small as compared with the normal volume of meniscal surgery the authors are reported to routinely perform. The authors' definition of a sham procedure must be revisited. The authors' final conclusion that "arthroscopic partial meniscectomy is of no value" is simply not what the study found. We share the concerns that several other leading authorities have recently expressed about the societal implications of this work. Arthroscopic partial meniscectomy has revolutionized the way we are able to treat symptomatic meniscal pathology. However, this procedure, like all surgical procedures, must be properly indicated to truly benefit our patients. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction

    PubMed Central

    Barnea, Yoav; Inbal, Amir; Barsuk, Daphna; Menes, Tehila; Zaretski, Arik; Leshem, David; Weiss, Jerry; Schneebaum, Schlomo; Gur, Eyal

    2014-01-01

    Background Oncoplastic breast reduction in women with medium to large breasts has reportedly benefitted them both oncologically and cosmetically. We present our experience with an oncoplastic breast reduction technique using a vertical scar superior-medial pedicle pattern for immediate partial breast reconstruction. Methods All patients with breast tumours who underwent vertical scar superior-medial pedicle reduction pattern oncoplastic surgery at our centre between September 2006 and June 2010 were retrospectively studied. Follow-up continued from 12 months to 6 years. Results Twenty women (age 28–72 yr) were enrolled: 16 with invasive carcinoma and 4 with benign tumours. They all had tumour-free surgical margins, and no further oncological operations were required. The patients expressed a high degree of satisfaction from the surgical outcome in terms of improved quality of life and a good cosmetic result. Conclusion The vertical scar superior-medial pedicle reduction pattern is a versatile oncoplastic technique that allows breast tissue rearrangement for various tumour locations. It is oncologically beneficial and is associated with high patient satisfaction. PMID:25078939

  17. Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction.

    PubMed

    Barnea, Yoav; Inbal, Amir; Barsuk, Daphna; Menes, Tehila; Zaretski, Arik; Leshem, David; Weiss, Jerry; Schneebaum, Schlomo; Gur, Eyal

    2014-08-01

    Oncoplastic breast reduction in women with medium to large breasts has reportedly benefitted them both oncologically and cosmetically. We present our experience with an oncoplastic breast reduction technique using a vertical scar superior-medial pedicle pattern for immediate partial breast reconstruction. All patients with breast tumours who underwent vertical scar superior-medial pedicle reduction pattern oncoplastic surgery at our centre between September 2006 and June 2010 were retrospectively studied. Follow-up continued from 12 months to 6 years. Twenty women (age 28-72 yr) were enrolled: 16 with invasive carcinoma and 4 with benign tumours. They all had tumour-free surgical margins, and no further oncological operations were required. The patients expressed a high degree of satisfaction from the surgical outcome in terms of improved quality of life and a good cosmetic result. The vertical scar superior-medial pedicle reduction pattern is a versatile oncoplastic technique that allows breast tissue rearrangement for various tumour locations. It is oncologically beneficial and is associated with high patient satisfaction.

  18. Reanimation of elbow extension with medial pectoral nerve transfer in partial injuries to the brachial plexus.

    PubMed

    Flores, Leandro Pretto

    2013-03-01

    Recent advancements in operative treatment of the brachial plexus authorized more extensive repairs and, currently, elbow extension can be included in the rank of desirable functions to be restored. This study aims to describe the author's experience in using the medial pectoral nerve for reinnervation of the triceps brachii in patients sustaining C5-7 palsies of the brachial plexus. This is a retrospective study of the outcomes regarding recovery of elbow extension in 12 patients who underwent transfer of the medial pectoral nerve to the radial nerve or to the branch of the long head of the triceps. The radial nerve was targeted in 3 patients, and the branch to the long head of the triceps was targeted in 9. Grafts were used in 6 patients. Outcomes assessed as Medical Research Council Grades M4 and M3 for elbow extension were noted in 7 (58%) and 5 (42%) patients, respectively. The medial pectoral nerve is a reliable donor for elbow extension recovery in patients who have sustained C5-7 nerve root injuries.

  19. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review.

    PubMed

    Papalia, Rocco; Del Buono, Angelo; Osti, Leonardo; Denaro, Vincenzo; Maffulli, Nicola

    2011-01-01

    This review defines the recognized risk factors responsible for the development of knee osteoarthritis after surgical management of meniscal tears. We performed a literature search using Medline, Ovid, Cochrane and Google Scholar using the keywords: 'Meniscal tears', 'meniscectomy', 'osteoarthritis', 'complications' and 'risk factors'. Thirty-two published studies were identified. In the long term, osteoarthritis develops in the knee of patients undergoing surgery for meniscal tears. The Coleman methodology score showed great heterogeneity in terms of patient characteristics and outcome assessment. Amount of meniscus removed, duration of pre-operative symptoms and lateral meniscectomy show strong statistical association to onset of knee osteoarthritis. We did not find univocal findings defining the risk factors responsible for the development of post-operative knee osteoarthritis. There is a need for standardized clinical and imaging validated scale to improve definition of post-operative knee osteoarthritis to allow easier and more reliable comparison of outcomes in different studies. Appropriately powered randomized controlled trials reporting clinical and imaging-related outcomes in patients undergoing arthroscopic minimally invasive procedures and meniscal suturing should be performed. Comparing imaging findings of patients undergoing arthroscopic partial and open meniscectomy, a lower incidence of knee osteoarthritic evolution was detected after arthroscopy. The amount of removed meniscus is the most important predictor factor for the development of osteoarthritis. Minimally invasive procedures seem to reduce the incidence of long-term osteoarthritic changes of the knee compared with more invasive open and or arthroscopic procedures.

  20. Medial entorhinal cortex lesions only partially disrupt hippocampal place cells and hippocampus-dependent place memory

    PubMed Central

    Hales, Jena B; Schlesiger, Magdalene I; Leutgeb, Jill K; Squire, Larry R; Leutgeb, Stefan; Clark, Robert E

    2014-01-01

    SUMMARY Entorhinal cortex provides the primary cortical projections to the hippocampus, a brain structure critical for memory. However, it remains unclear how the precise firing patterns of medial entorhinal cortex (MEC) cells influence hippocampal physiology and hippocampus-dependent behavior. We found that complete bilateral lesions of MEC resulted in a lower proportion of active hippocampal cells. The remaining active cells had place fields, but with decreased spatial precision and decreased long-term spatial stability. In addition, MEC rats were as impaired at acquiring the watermaze as hippocampus rats, while rats with combined MEC and hippocampal lesions had an even greater deficit. However, MEC rats were not impaired on other hippocampus-dependent tasks, including those in which an object location or context was remembered. Thus, MEC is not necessary for all types of spatial coding, nor for all types of hippocampus-dependent memory, but is necessary for the normal acquisition of place memory. PMID:25437546

  1. Arthroscopic partial meniscectomy: a long-term follow-up.

    PubMed

    Faunø, P; Nielsen, A B

    1992-01-01

    A follow-up study was conducted to clarify the clinical and radiological long-term consequences of arthroscopic meniscus resection. One hundred thirty-six patients who had unilateral arthroscopic resection of an isolated meniscal tear attended for an interview and a physical and radiological examination. Follow-up averaged 8.5 years, with a range of 7.9-11.6 years. The reoperation rate was as high as 22.8%, but was the lowest in the bucket handle tear group (13%). Pain after exercise was less frequent among patients treated for a bucket handle tear compared to other lesions. Fifty-three percent of the patients had at least one of the Fairbanks change in the operated knee and only 22% in the control knees. The radiographic result was not influenced by the type of meniscus lesion nor were high age or intraoperatively described cartilage damage factors of significance. Malalignment less than 4 degrees of valgus and greater than 10 degrees of valgus was found to be a significant risk factor for the development of degenerative changes following meniscus resection.

  2. [Effects of meniscectomy and transplantation of human knee on stress of tibiofemoral articular surface].

    PubMed

    Wang, Xishun; Zhang, Yadong; Hou, Shuxun; Wu, Wenwen; Zhang, Hong; Luo, Dianzhong; Gu, Dongqiang; Zhao, Yantao

    2014-01-01

    To investigate the effects of meniscectomy and transplantation repair ot the knee on the stress area and average pressure of the tibiofemoral articular surface so as to provide a reference for the relevant basic and clinical researches. Seven qualified right knee joints from adult men cadavers were selected. Required structure was retained after careful dissection. The pressure-sensitive paper was clipped to the proper size in accordance with the measured size of the tibial platform to reserve. The experiment was divided into 4 groups: normal knee group (group A), knee meniscus injury group (group B), knee meniscectomy group (group C), and knee meniscus transplantation group (group D). A horizontal incision above the meniscus was made in the position of knee joint capsule, and the pressure-sensitive paper was placed into the medial and lateral space of the knee joint, then the proximal tibia and distal femur were fixed stably and finally a universal mechanical machine was used for testing in appropriate environmental conditions (the knee joints were given longitudinal 700 N pressure at 00 extension and 30, 60, 90, and 1200 flexion for continuous 120 seconds) until the full color reaction. The knee models were prepared, and then the universal mechanical machine was used to perform a test according to the method stated above respectively. The pressure-sensitive paper was removed, and the color negative films were separated and marked. Colorful image analysis system was used to calculate and analyze the stress area and average pressure after the scanner being used to collect image information. The stress area was gradually reduced and the average pressure was gradually increased with increasing flexion angle of the knee. There was significant difference in the stress area and the average pressure between various flexion angles in 4 groups (P < 0.05). Group C had significantly lower stress area and significantly higher average pressure than the other 3 groups (P < 0

  3. Phasic-like stimulation of the medial forebrain bundle augments striatal gene expression despite methamphetamine-induced partial dopamine denervation.

    PubMed

    Howard, Christopher D; Pastuzyn, Elissa D; Barker-Haliski, Melissa L; Garris, Paul A; Keefe, Kristen A

    2013-05-01

    Methamphetamine-induced partial dopamine depletions are associated with impaired basal ganglia function, including decreased preprotachykinin mRNA expression and impaired transcriptional activation of activity-regulated, cytoskeleton-associated (Arc) gene in striatum. Recent work implicates deficits in phasic dopamine signaling as a potential mechanism linking methamphetamine-induced dopamine loss to impaired basal ganglia function. This study thus sought to establish a causal link between phasic dopamine transmission and altered basal ganglia function by determining whether the deficits in striatal neuron gene expression could be restored by increasing phasic dopamine release. Three weeks after pretreatment with saline or a neurotoxic regimen of methamphetamine, rats underwent phasic- or tonic-like stimulation of ascending dopamine neurons. Striatal gene expression was examined using in situ hybridization histochemistry. Phasic-like, but not tonic-like, stimulation induced immediate-early genes Arc and zif268 in both groups, despite the partial striatal dopamine denervation in methamphetamine-pretreated rats, with the Arc expression occurring in presumed striatonigral efferent neurons. Phasic-like stimulation also restored preprotachykinin mRNA expression. These results suggest that disruption of phasic dopamine signaling likely underlies methamphetamine-induced impairments in basal ganglia function, and that restoring phasic dopamine signaling may be a viable approach to manage long-term consequences of methamphetamine-induced dopamine loss on basal ganglia functions. © 2013 International Society for Neurochemistry.

  4. Pathways of load-induced cartilage damage causing cartilage degeneration in the knee after meniscectomy.

    PubMed

    Wilson, W; van Rietbergen, B; van Donkelaar, C C; Huiskes, R

    2003-06-01

    Results of both clinical and animal studies show that meniscectomy often leads to osteoarthritic degenerative changes in articular cartilage. It is generally assumed that this process of cartilage degeneration is due to changes in mechanical loading after meniscectomy. It is, however, not known why and where this cartilage degeneration starts. Load induced cartilage damage is characterized as either type (1)--damage without disruption of the underlying bone or calcified cartilage layer--or type (2), subchondral fracture with or without damage to the overlying cartilage. We asked the question whether cartilage degeneration after meniscectomy is likely to be initiated by type (1) and/or type (2) cartilage damage. To investigate that we applied an axisymmetric biphasic finite element analysis model of the knee joint. In this model the articular cartilage layers of the tibial and the femoral condyles, the meniscus and the bone underlying the articular cartilage of the tibia plateau were included. The model was validated with data from clinical studies, in which the effects of meniscectomy on contact areas and pressures were measured. It was found that both the maximal values and the distributions of the shear stress in the articular cartilage changed after meniscectomy, and that these changes could lead to both type (1) and type (2) cartilage damage. Hence it likely that the cartilage degeneration seen after meniscectomy is initiated by both type (1) and type (2) cartilage damage.

  5. Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty.

    PubMed

    Wollina, Uwe; Heinig, Birgit; Nowak, Andreas

    2014-01-01

    Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome. We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used. We report on three women aged 55-77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high. A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities.

  6. Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty

    PubMed Central

    Wollina, Uwe; Heinig, Birgit; Nowak, Andreas

    2014-01-01

    Background Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome. Methods We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used. Results We report on three women aged 55–77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high. Conclusion A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities. PMID:24489474

  7. In vivo Cartilage Strain Increases Following Medial Meniscal Tear and Correlates with Synovial Fluid Matrix Metalloproteinase Activity

    PubMed Central

    Carter, Teralyn E.; Taylor, Kevin A.; Spritzer, Charles E.; Utturkar, Gangadhar M.; Taylor, Dean C.; Moorman, Claude T.; Garrett, William E.; Guilak, Farshid; McNulty, Amy L.; DeFrate, Louis E.

    2015-01-01

    Meniscal tears are common injuries, and while partial meniscectomy is a frequent treatment option, general meniscus loss is a risk factor for the development of osteoarthritis. The goal of this study was to measure the in vivo tibiofemoral cartilage contact patterns in patients with meniscus tears in relation to biomarkers of cartilage catabolism in the synovial fluid of these joints. A combination of magnetic resonance imaging and biplanar fluoroscopy was used to determine the in vivo motion and cartilage contact mechanics of the knee. Subjects with isolated medial meniscus tears were analyzed while performing a quasi-static lunge, and the contralateral uninjured knee was used as a control. Synovial fluid was collected from the injured knee and matrix metalloproteinase (MMP) activity, sulfated glycosaminoglycan, cartilage oligomeric matrix protein, prostaglandin E2, and the collagen type II cleavage biomarker C2C were measured. Contact strain in the medial compartment increased significantly in the injured knees compared to contralateral control knees. In the lateral compartment, the contact strain in the injured knee was significantly increased only at the maximum flexion angle (105°). The average cartilage strain at maximum flexion positively correlated with total MMP activity in the synovial fluid. These findings show that meniscal injury leads to loss of normal joint function and increased strain of the articular cartilage, which correlated to elevated total MMP activity in the synovial fluid. The increased strain and total MMP activity may reflect, or potentially contribute to, the early development of osteoarthritis that is observed following meniscal injury. PMID:25801424

  8. Cytotoxic lesion of the medial prefrontal cortex abolishes the partial reinforcement extinction effect, attenuates prepulse inhibition of the acoustic startle reflex and induces transient hyperlocomotion, while sparing spontaneous object recognition memory in the rat.

    PubMed

    Yee, B K

    2000-01-01

    The partial reinforcement extinction effect refers to the increase in resistance to extinction of an operant response acquired under partial reinforcement relative to that acquired under continuous reinforcement. Prepulse inhibition of the acoustic startle response refers to the reduction in startle reactivity towards an intense acoustic pulse stimulus when it is shortly preceded by a weak prepulse stimulus. These two behavioural phenomena appear to be related to different forms of attentional processes. While the prepulse inhibition effect reflects an inherent early attentional gating mechanism, the partial reinforcement extinction effect is believed to involve the development of acquired inattention, i.e. the latter requires the animals to learn about what to and what not to attend. Impairments in prepulse inhibition and the partial reinforcement extinction effect have been independently linked to the neuropsychology of attentional dysfunctions seen in schizophrenia. The proposed neural substrates underlying these behaviourial phenomena also appear to overlap considerably: both focus on the nucleus accumbens and emphasize the functional importance of its limbic afferents, including that originating from the medial prefrontal cortex, on accumbal output/activity. The present study demonstrated that cytotoxic medial prefrontal cortex lesions which typically damaged the prelimbic, the infralimbic and the dorsal anterior cingulate areas could lead to the abolition of the partial reinforcement extinction effect and the attenuation of prepulse inhibition. The lesions also resulted in a transient elevation of spontaneous locomotor activity. In contrast, the same lesions spared performance in a spontaneous object recognition memory test, in which the lesioned animals displayed normal preference for a novel object when the novel object was presented in conjunction with a familiar object seen 10 min earlier within an open field arena. The present results lend support to the

  9. AMECM/DCB scaffold prompts successful total meniscus reconstruction in a rabbit total meniscectomy model.

    PubMed

    Yuan, Zhiguo; Liu, Shuyun; Hao, Chunxiang; Guo, Weimin; Gao, Shuang; Wang, Mingjie; Chen, Mingxue; Sun, Zhen; Xu, Yichi; Wang, Yu; Peng, Jiang; Yuan, Mei; Guo, Quan-Yi

    2016-12-01

    Tissue-engineered meniscus regeneration is a very promising treatment strategy for meniscus lesions. However, generating the scaffold presents a huge challenge for meniscus engineering as this has to meet particular biomechanical and biocompatibility requirements. In this study, we utilized acellular meniscus extracellular matrix (AMECM) and demineralized cancellous bone (DCB) to construct three different types of three-dimensional porous meniscus scaffold: AMECM, DCB, and AMECM/DCB, respectively. We tested the scaffolds' physicochemical characteristics and observed their interactions with meniscus fibrochondrocytes to evaluate their cytocompatibility. We implanted the three different types of scaffold into the medial knee menisci of New Zealand rabbits that had undergone total meniscectomy; negative control rabbits received no implants. The reconstructed menisci and corresponding femoral condyle and tibial plateau cartilage were all evaluated at 3 and 6 months (n = 8). The in vitro study demonstrated that the AMECM/DCB scaffold had the most suitable biomechanical properties, as this produced the greatest compressive and tensile strength scores. The AMECM/DCB and AMECM scaffolds facilitated fibrochondrocyte proliferation and the secretion of collagen and glycosaminoglycans (GAGs) more effectively than did the DCB scaffold. The in vivo experiments demonstrated that both the AMECM/DCB and DCB groups had generated neomeniscus at both 3 and 6 months post-implantation, but there was no obvious meniscus regeneration in the AMECM or control groups, so the neomeniscus analysis could not perform on AMECM and control group. At both 3 and 6 months, histological scores were better for regenerated menisci in the AMECM/DCB than in the DCB group, and significantly better for articular cartilage in the AMECM/DCB group compared with the other three groups. Knee MRI scores (Whole-Organ Magnetic Resonance Imaging Scores (WORMS)) were better in the AMECM/DCB group than in the

  10. Weekly injections of Hylan G-F 20 delay cartilage degeneration in partial meniscectomized rat knees.

    PubMed

    Yanagisawa, Katsuaki; Muneta, Takeshi; Ozeki, Nobutake; Nakagawa, Yusuke; Udo, Mio; Saito, Ryusuke; Koga, Hideyuki; Tsuji, Kunikazu; Sekiya, Ichiro

    2016-04-27

    Cross-linked hyaluronan--also called Hylan G-F 20--is a medical device developed to treat osteoarthritis of the knee. However, it is still controversial whether Hylan G-F 20 has a cartilage protective effect in trauma-induced osteoarthritis. We investigated whether Hylan G-F 20 delayed osteoarthritis progression in a partial meniscectomized rat model. Lewis rats were used for the experiments. The anterior medial meniscus was resected at the level of the medial collateral ligament in both knees. From 1 week after the surgery, 50 μl of Hylan G-F 20 was injected weekly into the left knee and phosphate buffered saline was injected into the right knee. Cartilage was evaluated for macroscopic findings, histology with safranin-o, and expression of type II collagen at 2, 4, and 8 weeks. Synovitis was also evaluated, and immunohistochemical analysis was performed for ED1. Macroscopic findings demonstrated that India ink positive area, representing fibrillated cartilage, was significantly smaller in the Hylan G-F 20 group than in the control group at 2, 4, and 8 weeks (n = 5). There were no significant differences in osteophyte score between the Hylan G-F 20 group and the control group at 2, 4, and 8 weeks. Histologically, the cartilage in the medial tibial plateau was destroyed at 8 weeks in the control group, while type II collagen expression was still observed at 8 weeks in the Hylan G-F 20 group. OARSI score for cartilage histology was significantly lower in the Hylan G-F 20 group than in the control group at 4 and 8 weeks (n = 5). There were no significant differences in synovial cell number or modified synovitis score between the Hylan G-F 20 group and the control group at 2, 4, and 8 weeks (n = 5). In the Hylan G-F 20 group, foreign bodies surrounded by ED1 positive macrophages were observed in the synovium. Weekly injections of Hylan G-F 20 starting 1 week after surgery delayed cartilage degeneration after meniscectomy in a rat model. Synovitis induced by

  11. McMurray Test: A Prediction of Arthroscopic Meniscectomy Outcomes in Patients with Knee Osteoarthritis.

    PubMed

    Ji, Cheng; Lin, Xiangjin; Zhu, Liulong; Li, Min

    2015-05-01

    The McMurray test is used to evaluate patients with meniscal tears of the knee. Analysis of the sensitivity and specificity of McMurray test and the correlation between McMurray sign and postoperative outcomes are helpful to screen the candidates for arthroscopic meniscectomy. The present study compares the results of McMurray test with arthroscopic examination in patients with knee osteoarthritis. We studied 149 patients diagnosed as meniscal lesion with osteoarthritis by radiology and had arthroscopic surgery. Our data show that positive McMurray sign implies good postoperative outcomes for the patients with meniscal tear associated with osteoarthritis. For patients with osteoarthritis, those whose positive McMurray signs are in line with their radiological findings indicate they are eligible candidates for arthroscopic meniscectomy. Our study suggests that McMurray sign can be used as an indication for both symptomatic meniscal tear and postoperative outcomes.

  12. The neural substrates for the rewarding and dopamine-releasing effects of medial forebrain bundle stimulation have partially discrepant frequency responses.

    PubMed

    Cossette, M-P; Conover, K; Shizgal, P

    2016-01-15

    Midbrain dopamine neurons have long been implicated in the rewarding effect produced by electrical brain stimulation of the medial forebrain bundle (MFB). These neurons are excited trans-synaptically, but their precise role in intracranial self-stimulation (ICSS) has yet to be determined. This study assessed the hypothesis that midbrain dopamine neurons are in series with the directly stimulated substrate for self-stimulation of the MFB and either perform spatio-temporal integration of synaptic input from directly activated MFB fibers or relay the results of such integration to efferent stages of the reward circuitry. Psychometric current-frequency trade-off functions were derived from ICSS performance, and chemometric trade-off functions were derived from stimulation-induced dopamine transients in the nucleus accumbens (NAc) shell, measured by means of fast-scan cyclic voltammetry. Whereas the psychometric functions decline monotonically over a broad range of pulse frequencies and level off only at high frequencies, the chemometric functions obtained with the same rats and electrodes are either U-shaped or level off at lower pulse frequencies. This discrepancy was observed when the dopamine transients were recorded in either anesthetized or awake subjects. The lack of correspondence between the psychometric and chemometric functions is inconsistent with the hypothesis that dopamine neurons projecting to the NAc shell constitute an entire series stage of the neural circuit subserving self-stimulation of the MFB.

  13. Posterolateral rotatory instability of the knee after arthroscopic subtotal lateral meniscectomy: a case report

    PubMed Central

    BULGHERONI, ERICA; BULGHERONI, PAOLO

    2014-01-01

    A 33-year-old Caucasian woman came to our attention complaining of lateral knee pain on the left side, severe external instability associated with varus malalignment, and difficulties in weight-bearing activities. The symptoms had appeared following two lateral meniscectomies on her discoid meniscus, performed elsewhere. The patient was initially submitted to an allograft meniscus transplantation exploiting the unloaded condition of lateral compartment and obtained pain relief. The posterolateral corner was reconstructed in combination with a valgus osteotomy to address the posterolateral rotatory instability. The follow-up assessment at two years after the last surgery showed no symptoms, maintenance of limb alignment and no evidence of joint degeneration. PMID:25606550

  14. Medial Collateral Ligament (MCL) Injuries

    MedlinePlus

    ... of Healthy Breakfasts Shyness Medial Collateral Ligament (MCL) Injuries KidsHealth > For Teens > Medial Collateral Ligament (MCL) Injuries ... Treatment Coping With an MCL Injury About MCL Injuries A torn medial collateral ligament (MCL) is a ...

  15. Medial canthal support structures: the medial retinaculum: a review.

    PubMed

    Kang, Hyera; Takahashi, Yasuhiro; Nakano, Takashi; Asamoto, Ken; Ikeda, Hiroshi; Kakizaki, Hirohiko

    2015-04-01

    The medial canthus is supported by several structures with a complicated 3-dimensional arrangement in a narrow space. Although the medial canthal tendon occupies a major portion of the area, the medial canthal support structures include the following entities: Horner's muscle, the medial rectus capsulopalpebral fascia including the medial check ligament, the medial horn of the levator aponeurosis, the medial horn supporting ligament, the medial horn of the lower eyelid retractors, the preseptal part of the orbicularis oculi muscle, and 3 variations of the Lockwood's ligament. We named the composite of these structures the "medial retinaculum," which is similar to the "lateral retinaculum" of the lateral canthus. Profound comprehension and consideration of the medial retinaculum warrants safe and effective surgery in the medial canthal region.

  16. Chuave Medial Verbs

    ERIC Educational Resources Information Center

    Thurman, Robert C.

    1975-01-01

    This article discusses two syntactic processes known as chaining and linkage, insofar as they are relevant to Chuave, a Papuan language spoken in the East New Guinea Highlands. These processes are discussed in relation to Chuave medial verbs. (CLK)

  17. Arthroscopic contact Nd:YAG laser meniscectomy: basic science, surgical technique, and clinical follow up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Fealy, Stephen V.; Gibney, Mary A.; Miller, Drew V.; Kelly, Anne M.

    1990-06-01

    Recent basic science studies (5) have provided a scientific foundation for the use of the Contact Nd:YAG Laser as an arthroscopic tool for xneniscal resection and acroxnioplasty of the shoulder in a saline medium. This study prospectively evaluates the results of a three stage laboratory investigation as well as the clinical results of arthroscopic xneniscal resection. Fifteen patients with meniscal tears underwent subtotal meniscectomies utilizing a Contact Nd:YAG Laser (Surgical Laser Technologies; Malvern, Pennsylvania) . This was done in a saline medium with an average laser wattage of 25 W, (range 20 W to 30 W). Patients were evaluated postoperatively with reference to subjective and objective parameters at one week and four weeks postoperatively. Patients were evaluated with regard to wound healing, intraarticular swelling and pain. Assessment of technical parameters such as ease of resection, time of resection and instrument access were compared to conventional instruments. All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing and swelling. In addition, although there was increased time with setting up the laser and calibrating it, there was not an increase in time for meniscal resection. Little, or no, secondary "trimmuning" was necessary with the laser. Increased accessibility was noted due to the small size of the laser. Arthroscopic Contact Nd:YAG Laser surgery is a safe and effective tool for menisca]. resection and coagulation in arthroscopic acromioplasties. It provides significant advantages over conventional cutting instruments with regard to accessibility and reduced need for secondary instruments.

  18. Diagnostic value of ultrasonography for clinical medial epicondylitis.

    PubMed

    Park, Gi-Young; Lee, Sung-Moon; Lee, Michael Y

    2008-04-01

    To assess the ultrasonographic findings and to evaluate the value of ultrasonography as a diagnostic method for detecting clinical medial epicondylitis. A prospective, single-blind study. An outpatient rehabilitation clinic in a tertiary university hospital. Twenty-one elbows from 18 patients with clinical medial epicondylitis and 25 elbows without medial epicondylitis were evaluated. Not applicable. The clinical diagnosis of medial epicondylitis was based on the patient's symptoms and clinical signs in a physical examination performed by a physiatrist. An experienced radiologist made the real-time ultrasonographic diagnosis based on the detection of at least one of the following abnormal findings: a focal hypoechoic or anechoic area, tendon nonvisualization, intratendinous calcifications, and cortical irregularity. Ultrasonography revealed positive findings in 20 of 21 elbows with medial epicondylitis and was negative in 23 of 25 without medial epicondylitis. Ultrasonography showed sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for clinical medial epicondylitis of 95.2%, 92%, 93.5%, 90.9%, and 95.8%, respectively. Tendinosis was observed in 15 elbows, and a partial-thickness tear, including 1 intrasubstance tear, was detected in 5 elbows. The most common ultrasonographic abnormality was a focal echogenic abnormality (15 hypoechoic, 5 anechoic) of the tendons. Our results indicate that ultrasonography is informative and accurate for the detection of clinical medial epicondylitis. Therefore, ultrasonography should be considered as an initial imaging method for evaluating medial epicondylitis.

  19. Lateral lid lysis for medial lid and medial canthus lacerations.

    PubMed

    Hecht, S D; Dijkstal, D

    1985-02-01

    Techniques are now being used to provide adequate healing time for medial lid and medial canthal full-thickness lacerations. Lateral upper and lower lid lysis allows the needed extended period of healing.

  20. Medial plica syndrome.

    PubMed

    Sznajderman, Tal; Smorgick, Yossi; Lindner, Dror; Beer, Yiftah; Agar, Gabriel

    2009-01-01

    Synovial plicae are membranous inward folds of the synovial lining of the knee joint capsula. Such folds are regularly found in the human knee, but most are asymptomatic and of little clinical consequence. However, they can become symptomatic and cause knee pain. In this review, we will discuss medial plica syndrome. Medial plica irritation of the knee is a common source of anterior knee pain. The main complaint is an intermittent, dull, aching pain in the area medial to the patella above the joint line and in the supramedial patellar area. Pain increases with activity, especially when knee flexion and extension are required. Treatment includes physiotherapy, reducing activity, and rest. In cases that do not respond initially to an exercise program, corticosteroid injections and non-steroidal antiinflammatory medication are given. Results of conservative treatment seem to be more appropriate in young patients with a short duration of symptoms. If conservative treatment fails, surgical treatment using arthroscopy is appropriate. During arthroscopy, excision of the whole plica should be achieved.

  1. Association of Quadriceps Strength and Psychosocial Factors With Single-Leg Hop Performance in Patients With Meniscectomy

    PubMed Central

    Hsu, Chao-Jung; George, Steven Z.; Chmielewski, Terese L.

    2016-01-01

    Background: Clinicians use the single-leg hop test to assess readiness for return to sports after knee injury. Few studies have reported the results of single-leg hop testing after meniscectomy. Additionally, the contributions of impairments in quadriceps strength and psychosocial factors to single-leg hop performance are unknown. Purpose: To compare single-leg hop performance (distance and landing mechanics) between limbs and to examine the association of single-leg hop performance with quadriceps strength and psychosocial factors in patients with meniscectomy. Study Design: Descriptive laboratory study. Methods: A total of 22 subjects who underwent meniscectomy for traumatic meniscal tears received either standard rehabilitation alone or with additional quadriceps strengthening. Testing was conducted immediately postrehabilitation and at 1 year postsurgery. A single-leg hop test was performed bilaterally, and hop distance was used to create a hop symmetry index. Landing mechanics (peak knee flexion angle, knee extension moment, and peak vertical ground-reaction force) were analyzed with a motion-capture system and a force plate. An isokinetic dynamometer (60 deg/s) assessed knee extensor peak torque and rate of torque development (RTD0-200ms and RTD0–peak torque). Questionnaires assessed fear of reinjury (Tampa Scale for Kinesiophobia [TSK-11]) and self-efficacy (Knee Activity Self-Efficacy [KASE]). Results: Rehabilitation groups did not significantly differ in single-leg hop performance; therefore, groups were combined for further analyses. The mean hop symmetry index was 88.6% and 98.9% at postrehabilitation and 1 year postsurgery, respectively. Compared with the nonsurgical limb, the surgical limb showed decreased peak knee flexion angle at postrehabilitation and decreased knee extension moment at 1 year postsurgery. The hop symmetry index was positively associated with peak torque, RTD0-200ms, and the KASE score at postrehabilitation. Moreover, at

  2. Association of Quadriceps Strength and Psychosocial Factors With Single-Leg Hop Performance in Patients With Meniscectomy.

    PubMed

    Hsu, Chao-Jung; George, Steven Z; Chmielewski, Terese L

    2016-12-01

    Clinicians use the single-leg hop test to assess readiness for return to sports after knee injury. Few studies have reported the results of single-leg hop testing after meniscectomy. Additionally, the contributions of impairments in quadriceps strength and psychosocial factors to single-leg hop performance are unknown. To compare single-leg hop performance (distance and landing mechanics) between limbs and to examine the association of single-leg hop performance with quadriceps strength and psychosocial factors in patients with meniscectomy. Descriptive laboratory study. A total of 22 subjects who underwent meniscectomy for traumatic meniscal tears received either standard rehabilitation alone or with additional quadriceps strengthening. Testing was conducted immediately postrehabilitation and at 1 year postsurgery. A single-leg hop test was performed bilaterally, and hop distance was used to create a hop symmetry index. Landing mechanics (peak knee flexion angle, knee extension moment, and peak vertical ground-reaction force) were analyzed with a motion-capture system and a force plate. An isokinetic dynamometer (60 deg/s) assessed knee extensor peak torque and rate of torque development (RTD0-200ms and RTD0-peak torque). Questionnaires assessed fear of reinjury (Tampa Scale for Kinesiophobia [TSK-11]) and self-efficacy (Knee Activity Self-Efficacy [KASE]). Rehabilitation groups did not significantly differ in single-leg hop performance; therefore, groups were combined for further analyses. The mean hop symmetry index was 88.6% and 98.9% at postrehabilitation and 1 year postsurgery, respectively. Compared with the nonsurgical limb, the surgical limb showed decreased peak knee flexion angle at postrehabilitation and decreased knee extension moment at 1 year postsurgery. The hop symmetry index was positively associated with peak torque, RTD0-200ms, and the KASE score at postrehabilitation. Moreover, at postrehabilitation, the peak knee flexion angle was positively

  3. Medial canthus retiform hemangioendothelioma

    PubMed Central

    Al-Faky, Yasser H; Al-Mosallam, Abdul Rahman; Al-Rikabi, Ammar C; Al-Sohaibani, Mohammed O

    2014-01-01

    Retiform hemangioendothelioma (RH) is a distinct entity in the spectrum of vascular tumors with a high local recurrence rate. It is considered a low-grade, well-differentiated cutaneous angiosarcoma with low metastatic potential. We report here for the first time a case of medial canthus recurrent RH. It may be helpful in our practice to include RH as a differential diagnosis of eyelid lesions. It is noteworthy that the progressive course and recurrence tendency of RH might be misdiagnosed as angiosarcoma or basal cell carcinoma (BCC), if not expected and carefully evaluated by the pathologist. PMID:24817752

  4. Effect of lateral meniscectomy and osteochondral grafting of a lateral femoral condylar defect on contact mechanics: a cadaveric study in dogs

    PubMed Central

    2013-01-01

    Background Osteochondral autograft transfer (OAT) aims at restoring normal articular cartilage surface geometry and articular contact mechanics. To date, no studies have evaluated the contact mechanics of the canine stifle following OAT. Additionally, there are no studies that evaluated the role of the meniscus in contact mechanics following OAT in human or canine femorotibial joints. The objective of this study was to measure the changes in femorotibial contact areas (CA), mean contact pressure (MCP) and peak contact pressure (PCP) before and after osteochondral autograft transplantation (OAT) of a simulated lateral femoral condylar cartilage defect with an intact lateral meniscus and following lateral meniscectomy. Results With an intact lateral meniscus, creation of an osteochondral defect caused a decrease in MCP and PCP by 11% and 30%, respectively, compared to the intact stifle (p < 0.01). With an intact meniscus, implanting an osteochondral graft restored MCP and PCP to 96% (p = 0.56) and 92% (p = 0.41) of the control values. Lateral meniscectomy with grafting decreased CA by 54% and increased PCP by 79% compared to the intact stifle (p < 0.01). Conclusions OAT restored contact pressures in stifles with a simulated lateral condylar defect when the meniscus was intact. The lateral meniscus has a significant role in maintaining normal contact pressures in both stifles with a defect or following OAT. Meniscectomy should be avoided when a femoral condylar defect is present and when performing OAT. PMID:23522348

  5. Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial Meniscus

    PubMed Central

    Syam, Kevin; Chouhan, Devendra K.; Dhillon, Mandeep Singh

    2017-01-01

    Purpose Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee. PMID:28231647

  6. Congenital dystrophic medial rectus muscles

    PubMed Central

    Murthy, Ramesh

    2017-01-01

    We report two patients, one with congenital dystrophic medial rectus muscles and one with absence of the medial rectus muscles; in addition, one of them had absence of the lateral rectus muscles. While absence of the superior oblique and superior rectus has been more commonly reported in literature, especially with craniofacial syndromes, our patients were nonsyndromic. Considering the risk of anterior segment ischemia, correction of the large-angle exotropia was performed by horizontal rectus muscle surgery where possible, along with transfer of the superior oblique tendon to the superior part of the normal medial rectus muscle insertion area to create a tethering effect with a good outcome. PMID:28300745

  7. Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Palacios, Jose Antonio; Yacuzzi, Carlos; Oñativia, Jose I.; Zicaro, Juan Pablo; Costa-Paz, Matias

    2017-01-01

    Objectives: Recurrent patellofemoral dislocation is usually a multifactorial pathology. Different surgical techniques have been described according to the etiology of dislocation. In absence of a severe malalignment or an anatomical patellofemoral dysplasia, reconstruction of Medial Patello-femoral Ligament (MPFL) can restore the normal tracking of the patella, avoiding lateral excursion. The purpose of this study was to evaluate clinical results and complications in patients who underwent a MPFL reconstruction. Methods: We retrospectively evaluated 19 patients who underwent an anatomic MPFL reconstruction using autologous semitendinosus graft between 2007 and 2012. Exclusion criteria were patients with less than three years of follow-up and those with an associated procedure such as distal realignment or trochleoplasty. Clinical outcomes were measured using Kujala score and return to sport rate. We registered the postoperative complications and recurrence rate. Results: Nine patients were men and 10 women with a mean age of 25 years. Average follow-up was 5.8 years. Nine patients (47.4%) returned to their previous sport level, 8 (42.1%) changed to another sport or decreased their level and 2 (10.5%) were unable to practice any sports at all. Kujala score improvement was from 62.8 preoperative to 88.8 postoperative. One patient decreased the Kujala score. Eighty-nine percent of patients were satisfied with their outcome. One patient had a patellar fracture and four developed an arthrofibrosis and required mobilization under anesthesia. No recurrences were registered. Conclusion: Isolated MPFL reconstruction for recurrent patellofemoral dislocation is an effective alternative in absence of severe malalignment or anatomical dysplasia. Although no recurrences where registered at minimum 3-year follow-up, almost half of the patients were not able to return to their previous sport level.

  8. The effect of intraarticular combinations of tramadol and ropivacaine with ketamine on postoperative pain after arthroscopic meniscectomy.

    PubMed

    Ayoglu, Hilal; Altunkaya, Hanife; Bayar, Ahmet; Turan, Isil Ozkocak; Ozer, Yetkin; Ege, Ahmet

    2010-03-01

    The purpose of this prospective randomized study was to evaluate the effects of intraarticular combinations of tramadol and ropivacaine with ketamine in postoperative pain control of patients undergoing arthroscopic meniscectomy. We randomly divided 80 patients into four groups to receive intraarticular 50 mg tramadol (Group T), 50 mg tramadol with 0.5 mg kg(-1) ketamine (Group TK), 75 mg ropivacaine (Group R), 75 mg ropivacaine with 0.5 mg kg(-1) ketamine (Group RK) in 20 ml normal saline at the end of surgery. Postoperative analgesia was provided with patient-controlled analgesia with morphine. Postoperative pain scores, total morphine consumption amount and side effects were recorded at intervals of 0, 1, 2, 4, 8, 12 and 24 h after the operation. Pain scores were higher in Group T when compared with Group R and Group RK at second and fourth hours, also compared with Group RK at zeroth, first, second, fourth and eighth hours. Total morphine consumption amount was found to be higher in Group T when compared to Group TK at eighth and twelfth hours and Group RK at eighth hours (P < 0.05). Total morphine consumption was lowest in Group TK (P < 0.05). There were no significant differences among the study groups regarding side effects. Administration of intraarticular tramadol-ketamine combination was found to be more effective in decreasing postoperative daily analgesic consumption.

  9. The vertical medial thigh lift.

    PubMed

    Capella, Joseph F

    2014-10-01

    This article discusses management of the post-weight loss thigh deformity. Beginning with an explanation of the soft tissue variables contributing to the thigh and medial thigh deformity in the postbariatric individual, the article describes the important elements of selecting and screening candidates for surgery and the ideal sequence of procedures that should be followed to optimize results in this patient population. A detailed step-by-step description of the author's technique for medial thigh lift is provided along with multiple examples of outcomes. Aftercare is reviewed along with potential complications and their management. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Medial temporal lobe volume predicts elders' everyday memory.

    PubMed

    Bailey, Heather R; Zacks, Jeffrey M; Hambrick, David Z; Zacks, Rose T; Head, Denise; Kurby, Christopher A; Sargent, Jesse Q

    2013-07-01

    Deficits in memory for everyday activities are common complaints among healthy and demented older adults. The medial temporal lobes and dorsolateral prefrontal cortex are both affected by aging and early-stage Alzheimer's disease, and are known to influence performance on laboratory memory tasks. We investigated whether the volume of these structures predicts everyday memory. Cognitively healthy older adults and older adults with mild Alzheimer's-type dementia watched movies of everyday activities and completed memory tests on the activities. Structural MRI was used to measure brain volume. Medial temporal but not prefrontal volume strongly predicted subsequent memory. Everyday memory depends on segmenting activity into discrete events during perception, and medial temporal volume partially accounted for the relationship between performance on the memory tests and performance on an event-segmentation task. The everyday-memory measures used in this study involve retrieval of episodic and semantic information as well as working memory updating. Thus, the current findings suggest that during perception, the medial temporal lobes support the construction of event representations that determine subsequent memory.

  11. Medial Temporal Lobe Volume Predicts Elders' Everyday Memory

    PubMed Central

    Bailey, Heather R.; Zacks, Jeffrey M.; Hambrick, David Z.; Zacks, Rose T.; Head, Denise; Kurby, Christopher A.; Sargent, Jesse Q.

    2013-01-01

    Deficits in memory for everyday activities are common complaints among healthy and demented older adults. The medial temporal lobes and dorsolateral prefrontal cortex are both affected by aging and early-stage Alzheimer's disease, and are known to influence performance on laboratory memory tasks. We investigated whether the volume of these structures predicts everyday memory. Cognitively healthy older adults and older adults with mild Alzheimer's-type dementia watched movies of everyday activities and completed memory tests on the activities. Structural MRI was used to measure brain volume. Medial temporal but not prefrontal volume strongly predicted subsequent memory. Everyday memory depends on segmenting activity into discrete events during perception, and medial temporal volume partially accounted for the relationship between performance on the memory tests and performance on an event-segmentation task. The everyday-memory measures used in this study involve retrieval of episodic and semantic information as well as working memory updating. Thus, the current findings suggest that during perception, the medial temporal lobes support the construction of event representations that determine subsequent memory. PMID:23630222

  12. Management of the Postbariatric Medial Thigh Deformity.

    PubMed

    Capella, Joseph F; Matarasso, Alan

    2016-05-01

    Thigh contour deformities-in particular, those of the medial thighs-are a common concern for many individuals seeking body contouring. Despite the frequency of this concern, some plastic surgeons have often been reluctant to embrace the medial thigh-lift procedure because of the risk for significant complications and relatively poor results. The authors' approach to medial thigh contouring is to address the variables outside of the medial thighs affecting the medial thighs before considering a medial thigh-lift procedure with a vertical component. In this article, the authors review the senior author's (J.F.C.) experience of 350 vertical medial thigh lifts in the weight-loss patient. The charts of 350 consecutive individuals who had undergone vertical medial thigh lifts were reviewed for complications and other variables. The procedures were all performed by the senior author between February of 2000 and February of 2014. The preoperative markings, current surgical technique, and postoperative care are described. There were 326 women and 24 men in the study, with an average age of 43 years. The overall complication rate was 45.14 percent. Skin dehiscence and seroma formation were the most frequent complications, at 31.14 percent and 18.18 percent, respectively. The vast majority of patients were pleased with the aesthetic and functional results of their surgery. The medial thigh deformities of the weight-loss patient are effectively addressed by a vertical medial thigh lift when the variables adjacent to the medial thighs are first treated by a body lift. Therapeutic, IV.

  13. Associative encoding of pictures activates the medial temporal lobes.

    PubMed

    Montaldi, D; Mayes, A R; Barnes, A; Pirie, H; Hadley, D M; Patterson, J; Wyper, D J

    1998-01-01

    It remains unresolved whether the medial temporal lobe activations found in recent neuroimaging studies are mediated by novelty detection alone, by specific kinds of encoding or consolidation operations, or both. This study attempted to see whether associative encoding or consolidation is sufficient to cause such activation by matching for novelty across conditions. Using single-photon emission computer tomography (SPECT) (with TC99mHMPAO), we compared the activation patterns produced by the associative encoding and the perceptual matching of novel complex scenes in 10 normal subjects using both statistical parametric mapping (SPM) and a regions-of-interest (ROI) approach. During the encoding condition, significant activations were detected in the left hippocampal/parahippocampal region, the left cingulate cortex, and the right prefrontal cortex, using both statistical techniques. Additionally, activation was found in the right cingulate cortex, and a trend towards activation was found in the right hippocampal/parahippocampal region using the ROI approach. In contrast, no medial temporal activations were found during the matching condition, which produced bilateral occipito-parietal and right posterior inferior parietal (supramarginal gyrus) activations. These results no only confirm that the associative encoding and/or consolidation of complex scenes is partially mediated by medial temporal lobe structures, but also demonstrate, for the first time, that associative encoding/consolidation is sufficient to produce such an activation. The implications of the high degree of consistency revealed by the results of the SPM and ROI comparison are discussed.

  14. Bottom-up Visual Integration in the Medial Parietal Lobe.

    PubMed

    Pflugshaupt, Tobias; Nösberger, Myriam; Gutbrod, Klemens; Weber, Konrad P; Linnebank, Michael; Brugger, Peter

    2016-03-01

    Largely based on findings from functional neuroimaging studies, the medial parietal lobe is known to contribute to internally directed cognitive processes such as visual imagery or episodic memory. Here, we present 2 patients with behavioral impairments that extend this view. Both had chronic unilateral lesions of nearly the entire medial parietal lobe, but in opposite hemispheres. Routine neuropsychological examination conducted >4 years after the onset of brain damage showed little deficits of minor severity. In contrast, both patients reported persistent unusual visual impairment. A comprehensive series of tachistoscopic experiments with lateralized stimulus presentation and comparison with healthy participants revealed partial visual hemiagnosia for stimuli presented to their contralesional hemifield, applying inferential single-case statistics to evaluate deficits and dissociations. Double dissociations were found in 4 experiments during which participants had to integrate more than one visual element, either through comparison or formation of a global gestalt. Against the background of recent neuroimaging findings, we conclude that of all medial parietal structures, the precuneus is the most likely candidate for a crucial involvement in such bottom-up visual integration.

  15. Etiology and Treatment of Delayed-Onset Medial Malleolar Pain Following Total Ankle Arthroplasty.

    PubMed

    Lundeen, Gregory A; Dunaway, Linda J

    2016-08-01

    Total ankle arthroplasty (TAA) has become a successful treatment for end-stage ankle arthritis. Some patients may still have pain or may present with new pain. Suggested sources of medial pain include tibialis posterior tendonitis, impingement, or medial malleolar stress fracture. Etiology and treatment remain unclear. The objective of our study was to evaluate patients with delayed-onset medial malleolar pain following TAA who underwent treatment with percutaneous medial malleolar screw placement and propose an etiology. Patients who had undergone TAA at our institution were reviewed and those with medial malleolar pain were identified. Clinical and radiographic examinations were performed pre- and postoperatively. Radiographs were compared with those from a cohort of controls without a history of medial pain. All affected patients failed conservative therapy and were treated with percutaneous placement of medial malleolar screws positioned from the malleolar tip and extending proximally beyond the tibial component. Postoperatively, patients were placed in an ace wrap and allowed to be weightbearing to tolerance, except for 1 patient initially restricted to partial weightbearing. Visual analog scale (VAS) scores were recorded. Seventy-four (74) patients underwent TAA by the corresponding author. All (100%) were female with an average age of 66 (range, 57-73) years. Average follow-up since screw placement was 21.4 (range, 10-41) months. Six (8.1%) underwent placement of 2 percutaneous medial malleolar screws. Patients presented with pain an average of 12 (range, 4-24) months postoperatively and underwent screw placement an average of 2.8 (range, 1-6) months after presentation. At the time of TAA, none had a coronal plane deformity and none underwent a deltoid ligament release as part of balancing. All (100%) patients had pain and swelling directly over the medial malleolus prior to screw placement. Postoperatively, 1 (17%) had mild pain clinically at this site and

  16. Medial Patella Subluxation: Diagnosis and Treatment

    PubMed Central

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

  17. The snapping medial antebrachial cutaneous nerve.

    PubMed

    Cesmebasi, Alper; O'driscoll, Shawn W; Smith, Jay; Skinner, John A; Spinner, Robert J

    2015-10-01

    Snapping elbow is a well-known condition where elbow flexion and extension elicits a painful, popping sensation. The most frequent etiology is anterior dislocation of the ulnar nerve over the medial epicondyle. Four patients (3 females and 1 male) presented with complaints of a popping sensation in the elbow, pain over the medial aspect of the forearm, and ulnar neuritis. All patients underwent preoperative dynamic ultrasound and surgical exploration of the medial elbow. Intraoperatively, snapping of the MABC over the medial epicondyle was discovered in all four patients. In three patients, there was abnormal displacement of the medial triceps and ulnar nerve: in two of these, both structures dislocated over the medial epicondyle and in one patient both structures subluxated. In each case, the MABC was decompressed (n = 1) and transposed (n = 3), and in three cases, the medial triceps and ulnar nerve were addressed as well. Symptomatic improvement was achieved in all cases. Retrospective review of the ultrasound revealed the snapping MABC, though it was less effective prospectively in the cases when snapping MABC was not suspected. In conclusion, snapping of the MABC broadens the spectrum of disorders that results in snapping elbow. To our knowledge, we are unaware of prior reports of this entity.

  18. Usefulness of a Transconjunctival Approach in the Reconstruction of the Medial Blow-Out Wall Fracture.

    PubMed

    Lee, Chi An; Sun, Hook; Yun, Ji Young

    2017-06-01

    A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.

  19. Bipartite medial cuneiform: new frequencies from skeletal collections and a meta-analysis of previous cases.

    PubMed

    Burnett, S E; Case, D T

    2011-04-01

    Bipartition of the medial cuneiform is a malsegmentation defect of the foot characterized by separation of the normal cuneiform into dorsal and plantar segments. In many cases, these segments are held together by means of a cartilaginous or fibrocartilaginous bridge, resulting in a deep, lytic-like pit in dry bone reminiscent of those seen in cases of non-osseous tarsal coalition. Partial bipartition, where separation of the two segments is incomplete, may also occur. Though originally documented over 250 years ago, relatively little is known about the bipartite medial cuneiform. The purpose of this paper is to present thirteen new cases (ten complete, three partial) from Egypt, England, South Africa, Denmark, and the United States, and to analyze all known cases to investigate patterns in sex, laterality, frequency, and associated anomalies. Results suggest that bipartite medial cuneiforms are significantly more prevalent in males. Bipartite medial cuneiforms are also frequently bilateral, perhaps indicating a strong genetic component. Identification of this condition in multiple individuals from a cemetery could, therefore, suggest a familial relationship. Frequencies of this variant are consistently less than 1% in most large samples, and significant frequency differences among samples from around the world are rare. Several other minor congenital variations have been noted in individuals with bipartition of the medial cuneiform. However, additional systematic research is needed to elucidate further the prevalence of associated variants.

  20. The biomechanical and histological effects of posterior cruciate ligament rupture on the medial tibial plateau.

    PubMed

    Deng, Zhenhan; Li, Yusheng; Lin, Zhangyuan; Zhu, Yong; Zhao, Ruibo

    2017-03-23

    The objective of this study was to investigate the biomechanical and histological effects of the posterior cruciate ligament (PCL) on the medial tibial plateau. A total of 12 cadaveric human knee specimens were collected and grouped as follows: the PCL intact group (n = 12), the anterolateral bundle rupture group (n = 6), the postmedial bundle rupture group (n = 6), and the PCL rupture group (n = 12). The strain on the anterior, middle, and posterior parts of the medial tibial plateau with an axial loading force at different flexion angles was measured and analyzed, respectively. Forty-eight rabbits were chosen for animal study: surgery was performed on the one side of each rabbit randomly (experimental group), while the other side was taken as control (control group). Every 12 rabbits were culled at each of the four selected time points to collect the medial tibial plateau for morphological and histological observation. The PCL rupture, either partial or complete, may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all positions. Noticeable time-dependent degenerative histological changes of the medial tibial plateau were observed in the rabbit models of PCL rupture. Compared with the control group, all the PCL rupture groups exhibited a higher expression of the matrix metalloproteinase-7 (MMP-7) and the tissue inhibitors of metalloproteinase-1 (TIMP-1) at all the time points. Either partial or complete PCL rupture may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all the positions and may cause cartilage degeneration on the medial tibial plateau.

  1. Screw fixation of medial malleolar fractures: a cadaveric biomechanical study challenging the current AO philosophy.

    PubMed

    Parker, L; Garlick, N; McCarthy, I; Grechenig, S; Grechenig, W; Smitham, P

    2013-12-01

    The AO Foundation advocates the use of partially threaded lag screws in the fixation of fractures of the medial malleolus. However, their threads often bypass the radiodense physeal scar of the distal tibia, possibly failing to obtain more secure purchase and better compression of the fracture. We therefore hypothesised that the partially threaded screws commonly used to fix a medial malleolar fracture often provide suboptimal compression as a result of bypassing the physeal scar, and proposed that better compression of the fracture may be achieved with shorter partially threaded screws or fully threaded screws whose threads engage the physeal scar. We analysed compression at the fracture site in human cadaver medial malleoli treated with either 30 mm or 45 mm long partially threaded screws or 45 mm fully threaded screws. The median compression at the fracture site achieved with 30 mm partially threaded screws (0.95 kg/cm(2) (interquartile range (IQR) 0.8 to 1.2) and 45 mm fully threaded screws (1.0 kg/cm(2) (IQR 0.7 to 2.8)) was significantly higher than that achieved with 45 mm partially threaded screws (0.6 kg/cm(2) (IQR 0.2 to 0.9)) (p = 0.04 and p < 0.001, respectively). The fully threaded screws and the 30mm partially threaded screws were seen to engage the physeal scar under an image intensifier in each case. The results support the use of 30 mm partially threaded or 45 mm fully threaded screws that engage the physeal scar rather than longer partially threaded screws that do not. A 45 mm fully threaded screw may in practice offer additional benefit over 30 mm partially threaded screws in increasing the thread count in the denser paraphyseal region.

  2. Scaffolds for partial meniscal replacement: an updated systematic review.

    PubMed

    Papalia, Rocco; Franceschi, Francesco; Diaz Balzani, Lorenzo; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    Meniscectomy, a most common orthopaedic procedure, results in increased contact area of the articular surfaces of tibia and femur leading to early osteoarthritis. We systematically review the literature on clinical outcomes following partial meniscal replacement using different scaffolds. We performed a comprehensive search of Medline, CINAHL, Embase and the Cochrane Central Registry of Controlled Trials. The reference lists of the selected articles were then examined by hand. Only studies focusing on investigation of clinical outcomes on patients undergoing a partial meniscal replacement using a scaffold were selected. We then evaluated the methodological quality of each article using the Coleman methodology score (CMS), a 10 criteria scoring list assessing the methodological quality of the selected studies (CMS). Fifteen studies were included, all prospective studies, but only 2 were randomized controlled trials. Biological scaffolds were involved in 12 studies, 2 studies investigated synthetic scaffolds, whereas 1 remaining article presented data from the use of both classes of device. The mean modified CMS was 64.6. Several demographic and biomechanical factors could influence the outcomes of this treatment modality. Partial replacement using both classes of scaffolds achieves significant and encouraging improved clinical results when compared with baseline values or with controls when present, without no adverse reaction related to the device. There is a need for more and better designed randomized trials, to confirm with a stronger level of evidence the promising preliminary results achieved by the current research.

  3. The medial habenula: still neglected

    PubMed Central

    Viswanath, Humsini; Carter, Asasia Q.; Baldwin, Philip R.; Molfese, David L.; Salas, Ramiro

    2013-01-01

    The habenula is a small, bilateral brain structure located at the dorsal end of the diencephalon. This structure sends projections to the dopaminergic striatum and receives inputs from the limbic forebrain, making the habenula a unique modulator of cross-talk between these brain regions. Despite strong interest in the habenula during the seventies and eighties (Herkenham and Nauta, 1977; Beckstead, 1979; Beckstead et al., 1979; Herkenham and Nauta, 1979; Caldecott-Hazard et al., 1988), interest waned due to lack of a clearly identifiable functional role. Following Matsumoto and Hikosaka's seminal work on the lateral habenula as a predictor of negative reward in monkeys, the habenula has undergone a resurgence of scientific interest. Matsumoto and Hikosaka demonstrated an increase in habenular neuron firing when monkeys did not receive an expected juice reward (Matsumoto and Hikosaka, 2007). Studies have shown that increased habenular activity inactivates dopaminergic cells in the Rostromedial Tegmental Nucleus (RMTg) through GABAergic mechanisms (Jhou et al., 2009a,b). Additional studies link habenular activity to the regulation of serotonin and norepinephrine, suggesting the habenula modulates multiple brain systems (Strecker and Rosengren, 1989; Amat et al., 2001). These discoveries ushered in a series of new studies that have refocused attention on the lateral habenula and the importance of this small brain structure (Bianco and Wilson, 2009; Jhou et al., 2009a; Matsumoto and Hikosaka, 2009; Sartorius et al., 2010; Savitz et al., 2011). Recently, Geisler and Trimble reviewed this renewed interest in: The Lateral Habenula: No Longer Neglected (Geisler and Trimble, 2008). While the lateral habenula (LHb) has been extensively studied, the anatomically and histochemically distinct medial habenula (MHb) remains largely understudied. This short review argues that the MHb is functionally important and should be studied more aggressively. PMID:24478666

  4. [Tibial periostitis ("medial tibial stress syndrome")].

    PubMed

    Fournier, Pierre-Etienne

    2003-06-01

    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  5. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation.

    PubMed

    Bedoya, Maria A; McGraw, Michael H; Wells, Lawrence; Jaramillo, Diego

    2014-09-01

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed.

  6. Medial medullary infarction: abnormal ocular motor findings.

    PubMed

    Kim, J Soo; Choi, K-D; Oh, S-Y; Park, S-H; Han, M-K; Yoon, B-W; Roh, J-K

    2005-10-25

    In 20 consecutive patients with isolated medial medullary infarction, abnormal ocular motor findings included nystagmus (n = 8), ocular contrapulsion (n = 5), and contralesional ocular tilt reaction (n = 2). The nystagmus was ipsilesional (n = 4), gaze-evoked (n = 5), upbeating (n = 4), and hemiseesaw (n = 1). The ocular motor abnormalities may be explained by involvements of the nucleus prepositus hypoglossi, medial longitudinal fasciculus or efferent fibers from the vestibular nuclei, climbing fibers, and cells of the paramedian tracts.

  7. The medial sural artery perforator free flap.

    PubMed

    Cavadas, P C; Sanz-Giménez-Rico, J R; Gutierrez-de la Cámara, A; Navarro-Monzonís, A; Soler-Nomdedeu, S; Martínez-Soriano, F

    2001-11-01

    The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.

  8. MRI volume of the medial frontal cortex predicts financial capacity in patients with mild Alzheimer's disease.

    PubMed

    Stoeckel, Luke E; Stewart, Christopher C; Griffith, H Randall; Triebel, Kristen; Okonkwo, Ozioma C; den Hollander, Jan A; Martin, Roy C; Belue, Katherine; Copeland, Jacquelynn N; Harrell, Lindy E; Brockington, John C; Clark, David G; Marson, Daniel C

    2013-09-01

    Persons with mild Alzheimer's disease (AD) have significant deficits in financial abilities. This study examined the relationship between brain structure volumes, cognition, and financial capacity in patients with mild AD. Sixteen mild AD patients and 16 older adult comparisons completed the Financial Capacity Instrument (FCI), a psychometric measure of financial abilities, and also underwent magnetic resonance imaging (MRI) to obtain volumes of the bilateral hippocampi, angular gyri, precunei, and medial and dorsolateral frontal cortices. Mild AD patients performed significantly below comparisons on the FCI and had significantly smaller hippocampi. Among mild AD patients, FCI performance was moderately correlated with frontal (medial and dorsolateral frontal cortex) and posterior (angular gyri and precunei) cortical volumes. Stepwise regression demonstrated that medial frontal cortex volume predicted FCI score. The relationship between medial frontal cortex volume and overall FCI score was partially mediated by two measures of simple attention (DRS Attention, DRS Construction). The findings suggest that medial frontal cortex atrophy and associated declines in simple attention play an increasingly important role in declining financial skills in patients with mild AD.

  9. Beta2-adrenergic agonist-induced hypertrophy of the quadriceps skeletal muscle does not modulate disease severity in the rodent meniscectomy model of osteoarthritis.

    PubMed

    Tonge, D P; Jones, S W; Parr, T; Bardsley, R; Doherty, M; Maciewicz, R A

    2010-04-01

    To examine whether beta2-adrenergic agonist-induced hypertrophy of the quadriceps skeletal muscle can modulate the severity of osteoarthritis (OA) in the rodent meniscectomy (MNX) model. Male Lewis rats were subcutaneously administered with 1.5 mg/kg/day clenbuterol hydrochloride (n=15) or saline vehicle (n=20) for 14 days. Following pre-treatment, five animals from each group were sacrificed to assess the immediate effects of clenbuterol. The remaining animals underwent either invasive knee surgery (clenbuterol pre-treated n=10; saline pre-treated n=10) or a sham control surgical procedure (saline pre-treated n=5). During disease initiation and progression, weight bearing was assessed by hindlimb loading. Myosin heavy chain (MHC) protein isoforms were quantified by silver stained SDS PAGE. OA severity was graded by assessment of toluidine blue stained step coronal sections of the total knee joint. Clenbuterol treatment resulted in an increase in total bodyweight, growth rate and in quadriceps skeletal muscle mass. Meniscal surgery resulted in the development of OA-like lesions, changes to weight bearing, and changes in MHC protein expression in the quadriceps. Clenbuterol-induced skeletal muscle hypertrophy had no effect on either weight bearing or articular pathology following MNX surgery. Our data reveal that clenbuterol-induced skeletal muscle hypertrophy is unable to mimic the beneficial clinical effects of increased musculature derived through targeted strength training in humans, in a rodent model of MNX-induced OA. In addition we observed fibre-type switching to "slow twitch" in the quadriceps muscle during the induction of OA that warrants further investigation as to its relationship to joint stability. 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  10. Medial thighplasty: Current concepts and practices.

    PubMed

    Bertheuil, N; Carloni, R; De Runz, A; Herlin, C; Girard, P; Watier, E; Chaput, B

    2016-02-01

    Medial thighplasty, also known as medial thigh lift, is a procedure that has been carried out for five decades. The original "Lewis" technique has undergone many changes, and thereby been rendered widely available to plastic surgeons. Given the increasingly high number of surgical reconstructions after massive weight loss, this technique is now an integral part of a surgeon's therapeutic arsenal as he strives to meet the evolving demands of patients. The objective of this article, which is based on a comprehensive review of the literature, is to summarize current knowledge on medial thighplasty and thereby allow plastic surgeons to adopt the operating technique best suited to the deformations presented by their patients and to the overall context. The different techniques, outcomes and complications are successively discussed. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Os subtibiale: Mimicking medial malleolar fracture.

    PubMed

    Topal, Murat; Köse, Ahmet; Dinçer, Recep; Baran, Tuncay; Köse, Mehmet; Çağatay Engin, M

    2017-06-01

    There are numerous sesamoids and accessory ossicles around the foot which can easily be misdiagnosed as fractures. Os subtibiale is a very rare normal variant of the medial malleolus which is usually diagnosed incidentally in routine ankle radiographs. In this report, we present a case series of 3 patients with os subtibiale who were admitted to the emergency department with ankle sprains and misdiagnosed as medial malleolar fractures. We would like to raise awareness to the very rare and usually asymptomatic os subtibiale as a diagnostic pitfall. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Medial Canthoplasty Combined with Conjunctivodacryocystorhinostomy for the Treatment of Delayed Medial Telecanthal Deformity

    PubMed Central

    Sun, Hua; Li, Yang; Huang, Qian; Ding, Jing-Wen; Hou, Zhi-Jia; Li, Dong-Mei

    2017-01-01

    Background: Rupture of the medial canthal ligament can be caused by many events. It remains a challenge to rebuild the drainage system and restore the function. The aim of this study was to evaluate the clinical efficacy of medial canthoplasty combined with conjunctivodacryocystorhinostomy (CDCR) in patients with medial telecanthal deformities and lacrimal drainage system damage. Methods: Twenty-two patients (22 eyes) treated with medial canthoplasty and CDCR during June 2012 to June 2014 were included in this retrospective study. For all patients, a self-tapping, titanium, low-profile head microscrew was drilled into the solid bone on the posterior aspect of the anterior lacrimal crest at the attachment position of the medial canthal ligament. Medpor-coated tear drainage tubes were applied. Distance of patient's lateral displacement before and after operation was recorded and compared. The complications of CDCR were described. Results: Before the surgery, distance of patient's canthal displacement was 4–6 mm. The canthal distance between two eyes of patients with surgery was 1 mm or less. Among patients with CDCR, four patients had proximal obstruction and two patients had distal obstruction. Five patients had tube malposition, for example, tube extrusion 1–3 months after surgery. Conclusions: Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system. PMID:28303853

  13. [Arthritis of the Medial Knee Joint Compartment].

    PubMed

    Matziolis, G; Röhner, E

    2015-10-01

    23 % of all persons older than 65 years suffer from osteoarthritis of the medial compartment of the knee joint, a very common situation in orthopaedic practice 1. As a result of the demographic trend the number of patients is expected to increase in the future. Based on specific joint biomechanics and kinematics the medial knee joint compartment is more frequently affected than the lateral. Only an understanding of the functional anatomy and underlying pathology allows a critical evaluation of different available conservative and operative treatment options. This article gives an overview of diagnostic and therapeutic strategies of osteoarthritis of the medial knee joint. Frequently performed surgeries, e.g. high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) will be presented in a comparative manner. The actual scientific evidence will be given with the goal of an evidence based therapy that is adopted to stage and pathology of osteoarthritis of the medial compartment of the knee joint. Georg Thieme Verlag KG Stuttgart · New York.

  14. Medial Patellar Instability: Treatment and Outcomes

    PubMed Central

    Moatshe, Gilbert; Cram, Tyler R.; Chahla, Jorge; Cinque, Mark E.; Godin, Jonathan A.; LaPrade, Robert F.

    2017-01-01

    Background: Historically, a lateral retinacular release was one of the primary surgical interventions used to treat lateral patellar instability. However, disruption of the lateral structures during this procedure has been associated with medial instability of the patella. Hypothesis: We hypothesize that good to excellent outcomes can be achieved at midterm follow-up after lateral patellotibial ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Thirteen patients were treated for medial patellar instability with a lateral patellotibial ligament reconstruction between May 2011 and December 2013 by a single surgeon. All patients had previously undergone a lateral release procedure and had symptomatic medial patellar instability. Patients were evaluated using patient-reported outcome scores at a minimum of 2 years postsurgery. Results: The mean Lysholm score improved from 45.6 (range, 11-76) to 71.9 (range, 30-91). The median preoperative Tegner activity scale score was 3 (range, 1-7), while the median postoperative score was 4 (range, 1-9). The median Western Ontario and McMaster Universities Arthritis Index (WOMAC) total score improved from 38 (range, 1-57) preoperatively to 6 postoperatively (range, 0-52). The mean patient satisfaction postoperatively was 8.2 (range, 5-10). Conclusion: Significantly improved outcomes can be achieved at midterm follow-up with a low rate of complications when reconstructing the lateral patellotibial ligament in the setting of iatrogenic medial patellar instability. PMID:28451613

  15. Affective Aprosodia from a Medial Frontal Stroke

    ERIC Educational Resources Information Center

    Heilman, Kenneth M.; Leon, Susan A.; Rosenbek, John C.

    2004-01-01

    Background and objectives: Whereas injury to the left hemisphere induces aphasia, injury to the right hemisphere's perisylvian region induces an impairment of emotional speech prosody (affective aprosodia). Left-sided medial frontal lesions are associated with reduced verbal fluency with relatively intact comprehension and repetition…

  16. Affective Aprosodia from a Medial Frontal Stroke

    ERIC Educational Resources Information Center

    Heilman, Kenneth M.; Leon, Susan A.; Rosenbek, John C.

    2004-01-01

    Background and objectives: Whereas injury to the left hemisphere induces aphasia, injury to the right hemisphere's perisylvian region induces an impairment of emotional speech prosody (affective aprosodia). Left-sided medial frontal lesions are associated with reduced verbal fluency with relatively intact comprehension and repetition…

  17. Medial elbow injury in young throwing athletes

    PubMed Central

    Gregory, Bonnie; Nyland, John

    2013-01-01

    Summary This report reviews the anatomy, overhead throwing biomechanics, injury mechanism and incidence, physical examination and diagnosis, diagnostic imaging and conservative treatment of medial elbow injuries in young throwing athletes. Based on the information a clinical management decision-making algorithm is presented. PMID:23888291

  18. Arthroscopic Rotator Cuff Repair With Absorbable Sutures in the Medial-Row Anchors.

    PubMed

    Tanaka, Makoto; Hayashida, Kenji; Kobayashi, Atsushi; Kakiuchi, Masaaki

    2015-11-01

    To report the retear rate and retear pattern after double-row arthroscopic rotator cuff repair (DR-ARCR) with the use of absorbable sutures as medial anchor sutures and to address the advantage of the use of absorbable sutures in medial-row anchors. Fifty-seven shoulders (22 male and 35 female patients; mean age, 66.1 years) with complete rotator cuff tears treated with DR-ARCR using absorbable mattress sutures as medial-row anchor sutures were included in the study. They included 35 medium, 17 large, and 5 massive tears. For the medial row, medial anchor sutures were replaced with absorbable mattress sutures. High-strength simple sutures were used for the lateral anchors. We evaluated retear patterns by magnetic resonance imaging examinations performed at 1 month, 3 months, 6 months, and 1 year postoperatively. The clinical conditions of all patients preoperatively and 2 years postoperatively were assessed by the University of California, Los Angeles rating scale and the American Shoulder and Elbow Surgeons shoulder index. A complete retear of the tendon at the footprint was observed in 5 shoulders. Complete discontinuity at the middle of the tendon around the medial-row anchors with a footprint remnant was observed in 1 shoulder. A thinned repaired rotator cuff was observed in 2 shoulders because of a partial retear of the deep layer. The overall retear rate was 14%. From before to after surgery, the University of California, Los Angeles score significantly improved from 18.4 to 32.9 (P < .0001) and the American Shoulder and Elbow Surgeons index improved from 55.1 to 87.7 (P < .0001). No complications were observed. The retear rates after DR-ARCR with absorbable sutures as medial-row anchors were 8.8% for complete retears of the tendon at the footprint and 1.7% for complete discontinuity of tendon around the medial-row anchors. This procedure provided a low retear rate around the medial-row anchors. Level IV, therapeutic case series. Copyright © 2015

  19. Partial Tonsillectomy.

    PubMed

    Wong, Kevin; Levi, Jessica R

    2017-03-01

    Evaluate the content and readability of health information regarding partial tonsillectomy. A web search was performed using the term partial tonsillectomy in Google, Yahoo!, and Bing. The first 50 websites from each search were evaluated using HONcode standards for quality and content. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and SMOG score. The Freeman-Halton extension of Fisher's exact test was used to compare categorical differences between engines. Less than half of the websites mentioned patient eligibility criteria (43.3%), referenced peer-reviewed literature (43.3%), or provided a procedure description (46.7%). Twenty-two websites (14.7%) were unrelated to partial tonsillectomy, and over half contained advertisements (52%). These finding were consistent across search engines and search terms. The mean FKGL was 11.6 ± 0.11, Gunning-Fog Index was 15.1 ± 0.13, Coleman-Liau Index was 14.6 ± 0.11, ARI was 12.9 ± 0.13, and SMOG grade was 14.0 ± 0.1. All readability levels exceeded the abilities of the average American adult. Current online information regarding partial tonsillectomy may not provide adequate information and may be written at a level too difficult for the average adult reader.

  20. Larger medial femoral to tibial condylar dimension may trigger posterior root tear of medial meniscus.

    PubMed

    Chung, Jun Young; Song, Hyung Keun; Jung, Myung Kuk; Oh, Hyeong Tak; Kim, Joon Ho; Yoon, Ji-Sang; Min, Byoung-Hyun

    2016-05-01

    The major meniscal functions are load bearing, load distribution, and shock absorption by increasing the tibiofemoral joint (TFJ) contact area and dissipating axial loads by conversion into hoop stresses. The increased hoop strain stretches the meniscus in outward direction towards radius, causing extrusion, which is associated with the root tear and resultant degenerative osteoarthritis. Since the larger contact area of medial TFJ may increase the hoop stresses, we hypothesized that the larger medial femoral to tibial condylar dimension would contribute to the development of medial meniscus posterior root tear (MMPRT). Thus, the purpose of the study was to assess the relationship between MMPRT and medial femoral to tibial condylar dimension. A case-control study was conducted to compare medial femoral to tibial condylar dimensions of patients with complete MMPRT (n = 59) with those of demography-matched controls (n = 59) during the period from 2010 to 2013. In each patient, MRIs were reviewed and several parameters were measured including articulation width of medial femoral condyle (MFC) at 0°, 30°, 60°, and 90°, medial tibial condyle (MTC) width, degree of meniscal extrusion, and medial femoral to tibial condylar width ratio (MFC/MTC) at 0°, 30°, 60°, and 90°, respectively. Demographic and radiographic data were assessed. A larger medial femoral to tibial condylar dimension was associated with MMPRT at 0° and 30° knee angles. Patients with MFC/MTC greater than 0.9 at 0° also showed about 2.5-fold increase in the chance of MMPRT. Those with meniscal extrusion greater than 3 mm also had about 17.1 times greater chance for the presence of MMPRT accordingly. A larger medial femoral to tibial condylar dimension may be considered as one of the regional contributors to the outbreak of MMPRT, and medial femoral to tibial condylar width ratio greater than 0.9 at 0° knee angle may be considered as a significant risk factor for MMPRT. III.

  1. Usefulness of a Transconjunctival Approach in the Reconstruction of the Medial Blow-Out Wall Fracture

    PubMed Central

    Lee, Chi An; Yun, Ji Young

    2017-01-01

    Background A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. Methods We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. Results A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. Conclusion It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor. PMID:28913311

  2. Isolated Medial Rectus Palsy: Rare Presentation of Mesencephalon Infarction.

    PubMed

    Yao, Yindan; Hong, Wenke; Fan, Zhenyi; Li, Da; Chang, Xianchao; Fan, Weinv

    2017-04-01

    Isolated medial rectus palsy due to mesencephalon lesion is extremely rare. We here describe a patient of midbrain infarction involving the medial rectus subnuclei presenting as isolated medial rectus palsy. Axial diffusion-weighted and coronal T2-weighted magnetic resonance imaging showed acute ischemic lesion in mesencephalon. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Suppression of the late component of the carotid occlusion reflex by lesion of the medial forebrain bundle in the rat.

    PubMed

    Lopes, O U; Timo-Iaria, C; Leitão-Filho, H A

    1981-04-01

    1. The pressor response to a prolonged carotid occlusion in the rat has two components: an early, fast increase in blood pressure, and a late, slow and sustained hypertension. Since the second component can be blocked by a disconnecting lesion near the medial side of the medial forebrain bundle, the hypothesis that this complex structure is involved in the integration of the late pressor reflex was tested. 2. The medial forebrain bundle was partially or completely destroyed, or a disconnecting lesion was made to interrupt some of its medially running afferents and/or efferents. Incomplete lesion caused a transient suppression of the second component in 4 rats, whereas complete lesion in 5 rats or probable interruption of the medial efferent pathways in 3 rats led to suppression of the late component when the one-minute occlusion was performed within one hour after the lesion. 3. The data show that the medial forebrain bundle plays an important role in the integration of the late component of the pressor response to prolonged carotid occlusion.

  4. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy.

    PubMed

    Jung, Woon-Hwa; Takeuchi, Ryohei; Chun, Chung-Woo; Lee, Jung-Su; Ha, Jae-Hun; Kim, Ji-Hyae; Jeong, Jae-Heon

    2014-01-01

    The purposes of this study were to evaluate regeneration of the articular cartilage after medial opening-wedge high tibial osteotomy for knees with medial-compartment osteoarthritis and to assess the clinical outcome and cartilage regeneration according to the postoperative limb alignment at 2 years postoperatively. The study involved 159 knees in 159 patients. For evaluation of cartilage degeneration, the International Cartilage Repair Society grading system was used for arthroscopic grading on initial arthroscopy during high tibial osteotomy. The patients underwent a second-look arthroscopic evaluation of the articular cartilage at the time of removal of the plate, an average of 2 years after the initial osteotomy. For evaluation of cartilage regeneration, the articular cartilage was classified into 2 stages as no regenerative change (grade 1) or white scattering with fibrocartilage, partial coverage with fibrocartilage, or even coverage with fibrocartilage (grade 2) on second-look arthroscopy. Maturation of the cartilage regeneration was defined as even coverage with fibrocartilage. "Immaturation" of the cartilage regeneration was defined as white scattering with fibrocartilage or partial coverage with fibrocartilage. Clinical evaluations were performed by use of Knee Society scores preoperatively and at 2 years postoperatively. We divided the knees into 3 groups according to the postoperative limb alignment. Group A comprised knees with a mechanical tibiofemoral angle of 0° or less. Group B comprised knees with a mechanical tibiofemoral angle greater than 0° and less than 6°. Group C comprised knees with a mechanical tibiofemoral angle of 6° or greater. Grade 2 regeneration was achieved in the medial femoral condyle articular cartilage in 92% of knees and in the medial tibial plateau articular cartilage in 69% of knees. Maturation of the cartilage regeneration was found in the medial femoral condyle articular cartilage in 4% of knees and in the medial

  5. Masseter and medial pterygoid muscle hypertrophy.

    PubMed

    Guruprasad, R; Rishi, Sudhirkumar; Nair, Preeti P; Thomas, Shaji

    2011-09-26

    Hypertrophy refers to an enlargement caused by an increase in the size but not in the number of cells. Generalised masticatory muscle hypertrophy may affect the temporalis muscle, masseters and medial pterygoids in a variety of combinations. Masseteric hypertrophy may present as either unilateral or bilateral painless swelling of unknown origin in the region of angle of mandible. It is a relatively rare condition and presents a diagnostic dilemma. While the history and clinical examination are important in differentiating this benign condition from parotid or dental pathology, they cannot necessarily exclude rare malignant lesion within the muscle. Advanced imaging modalities like CT and MRI are essential to confirm the diagnosis. Here the authors are reporting a unique case of masseter muscle hypertrophy along with medial pterygoid hypertrophy which was missed clinically but confirmed using CT and MRI.

  6. Medial Cochlear Efferent Function: A Theoretical Analysis

    NASA Astrophysics Data System (ADS)

    Mountain, David C.

    2011-11-01

    Since the discovery of the cochlear efferent system, many hypotheses have been put forth for its function. These hypotheses for its function range from protecting the cochlea from over stimulation to improving the detection of sounds in noise. It is known that the medial efferent system innervates the outer hair cells and that stimulation of this system reduces basilar membrane and auditory nerve sensitivity which suggests that this system acts to decrease the gain of the cochlear amplifier. Here I present modeling results as well as analysis of published experimental data that suggest that the function of the medial efferent reflex is to decrease the cochlear amplifier gain by just the right amount so that the nonlinearity in the basilar membrane response lines up perfectly with the inner hair cell nonlinear transduction process to produce a hair cell receptor potential that is proportional to the logarithm of the sound pressure level.

  7. [SECOT consensus on medial femorotibial osteoarthritis].

    PubMed

    Moreno, A; Silvestre, A; Carpintero, P

    2013-01-01

    A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  8. Masseter and medial pterygoid muscle hypertrophy

    PubMed Central

    R, Guruprasad; Rishi, Sudhirkumar; Nair, Preeti P; Thomas, Shaji

    2011-01-01

    Hypertrophy refers to an enlargement caused by an increase in the size but not in the number of cells. Generalised masticatory muscle hypertrophy may affect the temporalis muscle, masseters and medial pterygoids in a variety of combinations. Masseteric hypertrophy may present as either unilateral or bilateral painless swelling of unknown origin in the region of angle of mandible. It is a relatively rare condition and presents a diagnostic dilemma. While the history and clinical examination are important in differentiating this benign condition from parotid or dental pathology, they cannot necessarily exclude rare malignant lesion within the muscle. Advanced imaging modalities like CT and MRI are essential to confirm the diagnosis. Here the authors are reporting a unique case of masseter muscle hypertrophy along with medial pterygoid hypertrophy which was missed clinically but confirmed using CT and MRI. PMID:22679271

  9. Osteoligamentous injuries of the medial ankle joint.

    PubMed

    Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

    2015-12-01

    Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

  10. Medial septal lesion enhances general anesthesia response.

    PubMed

    Leung, L Stan; Ma, Jingyi; Shen, Bixia; Nachim, Ilan; Luo, Tao

    2013-09-01

    Electrolytic lesion of the medial septum, a basal forebrain nucleus that projects to the hippocampus, prolonged the emergence from general anesthesia in rats. Septal lesioned rats required a longer time to recover from a loss of righting reflex (LORR) and a loss of tail-pinch response after injectable (20 mg/kg i.p. pentobarbital, 5mg/kg i.v. propofol) or volatile (1.5% halothane, 2% isoflurane) anesthetic. When incremental doses of propofol were given i.p., septal lesioned rats as compared to control rats showed LORR at a lower dose of propofol. Similarly, when the rats were exposed to increasing concentrations of isoflurane, the percent of rats showing LORR was leftward shifted for lesioned rats as compared to control rats. Septal lesioned rats as compared to control rats showed decreased locomotor activity when exposed to 1.5% halothane. Lesion of the medial septum was confirmed by thionin-stained histological sections as well as loss of acetylcholinesterase (AchE) staining in the hippocampus, indicating a depletion of septohippocampal cholinergic afferents. Medial septal lesion resulted in a near complete loss of hippocampal theta rhythm during walking and a general decrease in power of the hippocampal EEG at all frequencies (0-100 Hz), during walking or immobility. It is concluded that lesion of medial septum, in part through a loss of septohippocampal cholinergic afferents, increased the anesthesia response to volatile and injectable general anesthetics, during both induction and emergence. It is suggested that the septohippocampal system participates in many components of general anesthesia including hypnosis, immobility, and analgesia.

  11. Osteochondrosis of the accessory ossification centre of the medial malleolus.

    PubMed

    Farsetti, Pasquale; Dragoni, Massimiliano; Potenza, Vito; Caterini, Roberto

    2015-01-01

    We report a case of a painful accessory ossification centre of the medial malleolus in an 11-year-old girl who was not involved in sports activities. The patient was treated conservatively, with complete clinical and radiographic healing of the medial malleolus 6 months after the first presentation. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during skeletal growth, such as traction apophysitis of the medial malleolus, osteochondrosis, osteochondritis or avascular necrosis of the distal tibial epiphysis. We speculate that this painful condition may be classified as an osteochondrosis of the accessory ossification centre of the medial malleolus.

  12. Variations in the origin of the medial calcaneal nerve.

    PubMed

    Dellon, A Lee; Kim, Jaesuk; Spaulding, Cecily M

    2002-02-01

    Previous anatomic studies of the medial heel region were done on embalmed human cadavers. Here, the innervation of the medial heel region was studied by dissecting living tissue with the use of 3.5-power loupe magnification during decompression of the medial ankle for tarsal tunnel syndrome in 85 feet. The medial heel was found to be innervated by just one medial calcaneal nerve in 37% of the feet, by two medial calcaneal nerves in 41%, by three medial calcaneal nerves in 19%, and by four medial calcaneal nerves in 3%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch, where it is at risk for injury during calcaneal spur removal or plantar fasciotomy. Knowledge of the variations in location of the medial calcaneal nerves may prevent neuroma formation during surgery and provide insight into the variability of heel symptoms associated with tarsal tunnel syndrome.

  13. Application of Additional Medial Plate in Treatment of Proximal Humeral Fractures With Unstable Medial Column

    PubMed Central

    He, Yu; He, Jiliang; Wang, Fu; Zhou, Dongsheng; Wang, Yan; Wang, Bomin; Xu, Shihong

    2015-01-01

    Abstract The purpose of this study was to use finite element analysis to compare the biomechanical characteristics after lateral locking plate (LLP) or LLP with a medial anatomical locking plate (LLP-MLP) fixation of proximal humeral fractures with an unstable medial column. First, a 3-dimensional, finite element analysis model was developed. Next, LLP and LLP-MLP implants were instrumented into the proximal humeral fracture models. Compressive and rotational loads were then applied to the humerus model to determine the biomechanical characteristics. Both normal and osteoporotic proximal humerus fractures were simulated using 2 internal fixation methods each under 7 loading conditions. To assess the biomechanical characteristics, the construct stiffness, fracture micromotion, and stress distribution on the implants were recorded and compared. The LLP-MLP method provided both lateral and medial support that reduced the stress on the LLP and the amount of displacement in the fracture region. In contrast, the LLP method resulted in more instability in the medial column and larger magnitudes of stress. In osteoporotic bone, the LLP was more inclined to fail than LLP-MLP. The LLP-MLP method provides a strong support for the medial column and increases the stability of the region surrounding the fracture. PMID:26469918

  14. Persistently active neurons in human medial frontal and medial temporal lobe support working memory.

    PubMed

    Kamiński, Jan; Sullivan, Shannon; Chung, Jeffrey M; Ross, Ian B; Mamelak, Adam N; Rutishauser, Ueli

    2017-04-01

    Persistent neural activity is a putative mechanism for the maintenance of working memories. Persistent activity relies on the activity of a distributed network of areas, but the differential contribution of each area remains unclear. We recorded single neurons in the human medial frontal cortex and medial temporal lobe while subjects held up to three items in memory. We found persistently active neurons in both areas. Persistent activity of hippocampal and amygdala neurons was stimulus-specific, formed stable attractors and was predictive of memory content. Medial frontal cortex persistent activity, on the other hand, was modulated by memory load and task set but was not stimulus-specific. Trial-by-trial variability in persistent activity in both areas was related to memory strength, because it predicted the speed and accuracy by which stimuli were remembered. This work reveals, in humans, direct evidence for a distributed network of persistently active neurons supporting working memory maintenance.

  15. Persistently active neurons in human medial frontal and medial temporal lobe support working memory

    PubMed Central

    Kamiński, J; Sullivan, S; Chung, JM; Ross, IB; Mamelak, AN; Rutishauser, U

    2017-01-01

    Persistent neural activity is a putative mechanism for the maintenance of working memories. Persistent activity relies on the activity of a distributed network of areas, but the differential contribution of each area remains unclear. We recorded single neurons in the human medial frontal cortex and the medial temporal lobe while subjects held up to three items in memory. We found persistently active neurons in both areas. Persistent activity of hippocampal and amygdala neurons was stimulus-specific, formed stable attractors, and was predictive of memory content. Medial frontal cortex persistent activity, on the other hand, was modulated by memory load and task set but was not stimulus-specific. Trial-by-trial variability in persistent activity in both areas was related to memory strength, because it predicted the speed and accuracy by which stimuli were remembered. This work reveals, in humans, direct evidence for a distributed network of persistently active neurons supporting working memory maintenance. PMID:28218914

  16. Management of medial-sided knee injuries, part 1: medial collateral ligament.

    PubMed

    Marchant, Milford H; Tibor, Lisa M; Sekiya, Jon K; Hardaker, William T; Garrett, William E; Taylor, Dean C

    2011-05-01

    The medial collateral ligament complex is a primary stabilizer that combines static and dynamic resistance to direct valgus stress while contributing significant restraints to rotatory motion and anterior-posterior translation. Varying opinions exist among investigators regarding injury classification and treatment algorithms. Whereas most agree that the majority of isolated medial collateral ligament complex injuries can be treated nonoperatively, isolated injuries with chronic instability and multiligament injuries may require operative intervention. Substantial confounding factors are present within published reports, making comparative analyses and systematic review challenging. This review focuses on the anatomy and biomechanics of the medial structures of the knee; it discusses the clinical evaluation of complex injuries; and it reviews nonoperative and operative treatment methods.

  17. Medially constrained deformable modeling for segmentation of branching medial structures: Application to aortic valve segmentation and morphometry.

    PubMed

    Pouch, Alison M; Tian, Sijie; Takebe, Manabu; Yuan, Jiefu; Gorman, Robert; Cheung, Albert T; Wang, Hongzhi; Jackson, Benjamin M; Gorman, Joseph H; Gorman, Robert C; Yushkevich, Paul A

    2015-12-01

    Deformable modeling with medial axis representation is a useful means of segmenting and parametrically describing the shape of anatomical structures in medical images. Continuous medial representation (cm-rep) is a "skeleton-first" approach to deformable medial modeling that explicitly parameterizes an object's medial axis and derives the object's boundary algorithmically. Although cm-rep has effectively been used to segment and model a number of anatomical structures with non-branching medial topologies, the framework is challenging to apply to objects with branching medial geometries since branch curves in the medial axis are difficult to parameterize. In this work, we demonstrate the first clinical application of a new "boundary-first" deformable medial modeling paradigm, wherein an object's boundary is explicitly described and constraints are imposed on boundary geometry to preserve the branching configuration of the medial axis during model deformation. This "boundary-first" framework is leveraged to segment and morphologically analyze the aortic valve apparatus in 3D echocardiographic images. Relative to manual tracing, segmentation with deformable medial modeling achieves a mean boundary error of 0.41 ± 0.10 mm (approximately one voxel) in 22 3DE images of normal aortic valves at systole. Deformable medial modeling is additionally demonstrated on pathological cases, including aortic stenosis, Marfan syndrome, and bicuspid aortic valve disease. This study demonstrates a promising approach for quantitative 3DE analysis of aortic valve morphology. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Post-ablative reconstruction of the medial canthus and medial orbital wall using conchal cartilage graft with three illustrative cases.

    PubMed

    Dagregorio, G; Darsonval, V

    2005-12-01

    When the medial third of the upper or lower eyelid has to be reconstructed after full-thickness tumour excision, we usually use Hübner tarsomarginal grafts, but when medial canthal lesions spread to the medial orbital wall without invading the orbital margin, conchal graft becomes our first surgical option. Previously reported solutions to this difficult problem are few and concern more directly medial orbital wall fractures. We found no article dealing specifically with the use of conchal graft in post-ablative reconstruction of the medial orbital wall. Nevertheless the concha presents great advantages over bone grafting or rib cartilage, because it is more flexible and malleable. And it is less prone to extrusion or infection as may be allografts implants. It is a very effective way to repair medial orbital defects, but graft reorientation must be perfect to match exactly the medial orbital wall concavity.

  19. The lateral column lengthening and medial column stabilization procedures.

    PubMed

    Chi, T D; Toolan, B C; Sangeorzan, B J; Hansen, S T

    1999-08-01

    The results of medial column stabilization, lateral column lengthening, and combined medial and lateral procedures were reviewed in the treatment of adult acquired flatfoot secondary to posterior tibialis tendon insufficiency. All bony procedures were accompanied by transfer of the flexor digitorum longus tendon to the medial cuneiform or stump of the posterior tibialis tendon and tendoachilles lengthening or gastrocnemius recession. Medial column fusion was performed for naviculocuneiform and cuneiform first metatarsal sag; lateral column lengthening was performed for calcaneovalgus deformity with a flat pitch angle; and combined procedures were performed for complex combined deformities. At 1 to 4 year followup of 65 feet, 88% of the feet that had lateral column lengthening, 80% that had medial column stabilization, and 88% of the feet that had medial and lateral procedures had a decrease in pain or were pain free. The lateral talar first metatarsal angle improved by 16 degrees in the patients in the lateral column lengthening group, 20 degrees in the patients in the medial column stabilization group, and 24 degrees in the patients in the combined medial and lateral procedures group. The anteroposterior talonavicular coverage angle improved by 14 degrees in the patients in the lateral column lengthening group, 10 degrees in the patients in the medial column stabilization group, and 14 degrees in the patients in the combined medial and lateral procedures group. These techniques effectively correct deformity without disrupting the essential joints of the hindfoot and midfoot.

  20. Microvascular medial femoral condylar flaps in 107 consecutive reconstructions in the head and neck.

    PubMed

    Brandtner, Christian; Hachleitner, Johannes; Bottini, Gian Battista; Buerger, Heinz; Gaggl, Alexander

    2016-07-01

    We have assessed the role of the medial femoral condylar flap in 107 patients who had reconstructions of the head and neck. We retrospectively reviewed their medical records for indications, complications, and outcomes. The flap was primarily used for coverage of alveolar ridge defects (n=67), secondly for defects of the facial bone, calvaria, or skull base (n=35), and thirdly for partial laryngeal defects (n=5). Two flaps were lost. One patient fractured a femur 5 weeks postoperatively. The duration of follow up ranged from 6 months to 12 years. The medial femoral condylar flap is well-suited to individual reconstructions of the alveolar ridge, midface, calvaria, skull base, and part of the larynx with poor recipient sites. The flap does not replace other wellknown flaps, but offers new solutions for solving special problems in head and neck surgery.

  1. A novel method for measuring medial compartment pressures within the knee joint in-vivo.

    PubMed

    Anderson, Iain A; MacDiarmid, Andrew A; Lance Harris, M; Mark Gillies, R; Phelps, Rhona; Walsh, W R

    2003-09-01

    A novel method for the measurement of knee joint forces in-vivo is described. A thin (0.2mm) flexible electronic pressure sensor was inserted through a narrow arthroscopic portal into the osteoarthritic medial compartment of the knee joint. The sensor partially covered the load bearing area. The surgery was performed under local anaesthetic during normal arthroscopic examination following patient consent. Results are presented for 11 patients. The method was used in a pilot study to assess the effects of four valgus knee braces on medial compartment forces. An analysis of variance could not detect un-loading by any brace although there were large variations in force output. These variations may be attributable to shifts in the sensor position. In-vivo measurement of joint force is technically feasible.

  2. Consensus Statement on Indications and Contraindications for Medial Unicompartmental Knee Arthroplasty.

    PubMed

    Berend, Keith R; Berend, Michael E; Dalury, David F; Argenson, Jean-Noel; Dodd, Chris A; Scott, Richard D

    2015-01-01

    Previous work, now nearly 30 years dated, is frequently cited as the "gold standard" for the indications and contraindications for medial unicompartmental knee arthroplasty (UKA). The purpose of this article is to review current literature on the indications and contraindications to UKA and develop a consensus statement based on those data. Six surgeons with a combined experience of performing more than 8,000 partial knee arthroplasties were surveyed. Surgeons then participated in a discussion, emerging proposal, collaborative modification, and final consensus phase. The final consensus on primary indications and contraindications is presented. Notably, the authors provide consensus on previous contraindications, which are no longer considered to be contraindications. The authors provide an updated and concise review of the current indications and contraindications for medial UKA using scientifically based consensus-building methodology.

  3. Medial unicondylar knee arthroplasty: technical pearls

    PubMed Central

    BONIFORTI, FILIPPO

    2015-01-01

    Unicondylar knee arthroplasty implantation is extremely demanding as the prosthesis needs to be integrated in the natural anatomy of the knee. It ensures the integrity of the natural knee kinematic. Some studies and registries data have shown lower success rate in comparison with total knee arthroplasty, and patient-related factors may have an impact on outcome. While, better results have been published by high volume centres. The indications for surgery should be reconsidered critically, even if medial osteoarthritis of the knee remains the most common. This article sets out the diagnostic, and surgical steps in order to fine tuning the unicompartmental replacement of the knee. PMID:26605256

  4. Partial proximal tibia fractures

    PubMed Central

    Raschke, Michael J.; Kittl, Christoph; Domnick, Christoph

    2017-01-01

    Partial tibial plateau fractures may occur as a consequence of either valgus or varus trauma combined with a rotational and axial compression component. High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density. Pre-operative classification of these fractures, by Müller AO, Schatzker or novel CT-based methods, helps to understand the fracture pattern and choose the surgical approach and treatment strategy in accordance with estimated bone mineral density and the individual history of each patient. Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Intra-articular joint displacement ⩾ 2 mm, open fractures or fractures of the medial condyle should be reduced and fixed operatively. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects. A variety of minimally invasive approaches, temporary osteotomies and novel techniques (e.g. arthroscopically assisted reduction or ‘jail-type’ screw osteosynthesis) offer a range of choices for the individual and are potentially less invasive treatments. Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors (age, compliance, mobility). To avoid stiffness, early functional mobilisation plays a major role in rehabilitation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160067. Originally published online at www.efortopenreviews.org PMID:28630761

  5. Medial knee joint loading increases in those who respond to hyaluronan injection for medial knee osteoarthritis.

    PubMed

    Briem, Kristin; Axe, Michael J; Snyder-Mackler, Lynn

    2009-11-01

    Knee osteoarthritis (OA) is a cause of decline in function and the medial compartment is often affected. Intraarticular injection of hyaluronic acid (HA) is indicated as a symptom modifying treatment with at least 6 months passing between consecutive injection series. The effects of HA injection on gait variables have not been extensively examined. Therefore, our objective was to investigate the effects of HA injection on gait in people with medial knee OA. Twenty-seven subjects were included; each was tested prior to treatment (baseline), no later than 3 weeks following the last injection (post-HA), and again 5 months after treatment ended (follow-up). Responder criteria were defined to identify responders and non-responders. Subjects underwent 3D gait analysis, muscle activity was sampled, and co-contraction indices were calculated. Responders experienced increased peak knee adduction moments post-HA, whereas non-responders did not. Improved self-report scores were associated with increased knee adduction moments and increased medial co-contraction. Pain relief may result in higher loading onto the already vulnerable medial compartment due to changes in lower limb mechanics and muscle activation patterns. Eventually this may result in a more rapid progression of joint deterioration.

  6. Medial subluxation of the patella without previous lateral retinacular release.

    PubMed

    Richman, N M; Scheller, A D

    1998-07-01

    This case presented a 17-year-old patient with persistent complaints localized to the right patellofemoral joint. Clinical examination demonstrated increased medial translation of the patella on manual stress. In contrast to previous published reports on medial patellar subluxation, this patient had not undergone prior lateral retinacular release. Arthroscopic examination documented medial tracking of the patella as well as excess medial translation. Imbrication of the patient's lateral patellar retinaculum centralized patella tracking and diminished medial translation on stress testing as observed arthroscopically and clinically. This case illustrates that medial patellar subluxation is a subtle problem that may be overlooked in the patient presenting with patellofemoral complaints and should be included in the differential diagnosis.

  7. Biomechanical consequences of patellar component medialization in total knee arthroplasty.

    PubMed

    Anglin, Carolyn; Brimacombe, Jill M; Wilson, David R; Masri, Bassam A; Greidanus, Nelson V; Tonetti, Jérôme; Hodgson, Antony J

    2010-08-01

    The optimal amount of patellar component medialization in knee arthroplasty is unknown. We measured the impact, on patellofemoral kinematics and contact force distribution, of 0.0-, 2.5-, and 5.0-mm patellar component medialization in 7 cadaveric specimens implanted with knee arthroplasty components. The knees were flexed dynamically in a weight-bearing rig. Medialization led to lateral shift of the patellar bone, slight medial shift of the patellar component in the femoral groove, lateral tilt of the patella, reduced patellofemoral contact force in later flexion, and lateral shift of the center of pressure in early flexion. Effects on shift and tilt were proportional to the amount of medialization. As a result of this investigation, we recommend medializing the patellar component slightly-on the order of 2.5 mm. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  8. [Medial epicondylitis. Etiology, diagnosis, therapeutic modalities].

    PubMed

    Tschantz, P; Meine, J

    1993-01-01

    Medial epicondylitis is rather uncommon, less frequent than external epicondylitis. For this reason, the diagnosis is thought of rather late. While taking the history, one should try to find out the possible causative effects. Symptoms of irritation of the cubital nerve, which are present in one out of five cases should be looked for. Several sports such as baseball, javelin or weight throwing, volleyball, climbing, tennis, golf, which need a strong flexion of the hand and fingers can induce this condition. However, in more than half of our patients, sports or professional activities were not in cause. The majority were housewives and do-it-yourself enthusiasts. Among our 55 operated cases, out of which few had professional or sports activities, we did not encounter during the operation the macroscopic tendinous lesions that are sometimes described by some authors. The treatment should be conservative in all cases. This includes rest, anti-inflammatory drugs, physiotherapy, muscular stretching, immobilisation in a cast, steroid infiltrations. One patient out of ten will have to be operated on. The operative techniques differ on some details, but they all include the desinsertion of the flexor muscles on the medial epicondyle. When there are clinical signs of irritation of the cubital nerve, it should be transposed anteriorly. The result of these operations is good in more than 90 per cent of the cases. However, a come back to professional sport can take as long as 8 months.

  9. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

    PubMed Central

    Bin Abd Razak, Hamid Rahmatullah; Amit Kanta, Mitra

    2016-01-01

    We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis. PMID:28070434

  10. The medial tibial stress syndrome. A cause of shin splints.

    PubMed

    Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

    1982-01-01

    The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

  11. Medial Prefrontal-Medial Temporal Theta Phase Coupling in Dynamic Spatial Imagery.

    PubMed

    Kaplan, Raphael; Bush, Daniel; Bisby, James A; Horner, Aidan J; Meyer, Sofie S; Burgess, Neil

    2017-03-01

    Hippocampal-medial prefrontal interactions are thought to play a crucial role in mental simulation. Notably, the frontal midline/medial pFC (mPFC) theta rhythm in humans has been linked to introspective thought and working memory. In parallel, theta rhythms have been proposed to coordinate processing in the medial temporal cortex, retrosplenial cortex (RSc), and parietal cortex during the movement of viewpoint in imagery, extending their association with physical movement in rodent models. Here, we used noninvasive whole-head MEG to investigate theta oscillatory power and phase-locking during the 18-sec postencoding delay period of a spatial working memory task, in which participants imagined previously learned object sequences either on a blank background (object maintenance), from a first-person viewpoint in a scene (static imagery), or moving along a path past the objects (dynamic imagery). We found increases in 4- to 7-Hz theta power in mPFC when comparing the delay period with a preencoding baseline. We then examined whether the mPFC theta rhythm was phase-coupled with ongoing theta oscillations elsewhere in the brain. The same mPFC region showed significantly higher theta phase coupling with the posterior medial temporal lobe/RSc for dynamic imagery versus either object maintenance or static imagery. mPFC theta phase coupling was not observed with any other brain region. These results implicate oscillatory coupling between mPFC and medial temporal lobe/RSc theta rhythms in the dynamic mental exploration of imagined scenes.

  12. Correction of Sunken Upper Eyelids by Anchoring the Central Fat Pad to the Medial Fat Pad during Upper Blepharoplasty.

    PubMed

    Jeon, Myeong Su; Jung, Gyu Yong; Lee, Dong Lark; Shin, Hea Kyeong

    2015-07-01

    Many methods have been proposed for the correction of sunken upper eyelids. These methods include surgical treatments, such as micro-fat, dermofat, or fascia-fat grafts, or the use of alloplastic materials. Here, we present our experience of sunken upper eyelid correction involving the simple addition of anchoring the central fat pad to the medial fat pad during upper blepharoplasty. We performed 74 cases of upper blepharoplasty with sunken upper eyelid correction between October 2013 and September 2014. The lateral portion of the central fat pad was partially dissected to facilitate anchoring. The medial fat pad was gently exposed and then pulled out to facilitate anchoring. After the rotation of the dissected lateral portion of the central fat pad by 180° to the medial side, it was anchored spreading to the medial fat pad. Photographs taken at 6 months postoperatively were presented to three physicians for objective assessment. Of the 74 patients, 54 patients followed at 6 months postoperatively were included in this retrospective, objective assessment. Sunken eyelids were effectively corrected in 51 of the 54 patients, but 3 had minimal effect because preaponeurotic fat pads had been removed during previous upper blepharoplasty. In addition to correcting sunken eyelids, lateral bulging was corrected and a better definition of the lateral portion of upper lid creases was obtained. Anchoring the central fat pad to the medial fat pad provides an effective means of correcting sunken upper eyelids during upper blepharoplasty.

  13. Medialized repair for retracted rotator cuff tears.

    PubMed

    Kim, Young-Kyu; Jung, Kyu-Hak; Won, Jun-Sung; Cho, Seung-Hyun

    2017-08-01

    The purpose of this study was to evaluate the functional outcomes of medialized rotator cuff repair and the continuity of repaired tendon in chronic retracted rotator cuff tears. Thirty-five consecutive patients were selected from 153 cases that underwent arthroscopic rotator cuff repair for more than medium-sized posterosuperior rotator cuff tears between July 2009 and July 2012 performed with the medialized repair. All cases were available for at least 2 years of postoperative follow-up. The visual analog scale of pain, muscle strength, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and University of California-Los Angeles score were evaluated. At the final follow-up, all clinical outcomes were significantly improved. The visual analog scale score for pain improved from 6 ± 1 preoperatively to 2 ± 1 postoperatively. The range of motion increased from preoperatively to postoperatively: active forward elevation, from 134° ± 49° to 150° ± 16°; active external rotation at the side, from 47° ± 15° to 55° ± 10°; and active internal rotation, from L3 to L1. The shoulder score also improved: Constant score, from 53.5 ± 16.7 to 79 ± 10; American Shoulder and Elbow Surgeons score, from 51 ± 15 to 82 ± 8; and University of California-Los Angeles score, from 14 ± 4 to 28 ± 4. The retear cases at the final follow-up were 6 (17%). Medialized repair may be useful in cases in which anatomic bone-to-tendon repair would be difficult because of the excessive tension of the repaired tendon and a torn tendon that does not reach the anatomic insertion. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Medial perirhinal cortex disambiguates confusable objects.

    PubMed

    Kivisaari, Sasa L; Tyler, Lorraine K; Monsch, Andreas U; Taylor, Kirsten I

    2012-12-01

    Our brain disambiguates the objects in our cluttered visual world seemingly effortlessly, enabling us to understand their significance and to act appropriately. The role of anteromedial temporal structures in this process, particularly the perirhinal cortex, is highly controversial. In some accounts, the perirhinal cortex is necessary for differentiating between perceptually and semantically confusable objects. Other models claim that the perirhinal cortex neither disambiguates perceptually confusable objects nor plays a unique role in semantic processing. One major hurdle to resolving this central debate is the fact that brain damage in human patients typically encompasses large portions of the anteromedial temporal lobe, such that the identification of individual substructures and precise neuroanatomical locus of the functional impairments has been difficult. We tested these competing accounts in patients with Alzheimer's disease with varying degrees of atrophy in anteromedial structures, including the perirhinal cortex. To assess the functional contribution of each anteromedial temporal region separately, we used a detailed region of interest approach. From each participant, we obtained magnetic resonance imaging scans and behavioural data from a picture naming task that contrasted naming performance with living and non-living things as a way of manipulating perceptual and semantic confusability; living things are more similar to one another than non-living things, which have more distinctive features. We manually traced neuroanatomical regions of interest on native-space cortical surface reconstructions to obtain mean thickness estimates for the lateral and medial perirhinal cortex and entorhinal cortex. Mean cortical thickness in each region of interest, and hippocampal volume, were submitted to regression analyses predicting naming performance. Importantly, atrophy of the medial perirhinal cortex, but not lateral perirhinal cortex, entorhinal cortex or

  15. An unusually medial axillary arch muscle.

    PubMed Central

    Dharap, A

    1994-01-01

    In the left upper limb of an adult male cadaver a triangular muscular slip, 3.5 cm long and 2.5 cm wide, arose from the lower border of latissimus dorsi just proximal to its tendon of insertion. It was inserted by a slender 6 cm long tendon mainly into the coracoid process of the scapula. Three short fibrous strands radiated from this slender tendon to gain attachments to pectoralis minor and the common tendon of origin of the short head of biceps brachii and coracobrachialis. In addition 2 flat tendinous bands attached the margin of this muscular slip to teres major. The thoracodorsal nerve entered the main bulk of latissimus dorsi close to the muscular slip but did not supply a separate branch to the latter. This is an axillary arch muscle in an unusually medial location. Images Fig. 1 Fig. 2 PMID:7928652

  16. Revision Gore-Tex medialization laryngoplasty.

    PubMed

    Cohen, Jacob T; Bates, Dwight D; Postma, Gregory N

    2004-09-01

    To evaluate the indications, results, and safety of revision Gore-Tex medialization laryngoplasty (GML). A retrospective chart review of 156 patients that underwent GML procedures between the years 1998-2002. Study population consisted of those patients who required revision surgery for any reason. Sixteen patients required 22 revision procedures. Indications for revision were divided into 2 groups, complications and glottal closure problems. Complications included extruded or displaced implants (n = 4). The most common glottal closure problem was undercorrection (n = 9). Others included anterior overcorrection (n = 1) and persistent posterior glottal gap (n = 2). Revision procedures included GML (n = 9), injection augmentation (n = 9), endoscopic implant removal (n = 2), and arytenoid adduction (n = 2). In patients with glottal closure problems, the GCI improved in all 10 and the voice rating scale improved in 9. Reasons for revision of GML are variable, the most common being undercorrection. A variety of safe, effective revision techniques are available with a high success rate.

  17. Motor unit organization of human medial gastrocnemius.

    PubMed Central

    Garnett, R A; O'Donovan, M J; Stephens, J A; Taylor, A

    1979-01-01

    1. The properties of fifty-seven motor units in human medial gastrocnemius have been studied using controlled intramuscular microstimulation, glycogen depletion and muscle biopsy. 2. Motor units could be divided into three classes on the basis of their mechanical properties. Type S units were slow, small and fatigue resistant. Type FR units were fast, intermediate in size, and fatigue resistant. Type FF units were fast, large and fatigable. 3. Glycogen depletion of a number of type S and FF units revealed them to be composed of type 1 and type 2b muscle fibres respectively. 4. The results suggest that during slowly increasing voluntary contractions where units are recruited in order of size, type 1 and 2a muscle fibres would be employed at low force levels followed by type 2b muscle fibres in stronger contractions. Images Fig. 5 Fig. 6 PMID:430414

  18. Motor unit organization of human medial gastrocnemius.

    PubMed

    Garnett, R A; O'Donovan, M J; Stephens, J A; Taylor, A

    1979-02-01

    1. The properties of fifty-seven motor units in human medial gastrocnemius have been studied using controlled intramuscular microstimulation, glycogen depletion and muscle biopsy. 2. Motor units could be divided into three classes on the basis of their mechanical properties. Type S units were slow, small and fatigue resistant. Type FR units were fast, intermediate in size, and fatigue resistant. Type FF units were fast, large and fatigable. 3. Glycogen depletion of a number of type S and FF units revealed them to be composed of type 1 and type 2b muscle fibres respectively. 4. The results suggest that during slowly increasing voluntary contractions where units are recruited in order of size, type 1 and 2a muscle fibres would be employed at low force levels followed by type 2b muscle fibres in stronger contractions.

  19. Medial septum regulates the hippocampal spatial representation

    PubMed Central

    Mamad, Omar; McNamara, Harold M.; Reilly, Richard B.; Tsanov, Marian

    2015-01-01

    The hippocampal circuitry undergoes attentional modulation by the cholinergic medial septum. However, it is unclear how septal activation regulates the spatial properties of hippocampal neurons. We investigated here what is the functional effect of selective-cholinergic and non-selective septal stimulation on septo-hippocampal system. We show for the first time selective activation of cholinergic cells and their differential network effect in medial septum of freely-behaving transgenic rats. Our data show that depolarization of cholinergic septal neurons evokes frequency-dependent response from the non-cholinergic septal neurons and hippocampal interneurons. Our findings provide vital evidence that cholinergic effect on septo-hippocampal axis is behavior-dependent. During the active behavioral state the activation of septal cholinergic projections is insufficient to evoke significant change in the spiking of the hippocampal neurons. The efficiency of septo-hippocampal processing during active exploration relates to the firing patterns of the non-cholinergic theta-bursting cells. Non-selective septal theta-burst stimulation resets the spiking of hippocampal theta cells, increases theta synchronization, entrains the spiking of hippocampal place cells, and tunes the spatial properties in a timing-dependent manner. The spatial properties are augmented only when the stimulation is applied in the periphery of the place field or 400–650 ms before the animals approached the center of the field. In summary, our data show that selective cholinergic activation triggers a robust network effect in the septo-hippocampal system during inactive behavioral state, whereas the non-cholinergic septal activation regulates hippocampal functional properties during explorative behavior. Together, our findings uncover fast septal modulation on hippocampal network and reveal how septal inputs up-regulate and down-regulate the encoding of spatial representation. PMID:26175674

  20. Medial humeral epicondylitis in clinically affected cats.

    PubMed

    Streubel, Ronny; Bilzer, Thomas; Grest, Paula; Damur, Daniel; Montavon, Pierre M

    2015-10-01

    To describe the clinical signs and histologic changes in cats clinically affected with medial humeral epicondylitis (MHE) and evaluate long-term outcome after either conservative or surgical treatment. Prospective cohort study. Client-owned cats (n = 17) with MHE. Cats diagnosed with MHE, based on clinical signs, radiographs and computed tomography (CT), were prospectively recruited. Cats were treated conservatively for an initial 4 weeks, followed by either surgery or continued conservative treatment. Followup examinations were performed at 6 and 12 weeks and at 6-49 months. Cats had a mean age of 10.3 years and presented for chronic lameness. Examination revealed pain on palpation caudodistal to the medial epicondyle and by exerting antebrachial supination/pronation with elbow and carpal flexion. Lameness was restricted to 1 limb although CT revealed bilateral disease in 11/17 cats. Free mineralized joint bodies were identified in 9/17 cats. Nine cats were treated surgically and 8 cats were treated conservatively. Intraoperative findings included new bone formation at the origin of the humeral head of the flexor carpi ulnaris muscle with displacement and adhesions of the ulnar nerve. Microscopic examination revealed neurogenic myopathy in 4/9 cats treated surgically. Seven of 9 cats treated surgically were free from lameness by 12 weeks. Seven of 8 cats treated conservatively were chronically lame throughout the study. Cats with forelimb lameness should be evaluated for MHE. This condition is associated with free joint bodies and neurogenic myopathy. Surgical treatment is associated with excellent outcome in the majority of cats. © Copyright 2015 by The American College of Veterinary Surgeons.

  1. Medial septum regulates the hippocampal spatial representation.

    PubMed

    Mamad, Omar; McNamara, Harold M; Reilly, Richard B; Tsanov, Marian

    2015-01-01

    The hippocampal circuitry undergoes attentional modulation by the cholinergic medial septum. However, it is unclear how septal activation regulates the spatial properties of hippocampal neurons. We investigated here what is the functional effect of selective-cholinergic and non-selective septal stimulation on septo-hippocampal system. We show for the first time selective activation of cholinergic cells and their differential network effect in medial septum of freely-behaving transgenic rats. Our data show that depolarization of cholinergic septal neurons evokes frequency-dependent response from the non-cholinergic septal neurons and hippocampal interneurons. Our findings provide vital evidence that cholinergic effect on septo-hippocampal axis is behavior-dependent. During the active behavioral state the activation of septal cholinergic projections is insufficient to evoke significant change in the spiking of the hippocampal neurons. The efficiency of septo-hippocampal processing during active exploration relates to the firing patterns of the non-cholinergic theta-bursting cells. Non-selective septal theta-burst stimulation resets the spiking of hippocampal theta cells, increases theta synchronization, entrains the spiking of hippocampal place cells, and tunes the spatial properties in a timing-dependent manner. The spatial properties are augmented only when the stimulation is applied in the periphery of the place field or 400-650 ms before the animals approached the center of the field. In summary, our data show that selective cholinergic activation triggers a robust network effect in the septo-hippocampal system during inactive behavioral state, whereas the non-cholinergic septal activation regulates hippocampal functional properties during explorative behavior. Together, our findings uncover fast septal modulation on hippocampal network and reveal how septal inputs up-regulate and down-regulate the encoding of spatial representation.

  2. Forefoot flexibility and medial tibial stress syndrome.

    PubMed

    Kudo, Shintarou; Hatanaka, Yasuhiko

    2015-12-01

    To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches. 131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL). The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff-MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively. Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.

  3. Force depression decays during shortening in the medial gastrocnemius of the rat.

    PubMed

    Till, Olaf; Siebert, Tobias; Blickhan, Reinhard

    2014-03-21

    Force depression due to shortening of activated skeletal muscles has previously been described to be long lasting during isometric contractions following the shortening. In the present study, using the medial gastrocnemius of the rat, effects of force depression have been made apparent during shortening by computationally partially compensating for the direct effect of shortening velocity due to the tension-velocity relation. Evidence was found for the decay and complete disappearance of force depression already during continuation of the shortening contraction to short muscle lengths.

  4. Angiotensin II Induces Region-Specific Medial Disruption during Evolution of Ascending Aortic Aneurysms

    PubMed Central

    Rateri, Debra L.; Davis, Frank M.; Balakrishnan, Anju; Howatt, Deborah A.; Moorleghen, Jessica J.; O’Connor, William N.; Charnigo, Richard; Cassis, Lisa A.; Daugherty, Alan

    2015-01-01

    Angiotensin II (Ang II) promotes development of ascending aortic aneurysms (AAs), but progression of this pathology is undefined. We evaluated factors potentially involved in progression, and determined the temporal sequence of tissue changes during development of Ang II–induced ascending AAs. Ang II infusion into C57BL/6J mice promoted rapid expansion of the ascending aorta, with significant increases within 5 days, as determined by both in vivo ultrasonography and ex vivo sequential acquisition of tissues. Rates of expansion were not significantly different in LDL receptor–null mice fed a saturated fat-enriched diet, demonstrating a lack of effect of hypercholesterolemia. Augmenting systolic blood pressure with norepinephrine infusion had no significant effect on ascending aortic expansion. Pathological changes observed within 5 days of Ang II infusion included increased medial thickness and intramural hemorrhage characterized by erythrocyte extravasation in outer lamellar layers of the media. Intramedial hemorrhage was not observed after prolonged Ang II infusion, although partial medial disruption was present. Elastin fragmentation and transmural medial breaks of the ascending aorta were observed with continued Ang II infusion, which were restricted to anterior aspects. CD45+ cells accumulated in adventitia but were minimal in media. Similar pathology was observed in tissues obtained from patients with ascending AAs. In conclusion, Ang II promotes ascending AAs through region-specific changes that are independent of hypercholesterolemia or systolic blood pressure. PMID:25038458

  5. Medial pivot knee in primary total knee arthroplasty.

    PubMed

    Atzori, Francesco; Salama, Wael; Sabatini, Luigi; Mousa, Shazly; Khalefa, Abdelrahman

    2016-01-01

    Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.

  6. Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results.

    PubMed

    Sadigursky, David; Garcia, Lucas Cortizo; Armede, Maurício; Oliveira, Lucas Rodrigues de; Carneiro, Rogério Jamil Fernandes; Colavolpe, Paulo Oliveira

    2017-01-01

    The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients. This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG) was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre- and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test. The mean age of the patients was 11.28 in both genders. Comparing the data of the pre- and post-operative period, the inverted J-sign was present in six patients (85.7%) vs. absent in one (14.3%). The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 vs. 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 vs. 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively. The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.

  7. Treatment algorithms in refractory partial epilepsy.

    PubMed

    Jobst, Barbara C

    2009-09-01

    An algorithm is a "step-by-step procedure for solving a problem or accomplishing some end....in a finite number of steps." (Merriam-Webster, 2009). Medical algorithms are decision trees to help with diagnostic and therapeutic decisions. For the treatment of epilepsy there is no generally accepted treatment algorithm, as individual epilepsy centers follow different diagnostic and therapeutic guidelines. This article presents two algorithms to guide decisions in the treatment of refractory partial epilepsy. The treatment algorithm describes a stepwise diagnostic and therapeutic approach to intractable medial temporal and neocortical epilepsy. The surgical algorithm guides decisions in the surgical treatment of neocortical epilepsy.

  8. Superficial radial sensory neuropathy: Medial and lateral branch injury.

    PubMed

    Cho, Nam Soon; Kim, Ki Hoon; Park, Byung Kyu; Kim, Dong Hwee

    2016-05-01

    Superficial radial sensory nerve (SRN) injury may involve the main nerve or its distal medial or lateral branch. We investigated the utility of SRN conduction studies on the medial and lateral branches in patients with suspected SRN injury. Fifteen patients with symptoms of SRN neuropathy were studied. Their clinical and electrophysiological findings were assessed according to sensory symptom areas. Three active recording electrode positions were used: snuff box (position A); medial branch (position B); and lateral branch (position C). In 7 patients with medial area symptoms, abnormal findings were seen in position B (100%) and position A (71%). In 3 patients with medial and lateral area symptoms, abnormal findings were seen in all positions. In 5 patients with lateral symptoms, abnormal findings were seen in position C only. Nerve conduction studies for each branch of the SRN are useful in patients with suspected SRN neuropathy. © 2016 Wiley Periodicals, Inc.

  9. Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?

    PubMed

    Konan, S; Haddad, F S

    2016-10-01

    Medial unicompartmental knee arthroplasty (UKA) is associated with successful outcomes in carefully selected patient cohorts. We hypothesised that severity and location of patellofemoral cartilage lesions significantly influences functional outcome after Oxford medial compartmental knee arthroplasty. We reviewed 100 consecutive UKAs at minimum eight-year follow-up (96 to 132). A single surgeon performed all procedures. Patients were selected based on clinical and plain radiographic assessment. All patients had end-stage medial compartment osteoarthritis (OA) with sparing of the lateral compartment and intact anterior cruciate ligaments. None of the patients had end-stage patellofemoral OA, but patients with anterior knee pain or partial thickness chondral loss were not excluded. There were 57 male and 43 female patients. The mean age at surgery was 69 years (41 to 82). At surgery the joint was carefully inspected for patellofemoral chondral loss and this was documented based on severity of cartilage loss (0 to 4 Outerbridge grading) and topographic location (medial, lateral, central, and superior or inferior). Functional scores collected included Oxford Knee Score (OKS), patient satisfaction scale and University College Hospital (UCH) knee score. Intraclass correlation was used to compare chondral damage to outcomes. All patients documented significant improvement in pain and improved functional scores at mid-term follow-up. There were four revisions (mean 2.9 years, 2 to 4; standard deviation (sd) 0.9) in this cohort, three for tibial loosening and one for femoral loosening. There was one infection that was treated with debridement and insert exchange. The mean OKS improved from 23.2 (sd 7.1) to 39.1 (sd 6.9); p < 0.001. The cohort with central and lateral grade 3 patellofemoral OA documented lower mean satisfaction with pain (90, sd 11.8) and function (87.5, sd 10.3) on the patient satisfaction scale. On the UCH scale, patients reported significantly decreased

  10. Perfusion-Related Complications are Similar for DIEP and MS FTRAM Flaps Harvested on Medial or Lateral Deep Inferior Epigastric Artery Branch Perforators for Breast Reconstruction

    PubMed Central

    Garvey, Patrick B.; Salavati, Seroos; Feng, Lei; Butler, Charles E.

    2011-01-01

    Background Anatomic studies suggest the deep inferior epigastric artery (DIEA) medial branch perfuses more tissue across the midline than the lateral branch. We hypothesized that unilateral DIEP and MS FTRAM flaps based on medial branch perforators would have fewer perfusion-related complications. Methods We evaluated 2043 consecutive free flap breast reconstructions and included unilateral reconstructions where DIEP or MS FTRAM flaps were definitively harvested from a single DIEA branch. We grouped flaps by tissue volume, i.e., Hemiflaps, Cross-Midline Flaps, and Total Flaps. Primary outcome measures were fat necrosis and partial flap necrosis. Logistic regression was used to evaluate the association between patient and reconstruction characteristics and perfusion outcomes. Results We included 228 patients: 120 (52.6%) medial and 108 (47.4%) lateral branch flaps. Mean follow-up was 33.2 months. Cross-Midline Flaps (79.8%) were most common, followed by Hemiflaps (15.4%) and Total Flaps (4.8%). Overall fat necrosis and partial flap necrosis rates were 10.5% and 3.1%, respectively. Medial and lateral branch flaps had similar rates of fat necrosis (8.3% vs. 13.0%, respectively; p=0.26) and partial flap necrosis (3.3% vs. 2.8%, respectively; p=1.0). DIEP and MS FTRAM flaps had no difference in the incidence of fat necrosis (10.2% vs. 11.3%; p=0.81) or partial necrosis (3.2% vs. 2.8%; p=1.0). Medial and lateral branch flap perfusion-related complications were also similar among the flap volume classifications. Conclusions We suggest that surgeons base their decisions regarding DIEA branch harvest on the clinical assessment of perforator perfusion quality rather than relying on the theoretic benefit of medial branch perforator harvest. PMID:22094755

  11. Medial capsule reefing in patellar instability.

    PubMed

    Cerciello, Simone; Vasso, Michele; Corona, Katia; Del Regno, Chiara; Panni, Alfredo Schiavone

    2014-10-01

    The efficacy of medial capsule reefing in the treatment of patellar instability is well documented. Aim of the present study was to prospectively evaluate the outcomes of an all-arthroscopic medial capsule reefing technique in young patients with painful patella syndrome and potential patellar instability. Thirty patients with painful patellar syndrome and potential patellar instability having undergone a minimum of 6 months of intensive rehabilitation were enrolled in the present study. All subjects were evaluated with physical examination, clinical and functional outcomes and complete imaging study. All patients were reviewed at an intermediate follow-up of 72 months. Average Kujala score improved from 72.9±15.0 to 88.4±7.6 (p<0.0001), average Larsen score from 15.0±2.5 to 17.2±2.2 (p<0.002), average Lysholm from 63.8±16.7 to 87.9±11.7 (p<0.0001) and average Fulkerson score from 69.5±21.5 to 90.8±9.8 (p<0.0001). No intraoperative or postoperative complications were recorded. Ninety per cent of patients were very satisfied or satisfied with their functional result. Twenty-eight patients were reviewed at the final follow-up, 120 months after surgery. Average Kujala was 87.7±8.8 (p<0.0001), average Larsen was 16.8±2.7 (p<0.01), average Lysholm was 87.6±14.3 (p<0.0001), and average Fulkerson was 87.2±13.9 (p<0.0001). Almost 86% of patients were very satisfied or satisfied with their result. However, slight deterioration of the outcomes over time was observed. At the final follow-up, the outcomes of all-arthroscopic technique were significantly improved from preoperative values; however, they were slightly inferior at the 72 months follow-up. This slight deterioration of the outcomes may be the consequence of the reduction in physical activities. Case series, Level IV.

  12. The medial scaffold of 3D unorganized point clouds.

    PubMed

    Leymarie, Frederic F; Kimia, Benjamin B

    2007-02-01

    We introduce the notion of the medial scaffold, a hierarchical organization of the medial axis of a 3D shape in the form of a graph constructed from special medial curves connecting special medial points. A key advantage of the scaffold is that it captures the qualitative aspects of shape in a hierarchical and tightly condensed representation. We propose an efficient and exact method for computing the medial scaffold based on a notion of propagation along the scaffold itself, starting from initial sources of the flow and constructing the scaffold during the propagation. We examine this method specifically in the context of an unorganized cloud of points in 3D, e.g., as obtained from laser range finders, which typically involve hundreds of thousands of points, but the ideas are generalizable to data arising from geometrically described surface patches. The computational bottleneck in the propagation-based scheme is in finding the initial sources of the flow. We thus present several ideas to avoid the unnecessary consideration of pairs of points which cannot possibly form a medial point source, such as the "visibility" of a point from another given a third point and the interaction of clusters of points. An application of using the medial scaffold for the representation of point samplings of real-life objects is also illustrated.

  13. Molecular mechanisms in the formation of the medial longitudinal fascicle

    PubMed Central

    Ahsan, Mansoor; Riley, Kerry-lyn; Schubert, Frank R

    2007-01-01

    The first neurons in the vertebrate brain form a stereotypical array of longitudinal and transversal axon tracts, the early axon scaffold. This scaffold is thought to lay down the basic structure for the later, more complex neuronal pathways in the brain. The ventral longitudinal tract is pioneered by neurons located at the ventral midbrain–forebrain boundary, which form the medial longitudinal fascicle. Recent studies have shed some light on the molecular mechanisms that control the development of the medial longitudinal fascicle. Here, we show that patterning molecules, notably the ventralizing signalling molecule Shh, are involved in the formation of medial longitudinal fascicle neurons and in medial longitudinal fascicle axon guidance. Downstream of Shh, several homeobox genes are expressed in the tegmentum. We describe the expression patterns of Sax1, Emx2, Six3, Nkx2.2 and Pax6 in the mesencephalon and pretectum in detail. Furthermore, we review the evidence of their molecular interactions, and their involvement in neuronal fate specification. In particular, Sax1 plays a major role in fate determination of medial longitudinal fascicle neurons. Finally, we discuss the available data on axon guidance mechanisms for the medial longitudinal fascicle, which suggest that different guidance molecules such as class 3 Semaphorins, Slits and Netrins act to determine the caudal and ventral course of the medial longitudinal fascicle axons. PMID:17623036

  14. A dysexecutive syndrome of the medial thalamus.

    PubMed

    Liebermann, Daniela; Ploner, Christoph J; Kraft, Antje; Kopp, Ute A; Ostendorf, Florian

    2013-01-01

    Thalamic stroke is associated with neurological and cognitive sequelae. Resulting neuropsychological deficits vary with the vascular territory involved. Whereas sensory, motor and memory deficits following thalamic stroke are comparatively well characterized, the exact relationship between executive dysfunction and thalamic damage remains more ambiguous. To assess the pattern of executive-cognitive deficits following thalamic stroke and its possible association with distinct thalamic nuclei, 19 patients with focal thalamic lesions were examined with high-resolution structural imaging and neuropsychological testing. Twenty healthy individuals served as controls. Patient MRIs were co-registered to an atlas of the human thalamus. Lesion overlap and subtraction analyses were used for lesion-to-symptom mapping. In eight patients (42.1%), neuropsychological assessment demonstrated a disproportionate deficit in the Wisconsin Card Sorting Test (WCST), while other executive and memory functions were much less affected. Subtraction analysis revealed an area in the left medial thalamus, mainly consisting of the centromedian and parafascicular nuclei (CM-Pf complex) that was damaged in these patients and spared in patients with normal WCST performance. Thus, damage to the CM-Pf complex may yield a distinct dysexecutive syndrome in which deficient maintenance and shifting between cognitive sets predominates. We hypothesize that the CM-Pf complex may contribute to maintenance and shifting of cognitive sets by virtue of its dense connections with the striatum. The pattern of executive dysfunction following thalamic stroke may vary considerably with lesion location.

  15. Medial olivocochlear reflex in ankylosing spondylitis patients.

    PubMed

    Beyazal, M S; Özgür, A; Terzi, S; Çeliker, M; Dursun, E

    2016-12-01

    Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease. Via autoimmune mediators, AS can damage the auditory system similar to other systems. Otoacoustic emission studies in AS patients showed that the damage that causes hearing loss was in the outer hair cells. The medial olivocochlear (MOC) reflex is used to evaluate the MOC efferent system (MOES), which includes the outer hair cells. The aim of this study was to evaluate the presence of subclinical damage in the inner ear with the aid of the MOC reflex test in AS patients with no hearing complaints. Thirty-four patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. Otoacoustic emission responses, MOC reflex results, and frequency-specific and total suppression findings were compared between the groups. The relationship between clinical and laboratory findings for the AS patients, and the MOC reflex data were also investigated. Reduced MOC reflex response (p = 0.04) and suppression (p = 0.019) were detected in AS patients. When the clinical and laboratory findings for the AS patients and the MOC reflex test results were compared, a significant correlation was found only between the MOC reflex and the erythrocyte sedimentation rate. The results showed that AS can damage the inner ear, especially the MOES, and can reduce the MOC reflex response without clinical hearing loss.

  16. Chronic medial instability of the elbow.

    PubMed

    Savoie, Felix H; O'Brien, Michael

    2017-01-01

    Damage to the medial collateral ligament of the elbow from an instability episode usually heals with non-operative treatment. In some cases, residual instability may occur, leading to functional impairment.Non-operative management can be successful when bracing, taping and therapy are used to stabilise the elbow.A recent report detailing the efficacy of platelet-rich plasma in effectively treating ulnar collateral ligament (UCL) injuries in throwers has shown promise. However, there remain specific groups that should be considered for repair or reconstruction. These may include throwing athletes, wrestlers and some individuals involved in highly active physical activity which demands stability of the elbow.The results of surgical repair and reconstruction allowing a return to sports are quite good, ranging from 84% to 94%. Complications are generally low and mostly centred on ulnar nerve injuries.This report represents a review of the literature concerning valgus instability over the past five years, supplemented by selective older articles where relevant. Cite this article: EFORT Open Rev 2017;2:1-6. DOI:10.1302/2058-5241.2.160037.

  17. Optogenetic dissection of medial prefrontal cortex circuitry

    PubMed Central

    Riga, Danai; Matos, Mariana R.; Glas, Annet; Smit, August B.; Spijker, Sabine; Van den Oever, Michel C.

    2014-01-01

    The medial prefrontal cortex (mPFC) is critically involved in numerous cognitive functions, including attention, inhibitory control, habit formation, working memory and long-term memory. Moreover, through its dense interconnectivity with subcortical regions (e.g., thalamus, striatum, amygdala and hippocampus), the mPFC is thought to exert top-down executive control over the processing of aversive and appetitive stimuli. Because the mPFC has been implicated in the processing of a wide range of cognitive and emotional stimuli, it is thought to function as a central hub in the brain circuitry mediating symptoms of psychiatric disorders. New optogenetics technology enables anatomical and functional dissection of mPFC circuitry with unprecedented spatial and temporal resolution. This provides important novel insights in the contribution of specific neuronal subpopulations and their connectivity to mPFC function in health and disease states. In this review, we present the current knowledge obtained with optogenetic methods concerning mPFC function and dysfunction and integrate this with findings from traditional intervention approaches used to investigate the mPFC circuitry in animal models of cognitive processing and psychiatric disorders. PMID:25538574

  18. Subspecialization in the human posterior medial cortex

    PubMed Central

    Bzdok, Danilo; Heeger, Adrian; Langner, Robert; Laird, Angela R.; Fox, Peter T.; Palomero-Gallagher, Nicola; Vogt, Brent A.; Zilles, Karl; Eickhoff, Simon B.

    2014-01-01

    The posterior medial cortex (PMC) is particularly poorly understood. Its neural activity changes have been related to highly disparate mental processes. We therefore investigated PMC properties with a data-driven exploratory approach. First, we subdivided the PMC by whole-brain coactivation profiles. Second, functional connectivity of the ensuing PMC regions was compared by task-constrained meta-analytic coactivation mapping (MACM) and task-unconstrained resting-state correlations (RSFC). Third, PMC regions were functionally described by forward/reverse functional inference. A precuneal cluster was mostly connected to the intraparietal sulcus, frontal eye fields, and right temporo-parietal junction; associated with attention and motor tasks. A ventral posterior cingulate cortex (PCC) cluster was mostly connected to the ventromedial prefrontal cortex and middle left inferior parietal cortex (IPC); associated with facial appraisal and language tasks. A dorsal PCC cluster was mostly connected to the dorsomedial prefrontal cortex, anterior/posterior IPC, posterior midcingulate cortex, and left dorsolateral prefrontal cortex; associated with delay discounting. A cluster in the retrosplenial cortex was mostly connected to the anterior thalamus and hippocampus. Furthermore, all PMC clusters were congruently coupled with the default mode network according to task-constrained but not task-unconstrained connectivity. We thus identified distinct regions in the PMC and characterized their neural networks and functional implications. PMID:25462801

  19. Subspecialization in the human posterior medial cortex.

    PubMed

    Bzdok, Danilo; Heeger, Adrian; Langner, Robert; Laird, Angela R; Fox, Peter T; Palomero-Gallagher, Nicola; Vogt, Brent A; Zilles, Karl; Eickhoff, Simon B

    2015-02-01

    The posterior medial cortex (PMC) is particularly poorly understood. Its neural activity changes have been related to highly disparate mental processes. We therefore investigated PMC properties with a data-driven exploratory approach. First, we subdivided the PMC by whole-brain coactivation profiles. Second, functional connectivity of the ensuing PMC regions was compared by task-constrained meta-analytic coactivation mapping (MACM) and task-unconstrained resting-state correlations (RSFC). Third, PMC regions were functionally described by forward/reverse functional inference. A precuneal cluster was mostly connected to the intraparietal sulcus, frontal eye fields, and right temporo-parietal junction; associated with attention and motor tasks. A ventral posterior cingulate cortex (PCC) cluster was mostly connected to the ventromedial prefrontal cortex and middle left inferior parietal cortex (IPC); associated with facial appraisal and language tasks. A dorsal PCC cluster was mostly connected to the dorsomedial prefrontal cortex, anterior/posterior IPC, posterior midcingulate cortex, and left dorsolateral prefrontal cortex; associated with delay discounting. A cluster in the retrosplenial cortex was mostly connected to the anterior thalamus and hippocampus. Furthermore, all PMC clusters were congruently coupled with the default mode network according to task-unconstrained but not task-constrained connectivity. We thus identified distinct regions in the PMC and characterized their neural networks and functional implications. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Partial breast brachytherapy

    MedlinePlus

    ... brachytherapy; Accelerated partial breast irradiation - brachytherapy; Partial breast radiation therapy - brachytherapy; Permanent breast seed implant; PBSI; Low-dose radiotherapy - breast; High-dose radiotherapy - breast; Electronic balloon ...

  1. CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults

    PubMed Central

    Ufuk, Furkan; Agladioglu, Kadir; Karabulut, Nevzat

    2016-01-01

    PURPOSE We aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination, and find a CT criterion to determine whether an individual is adult or not. METHODS Chest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system. RESULTS Epiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males. CONCLUSION CT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years. PMID:27015321

  2. A Distributed Neural Network Model for the Distinct Roles of Medial and Lateral HVC in Zebra Finch Song Production.

    PubMed

    Galvis, Daniel; Wu, Wei; Hyson, Richard L; Johnson, Frank; Bertram, Richard

    2017-04-05

    Male zebra finches produce a song consisting of a canonical sequence of syllables, learned from a tutor and repeated throughout its adult life. Much of the neural circuitry responsible for this behavior is located in the cortical premotor region HVC (acronym is name). In a recent study from our lab, we found that partial bilateral ablation of the medial portion of HVC has effects on the song that are qualitatively different from those of bilateral ablation of the lateral portion. In this report we describe a neural network organization that can explain these data, and in so doing suggests key roles for other brain nuclei in the production of song. We also suggest that syllables and the gaps between them are each coded separately by neural chains within HVC, and that the timing mechanisms for syllables and gaps are distinct. The design principles underlying this model assign distinct roles for medial and lateral HVC circuitry that explain the data on medial and lateral ablations. In addition, despite the fact that the neural coding of song sequence is distributed among several brain nuclei in our model, it accounts for data showing that cooling of HVC stretches syllables uniformly and to a greater extent than gaps. Finally, the model made unanticipated predictions about details of the effects of medial and lateral HVC ablations that were then confirmed by reanalysis of these previously acquired behavioral data.

  3. Medial temporal lobe and topographical memory.

    PubMed

    Urgolites, Zhisen J; Hopkins, Ramona O; Squire, Larry R

    2017-08-08

    There has been interest in the idea that medial temporal lobe (MTL) structures might be especially important for spatial processing and spatial memory. We tested the proposal that the MTL has a specific role in topographical memory as assessed in tasks of scene memory where the viewpoint shifts from study to test. Building on materials used previously for such studies, we administered three different tasks in a total of nine conditions. Participants studied a scene depicting four hills of different shapes and sizes and made a choice among four test images. In the Rotation task, the correct choice depicted the study scene from a shifted perspective. MTL patients succeeded when the study and test images were presented together but failed the moment the study scene was removed (even at a 0-s delay). In the No-Rotation task, the correct choice was a duplicate of the study scene. Patients were impaired to the same extent in the No-Rotation and Rotation tasks after matching for difficulty. Thus, an inability to accommodate changes in viewpoint does not account for patient impairment. In the Nonspatial-Perceptual task, the correct choice depicted the same overall coloring as the study scene. Patients were intact at a 2-s delay but failed at longer, distraction-filled delays. The different results for the spatial and nonspatial tasks are discussed in terms of differences in demand on working memory. We suggest that the difficulty of the spatial tasks rests on the neocortex and on the limitations of working memory, not on the MTL.

  4. Unloader Braces for Medial Compartment Knee Osteoarthritis

    PubMed Central

    Ramsey, Dan K.; Russell, Mary E.

    2009-01-01

    Background: For persons with unicompartment knee osteoarthritis (OA), off-unloader braces are a mechanical intervention designed to reduce pain, improve physical function, and possibly slow disease progression. Pain relief is thought to be mediated by distracting the involved compartment via external varus or valgus forces applied to the knee. In so doing, tibiofemoral alignment is improved, and load is shifted off the degenerative compartment, where exposure to potentially damaging and provocative mechanical stresses are reduced. Objectives: To provide a synopsis of the evidence documented in the scientific literature concerning the efficacy of off-loader knee braces for improving symptomatology associated with painful disabling medial compartment knee OA. Search Strategy: Relevant peer-reviewed publications were retrieved from a MEDLINE search using the terms with the reference terms osteoarthritis, knee, and braces (per Medical Subject Headings), plus a manual search of bibliographies from original and review articles and appropriate Internet resources. Results: For persons with combined unicompartment knee OA and mild to moderate instability, the strength of recommendation reported by the Osteoarthritis Research Society International in the ability of off-loader knee braces to reduce pain, improve stability, and diminish the risk of falling was 76% (95% confidence interval, 69%-83%). The more evidence the treatment is effective, the higher the percentage. Conclusions: Given the encouraging evidence that off-loader braces are effective in mediating pain relief in conjunction with knee OA and malalignment, bracing should be fully used before joint realignment or replacement surgery is considered. With the number of patients with varus deformities and knee pain predicted to increase as the population ages, a reduction of patient morbidity for this widespread chronic condition in combination with this treatment modality could have a positive impact on health care

  5. Medial tibial stress syndrome: a critical review.

    PubMed

    Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

  6. Anterior cruciate ligament and medial collateral ligament injuries.

    PubMed

    Bollier, Matthew; Smith, Patrick A

    2014-10-01

    The diagnosis and treatment of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have evolved over the past 30 years. A detailed physical examination along with careful review of the magnetic resonance imaging and stress radiographs will guide decision making. Early ACL reconstruction and acute MCL repair are recommended when there is increased medial joint space opening with valgus stress in extension, a significant meniscotibial deep MCL injury (high-riding medial meniscus), or a displaced tibial-sided superficial MCL avulsion (stener lesion of the knee). Delayed ACL reconstruction to allow for MCL healing is advised when increased valgus laxity is present only at 30 degrees of flexion and not at 0 degree. However, at the time of ACL surgery, medial stability has to be re-assessed after the reconstruction is completed. In patients with neutral alignment in the chronic setting, graft reconstruction of both the ACL and MCL is recommended.

  7. Evaluation of the medial elbow in the throwing athlete.

    PubMed

    Creighton, R Alexander; Bach, Bernard R; Bush-Joseph, Charles A

    2006-06-01

    The valgus forces generated by throwing athletes can cause injuries and permanently damage the medial elbow structures. Clinicians must have a clear understanding of the ulnar collateral ligament complex and the associated medial elbow structures at risk in these athletes. Taking a detailed history, conducting a physical examination, and obtaining imaging studies will aid in making the correct diagnosis and giving these injuries the appropriate treatment. Pain around the medial elbow is of concern to throwing athletes, coaches, and medical staff. Valgus forces generated by the throwing motion add considerable stress to the medial elbow structures and thus potentially cause injury. Baseball players, particularly pitchers, are most often affected, but athletes participating in sports such as football, volleyball, water polo, tennis, and javelin throwing can also be affected.

  8. Photocopy of photograph in Fitzsimons Army Medial Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medial Center Real Property Book (green cloth cover), south and west sides. - Fitzsimons General Hospital, Officers Quarters, Northeast Corner of West Harlow Avenue & North Seventh Street, Aurora, Adams County, CO

  9. GABAergic Projections from the Medial Septum Selectively Inhibit Interneurons in the Medial Entorhinal Cortex

    PubMed Central

    Gonzalez-Sulser, Alfredo; Parthier, Daniel; Candela, Antonio; McClure, Christina; Pastoll, Hugh; Garden, Derek; Sürmeli, Gülşen

    2014-01-01

    The medial septum (MS) is required for theta rhythmic oscillations and grid cell firing in the medial entorhinal cortex (MEC). While GABAergic, glutamatergic, and cholinergic neurons project from the MS to the MEC, their synaptic targets are unknown. To investigate whether MS neurons innervate specific layers and cell types in the MEC, we expressed channelrhodopsin-2 in mouse MS neurons and used patch-clamp recording in brain slices to determine the response to light activation of identified cells in the MEC. Following activation of MS axons, we observed fast monosynaptic GABAergic IPSPs in the majority (>60%) of fast-spiking (FS) and low-threshold-spiking (LTS) interneurons in all layers of the MEC, but in only 1.5% of nonstellate principal cells (NSPCs) and in no stellate cells. We also observed fast glutamatergic responses to MS activation in a minority (<5%) of NSPCs, FS, and LTS interneurons. During stimulation of MS inputs at theta frequency (10 Hz), the amplitude of GABAergic IPSPs was maintained, and spike output from LTS and FS interneurons was entrained at low (25–60 Hz) and high (60–180 Hz) gamma frequencies, respectively. By demonstrating cell type-specific targeting of the GABAergic projection from the MS to the MEC, our results support the idea that the MS controls theta frequency activity in the MEC through coordination of inhibitory circuits. PMID:25505326

  10. GABAergic projections from the medial septum selectively inhibit interneurons in the medial entorhinal cortex.

    PubMed

    Gonzalez-Sulser, Alfredo; Parthier, Daniel; Candela, Antonio; McClure, Christina; Pastoll, Hugh; Garden, Derek; Sürmeli, Gülşen; Nolan, Matthew F

    2014-12-10

    The medial septum (MS) is required for theta rhythmic oscillations and grid cell firing in the medial entorhinal cortex (MEC). While GABAergic, glutamatergic, and cholinergic neurons project from the MS to the MEC, their synaptic targets are unknown. To investigate whether MS neurons innervate specific layers and cell types in the MEC, we expressed channelrhodopsin-2 in mouse MS neurons and used patch-clamp recording in brain slices to determine the response to light activation of identified cells in the MEC. Following activation of MS axons, we observed fast monosynaptic GABAergic IPSPs in the majority (>60%) of fast-spiking (FS) and low-threshold-spiking (LTS) interneurons in all layers of the MEC, but in only 1.5% of nonstellate principal cells (NSPCs) and in no stellate cells. We also observed fast glutamatergic responses to MS activation in a minority (<5%) of NSPCs, FS, and LTS interneurons. During stimulation of MS inputs at theta frequency (10 Hz), the amplitude of GABAergic IPSPs was maintained, and spike output from LTS and FS interneurons was entrained at low (25-60 Hz) and high (60-180 Hz) gamma frequencies, respectively. By demonstrating cell type-specific targeting of the GABAergic projection from the MS to the MEC, our results support the idea that the MS controls theta frequency activity in the MEC through coordination of inhibitory circuits.

  11. Medial entorhinal cortex and medial septum contribute to self-motion-based linear distance estimation.

    PubMed

    Jacob, Pierre-Yves; Gordillo-Salas, Marta; Facchini, Justine; Poucet, Bruno; Save, Etienne; Sargolini, Francesca

    2017-02-04

    Path integration is a navigation strategy that requires animals to integrate self-movements during exploration to determine their position in space. The medial entorhinal cortex (MEC) has been suggested to play a pivotal role in this process. Grid cells, head-direction cells, border cells as well as speed cells within the MEC collectively provide a dynamic representation of the animal position in space based on the integration of self-movements. All these cells are strongly modulated by theta oscillations, thus suggesting that theta rhythmicity in the MEC may be essential for integrating and coordinating self-movement information during navigation. In this study, we first show that excitotoxic MEC lesions, but not dorsal hippocampal lesions, impair the ability of rats to estimate linear distances based on self-movement information. Next, we report similar deficits following medial septum inactivation, which strongly impairs theta oscillations in the entorhinal-hippocampal circuits. Taken together, these findings demonstrate a major role of the MEC and MS in estimating distances to be traveled, and point to theta oscillations within the MEC as a neural mechanism responsible for the integration of information generated by linear self-displacements.

  12. The perforator-based conjoint (chimeric) medial Sural(MEDIAL GASTROCNEMIUS) free flap.

    PubMed

    Sano, Kazufumi; Hallock, Geoffrey G; Hamazaki, Masahiro; Daicyo, Yoshihiro

    2004-12-01

    The prototypical conjoint or so-called "chimeric" free flap heretofore has been composed of several large independent flaps, each supplied by a separate major branch, that ultimately arise from a common source vessel. The perforator-based type of chimeric flap is a relatively new concept, usually involving multiple muscle perforator flaps each based on a solitary musculocutaneous perforator, but still arising from the same "mother" vessel. This principle of split cutaneous perforator flaps has been now successfully adapted to the medial suralMEDIAL GASTROCNEMIUS perforator free flap on 2 separate occasions. As a chimeric flap, there was greater flexibility in insetting, and overall flap width may be larger but still narrow enough to allow primary donor site closure; and yet, by definition, only a single recipient site was needed for any microanastomoses. This is further proof that the perforator-based chimeric free flap may be an option for any muscle perforator flap donor site, so that potential donor territories for conjoint flaps have become virtually unlimited.

  13. Medial rectus muscle anchoring in complete oculomotor nerve palsy.

    PubMed

    Lee, Si Hyung; Chang, Jee Ho

    2015-10-01

    The management of exotropia resulting from complete oculomotor nerve palsy is challenging. Conventional therapeutic interventions, including supramaximal resection and recession, superior oblique tendon resection and transposition, and several ocular anchoring procedures have yielded less-than-adequate results. Here we describe a novel surgical technique of anchoring the medial rectus muscle to the medial orbital wall in combination with lateral rectus disinsertion and reattachment to the lateral orbital wall.

  14. Traumatic fracture of the medial coronoid process in 24 dogs.

    PubMed

    Tan, Desmond K; Canapp, Sherman O; Leasure, Christopher S; Dycus, David L; O'Donnell, Erica

    2016-07-19

    To describe traumatic fracture of the medial coronoid process in dogs as a clinically distinct disease unrelated to congenital elbow dysplasia. Clinical records of dogs with acute, traumatic, unilateral lameness attributable to medial coronoid process disease were reviewed retrospectively. Clinical interpretation included findings on physical examination, orthopaedic examination, and subjective gait analysis. Radiographs of the affected and contralateral elbows were obtained and reviewed for pathology. Arthroscopy of the elbow joints was performed by one of three surgeons and findings were compared to preoperative diagnostics. Postoperative follow-up was continued for 16 weeks. Twenty-four dogs were included in this study. All dogs in this study were free of radiographic evidence of medial coronoid pathology. All dogs were diagnosed with a single, large, displaced or non-displaced fracture of the medial coronoid process, with no other joint pathology. Dogs generally had an excellent short-term outcome following arthroscopic treatment of the fractured medial coronoid process. Traumatic fracture of the medial coronoid process should be considered a clinical disease distinct from dysplasia-related fragmentation and should be considered as a differential diagnosis in dogs that are presented with the complaint of acute unilateral elbow discomfort or lameness, especially after concussive activities involving the forelimb. .

  15. Symptomatic Accessory Medial Meniscus Associated With Popliteal Pterygium Syndrome.

    PubMed

    Funk, Shawn S; Block, J Jake; Martus, Jeffrey E; Schoenecker, Jonathan G

    2015-01-01

    Anomalies of the meniscus are uncommon. These anomalous formations have been predominately described in the lateral compartment of the knee. Congenital abnormalities of the medial meniscus are rare. Chart and radiographic review of a single patient with a symptomatic congenital abnormality of the medial meniscus. The patient was a 5-year-old boy with popliteal pterygium who developed painful snapping in the medial knee after anterior hemiepiphyseodesis to improve his knee extension. The patient had achieved full-knee extension from a preoperative 45-degree flexion contracture. The newly developed snapping was attributed to the hemiepiphyseodesis implants. After implant removal, the snapping persisted and was localized at the medial joint line. Through an arthrotomy, a medial meniscus abnormality was identified and excised with resolution of symptoms. This report describes a symptomatic congenital abnormality of the medial meniscus in a child with popliteal pterygium. The patient was treated with excision of the anomalous structure with complete resolution of the symptoms. This is the first report of an intra-articular knee anomaly associated with popliteal pterygium syndrome.

  16. An anatomical measurement of medial femoral torsion.

    PubMed

    Kim, Ha Y; Lee, Sang K; Lee, Neung K; Choy, Won S

    2012-11-01

    Medial femoral torsion (MFT) can be corrected with derotational osteotomy. Derotational osteotomies can be performed in the proximal or the distal part of the femur. Similar results have been reported for these two procedures. The aim of this study was to evaluate the pathologic location of the MFT by measuring the degree of infratrochanteric and supratrochanteric torsion (STT) of the femur using computed tomography (CT) scans. The current study was carried out in patients with the chief complaint of an in-toeing gait because of the MFT. Sixty-seven patients were enrolled in the study. Forty-one patients (72 lower extremities) were included in the intervention group; 20 patients were included in the cerebral palsy (CP) group (35 lower extremities) and 21 patients were included in the developmental MFT group [developmental femoral torsional (DF) group, 37 lower extremities]. The control group included 26 patients (33 lower extremities) with uninjured limbs with a femoral or a tibial fracture. In this study, torsional angles [MFT, STT and infratrochanteric torsion (ITT)] were measured on CT scan using picture archiving and communication system measurement tools. To measure the STT and ITT, the most prominent points of the lesser and the greater trochanter were marked on CT scans; these two points were connected and were defined as the intertrochanteric line (ITL). The angle between the ITL and the axis of the femoral neck was defined as the STT. The angle between the ITL and the axis of the condylar axis was defined as the ITT. Two authors measured the MFT, STT, and ITT angles of each femur independently. The twisting of the femur had occurred in a different location for each case. In all groups, however, STT was reduced with increasing age; this change was statistically significantly. ITT of the each group showed a random distribution. The means of the ITT in the control group and the DF group did not change significantly, and that of the CP group tended to decrease

  17. Medial Patellofemoral Ligament Reconstruction Femoral Tunnel Accuracy

    PubMed Central

    Hiemstra, Laurie A.; Kerslake, Sarah; Lafave, Mark

    2017-01-01

    Background: Medial patellofemoral ligament (MPFL) reconstruction is a procedure aimed to reestablish the checkrein to lateral patellar translation in patients with symptomatic patellofemoral instability. Correct femoral tunnel position is thought to be crucial to successful MPFL reconstruction, but the accuracy of this statement in terms of patient outcomes has not been tested. Purpose: To assess the accuracy of femoral tunnel placement in an MPFL reconstruction cohort and to determine the correlation between tunnel accuracy and a validated disease-specific, patient-reported quality-of-life outcome measure. Study Design: Case series; Level of evidence, 4. Methods: Between June 2008 and February 2014, a total of 206 subjects underwent an MPFL reconstruction. Lateral radiographs were measured to determine the accuracy of the femoral tunnel by measuring the distance from the center of the femoral tunnel to the Schöttle point. Banff Patella Instability Instrument (BPII) scores were collected a mean 24 months postoperatively. Results: A total of 155 (79.5%) subjects had adequate postoperative lateral radiographs and complete BPII scores. The mean duration of follow-up (±SD) was 24.4 ± 8.2 months (range, 12-74 months). Measurement from the center of the femoral tunnel to the Schöttle point resulted in 143 (92.3%) tunnels being categorized as “good” or “ideal.” There were 8 failures in the cohort, none of which occurred in malpositioned tunnels. The mean distance from the center of the MPFL tunnel to the center of the Schöttle point was 5.9 ± 4.2 mm (range, 0.5-25.9 mm). The mean postoperative BPII score was 65.2 ± 22.5 (range, 9.2-100). Pearson r correlation demonstrated no statistically significant relationship between accuracy of femoral tunnel position and BPII score (r = –0.08; 95% CI, –0.24 to 0.08). Conclusion: There was no evidence of a correlation between the accuracy of MPFL reconstruction femoral tunnel in relation to the Schöttle point and

  18. Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty.

    PubMed

    Pagenstert, Geert; Seelhoff, Juliane; Henninger, Heath B; Wirtz, Dieter C; Valderrabano, Victor; Barg, Alexej

    2014-11-01

    We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study). Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis

    PubMed Central

    2013-01-01

    Background Dynamic joint loading, particularly the external knee adduction moment (KAM), is an important surrogate measure for the medio-lateral distribution of force across the knee joint in people with knee osteoarthritis (OA). Foot motion may alter the load on the medial tibiofemoral joint and hence affect the KAM. Therefore, this study aimed to investigate the relationship between tibia, rearfoot and forefoot motion in the frontal and transverse planes and the KAM in people with medial compartment knee OA. Method Motion of the knee, tibia, rearfoot and forefoot and knee moments were evaluated in 32 patients with clinically and radiographically-confirmed OA, predominantly in the medial compartment. Pearson’s correlation coefficient was used to investigate the association between peak values of tibia, rearfoot and forefoot motion in the frontal and transverse planes and 1st peak KAM, 2nd peak KAM, and the knee adduction angular impulse (KAAI). Results Lateral tilt of the tibia was significantly associated with increased 1st peak KAM (r = 0.60, p < 0.001), 2nd peak KAM (r = 0.67, p = 0.001) and KAAI (r = 0.82, p = 0.001). Increased peak rearfoot eversion was significantly correlated with decreased 2nd peak KAM (r = 0.59, p < 0.001) and KAAI (r = 0.50, p = 0.004). Decreased rearfoot internal rotation was significantly associated with increased 2nd peak KAM (r = −0.44, p = 0.01) and KAAI (r = −0.38, p = 0.02), while decreased rearfoot internal rotation relative to the tibia was significantly associated with increased 2nd peak KAM (r = 0.43, p = 0.01). Significant negative correlations were found between peak forefoot eversion relative to the rearfoot and 2nd peak KAM (r = −0.53, p = 0.002) and KAAI (r = −0.51, p = 0.003) and between peak forefoot inversion and 2nd peak KAM (r = −0.54, p = 0.001) and KAAI (r = −0.48, p = 0.005). Conclusion Increased rearfoot

  20. Contribution of the medial malleolus to tibiotalar joint contact characteristics.

    PubMed

    Lareau, Craig R; Bariteau, Jason T; Paller, David J; Koruprolu, Sarath C; DiGiovanni, Christopher W

    2015-02-01

    Isolated medial malleolus fractures are typically treated operatively to minimize the potential for articular incongruity, instability, nonunion, and posttraumatic arthritis. The literature, however, has not clearly demonstrated inferior outcomes with conservative treatment of these injuries. This study measured the effects of medial malleolus fracture and its resultant instability on tibiotalar joint contact characteristics. We hypothesized that restoration of anatomical alignment and stability through fixation would significantly improve contact characteristics. A Tekscan pressure sensor was inserted and centered over the talar dome in 8 cadaveric foot and ankle specimens. Each specimen was loaded at 700 N in multiple coronal and sagittal plane orientations. After testing fractured samples, the medial malleolus was anatomically fixed before repeat testing. Contact area and pressure were analyzed using a 2-way repeated-measure ANOVA. In treated fractures, contact areas were higher, and mean contact pressures were lower for all positions. These differences were statistically significant in the majority of orientations and approached statistical significance in pure plantarflexion and pure inversion. Decreases in contact area varied from 15.1% to 42.1%, with the most dramatic reductions in positions of hindfoot eversion. These data emphasize the importance of the medial malleolus in maintaining normal tibiotalar contact area and pressure. The average decrease in contact area after simulated medial malleolar fractures was 27.8% (>40% in positions of hindfoot eversion). Such differences become clinically relevant in cases of medial malleolar nonunion or malunion. Therefore, we recommend anatomical reduction and fixation of medial malleolus fractures with any displacement. Therapeutic Level V-Cadaveric Study. © 2014 The Author(s).

  1. Knee stabilization in patients with medial compartment knee osteoarthritis

    PubMed Central

    Lewek, Michael D.; Ramsey, Dan K.; Snyder-Mackler, Lynn; Rudolph, Katherine S.

    2005-01-01

    OBJECTIVE Individuals with medial knee osteoarthritis (MKOA) experience knee laxity and instability. Muscle stabilization strategies may influence the long term integrity of the joint. In this study we determined how individuals with medial knee OA respond to a rapid valgus knee movement to investigate the relationship between muscle stabilization strategies and knee instability. METHODS Twenty one subjects with MKOA and genu varum, and 19 control subjects were tested. Subjects stood with the test limb on a moveable platform that translated laterally to rapidly stress the knee’s medial periarticular structures and create a potentially destabilizing feeling at the knee joint. Knee motion and muscle responses were recorded. Subjects rated their knee instability with a self-report questionnaire about knee instability during daily activities. RESULTS Prior to plate movement the OA subjects demonstrated more medial muscle co-contraction (p=0.014). Following plate movement the OA subjects shifted less weight off the test limb (p = 0.013) and had more medial co-contraction (p=0.037). Those without instability had higher VMMH co-contraction than those who reported more instability (p=0.038). Knee stability correlated positively with VMMH co-contraction prior to plate movement (r = 0.459; p = 0.042). CONCLUSION This study demonstrates that individuals with MKOA attempt to stabilize the knee with greater medial muscle co-contraction in response to laxity that appears on only the medial side of the joint. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction and needs to be altered to slow or stop the progression of the OA disease process. PMID:16142714

  2. [Submammary skin incision for longitudinal medial sternotomy].

    PubMed

    Ramírez Marroquín, S; Rojas Pacheco, A M; Herrera Alarcón, V; Santibáñez Escobar, F; Molina Méndez, J; Serrano Gallardo, G; Barragán García, R

    1996-01-01

    The submammary incision has been postulated as an alternative in median sternotomy approach since 1960. We used this incision in 32 females patients from 1 to 24 years. The diagnoses were atrial septal defects (ASD) 23 patients, ventricular septal defect (VSD) 2 patients, double outlet right ventricle 1 patient, supravalvular aortic stenosis 1 patient, ASD with VSD 3 patients and partial anomalous pulmonary venous connection 1 patient. Nine patients had a complication: cheloid scar 1 patient, seroma 2 patients, wound dehiscence 3 patients, and diminution of sensitivity 3 patients. We conclude, that this type of surgical approach is an excellent alternative for women with good aesthetic and psychological results. Their complications are easy to correct.

  3. Ultrastructure of medial rectus muscles in patients with intermittent exotropia

    PubMed Central

    Yao, J; Wang, X; Ren, H; Liu, G; Lu, P

    2016-01-01

    Purpose To study the ultrastructure of the medial rectus in patients with intermittent exotropia at different ages. Patients and methods The medial recti were harvested surgically from 20 patients with intermittent exotropia. Patients were divided into adolescent (age<18 years, n=10) and adult groups (age >18 years, n=10). The normal control group included five patients without strabismus and undergoing eye enucleation. Hematoxylin and eosin staining and transmission electron microscopy were used to visualize the medial recti. Western blot was used to determine the levels of myosin and actin. Results Varying fiber thickness, atrophy, and misalignment of the medial recti were visualized under optical microscope in patients with exotropia. Electron microscopy revealed sarcomere destruction, myofilament disintegration, unclear dark and light bands, collagen proliferation, and fibrosis. The adolescent group manifested significantly higher levels of myosin and actin than the adult group (P<0.05). Conclusion Younger patients with intermittent exotropia show stronger contraction of the medial recti compared with older patients. Our findings suggest that childhood was the appropriate time for surgery as the benefit of the intervention was better than in adulthood. PMID:26514242

  4. Excised larynx evaluation of subthyroid cartilage approach to medialization thyroplasty.

    PubMed

    Thompson, James D; Hoffman, Matthew R; Scholp, Austin; Devine, Erin E; Jiang, Jack J; McCulloch, Timothy M

    2017-09-11

    To describe an alternative approach to medialization thyroplasty involving dissection underneath the thyroid cartilage with placement of a Gore-Tex implant, and to evaluate its effect on a range of phonatory measures using an excised canine larynx model. Animal model. On each of eight excised canine larynges, the conditions of normal, paralysis, medialization thyroplasty by standard transthyroid cartilage approach, and medialization thyroplasty by experimental subthyroid cartilage approach were performed. Aerodynamic, acoustic, and mucosal wave parameters were measured for each condition. Compared to the vocal fold paralysis state, both the transthyroid and subthyroid approaches for Gore-Tex insertion resulted in significant decreases in phonation threshold pressure and phonation threshold flow. Both approaches also significantly decreased percent jitter, decreased percent shimmer, and improved signal-to-noise ratio. The mucosal wave was preserved after insertion of the Gore-Tex implant for both approaches. For all the phonatory measures except phonation threshold flow, there were no significant differences between the transthyroid and subthyroid approaches. Gore-Tex implantation via a subthyroid approach in an excised canine larynx model can produce effective medialization, preserve the mucosal wave, and significantly improve aerodynamic and acoustic parameters without meaningful difference compared to a traditional transthyroid approach. The subthyroid approach does not require creation of a thyroid cartilage window and could be a potentially valuable alternative method of performing medialization thyroplasty. NA Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Lateral–Medial Dissociation in Orbitofrontal Cortex–Hypothalamus Connectivity

    PubMed Central

    Hirose, Satoshi; Osada, Takahiro; Ogawa, Akitoshi; Tanaka, Masaki; Wada, Hiroyuki; Yoshizawa, Yasunori; Imai, Yoshio; Machida, Toru; Akahane, Masaaki; Shirouzu, Ichiro; Konishi, Seiki

    2016-01-01

    The orbitofrontal cortex (OFC) is involved in cognitive functions, and is also closely related to autonomic functions. The OFC is densely connected with the hypothalamus, a heterogeneous structure controlling autonomic functions that can be divided into two major parts: the lateral and the medial. Resting-state functional connectivity has allowed us to parcellate the cerebral cortex into putative functional areas based on the changes in the spatial pattern of connectivity in the cerebral cortex when a seed point is moved from one voxel to another. In the present high spatial-resolution fMRI study, we investigate the connectivity-based organization of the OFC with reference to the hypothalamus. The OFC was parcellated using resting-state functional connectivity in an individual subject approach, and then the functional connectivity was examined between the parcellated areas in the OFC and the lateral/medial hypothalamus. We found a functional double dissociation in the OFC: the lateral OFC (the lateral orbital gyrus) was more likely connected with the lateral hypothalamus, whereas the medial OFC (the medial orbital and rectal gyri) was more likely connected with the medial hypothalamus. These results demonstrate the fundamental heterogeneity of the OFC, and suggest a potential neural basis of the OFC–hypothalamic functional interaction. PMID:27303281

  6. Partial tooth gear bearings

    NASA Technical Reports Server (NTRS)

    Vranish, John M. (Inventor)

    2010-01-01

    A partial gear bearing including an upper half, comprising peak partial teeth, and a lower, or bottom, half, comprising valley partial teeth. The upper half also has an integrated roller section between each of the peak partial teeth with a radius equal to the gear pitch radius of the radially outwardly extending peak partial teeth. Conversely, the lower half has an integrated roller section between each of the valley half teeth with a radius also equal to the gear pitch radius of the peak partial teeth. The valley partial teeth extend radially inwardly from its roller section. The peak and valley partial teeth are exactly out of phase with each other, as are the roller sections of the upper and lower halves. Essentially, the end roller bearing of the typical gear bearing has been integrated into the normal gear tooth pattern.

  7. Partial (focal) seizure

    MedlinePlus

    ... Jacksonian seizure; Seizure - partial (focal); Temporal lobe seizure; Epilepsy - partial seizures ... Abou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Daroff ... Practice . 7th ed. Philadelphia, PA: Elsevier; 2016:chap 101. ...

  8. Medial temporal lobe contributions to cued retrieval of items and contexts.

    PubMed

    Hannula, Deborah E; Libby, Laura A; Yonelinas, Andrew P; Ranganath, Charan

    2013-10-01

    Several models have proposed that different regions of the medial temporal lobes contribute to different aspects of episodic memory. For instance, according to one view, the perirhinal cortex represents specific items, parahippocampal cortex represents information regarding the context in which these items were encountered, and the hippocampus represents item-context bindings. Here, we used event-related functional magnetic resonance imaging (fMRI) to test a specific prediction of this model-namely, that successful retrieval of items from context cues will elicit perirhinal recruitment and that successful retrieval of contexts from item cues will elicit parahippocampal cortex recruitment. Retrieval of the bound representation in either case was expected to elicit hippocampal engagement. To test these predictions, we had participants study several item-context pairs (i.e., pictures of objects and scenes, respectively), and then had them attempt to recall items from associated context cues and contexts from associated item cues during a scanned retrieval session. Results based on both univariate and multivariate analyses confirmed a role for hippocampus in content-general relational memory retrieval, and a role for parahippocampal cortex in successful retrieval of contexts from item cues. However, we also found that activity differences in perirhinal cortex were correlated with successful cued recall for both items and contexts. These findings provide partial support for the above predictions and are discussed with respect to several models of medial temporal lobe function.

  9. Medial Temporal Lobe Contributions to Cued Retrieval of Items and Contexts

    PubMed Central

    Hannula, Deborah E.; Libby, Laura A.; Yonelinas, Andrew P.; Ranganath, Charan

    2013-01-01

    Several models have proposed that different regions of the medial temporal lobes contribute to different aspects of episodic memory. For instance, according to one view, the perirhinal cortex represents specific items, parahippocampal cortex represents information regarding the context in which these items were encountered, and the hippocampus represents item-context bindings. Here, we used event-related functional magnetic resonance imaging (fMRI) to test a specific prediction of this model – namely, that successful retrieval of items from context cues will elicit perirhinal recruitment and that successful retrieval of contexts from item cues will elicit parahippocampal cortex recruitment. Retrieval of the bound representation in either case was expected to elicit hippocampal engagement. To test these predictions, we had participants study several item-context pairs (i.e., pictures of objects and scenes, respectively), and then had them attempt to recall items from associated context cues and contexts from associated item cues during a scanned retrieval session. Results based on both univariate and multivariate analyses confirmed a role for hippocampus in content-general relational memory retrieval, and a role for parahippocampal cortex in successful retrieval of contexts from item cues. However, we also found that activity differences in perirhinal cortex were correlated with successful cued recall for both items and contexts. These findings provide partial support for the above predictions and are discussed with respect to several models of medial temporal lobe function. PMID:23466350

  10. V1 surface size predicts GABA concentration in medial occipital cortex.

    PubMed

    Bergmann, Johanna; Pilatus, Ulrich; Genç, Erhan; Kohler, Axel; Singer, Wolf; Pearson, Joel

    2016-01-01

    A number of recent studies have established a link between behavior and the anatomy of the primary visual cortex (V1). However, one often-raised criticism has been that these studies provide little insight into the mechanisms of the observed relationships. As inhibitory neural interactions have been postulated as an important mechanism for those behaviors related to V1 anatomy, we measured the concentration of inhibitory gamma-amino butyric acid (GABA) in the medial occipital cortex where V1 is located using magnetic resonance spectroscopy (MRS) and estimated the surface area of V1 using fMRI retinotopic mapping. We found a significant positive relationship between GABA concentration and V1 surface area. This relationship was present irrespective of whether the MRS voxel had a fixed size across participants or was proportionally sized to each individual's V1 surface area. Hence, individuals with a larger V1 had a higher GABA concentration in the medial occipital cortex. By tying together V1 size and GABA concentration, our findings point towards individual differences in the level of neural inhibition that might partially mediate the relationships between behavior and V1 neuroanatomy. In addition, they illustrate how stable microscopic properties of neural activity and function are reflected in macro-measures of V1 structure. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. "The Superficial Quad Technique" for Medial Patellofemoral Ligament Reconstruction: The Surgical Video Technique.

    PubMed

    Goyal, Deepak

    2015-10-01

    With the introduction of the superficial quad technique, there has been a recent revival of interest in the quadriceps tendon as a graft choice for medial patellofemoral ligament (MPFL) reconstruction. The superficial quad technique has many anatomic advantages because the length, breadth, and thickness of the graft are similar to those of the native MPFL; moreover, the graft provides a continuous patellar attachment at the superior half of the medial border of the patella. The technique requires neither a patellar bony procedure nor patellar hardware. Biomechanically, the mean strength and stiffness of the graft are very similar to those of the native MPFL. The anatomic and biomechanical advantages depend on correct identification of the anatomic superficial lamina of the quadriceps tendon; hence the correct harvesting technique for the superficial lamina is crucial. Various sub-techniques for harvesting the quadriceps graft have emerged recently, such as superficial strip, pedicled, or partial graft harvesting; these can create confusion for surgeons. Additional confusion related to the preparation and fixation of the graft should also be addressed to avoid any potential complications. A step-by-step video of the superficial quad technique is presented, covering the exact dissection of the graft material and its preparation, delivery, and fixation.

  12. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies.

    PubMed

    Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit

    2014-01-01

    In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered.

  13. A pseudo-iatrogenic case of medial clavicular fracture

    PubMed Central

    Staal, Heleen Muriel; Willems, Willem Jacob

    2008-01-01

    Medial fractures are the least common type of clavicular fracture (2–10%). The patient is a 29-year-old gynaecology resident with hyper-laxity and sternoclavicular instability. The latter had been surgically stabilized with Dacron® tape, which eroded the bone causing an usura. Acute right shoulder pain occurred 10 years later. CT revealed medial clavicular stress fracture. After 4 weeks of conservative management, internal fixation followed. Five months postoperatively the patient performed all activities without pain. In this patient the weakened medial clavicle due to usura clearly played a role in both the site and nature of the fracture. Furthermore, CT is essential in arriving at the correct diagnosis. PMID:18427920

  14. A pseudo-iatrogenic case of medial clavicular fracture.

    PubMed

    Poelmann, Tibor Antonius Johannes; Staal, Heleen Muriel; Willems, Willem Jacob

    2008-04-01

    Medial fractures are the least common type of clavicular fracture (2-10%). The patient is a 29-year-old gynaecology resident with hyper-laxity and sternoclavicular instability. The latter had been surgically stabilized with Dacron((R)) tape, which eroded the bone causing an usura. Acute right shoulder pain occurred 10 years later. CT revealed medial clavicular stress fracture. After 4 weeks of conservative management, internal fixation followed. Five months postoperatively the patient performed all activities without pain. In this patient the weakened medial clavicle due to usura clearly played a role in both the site and nature of the fracture. Furthermore, CT is essential in arriving at the correct diagnosis.

  15. Traumatic fragmented medial coronoid process in a Chihuahua.

    PubMed

    Hadley, H S; Wheeler, J L; Manley, P A

    2009-01-01

    Fragmented medial coronoid process (FMCP) is a disease process that has not previously been reported in toy-breed dogs. This report describes a presumptive case of FMCP in a 14-month-old Chihuahua that was presented for evaluation approximately four weeks following acute onset of moderate lameness in the left forelimb. Definitive diagnosis of a fragmented medial coronoid process was based upon computed tomography (CT) scan. A CT scan also demonstrated moderate joint incongruity in the affected elbow. Surgical removal of the fragment and subtotal coronoidectomy were performed via a medial arthrotomy. An ulnar ostectomy was also performed to address joint incongruity. Histology of specimens removed at surgery did not demonstrate evidence of microdamage as characteristic of FMCP in large breed dogs, and instead, suggested that the fracture was acute and traumatic in nature. Rapid return to function was observed following surgery.

  16. How I Do It: Medial Flap Inferior Turbinoplasty.

    PubMed

    Barham, Henry P; Knisely, Anna; Harvey, Richard J; Sacks, Raymond

    2015-01-01

    Techniques for inferior turbinate reduction vary from complete turbinectomy to limited cauterization. Surgical methods differ on the degree of tissue reduction and reliance on surgical tissue removal versus tissue ablation. The technique and surgical steps of our preferred method of turbinate reduction are presented. Critical steps include proper design of the medial flap and removal of turbinate bone and lateral mucosa to allow lateral positioning of the medial flap. Bipolar cautery of the inferior turbinate artery branches allows complete haemostasis and undermining of the head allows proper debulking of the anterior aspect of the turbinate and widening of the nasal valve area. The medial flap inferior turbinoplasty provides consistent, robust results. Long-term relief of obstructive symptoms without additional risk of complication is expected with this procedure.

  17. Isolated medial foot compartment syndrome after ankle sprain.

    PubMed

    Cortina, Josep; Amat, Carles; Selga, Jordi; Corona, Pablo Salvador

    2014-03-01

    Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication. We report the case of a 31-year-old man who developed a medial foot compartment syndrome after suffering a deltoid ligament rupture at ankle while playing football. The patient underwent a medial compartment fasciotomy with resolution of symptoms. Compartment syndromes of the foot are rare and have been reported to occur after severe trauma. But, there are some reports in the literature of acute exertional compartment syndrome. In our case, the compartment syndrome appeared after an ankle sprain without vascular injuries associated. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  18. Medial collateral ligament reconstruction in the baseball Pitcher's elbow.

    PubMed

    Erne, Holger C; Zouzias, Ioannis C; Rosenwasser, Melvin P

    2009-08-01

    Pitchers are prone to elbow injuries because of high and repetitive valgus stresses on the elbow. The anterior bundle of the medial ulnar collateral ligament (MCL) of the elbow is the primary restraint and is often attenuated with time, leading to functional incompetence and ultimate failure. Pitchers with a history of medial elbow pain, reduced velocity, and loss of command may have an MCL injury in evolution. Physical examination and imaging can confirm the diagnosis. Treatment begins with rest and activity modification. All medial elbow pain is not MCL injury. Surgery is considered only for talented athletes who wish to return to competitive play and may include elite scholastic and other collegiates and professionals. The technique for MCL reconstruction was first described in 1986. Many variations have been offered since then, which can result in predictable outcomes, allowing many to return to the same level of competitive play.

  19. Gore-Tex medialization laryngoplasty for treatment of dysphagia.

    PubMed

    Hendricker, Ryan M; deSilva, Brad W; Forrest, L Arick

    2010-04-01

    Gore-Tex medialization laryngoplasty is a well described procedure for the management of glottal incompetence with associated phonatory disturbance. Limited literature exists describing the use of this procedure in the management of dysphagia. We describe our experience with Gore-Tex medialization laryngoplasty and the treatment of dysphagia. Case series with chart review. Tertiary referral center. Between April 2000 and September 2008, 189 Gore-Tex medialization laryngoplasties were performed on 180 patients by the senior author. Complete records and analysis were available for and performed on 121 procedures for 113 patients. The main outcome measures were discontinuation of gastrostomy tube (g-tube) use or avoidance of g-tube, as well as clinical subjective improvement in swallowing function. Fifty-seven of 113 (50%) patients had complaints of dysphagia at presentation, with 47 of 57 (82%) having an objective swallowing evaluation. Thirty-two of 47 (68%) had documented penetration and/or aspiration. Twenty of 57 (35%) patients with dysphagia required g-tubes for alimentation. Eleven of 20 (55%) patients were able to discontinue g-tube use after Gore-Tex medialization laryngoplasty, and an additional five patients with aspiration were able to avoid need for g-tubes with Gore-Tex medialization laryngoplasty and swallowing therapy. Gore-Tex medialization laryngoplasty is a well tolerated and well described treatment for the management of glottal incompetence. The procedure is an appropriate adjunct in dysphagia management for the appropriate patient population. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

  20. Medial circumflex femoral artery flap for ischial pressure sore

    PubMed Central

    Palanivelu, S.

    2009-01-01

    A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap. PMID:19881020

  1. Pituitary adenoma with seizures: PET demonstration of reduced glucose utilization in the medial temporal lobe

    SciTech Connect

    Bairamian, D.; Di Chiro, G.; Blume, H.; Ehrenberg, B.

    1986-05-01

    A patient with a benign chromophobe adenoma, who had incomplete surgical removal followed by radiotherapy, continued to have epileptic seizures up to two or three times a day. She was studied with positron emission tomography using /sup 18/F-2-deoxyglucose (FDG). This technique showed a high level of glucose utilization in the area of the operated tumor but also clear reduction of glucose utilization in the left medial temporal region adjacent to the sella and the scar tissue from the neoplasm. This area of reduced glucose utilization corresponded well to the same finding observed in other patients with complex partial epilepsy. A left temporal anterior lobectomy was carried out followed by improved control of the epilepsy. Positron emission tomography using FDG, together with electrophysiological examinations, may assist in the management of epilepsy related to pituitary tumors.

  2. Medial Meniscal Extrusion Relates to Cartilage Loss in Specific Femorotibial Subregions- Data from the Osteoarthritis Initiative

    PubMed Central

    Bloecker, K.; Wirth, W.; Guermazi, A.; Hunter, DJ; Resch, H.; Hochreiter, J.; Eckstein, F.

    2015-01-01

    Objective Medial meniscal extrusion is known to be related to structural progression of knee OA. However, it is unclear whether medial meniscal extrusion is more strongly associated with cartilage loss in certain medial femorotibial subregions than to others. Methods Segmentation of the medial tibial and femoral cartilage (baseline; 1-year follow-up) and the medial meniscus (baseline) was performed in 60 participants with frequent knee pain (age 61.3±9.2y, BMI 31.3±3.9 kg/m2) and with unilateral medial radiographic joint space narrowing (JSN) grade 1–3, using double echo steady state MR-images. Medial meniscal extrusion distance and extrusion area (%) between the external meniscal and tibial margin at baseline, and longitudinal medial cartilage loss in eight anatomical subregions were determined. Results A significant association (Pearson correlation coefficient) was seen between medial meniscus extrusion area in JSN knees and cartilage loss over one year throughout the entire medial femorotibial compartment. The strongest correlation was with cartilage loss in the external medial tibia (r=−0.34 [p<0.01] in JSN, and r=−0.30 [p=0.02] in noJSN knees). Conclusion Medial meniscus extrusion was associated with subsequent medial cartilage loss. The external medial tibial cartilage may be particularly vulnerable to thinning once the meniscus extrudes and its surface is “exposed” to direct, non-physiological, cartilage-cartilage contact. PMID:25988986

  3. 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.

  4. Foot polydactyly and bipartite medial cuneiform: A case of co-occurrence in a Celtic skeleton from Verona (Italy).

    PubMed

    Laffranchi, Z; Martín Flórez, J S; Jiménez Brobeil, S A; Castellani, V

    2015-06-01

    We report a case of bilateral foot polydactyly and bipartite medial cuneiform in a male individual buried in a Celtic/Roman necropolis (3rd to 1st century BCE) in the city of Verona (Italy). During the construction of an underground garage in the main courtyard of the Bishop's Seminary at Verona between 2005 and 2010, archaeologists uncovered the remains of 174 individuals (108 non-adults and 66 adults). It is thought that these graves could belong to some of the first inhabitants of the urban area of Verona. The individual presented here (US 2807) is a middle-aged male (40-50 years) in a good state of preservation. His estimated stature is 1756 mm (± 32.1 mm). This male presents congenital anomalies in the feet and dental agenesis. We believe this to be the only known archaeological case of bilateral postaxial polydactyly with forked (Y) shape, in which both fifth metatarsals are associated with complete bipartition of the left medial cuneiform and partial bipartition of the right one. Polydactyly is fairly common in modern clinical cases but bipartite medial cuneiform is relatively rare; neither of these congenital conditions is well documented archaeologically. Copyright © 2015 Elsevier GmbH. All rights reserved.

  5. Medial Patellofemoral Ligament Reconstruction in a Below-Knee Amputee.

    PubMed

    El-Tawil, Sherif; Elfons Tawafig, Marian; Miles, Jonathan

    2015-01-01

    Patellar instability is a common finding in patients with below-knee amputation and yet management options are not commonly described in the literature. We describe the first reported case of a medial patellofemoral ligament reconstruction using allograft in a patient with a below-knee amputation. Clinical outcome at two-year follow-up remains very good.

  6. Medial Patellofemoral Ligament Reconstruction in a Below-Knee Amputee

    PubMed Central

    El-Tawil, Sherif; Elfons Tawafig, Marian; Miles, Jonathan

    2015-01-01

    Patellar instability is a common finding in patients with below-knee amputation and yet management options are not commonly described in the literature. We describe the first reported case of a medial patellofemoral ligament reconstruction using allograft in a patient with a below-knee amputation. Clinical outcome at two-year follow-up remains very good. PMID:26579321

  7. Theta Synchronizes the Activity of Medial Prefrontal Neurons during Learning

    ERIC Educational Resources Information Center

    Paz, Rony; Bauer, Elizabeth P.; Pare, Denis

    2008-01-01

    Memory consolidation is thought to involve the gradual transfer of transient hippocampal-dependent traces to distributed neocortical sites via the rhinal cortices. Recently, medial prefrontal (mPFC) neurons were shown to facilitate this process when their activity becomes synchronized. However, the mechanisms underlying this enhanced synchrony…

  8. Medial thigh myocutaneous flap for covering extended hemipelvectomy.

    PubMed

    Luna-Perez, P; Herrera, L

    1995-12-01

    When a large tumour involves the buttock and anterolateral upper thigh, modifications to the classical hemipelvectomy may be required for its removal. Herein, we report the use of a medial myocutaneous flap for coverage of soft tissue defects produced by such procedures.

  9. Medial Prefrontal Cortex Lesions Abolish Contextual Control of Competing Responses

    ERIC Educational Resources Information Center

    Haddon, J. E.; Killcross, A. S.

    2005-01-01

    There is much debate as to the extent and nature of functional specialization within the different subregions of the prefrontal cortex. The current study was undertaken to investigate the effect of damage to medial prefrontal cortex subregions in the rat. Rats were trained on two biconditional discrimination tasks, one auditory and one visual, in…

  10. Medial Temporal Lobe Memory in Childhood: Developmental Transitions

    ERIC Educational Resources Information Center

    Townsend, Elise L.; Richmond, Jenny L.; Vogel-Farley, Vanessa K.; Thomas, Kathleen

    2010-01-01

    The medial temporal lobes (MTL) support declarative memory and mature structurally and functionally during the postnatal years in humans. Although recent work has addressed the development of declarative memory in early childhood, less is known about continued development beyond this period of time. The purpose of this investigation was to explore…

  11. Medial Temporal Lobe Memory in Childhood: Developmental Transitions

    ERIC Educational Resources Information Center

    Townsend, Elise L.; Richmond, Jenny L.; Vogel-Farley, Vanessa K.; Thomas, Kathleen

    2010-01-01

    The medial temporal lobes (MTL) support declarative memory and mature structurally and functionally during the postnatal years in humans. Although recent work has addressed the development of declarative memory in early childhood, less is known about continued development beyond this period of time. The purpose of this investigation was to explore…

  12. Medial Temporal Lobe Structures Contribute to On-Line Processing

    ERIC Educational Resources Information Center

    Warren, David

    2009-01-01

    For the last five decades, the medial temporal lobes have been generally understood to facilitate enduring representation of certain kinds of information. In particular, knowledge about the relations among items and concepts appears to rely on that region of the brain. Recent results suggest that those same structures also play a subtle role in…

  13. Temporary Medial Upper Eyelid Lagophthalmos after External Dacryocystorhinostomy.

    PubMed

    Haefliger, I O; Meienberg, O; Pimentel de Figueiredo, A R

    2016-04-01

    Background. Report of three cases of medial upper eyelid lagophthalmos as complication of external dacryocystorhinostomy. History and Signs. Shortly after dacryocystorhinostomy (skin incision on the side of the nose), three of ten consecutive patients (28 ± 4 years; mean ± standard deviation), presented with an ipsilateral lagophthalmos of 4 ± 1 mm in voluntary eyelid closure and 6 ± 1 mm in spontaneous blink. The lagophthalmos was due to a selective paresis of the medial part of the orbicularis oculi muscle of the upper eyelid. Patient 1 complained bitterly of dry eye symptoms and of her lagophthalmos. Patient 2 had mild symptoms but became very concerned after peers made her aware of her asymmetric blink. Patient 3 was asymptomatic and did not notice anything particular. Therapy and Outcome. Lagophthalmos resolved spontaneously within three months after surgery, first by improvement of voluntary eyelid closure and then of spontaneous blinking. Conclusions. Temporary lagophthalmos can occur as a complication of external dacryocystorhinostomy, most likely due to damage of the (only recently described) superficial buccal and/or zygomatic branches of the facial nerve that run upward to cross over the medial ligament and innervate the medial part of the orbicularis oculi muscle. Georg Thieme Verlag KG Stuttgart · New York.

  14. Sural Versus Perforator Flaps for Distal Medial Leg Wounds.

    PubMed

    Schannen, Andrew P; Truchan, Lisa; Goshima, Kaoru; Bentley, Roger; DeSilva, Gregory L

    2015-12-01

    Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. Copyright 2015, SLACK Incorporated.

  15. Arthroscopic Treatment of Medial Femoral Condylar Coronal Fractures and Nonunions

    PubMed Central

    Ercin, Ersin; Bilgili, M. Gokhan; Basaran, S. Hakan; Baca, Emre; Kural, Cemal; Avkan, M. Cevdet

    2013-01-01

    Nonunion of medial femoral condylar coronal fractures are uncommon. In neglected Hoffa fractures despite nonunion, there is a risk of missing accompanying ligamentous and intra-articular injuries. Neither preoperative clinical examination nor magnetic resonance imaging showed these injuries before arthroscopy. Arthroscopy before internal fixation gives additional information and changes the surgical protocol for these fractures and nonunions. PMID:24400191

  16. Default Network Connectivity in Medial Temporal Lobe Amnesia

    PubMed Central

    Hayes, Scott M.; Salat, David H.; Verfaellie, Mieke

    2012-01-01

    There is substantial overlap between the brain regions supporting episodic memory and the default network. However, in humans the impact of bilateral medial temporal lobe (MTL) damage on a large-scale neural network such as the default mode network is unknown. To examine this issue, resting functional magnetic resonance imaging (fMRI) was performed with amnesic patients and control participants. Seed-based functional connectivity analyses revealed robust default network connectivity in amnesia in cortical default network regions such as medial prefrontal cortex, posterior medial cortex, and lateral parietal cortex, as well as evidence of connectivity to residual MTL tissue. Relative to control participants, decreased posterior cingulate cortex connectivity to MTL and increased connectivity to cortical default network regions including lateral parietal and medial prefrontal cortex was observed in amnesia. In contrast, somatomotor network connectivity was intact in amnesia, indicating bilateral MTL lesions may selectively impact the default network. Changes in default network connectivity in amnesia were largely restricted to the MTL subsystem, providing preliminary support from MTL amnesic patients that the default network can be fractionated into functionally and structurally distinct components. To our knowledge, this is the first examination of the default network in amnesia. PMID:23077048

  17. Medial Prefrontal Cortex Lesions Abolish Contextual Control of Competing Responses

    ERIC Educational Resources Information Center

    Haddon, J. E.; Killcross, A. S.

    2005-01-01

    There is much debate as to the extent and nature of functional specialization within the different subregions of the prefrontal cortex. The current study was undertaken to investigate the effect of damage to medial prefrontal cortex subregions in the rat. Rats were trained on two biconditional discrimination tasks, one auditory and one visual, in…

  18. Scene-Selectivity and Retinotopy in Medial Parietal Cortex

    PubMed Central

    Silson, Edward H.; Steel, Adam D.; Baker, Chris I.

    2016-01-01

    Functional imaging studies in human reliably identify a trio of scene-selective regions, one on each of the lateral [occipital place area (OPA)], ventral [parahippocampal place area (PPA)], and medial [retrosplenial complex (RSC)] cortical surfaces. Recently, we demonstrated differential retinotopic biases for the contralateral lower and upper visual fields within OPA and PPA, respectively. Here, using functional magnetic resonance imaging, we combine detailed mapping of both population receptive fields (pRF) and category-selectivity, with independently acquired resting-state functional connectivity analyses, to examine scene and retinotopic processing within medial parietal cortex. We identified a medial scene-selective region, which was contained largely within the posterior and ventral bank of the parieto-occipital sulcus (POS). While this region is typically referred to as RSC, the spatial extent of our scene-selective region typically did not extend into retrosplenial cortex, and thus we adopt the term medial place area (MPA) to refer to this visually defined scene-selective region. Intriguingly MPA co-localized with a region identified solely on the basis of retinotopic sensitivity using pRF analyses. We found that MPA demonstrates a significant contralateral visual field bias, coupled with large pRF sizes. Unlike OPA and PPA, MPA did not show a consistent bias to a single visual quadrant. MPA also co-localized with a region identified by strong differential functional connectivity with PPA and the human face-selective fusiform face area (FFA), commensurate with its functional selectivity. Functional connectivity with OPA was much weaker than with PPA, and similar to that with face-selective occipital face area (OFA), suggesting a closer link with ventral than lateral cortex. Consistent with prior research, we also observed differential functional connectivity in medial parietal cortex for anterior over posterior PPA, as well as a region on the lateral

  19. A Finite Element Analysis of Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    DeVries Watson, Nicole A.; Duchman, Kyle R.; Bollier, Matthew J.; Grosland, Nicole M.

    2015-01-01

    Background The medial patellofemoral ligament is the primary soft-tissue restraint to lateral patella translation. Medial patellofemoral ligament reconstruction has become a viable surgical option to provide patellar stability in patients with recurrent instability. The primary goal of this study was to determine the effect of medial patellofemoral ligament reconstruction on the lateral force-displacement behavior of the patella using finite element analyses. Methods A finite element model of the knee was created using cadaveric image data. Experimental testing was performed to validate the computational model. After validation, the model was modified to study the effect of various medial patellofemoral ligament reconstruction insertion sites, allowing comparison of patellofemoral contact force and pressure. Results For the intact anatomic model, the lateral restraining force was 80.0 N with a corresponding patellar contact area of 54.97 mm2. For the anatomic reconstructed medial patellofemoral ligament model, the lateral restraining force increased to 148.9 N with a contact area of 71.78 mm2. This compared favorably to the corresponding experimental study. The force required to laterally displace the patella increased when the femoral insertion site was moved anteriorly or distally. The lateral restraining force decreased when the femoral insertion site moved proximally and the patellar insertion site moved either proximal or distal by 5 mm. Conclusion The line of action was altered with insertion site position, which in turn changed the amount of force it took to displace the patella laterally. Considering the model constraints, an anterior femoral attachment may over constrain the patella and increase cartilage wear due to increase contact area and restraining force. Clinical Relevance A malpositioned femoral tunnel in MPFL reconstruction could increase restraining forces and PF contact pressure, thus it is suggested to use intra-operative fluoroscopy to confirm

  20. The Treatment and Outcomes of Medial Malleolar Stress Fractures

    PubMed Central

    Irion, Val; Miller, Timothy L.; Kaeding, Christopher C.

    2014-01-01

    Context: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. Objective: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. Data Sources: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. Study Selection: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. Results: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. Conclusion: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play. PMID:25364485

  1. Does meniscus removal affect ACL-deficient knee laxity? An in vivo study.

    PubMed

    Zaffagnini, S; Signorelli, C; Bonanzinga, T; Grassi, A; Galán, H; Akkawi, I; Bragonzoni, L; Cataldi, F; Marcacci, M

    2016-11-01

    The purpose of the present study was to determine, in vivo, the effect of different types of meniscectomy on an ACL-deficient knee. Using a computer-assisted navigation system, 56 consecutive patients (45 men and 11 women) were subjected to a biomechanical testing with Lachman test (AP30), drawer test (AP90), internal/external rotation test, varus/valgus rotation test and pivot-shift test. The patients were divided into three groups according to the status of the medial meniscus. Group BH, 8 patients with bucket-handle tear of medial meniscus underwent a subtotal meniscectomy; Group PHB, 19 patients with posterior horn body of medial meniscus tear underwent a partial meniscectomy; and Group CG with isolated ACL rupture, as a control group, with 29 patients. A significant difference in anterior tibial translation was seen at 30 grades and in 90 grades between BH and PHB groups compared to the CG. In response to pivot-shift test, no significant differences in terms of AREA and POSTERIOR ACC were found among the three groups (n.s). Concerning the anterior displacement of the pivot shift a statistically significant differences among the three tested groups was found. The present study shows that meniscal defects significantly affect the kinematics of an ACL-deficient knee in terms of anterior tibial translation under static and dynamic testing.

  2. Island medial plantar artery perforator flap for reconstruction of plantar defects.

    PubMed

    Koshima, Isao; Narushima, Mitsunaga; Mihara, Mokoto; Nakai, Ikuo; Akazawa, Satoshi; Fukuda, Norio; Watanabe, Yorikatsu; Nakagawa, Masahiro

    2007-11-01

    Three cases in which island medial plantar artery perforator flaps were successfully transferred for coverage of the plantar defects are described. This perforator flap is different from the medial plantar flap based on the medial plantar artery. The flap has no fascial component and is nourished only with the perforator of the medial plantar vessel. Therefore, transection of the medial plantar artery is usually unnecessary. This flap can cover defects on the forefoot and heel without transaction of the medial plantar system. The advantages of this flap are no need for deep or long dissection for the medial plantar vessel, no exposure of the plantar sensory nerve, a short time for flap elevation, minimal donor-site morbidity, relatively large flap survival, and no damage of both the posterior tibial and medial plantar neurovascular systems.

  3. Medial Auditory Thalamus Inactivation Prevents Acquisition and Retention of Eyeblink Conditioning

    ERIC Educational Resources Information Center

    Halverson, Hunter E.; Poremba, Amy; Freeman, John H.

    2008-01-01

    The auditory conditioned stimulus (CS) pathway that is necessary for delay eyeblink conditioning was investigated using reversible inactivation of the medial auditory thalamic nuclei (MATN) consisting of the medial division of the medial geniculate (MGm), suprageniculate (SG), and posterior intralaminar nucleus (PIN). Rats were given saline or…

  4. Dynamic Changes in Acetylcholine Output in the Medial Striatum during Place Reversal Learning

    ERIC Educational Resources Information Center

    Ragozzino, Michael E.; Choi, Daniel

    2004-01-01

    The present studies explored the role of the medial striatum in learning when task contingencies change. Experiment 1 examined whether the medial striatum is involved in place reversal learning. Testing occurred in a modified cross-maze across two consecutive sessions. Injections of the local anesthetic, bupivacaine, into the medial striatum, did…

  5. Partial Torus Instability

    NASA Astrophysics Data System (ADS)

    Olmedo, Oscar; Zhang, J.

    2010-05-01

    Flux ropes are now generally accepted to be the magnetic configuration of Coronal Mass Ejections (CMEs), which may be formed prior or during solar eruptions. In this study, we model the flux rope as a current-carrying partial torus loop with its two footpoints anchored in the photosphere, and investigate its instability in the context of the torus instability (TI). Previous studies on TI have focused on the configuration of a circular torus and revealed the existence of a critical decay index. Our study reveals that the critical index is a function of the fractional number of the partial torus, defined by the ratio between the arc length of the partial torus above the photosphere and the circumference of a circular torus of equal radius. We refer to this finding the partial torus instability (PTI). It is found that a partial torus with a smaller fractional number has a smaller critical index, thus requiring a more gradually decreasing magnetic field to stabilize the flux rope. On the other hand, the partial torus with a larger fractional number has a larger critical index. In the limit of a circular torus when the fractional number approaches one, the critical index goes to a maximum value that depends on the distribution of the external magnetic field. We demonstrate that the partial torus instability helps us to understand the confinement, growth, and eventual eruption of a flux rope CME.

  6. Medial orbitofrontal cortex is associated with fatigue sensation.

    PubMed

    Tajima, Seiki; Yamamoto, Shigeyuki; Tanaka, Masaaki; Kataoka, Yosky; Iwase, Masao; Yoshikawa, Etsuji; Okada, Hiroyuki; Onoe, Hirotaka; Tsukada, Hideo; Kuratsune, Hirohiko; Ouchi, Yasuomi; Watanabe, Yasuyoshi

    2010-01-01

    Fatigue is an indispensable bioalarm to avoid exhaustive state caused by overwork or stresses. It is necessary to elucidate the neural mechanism of fatigue sensation for managing fatigue properly. We performed H(2) ( 15)O positron emission tomography scans to indicate neural activations while subjects were performing 35-min fatigue-inducing task trials twice. During the positron emission tomography experiment, subjects performed advanced trail-making tests, touching the target circles in sequence located on the display of a touch-panel screen. In order to identify the brain regions associated with fatigue sensation, correlation analysis was performed using statistical parametric mapping method. The brain region exhibiting a positive correlation in activity with subjective sensation of fatigue, measured immediately after each positron emission tomography scan, was located in medial orbitofrontal cortex (Brodmann's area 10/11). Hence, the medial orbitofrontal cortex is a brain region associated with mental fatigue sensation. Our findings provide a new perspective on the neural basis of fatigue.

  7. Downregulation of the posterior medial frontal cortex prevents social conformity.

    PubMed

    Klucharev, Vasily; Munneke, Moniek A M; Smidts, Ale; Fernández, Guillén

    2011-08-17

    We often change our behavior to conform to real or imagined group pressure. Social influence on our behavior has been extensively studied in social psychology, but its neural mechanisms have remained largely unknown. Here we demonstrate that the transient downregulation of the posterior medial frontal cortex by theta-burst transcranial magnetic stimulation reduces conformity, as indicated by reduced conformal adjustments in line with group opinion. Both the extent and probability of conformal behavioral adjustments decreased significantly relative to a sham and a control stimulation over another brain area. The posterior part of the medial frontal cortex has previously been implicated in behavioral and attitudinal adjustments. Here, we provide the first interventional evidence of its critical role in social influence on human behavior.

  8. Working memory and left medial temporal cortical thickness.

    PubMed

    Pastura, Giuseppe; Kubo, Tadeu Takao Almodovar; Regalla, Maria Angélica; Mesquita, Cíntia Machado; Coutinho, Gabriel; Gasparetto, Emerson Leandro; Figueiredo, Otávio; Mattos, Paulo; Araújo, Alexandra Prüfer de Queiroz Campos

    2016-10-01

    To perform a pilot study to investigate the association between working memory and cortical thickness in a sample of attention deficit/hyperactivity disorder (ADHD) children. Seventeen children aged 7-10 years diagnosed with ADHD and 16 healthy children underwent a magnetic resonance scan for cortical thickness measurements. Data was correlated with working memory performance using the Backwards Digit Span subtest of the Wechsler Intelligence Scale for Children. Working memory impairment, evidenced by lower scores on the Backwards Digit Span, was observed in patients with ADHD compared to healthy controls. There was a direct correlation between working memory and cortical thickness of the left medial temporal lobe (Spearman's correlation coefficient: 0.499; p < 0.005). Our data suggests, for the first time, a correlation between working memory, evaluated by the Backwards Digit Span, and left medial temporal cortical thickness.

  9. Medial prefrontal D1 dopamine neurons control food intake

    PubMed Central

    Land, Benjamin B; Narayanan, Nandakumar S; Liu, Rong-Jian; Gianessi, Carol A; Brayton, Catherine E; Grimaldi, David; Sarhan, Maysa; Guarnieri, Douglas J; Deisseroth, Karl; Aghajanian, George K; Dileone, Ralph J

    2014-01-01

    Although the prefrontal cortex influences motivated behavior, its role in food intake remains unclear. Here, we demonstrate a role for D1-type dopamine receptor-expressing neurons in the medial prefrontal cortex (mPFC) in the regulation of feeding. Food intake increases activity in D1 neurons of the mPFC in mice, and optogenetic photostimulation of D1 neurons increases feeding. Conversely, inhibition of D1 neurons decreases intake. Stimulation-based mapping of prefrontal D1 neuron projections implicates the medial basolateral amygdala (mBLA) as a downstream target of these afferents. mBLA neurons activated by prefrontal D1 stimulation are CaMKII positive and closely juxtaposed to prefrontal D1 axon terminals. Finally, photostimulating these axons in the mBLA is sufficient to increase feeding, recapitulating the effects of mPFC D1 stimulation. These data describe a new circuit for top-down control of food intake. PMID:24441680

  10. REHABILITATION FOLLOWING MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION FOR PATELLAR INSTABILITY

    PubMed Central

    Prohaska, Daniel

    2017-01-01

    Patellar instability is a common problem seen by physical therapists, athletic trainers and orthopedic surgeons. Although following an acute dislocation, conservative rehabilitation is usually the first line of defense; refractory cases exist that may require surgical intervention. Substantial progress has been made in the understanding of the medial patellofemoral ligament (MPFL) and its role as the primary stabilizer to lateral patellar displacement. Medial patellofemoral ligament disruption is now considered to be the essential lesion following acute patellar dislocation due to significantly high numbers of ruptures following this injury. Evidence is now mounting that demonstrates the benefits of early reconstruction with a variety of techniques. Recently rehabilitation has become more robust and progressive due to our better understanding of soft tissue reconstruction and repair techniques. The purpose of this manuscript is to describe the etiology of patellar instability, the anatomy and biomechanics and examination of patellofemoral instability, and to describe surgical intervention and rehabilitation following MPFL rupture. Level of Evidence 5 PMID:28593102

  11. Medial epicanthoplasty using the palpebral margin incision method.

    PubMed

    Chen, Wen; Li, Shenkai; Li, Yangqun; Wang, Yining

    2009-12-01

    Epicanthal deformity is one of the most frequently encountered cosmetic problems in Asian people. Herein, we introduce a new method for correction of epicanthal folds, which always is performed in combination with double eyelidplasty. First, through upper and lower palpebral margin incisions, we release and excise the connective and orbicularis oculi muscle dense fibres underlying the epicanthal folds, as well as the superficial head of the medial canthal ligament. After repositioning the medial canthus in a double eyelidplastic procedure, we cut off the redundant skin tissue and close the incisions. 82 epicanthoplasties have been performed during the past 2 years. Follow-up time ranged from 1 to 32 months. Postsurgery scars were invisible in all cases. All patients were satisfied with the results. No recurrence of the epicanthal fold was observed. The new method introduced has advantages in avoiding scar formation and is an especially suitable approach for epicanthoplasty in Asian patients.

  12. 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.

  13. Taiwanese life scientists less "medialized" than their Western colleagues.

    PubMed

    Lo, Yin-Yueh; Peters, Hans Peter

    2015-01-01

    The article presents results from surveys of life scientists in Taiwan (n=270) and in Germany (n=326). Fewer Taiwanese than German researchers have frequent contact with the media and they rate their experiences with journalists less positively. Furthermore, they are less prepared to adapt to journalistic expectations and to a greater extent than German researchers they expect journalists to consider scientific criteria in their reporting. These findings are interpreted in Weingart's "medialization of science" framework as indicators of lower medialization of science in Taiwan than in Germany. However, Taiwanese scientists are more willing than German scientists to accept journalistic simplification at the expense of accuracy. This is explained as an adaptation to the media system and to the perceived scientific literacy of the media audience. We hypothesize that cultural differences regarding the relative priority of relational vs. rational communication goals may also contribute to more tolerance of journalistic simplification in Taiwan. © The Author(s) 2013.

  14. [A case of medial medullary infarction without Dejerine syndrome].

    PubMed

    Kobayashi, Y; Shimada, A; Takabatake, M

    1999-12-01

    A 67-year-old man with right hemiparesis and dysarthria was admitted with right hemiparesis involving the face, hyperpathia, numbness and pain of the right body and limb except the face, and had hyperreflexia and pathological reflex in the right limb. Brain MRI on the day after admission disclosed no lesion which might explain the symptoms. Short latency somatosensory evoked potential showed a low amplitude after P14 when the right side was stimulated. Cerebral angiography revealed occlusion of the left vertebral artery. Brain MRI on the 18th hospital day disclosed left medial medullary infarction, so we diagnosed medial medullary syndrome. This case was hard to diagnose, because of the atypical features and the absence of an abnormal lesion on the initial MRI.

  15. Cochlear shape description and analyzing via medial models

    NASA Astrophysics Data System (ADS)

    Gaa, Johannes; Kahrs, Lüder A.; Müller, Samuel; Majdani, Omid; Ortmaier, Tobias

    2015-03-01

    Planning and analyzing of surgical interventions are often based on computer models derived from computed tomography images of the patient. In the field of cochlear implant insertion the modeling of several structures of the inner ear is needed. One structure is the overall helical shape of the cochlea itself. In this paper we analyze the cochlea by applying statistical shape models with medial representation. The cochlea is considered as tubular structure. A model representing the skeleton of training data and an atomic composition of the structure is built. We reduce the representation to a linear chain of atoms. As result a compact discrete model is possible. It is demonstrated how to place the atoms and build up their correspondence through a population of training data. The outcome of the applied representation is discussed in terms of impact on automated segmentation algorithms and known advantages of medial models are revisited.

  16. Arytenoid adduction combined with Gore-Tex medialization thyroplasty.

    PubMed

    McCulloch, T M; Hoffman, H T; Andrews, B T; Karnell, M P

    2000-08-01

    To describe the technique of combined Gore-Tex medialization thyroplasty with arytenoid adduction and to determine the long-term vocal outcome of patients treated for unilateral vocal cord paralysis with this procedure. A retrospective chart review and patient reevaluation for patients treated at The University of Iowa Hospitals and Clinics between May 1995 and June 1999. The review addressed patient demographics, perioperative and long-term complications, and voice outcomes. Details of the surgical technique are provided within the manuscript. Seventy-two Gore-Tex medialization procedures were completed. Arytenoid adduction was included in 22 of these procedures. This subset of patients was compared with the patients treated with Gore-Tex alone. No major postoperative complications occurred in either group. Preoperative and postoperative voice and videostroboscopy data were available for 19 arytenoid adduction patients and 25 Gore-Tex alone patients. On a seven-point scale (6 [severely abnormal] --> 0 [normal voice]), the average patient rating of voice dysfunction improved from 4.2 to 1.6 (arytenoid adduction) and 4.5 to 2.8 (Gore-Tex alone). Maximum phonation time improved from 6.9 seconds to 16.7 seconds in the arytenoid adduction group. Subjective voice assessment employing the four-point GRBAS scale (3 [severely abnormal] --> 0 [normal]) identified average improvement from an overall grade of 2.1 to 0.8 arytenoid adduction and 2.2 to 1.5 in the Gore-Tex alone group. Improvement was identified in the vocal quality of breathiness from 1.9 to 0.2 (arytenoid adduction) and 1.9 to 0.9 (Gore-Tex alone). The combined technique of Gore-Tex medialization thyroplasty and arytenoid adduction provide functional results that appear to exceed the improvement attained with medialization alone.

  17. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction.

    PubMed

    Ventura, Alberto; Legnani, Claudio; Terzaghi, Clara; Iori, Stefano; Borgo, Enrico

    2017-03-01

    The purpose of the present study was to retrospectively evaluate the outcomes of patients who underwent combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to a high success rate in patients affected by isolated medial unicompartmental osteoarthritis and concomitant ACL deficiency. Fourteen patients with primary ACL lesion and concomitant medial compartment symptomatic osteoarthritis treated from 2006 to 2010 were followed up for an average time of 26.7 months (SD 4.2). Assessment included KOOS score, Oxford Knee score, American Knee Society scores, WOMAC index of osteoarthritis, Tegner activity level and objective examination including instrumented laxity test with KT-1000 arthrometer. Radiological assessment was done with standard simple radiographs in order to get information about any presence of loosening of the components. KOOS score, OKS, WOMAC index and the AKSS improved significantly after surgery (p < 0.001). Regarding AKSS, improvement was noted both in the objective score and in the functional one (p < 0.001). There was no clinical evidence of instability in any of the knees as evaluated with clinical laxity testing. No pathologic radiolucent lines were observed around the components. In one patient signs of osteoarthritis in the lateral compartment were observed 28 months after surgery. UKA combined with ACL reconstruction is a valid therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency in young and active patients and confirms subjective and objective clinical improvement 2 years after surgery. The use of a fixed-bearing prosthesis represents a reliable feature as it allows to overcome problems of improper ligament tensioning during the implantation of the components. IV.

  18. New technique of reconstruction for medial elbow instability.

    PubMed

    Slullitel, Miguel Hector; Andres, Glasberg Ernesto

    2010-12-01

    This study reports a new substitution technique as a choice to repair both acute and chronic injuries of the ulnar collateral ligament of the elbow. Different researchers have described different techniques to reconstruct the medial ligament complex with similar results (with the use of grafts). There is a shared variable in the latest reports, the interpretation of the anterior bundle as the most important structure, for medial elbow stability and the only structure to be repaired as well. The approach to the medial structures of the elbow is similar to most of the surgical techniques. It consists of an incision on the medial aspect of the elbow, centered on the epicondyle, of length 4 inches. The reconstruction uses a strip of the aponeurosis of the flexor carpi ulnaris (FCU) reinforced with Kracow stitches. The graft is harvested using the strong aponeurosis of the FCU, a vascularized structure, a viable option and with sufficient resistance to bear the tension of the inner aspect of the elbow. The surgical morbidity is also reduced as the graft is not taken from other zones. As the distal insertion of the neo-ligament, the proximal fixation of the FCU is used in the sublime tubercle, inverting the direction of the fibers of this strip from distal to proximal. The proximal fixation of this ligament is an osseous tunnel in the epitroclea secured with an interference screw. Common complications are those resulting from the approach and the ulnar nerve manipulation. Owing to the satisfactory stability outcome achieved by this technique, early rehabilitation may start without inconveniences.

  19. Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: a 7-year single-center experience with 21 consecutive cases.

    PubMed

    Jing-Chun, Zhao; Kai, Shi; Jia-Ao, Yu; Chun-Jing, Xian; Lai-Jin, Lu; Chun-Hui, Xie

    2015-01-01

    The medial crural fasciocutaneous flap is a reliable cutaneous flap that can be used for soft tissue reconstruction in the extremities. The purpose of this article is to evaluate the application and clinical significance of this surgical technique in the reconstruction of heel soft tissue defects. Twenty-one cases of heel soft tissue defect between March 2005 and March 2012 were included in this study. Wound sizes varied from 5.0 × 5.5 to 7.5 × 10.0 cm. All cases were managed with a reverse medial crural fasciocutaneous flap. Patient demographics and case information were analyzed and are reported. The sizes of the reverse medial crural fasciocutaneous flap varied from 6.5 × 10.0 to 9.0 × 15.0 cm; the average size was 7.7 × 13.8 cm. Out of the 21 consecutive cases, 20 flaps survived intact and one flap underwent partial necrosis. Follow-up observations were conducted for 6-36 months. The cosmetic results were satisfactory, without apparent bulkiness; the weight-bearing outcomes were satisfactory. The donor site can be closed primarily or by skin graft. Reverse medial crural fasciocutaneous flap transfer is appropriate for the reconstruction of heel soft tissue defects. The method is safe and can cover large heel defects.

  20. Biomechanics of medial unicondylar in combination with patellofemoral knee arthroplasty.

    PubMed

    Heyse, Thomas J; El-Zayat, Bilal F; De Corte, Ronny; Scheys, Lennart; Chevalier, Yan; Fuchs-Winkelmann, Susanne; Labey, Luc

    2014-01-01

    Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this. Six fresh frozen full leg cadaver specimens were prepared and mounted in a kinematic rig with six degrees of freedom for the knee joint. Three motion patterns were applied with the native knee and after sequential implantation of medial UKA and patellofemoral joint replacement (PFJ): passive flexion-extension, open chain extension, and squatting. During the loaded motions, quadriceps and hamstrings muscle forces were applied. Infrared cameras continuously recorded the trajectories of marker frames rigidly attached to femur, tibia and patella. Prior computer tomography allowed identification of coordinate frames of the bones. Strains in the collateral ligaments were calculated from insertion site distances. UKA led to a less adducted and internally rotated tibia and a more strained medial collateral ligament (MCL). Addition of a patellofemoral replacement led to a more posterior position of both femoral condyles, a more dorsally located tibiofemoral contact point and higher MCL strain with squatting. In comparison to UKA modular BKA leads to a more dorsal tibial contact point, a medial femoral condyle being located more posteriorly, and more MCL strain. Mainly the changes to the trochlear anatomy as introduced by PFJ may account for these differences. © 2014 Elsevier B.V. All rights reserved.

  1. Medial Gastrocnemius Myoelectric Control of a Robotic Ankle Exoskeleton

    PubMed Central

    Kinnaird, Catherine R.; Ferris, Daniel P.

    2010-01-01

    A previous study from our laboratory showed that when soleus electromyography was used to control the amount of plantar flexion assistance from a robotic ankle exoskeleton, subjects significantly reduced their soleus activity to quickly return to normal gait kinematics. We speculated that subjects were primarily responding to the local mechanical assistance of the exoskeleton rather than directly attempting to reduce exoskeleton mechanical power via decreases in soleus activity. To test this observation we studied ten healthy subjects walking on a treadmill at 1.25 m/s while wearing a robotic exoskeleton proportionally controlled by medial gastrocnemius activation. We hypothesized that subjects would primarily decrease soleus activity due to its synergistic mechanics with the exoskeleton. Subjects decreased medial gastrocnemius recruitment by 12% (p<0.05) but decreased soleus recruitment by 27% (p<0.05). In agreement with our hypothesis, the primary reduction in muscle activity was not for the control muscle (medial gastrocnemius) but for the anatomical synergist to the exoskeleton (soleus). These findings indicate that anatomical morphology needs to be considered carefully when designing software and hardware for robotic exoskeletons. PMID:19211321

  2. A combinatorial optogenetic approach to medial habenula function

    NASA Astrophysics Data System (ADS)

    Turner, Eric E.; Hsu, Yun-Wei; Wang, Si; Morton, Glenn; Zeng, Hongkui

    2013-03-01

    The habenula is a brain region found in all vertebrate species. It consists of medial and lateral subnuclei which make complex descending connections to the brainstem. Although the medial habenula (MHb) and its projection, the fasciculus retroflexus (FR), have been recognized for decades, their function remains obscure. The small size of the MHb in rodents, and the cellular and molecular complexity of this region, have made it difficult to study the function of this region with high specificity. Here we describe a Cre-mediated genetic system for expressing the microbial opsin channelrhodopsin (ChR2) specifically in the dorsal (dMHb) and ventral (vMHb) medial habenula. Genetically targeted expression of ChR2 allows MHb neurons to be selectively activated with light in acute brain slices with electrophysiological readouts, and in vivo by means of custom-built fiber optic cannulas. These tools will allow highly specific studies of MHb circuitry and the role of the MHb in behaviors related to addiction and mood regulation.

  3. The Fate of Old Memories after Medial Temporal Lobe Damage

    PubMed Central

    Bayley, Peter J.; Hopkins, Ramona O.; Squire, Larry R.

    2008-01-01

    Damage to the hippocampal region and related medial temporal lobe structures (perirhinal, entorhinal, and parahippocampal cortices) impairs new learning (anterograde amnesia) as well as memory for information that was acquired before the damage occurred (retrograde amnesia). We assessed retrograde amnesia with the Autobiographical Memory Interview (AMI) and with a news events test in six patients with damage limited primarily to the hippocampal region (H group) and two patients with large medial temporal lobe lesions (MTL group). On the news event test, the H group exhibited temporally limited retrograde amnesia covering ∼5 years. On the same test, the MTL group exhibited an extensive retrograde amnesia covering decades. Nevertheless, performance was relatively spared for very remote time periods. On the AMI, all patients had intact remote autobiographical memory. Because our patients with hippocampal lesions, as well as our patients with large MTL lesions, performed normally on the AMI, patients who perform poorly on the same test presumably have damage beyond the hippocampus and related structures in the medial temporal lobe. The findings emphasize the difference in the extent of retrograde amnesia associated with hippocampal lesions and large MTL lesions. PMID:17182781

  4. Radiofrequency Neurotomy of Cervical Medial Branches for Chronic Cervicobrachialgia

    PubMed Central

    Shin, Woo-Ram; Shin, Dong-Gyu; Shin, Dong-Ah

    2006-01-01

    Chronic neck and arm pain or cervicobrachialgia commonly occurs with the degeneration of cervical spine. Authors investigated the usefulness of radiofrequency (RF) neurotomies of cervical medial branches in patients with cervicobrachialgia and analyzed the factors which can influence the treatment outcome. Demographic data, types of pain distribution, responses of double controlled blocks, electrical stimulation parameters, numbers and levels of neurotomies, and surgical outcomes were evaluated after mean follow-up of 12 months. Pain distribution pattern was not significantly correlated with the results of diagnostic blocks. Average stimulation intensity was 0.45 V, ranging from 0.3 to 0.69, to elicit pain response in cervical medial branches. The most common involvement of nerve branches was C4 (89%), followed by C5 (82%), C6 (75%), and C7 (43%). Among total of 28 patients, nineteen (68%) reported successful outcome according to outcome criteria after 6 months of follow-up (p=0.001), and eight (42%) of 19 patients reported complete relief (100%) of pain. Four patients showed recurrence of pain between 6 and 12 months. It was therefore concluded that cervical medial branch neurotomy is considered useful therapeutic modality for the management of cervicobrachialgia in selected patients, particularly in degenerative zygapophyseal disorders. PMID:16479077

  5. Radiofrequency neurotomy of cervical medial branches for chronic cervicobrachialgia.

    PubMed

    Shin, Woo-Ram; Kim, Hyoung-Ihl; Shin, Dong-Gyu; Shin, Dong-Ah

    2006-02-01

    Chronic neck and arm pain or cervicobrachialgia commonly occurs with the degeneration of cervical spine. Authors investigated the usefulness of radiofrequency (RF) neurotomies of cervical medial branches in patients with cervicobrachialgia and analyzed the factors which can influence the treatment outcome. Demographic data, types of pain distribution, responses of double controlled blocks, electrical stimulation parameters, numbers and levels of neurotomies, and surgical outcomes were evaluated after mean follow-up of 12 months. Pain distribution pattern was not significantly correlated with the results of diagnostic blocks. Average stimulation intensity was 0.45 V, ranging from 0.3 to 0.69, to elicit pain response in cervical medial branches. The most common involvement of nerve branches was C4 (89%), followed by C5 (82%), C6 (75%), and C7 (43%). Among total of 28 patients, nineteen (68%) reported successful outcome according to outcome criteria after 6 months of followup (p=0.001), and eight (42%) of 19 patients reported complete relief (100%) of pain. Four patients showed recurrence of pain between 6 and 12 months. It was therefore concluded that cervical medial branch neurotomy is considered useful therapeutic modality for the management of cervicobrachialgia in selected patients, particularly in degenerative zygapophyseal disorders.

  6. Dopamine in the medial amygdala network mediates human bonding

    PubMed Central

    Touroutoglou, Alexandra; Rudy, Tali; Salcedo, Stephanie; Feldman, Ruth; Hooker, Jacob M.; Dickerson, Bradford C.; Catana, Ciprian; Barrett, Lisa Feldman

    2017-01-01

    Research in humans and nonhuman animals indicates that social affiliation, and particularly maternal bonding, depends on reward circuitry. Although numerous mechanistic studies in rodents demonstrated that maternal bonding depends on striatal dopamine transmission, the neurochemistry supporting maternal behavior in humans has not been described so far. In this study, we tested the role of central dopamine in human bonding. We applied a combined functional MRI-PET scanner to simultaneously probe mothers’ dopamine responses to their infants and the connectivity between the nucleus accumbens (NAcc), the amygdala, and the medial prefrontal cortex (mPFC), which form an intrinsic network (referred to as the “medial amygdala network”) that supports social functioning. We also measured the mothers’ behavioral synchrony with their infants and plasma oxytocin. The results of this study suggest that synchronous maternal behavior is associated with increased dopamine responses to the mother’s infant and stronger intrinsic connectivity within the medial amygdala network. Moreover, stronger network connectivity is associated with increased dopamine responses within the network and decreased plasma oxytocin. Together, these data indicate that dopamine is involved in human bonding. Compared with other mammals, humans have an unusually complex social life. The complexity of human bonding cannot be fully captured in nonhuman animal models, particularly in pathological bonding, such as that in autistic spectrum disorder or postpartum depression. Thus, investigations of the neurochemistry of social bonding in humans, for which this study provides initial evidence, are warranted. PMID:28193868

  7. Speed and Oscillations: Medial Septum Integration of Attention and Navigation.

    PubMed

    Tsanov, Marian

    2017-01-01

    Several cortical and diencephalic limbic brain regions incorporate neurons that fire in correlation with the speed of whole-body motion, also known as linear velocity. Besides the field mapping and head-directional information, the linear velocity is among the major signals that guide animal's spatial navigation. Large neuronal populations in the same limbic regions oscillate with theta rhythm during spatial navigation or attention episodes; and the frequency of theta also correlates with linear velocity. A functional similarity between these brain areas is that their inactivation impairs the ability to form new spatial memories; whereas an anatomical similarity is that they all receive projections from medial septum-diagonal band of Broca complex. We review recent findings supporting the model that septal theta rhythm integrates different sensorimotor signals necessary for spatial navigation. The medial septal is described here as a circuitry that mediates experience-dependent balance of sustained attention and path integration during navigation. We discuss the hypothesis that theta rhythm serves as a key mechanism for the aligning of intrinsic spatial representation to: (1) rapid change of position in the spatial environment; (2) continuous alteration of sensory signals throughout navigation; and (3) adapting levels of attentional behavior. The synchronization of these spatial, somatosensory and neuromodulatory signals is proposed here to be anatomically and physiologically mediated by the medial septum.

  8. Aging, self-referencing, and medial prefrontal cortex.

    PubMed

    Gutchess, Angela H; Kensinger, Elizabeth A; Schacter, Daniel L

    2007-01-01

    The lateral prefrontal cortex undergoes both structural and functional changes with healthy aging. In contrast, there is little structural change in the medial prefrontal cortex, but relatively little is known about the functional changes to this region with age. Using an event-related fMRI design, we investigated the response of medial prefrontal cortex during self-referencing in order to compare age groups on a task that young and elderly perform similarly and that is known to actively engage the region in young adults. Nineteen young (M age = 23) and seventeen elderly (M age = 72) judged whether adjectives described themselves, another person, or were presented in upper case. We assessed the overlap in activations between young and elderly for the self-reference effect (self vs. other person), and found that both groups engage medial prefrontal cortex and mid-cingulate during self-referencing. The only cerebral differences between the groups in self versus other personality assessment were found in somatosensory and motor-related areas. In contrast, age-related modulations were found in the cerebral network recruited for emotional valence processing. Elderly (but not young) showed increased activity in the dorsal prefrontal cortex for positive relative to negative items, which could reflect an increase in controlled processing of positive information for elderly adults.

  9. Medial maxillectomy in recalcitrant sinusitis: when, why and how?

    PubMed

    Konstantinidis, Iordanis; Constantinidis, Jannis

    2014-02-01

    We reviewed all journal articles relevant to endoscopic medial maxillectomy in patients with recalcitrant chronic maxillary sinusitis in order to present all indications, the underlying pathophysiology and the developed surgical techniques. Despite the high success rate of middle meatal antrostomy, cases with persistent maxillary sinus disease exist and often need a more extended endoscopic procedure for the better control of the disease. Such surgical option uses gravity for better sinus drainage and offers better saline irrigation, local application of medications and follow-up inspection. An endoscopic medial maxillectomy and its modified forms offer a wider surgical field and access to all 'difficult' areas of the maxillary sinus. Patients with previous limited endoscopic sinus surgery or extended open surgery, cystic fibrosis, extensive mucoceles, allergic fungal sinusitis, odontogenic infections, foreign bodies and so on may suffer from recurrent disease requiring an endoscopic medial maxillectomy. Depending on the disease, various modifications of the procedure can be performed preserving the anterior buttress, nasolacrimal duct and inferior turbinate if possible.

  10. Medial vestibular connections with the hypocretin (orexin) system

    NASA Technical Reports Server (NTRS)

    Horowitz, Seth S.; Blanchard, Jane; Morin, Lawrence P.

    2005-01-01

    The mammalian medial vestibular nucleus (MVe) receives input from all vestibular endorgans and provides extensive projections to the central nervous system. Recent studies have demonstrated projections from the MVe to the circadian rhythm system. In addition, there are known projections from the MVe to regions considered to be involved in sleep and arousal. In this study, afferent and efferent subcortical connectivity of the medial vestibular nucleus of the golden hamster (Mesocricetus auratus) was evaluated using cholera toxin subunit-B (retrograde), Phaseolus vulgaris leucoagglutinin (anterograde), and pseudorabies virus (transneuronal retrograde) tract-tracing techniques. The results demonstrate MVe connections with regions mediating visuomotor and postural control, as previously observed in other mammals. The data also identify extensive projections from the MVe to regions mediating arousal and sleep-related functions, most of which receive immunohistochemically identified projections from the lateral hypothalamic hypocretin (orexin) neurons. These include the locus coeruleus, dorsal and pedunculopontine tegmental nuclei, dorsal raphe, and lateral preoptic area. The MVe itself receives a projection from hypocretin cells. CTB tracing demonstrated reciprocal connections between the MVe and most brain areas receiving MVe efferents. Virus tracing confirmed and extended the MVe afferent connections identified with CTB and additionally demonstrated transneuronal connectivity with the suprachiasmatic nucleus and the medial habenular nucleus. These anatomical data indicate that the vestibular system has access to a broad array of neural functions not typically associated with visuomotor, balance, or equilibrium, and that the MVe is likely to receive information from many of the same regions to which it projects.

  11. Medial vestibular connections with the hypocretin (orexin) system

    NASA Technical Reports Server (NTRS)

    Horowitz, Seth S.; Blanchard, Jane; Morin, Lawrence P.

    2005-01-01

    The mammalian medial vestibular nucleus (MVe) receives input from all vestibular endorgans and provides extensive projections to the central nervous system. Recent studies have demonstrated projections from the MVe to the circadian rhythm system. In addition, there are known projections from the MVe to regions considered to be involved in sleep and arousal. In this study, afferent and efferent subcortical connectivity of the medial vestibular nucleus of the golden hamster (Mesocricetus auratus) was evaluated using cholera toxin subunit-B (retrograde), Phaseolus vulgaris leucoagglutinin (anterograde), and pseudorabies virus (transneuronal retrograde) tract-tracing techniques. The results demonstrate MVe connections with regions mediating visuomotor and postural control, as previously observed in other mammals. The data also identify extensive projections from the MVe to regions mediating arousal and sleep-related functions, most of which receive immunohistochemically identified projections from the lateral hypothalamic hypocretin (orexin) neurons. These include the locus coeruleus, dorsal and pedunculopontine tegmental nuclei, dorsal raphe, and lateral preoptic area. The MVe itself receives a projection from hypocretin cells. CTB tracing demonstrated reciprocal connections between the MVe and most brain areas receiving MVe efferents. Virus tracing confirmed and extended the MVe afferent connections identified with CTB and additionally demonstrated transneuronal connectivity with the suprachiasmatic nucleus and the medial habenular nucleus. These anatomical data indicate that the vestibular system has access to a broad array of neural functions not typically associated with visuomotor, balance, or equilibrium, and that the MVe is likely to receive information from many of the same regions to which it projects.

  12. Arthroscopic Removal of Shotgun Pellet From Within the Medial Meniscus

    PubMed Central

    Lacy, Kyle; Cooke, Chris; Cooke, Pat; Tonnos, Frederick

    2016-01-01

    Arthroscopic techniques are effective for the removal of intra-articular bullet and metal fragments after gunshot wounds to the shoulder, hip, knee, and sacroiliac joints. Surgical removal of bullets retained within the synovial joints is indicated; lead is dissolved by synovial fluid over time, leading to proliferative synovitis, lead arthropathy, elevated serum lead levels, and lead toxicity. We present an arthroscopic technique for removal of a shotgun pellet retained within the medial meniscus. In this technique, diagnostic knee arthroscopy is initially performed, which allows for localization of the pellet within the medial meniscus. An up-biter is used to resect the inner rim of meniscus surrounding the pellet, and the pellet is removed with a grasper. This arthroscopic approach is advantageous because it allows for efficient visualization of the pellet within the meniscus, thorough visualization of all compartments of the knee, a reduction in blood loss, and a decrease in surgical morbidity to the surrounding cartilaginous, neurovascular, and soft-tissue structures. This technique may therefore be one option to address bullet fragments or shotgun pellets that are retained within the medial meniscus. PMID:27073774

  13. Partial triceps disruption: a case report.

    PubMed

    Foulk, David M; Galloway, Marc T

    2011-03-01

    Partial triceps tendon disruptions are a rare injury that can lead to debilitating outcomes if misdiagnosed or managed inappropriately. The clinician should have a high index of suspicion when the mechanism involves a fall onto an outstretched arm and there is resultant elbow extension weakness along with pain and swelling. The most common location of rupture is at the tendon-osseous junction. This case report illustrates a partial triceps tendon disruption with involvement of, primarily, the medial head and the superficial expansion. Physical examination displayed weakness with resisted elbow extension in a flexed position over 90°. Radiographs revealed a tiny fleck of bone proximal to the olecranon, but this drastically underestimated the extent of injury upon surgical exploration. Magnetic resonance imaging is essential to ascertain the percentage involvement of the tendon; it can be used for patient education and subsequently to determine treatment recommendations. Although excellent at finding associated pathology, it may misjudge the size of the tear. As such, physicians must consider associated comorbidities and patient characteristics when formulating treatment plans.

  14. Twisted partially pure spinors

    NASA Astrophysics Data System (ADS)

    Herrera, Rafael; Tellez, Ivan

    2016-08-01

    Motivated by the relationship between orthogonal complex structures and pure spinors, we define twisted partially pure spinors in order to characterize spinorially subspaces of Euclidean space endowed with a complex structure.

  15. Partially coherent nonparaxial beams.

    PubMed

    Duan, Kailiang; Lü, Baida

    2004-04-15

    The concept of a partially coherent nonparaxial beam is proposed. A closed-form expression for the propagation of nonparaxial Gaussian Schell model (GSM) beams in free space is derived and applied to study the propagation properties of nonparaxial GSM beams. It is shown that for partially coherent nonparaxial beams a new parameter f(sigma) has to be introduced, which together with the parameter f, determines the beam nonparaxiality.

  16. Spontaneous osteonecrosis of the knee involving both the medial femoral condyle and the medial tibial plateau: report of three cases.

    PubMed

    Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Kim, Duk Su; Kim, Taek Keun

    2008-08-01

    Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle or plateau. The medial femoral condyle (MFC) is most often involved and spontaneous osteonecrosis of the medial tibial plateau (MTP) is a rare condition, representing only 2% of all necroses reported in the knee. SPONK involving both the MFC and the MTP is extremely rare. SPONK occurring in either the MFC or the MTP individually might extend to the corresponding side of the knee in the advanced end-stage; however, in that situation, significant degenerative changes would exist and it might be difficult to differentiate end-stage SPONK form severe osteoarthritis. SPONK affecting both the MFC and the MTP without significant secondary osteoarthritic changes has not been reported, even though it is difficult to know which occurs first. We have cared for three patients with histologically proven osteonecrosis of the MFC and MTP and report their radiologic features.

  17. PARTIAL TORUS INSTABILITY

    SciTech Connect

    Olmedo, Oscar; Zhang Jie

    2010-07-20

    Flux ropes are now generally accepted to be the magnetic configuration of coronal mass ejections (CMEs), which may be formed prior to or during solar eruptions. In this study, we model the flux rope as a current-carrying partial torus loop with its two footpoints anchored in the photosphere, and investigate its stability in the context of the torus instability (TI). Previous studies on TI have focused on the configuration of a circular torus and revealed the existence of a critical decay index of the overlying constraining magnetic field. Our study reveals that the critical index is a function of the fractional number of the partial torus, defined by the ratio between the arc length of the partial torus above the photosphere and the circumference of a circular torus of equal radius. We refer to this finding as the partial torus instability (PTI). It is found that a partial torus with a smaller fractional number has a smaller critical index, thus requiring a more gradually decreasing magnetic field to stabilize the flux rope. On the other hand, a partial torus with a larger fractional number has a larger critical index. In the limit of a circular torus when the fractional number approaches 1, the critical index goes to a maximum value. We demonstrate that the PTI helps us to understand the confinement, growth, and eventual eruption of a flux-rope CME.

  18. Partial Torus Instability

    NASA Astrophysics Data System (ADS)

    Olmedo, Oscar; Zhang, Jie

    2010-07-01

    Flux ropes are now generally accepted to be the magnetic configuration of coronal mass ejections (CMEs), which may be formed prior to or during solar eruptions. In this study, we model the flux rope as a current-carrying partial torus loop with its two footpoints anchored in the photosphere, and investigate its stability in the context of the torus instability (TI). Previous studies on TI have focused on the configuration of a circular torus and revealed the existence of a critical decay index of the overlying constraining magnetic field. Our study reveals that the critical index is a function of the fractional number of the partial torus, defined by the ratio between the arc length of the partial torus above the photosphere and the circumference of a circular torus of equal radius. We refer to this finding as the partial torus instability (PTI). It is found that a partial torus with a smaller fractional number has a smaller critical index, thus requiring a more gradually decreasing magnetic field to stabilize the flux rope. On the other hand, a partial torus with a larger fractional number has a larger critical index. In the limit of a circular torus when the fractional number approaches 1, the critical index goes to a maximum value. We demonstrate that the PTI helps us to understand the confinement, growth, and eventual eruption of a flux-rope CME.

  19. Realignment treatment for medial tibiofemoral osteoarthritis: randomised trial.

    PubMed

    Hunter, David; Gross, K D; McCree, Paula; Li, Ling; Hirko, Kelly; Harvey, William F

    2012-10-01

    The objective of this 30-week randomised crossover trial was to determine whether a multi-modal realignment treatmentwould be successful in relieving pain and improving function among persons with medial tibiofemoral osteoarthritis (OA). The authors conducted a double-blind randomised crossover trial of a multi-modal realignment treatment for medial tibiofemoral OA. Trial participants met American College of Rheumatology criteria for OA, with knee pain, aching or stiffness on most days of the past month and radiographic evidence of a definite osteophyte with predominant medial tibiofemoral OA. The authors tested two different treatments: (A) control treatment consisting of a neutral knee brace (no valgus angulation), flat unsupportive foot orthoses and shoes with a flexible mid-sole; and (B) active treatment consisting of a valgus knee brace, customised neutral foot orthoses and shoes designed for motion control. For each subject, the trial lasted 30 weeks, including 12 weeks each of active treatment and control treatment separated by a 6-week washout period. The primary outcome of the linear regression model was change in knee pain and function, as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). 80 participants with medial tibiofemoral OA were randomised. Their mean age was 62 years, their mean body mass index was 34 kg/m(2) and their mean WOMAC Pain score was 9.2 (0-20 scale). There was no evidence of a carryover effect. The regression model demonstrated that the mean difference in pain between the active treatment and the control treatment was -1.82 units (95% CI -3.05 to -0.60; p=0.004) on the WOMAC Pain scale, indicating a small but statistically significant decrease in pain with the multi-modal active treatment. For WOMAC Function, the realignment intervention had a non-significant effect on function, with a -2.90 unit decrease (95% CI -6.60 to 0.79) compared with the control condition (p=0.12). Multi-modal realignment

  20. Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children.

    PubMed

    Gourineni, Prasad; Gupta, Asheesh

    2011-10-01

    Tillaux and Triplane fractures occur in children predominantly from external rotation mechanism. We hypothesized that in displaced fractures, the talus would shift laterally along with the distal fibula and the distal tibial epiphyseal fragment increasing the medial joint space. Consecutive cases evaluated retrospectively. Level I and Level II centers. Twenty-two skeletally immature patients with 14 displaced Triplane fractures and eight displaced Tillaux fractures were evaluated for medial joint space widening. Measurement of fracture displacement and medial joint space widening before and after intervention. Thirteen Triplane and six Tillaux fractures (86%) showed medial space widening of 1 to 9 mm and equal to the amount of fracture displacement. Reduction of the fracture reduced the medial space to normal. There were no known complications. Medial space widening of the ankle may be a sign of ankle fracture displacement. Anatomic reduction of the fracture reduces the medial space and may improve the results in Tillaux and Triplane fractures.

  1. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release.

    PubMed

    Atoun, Ehud; Debbi, Ronen; Lubovsky, Omri; Weiler, Andreas; Debbi, Eytan; Rath, Ehud

    2013-02-01

    Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.

  2. Mid-term results of Oxford phase-3 medial unicompartmental knee arthroplasty for medial arthritis in Chinese patients.

    PubMed

    Xu, Taotao; Lao, Yangjun; Wang, Jitao; Liu, Fucun; Xiao, Luwei; Tong, Peijian

    2017-04-01

    The purpose of this study was to evaluate the mid-term results of an Oxford phase-3 unicompartmental knee arthroplasty (UKA) for medial arthritis in Chinese patients. The study included 64 patients who underwent a minimally invasive Oxford phase-3 UKA for medial knee arthritis. The patients were clinically evaluated preoperatively and at the final follow-up according to the clinical and functional components of the Knee Society Score (KSS), the Hospital for Special Surgery knee score and range of motion. A Kaplan-Meier survivorship analysis was performed with revision surgery as the end point. The mean preoperative clinical KSSs increased from 63.2 to 91.4 post-operatively, and the mean functional KSSs increased from 54.9 to 86.5 post-operatively. In addition, the mean Hospital for Special Surgery scores increased from 59.5 to 86.4. The mean active knee flexion increased from 109.1° preoperatively to 123.6° post-operatively. A total of six patients (six knees) required revision surgery at the time of the maximum 10-year follow-up. Four conversions to total knee arthroplasty were performed because of arthritis progression in the lateral compartment. One revision to total knee arthroplasty was performed for aseptic loosening, and one liner exchange was performed for wear. The cumulative survival rates at the 6- and 8-year follow-ups were 97% and 93%, respectively. Oxford phase-3 UKA was largely applicable for medial arthritis in Chinese patients. However, the Oxford phase-3 medial UKA selection criteria for young Chinese males need further exploration to obtain the best treatment effect. © 2016 Royal Australasian College of Surgeons.

  3. Effect of anteromedial and posterolateral anterior cruciate ligament bundles on resisting medial and lateral tibiofemoral compartment subluxations.

    PubMed

    Gardner, Eric J; Noyes, Frank R; Jetter, Andrew W; Grood, Edward S; Harms, Samuel P; Levy, Martin S

    2015-05-01

    This study analyzed the interaction of the anteromedial and posterolateral portions of the anterior cruciate ligament (ACL) in resisting medial and lateral tibiofemoral compartment subluxations under multiple loading conditions. By use of a 6-df robotic simulator, 10 human cadaveric knees were tested in 3 states: intact ACL, partial ACL (loss of either the anteromedial bundle [AMB] or posterolateral bundle [PLB]), and deficient ACL. The testing profile involved anterior-posterior translation and internal-external rotation, as well as 3 pivot-shift loading conditions with varying internal rotation torque (1- or 5-Nm) and coupled anterior force (35- or 100-N). Digitization of anatomic landmarks provided tibiofemoral compartment translations and centers of tibial rotation. During pivot-shift testing (100-N anterior force, 1-Nm internal rotation torque, and 7-Nm valgus), the lateral and medial compartment anterior translation increased by a mean of 2.5 ± 0.8 mm (P = .016) and 3.4 ± 2.0 mm (P = .001), respectively, on AMB sectioning and 1.3 ± 0.9 mm (P = .329) and 0.6 ± 0.7 mm (P = .544), respectively, on PLB sectioning. Higher internal rotation torque (5 Nm v 1 Nm) on pivot-shift testing reduced central and medial anterior translation after ACL sectioning. There was no change in internal rotation on AMB or PLB sectioning. During the Lachman test (100-N), AMB and PLB sectioning increased central translation by 3.6 ± 1.6 mm (P = .001) and 0.7 ± 0.6 mm (P = .498), respectively. Both ACL bundles function synergistically in resisting medial and lateral compartment subluxations on the Lachman and pivot-shift tests. The AMB provided more restraint to anterior tibial translation during both tests as compared with the PLB. PLB sectioning produced no statistically significant change in anterior translation on the Lachman or pivot-shift test. Neither bundle contributed to resisting internal rotation. An ACL graft designed to duplicate the AMB would theoretically

  4. Contralateral breast dose from partial breast brachytherapy.

    PubMed

    Robinson, R Cole; Nelson, Christopher L; Bloom, Elizabeth S; Kisling, Kelly D; Mason, Bryan E; Fisher, Gary D; Kirsner, Steven M

    2015-11-08

    The purpose of this study was to determine the dose to the contralateral breast during accelerated partial breast irradiation (APBI) and to compare it to external beam-published values. Thermoluminescent dosimeter (TLD) packets were used to measure the dose to the most medial aspect of the contralateral breast during APBI simulation, daily quality assurance (QA), and treatment. All patients in this study were treated with a single-entry, multicatheter device for 10 fractions to a total dose of 34 Gy. A mark was placed on the patient's skin on the medial aspect of the opposite breast. Three TLD packets were taped to this mark during the pretreatment simulation. Simulations consisted of an AP and Lateral scout and a limited axial scan encompassing the lumpectomy cavity (miniscan), if rotation was a concern. After the simulation the TLD packets were removed and the patients were moved to the high-dose-rate (HDR) vault where three new TLD packets were taped onto the patients at the skin mark. Treatment was administered with a Nucletron HDR afterloader using Iridium-192 as the treatment source. Post-treatment, TLDs were read (along with the simulation and QA TLD and a set of standards exposed to a known dose of 6 MV photons). Measurements indicate an average total dose to the contralateral breast of 70 cGy for outer quadrant implants and 181 cGy for inner quadrant implants. Compared to external beam breast tangents, these results point to less dose being delivered to the contralateral breast when using APBI.

  5. Multimodal intervention in older adults improves resting-state functional connectivity between the medial prefrontal cortex and medial temporal lobe.

    PubMed

    Li, Rui; Zhu, Xinyi; Yin, Shufei; Niu, Yanan; Zheng, Zhiwei; Huang, Xin; Wang, Baoxi; Li, Juan

    2014-01-01

    The prefrontal cortex and medial temporal lobe are particularly vulnerable to the effects of aging. The disconnection between them is suggested to be an important cause of cognitive decline in normal aging. Here, using multimodal intervention training, we investigated the functional plasticity in resting-state connectivity of these two regions in older adults. The multimodal intervention, comprised of cognitive training, Tai Chi exercise, and group counseling, was conducted to explore the regional connectivity changes in the default-mode network, as well as changes in prefrontal-based voxel-wise connectivity in the whole brain. Results showed that the intervention selectively affected resting-state functional connectivity between the medial prefrontal cortex and medial temporal lobe. Moreover, the strength of resting-state functional connectivity between these regions correlated with individual cognitive performance. Our results suggest that multimodal intervention could postpone the effects of aging and improve the function of the regions that are most heavily influenced by aging, as well as play an important role in preserving the brain and cognition during old age.

  6. Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau levelling osteotomy in dogs.

    PubMed

    Pozzi, A; Litsky, A S; Field, J; Apelt, D; Meadows, C; Johnson, K A

    2008-01-01

    To evaluate the effect of medial meniscal release (MMR) and medial, caudal pole hemimeniscectomy (MCH) on pressure distribution in the cranial cruciate ligament (CCL) deficient canine stifle, and with tibial plateau levelling osteotomy (TPLO). Twelve adult dogs. In experiment one, six pairs of cadaveric canine stifles with an intact CCL were axially loaded with a servo-hydraulic material testing machine and pressure distributions were mapped and quantified using pressure sensitive films. Axial loading of each joint was then repeated following MMR, and again after MCH. In experiment two, six pairs of cadaveric canine stifles with or without TPLO were tested before and after CCL transection, and each MMR and MCH procedure using the same methods of experiment 1. In experiment one, MMR and MCH had significant effects on the pressure distribution resulting in a 2.5-fold increase in the percentage of surface area with pressure higher than 10 MPa. In experiment two, CCL transection resulted in a significant change in pressure distribution only in the stifle without TPLO (P<0.05). Both MMR and MCH resulted in a 1.7-fold increase in the percentage of area with peak pressure in the stifle with TPLO (P<0.05). Meniscal surgery results in a change in pressure distribution and magnitude within the medial compartment of the stifle. Compromised function of the meniscus by either MMR or MCH result in stress concentration which may predispose to osteoarthritis.

  7. The effect of different depths of medial heel skive on plantar pressures

    PubMed Central

    2012-01-01

    Background Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. Methods Thirty healthy adults (mean age 24 years, range 18–46) with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i) no medial heel skive, (ii) a 2 mm medial heel skive, (iii) a 4 mm medial heel skive and (iv) a 6 mm medial heel skive. Results Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot – there was a 15% increase (p = 0.001) with the 4 mm skive and a 29% increase (p < 0.001) with the 6 mm skive. No significant change was observed with the 2 mm medial heel skive. With respect to the midfoot and forefoot, there were no significant differences between the orthoses. Conclusions This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification. PMID:22889267

  8. A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament

    PubMed Central

    Lee, Seung-Yup; Yang, Jae-Hyuk; Lee, Yong-In

    2016-01-01

    Introduction Numerous methods of medial soft tissue release for severe varus deformity during total knee arthroplasty (TKA) have been reported. These include tibial stripping of the superficial medial collateral ligament (MCL), pie-crusting technique, and medial epicondylar osteotomy. However, there are inherent disadvantages in these techniques. Authors hereby present a novel quantitative method: femoral origin release of the medial collateral ligament (FORM). Surgical Technique For medial tightness remaining even after the release of the deep MCL and semimembranosus, the FORM is initiated with identification of the femoral insertion area of the MCL with the knee in flexion. Starting from the most posterior part of the femoral insertion, one third of the MCL femoral insertion is released from its attachment. If necessary, further sequential medial release is performed. Materials and Methods Seventeen knees that underwent the FORM were evaluated for radiological and clinical outcomes. Results Regardless of the extent of the FORM, no knees showed residual valgus instability at 24 weeks after surgery. Conclusions As the FORM is performed in a stepwise manner, fine adjustment during medial release might be beneficial to prevent inadvertent over-release of the medial structures of the knee. PMID:27274473

  9. Parametric study of orthopedic insole of valgus foot on partial foot amputation.

    PubMed

    Guo, Jun-Chao; Wang, Li-Zhen; Chen, Wei; Du, Cheng-Fei; Mo, Zhong-Jun; Fan, Yu-Bo

    2016-01-01

    Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°-10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.

  10. Custom-Molded Foot-Orthosis Intervention and Multisegment Medial Foot Kinematics During Walking

    PubMed Central

    Cobb, Stephen C.; Tis, Laurie L.; Johnson, Jeffrey T.; Wang, Yong “Tai”; Geil, Mark D.

    2011-01-01

    Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Interventions : After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid-stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F1,14 = 5.24, P = .04, partial η2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F1,14 = 7.87, P = .01, partial η2 = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F1,14 = 4.32, P = .08, partial η2 = 0.38) or full-contact orthosis (F1,14 = 4.10, P = .08, partial η2 = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might

  11. Methanol partial oxidation reformer

    DOEpatents

    Ahmed, Shabbir; Kumar, Romesh; Krumpelt, Michael

    1999-01-01

    A partial oxidation reformer comprising a longitudinally extending chamber having a methanol, water and an air inlet and an outlet. An igniter mechanism is near the inlets for igniting a mixture of methanol and air, while a partial oxidation catalyst in the chamber is spaced from the inlets and converts methanol and oxygen to carbon dioxide and hydrogen. Controlling the oxygen to methanol mole ratio provides continuous slightly exothermic partial oxidation reactions of methanol and air producing hydrogen gas. The liquid is preferably injected in droplets having diameters less than 100 micrometers. The reformer is useful in a propulsion system for a vehicle which supplies a hydrogen-containing gas to the negative electrode of a fuel cell.

  12. Methanol partial oxidation reformer

    DOEpatents

    Ahmed, S.; Kumar, R.; Krumpelt, M.

    1999-08-17

    A partial oxidation reformer is described comprising a longitudinally extending chamber having a methanol, water and an air inlet and an outlet. An igniter mechanism is near the inlets for igniting a mixture of methanol and air, while a partial oxidation catalyst in the chamber is spaced from the inlets and converts methanol and oxygen to carbon dioxide and hydrogen. Controlling the oxygen to methanol mole ratio provides continuous slightly exothermic partial oxidation reactions of methanol and air producing hydrogen gas. The liquid is preferably injected in droplets having diameters less than 100 micrometers. The reformer is useful in a propulsion system for a vehicle which supplies a hydrogen-containing gas to the negative electrode of a fuel cell. 7 figs.

  13. Methanol partial oxidation reformer

    DOEpatents

    Ahmed, S.; Kumar, R.; Krumpelt, M.

    1999-08-24

    A partial oxidation reformer is described comprising a longitudinally extending chamber having a methanol, water and an air inlet and an outlet. An igniter mechanism is near the inlets for igniting a mixture of methanol and air, while a partial oxidation catalyst in the chamber is spaced from the inlets and converts methanol and oxygen to carbon dioxide and hydrogen. Controlling the oxygen to methanol mole ratio provides continuous slightly exothermic partial oxidation reactions of methanol and air producing hydrogen gas. The liquid is preferably injected in droplets having diameters less than 100 micrometers. The reformer is useful in a propulsion system for a vehicle which supplies a hydrogen-containing gas to the negative electrode of a fuel cell. 7 figs.

  14. Methanol partial oxidation reformer

    DOEpatents

    Ahmed, Shabbir; Kumar, Romesh; Krumpelt, Michael

    2001-01-01

    A partial oxidation reformer comprising a longitudinally extending chamber having a methanol, water and an air inlet and an outlet. An igniter mechanism is near the inlets for igniting a mixture of methanol and air, while a partial oxidation catalyst in the chamber is spaced from the inlets and converts methanol and oxygen to carbon dioxide and hydrogen. Controlling the oxygen to methanol mole ratio provides continuous slightly exothermic partial oxidation reactions of methanol and air producing hydrogen gas. The liquid is preferably injected in droplets having diameters less than 100 micrometers. The reformer is useful in a propulsion system for a vehicle which supplies a hydrogen-containing gas to the negative electrode of a fuel cell.

  15. Oxygen partial pressure sensor

    DOEpatents

    Dees, Dennis W.

    1994-01-01

    A method for detecting oxygen partial pressure and an oxygen partial pressure sensor are provided. The method for measuring oxygen partial pressure includes contacting oxygen to a solid oxide electrolyte and measuring the subsequent change in electrical conductivity of the solid oxide electrolyte. A solid oxide electrolyte is utilized that contacts both a porous electrode and a nonporous electrode. The electrical conductivity of the solid oxide electrolyte is affected when oxygen from an exhaust stream permeates through the porous electrode to establish an equilibrium of oxygen anions in the electrolyte, thereby displacing electrons throughout the electrolyte to form an electron gradient. By adapting the two electrodes to sense a voltage potential between them, the change in electrolyte conductivity due to oxygen presence can be measured.

  16. Oxygen partial pressure sensor

    DOEpatents

    Dees, D.W.

    1994-09-06

    A method for detecting oxygen partial pressure and an oxygen partial pressure sensor are provided. The method for measuring oxygen partial pressure includes contacting oxygen to a solid oxide electrolyte and measuring the subsequent change in electrical conductivity of the solid oxide electrolyte. A solid oxide electrolyte is utilized that contacts both a porous electrode and a nonporous electrode. The electrical conductivity of the solid oxide electrolyte is affected when oxygen from an exhaust stream permeates through the porous electrode to establish an equilibrium of oxygen anions in the electrolyte, thereby displacing electrons throughout the electrolyte to form an electron gradient. By adapting the two electrodes to sense a voltage potential between them, the change in electrolyte conductivity due to oxygen presence can be measured. 1 fig.

  17. Methanol partial oxidation reformer

    DOEpatents

    Ahmed, Shabbir; Kumar, Romesh; Krumpelt, Michael

    1999-01-01

    A partial oxidation reformer comprising a longitudinally extending chamber having a methanol, water and an air inlet and an outlet. An igniter mechanism is near the inlets for igniting a mixture of methanol and air, while a partial oxidation catalyst in the chamber is spaced from the inlets and converts methanol and oxygen to carbon dioxide and hydrogen. Controlling the oxygen to methanol mole ratio provides continuous slightly exothermic partial oxidation reactions of methanol and air producing hydrogen gas. The liquid is preferably injected in droplets having diameters less than 100 micrometers. The reformer is useful in a propulsion system for a vehicle which supplies a hydrogen-containing gas to the negative electrode of a fuel cell.

  18. Arthroscopic decompressive medial release of the varus arthritic knee: Expanding the functional envelope.

    PubMed

    Leon, H O; Blanco, C E; Guthrie, T B

    2001-05-01

    We present the rationale and technique for treating medial knee osteoarthritis by dynamically unloading the medial compartment of the knee. Recent advances in kinematic studies indicate a dynamic linkage between differing degrees of freedom in the knee joint. Both the adduction moment and the foot progression angle are important determinants of medial compartment loading. The medially osteoarthritic knee has progressive compromise of free motion in more than 1 plane. Arthroscopic decompressive medial release unloads the medial compartment by release of the medial capsule and medial collateral ligament in the presence of intact cruciate ligaments, which may allow a decreased adduction moment and decrease of the external rotation restraint in extension found in more severely osteoarthritic knees. A case series of 38 patients with medial gonarthrosis was treated by this technique at the Hermanos Ameijeiras Hospital in Havana, Cuba. All patients had good results without postoperative valgus instability or significant complications. We feel that this technique warrants further clinical and biomechanical study for its use in isolation or in combination with high tibial osteotomy or minimally invasive selective osteotomy for the treatment of medial gonarthrosis of the knee. A minimally invasive, selective approach to biomechanical factors in osteoarthritis may be combined with other modulating techniques in efforts to forestall or prevent the need for total joint replacement.

  19. Partially strong WW scattering

    SciTech Connect

    Cheung Kingman; Chiang Chengwei; Yuan Tzuchiang

    2008-09-01

    What if only a light Higgs boson is discovered at the CERN LHC? Conventional wisdom tells us that the scattering of longitudinal weak gauge bosons would not grow strong at high energies. However, this is generally not true. In some composite models or general two-Higgs-doublet models, the presence of a light Higgs boson does not guarantee complete unitarization of the WW scattering. After partial unitarization by the light Higgs boson, the WW scattering becomes strongly interacting until it hits one or more heavier Higgs bosons or other strong dynamics. We analyze how LHC experiments can reveal this interesting possibility of partially strong WW scattering.

  20. Medial prefrontal cortical integration of psychological stress in rats.

    PubMed

    McDougall, S J; Widdop, Robert E; Lawrence, Andrew J

    2004-11-01

    The present study aimed to determine whether the medial prefrontal cortex (mPFC) (prelimbic and infralimbic regions) is implicated in the integration of a stress response. Sprague-Dawely rats were implanted with telemetry probes and guide cannulae so that either muscimol or vehicle could be administered locally within the mPFC or dorsomedial hypothalamus (DMH). The heart rate and blood pressure of rats was continuously recorded as either muscimol or vehicle was administered centrally and rats were either exposed to restraint stress or left alone in their home cages. After the stress challenge, or equivalent period, rats that had received intra-mPFC injections were processed for immunohistochemical detection of Fos throughout the neuraxis. Bilateral microinjection of muscimol into the mPFC had no effect upon either baseline cardiovascular parameters or restraint stress-induced tachycardia or pressor responses whereas, in the DMH, pretreatment with muscimol attenuated the cardiovascular stress response. Analysis of Fos expression throughout the CNS of nonstressed rats showed no effect of muscimol injections into the mPFC on baseline expression in the nuclei examined. In contrast, rats that had received muscimol injections into their mPFC and were subsequently restrained exhibited an increase in the number of Fos-positive cells in the DMH, medial amygdala, and medial nucleus tractus solitarius as compared to vehicle-injected rats that experienced restraint stress. These results indicate that, during acute psychological stress, the mPFC does not modulate the cardiovascular system in rats but does inhibit specific subcortical nuclei to exert control over aspects of an integrated response to a stressor.

  1. Voice Outcome after Gore-Tex Medialization Thyroplasty

    PubMed Central

    Elnashar, Ismail; El-Anwar, Mohammad; Amer, Hazem; Quriba, Amal

    2015-01-01

    Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6 months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients and more extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion. PMID:26157500

  2. Isolated medial incisional approach to subtalar and talonavicular arthrodesis.

    PubMed

    Weinraub, Glenn M; Schuberth, John M; Lee, Michael; Rush, Shannon; Ford, Lawrence; Neufeld, Jason; Yu, Jenny

    2010-01-01

    Triple arthrodesis is commonly used to correct complex deformity with hindfoot valgus. The authors use an isolated medial incisional approach for subtalar and talonavicular joint arthrodesis to correct hindfoot deformity, including high degrees of hindfoot valgus. To assess outcomes achieved with this approach, we reviewed the records of 45 patients from the practices of 5 surgeons. Independent variables evaluated included patient age, primary pathology, use of biologic agents, operative time, time to union, and complications. The median patient age was 57 years (range, 14-78 years). Pathology leading to fusion included 27 (60%) posterior tibial tendon dysfunction, 6 (13.3%) tarsal coalition, 7 (5.5%) degenerative joint disease, 2 (4.4%) rheumatoid arthritis, and 1 (2.2%) each, with Charcot neuroarthropathy, multiple sclerosis, and poliomyelitis. Orthobiological materials were used in 27 (60.0%) of the patients. The median duration of surgery was 87 minutes (range, 65-164 minutes), and the median time to successful arthrodesis was 8 weeks (range, 6-20 weeks). A complication was observed in 6 (13.3%) of the patients, including 1 each of the following: painful calcaneal-cuboid joint, talar fracture, incision dehiscence, poor exposure that required abandonment of the procedure, elevated first ray, and painful fixation. None of the patients experienced a nonunion or an adverse event related to the medial neurovascular structures. Based on our experience with the procedure, the single medial-incision subtalar and talonavicular joint arthrodesis is a useful alternative to triple arthrodesis for the correction of hindfoot valgus deformity. Copyright 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Modulating Phonation Through Alteration of Vocal Fold Medial Surface Contour

    PubMed Central

    Mau, Ted; Muhlestein, Joseph; Callahan, Sean; Chan, Roger W.

    2012-01-01

    Objectives 1. To test whether alteration of the vocal fold medial surface contour can improve phonation. 2. To demonstrate that implant material properties affect vibration even when implant is deep to the vocal fold lamina propria. Study Design Induced phonation of excised human larynges. Methods Thirteen larynges were harvested within 24 hours post-mortem. Phonation threshold pressure (PTP) and flow (PTF) were measured before and after vocal fold injections using either calcium hydroxylapatite (CaHA) or hyaluronic acid (HA). Small-volume injections (median 0.0625 mL) were targeted to the infero-medial aspect of the thyroarytenoid (TA) muscle. Implant locations were assessed histologically. Results The effect of implantation on PTP was material-dependent. CaHA tended to increase PTP, whereas HA tended to decrease PTP (Wilcoxon test P = 0.00013 for onset). In contrast, the effect of implantation on PTF was similar, with both materials tending to decrease PTF (P = 0.16 for onset). Histology confirmed implant presence in the inferior half of the vocal fold vertical thickness. Conclusions Taken together, these data suggested the implants may have altered the vocal fold medial surface contour, potentially resulting in a less convergent or more rectangular glottal geometry as a means to improve phonation. An implant with a closer viscoelastic match to vocal fold cover is desirable for this purpose, as material properties can affect vibration even when the implant is not placed within the lamina propria. This result is consistent with theoretical predictions and implies greater need for surgical precision in implant placement and care in material selection. PMID:22865592

  4. Medial tibial pain: a dynamic contrast-enhanced MRI study.

    PubMed

    Mattila, K T; Komu, M E; Dahlström, S; Koskinen, S K; Heikkilä, J

    1999-09-01

    The purpose of this study was to compare the sensitivity of different magnetic resonance imaging (MRI) sequences to depict periosteal edema in patients with medial tibial pain. Additionally, we evaluated the ability of dynamic contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRI. T1-, T2-weighted, proton density axial images and dynamic and static phase post-contrast images were compared in ability to depict periosteal edema. STIR was used in seven cases to depict bone marrow edema. Images were analyzed to detect signs of compartment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls. In detecting periosteal edema, post-contrast T1-weighted images were better than spin echo T2-weighted and proton density images or STIR images, but STIR depicted the bone marrow edema best. DCES best demonstrated the gradually enhancing periostitis. Four subjects with severe periosteal edema had visually detectable pathologic enhancement during DCES in the deep posterior compartment of the leg. Percentage enhancement in the deep posterior compartment of the leg was greater in patients than in controls. The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it continued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment. MRI can depict both these conditions. In patients with medial tibial pain, MR imaging protocol should include axial STIR images (to depict bone pathology) with T1-weighted axial pre and post-contrast images, and dynamic contrast enhanced imaging to show periosteal edema and abnormal contrast enhancement within a compartment.

  5. Voice Outcome after Gore-Tex Medialization Thyroplasty.

    PubMed

    Elnashar, Ismail; El-Anwar, Mohammad; Amer, Hazem; Quriba, Amal

    2015-07-01

    Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6 months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients and more extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

  6. Immediate effect of valgus bracing on knee joint moments in meniscectomised patients: An exploratory study.

    PubMed

    Thorning, Maria; Thorlund, Jonas B; Roos, Ewa M; Wrigley, Tim V; Hall, Michelle

    2016-12-01

    Patients undergoing medial arthroscopic partial meniscectomy are at increased risk of developing and/or progressing knee osteoarthritis, with increased medial compartment load being a potential contributor. The aim of this study was to evaluate the immediate effect of a valgus unloader knee brace on knee joint moments in patients following medial arthroscopic partial meniscectomy. Within-participant design. Twenty-two patients (age 35-55 years) who had undergone medial arthroscopic partial meniscectomy within the previous 8-15 months completed three-dimensional analysis of gait, forward lunge and one-leg rise during two conditions: with and without a valgus unloader knee brace. Outcome measures included the peak and impulse of the knee adduction moment and the peak knee flexion moment. The peak knee flexion moment increased during brace condition for forward lunge (mean difference [95% CI]) 0.54 [0.27-0.82] (Nm/(BW×HT)%), p<0.001 and one-leg rise (mean difference 0.45 [95% CI 0.08-0.82] (Nm/(BW×HT)%), p=0.022). No other significant differences were found between conditions in any of the included tasks. A significant effect of the knee brace was detected in terms of an increase in peak knee flexion moment during the more demanding tasks such as forward lunge and one-leg rise. This increase implies enhanced stability of the knee provided by the brace, which may induce increased knee function and knee-related confidence during strenuous tasks. Future research is required to explore the structural implications. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  7. The medial antebrachial cutaneous nerve: antidromic and orthodromic conduction studies.

    PubMed

    Seror, Paul

    2002-09-01

    Medial antebrachial cutaneous nerve (MABCN) conduction studies were performed antidromically and orthodromically in 70 control subjects to determine normal values and define the lower limits of normality. The mean sensory action potential (SAP) amplitudes were 17.7 and 17.5 microV and the sensory conduction velocities were 60 and 61 m/s, respectively, with the antidromic and orthodromic techniques. With both techniques, no SAP amplitude was lower than 6 microV. The lower limits of normal of the interside amplitude ratio were 1.66 when both techniques were used and 2.0 when only one was used.

  8. The Efferent Medial Olivocochlear-Hair Cell Synapse

    PubMed Central

    Elgoyhen, Ana Belén; Katz, Eleonora

    2011-01-01

    Amplification of incoming sounds in the inner ear is modulated by an efferent pathway which travels back from the brain all the way to the cochlea. The medial olivocochlear system makes synaptic contacts with hair cells, where the neurotransmitter acetylcholine is released. Synaptic transmission is mediated by a unique nicotinic cholinergic receptor composed of α9 and α10 subunits, which is highly Ca2+ permeable and is coupled to a Ca2+-activated SK potassium channel. Thus, hyperpolarization of hair cells follows efferent fiber activation. In this work we review the literature that has enlightened our knowledge concerning the intimacies of this synapse. PMID:21762779

  9. Successful salvage of a recurrently dislocating Oxford medial unicompartmental bearing.

    PubMed

    van Tienen, Tony G; Taylor, Susan J; Brink, Rodney B

    2010-04-01

    Dislocation of the bearing of the Oxford medial unicompartmental arthroplasty is a rare but serious complication. We report the case of a 48-year-old woman with a classic anteromedial arthritis who had 2 bearing dislocations within the first 3 months after index surgery. These were attributable to posterior bony impingement of the bearing against a small retained osteophyte. After arthroscopic resection of the osteophyte, she has retained her original components with no further dislocations or signs of impending failure 7 years later. This case report emphasizes the importance of osteophyte removal from the back of the femoral condyle during an Oxford unicompartmental arthroplasty. (c) 2010 Elsevier Inc. All rights reserved.

  10. Considerations for the Management of Medial Orbital Wall Blowout Fracture

    PubMed Central

    Park, Youngsoo; Chung, Kyu Jin

    2016-01-01

    Recently, diagnoses of and operations for medial orbital blowout fracture have increased because of the development of imaging technology. In this article, the authors review the literature, and overview the accumulated knowledge about the orbital anatomy, fracture mechanisms, surgical approaches, reconstruction materials, and surgical methods. In terms of surgical approaches, transcaruncular, transcutaneous, and transnasal endoscopic approaches are discussed. Reconstruction methods including onlay covering, inlay implantation, and repositioning methods are also discussed. Consideration and understanding of these should lead to more optimal outcomes. PMID:27218019

  11. Medial ectropion repair of lower eyelids with a cicatricial component.

    PubMed

    Hesse, Richard J

    2011-01-01

    A new technique for the management of medial ectropion with a mild to moderate cicatricial component is presented that avoids the necessity for skin grafting. A subciliary incision is made inferior to the punctum and extending laterally, followed by preseptal dissection to the orbital rim. A base-up triangle of the posterior lamella is then excised lateral to the punctum. This is closed with a marginal mattress suture. Tightening of the posterior lamella in this fashion produces laxity in the anterior lamella, which can then be closed without tension, eliminating the need for skin grafting.

  12. Snapping knee caused by the thickening of the medial hamstrings.

    PubMed

    de la Hera Cremades, B; Escribano Rueda, L; Lara Rubio, A

    2016-11-17

    We report a case of symptomatic subluxation of the semitendinosus and gracilis over the medial condyle of the tibia caused by the thickening of its tendons. Snapping was reproduced on active extension. Clinical examination and, above all, dynamic ultrasound were the key for the diagnosis because other imaging tests were normal. Due to failure of conservative treatment with physiotherapy and infiltrations, surgery was undertaken, involving desinsertion and excision of distal 8cm segment of the semitendinosus and gracilis tendons. At the present time (6 months postoperatively), the patient is symptom-free and has returned to the previous normal life activities.

  13. Ultrasound-Assisted Endoscopic Partial Plantar Fascia Release

    PubMed Central

    Ohuchi, Hiroshi; Ichikawa, Ken; Shinga, Kotaro; Hattori, Soichi; Yamada, Shin; Takahashi, Kazuhisa

    2013-01-01

    Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure. PMID:24265989

  14. Partial gravity habitat study

    NASA Technical Reports Server (NTRS)

    Capps, Stephen; Lorandos, Jason; Akhidime, Eval; Bunch, Michael; Lund, Denise; Moore, Nathan; Murakawa, Kiosuke

    1989-01-01

    The purpose of this study is to investigate comprehensive design requirements associated with designing habitats for humans in a partial gravity environment, then to apply them to a lunar base design. Other potential sites for application include planetary surfaces such as Mars, variable-gravity research facilities, and a rotating spacecraft. Design requirements for partial gravity environments include locomotion changes in less than normal earth gravity; facility design issues, such as interior configuration, module diameter, and geometry; and volumetric requirements based on the previous as well as psychological issues involved in prolonged isolation. For application to a lunar base, it is necessary to study the exterior architecture and configuration to insure optimum circulation patterns while providing dual egress; radiation protection issues are addressed to provide a safe and healthy environment for the crew; and finally, the overall site is studied to locate all associated facilities in context with the habitat. Mission planning is not the purpose of this study; therefore, a Lockheed scenario is used as an outline for the lunar base application, which is then modified to meet the project needs. The goal of this report is to formulate facts on human reactions to partial gravity environments, derive design requirements based on these facts, and apply the requirements to a partial gravity situation which, for this study, was a lunar base.

  15. Swallowed partial dentures

    PubMed Central

    Hashmi, Syed; Walter, John; Smith, Wendy; Latis, Sergios

    2004-01-01

    Swallowed or inhaled partial dentures can present a diagnostic challenge. Three new cases are described, one of them near-fatal because of vascular erosion and haemorrhage. The published work points to the importance of good design and proper maintenance. The key to early recognition is awareness of the hazard by denture-wearers, carers and clinicians. PMID:14749401

  16. Dilemmas of partial cooperation.

    PubMed

    Stark, Hans-Ulrich

    2010-08-01

    Related to the often applied cooperation models of social dilemmas, we deal with scenarios in which defection dominates cooperation, but an intermediate fraction of cooperators, that is, "partial cooperation," would maximize the overall performance of a group of individuals. Of course, such a solution comes at the expense of cooperators that do not profit from the overall maximum. However, because there are mechanisms accounting for mutual benefits after repeated interactions or through evolutionary mechanisms, such situations can constitute "dilemmas" of partial cooperation. Among the 12 ordinally distinct, symmetrical 2 x 2 games, three (barely considered) variants are correspondents of such dilemmas. Whereas some previous studies investigated particular instances of such games, we here provide the unifying framework and concisely relate it to the broad literature on cooperation in social dilemmas. Complementing our argumentation, we study the evolution of partial cooperation by deriving the respective conditions under which coexistence of cooperators and defectors, that is, partial cooperation, can be a stable outcome of evolutionary dynamics in these scenarios. Finally, we discuss the relevance of such models for research on the large biodiversity and variation in cooperative efforts both in biological and social systems.

  17. Partial polarizer filter

    NASA Technical Reports Server (NTRS)

    Title, A. M. (Inventor)

    1978-01-01

    A birefringent filter module comprises, in seriatum. (1) an entrance polarizer, (2) a first birefringent crystal responsive to optical energy exiting the entrance polarizer, (3) a partial polarizer responsive to optical energy exiting the first polarizer, (4) a second birefringent crystal responsive to optical energy exiting the partial polarizer, and (5) an exit polarizer. The first and second birefringent crystals have fast axes disposed + or -45 deg from the high transmitivity direction of the partial polarizer. Preferably, the second crystal has a length 1/2 that of the first crystal and the high transmitivity direction of the partial polarizer is nine times as great as the low transmitivity direction. To provide tuning, the polarizations of the energy entering the first crystal and leaving the second crystal are varied by either rotating the entrance and exit polarizers, or by sandwiching the entrance and exit polarizers between pairs of half wave plates that are rotated relative to the polarizers. A plurality of the filter modules may be cascaded.

  18. A geometric morphometric analysis of the medial tibial condyle of African hominids.

    PubMed

    Sylvester, Adam D

    2013-10-01

    Although the hominid knee has been heavily scrutinized, shape variation of the medial tibial condyle has yet to be described. Humans, chimpanzees, and gorillas differ in the shape of their medial femoral condyles and in their capacity for external and internal rotation of the tibia relative to the femur. I hypothesize that these differences should be reflected in the shape of the medial tibial condyle of these hominids. Here I use geometric morphometric techniques to uncover shape differences between the medial tibial condyles of humans, chimpanzees, and gorillas. Humans are distinguished from the other two species by having a much more oval-shaped medial tibial condyle, while those of chimpanzees and gorillas are more triangular in outline. Gorillas (especially males) are distinguished by having more concavely-curved condyles (mediolateral direction), which is interpreted as an effect of heavy loading through the medial compartment of the knee in conjunction with differences in the degree of arboreality. Copyright © 2013 Wiley Periodicals, Inc.

  19. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience☆

    PubMed Central

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Objective To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. Method The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. Results Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. Conclusion Reconstruction of the medial patellofemoral ligament

  20. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

    PubMed

    Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

    2011-02-01

    Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.

  1. The medial gastrocnemius muscle attenuates force fluctuations during plantar flexion.

    PubMed

    Shinohara, Minoru; Yoshitake, Yasuhide; Kouzaki, Motoki; Fukunaga, Tetsuo

    2006-02-01

    Force fluctuations during steady contractions of multiple agonist muscles may be influenced by the relative contribution of force by each muscle. The purpose of the study was to compare force fluctuations during steady contractions performed with the plantar flexor muscles in different knee positions. Nine men (25.8+/-5.1 years) performed steady contractions of the plantar flexor muscles in the knee-flexed and knee-extended (greater involvement of the gastrocnemii muscles) positions. The maximal voluntary contraction (MVC) force was 32% greater in the knee-extended position compared with the knee-flexed position. The target forces were 2.5-10% MVC force in the respective position. The amplitude of electromyogram in the medial gastrocnemius muscle was greater in the knee-extended position (10.50+/-9.80%) compared with the knee-flexed position (1.26+/-1.15%, P<0.01). The amplitude of electromyogram in the soleus muscle was not influenced by the knee position. The amplitude of electromyogram in the lateral gastrocnemius and tibialis anterior muscles was marginal and unaltered with knee position. At the same force (in Newtons), the standard deviation of force was lower in the knee-extended position compared with the knee-flexed position. These results indicate that force fluctuations during plantar flexion are attenuated with greater involvement of the medial gastrocnemius muscle.

  2. Function of the medial meniscus in force transmission and stability.

    PubMed

    Walker, Peter S; Arno, Sally; Bell, Christopher; Salvadore, Gaia; Borukhov, Ilya; Oh, Cheongeun

    2015-06-01

    We studied the combined role of the medial meniscus in distributing load and providing stability. Ten normal knees were loaded in combinations of compressive and shear loading as the knee was flexed over a full range. A digital camera tracked the motion, from which femoral-tibial contacts were determined by computer modelling. Load transmission was determined from the Tekscan for the anterior horn, central body, posterior horn, and the uncovered cartilage in the centre of the meniscus. For the three types of loading; compression only, compression and anterior shear, compression and posterior shear; between 40% and 80% of the total load was transmitted through the meniscus. The overall average was 58%, the remaining 42% being transmitted through the uncovered cartilage. The anterior horn was loaded only up to 30 degrees flexion, but played a role in controlling anterior femoral displacement. The central body was loaded 10-20% which would provide some restraint to medial femoral subluxation. Overall the posterior horn carried the highest percentage of the shear load, especially after 30 degrees flexion when a posterior shear force was applied, where the meniscus was estimated to carry 50% of the shear force. This study added new insights into meniscal function during weight bearing conditions, particularly its role in early flexion, and in transmitting shear forces.

  3. Clinical results in reconstruction of medial patellofemoral ligament

    PubMed Central

    Irigoitia, Nicolas Alejandro; Catan, Agustín Felipe; Arroquy, Damián; Guiñazu, Jorge; Vilaseca, Tomas; Nazur, Gabriel; Bisso, Martín Carboni

    2017-01-01

    Background: The reconstruction of the medial patellofemoral ligament (MPFL) is the most suitable treatment for the patellar instability at the present in patients with two or more episodes of dislocation or only one with condral lesion. This is because it is the principal medial stabilizer of the patella. This process could be supplemented with an osseous correction as tibial tuberosity transference. Objectives: assess the clinical results of the reconstruction of the MPLF in patients with patellar instability. Study Design: Case series, level of evidence IV. Methods: We enroll all patients with this procedure between form April 2011 to February 2015, the sample has 27 reconstruction in 25 patients, who has two or more episodes of patellar dislocation. The graft used was gracilis tendon, set with suture anchor, and tibial tuberosity transfer in 9 patients who need an osseous procedure. Results: The average Kujala score was 90,1 points ( 64-100). Was necessary tibial tuberosity transference in one third of se sample. And in those patients there no difference compared with the isolated reconstruction.There was no episode of patellar dislocation or a second surgical time in the sample. Conclusion: The reconstruction of MPLF show excellent clinical outcomes in a short and medium terms , with 0% of dislocation and no second surgical time, in this kind of patients.

  4. Modified endoscopic medial maxillectomy for zygomatic implant salvage

    PubMed Central

    Tajudeen, Bobby A.; Adappa, Nithin D.; Palmer, James N.

    2016-01-01

    Objectives: Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy. Methods: We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation. Results: The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test. Conclusion: We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant. PMID:28107147

  5. Is testing the voice under sedation reliable in medialization thyroplasty?

    PubMed

    Oishi, Natsuki; Herrero, Ricard; Martin, Ana; Basterra, Jorge; Zapater, Enrique

    2016-12-01

    Medialization thyroplasty is an accepted method for improving non-compensated unilateral vocal cord palsy. Most surgeons decide the depth of penetration of the prosthesis by monitoring the voice changes in the patient during the surgical procedure. General anesthesia with intubation is incompatible with this procedure. Sedation is recommended. In this study we want to objectivize and quantify the influence of sedation and position on voice in order to know if this anesthetic procedure is justified in medialization thyroplasties. A prospective study. This study involved 15 adult patients who underwent sedation. Voice recordings were performed in each patient in three different positions and conditions: the seated position without sedation, the supine position without sedation, and the supine position under the effects of sedation. The sedation drugs used were midazolam, fentanyl, and propofol. The level of sedation was monitored using the observational scale and the bispectral index. The acoustic data obtained from sustained vowel sounds from patient recordings showed that sedation significantly affected the values of pitch. Compared to recordings from patients without sedation, pitch values in patients under sedation were significantly higher for jitter local and shimmer local recordings and significantly lower for pitch and harmonics-to-noise ratio. The supine position was shown not to influence on the voice. Sedation exerts an important influence on voice quality. General anesthesia could be an alternative, focusing our attention on monitoring the glottis with a fibrolaryngoscope during the surgical procedure. No sedation at all can also be an alternative.

  6. MRI parcellation of ex vivo medial temporal lobe.

    PubMed

    Augustinack, Jean C; Magnain, Caroline; Reuter, Martin; van der Kouwe, André J W; Boas, David; Fischl, Bruce

    2014-06-01

    Recent advancements in radio frequency coils, field strength and sophisticated pulse sequences have propelled modern brain mapping and have made validation to biological standards - histology and pathology - possible. The medial temporal lobe has long been established as a pivotal brain region for connectivity, function and unique structure in the human brain, and reveals disconnection in mild Alzheimer's disease. Specific brain mapping of mesocortical areas affected with neurofibrillary tangle pathology early in disease progression provides not only an accurate description for location of these areas but also supplies spherical coordinates that allow comparison between other ex vivo cases and larger in vivo datasets. We have identified several cytoarchitectonic features in the medial temporal lobe with high resolution ex vivo MRI, including gray matter structures such as the entorhinal layer II 'islands', perirhinal layer II-III columns, presubicular 'clouds', granule cell layer of the dentate gyrus as well as lamina of the hippocampus. Localization of Brodmann areas 28 and 35 (entorhinal and perirhinal, respectively) demonstrates MRI based area boundaries validated with multiple methods and histological stains. Based on our findings, both myelin and Nissl staining relate to contrast in ex vivo MRI. Precise brain mapping serves to create modern atlases for cortical areas, allowing accurate localization with important applications to detecting early disease processes. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Radiotherapy for basal cell carcinoma of the medial canthus region.

    PubMed

    Swanson, Erika L; Amdur, Robert J; Mendenhall, William M; Morris, Christopher G; Kirwan, Jessica M; Flowers, Franklin

    2009-12-01

    To report outcome for patients treated with radiotherapy (RT) for basal cell carcinoma of the medial canthus. Retrospective review. Thirty-three patients treated with RT at the University of Florida between 1965 and 2005 for basal cell carcinoma of the medial canthus were retrospectively reviewed. RT was the primary treatment for gross disease in 70% of patients and for positive margin after resection in 30%. The prescribed dose was 50 to 60 Gy at 2.0 to 2.5 Gy per fraction. Surviving patients were followed for a median of 14 years. Tumor recurred at the primary site in 10%. There were no regional recurrences or distant metastases. The local control rate was 100% in patients treated with surgery followed by RT for positive margins. In patients treated with RT alone, the local control rate was 94% with de novo lesions and 67% if the lesion was recurrent after prior surgery. Cause-specific survival was 95% at 10 years; overall survival was 52% at 10 years. There were no severe complications. Chronic epiphora was present in 21% and chronic dry eye symptoms in 3%. With the proper technique, RT produces excellent results in several of these patients. Patients with recurrent tumors and gross disease at the time of RT have a suboptimal cure rate. Our plan is to increase the RT dose to 64.8 Gy at 1.8 Gy per fraction.

  8. Intrinsic Regression Models for Medial Representation of Subcortical Structures

    PubMed Central

    Shi, Xiaoyan; Zhu, Hongtu; Ibrahim, Joseph G.; Liang, Faming; Lieberman, Jeffrey; Styner, Martin

    2011-01-01

    The aim of this paper is to develop a semiparametric model for describing the variability of the medial representation of subcortical structures, which belongs to a Riemannian manifold, and establishing its association with covariates of interest, such as diagnostic status, age and gender. We develop a two-stage estimation procedure to calculate the parameter estimates. The first stage is to calculate an intrinsic least squares estimator of the parameter vector using the annealing evolutionary stochastic approximation Monte Carlo algorithm and then the second stage is to construct a set of estimating equations to obtain a more efficient estimate with the intrinsic least squares estimate as the starting point. We use Wald statistics to test linear hypotheses of unknown parameters and establish their limiting distributions. Simulation studies are used to evaluate the accuracy of our parameter estimates and the finite sample performance of the Wald statistics. We apply our methods to the detection of the difference in the morphological changes of the left and right hippocampi between schizophrenia patients and healthy controls using medial shape description. PMID:23794769

  9. Medial cortex strain distribution during noncemented total hip arthroplasty.

    PubMed

    Elias, J J; Nagao, M; Chu, Y H; Carbone, J J; Lennox, D W; Chao, E Y

    2000-01-01

    Intraoperative proximal femur fractures are a significant concern during noncemented total hip arthroplasty. The current study was performed to investigate the hypothesis that broaching the femur and inserting the stem without using mallet applied impact loads will reduce the risk of intraoperative fracture. Rosette strain gauges were applied to the medial and anteromedial cortex of six human anatomic specimen femurs to compare the strain distribution for broaching and stem insertion. Eight additional femurs were used to compare the strain distribution for stem insertion using impact loading and constant rate stem insertion. For the impact loading stem insertions, the soft tissues surrounding the femur were modeled. Constant rate stem insertions were performed using a mechanical testing machine. The largest strains measured at the medial and anteromedial sites primarily were aligned with the femur hoop axis. The largest strain magnitude, orientation, and sign (tensile or compressive) varied widely among femurs. The stem insertion strains were significantly larger than the broaching strains (two-way analysis of variance with replication). The impact stem insertion strains were not significantly different from the constant rate stem insertion strains. The results indicate that the femur geometry and material properties have a greater influence on the strain distribution than does the implantation technique.

  10. Medial Foot Loading on Ankle and Knee Biomechanics

    PubMed Central

    Mitchell, Lyneil C.J.; Ford, Kevin R.; Minning, Stephen; Myer, Gregory D.; Mangine, Robert E.

    2008-01-01

    Background The incidence of anterior cruciate ligament (ACL) injuries among females continues at disproportionate rates compared to males, with research indicating inconclusive multifactorial causality. Data from previous retrospective studies suggest an effect of abnormal foot and ankle bio-mechanics on pathology at the knee, including the ACL. Objective To determine if a relationship exists between plantar foot loading patterns during normal gait and high risk biomechanics purported to increase risk of ACL injury. Methods Dynamic barefoot plantar pressure distribution was measured on 33 female collegiate soccer players. Groups were divided according to their predominant gait loading pattern (medial or lateral). Three dimensional (3-D) motion analysis was conducted during drop vertical jumps to assess vertical ground reaction force and discrete angle and joint moment variables of the lower extremities. Results No significant differences occured in sagittal or coronal plane knee joint kinematics and kinetics between the medial and lateral loading groups. Discussion Dynamic foot and ankle biomechanics during gait do not appear to be related to lower extremity kinematics or kinetics during landing in collegiate female soccer players. Conclusion The exact cause of the abnormal differences in female landing biomechanics has not been irrefutably defined. This study suggests no effect of foot and ankle biomechanics exists on the landing mechanics of female soccer players. PMID:20379384

  11. Medial prefrontal cortex role in recognition memory in rodents.

    PubMed

    Morici, Juan Facundo; Bekinschtein, Pedro; Weisstaub, Noelia V

    2015-10-01

    The study of the neurobiology of recognition memory, defined by the integration of the different components of experiences that support recollection of past experiences have been a challenge for memory researches for many years. In the last twenty years, with the development of the spontaneous novel object recognition task and all its variants this has started to change. The features of recognition memory include a particular object or person ("what"), the context in which the experience took place, which can be the arena itself or the location within a particular arena ("where") and the particular time at which the event occurred ("when"). This definition instead of the historical anthropocentric one allows the study of this type of episodic memory in animal models. Some forms of recognition memory that require integration of different features recruit the medial prefrontal cortex. Focusing on findings from spontaneous recognition memory tasks performed by rodents, this review concentrates on the description of previous works that have examined the role that the medial prefrontal cortex has on the different steps of recognition memory. We conclude that this structure, independently of the task used, is required at different memory stages when the task cannot be solved by a single item strategy.

  12. Physiologic bone remodeling in medial aspect of proximal tibia after under-release of medial soft tissue during total knee arthroplasty.

    PubMed

    Kim, Sang-Min; Seo, Jai-Gon; Lim, Seung-Jae; Lee, Sung-Sahn; Moon, Young-Wan

    2014-06-01

    This study was undertaken to investigate the incidence and to identify predictors of physiologic remodeling in the medial aspect of the proximal tibia in varus knees after total knee arthroplasty (TKA). One hundred and sixty-six consecutive patients (221 knees) who underwent navigation-assisted TKA and were followed for a minimum of 2 years were included. Changes in bone radiolucency in the medial aspect of the proximal tibia on the radiographs were investigated at each follow-up. All information on potential factors affecting medial tibial remodeling were retrieved and classified as being patient-, radiography-, or surgery-related. Radiographic change of bone stock in the medial aspect of the proximal tibia was observed in 18 % of knees (39/221). In all of these cases, this was first detected within 3 months after surgery. During the initial phase to 3 months after surgery, bone stock radiolucency typically increased, but then gradually decreased and after 1 year postoperatively, radiolucency no longer changes with time. Of the 15 variables analyzed, the difference between medial extension gap after bone cutting and prostheses thickness was found to be significantly associated with occurrence of radiographic change of bone stock. In some varus knees showing physiologic bone remodeling in the medial aspect of the proximal tibia after TKA, prostheses thickness showed a strong tendency to be larger than the medial extension gap after bone cutting.

  13. Increased Intrinsic Activity of Medial-Temporal Lobe Subregions is Associated with Decreased Cortical Thickness of Medial-Parietal Areas in Patients with Alzheimer's Disease Dementia.

    PubMed

    Pasquini, Lorenzo; Scherr, Martin; Tahmasian, Masoud; Myers, Nicholas E; Ortner, Marion; Kurz, Alexander; Förstl, Hans; Zimmer, Claus; Grimmer, Timo; Akhrif, Atae; Wohlschläger, Afra M; Riedl, Valentin; Sorg, Christian

    2016-01-01

    In Alzheimer's disease (AD), disrupted connectivity between medial-parietal cortices and medial-temporal lobes (MTL) is linked with increased MTL local functional connectivity, and parietal atrophy is associated with increased MTL memory activation. We hypothesized that intrinsic activity in MTL subregions is increased and associated with medial-parietal degeneration and impaired memory in AD. To test this hypothesis, resting-state-functional and structural-MRI was assessed in 22 healthy controls, 22 mild cognitive impairment patients, and 21 AD-dementia patients. Intrinsic activity was measured by power-spectrum density of blood-oxygenation-level-dependent signal, medial-parietal degeneration by cortical thinning. In AD-dementia patients, intrinsic activity was increased for several right MTL subregions. Raised intrinsic activity in dentate gyrus and cornu ammonis 1 was associated with cortical thinning in posterior cingulate cortices, and at-trend with impaired delayed recall. Critically, increased intrinsic activity in the right entorhinal cortex was associated with ipsilateral posterior cingulate degeneration. Our results provide evidence that in AD, intrinsic activity in MTL subregions is increased and associated with medial-parietal atrophy. Results fit a model in which medial-parietal degeneration contributes to MTL dysconnectivity from medial-parietal cortices, potentially underpinning disinhibition-like changes in MTL activity.

  14. The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

    PubMed Central

    Liu, Yanjie; Pan, Yao; Zhang, Wei; Zhang, Changqing; Zeng, Bingfang; Chen, Yunfeng

    2014-01-01

    Background The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures. Methods Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. Results Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001). When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P≤0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. Conclusions Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure. PMID:25084520

  15. Pelvic limb alignment in small breed dogs: a comparison between affected and free subjects from medial patellar luxation.

    PubMed

    Olimpo, Matteo; Piras, Lisa Adele; Peirone, Bruno

    2016-01-01

    Small breed dogs are 12 times more likely to develop medial patellar luxation (MPL) than large breed dogs and breed predisposition has been reported. Many surgical techniques are available for correction of patellar luxation in dogs. However, recent studies reported an 8% incidence of reluxation when traditional techniques are used. The relatively high frequency of major complications and patellar reluxation may be partially caused by inadequate appreciation of the underlying skeletal deformity and subsequent incorrect selection and application of traditional techniques. The aims of this study were to report the normal values of the anatomic and mechanical joint angles of the femur and tibia in small breed dogs and to compare these data to a population of small breed dogs affected by different degrees of MPL. Normal values of the anatomic and mechanical angles of the femur are similar to the ones reported in literature in Pomeranian dogs. Normal values of the anatomic and mechanical angles of the tibia have been described for the first time. Significant differences were found between normal population and dogs affected by grade 4 MPL in relation to anatomical Lateral Distal Femoral Angle (aLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), and mechanical Caudal Proximal Tibial Angle (mCaPTA).

  16. Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: a case report and review of the literature.

    PubMed

    Mizushima, H; Kobayashi, N; Yoshiharu, S; Kazuo, H; Dohi, K; Sasaki, K; Matsumoto, K

    1999-08-01

    Distal aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Most have been located at the cerebellopontine angle. Only three cases, including ours, located in the medial branch of the AICA have been reported in the literature. A 55-year-old female presented with epilepsy that she experienced for the first time. Computed tomography and magnetic resonance imaging revealed no abnormality. Digital subtraction angiography (DSA) disclosed a rare aneurysm at the medial branch of the distal anterior inferior cerebellar artery. In the blood workup on her admission, a mild inflammatory sign was found, and bacterial aneurysm was suggested as the presumptive differential diagnosis. Repeated DSA was performed 3 months after admission, but the aneurysm did not disappear. She then underwent a suboccipital craniotomy in the prone position. The aneurysm was clipped and partially resected for the pathological examination. Histologic examination revealed a true aneurysm. She was discharged without neurological deficit. In this report, we summarize the previous cases and discuss the location and clinical manifestations of aneurysms of the AICA through a review of the literature.

  17. Preserved Self-Awareness following Extensive Bilateral Brain Damage to the Insula, Anterior Cingulate, and Medial Prefrontal Cortices

    PubMed Central

    Khalsa, Sahib S.; Damasio, Antonio; Tranel, Daniel; Landini, Gregory; Williford, Kenneth

    2012-01-01

    It has been proposed that self-awareness (SA), a multifaceted phenomenon central to human consciousness, depends critically on specific brain regions, namely the insular cortex, the anterior cingulate cortex (ACC), and the medial prefrontal cortex (mPFC). Such a proposal predicts that damage to these regions should disrupt or even abolish SA. We tested this prediction in a rare neurological patient with extensive bilateral brain damage encompassing the insula, ACC, mPFC, and the medial temporal lobes. In spite of severe amnesia, which partially affected his “autobiographical self”, the patient's SA remained fundamentally intact. His Core SA, including basic self-recognition and sense of self-agency, was preserved. His Extended SA and Introspective SA were also largely intact, as he has a stable self-concept and intact higher-order metacognitive abilities. The results suggest that the insular cortex, ACC and mPFC are not required for most aspects of SA. Our findings are compatible with the hypothesis that SA is likely to emerge from more distributed interactions among brain networks including those in the brainstem, thalamus, and posteromedial cortices. PMID:22927899

  18. Missed Medial Malleolar Fracture Associated With Achilles Tendon Rupture: A Case Report and Literature Review.

    PubMed

    Nakajima, Koji; Taketomi, Shuji; Inui, Hiroshi; Nakamura, Kensuke; Sanada, Takaki; Tanaka, Sakae

    2016-01-01

    A 45-year-old man sustained an Achilles tendon rupture while playing futsal. A concomitant medial malleolar fracture was not diagnosed until the patient underwent an operation for Achilles tendon repair. A routine postoperative radiograph showed a minimally displaced medial malleolar fracture. Conservative treatment was chosen for the fracture. The function of the Achilles tendon recovered well, and the fracture was united. A medial malleolar fracture can be missed when an Achilles tendon rupture occurs simultaneously. Thus, surgeons should consider the possibility of medial malleolar fracture associated with an Achilles tendon rupture. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. The medial malleolus osteoligamentous complex and its role in ankle fractures.

    PubMed

    Davidovitch, Roy I; Egol, Kenneth A

    2009-01-01

    Ankle stability in ankle fractures is dependent on multiple factors. The medial malleolus and the associated deltoid ligament provide for ankle stability on the medial side. Over the years, the relative importance of this medial malleolar osteoligamentous complex (MMOLC) has been debated. This review will describe the evolution of ankle fracture surgery from the perspective of the contribution of the MMOLC to re-establishing ankle stability. Also discussed are the surgical and nonsurgical treatment options, various presentations of medial sided injuries in ankle fractures, and, finally, current recommendations for fixation.

  20. The significance of medial sural artery integrity in popliteal artery trauma: a case report.

    PubMed

    Tzilalis, V D; Georgiadis, G S; Papas, T T; Arvanitis, D P; Lazarides, M K

    2005-12-01

    Two patients with popliteal artery trauma who underwent secondary amputations due to refractory calf sepsis despite a patent arterial repair are presented in this case report. The medial sural artery, the main arterial supply of the medial head of the gastrocnemius, was surgically severed in both patients owing to the use of a continuous medial incision from the supra level to infragenicular level. The compromised arterial supply of the medial head of the gastrocnemius muscle may have contributed to the devitalization of the muscle and the subsequent calf sepsis, and it is speculated that this was related to the unfavorable outcome.

  1. Medial tibial pain. A prospective study of its cause among military recruits.

    PubMed

    Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z

    1986-12-01

    In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

  2. Chronic Ritalin administration during adulthood increases serotonin pool in rat medial frontal cortex.

    PubMed

    Daniali, Samira; Madjd, Zahra; Shahbazi, Ali; Niknazar, Somayeh; Shahbazzadeh, Delavar

    2013-01-01

    Ritalin has high tendency to be abused. It has been the main indication to control attention deficit hyperactivity disorder. The college students may seek for it to improve their memory, decrease the need for sleep (especially during exams), which at least partially, can be related to serotonergic system. Therefore, it seems worthy to evaluate the effect of Ritalin intake on mature brain. There are many studies on Ritalin effect on developing brain, but only few studies on adults are available. This study was undertaken to find Ritalin effect on serotonin transporter (SERT) density in medial frontal cortex (MFC) of mature rat. Thirty male Wistar rats were used in the study. Rats were assigned into five groups (n = 6 per group): one control, two Ritalin and two vehicle groups. Twelve rats received Ritalin (20 mg/kg/twice a day) orally for eleven continuous days. After one week of withdrawal and another two weeks of rest, in order to evaluate short-term effects of Ritalin, six rats were sacrificed. Another six rats were studied to detect the long-term effects of Ritalin; therefore, they were sacrificed 12 weeks after the previous group. The immunohistochemistry was performed to evaluate the results. Immunohistochemistry studies showed a higher density of SERT in both 2 and 12 weeks after withdrawal from Ritalin intake in MFC of rat and there was no significant difference between these two groups. Our findings demonstrated both short- and long-term effects of Ritalin on frontal serotonergic system after withdrawal period.

  3. The anxiogenic drug FG-7142 increases serotonin metabolism in the rat medial prefrontal cortex.

    PubMed

    Evans, Andrew K; Abrams, Jolane K; Bouwknecht, J Adriaan; Knight, David M; Shekhar, Anantha; Lowry, Christopher A

    2006-06-01

    The neural mechanisms underlying anxiety states are believed to involve interactions among forebrain limbic circuits and brainstem serotonergic systems. Consistent with this hypothesis, FG-7142, a partial inverse agonist at the benzodiazepine allosteric site of the GABAA receptor, increases c-Fos expression within a subpopulation of brainstem serotonergic neurons. Paradoxically, FG-7142 has no effect on extracellular serotonin concentrations, as measured using in vivo microdialysis, in certain anxiety-related brain structures. This study tested the hypothesis that FG-7142 alters serotonin metabolism within one or more nodes of a defined anxiety-related forebrain circuit. Rats received one of four treatments (vehicle, 1.9, 3.8, or 7.5 mg/kg FG-7142, i.p.) and brains were collected 1 h following treatment. Thirteen forebrain regions were microdissected and analyzed for l-tryptophan, serotonin, and 5-hydroxyindoleacetic acid concentrations using high pressure liquid chromatography with electrochemical detection. FG-7142 (7.5 mg/kg) increased l-tryptophan, serotonin, and 5-hydroxyindoleacetic acid concentrations in the prelimbic cortex but not in several other regions studied including subdivisions of the amygdala and bed nucleus of the stria terminalis. These data demonstrate that FG-7142 alters brain tryptophan concentrations and serotonin metabolism in specific components of an anxiety-related forebrain circuit including the medial prefrontal cortex, an important structure involved in executive function and the regulation of emotional behavior.

  4. Nicotine induction of theta frequency oscillations in rodent medial septal diagonal band in vitro.

    PubMed

    Lu, Cheng-biao; Li, Cheng-zhang; Li, Dong-liang; Henderson, Zaineb

    2013-06-01

    This study aimed to examine the role of the nicotinic receptor (nAChR) in the generation of theta oscillations (4-12 Hz) in vitro. Electrophysiological studies were performed on medial septal diagonal band area (MSDB) slices to measure theta oscillation. Immunofluorescence and confocal microscopy studies were carried out to detect α4 nAChR and β2 nAChR subunits in perfused-fixed tissue from VGluT2-GFP and GAD67-GFP transgenic mice. Application of nicotine to MSDB slices produced persistent theta oscillations in which area power increased in a dose-responsive manner. This activity was inhibited by GABAA receptor antagonists and partially by ionotropic glutamate receptor antagonists, indicating the involvement of local GABAergic and glutamatergic neurons in the production of the rhythmic activity. The nicotine-induced theta activity was also inhibited selectively by non-α7*nAChR antagonists, suggesting the presence of these receptor types on GABAergic and glutamatergic neuron populations in the MSDB. This was confirmed by immunofluorescence and confocal microscopy studies in transgenic mice in which the GABAergic and glutamatergic neurons express green fluorescent protein (GFP), showing localisation of β2 nAChR and α4 nAChR subunits, the most common constituents of non-α7*nAChRs, in both cell types in the MSDB. Theta activity in the MSDB may be generated by tonic stimulation of non-α7*nAChRs.

  5. A Case of Spontaneous Osteonecrosis of the Knee with Early and Simultaneous Involvement of the Medial Femoral Condyle and Medial Tibial Plateau

    PubMed Central

    Fujita, Shinya; Arai, Yuji; Honjo, Kuniaki; Nakagawa, Shuji; Kubo, Toshikazu

    2016-01-01

    Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle, most often the medial femoral condyle (MFC). Involvement of the medial tibial plateau (MTP) is less common, occurring in about 2% of knees with SPONK. Early onset SPONK on the ipsilateral side of the medial compartment is very rare, with, to our knowledge, only four cases reported to date. We describe a very rare case of SPONK with early simultaneous development in the MFC and MTP. Serial plain radiographs and magnetic resonance imaging showed that SPONK in both condyles followed a similar progressive course. The pathological findings in these lesions were similar to those observed in subchondral insufficiency fractures. PMID:27242941

  6. A Case of Spontaneous Osteonecrosis of the Knee with Early and Simultaneous Involvement of the Medial Femoral Condyle and Medial Tibial Plateau.

    PubMed

    Fujita, Shinya; Arai, Yuji; Honjo, Kuniaki; Nakagawa, Shuji; Kubo, Toshikazu

    2016-01-01

    Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle, most often the medial femoral condyle (MFC). Involvement of the medial tibial plateau (MTP) is less common, occurring in about 2% of knees with SPONK. Early onset SPONK on the ipsilateral side of the medial compartment is very rare, with, to our knowledge, only four cases reported to date. We describe a very rare case of SPONK with early simultaneous development in the MFC and MTP. Serial plain radiographs and magnetic resonance imaging showed that SPONK in both condyles followed a similar progressive course. The pathological findings in these lesions were similar to those observed in subchondral insufficiency fractures.

  7. Are Early Results of Robotic Assisted Medial Unicompartmental Knee Arthroplasty Successful?

    PubMed Central

    Haklar, Uğur; Ulusoy, Ertuğrul; Şimşek, Tayfun; Terzi, Nuray

    2014-01-01

    Objectives: Robotic surgery studies have been increasing in literature in the past years due to its operative advantages on reducing error and improving functional success in partial knee arthroplasty. Methods: Data were prospectively collected in 21 patients (31 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – January 2014 in our clinic with an average follow-up time of 5.5 months. Clinical outcomes were evaluated with American Knee Society Scoring System. Additionally, intra-operative digitally planned implant positions on the robot’s software were compared with post-operative radiographic component alignment. In the radiographic evaluation; anatomic axis of the tibia was observed in the coronal plane. Tibial posterior slope and flexion angle of the femoral component were observed in the sagittal plane. Results: Pre-operatively 1 patient was scored fair (60 points) and 20 patients were scored poor (mean, 46.6 points) on American Knee Society Scoring System. Post-operatively all 21 patients had excellent knee scores (mean, 99.67 points). Function-wise 7 patients were scored fair (mean, 60 points) and 14 patients were scored poor (mean, 30.7 points) again on American Knee Society Functional Scoring System. Post-operatively all 21 patients exhibited excellent function scores (mean, 99.04 points). In the radiological evaluation, intra-operative robotic analyses were compared with post-operative radiographic alignment. No significant difference was observed statistically (paired t-test, p < 0.05). This comparison is valuable as Lonner, Hernigou, Collier report that mal-alignment by as little as 2° may predispose to implant failures. Conclusion: Robotic assistance greatly improves clinical and functional outcomes and may help prevent implant failures due to surgical error and mal-alignment in partial knee arthroplasty.

  8. Partially coherent ultrafast spectrography

    PubMed Central

    Bourassin-Bouchet, C.; Couprie, M.-E.

    2015-01-01

    Modern ultrafast metrology relies on the postulate that the pulse to be measured is fully coherent, that is, that it can be completely described by its spectrum and spectral phase. However, synthesizing fully coherent pulses is not always possible in practice, especially in the domain of emerging ultrashort X-ray sources where temporal metrology is strongly needed. Here we demonstrate how frequency-resolved optical gating (FROG), the first and one of the most widespread techniques for pulse characterization, can be adapted to measure partially coherent pulses even down to the attosecond timescale. No modification of experimental apparatuses is required; only the processing of the measurement changes. To do so, we take our inspiration from other branches of physics where partial coherence is routinely dealt with, such as quantum optics and coherent diffractive imaging. This will have important and immediate applications, such as enabling the measurement of X-ray free-electron laser pulses despite timing jitter. PMID:25744080

  9. Laparoscopic partial splenic resection.

    PubMed

    Uranüs, S; Pfeifer, J; Schauer, C; Kronberger, L; Rabl, H; Ranftl, G; Hauser, H; Bahadori, K

    1995-04-01

    Twenty domestic pigs with an average weight of 30 kg were subjected to laparoscopic partial splenic resection with the aim of determining the feasibility, reliability, and safety of this procedure. Unlike the human spleen, the pig spleen is perpendicular to the body's long axis, and it is long and slender. The parenchyma was severed through the middle third, where the organ is thickest. An 18-mm trocar with a 60-mm Endopath linear cutter was used for the resection. The tissue was removed with a 33-mm trocar. The operation was successfully concluded in all animals. No capsule tears occurred as a result of applying the stapler. Optimal hemostasis was achieved on the resected edges in all animals. Although these findings cannot be extended to human surgery without reservations, we suggest that diagnostic partial resection and minor cyst resections are ideal initial indications for this minimally invasive approach.

  10. Partially coherent ultrafast spectrography

    NASA Astrophysics Data System (ADS)

    Bourassin-Bouchet, C.; Couprie, M.-E.

    2015-03-01

    Modern ultrafast metrology relies on the postulate that the pulse to be measured is fully coherent, that is, that it can be completely described by its spectrum and spectral phase. However, synthesizing fully coherent pulses is not always possible in practice, especially in the domain of emerging ultrashort X-ray sources where temporal metrology is strongly needed. Here we demonstrate how frequency-resolved optical gating (FROG), the first and one of the most widespread techniques for pulse characterization, can be adapted to measure partially coherent pulses even down to the attosecond timescale. No modification of experimental apparatuses is required; only the processing of the measurement changes. To do so, we take our inspiration from other branches of physics where partial coherence is routinely dealt with, such as quantum optics and coherent diffractive imaging. This will have important and immediate applications, such as enabling the measurement of X-ray free-electron laser pulses despite timing jitter.

  11. Hierarchical partial order ranking.

    PubMed

    Carlsen, Lars

    2008-09-01

    Assessing the potential impact on environmental and human health from the production and use of chemicals or from polluted sites involves a multi-criteria evaluation scheme. A priori several parameters are to address, e.g., production tonnage, specific release scenarios, geographical and site-specific factors in addition to various substance dependent parameters. Further socio-economic factors may be taken into consideration. The number of parameters to be included may well appear to be prohibitive for developing a sensible model. The study introduces hierarchical partial order ranking (HPOR) that remedies this problem. By HPOR the original parameters are initially grouped based on their mutual connection and a set of meta-descriptors is derived representing the ranking corresponding to the single groups of descriptors, respectively. A second partial order ranking is carried out based on the meta-descriptors, the final ranking being disclosed though average ranks. An illustrative example on the prioritization of polluted sites is given.

  12. Partially integrated exhaust manifold

    SciTech Connect

    Hayman, Alan W; Baker, Rodney E

    2015-01-20

    A partially integrated manifold assembly is disclosed which improves performance, reduces cost and provides efficient packaging of engine components. The partially integrated manifold assembly includes a first leg extending from a first port and terminating at a mounting flange for an exhaust gas control valve. Multiple additional legs (depending on the total number of cylinders) are integrally formed with the cylinder head assembly and extend from the ports of the associated cylinder and terminate at an exit port flange. These additional legs are longer than the first leg such that the exit port flange is spaced apart from the mounting flange. This configuration provides increased packaging space adjacent the first leg for any valving that may be required to control the direction and destination of exhaust flow in recirculation to an EGR valve or downstream to a catalytic converter.

  13. Isolated lesion of the medial orbital wall following endonasal surgery. Isolated fractures of the medial orbital wall.

    PubMed

    Scassellati-Sforzolini, G; Cavina, C; Scassellati-Sforzolini, B; Vancini, F; Cavina, C

    Isolated fractures of the medial orbital wall are infrequent. The diagnostic triad includes: adduction block, exotropia with diplopia in all directions of gaze, positive passive duction in abduction. Sometimes a slight enophthalmos is present. Computed tomography shows the extension and the seat of the fracture. The authors illustrate the case of a 60 year old male who presented with a breach of the medial orbital wall following endonasal surgery. The patient was successfully operated using an iliac bone graft inserted via an eyebrow-nasal cutaneous approach, after a previous attempt with a transconjunctival approach performed in another hospital had failed. A good functional and aesthetic result was observed within the first year after surgery. After almost 11 years a full adduction is still present and diplopia is absent. The authors underline the importance of an early diagnosis and prompt surgical treatment. The fat-muscle entrapment should be removed and the bone defect closed. A close cooperation between ophthalmologist and plastic surgeon is suggested.

  14. Activated partial thromboplastin time.

    PubMed

    Ignjatovic, Vera

    2013-01-01

    Activated partial thromboplastin time (APTT) is a commonly used coagulation assay that is easy to perform, is affordable, and is therefore performed in most coagulation laboratories, both clinical and research, worldwide. The APTT is based on the principle that in citrated plasma, the addition of a platelet substitute, factor XII activator, and CaCl2 allows for formation of a stable clot. The time required for the formation of a stable clot is recorded in seconds and represents the actual APTT result.

  15. Comparison of Medial and Lateral Meniscus Root Tears.

    PubMed

    Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

    2015-01-01

    The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years) and 30 years (range: 14-62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is common in

  16. Salter-Harris Type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus.

    PubMed

    Cass, J R; Peterson, H A

    1983-10-01

    Salter-Harris Type-IV fractures of the epiphysis extend through the articular cartilage, epiphysis, physis, and metaphysis and have a high rate of complications secondary to premature partial closure of the physis. In this study we attempted to determine which Type-IV fractures of the distal end of the tibia result in premature partial closure, how the various treatment modalities affect the risk of premature physeal closure, and how the complication itself might be best managed. Thirty-two Type-IV fractures of the distal end of the tibia were seen at the Mayo Clinic during a five-year period. Eighteen injuries involved the medial malleolus, thirteen were so-called triplane fractures, and one was a fracture of the lateral part of the plafond. In the eighteen ankles with a fracture that involved the medial malleolus, extension of the fracture into the metaphysis could often be appreciated only on oblique roentgenograms. The patients' ages at the time of fracture ranged from one year and one month to fifteen years and six months old. In nine of the eighteen tibiae with a fracture of the medial malleolus premature partial closure of the distal physis developed, resulting in angular deformity or limb-length discrepancy sufficient to require operative treatment (epiphyseodesis, corrective osteotomy, or excision of a physeal bar). A physeal bar was best detected by tomograms made in two planes and by scanograms. Bar formation may be treated by excision of the bar, arrest of the whole physis, osteotomy, or combinations of these procedures. Of the thirteen patients with a triplane fracture and the one with a Type-IV fracture of the lateral part of the plafond, all fourteen were near maturity at the time of injury, and no growth-arrest problems developed.

  17. Effect of chemical stimulation of the medial frontal lobe on the micturition reflex in rats.

    PubMed

    Nishijima, Saori; Sugaya, Kimio; Kadekawa, Katsumi; Ashitomi, Katsuhiro; Yamamoto, Hideyuki

    2012-03-01

    We assessed the influence of the medial frontal lobe on micturition after chemical stimulation. We also examined the relation between the medial frontal lobe and the rostral pontine reticular formation, which has a strong inhibitory effect on micturition. A total of 35 female rats underwent continuous cystometry. Bladder activity changes were examined after physiological saline, glutamate, the glutamate receptor antagonist MK-801, noradrenaline or the adrenergic α-1 receptor antagonist naftopidil was injected in the medial frontal lobe. When glutamate was injected in the medial frontal lobe, MK-801 was also injected in the rostral pontine reticular formation. Glutamate injection in the medial frontal lobe prolonged the interval between bladder contractions while injection of the glutamate antagonist MK-801 shortened the interval. Glutamate injection in the medial frontal lobe just after MK-801 injection in the ipsilateral rostral pontine reticular formation also prolonged the interval between bladder contractions. However, after prior injection of MK-801 in the bilateral rostral pontine reticular formation glutamate injection in the medial frontal lobe did not influence cystometric parameters. Noradrenaline injection in the medial frontal lobe shortened the interval between bladder contractions while injection of its antagonist naftopidil prolonged the interval. Medial frontal lobe neurons excited by glutamate inhibited the micturition reflex via activation of the rostral pontine reticular formation by glutamatergic projection while medial frontal lobe neurons excited by noradrenaline facilitated the micturition reflex. Thus, the medial frontal lobe may be an important integration center for the initiation of micturition and urine storage mechanisms. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Radiological analysis of the medial epicondyle in the adolescent throwing athlete

    PubMed Central

    Ng, Wuey Min; Chan, Chee Ken; Takahashi, Norimasa; Kawai, Nobuaki; Teh, Kok Kheng; Saravana, R; Sugaya, Hiroyuki

    2017-01-01

    INTRODUCTION Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15–17 years and had fused epicondyles. METHODS In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated. RESULTS Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm2, while that of the non-dominant arm was 189.14 ± 39.56 mm2 (p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles. CONCLUSION Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations. PMID:26976222

  19. The Medial Temporal Lobe Supports Conceptual Implicit Memory

    PubMed Central

    Wang, Wei-Chun; Lazzara, Michele M.; Ranganath, Charan; Knight, Robert T.; Yonelinas, Andrew P.

    2010-01-01

    Summary The medial temporal lobe (MTL) is generally thought to be critical for explicit, but not implicit, memory. Here, we demonstrate that the perirhinal cortex (PRc), within the MTL, plays a role in conceptually-driven implicit memory. Amnesic patients with MTL lesions that converged on the left PRc exhibited deficits on two conceptual implicit tasks (i.e., exemplar generation and semantic decision). A separate functional magnetic resonance imaging (fMRI) study in healthy subjects indicated that PRc activation during encoding of words was predictive of subsequent exemplar generation. Moreover, across subjects, the magnitude of the fMRI and behavioral conceptual priming effects were directly related. Additionally, the PRc region implicated in the fMRI study was the same region of maximal lesion overlap in the patients with impaired conceptual priming. These patient and imaging results converge to suggest that the PRc plays a critical role in conceptual implicit memory, and possibly conceptual processing in general. PMID:21144998

  20. Medial prefrontal cortex predicts internally driven strategy shifts

    PubMed Central

    Schuck, Nicolas W.; Gaschler, Robert; Wenke, Dorit; Heinzle, Jakob; Frensch, Peter A.; Haynes, John-Dylan; Reverberi, Carlo

    2015-01-01

    Summary Many daily behaviors require us to actively focus on the current task and ignore all other distractions. Yet, ignoring everything else might hinder the ability to discover new ways to achieve the same goal. Here, we studied the neural mechanisms that support the spontaneous change to better strategies while an established strategy is executed. Multivariate neuroimaging analysis showed that before the spontaneous change to an alternative strategy, medial prefrontal cortex (MPFC) encoded information that was irrelevant for the current strategy but necessary for the later strategy. Importantly, this neural effect was related to future behavioral changes: information encoding in MPFC was changed only in participants who eventually switched their strategy and started before the actual strategy change. This allowed us to predict spontaneous strategy shifts ahead of time. These findings suggest that MPFC might internally simulate alternative strategies and sheds new light on the organization of PFC. PMID:25819613

  1. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    PubMed Central

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

  2. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

    PubMed Central

    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal-Blanquet, Joan; Gelber, Pablo E; Monllau, Joan Carles

    2017-01-01

    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented. PMID:28251062

  3. Emotional processing in anterior cingulate and medial prefrontal cortex

    PubMed Central

    Etkin, Amit; Egner, Tobias; Kalisch, Raffael

    2010-01-01

    Negative emotional stimuli activate a broad network, including the medial prefrontal (mPFC) and anterior cingulate (ACC) cortices. An early influential view dichotomized these regions into dorsal-caudal “cognitive” and ventral-rostral “affective” subdivisions. In this review, we examine a wealth of recent research on negative emotions in animals and humans, using the example of fear/anxiety, and conclude that, contrary to the traditional dichotomy, both subdivisions make key contributions to emotional processing. Specifically, dorsal-caudal regions of the ACC/mPFC are involved in appraisal and expression of negative emotion, while ventral-rostral portions of the ACC/mPFC have a regulatory role with respect to limbic regions involved in generating emotional responses. Moreover, this new framework is broadly consistent with emerging data on other negative and positive emotions. PMID:21167765

  4. Sports injury to a bipartite medial cuneiform in a child.

    PubMed

    Eves, Timothy B; Ahmad, Mudussar A; Oddy, Michael J

    2014-01-01

    We report the case of an 11-year-old boy who had sustained a soccer injury to his mid-foot. Plain radiography did not reveal any fracture to account for the severity of his symptoms or his inability to bear weight. Magnetic resonance imaging was undertaken and demonstrated the medial cuneiform to be a bipartite bone consisting of 2 ossicles connected by a synchondrosis. No acute fracture or diastasis of the bipartite bone was demonstrated; however, significant bone marrow edema was noted, corresponding to the site of the injury and his clinical point bony tenderness. This anatomic variant should be considered as a rare differential diagnosis in the skeletally immature foot. The injury was treated nonoperatively with a non-weightbearing cast and pneumatic walker immobilization, with successful resolution of his symptoms and a return to sports activity by 4 months after injury.

  5. Myositis ossificans traumatica of temporalis and medial pterygoid muscle

    PubMed Central

    Reddy, Shyam Prasad D; Prakash, Ajay P; Keerthi, M; Rao, Brahmaji J

    2014-01-01

    Myositis ossificans is a rare disease that is characterized by bone deposition in the muscle or soft tissues. Myositis ossificans of the masticatory muscles is an uncommon finding. The condition is benign and results in heterotopic bone formation in the muscles of mastication, usually producing limitation of opening of the jaws. It is important to know the exact cause of the limitation of opening of the jaws for successful treatment. Computed tomographic scan and panoramic radiographs along with histological findings are essential diagnostic aids for evaluating conditions such as myositis ossificans. A rare case of myositis ossificans traumatica of temporalis and medial pterygoid muscle is presented here along with the discussion of clinical, radiological and histological features. The present case emphasizes not only on the importance of considering myositis ossificans in the differential diagnosis of limitation of opening of the jaws but also on the improvement of the overall mouth opening and treatment results. PMID:25328311

  6. Myositis ossificans traumatica of temporalis and medial pterygoid muscle.

    PubMed

    Reddy, Shyam Prasad D; Prakash, Ajay P; Keerthi, M; Rao, Brahmaji J

    2014-05-01

    Myositis ossificans is a rare disease that is characterized by bone deposition in the muscle or soft tissues. Myositis ossificans of the masticatory muscles is an uncommon finding. The condition is benign and results in heterotopic bone formation in the muscles of mastication, usually producing limitation of opening of the jaws. It is important to know the exact cause of the limitation of opening of the jaws for successful treatment. Computed tomographic scan and panoramic radiographs along with histological findings are essential diagnostic aids for evaluating conditions such as myositis ossificans. A rare case of myositis ossificans traumatica of temporalis and medial pterygoid muscle is presented here along with the discussion of clinical, radiological and histological features. The present case emphasizes not only on the importance of considering myositis ossificans in the differential diagnosis of limitation of opening of the jaws but also on the improvement of the overall mouth opening and treatment results.

  7. Medial temporal lobe memory in childhood: Developmental transitions

    PubMed Central

    Townsend, Elise L.; Richmond, Jenny L.; Vogel-Farley, Vanessa K.; Thomas, Kathleen

    2009-01-01

    The medial temporal lobes (MTL) support declarative memory and mature structurally and functionally during the postnatal years in humans. Although recent work has addressed the development of declarative memory in early childhood, less is known about continued development beyond this period of time. The purpose of this investigation was to explore MTL-dependent memory across middle childhood. Children (6 – 10 years old) and adults completed two computerized tasks, place learning (PL) and transitive inference (TI), that each examined relational memory, as well as the flexible use of relational learning. Findings suggest that the development of relational memory precedes the development of the ability to use relational knowledge flexibly in novel situations. Implications for the development of underlying brain areas and ideas for future neuroimaging investigations are discussed. PMID:20712740

  8. Patellofemoral Pressure Changes After Static and Dynamic Medial Patellofemoral Ligament Reconstructions.

    PubMed

    Rood, Akkie; Hannink, Gerjon; Lenting, Anke; Groenen, Karlijn; Koëter, Sander; Verdonschot, Nico; van Kampen, Albert

    2015-10-01

    Reconstructing the medial patellofemoral ligament (MPFL) has become a key procedure for stabilizing the patella. Different techniques to reconstruct the MPFL have been described: static techniques in which the graft is fixed rigidly to the bone or dynamic techniques with soft tissue fixation. Static MPFL reconstruction is most commonly used. However, dynamic reconstruction deforms more easily and presumably functions more like the native MPFL. The aim of the study was to evaluate the effect of the different MPFL fixation techniques on patellofemoral pressures compared with the native situation. The hypothesis was that dynamic reconstruction would result in patellofemoral pressures closer to those generated in an intact knee. Controlled laboratory study. Seven fresh-frozen knee specimens were tested in an in vitro knee joint loading apparatus. Tekscan pressure-sensitive films fixed to the retropatellar cartilage measured mean patellofemoral and peak pressures, contact area, and location of the center of force (COF) at fixed flexion angles from 0° to 110°. Four different conditions were tested: intact, dynamic, partial dynamic, and static MPFL reconstruction. Data were analyzed using linear mixed models. Static MPFL reconstruction resulted in higher peak and mean pressures from 60° to 110° of flexion (P < .001). There were no differences in pressure between the 2 different dynamic reconstructions and the intact situation (P > .05). The COF in the static reconstruction group moved more medially on the patella from 50° to 110° of flexion compared with the other conditions. The contact area showed no significant differences between the test conditions. After static MPFL reconstruction, the patellofemoral pressures in flexion angles from 60° to 110° were 3 to 5 times higher than those in the intact situation. The pressures after dynamic MPFL reconstruction were similar as compared with those in the intact situation, and therefore, dynamic MPFL reconstruction

  9. Quantifying Medial Temporal Lobe Damage in Memory-Impaired Patients

    PubMed Central

    Gold, Jeffrey J.; Squire, Larry R.

    2009-01-01

    Studies of memory-impaired patients will be most useful when quantitative neuroanatomical information is available about the patients being studied. Toward that end, in the case of medial temporal lobe amnesia, protocols have been developed from histological material that identify the boundaries of relevant structures on magnetic resonance images. Because the size of these structures varies considerably in the normal population, some correction for overall brain size is usually employed when calculating volume measurements. Although different correction procedures have been used to normalize for brain size, there has been little study of how well different methods reduce variability and which methods might be most useful. We measured the volume of the hippocampal region (hippocampus proper, dentate gyrus, and subicular complex) and the volumes of the temporopolar, entorhinal, perirhinal, and parahippocampal cortices in five memory-impaired patients and 30 controls. We then compared three different methods for normalizing the volume measurements: normalization by intracranial volume, normalization by aligning the brain to a standard atlas, and normalization by brain area at the level of the anterior commissure. Normalization by intracranial volume reduced variability in the volume measurements of nearly all brain regions to a greater extent than did normalization by other methods. When normalized by intracranial volume, the patients exhibited a mean reduction in hippocampal volume of about 40% and negligible reductions in the volumes of other medial temporal lobe structures. On the basis of earlier histological analysis of two other patients (L.M. and W.H.), who also had reductions in hippocampal size of about 40%, we suggest that a volume reduction in this range likely indicates a nearly complete loss of hippocampal neurons. PMID:15390163

  10. Reversed Procrastination by Focal Disruption of Medial Frontal Cortex.

    PubMed

    Jha, Ashwani; Diehl, Beate; Scott, Catherine; McEvoy, Andrew W; Nachev, Parashkev

    2016-11-07

    An enduring puzzle in the neuroscience of voluntary action is the origin of the remarkably wide dispersion of the reaction time distribution, an interval far greater than is explained by synaptic or signal transductive noise [1, 2]. That we are able to change our planned actions-a key criterion of volition [3]-so close to the time of their onset implies decision-making must reach deep into the execution of action itself [4-6]. It has been influentially suggested the reaction time distribution therefore reflects deliberate neural procrastination [7], giving alternative response tendencies sufficient time for fair competition in pursuing a decision threshold that determines which one is behaviorally manifest: a race model, where action selection and execution are closely interrelated [8-11]. Although the medial frontal cortex exhibits a sensitivity to reaction time on functional imaging that is consistent with such a mechanism [12-14], direct evidence from disruptive studies has hitherto been lacking. If movement-generating and movement-delaying neural substrates are closely co-localized here, a large-scale lesion will inevitably mask any acceleration, for the movement itself could be disrupted. Circumventing this problem, here we observed focal intracranial electrical disruption of the medial frontal wall in the context of the pre-surgical evaluation of two patients with epilepsy temporarily reversing such hypothesized procrastination. Effector-specific behavioral acceleration, time-locked to the period of electrical disruption, occurred exclusively at a specific locus at the ventral border of the pre-supplementary motor area. A cardinal prediction of race models of voluntary action is thereby substantiated in the human brain. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Breast-feeding after vertical mammaplasty with medial pedicle.

    PubMed

    Cruz-Korchin, Norma; Korchin, Leo

    2004-09-15

    A retrospective study was performed in which the breast-feeding success of women of childbearing age (15 to 40 years) with macromastia but no prior breast surgery was compared with that of women of similar age who had undergone medial pedicle/vertical pattern reduction mammaplasty. All women completed a self-administered questionnaire that provided information on their breast-feeding success. The control group consisted of 149 women with macromastia (mean age, 27 years) who had been evaluated for possible breast reduction surgery and who had children before their consultation. The study group consisted of 58 women (mean age, 29 years) who had children after their vertical mammaplasty. The mean weight of breast tissue removed was 610 g per breast. None of the patients had absent nipple sensation. A period of 2 weeks or more was chosen as the defining duration of a successful breast-feeding attempt. Those individuals judged able to breast-feed were further classified on the basis of having breast-fed exclusively or with supplementation. The results demonstrated that, of the women who attempted to breast-feed, 61 percent in the control group and 65 percent in the study group were successful, with no significant difference between the groups (p > 0.05). The breakdown of the successful groups indicated that 36 percent in the control group and 38 percent in the study group supplemented their breast-feeding with formula. The groups were not significantly different (p > 0.05). In conclusion, this study found no significant difference in the rate of breast-feeding success between women who had medial pedicle/vertical pattern reduction mammaplasty and women who had no prior breast surgery.

  12. Dysphagia in unilateral medullary infarction: lateral vs medial lesions.

    PubMed

    Kwon, Miseon; Lee, Jae H; Kim, Jong S

    2005-09-13

    To study dysphagia in pure, unilateral medullary infarction using video fluoroscopic swallowing (VFS) tests and to compare the results between lateral medullary infarction (LMI) and medial medullary infarction (MMI). We studied 46 patients with medullary infarction (37 LMI, 9 MMI). Based on the MRI findings, each LMI was classified rostrocaudally as either a rostral or caudal lesion, and horizontally as either a superficial (lateral + dorsal) or nonsuperficial lesion. Each MMI was assigned to either a deep (lesion extending to the dorsal surface) or superficial lesion group. VFS examination was conducted and an 8-point scale was used for assessing the severity of dysphagia. Based on these results, dysphagia was classified as: 1) problems on timing of hyolaryngeal excursion (PT), and 2) problems on range of hyolaryngeal excursion (PR). Dysphagia was more frequent (p < 0.05) in MMI patients (78%) than in LMI patients (35%). Among the LMI patients, dysphagia was more frequent (p < 0.01) and severe (p < 0.01) in the rostral than in the caudal group and in the nonsuperficial than in the superficial group. In the MMI group, there was no difference in the frequency of dysphagia between the deep and superficial groups. Regarding the characteristics of dysphagia, seven (54%) of the LMI patients had PR, five (38%) had PT, and one (8%) had both. For the MMI patients, PT was frequent (86%) but PR was present in only one patient (14%). Five MMI patients (71%) showed no responses to penetration or aspiration, and silent dysphagia was observed in only four LMI patients (31%). Dysphagia is as frequent and severe in medial medullary infarction (MMI) as in lateral medullary infarction (LMI) patients. The types and characteristics of dysphagia are different between the LMI and MMI patients, implicating the rationale for a different treatment strategy.

  13. Medialized Versus Lateralized Center of Rotation in Reverse Shoulder Arthroplasty.

    PubMed

    Streit, Jonathan J; Shishani, Yousef; Gobezie, Reuben

    2015-12-01

    Reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. The purpose of this prospective study was to directly compare 2 reverse shoulder arthroplasty designs. Two treatment groups and 1 control group were identified. Group I comprised 9 patients using a medialized Grammont-style (GRM) prosthesis with a neck-shaft angle of 155°. Group II comprised 9 patients using a lateralized (LAT) prosthesis with a neck-shaft angle of 135°. Pre- and postoperative assessment of range of motion, American Shoulder and Elbow Surgeons score, and visual analog scale pain score were performed. Radiographic measurements of lateral humeral offset and acromiohumeral distance were compared. The GRM prosthesis achieved greater forward flexion (143.9° vs 115.6°; P=.05), whereas the LAT achieved greater external rotation (35.0° vs 28.3°; P=.07). The lateral humeral offset was greater for the LAT prosthesis compared with the GRM prosthesis, but this distance was not significantly different from that found in the control group. The acromiohumeral distance was significantly greater in the GRM prosthesis group compared with both the LAT and the control groups. The results of this study confirm that different reverse shoulder arthroplasty designs produce radiographically different anatomy. Whereas the GRM prosthesis significantly alters the anatomy of the shoulder, the LAT design can preserve some anatomic relationships found in the normal shoulder. The clinical outcomes indicate that this may have an effect on range of motion, with traditional designs achieving greater forward flexion and lateralized designs achieving greater external rotation. Copyright 2015, SLACK Incorporated.

  14. Proximal Scaphoid Arthroplasty Using the Medial Femoral Trochlea Flap

    PubMed Central

    Higgins, James P.; Burger, Heinze K.

    2013-01-01

    Background The medial trochlea of the femur (medial femoral trochlea, MFT) provides a source of convex osteocartilaginous vascularized bone that has been demonstrated to have a similar contour to the proximal scaphoid. This provides a potential solution for difficult recalcitrant proximal pole scaphoid nonunions. Materials and Methods Sixteen consecutive patients who underwent MFT proximal scaphoid arthroplasty were reviewed. Follow-up data were recorded at a minimum of 6 months, with an average of 14 months. The results of this cohort were previously reported in detail but are summarized herein. Description of Technique The ability to reconstruct both bone and cartilage of the nonunion enables the surgeon to resect the nonunited proximal pole to prepare for scaphoid reconstruction. A segment of osteocartilaginous MFT is harvested in dimensions required by the scaphoid defect. The MFT segment is harvested on the transverse branch of the descending geniculate vessels. Fixation may be achieved with ease due to the size of the reconstructed segment. Results Computed tomography imaging demonstrated 15 of 16 reconstructed scaphoids achieving osseous union. Follow-up range of motion (ROM) of the wrist averaged 46.0° extension (range 28-80°) and 43.8° flexion (range 10-80°), which was similar to preoperative (average 45.7° extension and 43.0° flexion). Scapholunate angles remained unaffected (51.6° preoperatively and 48.6° postoperatively), indicating preservation of carpal relationships. Conclusions Vascularized MFT flaps provide a useful tool in the treatment of difficult proximal pole scaphoid nonunions. Early follow-up demonstrates high rate of achieving union with acceptable ROM and good pain relief. PMID:24436821

  15. Perfusion network shift during seizures in medial temporal lobe epilepsy.

    PubMed

    Sequeira, Karen M; Tabesh, Ali; Sainju, Rup K; DeSantis, Stacia M; Naselaris, Thomas; Joseph, Jane E; Ahlman, Mark A; Spicer, Kenneth M; Glazier, Steve S; Edwards, Jonathan C; Bonilha, Leonardo

    2013-01-01

    Medial temporal lobe epilepsy (MTLE) is associated with limbic atrophy involving the hippocampus, peri-hippocampal and extra-temporal structures. While MTLE is related to static structural limbic compromise, it is unknown whether the limbic system undergoes dynamic regional perfusion network alterations during seizures. In this study, we aimed to investigate state specific (i.e. ictal versus interictal) perfusional limbic networks in patients with MTLE. We studied clinical information and single photon emission computed tomography (SPECT) images obtained with intravenous infusion of the radioactive tracer Technetium- Tc 99 m Hexamethylpropyleneamine Oxime (Tc-99 m HMPAO) during ictal and interictal state confirmed by video-electroencephalography (VEEG) in 20 patients with unilateral MTLE (12 left and 8 right MTLE). Pair-wise voxel-based analyses were used to define global changes in tracer between states. Regional tracer uptake was calculated and state specific adjacency matrices were constructed based on regional correlation of uptake across subjects. Graph theoretical measures were applied to investigate global and regional state specific network reconfigurations. A significant increase in tracer uptake was observed during the ictal state in the medial temporal region, cerebellum, thalamus, insula and putamen. From network analyses, we observed a relative decreased correlation between the epileptogenic temporal region and remaining cortex during the interictal state, followed by a surge of cross-correlated perfusion in epileptogenic temporal-limbic structures during a seizure, corresponding to local network integration. These results suggest that MTLE is associated with a state specific perfusion and possibly functional organization consisting of a surge of limbic cross-correlated tracer uptake during a seizure, with a relative disconnection of the epileptogenic temporal lobe in the interictal period. This pattern of state specific shift in metabolic networks in

  16. The topology of dermatomal projection in the medial lemniscal system

    PubMed Central

    Werner, Gerhard; Whitsel, Barry L.

    1967-01-01

    1. The topographic organization of first order afferent fibres in the lumbar, sacral and coccygeal dorsal roots, and in the fasciculus gracilis was studied in squirrel monkeys. 2. At the entry zone, progressing from caudal to rostral, dorsal root filaments receive fibres from tail and hind-limb receptive fields which serially overlap and describe a spiral-shaped trajectory. The latter starts with tail, progresses post-axially towards the foot, crosses the foot from lateral to medial, and ascends the preaxial leg. 3. In the fasciculus gracilis, this arrangement of fibres at the dorsal root entry zone is preserved in its entirety. It assumes the form of a fibre lamination, with the most caudal dorsal root fibres occupying a dorso-medial location; further rostral dorsal root fibres come to lie more ventrolaterally. 4. Dorsum and sole of foot project in an overlapping and interdigitating manner to the fibre lamina of the 7th lumber dermatome in the fasciculus gracilis. Thereby, dorsum and sole of foot behave in the projection as if they were one and the same surface. 5. The argument is presented that the foot and its projection on to the cross-sectional plane of the dorsal funiculus are topologically equivalent and that the hind-limb as a whole and its projection are not. On the other hand, homotopic mapping of the foot together with the sequential fibre organization in the dorsal funiculus enable many more types of closed curves on the body surface to remain arc-wise connected in the projection than would otherwise be possible. ImagesPlate 1 PMID:4963874

  17. Partial Southwest Elevation Mill #5 West (Part 3), Partial ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Partial Southwest Elevation - Mill #5 West (Part 3), Partial Southwest Elevation - Mill #5 West (with Section of Courtyard) (Parts 1 & 2) - Boott Cotton Mills, John Street at Merrimack River, Lowell, Middlesex County, MA

  18. Feasibility of the Medial Temporal lobe Atrophy index (MTAi) and derived methods for measuring atrophy of the medial temporal lobe

    PubMed Central

    Conejo Bayón, Francisco; Maese, Jesús; Fernandez Oliveira, Aníbal; Mesas, Tamara; Herrera de la Llave, Estibaliz; Álvarez Avellón, Tania; Menéndez-González, Manuel

    2014-01-01

    Introduction: The Medial Temporal-lobe Atrophy index (MTAi), 2D-Medial Temporal Atrophy (2D-MTA), yearly rate of MTA (yrRMTA) and yearly rate of relative MTA (yrRMTA) are simple protocols for measuring the relative extent of atrophy in the medial temporal lobe (MTL) in relation to the global brain atrophy. Albeit preliminary studies showed interest of these methods in the diagnosis of Alzheimer’s disease (AD), frontotemporal lobe degeneration (FTLD) and correlation with cognitive impairment in Parkinson’s disease (PD), formal feasibility and validity studies remained pending. As a first step, we aimed to assess the feasibility. Mainly, we aimed to assess the reproducibility of measuring the areas needed to compute these indices. We also aimed to assess the efforts needed to start using these methods correctly. Methods: A series of 290 1.5T-MRI studies from 230 subjects ranging 65–85 years old who had been studied for cognitive impairment were used in this study. Six inexperienced tracers (IT) plus one experienced tracer (ET) traced the three areas needed to compute the indices. Finally, tracers underwent a short survey on their experience learning to compute the MTAi and experience of usage, including items relative to training time needed to understand and apply the MTAi, time to perform a study after training and overall satisfaction. Results: Learning to trace the areas needed to compute the MTAi and derived methods is quick and easy. Results indicate very good intrarater Intraclass Correlation Coefficient (ICC) for the MTAi, good intrarater ICC for the 2D-MTA, yrMTA and yrRMTA and also good interrater ICC for the MTAi, 2D-MTA, yrMTA and yrRMTA. Conclusion: Our data support that MTAi and derived methods (2D-MTA, yrMTA and yrRTMA) have good to very good intrarater and interrater reproducibility and may be easily implemented in clinical practice even if new users have no experience tracing the area of regions of interest. PMID:25414666

  19. Paternalism and partial autonomy.

    PubMed Central

    O'Neill, O

    1984-01-01

    A contrast is often drawn between standard adult capacities for autonomy, which allow informed consent to be given or withheld, and patients' reduced capacities, which demand paternalistic treatment. But patients may not be radically different from the rest of us, in that all human capacities for autonomous action are limited. An adequate account of paternalism and the role that consent and respect for persons can play in medical and other practice has to be developed within an ethical theory that does not impose an idealised picture of unlimited autonomy but allows for the variable and partial character of actual human autonomy. PMID:6520849

  20. Situational Restriction of Elevation in Adduction Relieved by Faden on the Medial Rectus

    PubMed Central

    Muralidhar, R.; Vijayalakshmi, P.; Sujatha, K.; Shetty, Shashikanth; Malay, K.; Rosenberg, Steve

    2016-01-01

    We describe a patient with situational restriction of elevation in adduction in his left eye. Clinical examination pointed to instability of the left medial rectus pulley. This was corrected by Faden on the medial rectus. The importance of this relatively new concept in identifying and treating orbital pulley instability is discussed. PMID:27162460

  1. Left medial orbitofrontal cortex volume correlates with skydive-elicited euphoric experience.

    PubMed

    Carlson, Joshua M; Cha, Jiook; Fekete, Tomer; Greenberg, Tsafrir; Mujica-Parodi, Lilianne R

    2016-11-01

    The medial orbitofrontal cortex has been linked to the experience of positive affect. Greater medial orbitofrontal cortex volume is associated with greater expression of positive affect and reduced medial orbital frontal cortex volume is associated with blunted positive affect. However, little is known about the experience of euphoria, or extreme joy, and how this state may relate to variability in medial orbitofrontal cortex structure. To test the hypothesis that variability in euphoric experience correlates with the volume of the medial orbitofrontal cortex, we measured individuals' (N = 31) level of self-reported euphoria in response to a highly anticipated first time skydive and measured orbitofrontal cortical volumes with structural magnetic resonance imaging. Skydiving elicited a large increase in self-reported euphoria. Participants' euphoric experience was predicted by the volume of their left medial orbitofrontal cortex such that, the greater the volume, the greater the euphoria. Further analyses indicated that the left medial orbitofrontal cortex and amygdalo-hippocampal complex independently explain variability in euphoric experience and that medial orbitofrontal cortex volume, in conjunction with other structures within the mOFC-centered corticolimbic circuit, can be used to predict individuals' euphoric experience.

  2. Brief Report: Medial Temporal Lobe and Autism: A Putative Animal Model in Primates.

    ERIC Educational Resources Information Center

    Bachevalier, Jocelyne

    1996-01-01

    Research on humans and monkeys is reviewed that supports the view that the medial temporal lobe, and, perhaps more specifically the amygdala, is the neural substrate underlying social deficits in autism. The relationship of early medial temporal lobe lesions to memory and socioemotional behavior is reviewed, as are the roles of the amygdala and…

  3. Anterolateral Versus Medial Plating of Distal Extra-articular Tibia Fractures: A Biomechanical Model.

    PubMed

    Pirolo, Joseph M; Behn, Anthony W; Abrams, Geoffrey D; Bishop, Julius A

    2015-09-01

    Both medial and anterolateral plate applications have been described for the treatment of distal tibia fractures, each with distinct advantages and disadvantages. The objective of this study was to compare the biomechanical properties of medial and anterolateral plating constructs used to stabilize simulated varus and valgus fracture patterns of the distal tibia. In 16 synthetic tibia models, a 45° oblique cut was made to model an Orthopedic Trauma Association type 43-A1.2 distal tibia fracture in either a varus or valgus injury pattern. Each fracture was then reduced and plated with a precontoured medial or anterolateral distal tibia plate. The specimens were biomechanically tested in axial and torsional loading, cyclic axial loading, and load to failure. For the varus fracture pattern, medial plating showed less fracture site displacement and rotation and was stiffer in both axial and torsional loading (P<.05). For the valgus fracture pattern, there was no statistically significant difference between medial and anterolateral plating. There were no significant differences between the 2 constructs for either fracture pattern with respect to ultimate load, displacement, or energy absorption in load to failure testing. When used to stabilize varus fracture patterns, medial plates showed superior biomechanical performance compared with anterolateral plates. In this application, the medial plates functioned in anti-glide mode. For valgus fracture patterns, no biomechanical differences between anterolateral and medial plating were observed. In clinical practice, surgeons should take this biomechanical evidence into account when devising a treatment strategy for fixation of distal tibia fractures.

  4. Experts' Understanding of Partial Derivatives Using the Partial Derivative Machine

    ERIC Educational Resources Information Center

    Roundy, David; Weber, Eric; Dray, Tevian; Bajracharya, Rabindra R.; Dorko, Allison; Smith, Emily M.; Manogue, Corinne A.

    2015-01-01

    Partial derivatives are used in a variety of different ways within physics. Thermodynamics, in particular, uses partial derivatives in ways that students often find especially confusing. We are at the beginning of a study of the teaching of partial derivatives, with a goal of better aligning the teaching of multivariable calculus with the needs of…

  5. Experts' Understanding of Partial Derivatives Using the Partial Derivative Machine

    ERIC Educational Resources Information Center

    Roundy, David; Weber, Eric; Dray, Tevian; Bajracharya, Rabindra R.; Dorko, Allison; Smith, Emily M.; Manogue, Corinne A.

    2015-01-01

    Partial derivatives are used in a variety of different ways within physics. Thermodynamics, in particular, uses partial derivatives in ways that students often find especially confusing. We are at the beginning of a study of the teaching of partial derivatives, with a goal of better aligning the teaching of multivariable calculus with the needs of…

  6. Reverse Evans peroneus brevis medial ankle stabilization for balancing valgus ankle contracture during total ankle replacement.

    PubMed

    Roukis, Thomas S; Prissel, Mark A

    2014-01-01

    Medial ankle instability secondary to deltoid ligament insufficiency is frequently encountered when performing total ankle replacement and remains a challenge. In the present techniques report, we describe a "reverse" Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction for medial ankle stabilization harvested through limited incisions using simple topographic anatomic landmarks. The harvested peroneus brevis tendon is brought through a drill hole in the talus from laterally to medially, aiming for the junction of the talar neck and body plantar to the midline. The tendon is the brought superiorly and obliquely to the anterior medial aspect of the distal tibia where it is secured under a plate and screw construct. This modified Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction is useful in providing medial ankle stability during or after primary and revision total ankle replacement.

  7. Medial-point description of shape: a representation for action coding and its psychophysical correlates.

    PubMed

    Kovács, I; Fehér, A; Julesz, B

    1998-08-01

    We describe a region-based shape representation that might be particularly useful from a biological perspective because it promotes the localization of objects, and object parts relative to each other. The proposed medial-point representation is similar to medial-axis type representations, but it is more compact. The medial points are those points along the medial axis that are equidistant from the longest segments of the boundary, therefore they represent the largest amount of edge information. The main advantage is that the original image can be reduced to a small number of points. We also provide psychophysical correlates of the representation for shapes with increasing complexity. Using a reverse mapping technique, we find that variations of contrast sensitivity within figures are defined by the shape of the bounding contour, and the peaks in the sensitivity maps correspond to the medial points of the proposed representation.

  8. Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches

    PubMed Central

    Goel, Shivi; Kumar, Ashwani; Mehta, Vandana; Suri, Rajesh Kumar

    2014-01-01

    During routine dissection of the upper extremity of an adult male cadaver, multiple variations in branches of medial and lateral cords of brachial plexus were encountered. Three unique findings were observed. First, intercordal neural communications between the lateral and medial cords were observed. Second, two lateral pectoral nerves and one medial pectoral nerve were seen to arise from the lateral and medial cord respectively. The musculocutaneous nerve did not pierce the coracobrachialis. Finally, the ulnar nerve arose by two roots from the medial cord. Knowledge of such variations is of interest to anatomists, radiologists, neurologists, anesthesiologists, and surgeons. The aim of our study is to provide additional information about abnormal brachial plexus and its clinical implications. PMID:24693486

  9. Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee.

    PubMed

    Kurzweil, Peter R; Kelley, Steven T

    2006-06-01

    The medial side is one of the most commonly injured areas of the knee. The anatomy, diagnosis, and treatment of medial collateral ligament and posteromedial corner (PMC) injuries can be challenging. Understanding the mechanism of injury and performing a thorough physical examination and radiographic evaluation is essential. Frequently, there are concomitant meniscal and other ligament injuries associated with medial-side injuries. Correct identification of all injured structures is important, as missed diagnoses can lead to significant disability. Unrecognized PMC injuries have been implicated in anteromedial rotary instability and failed anterior cruciate ligament reconstructions. Valgus stress testing is the cornerstone for the identification of medial-side knee injuries. Coronal sequences from magnetic resonance imaging are the most useful tool to view the medial collateral ligament and posteromedial structures. Stress x-rays and ultrasound may also be helpful. Thorough physical examination and imaging of injuries to the PMC should dictate the appropriate treatment for optimal results.

  10. Unilateral removable partial dentures.

    PubMed

    Goodall, W A; Greer, A C; Martin, N

    2017-01-27

    Removable partial dentures (RPDs) are widely used to replace missing teeth in order to restore both function and aesthetics for the partially dentate patient. Conventional RPD design is frequently bilateral and consists of a major connector that bridges both sides of the arch. Some patients cannot and will not tolerate such an extensive appliance. For these patients, bridgework may not be a predictable option and it is not always possible to provide implant-retained restorations. This article presents unilateral RPDs as a potential treatment modality for such patients and explores indications and contraindications for their use, including factors relating to patient history, clinical presentation and patient wishes. Through case examples, design, material and fabrication considerations will be discussed. While their use is not widespread, there are a number of patients who benefit from the provision of unilateral RPDs. They are a useful treatment to have in the clinician's armamentarium, but a highly-skilled dental team and a specific patient presentation is required in order for them to be a reasonable and predictable prosthetic option.

  11. Is Titan Partially Differentiated?

    NASA Astrophysics Data System (ADS)

    Mitri, G.; Pappalardo, R. T.; Stevenson, D. J.

    2009-12-01

    The recent measurement of the gravity coefficients from the Radio Doppler data of the Cassini spacecraft has improved our knowledge of the interior structure of Titan (Rappaport et al. 2008 AGU, P21A-1343). The measured gravity field of Titan is dominated by near hydrostatic quadrupole components. We have used the measured gravitational coefficients, thermal models and the hydrostatic equilibrium theory to derive Titan's interior structure. The axial moment of inertia gives us an indication of the degree of the interior differentiation. The inferred axial moment of inertia, calculated using the quadrupole gravitational coefficients and the Radau-Darwin approximation, indicates that Titan is partially differentiated. If Titan is partially differentiated then the interior must avoid melting of the ice during its evolution. This suggests a relatively late formation of Titan to avoid the presence of short-lived radioisotopes (Al-26). This also suggests the onset of convection after accretion to efficiently remove the heat from the interior. The outer layer is likely composed mainly of water in solid phase. Thermal modeling indicates that water could be present also in liquid phase forming a subsurface ocean between an outer ice I shell and a high pressure ice layer. Acknowledgments: This work was conducted at the Jet Propulsion Laboratory, California Institute of Technology, under contract with the National Aeronautics and Space Administration.

  12. The medial septum acts through the medial preoptic area for thermoregulation and works with it for sleep regulation.

    PubMed

    Srividya, Rajagopalan; Mallick, Hruda Nanda; Kumar, Velayudhan Mohan

    2007-01-01

    The chronic changes in sleep-wakefulness (S-W), body temperature (Tb), locomotor activity (LMA) and thermal preference were studied in male Wistar rats after the destruction of neurons in both the medial preoptic area (mPOA) and the medial septum (MS) by intracerebral injection of N-methyl-D-aspartic acid. An increase in the Tb, and a preference for higher ambient temperature (Tamb) of 30 degrees C were observed after the combined lesion of the mPOA and the MS. Similar changes were reported to occur after the lesion that was restricted to the mPOA. But these alterations were in contrast to the decrease in Tb and preference for lower Tamb, observed after the MS lesion. The thermostat of the brain would have been reset at a higher level after the combined lesion, as there was an increase in Tb, along with a preference for a higher Tamb, and an increase in LMA. There was a reduction in the frequency and the duration of the slow wave sleep (SWS) episodes, and a reduction in the frequency of the paradoxical sleep (PS) episodes after the combined lesion. The destruction of the MS neurons was probably responsible for the reduction in the frequency of SWS, whereas the loss of mPOA neurons was responsible for the decrease in the duration of SWS and frequency of PS. It can be suggested that the MS exerts its influence on thermoregulation through the mPOA. However, the MS and the mPOA seem to play independent, but complementary roles in sleep promotion.

  13. Furnace brazing under partial vacuum

    NASA Technical Reports Server (NTRS)

    Mckown, R. D.

    1979-01-01

    Brazing furnace utilizing partial-vacuum technique reduces tooling requirements and produces better bond. Benefit in that partial vacuum helps to dissociate metal oxides that inhibit metal flow and eliminates heavy tooling required to hold parts together during brazing.

  14. Furnace brazing under partial vacuum

    NASA Technical Reports Server (NTRS)

    Mckown, R. D.

    1979-01-01

    Brazing furnace utilizing partial-vacuum technique reduces tooling requirements and produces better bond. Benefit in that partial vacuum helps to dissociate metal oxides that inhibit metal flow and eliminates heavy tooling required to hold parts together during brazing.

  15. Medial or medio-lateral graft tympanoplasty for repair of tympanic membrane perforation.

    PubMed

    Jung, Timothy; Kim, You Hyun; Kim, Yoon Hwan; Park, Seong Kook; Martin, Dusan

    2009-07-01

    To describe and evaluate the medio-lateral graft tympanoplasty(1) for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation and medial graft tympanoplasty for posterior TM perforation. Retrospective study of 200 patients who underwent medio-lateral graft tympanoplasty (100 cases) and medial graft tympanoplasty (100 cases) at community and tertiary care medical centers from 1995 to 2006. All patients underwent preoperative and postoperative audiograms. In the medial graft tympanoplasty, the graft is placed entirely medial to the remaining TM and malleus. First, margin of TM perforation is denuded removing ring of squamous tissue. Tympanomeatal flap is elevated. Temporalis fascia is harvested, semidried, and grafted medial to the TM perforation and malleus with Gelfoam packing supporting the graft. In the medio-lateral graft technique, posterior tympanomeatal flap is elevated same as in the medial graft tympanoplasty first. Anterior-medial canal skin is elevated down to the annulus. At the annulus only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial to posterior half of the perforation and lateral to anterior half of the de-epithelialized TM perforation up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second layer closure. Patients were followed for at least six months. Outcome was considered successful if TM is healed and intact. There were four failures (96% success rate) in medial graft method for posterior TM perforation due to infection and re-perforation. In the medio-lateral graft tympanoplasty, there were three failures (97% success rate) due to a postoperative infection, anterior blunting and recurrent cholesteatoma. The medial graft tympanoplasty works well for posterior TM perforation. The medio-lateral graft method is an excellent method for the reconstruction of large anterior or subtotal TM perforation

  16. Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty.

    PubMed

    Thienpont, Emmanuel

    2013-10-01

    To identify whether less proximal muscle damage during minimally invasive surgery will allow faster recovery after total knee arthroplasty in comparison with a quadriceps incision approach. A limited medial parapatellar approach without tibial medial collateral ligament (MCL) release was compared to a subvastus approach without tibial medial collateral ligament release (far medial subvastus). One hundred and eighty patients were studied. In the mini-parapatellar group, ninety patients and in the far medial subvastus group, the remaining ninety patients were included. The evaluation was based on the Knee Society Score, VAS, morphine consumption, range of motion, time to straight leg raising, walking without aid, stairs and period of hospitalization. Alignment on full leg radiographs and component position on plain films were measured. The far medial subvastus group showed faster recovery with earlier straight leg raising (1.7 ± 0.5 vs. 2.7 ± 0.4 days), postoperative weight bearing without aid (1.7 ± 0.6 vs. 2 ± 0.8 days) and stair negotiation (3 ± 0.4 vs. 4 ± 0.3 days) resulting in shorter length of stay (4 ± 0.5 vs. 5 ± 1.2 days). Comparable Knee Society Scores (88.5 ± 6.8 vs. 90 ± 10), Function Scores (90 ± 10) and alignment (5.4° ± 2.1° vs. 5.0° ± 2.4°) between the medial parapatellar and far medial subvastus group were observed at a follow-up of 24 months. An increase in operative time for the far medial subvastus was observed (55 ± 10.6 min vs. 67 ± 12 min tourniquet time) but without complications. The MCL sparing far medial subvastus approach allows good surgical exposure, faster straight leg raising, full weight bearing without aid and shorter length of stay with most importantly no radiological malalignment. Therapeutic study, Level II.

  17. Carotid extra-medial thickness in childhood: early life effects on the arterial adventitia.

    PubMed

    Skilton, Michael R; Sullivan, Tim R; Ayer, Julian G; Harmer, Jason A; Toelle, Brett G; Webb, Karen; Marks, Guy B; Celermajer, David S

    2012-06-01

    Structural modification of the arterial adventitia may be an early event in atherosclerosis. Carotid extra-medial thickness is a new measure of arterial adventitial thickness. We examined the association of cardiovascular risk factors with extra-medial thickness, in childhood. Carotid extra-medial thickness was assessed by high-resolution ultrasound in 389 non-diabetic children aged 8-years. A non-fasting blood sample was collected from 314 participants. Associations of gender, age, lipoproteins, blood pressure, BMI z-score, waist:height ratio and parental history of early vascular disease, with extra-medial thickness were examined. Carotid extra-medial thickness was lower in girls (r=-.163, P=.001) and directly associated with systolic (r=.128, P=.009), diastolic blood pressure (r=.130, P=.009), and height (r=.170, P=.0006). These associations remained after adjustment for carotid intima-media thickness. In multivariable analysis including carotid intima-media thickness, only gender and height were significantly associated with carotid extra-medial thickness. In gender-stratified analysis, the strongest associations with extra-medial thickness were BMI z-score (r=.181, P=.01), height (r=.210, P=.003) and diastolic blood pressure (r=.167, P=.02) for boys; and systolic blood pressure (r=.153, P=.03) and parental history of premature cardiovascular disease (r=.139, P=.05) for girls. The association of BMI z-score with extra-medial thickness differed by gender (P-interaction=.04). Carotid extra-medial thickness is independently associated with gender and height in childhood. Extra-medial thickness may provide important information concerning early arterial health, particularly related to the arterial adventitia. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Connections of the medial telencephalic wall in the spotted African Lungfish.

    PubMed

    Northcutt, R Glenn; Westhoff, Guido

    2011-01-01

    The extent and boundaries of the roof, or pallium, of the telencephalon in lungfishes have been debated for over 30 years, and two hypotheses exist. Proponents of a restricted pallium claim that the medial border of the pallium occurs in a dorsal position and that the entire medial hemispheric wall is formed by the septal nuclei. Proponents of an extended pallium claim that the medial border of the pallium occurs in a more ventral position and that the medial hemispheric wall is divided into a dorsal medial pallium and ventral septal nuclei, as in amphibians. Immunohistochemical data have generally been interpreted to support the hypothesis of an extended pallium, but disagreement still exists. To clarify the extent of the pallium in lungfishes, the connections of the dorsal and ventral divisions of the medial hemispheric wall in the Spotted African Lungfish were examined using a number of neuronal tracers. In amphibians and other tetrapods, the afferent projections to the medial pallium and the septal nuclei differ extensively, as do the commissural routes taken by decussating interhemispheric connections. Although the descending projections of the medial pallium and septal nuclei are very similar to one another in amphibians and other tetrapods, they do differ in that the septal nuclei and the ventral thalamus are extensively interlinked, whereas the medial pallium lacks such connections. These differences also characterize the connections of the dorsal and ventral divisions of the medial hemispheric wall in the Spotted African Lungfish, which supports the hypothesis of an extended pallium. The telencephalic organization in lungfishes thus appears remarkably similar to that in amphibians and reflects a pattern that almost certainly existed in the last common ancestor of lungfishes and tetrapods. Copyright © 2011 S. Karger AG, Basel.

  19. Transcaruncular Approach for Treatment of Medial Wall and Large Orbital Blowout Fractures

    PubMed Central

    Nguyen, Dennis C.; Shahzad, Farooq; Snyder-Warwick, Alison; Patel, Kamlesh B.; Woo, Albert S.

    2015-01-01

    We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular–transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular–transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular–transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm2; the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm2. Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular–transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest). PMID:26889348

  20. Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

    PubMed

    Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

    2014-10-01

    Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Close but no cigar: Spatial precision deficits following medial temporal lobe lesions provide novel insight into theoretical models of navigation and memory.

    PubMed

    Kolarik, Branden S; Baer, Trevor; Shahlaie, Kiarash; Yonelinas, Andrew P; Ekstrom, Arne D

    2017-09-09

    Increasing evidence suggests that the human hippocampus contributes to a range of different behaviors, including episodic memory, language, short-term memory, and navigation. A novel theoretical framework, the Precision and Binding Model, accounts for these phenomenon by describing a role for the hippocampus in high-resolution, complex binding. Other theories like Cognitive Map Theory, in contrast, predict a specific role for the hippocampus in allocentric navigation, while Declarative Memory Theory predicts a specific role in delay-dependent conscious memory. Navigation provides a unique venue for testing these predictions, with past results from research with humans providing inconsistent findings regarding the role of the human hippocampus in spatial navigation. Here, we tested five patients with lesions primarily restricted to the hippocampus and those extending out into the surrounding medial temporal lobe cortex on a virtual water maze task. Consistent with the Precision and Binding Model, we found partially intact allocentric memory in all patients, with impairments in the spatial precision of their searches for a hidden target. We found similar impairments at both immediate and delayed testing. Our findings are consistent with the Precision and Binding Model of hippocampal function, arguing for its role across domains in high-resolution, complex binding. Remembering goal locations in one's environment is a critical skill for survival. How this information is represented in the brain is still not fully understood, but is believed to rely in some capacity on structures in the medial temporal lobe. Contradictory findings from studies of both humans and animals have been difficult to reconcile with regard to the role of the MTL, specifically the hippocampus. By assessing impairments observed during navigation to a goal in patients with medial temporal lobe damage we can better understand the role these structures play in such behavior. Utilizing virtual reality

  2. Partially segmented deformable mirror

    DOEpatents

    Bliss, E.S.; Smith, J.R.; Salmon, J.T.; Monjes, J.A.

    1991-05-21

    A partially segmented deformable mirror is formed with a mirror plate having a smooth and continuous front surface and a plurality of actuators to its back surface. The back surface is divided into triangular areas which are mutually separated by grooves. The grooves are deep enough to make the plate deformable and the actuators for displacing the mirror plate in the direction normal to its surface are inserted in the grooves at the vertices of the triangular areas. Each actuator includes a transducer supported by a receptacle with outer shells having outer surfaces. The vertices have inner walls which are approximately perpendicular to the mirror surface and make planar contacts with the outer surfaces of the outer shells. The adhesive which is used on these contact surfaces tends to contract when it dries but the outer shells can bend and serve to minimize the tendency of the mirror to warp. 5 figures.

  3. Partially segmented deformable mirror

    DOEpatents

    Bliss, Erlan S.; Smith, James R.; Salmon, J. Thaddeus; Monjes, Julio A.

    1991-01-01

    A partially segmented deformable mirror is formed with a mirror plate having a smooth and continuous front surface and a plurality of actuators to its back surface. The back surface is divided into triangular areas which are mutually separated by grooves. The grooves are deep enough to make the plate deformable and the actuators for displacing the mirror plate in the direction normal to its surface are inserted in the grooves at the vertices of the triangular areas. Each actuator includes a transducer supported by a receptacle with outer shells having outer surfaces. The vertices have inner walls which are approximately perpendicular to the mirror surface and make planar contacts with the outer surfaces of the outer shells. The adhesive which is used on these contact surfaces tends to contract when it dries but the outer shells can bend and serve to minimize the tendency of the mirror to warp.

  4. Partial oxidation catalyst

    DOEpatents

    Krumpelt, Michael; Ahmed, Shabbir; Kumar, Romesh; Doshi, Rajiv

    2000-01-01

    A two-part catalyst comprising a dehydrogenation portion and an oxide-ion conducting portion. The dehydrogenation portion is a group VIII metal and the oxide-ion conducting portion is selected from a ceramic oxide crystallizing in the fluorite or perovskite structure. There is also disclosed a method of forming a hydrogen rich gas from a source of hydrocarbon fuel in which the hydrocarbon fuel contacts a two-part catalyst comprising a dehydrogenation portion and an oxide-ion conducting portion at a temperature not less than about 400.degree. C. for a time sufficient to generate the hydrogen rich gas while maintaining CO content less than about 5 volume percent. There is also disclosed a method of forming partially oxidized hydrocarbons from ethanes in which ethane gas contacts a two-part catalyst comprising a dehydrogenation portion and an oxide-ion conducting portion for a time and at a temperature sufficient to form an oxide.

  5. Severe pes planovalgus successfully treated in a patient with mutilating rheumatoid arthritis using a new surgical approach involving medial malleolar resection and medial displacement of the talus: A case report.

    PubMed

    Matsumoto, Takumi; Nakamura, Ichiro; Juji, Takuo; Ito, Katsumi

    2015-05-28

    We report the case of a 56-year-old female with mutilating rheumatoid arthritis, who developed severe pes planovalgus. The foot was successfully reconstructed through a combination of osteotomies, including medial displacement of the talus accompanied by resection of the medial malleolus. This maneuver enabled a ∼1-cm medial displacement of the hindfoot while minimizing the adverse effect on forefoot rotation.

  6. Does medial tenderness predict deep deltoid ligament incompetence in supination-external rotation type ankle fractures?

    PubMed

    DeAngelis, Nicola A; Eskander, Mark S; French, Bruce G

    2007-04-01

    To identify whether medial tenderness is a predictor of deep deltoid ligament incompetence in supination-external rotation ankle fractures. All Weber B lateral malleolar fractures with normal medial clear space over a 9 month period were prospectively included in the study. Fracture patterns not consistent with a supination-external rotation mechanism were excluded. High-volume tertiary care referral center and Level I trauma center. Fifty-five skeletally mature patients with a Weber B lateral malleolar fracture and normal medial clear space presenting to our institution were included. All study patients had ankle anteroposterior, lateral, and mortise radiographs. Each patient was seen and evaluated by an orthopedic specialist and the mechanism of injury was recorded. Each patient was assessed for tenderness to palpation in the region of the deltoid ligament and then had an external rotation stress mortise radiograph. Correlating medial tenderness with deep deltoid competence as measured by stress radiographs. Thirteen patients (23.6%) were tender medially and had a positive external rotation stress radiograph. Thirteen patients (23.6%) were tender medially and had a negative external rotation stress radiograph. Nineteen patients (34.5%) were nontender medially and had a negative external rotation stress radiograph. Ten patients (18.2%) were nontender medially and had a positive external rotation stress radiograph. We calculated a chi statistic of 2.37 as well as the associated P value of 0.12. Medial tenderness as a measure of deep deltoid ligament incompetence had a sensitivity of 57%, a specificity of 59%, a positive predictive value of 50%, a negative predictive value of 66%, and an accuracy of 42%. There was no statistical significance between the presence of medial tenderness and deep deltoid ligament incompetence. There is a 25% chance of the fracture in question with medial tenderness having a positive external rotation stress and a 25% chance the fracture

  7. Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer.

    PubMed

    Poortmans, Philip M; Collette, Sandra; Kirkove, Carine; Van Limbergen, Erik; Budach, Volker; Struikmans, Henk; Collette, Laurence; Fourquet, Alain; Maingon, Philippe; Valli, Mariacarla; De Winter, Karin; Marnitz, Simone; Barillot, Isabelle; Scandolaro, Luciano; Vonk, Ernest; Rodenhuis, Carla; Marsiglia, Hugo; Weidner, Nicola; van Tienhoven, Geertjan; Glanzmann, Christoph; Kuten, Abraham; Arriagada, Rodrigo; Bartelink, Harry; Van den Bogaert, Walter

    2015-07-23

    The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracic-wall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median follow-up of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal

  8. The Medial Orbitofrontal Cortex Regulates Sensitivity to Outcome Value

    PubMed Central

    Zimmermann, Kelsey S.; Allen, Amanda G.; Taylor, Jane R.

    2016-01-01

    An essential component of goal-directed decision-making is the ability to maintain flexible responding based on the value of a given reward, or “reinforcer.” The medial orbitofrontal cortex (mOFC), a subregion of the ventromedial prefrontal cortex, is uniquely positioned to regulate this process. We trained mice to nose poke for food reinforcers and then stimulated this region using CaMKII-driven Gs-coupled designer receptors exclusively activated by designer drugs (DREADDs). In other mice, we silenced the neuroplasticity-associated neurotrophin brain-derived neurotrophic factor (BDNF). Activation of Gs-DREADDs increased behavioral sensitivity to reinforcer devaluation, whereas Bdnf knockdown blocked sensitivity. These changes were accompanied by modifications in breakpoint ratios in a progressive ratio task, and they were recapitulated in Bdnf+/− mice. Replacement of BDNF selectively in the mOFC in Bdnf+/− mice rescued behavioral deficiencies, as well as phosphorylation of extracellular-signal regulated kinase 1/2 (ERK1/2). Thus, BDNF expression in the mOFC is both necessary and sufficient for the expression of typical effort allocation relative to an anticipated reinforcer. Additional experiments indicated that expression of the immediate-early gene c-fos was aberrantly elevated in the Bdnf+/− dorsal striatum, and BDNF replacement in the mOFC normalized expression. Also, systemic administration of an MAP kinase kinase inhibitor increased breakpoint ratios, whereas the addition of discrete cues bridging the response–outcome contingency rescued breakpoints in Bdnf+/− mice. We argue that BDNF–ERK1/2 in the mOFC is a key regulator of “online” goal-directed action selection. SIGNIFICANCE STATEMENT Goal-directed response selection often involves predicting the consequences of one's actions and the value of potential payoffs. Lesions or chemogenetic inactivation of the medial orbitofrontal cortex (mOFC) in rats induces failures in retrieving outcome

  9. Effects of different medial arch support heights on rearfoot kinematics

    PubMed Central

    Mayer, Frank; Baur, Heiner

    2017-01-01

    Background Foot orthoses are usually assumed to be effective by optimizing mechanically dynamic rearfoot configuration. However, the effect from a foot orthosis on kinematics that has been demonstrated scientifically has only been marginal. The aim of this study was to examine the effect of different heights in medial arch-supported foot orthoses on rear foot motion during gait. Methods Nineteen asymptomatic runners (36±11years, 180±5cm, 79±10kg; 41±22km/week) participated in the study. Trials were recorded at 3.1 mph (5 km/h) on a treadmill. Athletes walked barefoot and with 4 different not customized medial arch-supported foot orthoses of various arch heights (N:0 mm, M:30 mm, H:35 mm, E:40mm). Six infrared cameras and the `Oxford Foot Model´ were used to capture motion. The average stride in each condition was calculated from 50 gait cycles per condition. Eversion excursion and internal tibia rotation were analyzed. Descriptive statistics included calculating the mean ± SD and 95% CIs. Group differences by condition were analyzed by one factor (foot orthoses) repeated measures ANOVA (α = 0.05). Results Eversion excursion revealed the lowest values for N and highest for H (B:4.6°±2.2°; 95% CI [3.1;6.2]/N:4.0°±1.7°; [2.9;5.2]/M:5.2°±2.6°; [3.6;6.8]/H:6.2°±3.3°; [4.0;8.5]/E:5.1°±3.5°; [2.8;7.5]) (p>0.05). Range of internal tibia rotation was lowest with orthosis H and highest with E (B:13.3°±3.2°; 95% CI [11.0;15.6]/N:14.5°±7.2°; [9.2;19.6]/M:13.8°±5.0°; [10.8;16.8]/H:12.3°±4.3°; [9.0;15.6]/E:14.9°±5.0°; [11.5;18.3]) (p>0.05). Differences between conditions were small and the intrasubject variation high. Conclusion Our results indicate that different arch support heights have no systematic effect on eversion excursion or the range of internal tibia rotation and therefore might not exert a crucial influence on rear foot alignment during gait. PMID:28257426

  10. Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients.

    PubMed

    Streit, Marcus R; Streit, Julia; Walker, Tilman; Bruckner, Thomas; Philippe Kretzer, J; Ewerbeck, Volker; Merle, Christian; Aldinger, Peter R; Gotterbarm, Tobias

    2017-03-01

    Advanced knee arthritis in young patients is a challenging problem that may necessitate surgical treatment. There are few published studies of mobile-bearing unicompartmental knee arthroplasty (UKA) in young patients, while indications have expanded to its use in this demanding patient group. The clinical and radiographic results of the first 118 consecutive Oxford medial UKAs (OUKA) using a minimally invasive technique (phase 3) in 101 patients 60 years of age or younger at the time of surgery were evaluated. Median age at surgery was 57 (25-60) years. Kaplan-Meier survivorship analysis was used to estimate implant survival. Mean time of follow-up evaluation was five (SD 1.6) years. At final follow-up, three patients (three knees) had died, and two patients (three knees) were lost to follow-up. Five knees were revised: three for unexplained pain, one for early infection and one for bearing fracture. There was one impending revision for progression of osteoarthritis in the lateral compartment. The radiographic review demonstrated that 5 % of the knees had progressive arthritis in the lateral knee compartment, of those 2 % with full joint space loss and pain. The Kaplan-Meier survival analysis, using revision for any reason as the endpoint, estimated the five-year survival rate at 97 % (95 % CI 91-99). Ninety-six per cent of the non-revised patients were satisfied with the outcome, and 4 % were dissatisfied. The mean Oxford knee score was 41 (SD 7), with 6 % of the knees having a poor result. The mean AKSS was 89 (SD 14), mean flexion was 129° (SD 13) and the mean UCLA score was 6.8 (SD 1.5). Minimally invasive Oxford medial UKA was reliable and effective in this young and active patient cohort providing high patient satisfaction at mid-term follow-up. Progressive arthritis in the lateral knee compartment was a relevant failure mode in this age group. Most revisions were performed for unexplained pain, while we did not find loosening or wear in any patient

  11. Location and tension of the medial palpebral ligament.

    PubMed

    Hwang, Kun; Huan, Fan; Nam, Yong Seok; Han, Seung Ho; Kim, Dae Joong

    2013-11-01

    The aim of this study was to elucidate the precise anatomic location and tension of the medial palpebral ligament (MPL). Eleven hemifaces of 10 fresh Korean adult cadavers were used in this study. Nine specimens were used for measurement of dissection and tension, and 2 were used for histologic study. Measurements of tensile strength of each part of the MPL and Horner muscle were performed using a force gauge.The MPL consisted of 2 layers in all specimens dissected. The superficial layer of the palpebral ligament (SMPL) was observed from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. The Horner muscle was observed at the posterior lacrimal crest just lateral to the attachment of the DMPL and ran laterally to the tarsal plate deep to the SMPL. The SMPL began at 4.5 ± 2.3 mm lateral to the nasomaxillary suture line to the upper and lower tarsal plates. Its transverse length was 9.6 ± 1.5 mm, and vertical width was 2.4 ± 0.7 mm, and its thickness was 4.5 ± 2.3 mm. The transverse length of the DMPL was 3.7 ± 0.4 mm, and its vertical width was 2.9 ± 1.3 mm, with a thickness of 0.3 ± 0.1 mm. The transverse length of the Horner muscle was 7.6 ± 1.9 mm, and its vertical width was 4.06 ± 1.5 mm, with a thickness of 0.4 ± 0.1 mm. The tensile strength of the SMPL was 13.4 ± 3.2 N, that of the DMPL was 4.1 ± 1.7 N, and that for Horner muscle was 9.0 ± 3.1 N. The tensile strength of the SMPL was significantly higher than that of the DMPL (P = 0.003).We reconfirmed that the MPL consisted of 2 layers: superficial layer and deep layer. Our results might be of use in surgeries of the medial canthi.

  12. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.

    PubMed

    Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi

    2016-02-01

    Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy

  13. Cocaine-induced increases in medial prefrontal cortical GABA transmission involves glutamatergic receptors.

    PubMed

    Jayaram, Prathiba; Steketee, Jeffery D

    2006-02-15

    A recent study showed that cocaine-induced sensitization is associated with an increase in GABA (gamma-aminobutyric acid) transmission in the medial prefrontal cortex. Since previous studies have demonstrated that sensitization is associated with enhanced medial prefrontal cortex glutamatergic transmission, the present study examined the role of N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid/kainate (AMPA/KA) receptors in cocaine-induced increases in medial prefrontal cortex GABA levels. Male Sprague-Dawley rats received four daily injections of saline (1 ml/kg, i.p.) or cocaine (15 mg/kg). One day later, animals were infused with NMDA or AMPA/KA antagonists 3-[(R)-2 carboxypiperazin-4-yl]-propyl-1-phosphonic acid (CPP) and 6,7-dinitroquinoxaline-2,3-dione (DNQX), respectively, into medial prefrontal cortex via microdialysis probe for 60 min before receiving systemic challenge injections of saline or cocaine. Cocaine-sensitized animals showed an increase in extracellular medial prefrontal cortex GABA levels that was blocked by prior medial prefrontal cortex infusion of DNQX, but not CPP. These data indicate that enhanced medial prefrontal cortex GABA transmission seen in cocaine-sensitized animals involves glutamatergic stimulation of AMPA receptors.

  14. The effects of thermal capsulorrhaphy of medial parapatellar capsule on patellar lateral displacement

    PubMed Central

    Zheng, Naiquan; Davis, Brent R; Andrews, James R

    2008-01-01

    Background The effectiveness of thermal shrinkage on the medial parapatellar capsule for treating recurrent patellar dislocation is controversial. One of reasons why it is still controversial is that the effectiveness is still qualitatively measured. The purpose of this study was to quantitatively determine the immediate effectiveness of the medial parapatellar capsule shrinkage as in clinical setting. Methods Nine cadaveric knees were used to collect lateral displacement data before and after medial shrinkage or open surgery. The force and displacement were recorded while a physician pressed the patella from the medial side to mimic the physical exam used in clinic. Ten healthy subjects were used to test the feasibility of the technique on patients and establish normal range of lateral displacement of the patella under a medial force. The force applied, the resulting displacement and the ratio of force over displacement were compared among four data groups (normal knees, cadaveric knees before medial shrinkage, after shrinkage and after open surgery). Results Displacements of the cadaveric knees both before and after thermal modification were similar to normal subjects, and the applied forces were significantly higher. No significant differences were found between before and after thermal modification groups. After open surgery, displacements were reduced significantly while applied forces were significantly higher. Conclusion No immediate difference was found after thermal shrinkage of the medial parapatellar capsule. Open surgery immediately improved of the lateral stiffness of the knee capsule. PMID:18826583

  15. Glutamate co-transmission from developing medial nucleus of the trapezoid body--lateral superior olive synapses is cochlear dependent in kanamycin-treated rats.

    PubMed

    Lee, Jae Ho; Pradhan, Jonu; Maskey, Dhiraj; Park, Ki Sup; Hong, Sung Hwa; Suh, Myung-Whan; Kim, Myeung Ju; Ahn, Seung Cheol

    2011-02-11

    Cochlear dependency of glutamate co-transmission at the medial nucleus of the trapezoid body (MNTB)--the lateral superior olive (LSO) synapses was investigated using developing rats treated with high dose kanamycin. Rats were treated with kanamycin from postnatal day (P) 3 to P8. A scanning electron microscopic study on P9 demonstrated partial cochlear hair cell damage. A whole cell voltage clamp experiment demonstrated the increased glutamatergic portion of postsynaptic currents (PSCs) elicited by MNTB stimulation in P9-P11 kanamycin-treated rats. The enhanced VGLUT3 immunoreactivities (IRs) in kanamycin-treated rats and asymmetric VGLUT3 IRs in the LSO of unilaterally cochlear ablated rats supported the electrophysiologic data. Taken together, it is concluded that glutamate co-transmission is cochlear-dependent and enhanced glutamate co-transmission in kanamycin-treated rats is induced by partial cochlear damage.

  16. The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial

    PubMed Central

    Chapman, Graham J.; Parkes, Matthew J.; Forsythe, Laura.; Felson, David T.

    2015-01-01

    ABSTRACT Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three‐dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1646–1654, 2015. PMID:25991385

  17. The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial.

    PubMed

    Jones, Richard K; Chapman, Graham J; Parkes, Matthew J; Forsythe, Laura; Felson, David T

    2015-11-01

    Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three-dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading.

  18. Decoding Representations of Scenes in the Medial Temporal Lobes

    PubMed Central

    Bonnici, Heidi M; Kumaran, Dharshan; Chadwick, Martin J; Weiskopf, Nikolaus; Hassabis, Demis; Maguire, Eleanor A

    2012-01-01

    Recent theoretical perspectives have suggested that the function of the human hippocampus, like its rodent counterpart, may be best characterized in terms of its information processing capacities. In this study, we use a combination of high-resolution functional magnetic resonance imaging, multivariate pattern analysis, and a simple decision making task, to test specific hypotheses concerning the role of the medial temporal lobe (MTL) in scene processing. We observed that while information that enabled two highly similar scenes to be distinguished was widely distributed throughout the MTL, more distinct scene representations were present in the hippocampus, consistent with its role in performing pattern separation. As well as viewing the two similar scenes, during scanning participants also viewed morphed scenes that spanned a continuum between the original two scenes. We found that patterns of hippocampal activity during morph trials, even when perceptual inputs were held entirely constant (i.e., in 50% morph trials), showed a robust relationship with participants' choices in the decision task. Our findings provide evidence for a specific computational role for the hippocampus in sustaining detailed representations of complex scenes, and shed new light on how the information processing capacities of the hippocampus may influence the decision making process. © 2011 Wiley Periodicals, Inc. PMID:21656874

  19. Capsaicin augments synaptic transmission in the rat medial preoptic nucleus.

    PubMed

    Karlsson, Urban; Sundgren-Andersson, Anna K; Johansson, Staffan; Krupp, Johannes J

    2005-05-10

    The medial preoptic nucleus (MPN) is the major nucleus of the preoptic area (POA), a hypothalamic area involved in the regulation of body-temperature. Injection of capsaicin into this area causes hypothermia in vivo. Capsaicin also causes glutamate release from hypothalamic slices. However, no data are available on the effect of capsaicin on synaptic transmission within the MPN. Here, we have studied the effect of exogenously applied capsaicin on spontaneous synaptic activity in hypothalamic slices of the rat. Whole-cell patch-clamp recordings were made from visually identified neurons located in the MPN. In a subset of the studied neurons, capsaicin enhanced the frequency of spontaneous glutamatergic EPSCs. Remarkably, capsaicin also increased the frequency of GABAergic IPSCs, an effect that was sensitive to removal of extracellular calcium, but insensitive to tetrodotoxin. This suggests an action of capsaicin at presynaptic GABAergic terminals. In contrast to capsaicin, the TRPV4 agonist 4alpha-PDD did not affect GABAergic IPSCs. Our results show that capsaicin directly affects synaptic transmission in the MPN, likely through actions at presynaptic terminals as well as on projecting neurons. Our data add to the growing evidence that capsaicin receptors are not only expressed in primary afferent neurons, but also contribute to synaptic processing in some CNS regions.

  20. Intact implicit verbal relational memory in medial temporal lobe amnesia

    PubMed Central

    Verfaelllie, Mieke; LaRocque, Karen F.; Keane, Margaret M.

    2012-01-01

    To elucidate the role of the hippocampus in unaware relational memory, the present study examined the performance of amnesic patients with medial temporal lobe (MTL) lesions on a cued category-exemplar generation task. In contrast to a prior study in which amnesic patients showed impaired performance (Verfaellie et al., Cognitive, Affective, and Behavioral Neuroscience, 2006, 6, 91–101), the current study employed a task that required active processing of the context word at test. In this version of the task, amnesic patients, like control participants, showed enhanced category exemplar priming when the context word associated with the target at study was reinstated at test. The finding of intact implicit memory for novel associations following hippocampal lesions in a task that requires flexible use of retrieval cues is inconsistent with a relational memory view that suggests that the hippocampus is critical for all forms of relational memory, regardless of awareness. Instead, it suggests that unaware memory for within-domain associations does not require MTL mediation. PMID:22609574

  1. Intact implicit verbal relational memory in medial temporal lobe amnesia.

    PubMed

    Verfaelllie, Mieke; LaRocque, Karen F; Keane, Margaret M

    2012-07-01

    To elucidate the role of the hippocampus in unaware relational memory, the present study examined the performance of amnesic patients with medial temporal lobe (MTL) lesions on a cued category-exemplar generation task. In contrast to a prior study in which amnesic patients showed impaired performance (Verfaellie et al., Cognitive, Affective, and Behavioral Neuroscience, 2006, 6, 91-101), the current study employed a task that required active processing of the context word at test. In this version of the task, amnesic patients, like control participants, showed enhanced category exemplar priming when the context word associated with the target at study was reinstated at test. The finding of intact implicit memory for novel associations following hippocampal lesions in a task that requires flexible use of retrieval cues is inconsistent with a relational memory view that suggests that the hippocampus is critical for all forms of relational memory, regardless of awareness. Instead, it suggests that unaware memory for within-domain associations does not require MTL mediation. Published by Elsevier Ltd.

  2. Autobiographical memory, future imagining, and the medial temporal lobe.

    PubMed

    Dede, Adam J O; Wixted, John T; Hopkins, Ramona O; Squire, Larry R

    2016-11-22

    In two experiments, patients with damage to the medial temporal lobe (MTL) and healthy controls produced detailed autobiographical narratives as they remembered past events (recent and remote) and imagined future events (near and distant). All recent events occurred after the onset of memory impairment. The first experiment aimed to replicate the methods of Race et al. [Race E, Keane MM, Verfaellie M (2011) J Neurosci 31(28):10262-10269]. Transcripts from that study were kindly made available for independent analysis, which largely reproduced the findings from that study. Our patients produced marginally fewer episodic details than controls. Patients from the earlier study were more impaired than our patients. Patients in both groups had difficulty in returning to their narratives after going on tangents, suggesting that anterograde memory impairment may have interfered with narrative construction. In experiment 2, the experimenter used supportive questioning to help keep participants on task and reduce the burden on anterograde memory. This procedure increased the number of details produced by all participants and rescued the performance of our patients for the distant past. Neither of the two patient groups had any special difficulty in producing spatial details. The findings suggest that constructing narratives about the remote past and the future does not depend on MTL structures, except to the extent that anterograde amnesia affects performance. The results further suggest that different findings about the status of autobiographical memory likely depend on differences in the location and extent of brain damage in different patient groups.

  3. Map reading, navigating from maps, and the medial temporal lobe.

    PubMed

    Urgolites, Zhisen J; Kim, Soyun; Hopkins, Ramona O; Squire, Larry R

    2016-12-13

    We administered map-reading tasks in which participants navigated an array of marks on the floor by following paths on hand-held maps that made up to nine turns. The burden on memory was minimal because the map was always available. Nevertheless, because the map was held in a fixed position in relation to the body, spatial computations were continually needed to transform map coordinates into geographical coordinates as participants followed the maps. Patients with lesions limited to the hippocampus (n = 5) performed similar to controls at all path lengths (experiment 1). They were also intact at executing single moves to an adjacent location, even when trials began by facing in a direction that put the map coordinates and geographical coordinates into conflict (experiment 2). By contrast, one patient with large medial temporal lobe (MTL) lesions performed poorly overall in experiment 1 and poorly in experiment 2 when trials began by facing in the direction that placed the map coordinates and geographical coordinates in maximal conflict. Directly after testing, all patients were impaired at remembering factual details about the task. The findings suggest that the hippocampus is not needed to carry out the spatial computations needed for map reading and navigating from maps. The impairment in map reading associated with large MTL lesions may depend on damage in or near the parahippocampal cortex.

  4. Single-cell recordings in the human medial temporal lobe

    PubMed Central

    Rey, Hernan G; Ison, Matias J; Pedreira, Carlos; Valentin, Antonio; Alarcon, Gonzalo; Selway, Richard; Richardson, Mark P; Quian Quiroga, Rodrigo

    2015-01-01

    Recordings from individual neurons in patients who are implanted with depth electrodes for clinical reasons have opened the possibility to narrow down the gap between neurophysiological studies in animals and non-invasive (e.g. functional magnetic resonance imaging, electroencephalogram, magnetoencephalography) investigations in humans. Here we provide a description of the main procedures for electrode implantation and recordings, the experimental paradigms used and the main steps for processing the data. We also present key characteristics of the so-called ‘concept cells’, neurons in the human medial temporal lobe with selective and invariant responses that represent the meaning of the stimulus, and discuss their proposed role in declarative memory. Finally, we present novel results dealing with the stability of the representation given by these neurons, by studying the effect of stimulus repetition in the strength of the responses. In particular, we show that, after an initial decay, the response strength reaches an asymptotic value after approximately 15 presentations that remains above baseline for the whole duration of the experiment. PMID:25163775

  5. Anterior medial prefrontal cortex implements social priming of mimicry

    PubMed Central

    Hamilton, Antonia F. de C.

    2015-01-01

    The neural and cognitive mechanisms by which primed constructs can impact on social behavior are poorly understood. In the present study, we used functional magnetic resonance imaging (fMRI) to explore how scrambled sentence priming can impact on mimicry behavior. Sentences involving pro/antisocial events from a first/third-person point of view were presented in short blocks, followed by a reaction-time assessment of mimicry. Behavioral results showed that both prosociality and viewpoint impact on mimicry, and fMRI analysis showed this effect is implemented by anterior medial prefrontal cortex (amPFC). We suggest that social primes may subtly modulate processing in amPFC in a manner linked to the later behavior, and that this same region also implements the top-down control of mimicry responses. This priming may be linked to processing of self-schemas in amPFC. Our findings demonstrate how social priming can be studied with fMRI, and have important implications for our understanding of the underlying mechanisms of prime-to-behavior effects as well as for current theories in social psychology. PMID:25009194

  6. Medial Temporal Lobe Roles in Human Path Integration

    PubMed Central

    Yamamoto, Naohide; Philbeck, John W.; Woods, Adam J.; Gajewski, Daniel A.; Arthur, Joeanna C.; Potolicchio, Samuel J.; Levy, Lucien; Caputy, Anthony J.

    2014-01-01

    Path integration is a process in which observers derive their location by integrating self-motion signals along their locomotion trajectory. Although the medial temporal lobe (MTL) is thought to take part in path integration, the scope of its role for path integration remains unclear. To address this issue, we administered a variety of tasks involving path integration and other related processes to a group of neurosurgical patients whose MTL was unilaterally resected as therapy for epilepsy. These patients were unimpaired relative to neurologically intact controls in many tasks that required integration of various kinds of sensory self-motion information. However, the same patients (especially those who had lesions in the right hemisphere) walked farther than the controls when attempting to walk without vision to a previewed target. Importantly, this task was unique in our test battery in that it allowed participants to form a mental representation of the target location and anticipate their upcoming walking trajectory before they began moving. Thus, these results put forth a new idea that the role of MTL structures for human path integration may stem from their participation in predicting the consequences of one's locomotor actions. The strengths of this new theoretical viewpoint are discussed. PMID:24802000

  7. Medial Prefrontal Cortex Reduces Memory Interference by Modifying Hippocampal Encoding.

    PubMed

    Guise, Kevin G; Shapiro, Matthew L

    2017-04-05

    The prefrontal cortex (PFC) is crucial for accurate memory performance when prior knowledge interferes with new learning, but the mechanisms that minimize proactive interference are unknown. To investigate these, we assessed the influence of medial PFC (mPFC) activity on spatial learning and hippocampal coding in a plus maze task that requires both structures. mPFC inactivation did not impair spatial learning or retrieval per se, but impaired the ability to follow changing spatial rules. mPFC and CA1 ensembles recorded simultaneously predicted goal choices and tracked changing rules; inactivating mPFC attenuated CA1 prospective coding. mPFC activity modified CA1 codes during learning, which in turn predicted how quickly rats adapted to subsequent rule changes. The results suggest that task rules signaled by the mPFC become incorporated into hippocampal representations and support prospective coding. By this mechanism, mPFC activity prevents interference by "teaching" the hippocampus to retrieve distinct representations of similar circumstances.

  8. Behavioral control, the medial prefrontal cortex, and resilience

    PubMed Central

    Maier, Steven F.; Amat, Jose; Baratta, Michael V.; Paul, Evan; Watkins, Linda R.

    2006-01-01

    The degree of control that an organism has over a stressor potently modulates the impact of the stressor, with uncontrollable stressors producing a constellation of outcomes that do not occur if the stressor is behaviorally controllable. It has generally been assumed that this occurs because uncontrollability actively potentiates the effects of stressors. Here it will be suggested that in addition, or instead, the presence of control actively inhibits the impact of stressors. At least in part this occurs because (i) the presence of control is detected by regions of the ventral medial prefrontal cortex (mPFCv); and (ii) detection of control activates mPFCv output to stress-responsive brain stem and limbic structures that actively inhibit stress-induced activation of these structures, Furthermore, an initial experience with control over stress alters the mPFCv response to subsequent stressors so that mPFCv output is activated even if the subsequent stressor is uncontrollable, thereby making the organism resilient. The general implications of these results for understanding resilience in the face of adversity are discussed. PMID:17290798

  9. The role of the medial prefrontal cortex in social categorization

    PubMed Central

    Morrison, Samantha

    2014-01-01

    Group membership is an important aspect of our everyday behavior. Recently, we showed that existing relevant in-group labels increased activation in the medial prefrontal cortex (MPFC) compared with out-group labels, suggesting a role of the MPFC in social categorization. However, the question still remains whether this increase in MPFC activation for in-group representation is solely related with previous experience with the in-group. To test this, we randomly assigned participants to a red or blue team and in a subsequent functional magnetic resonance imaging experiment they categorized red and blue team words as belonging to either the in-group or the out-group. Results showed that even under these minimal conditions increased activation was found in the MPFC when participants indicated that they belonged to a group, as compared with when they did not. This effect was found to be associated with the level of group identification. These results confirm the role of MPFC in social categorization. PMID:23175678

  10. Basket-Weave Technique for Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Kodkani, Pranjal S.

    2015-01-01

    The anatomy of the medial patellofemoral ligament (MPFL) has been well defined, with parts of its uppermost fibers having a soft-tissue insertion onto the vastus intermedius. Bone tunnels and implants on the patellar side therefore cannot replicate this anatomic construct precisely. Because of implants and tunnels, complications have been reported with bone tunnel fracture. Similarly, on the femoral side, rigid fixation with implants can result in over-constraint with compromised results. Moreover, bone tunnels cannot be used in skeletally immature cases. To overcome issues related to bone tunneling and implants, as well as to reconstruct the MPFL in a precise anatomic manner, an all–soft-tissue fixation technique was devised. Bony landmarks were used as reference points instead of radiologic markers to achieve a more precise construct and to eliminate intraoperative radiography. Hamstring graft was used to reconstruct the MPFL. Special suturing techniques were used to achieve optimal graft fixation with minimal suture knots. A special tissue elevator–suture passer device was designed to facilitate graft passage and ease in performing the procedure. This technique permits differential tensioning, and therefore one achieves stability throughout the range of motion. PMID:26258044

  11. [Tips and Tricks for Mobile Bearing Medial Unicondylar Knee Replacement].

    PubMed

    Walker, T; Streit, M R; Gotterbarm, T; Aldinger, P R

    2015-06-01

    The term anteromedial osteoarthritis of the knee joint was first established in 1991 by White et al. and describes an isolated osteoarthritis of the medial tibiofemoral compartment with intact posterior tibial cartilage in patients with a functionally intact anterior cruciate ligament and occurs in about 30 % of all patients with clinically relevant gonarthrosis. In these patients, there is the possibility for minimally invasive unicondylar knee arthroplasty. One of the most commonly used prosthesis with long-term experience is the Oxford Uni knee prosthesis (Biomet UK Limited, Swindon, UK). The most recent phase of development of this prosthesis focused on improving the reliability of the instruments (Microplasty) which allows a more reproducible execution of the operation to help eliminate early failure due to surgical errors. In the following article, the essential surgical steps of minimally invasive implantation of the Oxford Uni with the Microplasty instrumentation in a patient with severe anteromedial osteoarthritis of the knee joint are demonstrated and explained. Georg Thieme Verlag KG Stuttgart · New York.

  12. Content Representation in the Human Medial Temporal Lobe

    PubMed Central

    Liang, Jackson C.; Wagner, Anthony D.

    2013-01-01

    Current theories of medial temporal lobe (MTL) function focus on event content as an important organizational principle that differentiates MTL subregions. Perirhinal and parahippocampal cortices may play content-specific roles in memory, whereas hippocampal processing is alternately hypothesized to be content specific or content general. Despite anatomical evidence for content-specific MTL pathways, empirical data for content-based MTL subregional dissociations are mixed. Here, we combined functional magnetic resonance imaging with multiple statistical approaches to characterize MTL subregional responses to different classes of novel event content (faces, scenes, spoken words, sounds, visual words). Univariate analyses revealed that responses to novel faces and scenes were distributed across the anterior–posterior axis of MTL cortex, with face responses distributed more anteriorly than scene responses. Moreover, multivariate pattern analyses of perirhinal and parahippocampal data revealed spatially organized representational codes for multiple content classes, including nonpreferred visual and auditory stimuli. In contrast, anterior hippocampal responses were content general, with less accurate overall pattern classification relative to MTL cortex. Finally, posterior hippocampal activation patterns consistently discriminated scenes more accurately than other forms of content. Collectively, our findings indicate differential contributions of MTL subregions to event representation via a distributed code along the anterior–posterior axis of MTL that depends on the nature of event content. PMID:22275474

  13. Correlating Function and Imaging Measures of the Medial Longitudinal Fasciculus

    PubMed Central

    Sakaie, Ken; Takahashi, Masaya; Remington, Gina; Wang, Xiaofeng; Conger, Amy; Conger, Darrel; Dimitrov, Ivan; Jones, Stephen; Frohman, Ashley; Frohman, Teresa; Sagiyama, Koji; Togao, Osamu

    2016-01-01

    Objective To test the validity of diffusion tensor imaging (DTI) measures of tissue injury by examining such measures in a white matter structure with well-defined function, the medial longitudinal fasciculus (MLF). Injury to the MLF underlies internuclear ophthalmoparesis (INO). Methods 40 MS patients with chronic INO and 15 healthy controls were examined under an IRB-approved protocol. Tissue integrity of the MLF was characterized by DTI parameters: longitudinal diffusivity (LD), transverse diffusivity (TD), mean diffusivity (MD) and fractional anisotropy (FA). Severity of INO was quantified by infrared oculography to measure versional disconjugacy index (VDI). Results LD was significantly lower in patients than in controls in the medulla-pons region of the MLF (p < 0.03). FA was also lower in patients in the same region (p < 0.0004). LD of the medulla-pons region correlated with VDI (R = -0.28, p < 0.05) as did FA in the midbrain section (R = 0.31, p < 0.02). Conclusions This study demonstrates that DTI measures of brain tissue injury can detect injury to a functionally relevant white matter pathway, and that such measures correlate with clinically accepted evaluation indices for INO. The results validate DTI as a useful imaging measure of tissue integrity. PMID:26800522

  14. Assessing cognitive function following medial prefrontal stroke in the rat.

    PubMed

    Livingston-Thomas, Jessica M; Jeffers, Matthew S; Nguemeni, Carine; Shoichet, Molly S; Morshead, Cindi M; Corbett, Dale

    2015-11-01

    Cognitive impairments are prevalent following clinical stroke; however, preclinical research has focused almost exclusively on motor deficits. In order to conduct systematic evaluations into the nature of post-stroke cognitive dysfunction and recovery, it is crucial to develop focal stroke models that predominantly affect cognition while leaving motor function intact. Herein, we evaluated a range of cognitive functions 1-4 months following focal medial prefrontal cortex (mPFC) stroke using a battery of tests. Male Sprague-Dawley rats underwent focal ischemia induced in the mPFC using bilateral intracerebral injections of endothelin-1, or sham surgery. Cognitive function was assessed using an open field, several object recognition tests, attentional set-shifting, light-dark box, spontaneous alternation, Barnes maze, and win-shift/win-stay tests. Prefrontal cortex damage resulted in significant changes in object recognition function, behavioural flexibility, and anxiety-like behaviour, while spontaneous alternation and locomotor function remained intact. These deficits are similar to the cognitive deficits following stroke in humans. Our results suggest that this model may be useful for identifying and developing potential therapies for improving post-stroke cognitive dysfunction.

  15. Structural development and dorsoventral maturation of the medial entorhinal cortex.

    PubMed

    Ray, Saikat; Brecht, Michael

    2016-04-02

    We investigated the structural development of superficial-layers of medial entorhinal cortex and parasubiculum in rats. The grid-layout and cholinergic-innervation of calbindin-positive pyramidal-cells in layer-2 emerged around birth while reelin-positive stellate-cells were scattered throughout development. Layer-3 and parasubiculum neurons had a transient calbindin-expression, which declined with age. Early postnatally, layer-2 pyramidal but not stellate-cells co-localized with doublecortin - a marker of immature neurons - suggesting delayed functional-maturation of pyramidal-cells. Three observations indicated a dorsal-to-ventral maturation of entorhinal cortex and parasubiculum: (i) calbindin-expression in layer-3 neurons decreased progressively from dorsal-to-ventral, (ii) doublecortin in layer-2 calbindin-positive-patches disappeared dorsally before ventrally, and (iii) wolframin-expression emerged earlier in dorsal than ventral parasubiculum. The early appearance of calbindin-pyramidal-grid-organization in layer-2 suggests that this pattern is instructed by genetic information rather than experience. Superficial-layer-microcircuits mature earlier in dorsal entorhinal cortex, where small spatial-scales are represented. Maturation of ventral-entorhinal-microcircuits - representing larger spatial-scales - follows later around the onset of exploratory behavior.

  16. Intertester reliability of clinical judgments of medial knee ligament integrity.

    PubMed

    McClure, P W; Rothstein, J M; Riddle, D L

    1989-04-01

    The purpose of this study was to determine the intertester reliability of judgments based on tibiofemoral joint abduction (TFJA) tests of the medial collateral ligament (MCL). The TFJA tests were performed by three physical therapists on 50 patients with unilateral knee problems. The therapists used the techniques they normally use in clinical practice and tested TFJA with the knee in both 0 and 30 degrees of flexion. Three variables were evaluated: the amount of TFJA, pain elicited during the test, and the type of end-feel. When the test was performed with the subjects' knees in 0 degrees of flexion, the weighted Kappa value for judgments of motion was .06, the Kappa value for judgments of whether pain was elicited was .40, and the Kappa value for end-feel was .00. For the 30-degree test position, the weighted Kappa value for judgments of the amount of TFJA was .16, and the Kappa values for judgments of pain and end-feel were .33 and .38, respectively. The results suggest that judgments based on TFJA tests may not be reliable when taken in a clinical setting by physical therapists.

  17. Medial temporal lobe damage impairs representation of simple stimuli.

    PubMed

    Warren, David E; Duff, Melissa C; Tranel, Daniel; Cohen, Neal J

    2010-01-01

    Medial temporal lobe (MTL) damage in humans is typically thought to produce a circumscribed impairment in the acquisition of new enduring memories, but recent reports have documented deficits even in short-term maintenance. We examined possible maintenance deficits in a population of MTL amnesics, with the goal of characterizing their impairments as either representational drift or outright loss of representation over time. Patients and healthy comparisons performed a visual search task in which the similarity of various lures to a target was varied parametrically. Stimuli were simple shapes varying along one of several visual dimensions. The task was performed in two conditions, one presenting a sample target simultaneously with the search array and the other imposing a delay between sample and array. Eye-movement data collected during search revealed that the duration of fixations to items varied with lure-target similarity for all participants, i.e., fixations were longer for items more similar to the target. In the simultaneous condition, patients and comparisons exhibited an equivalent effect of similarity on fixation durations. However, imposing a delay modulated the effect differently for the two groups: in comparisons, fixation duration to similar items was exaggerated; in patients, the original effect was diminished. These findings indicate that MTL lesions subtly impair short-term maintenance of even simple stimuli, with performance reflecting not the complete loss of the maintained representation but rather a degradation or progressive drift of the representation over time.

  18. Medial temporal lobe roles in human path integration.

    PubMed

    Yamamoto, Naohide; Philbeck, John W; Woods, Adam J; Gajewski, Daniel A; Arthur, Joeanna C; Potolicchio, Samuel J; Levy, Lucien; Caputy, Anthony J

    2014-01-01

    Path integration is a process in which observers derive their location by integrating self-motion signals along their locomotion trajectory. Although the medial temporal lobe (MTL) is thought to take part in path integration, the scope of its role for path integration remains unclear. To address this issue, we administered a variety of tasks involving path integration and other related processes to a group of neurosurgical patients whose MTL was unilaterally resected as therapy for epilepsy. These patients were unimpaired relative to neurologically intact controls in many tasks that required integration of various kinds of sensory self-motion information. However, the same patients (especially those who had lesions in the right hemisphere) walked farther than the controls when attempting to walk without vision to a previewed target. Importantly, this task was unique in our test battery in that it allowed participants to form a mental representation of the target location and anticipate their upcoming walking trajectory before they began moving. Thus, these results put forth a new idea that the role of MTL structures for human path integration may stem from their participation in predicting the consequences of one's locomotor actions. The strengths of this new theoretical viewpoint are discussed.

  19. The role of the medial prefrontal cortex in social categorization.

    PubMed

    Molenberghs, Pascal; Morrison, Samantha

    2014-03-01

    Group membership is an important aspect of our everyday behavior. Recently, we showed that existing relevant in-group labels increased activation in the medial prefrontal cortex (MPFC) compared with out-group labels, suggesting a role of the MPFC in social categorization. However, the question still remains whether this increase in MPFC activation for in-group representation is solely related with previous experience with the in-group. To test this, we randomly assigned participants to a red or blue team and in a subsequent functional magnetic resonance imaging experiment they categorized red and blue team words as belonging to either the in-group or the out-group. Results showed that even under these minimal conditions increased activation was found in the MPFC when participants indicated that they belonged to a group, as compared with when they did not. This effect was found to be associated with the level of group identification. These results confirm the role of MPFC in social categorization.

  20. Medial prefrontal cortex neuronal circuits in fear behavior.

    PubMed

    Courtin, J; Bienvenu, T C M; Einarsson, E Ö; Herry, C

    2013-06-14

    The medial prefrontal cortex (mPFC) has emerged as a key structure involved in the modulation of fear behavior over the past few decades. Anatomical, functional and electrophysiological studies have begun to shed light on the precise mechanisms by which different prefrontal regions regulate the expression and inhibition of fear behavior. These studies have established a canonical view of mPFC functions during fear behavior with dorsal regions selectively involved in the expression of fear behavior and ventral regions linked to the inhibition of fear behavior. Although numerous reports support this view, recent data have refined this model and suggested that dorsal prefrontal regions might also play an important role in the encoding of fear behavior itself. The recent development of sophisticated approaches such as large scale neuronal recordings, simultaneous multisite recordings of spiking activity and local field potentials (LFPs) along with optogenetic approaches will facilitate the testing of these new hypotheses in the near future. Here we provide an extensive review of the literature on the role of mPFC in fear behavior and propose further directions to dissect the contribution of specific prefrontal neuronal elements and circuits in the regulation of fear behavior. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

  1. Medial efferent mechanisms in children with auditory processing disorders.

    PubMed

    Mishra, Srikanta K

    2014-01-01

    Auditory processing disorder (APD) affects about 2-5% of children. However, the nature of this disorder is poorly understood. Children with APD typically have difficulties in complex listening situations. One mechanism thought to aid in listening-in-noise is the medial olivocochlear (MOC) inhibition. The purpose of this review was to critically analyze the published data on MOC inhibition in children with APD to determine whether the MOC efferents are involved in these individuals. The otoacoustic emission (OAE) methods used to assay MOC reflex were examined in the context of the current understanding of OAE generation mechanisms. Relevant literature suggests critical differences in the study population and OAE methods. Variables currently known to influence MOC reflex measurements, for example, middle-ear muscle reflexes or OAE signal-to-noise ratio, were not controlled in most studies. The use of potentially weaker OAE methods and the remarkable heterogeneity across studies does not allow for a definite conclusion whether or not the MOC reflex is altered in children with APD. Further carefully designed studies are needed to confirm the involvement of MOC efferents in APD. Knowledge of efferent functioning in children with APD would be mechanistically and clinically beneficial.

  2. Structural development and dorsoventral maturation of the medial entorhinal cortex

    PubMed Central

    Ray, Saikat; Brecht, Michael

    2016-01-01

    We investigated the structural development of superficial-layers of medial entorhinal cortex and parasubiculum in rats. The grid-layout and cholinergic-innervation of calbindin-positive pyramidal-cells in layer-2 emerged around birth while reelin-positive stellate-cells were scattered throughout development. Layer-3 and parasubiculum neurons had a transient calbindin-expression, which declined with age. Early postnatally, layer-2 pyramidal but not stellate-cells co-localized with doublecortin – a marker of immature neurons – suggesting delayed functional-maturation of pyramidal-cells. Three observations indicated a dorsal-to-ventral maturation of entorhinal cortex and parasubiculum: (i) calbindin-expression in layer-3 neurons decreased progressively from dorsal-to-ventral, (ii) doublecortin in layer-2 calbindin-positive-patches disappeared dorsally before ventrally, and (iii) wolframin-expression emerged earlier in dorsal than ventral parasubiculum. The early appearance of calbindin-pyramidal-grid-organization in layer-2 suggests that this pattern is instructed by genetic information rather than experience. Superficial-layer-microcircuits mature earlier in dorsal entorhinal cortex, where small spatial-scales are represented. Maturation of ventral-entorhinal-microcircuits – representing larger spatial-scales – follows later around the onset of exploratory behavior. DOI: http://dx.doi.org/10.7554/eLife.13343.001 PMID:27036175

  3. Autonoetic Consciousness in Autobiographical Memories after Medial Temporal Lobe Resection

    PubMed Central

    Noulhiane, M.; Piolino, P.; Hasboun, D.; Clemenceau, S.; Baulac, M.; Samson, S.

    2008-01-01

    This study aims to investigate autonoetic consciousness associated with episodic autobiographical memory in patients who had undergone unilateral medial temporal lobe resection for intractable epilepsy. Autonoetic consciousness, defined as the conscious feeling of mentally travelling back in time to relive a specific event, was assessed using the Remember/Know (R/K) paradigm across different time periods as proposed in the autobiographical memory task developed by Piolino et al. (TEMPau task). Results revealed that the two patient groups (left and right temporal resection) gave reduced sense of reliving (R) responses and more familiarity (K) responses than healthy controls. This poor autonoetic consciousness was highlighted when patients were asked to justify their Remember responses by recalling sensory-perceptive, affective or spatiotemporal specific details across all life periods. These results support the bilateral MTL contribution to episodic autobiographical memory covering the entire lifespan, which is consistent with the multiple trace theory of MTL function [7,9]. This study also demonstrates the bilateral involvement of MTL structures in recalling specific details of personal events characterized by autonoetic consciousness. PMID:18413911

  4. Role of the medial prefrontal cortex in coping and resilience *

    PubMed Central

    Maier, Steven F.; Watkins, Linda R.

    2010-01-01

    The degree of behavioral control that an organism has over an aversive event is well known to modulate the behavioral and neurochemical consequences of exposure to the event. Here we review recent research that suggests that the experience of control over a potent stressor alters how the organism responds to future aversive events as well as to the stressor being controlled. More specifically, subjects that have experienced control show blunted behavioral and neurochemical responses to subsequent stressors occurring days to months later. Indeed, these subjects respond as if a later uncontrollable stressor is actually controllable. Further, we review research indicating that the stress-resistance induced by control depends on control-induced activation of ventral medial prefrontal cortical (vmPFC) inhibitory control over brainstem and limbic structures. Furthermore, there appears to be plasticity in these circuits such that the experience of control alters the vmPFC in such a way that later uncontrollable stressors now activate the vmPFC circuitry, leading to inhibition of stress-responsive limbic and brainstem structures, i.e., stressor resistance. This controllability-induced proactive stressor resistance generalizes across very different stressors and may be involved in determining individual difference in reactions to traumatic events. PMID:20727864

  5. A general role for medial prefrontal cortex in event prediction

    PubMed Central

    Alexander, William H.; Brown, Joshua W.

    2014-01-01

    A recent computational neural model of medial prefrontal cortex (mPFC), namely the predicted response-outcome (PRO) model (Alexander and Brown, 2011), suggests that mPFC learns to predict the outcomes of actions. The model accounted for a wide range of data on the mPFC. Nevertheless, numerous recent findings suggest that mPFC may signal predictions and prediction errors even when the predicted outcomes are not contingent on prior actions. Here we show that the existing PRO model can learn to predict outcomes in a general sense, and not only when the outcomes are contingent on actions. A series of simulations show how this generalized PRO model can account for an even broader range of findings in the mPFC, including human ERP, fMRI, and macaque single-unit data. The results suggest that the mPFC learns to predict salient events in general and provides a theoretical framework that links mPFC function to model-based reinforcement learning, Bayesian learning, and theories of cognitive control. PMID:25071539

  6. Effects of Response Force Parameters on Medial-Frontal Negativity

    PubMed Central

    Armbrecht, Anne-Simone; Gibbons, Henning; Stahl, Jutta

    2013-01-01

    The response-related medial-frontal activity (MFN) is often supposed to reflect action-monitoring and error-processing activity. The present force-production task was designed to investigate the effects of two response parameters (i.e., peak response force and time-to-peak, TTP) on the MFN separately. In a 2 × 2 design (high vs. low target force and short vs. long TTP), 22 participants had to produce isometric force pulses to match one of four conditions (e.g., a high target force with a long TTP). Significant main effects of both target force and target TTP were revealed. As previously shown, the MFN amplitude was higher in the high target-force condition than in the low target-force condition. Contrary to the initial expectations, a long TTP had the effect of reducing the MFN amplitude. There was no error-specific effect on the MFN. The force-unit monitoring model (FUMM) is suggested to account for the force- and TTP- specific variations of MFN amplitude, latency and slope. PMID:23349950

  7. Anterior medial prefrontal cortex implements social priming of mimicry.

    PubMed

    Wang, Yin; Hamilton, Antonia F de C

    2015-04-01

    The neural and cognitive mechanisms by which primed constructs can impact on social behavior are poorly understood. In the present study, we used functional magnetic resonance imaging (fMRI) to explore how scrambled sentence priming can impact on mimicry behavior. Sentences involving pro/antisocial events from a first/third-person point of view were presented in short blocks, followed by a reaction-time assessment of mimicry. Behavioral results showed that both prosociality and viewpoint impact on mimicry, and fMRI analysis showed this effect is implemented by anterior medial prefrontal cortex (amPFC). We suggest that social primes may subtly modulate processing in amPFC in a manner linked to the later behavior, and that this same region also implements the top-down control of mimicry responses. This priming may be linked to processing of self-schemas in amPFC. Our findings demonstrate how social priming can be studied with fMRI, and have important implications for our understanding of the underlying mechanisms of prime-to-behavior effects as well as for current theories in social psychology.

  8. Transient medial prefrontal perturbation reduces false memory formation.

    PubMed

    Berkers, Ruud M W J; van der Linden, Marieke; de Almeida, Rafael F; Müller, Nils C J; Bovy, Leonore; Dresler, Martin; Morris, Richard G M; Fernández, Guillén

    2017-03-01

    Knowledge extracted across previous experiences, or schemas, benefit encoding and retention of congruent information. However, they can also reduce specificity and augment memory for semantically related, but false information. A demonstration of the latter is given by the Deese-Roediger-McDermott (DRM) paradigm, where the studying of words that fit a common semantic schema are found to induce false memories for words that are congruent with the given schema, but were not studied. The medial prefrontal cortex (mPFC) has been ascribed the function of leveraging prior knowledge to influence encoding and retrieval, based on imaging and patient studies. Here, we used transcranial magnetic stimulation (TMS) to transiently perturb ongoing mPFC processing immediately before participants performed the DRM-task. We observed the predicted reduction in false recall of critical lures after mPFC perturbation, compared to two control groups, whereas veridical recall and recognition memory performance remained similar across groups. These data provide initial causal evidence for a role of the mPFC in biasing the assimilation of new memories and their consolidation as a function of prior knowledge.

  9. The Necessity of the Medial Temporal Lobe for Statistical Learning

    PubMed Central

    Schapiro, Anna C.; Gregory, Emma; Landau, Barbara; McCloskey, Michael; Turk-Browne, Nicholas B.

    2014-01-01

    The sensory input that we experience is highly patterned, and we are experts at detecting these regularities. Although the extraction of such regularities, or statistical learning (SL), is typically viewed as a cortical process, recent studies have implicated the medial temporal lobe (MTL), including the hippocampus. These studies have employed fMRI, leaving open the possibility that the MTL is involved but not necessary for SL. Here, we examined this issue in a case study of LSJ, a patient with complete bilateral hippocampal loss and broader MTL damage. In Experiments 1 and 2, LSJ and matched control participants were passively exposed to a continuous sequence of shapes, syllables, scenes, or tones containing temporal regularities in the co-occurrence of items. In a subsequent test phase, the control groups exhibited reliable SL in all conditions, successfully discriminating regularities from recombinations of the same items into novel foil sequences. LSJ, however, exhibited no SL, failing to discriminate regularities from foils. Experiment 3 ruled out more general explanations for this failure, such as inattention during exposure or difficulty following test instructions, by showing that LSJ could discriminate which individual items had been exposed. These findings provide converging support for the importance of the MTL in extracting temporal regularities. PMID:24456393

  10. Medial PFC Damage Abolishes the Self-reference Effect

    PubMed Central

    Philippi, Carissa L.; Duff, Melissa C.; Denburg, Natalie L.; Tranel, Daniel; Rudrauf, David

    2012-01-01

    Functional neuroimaging studies suggest that the medial PFC (mPFC) is a key component of a large-scale neural system supporting a variety of self-related processes. However, it remains unknown whether the mPFC is critical for such processes. In this study, we used a human lesion approach to examine this question. We administered a standard trait judgment paradigm [Kelley, W. M., Macrae, C. N., Wyland, C. L., Caglar, S., Inati, S., & Heatherton, T. F. Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785–794, 2002] to patients with focal brain damage to the mPFC. The self-reference effect (SRE), a memory advantage conferred by self-related processing, served as a measure of intact self-processing ability. We found that damage to the mPFC abolished the SRE. The results demonstrate that the mPFC is necessary for the SRE and suggest that this structure is important for self-referential processing and the neural representation of self. PMID:21942762

  11. Prevalence and cognitive impact of medial temporal atrophy in a hospital stroke service: retrospective cohort study.

    PubMed

    Kebets, Valeria; Gregoire, Simone M; Charidimou, Andreas; Barnes, Josephine; Rantell, Khadija; Brown, Martin M; Jäger, Hans R; Cipolotti, Lisa; Werring, David J

    2015-08-01

    Cerebrovascular disease and neurodegeneration cause cognitive impairment and frequently coexist. Our objectives were to investigate the prevalence and cognitive impact of medial temporal lobe atrophy - a radiological marker often associated with Alzheimer's disease - in a hospital stroke service. Retrospective cohort study of patients from a hospital stroke service. Patients assessed for suspected ischemic stroke or transient ischemic attack, irrespective of final diagnosis, underwent neuropsychological testing and magnetic resonance imaging. medial temporal lobe atrophy, white matter hyperintensities, lacunes, and cerebral microbleeds were rated using established criteria and validated scales. The associations between medial temporal lobe atrophy and cognition were tested using multivariable logistic regression analyses, adjusted for age and imaging markers of cerebrovascular disease. Three hundred and ninety-three patients were included, of whom 169 (43%; 95% confidence interval: 38·1-48·1%) had medial temporal lobe atrophy; in 38 patients (9·7%), medial temporal lobe atrophy was severe (mean score ≥2). In unadjusted logistic regression analyses in the whole cohort, mean medial temporal lobe atrophy score was associated with verbal memory, nominal and perceptual skills, executive function, and speed and attention. After adjustment for age, white matter hyperintensities, number of lacunes, presence of cerebral microbleeds, previous ischemic stroke or transient ischemic attack, and premorbid intelligence quotient, mean medial temporal lobe atrophy score remained associated with impairment in verbal memory (odds ratio: 1·64; 95% confidence interval 1·04-2·58) and nominal skills (odds ratio: 1·61; 95% confidence interval 1·04-2·48). Medial temporal lobe atrophy is common and has an independent impact on cognitive function in a stroke service population, independent of confounding factors including age and magnetic resonance imaging markers of

  12. The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players.

    PubMed

    Xu, Huan; Wang, Pin; Ye, Zhuo'er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

    2016-01-01

    Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

  13. Correlation between the knee adduction torque and medial contact force for a variety of gait patterns.

    PubMed

    Zhao, Dong; Banks, Scott A; Mitchell, Kim H; D'Lima, Darryl D; Colwell, Clifford W; Fregly, Benjamin J

    2007-06-01

    The external knee adduction torque has been proposed as a surrogate measure for medial compartment load during gait. However, a direct link between these two quantities has not been demonstrated using in vivo measurement of medial compartment load. This study uses in vivo data collected from a single subject with an instrumented knee implant to evaluate this link. The subject performed five different overground gait motions (normal, fast, slow, wide, and toe-out) with simultaneous collection of instrumented implant, video motion, and ground reaction data. For each trial, the knee adduction torque was measured externally while the total axial force applied to the tibial insert was measured internally. Based on data collected from the same subject performing treadmill gait under fluoroscopic motion analysis, a regression equation was developed to calculate medial contact force from the implant load cell measurements. Correlation analyses were performed for the stance phase and entire gait cycle to quantify the relationship between the knee adduction torque and both the medial contact force and the medial to total contact force ratio. When the entire gait cycle was analyzed, R(2) for medial contact force was 0.77 when all gait trials were analyzed together and between 0.69 and 0.93 when each gait trial was analyzed separately (p < 0.001 in all cases). For medial to total force ratio, R(2) was 0.69 for all trials together and between 0.54 and 0.90 for each trial separately (p < 0.001 in all cases). When only the stance phase was analyzed, R(2) values were slightly lower. These results support the hypothesis that the knee adduction torque is highly correlated with medial compartment contact force and medial to total force ratio during gait.

  14. The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players

    PubMed Central

    Xu, Huan; Wang, Pin; Ye, Zhuo’er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

    2016-01-01

    Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

  15. Functional Loss With Displacement of Medial Epicondyle Humerus Fractures: A Computer Simulation Study.

    PubMed

    Edmonds, Eric W; Santago, Anthony C; Saul, Katherine R

    2015-01-01

    Assessment and management of the medial humeral epicondyle fracture remains controversial, with conflicting reports of displacement direction and consequent functional deficits unclear. The purpose of this study was to define biomechanically likely directions of medial epicondyle fracture displacement and to determine possible changes in muscle function related to that displacement. A 3-dimensional computer model of the upper extremity was used to simulate the consequences of medial epicondyle fracture displacements from 1 to 20 mm in the anterior, medial, and inferior directions relative to the humerus with the elbow at 90-degree flexion and neutral forearm rotation (a replication of accepted positions for clinical strength testing). Muscle length and force were calculated following displacement. Maximum isometric wrist flexion moments were calculated over the full range of wrist motion based on known force-generating properties of the muscles. Anterior displacement resulted in shortened muscles and reduced wrist flexion moment, with a decrease in strength averaging 2% for every 1 mm of anterior fragment displacement at neutral wrist position (maximum decrease of 39% with 20 mm displacement). In contrast, displacement in the medial and inferior directions resulted in stretched muscles and increased wrist flexion moments and therefore are not biomechanically likely. Computer simulation of a medial epicondyle fracture suggests that anterior displacement could result in a dramatic loss of initial muscle strength and function. Medial displacement is unlikely to occur in vivo due to consequential muscle lengthening, suggesting that alternatives to the historical use of AP radiographs to assess displacement of this fracture are needed. Our work provides a biomechanical explanation for anterior displacement of medial epicondyle fractures observed radiographically and motivates alternative methods of fracture assessment. A functional basis for determining acceptable

  16. Chronic Ritalin Administration during Adulthood Increases Serotonin Pool in Rat Medial Frontal Cortex

    PubMed Central

    Daniali, Samira; Nahavandi, Arezo; Madjd, Zahra; Shahbazi, Ali; Niknazar, Somayeh; Shahbazzadeh, Delavar

    2013-01-01

    Background: Ritalin has high tendency to be abused. It has been the main indication to control attention deficit hyperactivity disorder. The college students may seek for it to improve their memory, decrease the need for sleep (especially during exams), which at least partially, can be related to serotonergic system. Therefore, it seems worthy to evaluate the effect of Ritalin intake on mature brain. There are many studies on Ritalin effect on developing brain, but only few studies on adults are available. This study was undertaken to find Ritalin effect on serotonin transporter (SERT) density in medial frontal cortex (MFC) of mature rat. Methods: Thirty male Wistar rats were used in the study. Rats were assigned into five groups (n = 6 per group): one control, two Ritalin and two vehicle groups. Twelve rats received Ritalin (20 mg/kg/twice a day) orally for eleven continuous days. After one week of withdrawal and another two weeks of rest, in order to evaluate short-term effects of Ritalin, six rats were sacrificed. Another six rats were studied to detect the long-term effects of Ritalin; therefore, they were sacrificed 12 weeks after the previous group. The immunohistochemistry was performed to evaluate the results. Results: Immunohistochemistry studies showed a higher density of SERT in both 2 and 12 weeks after withdrawal from Ritalin intake in MFC of rat and there was no significant difference between these two groups. Conclusions: Our findings demonstrated both short- and long-term effects of Ritalin on frontal serotonergic system after withdrawal period. PMID:23748891

  17. Gene expression profiling of the dorsolateral and medial orbitofrontal cortex in schizophrenia.

    PubMed

    Mladinov, Mihovil; Sedmak, Goran; Fuller, Heidi R; Babić Leko, Mirjana; Mayer, Davor; Kirincich, Jason; Štajduhar, Andrija; Borovečki, Fran; Hof, Patrick R; Šimić, Goran

    2016-01-01

    Schizophrenia is a complex polygenic disorder of unknown etiology. Over 3,000 candidate genes associated with schizophrenia have been reported, most of which being mentioned only once. Alterations in cognitive processing - working memory, metacognition and mentalization - represent a core feature of schizophrenia, which indicates the involvement of the prefrontal cortex in the pathophysiology of this disorder. Hence we compared the gene expression in postmortem tissue from the left and right dorsolateral prefrontal cortex (DLPFC, Brodmann's area 46), and the medial part of the orbitofrontal cortex (MOFC, Brodmann's area 11/12), in six patients with schizophrenia and six control brains. Although in the past decade several studies performed transcriptome profiling in schizophrenia, this is the first study to investigate both hemispheres, providing new knowledge about possible brain asymmetry at the level of gene expression and its relation to schizophrenia. We found that in the left hemisphere, twelve genes from the DLPFC and eight genes from the MOFC were differentially expressed in patients with schizophrenia compared to controls. In the right hemisphere there was only one gene differentially expressed in the MOFC. We reproduce the involvement of previously reported genes TARDBP and HNRNPC in the pathogenesis of schizophrenia, and report seven novel genes: SART1, KAT7, C1D, NPM1, EVI2A, XGY2, and TTTY15. As the differentially expressed genes only partially overlap with previous studies that analyzed other brain regions, our findings indicate the importance of considering prefrontal cortical regions, especially those in the left hemisphere, for obtaining disease-relevant insights.

  18. Gene expression profiling of the dorsolateral and medial orbitofrontal cortex in schizophrenia

    PubMed Central

    Mladinov, Mihovil; Sedmak, Goran; Fuller, Heidi R.; Babić Leko, Mirjana; Mayer, Davor; Kirincich, Jason; Štajduhar, Andrija; Borovečki, Fran; Hof, Patrick R.

    2016-01-01

    Abstract Schizophrenia is a complex polygenic disorder of unknown etiology. Over 3,000 candidate genes associated with schizophrenia have been reported, most of which being mentioned only once. Alterations in cognitive processing - working memory, metacognition and mentalization - represent a core feature of schizophrenia, which indicates the involvement of the prefrontal cortex in the pathophysiology of this disorder. Hence we compared the gene expression in postmortem tissue from the left and right dorsolateral prefrontal cortex (DLPFC, Brodmann's area 46), and the medial part of the orbitofrontal cortex (MOFC, Brodmann's area 11/12), in six patients with schizophrenia and six control brains. Although in the past decade several studies performed transcriptome profiling in schizophrenia, this is the first study to investigate both hemispheres, providing new knowledge about possible brain asymmetry at the level of gene expression and its relation to schizophrenia. We found that in the left hemisphere, twelve genes from the DLPFC and eight genes from the MOFC were differentially expressed in patients with schizophrenia compared to controls. In the right hemisphere there was only one gene differentially expressed in the MOFC. We reproduce the involvement of previously reported genes TARDBP and HNRNPC in the pathogenesis of schizophrenia, and report seven novel genes: SART1, KAT7, C1D, NPM1, EVI2A, XGY2, and TTTY15. As the differentially expressed genes only partially overlap with previous studies that analyzed other brain regions, our findings indicate the importance of considering prefrontal cortical regions, especially those in the left hemisphere, for obtaining disease-relevant insights. PMID:28123834

  19. Partially supervised speaker clustering.

    PubMed

    Tang, Hao; Chu, Stephen Mingyu; Hasegawa-Johnson, Mark; Huang, Thomas S

    2012-05-01

    Content-based multimedia indexing, retrieval, and processing as well as multimedia databases demand the structuring of the media content (image, audio, video, text, etc.), one significant goal being to associate the identity of the content to the individual segments of the signals. In this paper, we specifically address the problem of speaker clustering, the task of assigning every speech utterance in an audio stream to its speaker. We offer a complete treatment to the idea of partially supervised speaker clustering, which refers to the use of our prior knowledge of speakers in general to assist the unsupervised speaker clustering process. By means of an independent training data set, we encode the prior knowledge at the various stages of the speaker clustering pipeline via 1) learning a speaker-discriminative acoustic feature transformation, 2) learning a universal speaker prior model, and 3) learning a discriminative speaker subspace, or equivalently, a speaker-discriminative distance metric. We study the directional scattering property of the Gaussian mixture model (GMM) mean supervector representation of utterances in the high-dimensional space, and advocate exploiting this property by using the cosine distance metric instead of the euclidean distance metric for speaker clustering in the GMM mean supervector space. We propose to perform discriminant analysis based on the cosine distance metric, which leads to a novel distance metric learning algorithm—linear spherical discriminant analysis (LSDA). We show that the proposed LSDA formulation can be systematically solved within the elegant graph embedding general dimensionality reduction framework. Our speaker clustering experiments on the GALE database clearly indicate that 1) our speaker clustering methods based on the GMM mean supervector representation and vector-based distance metrics outperform traditional speaker clustering methods based on the “bag of acoustic features” representation and statistical

  20. Medial pterygoid trismus (myospasm) following inferior alveolar nerve block: case report and literature review.

    PubMed

    Wright, Edward F

    2011-01-01

    A patient developed a medial pterygoid trismus (myospasm) the day after receiving three inferior alveolar nerve blocks and a routine restoration. She had a significantly restricted mouth opening and significant medial pterygoid muscle pain when she opened beyond the restriction; however, she had no swelling, lymphadenopathy, or fever. A medial pterygoid myospasm can occur secondary to an inferior alveolar nerve block. This disorder generally is treated by the application of heat, muscle stretches, analgesic and/or muscle relaxant ingestion, and a physical therapy referral. The severity of the disorder typically dictates the extent of therapy that is needed.

  1. Extra Ossification Center at the Tip of the Medial Malleolus Suspected as Fracture: A Clinical Clue.

    PubMed

    Aydın, Deniz

    2016-01-01

    The appearance of displaced bone inferior (distal) to the medial malleolus, present on radiographs in an adolescent patient, can be confused with a fracture, when, in fact, it is the radiographic appearance of a secondary center of ossification. Foot and ankle surgeons should be aware of extra ossification centers and accessory bones, including one at the tip of the medial malleolus, to avoid misdiagnosis and overtreatment. In the present report, I describe the case of a 9-year-old male with bilateral extra ossification centers at the tip of each medial malleolus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Ulnar entrapment neuropathy along the medial intermuscular septum in the midarm.

    PubMed

    Nakajima, Masashi; Ono, Nobuko; Kojima, Tomoko; Kusunose, Koichi

    2009-05-01

    We report a patient with primary ulnar entrapment neuropathy in the midarm. Stimulation of multiple sites along the ulnar nerve showed a motor conduction block at a distance of 7.5-10 cm proximal to the medial epicondyle, where the nerve was compressed by the medial intermuscular septum. Anatomically, the possibility of ulnar nerve entrapment in this segment has long been suggested, and stimulation at least 10 cm above the medial epicondyle may reveal the entrapment. Muscle Nerve 39: 707-710, 2009.

  3. Miniarthrotomy assisted percutaneous screw fixation for displaced medial malleolus fractures – A novel technique

    PubMed Central

    Saini, Pramod; Aggrawal, Abhinav; Meena, Sanjay; Trikha, Vivek; Mittal, Samarth

    2014-01-01

    Aim To describe here a technique of miniarthrotomy assisted percutaneous screw insertion for displaced Herscovici type B and C medial malleolar fractures. Method Incision was made centred over the superomedial angle of the ankle mortise, about half a cm medial to tibialis anterior. Arthrotomy was done and reduction obtained. Percuntaneously, two 4 mm cancellous cannulated screws were inserted through medial malleolus. Results and conclusion This approach allows direct visualization of reduction, removal of entrapped soft tissue and preservation of saphenous vein and nerve. PMID:25983507

  4. A biomechanical study of the static stabilizing effect of knee braces on medial stability.

    PubMed

    Baker, B E; VanHanswyk, E; Bogosian, S; Werner, F W; Murphy, D

    1987-01-01

    The purpose of this project was to determine if commercially available braces could be shown to produce objective evidence of medial stabilization of the knee. Commercially available athletic braces were evaluated for their effect on abduction forces applied to a cadaver knee with no instability and with experimentally created medial instability. Under computer control, abduction forces were applied while simultaneous data were obtained from an electrogoniometer and transducers applied to the anterior cruciate ligament and the superficial medial collateral ligament at 0 degrees, 15 degrees, and 30 degrees of flexion. Our results showed a reduction in abduction angle using functional braces, whereas prophylactic braces demonstrated little or no protective effect.

  5. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results.

    PubMed

    Bonasia, D E; Bruzzone, M; Dettoni, F; Marmotti, A; Blonna, D; Castoldi, F; Gasparetto, F; D'Elicio, D; Collo, G; Rossi, R

    2012-01-01

    Injuries of the posteromedial corner of the knee are relatively common. These can be isolated or combined with other ligament lesions. In some cases the treatment of postero-medial corner injuries is controversial. After a brief description of the anatomy and biomechanics of the medial side of the knee, this paper reviews the indications for isolated and multiligamentous medial/posteromedial corner injuries both in the acute and in the chronic setting. In addition, the most common surgical techniques for repair and reconstruction are described in addition to outcomes based upon a review of the literature.

  6. Symptomatic Os Subtibiale Associated with Chronic Pain Around the Medial Malleolus in a Young Athlete.

    PubMed

    Iliev, Alexandar A; Georgiev, Georgi P; Landzhov, Boycho V; Slavchev, Svetoslav A; Dimitrova, Iva N; Ovtscharoff, Wladimir А

    2016-03-01

    An os subtibiale is a rare accessory bone located below or behind the medial malleolus. Herein we present a rare case of a painful os subtibiale in a young triathlete who presented with pain, redness and swelling below his left medial malleolus. Plain radiographs and three-dimensional computed tomography revealed a well-defined oval bone distal to the left medial malleolus. After conservative treatment failed, the ossicle was excised in an open surgery with complete resolution of symptoms. This case report emphasizes the need for clinical awareness of different anatomical variations of the bones of the foot.

  7. Proptosis of eyeball in children with medial rectus cysticercosis: report of 2 cases.

    PubMed

    Prasad, Rajniti; Bagri, Narendra; Mishra, Om Prakash; Singh, Mahendra Kumar

    2010-01-01

    To report 2 children with medial rectus cysticercosis presenting as proptosis of eyeball. Case report. In orbital cysticercosis, extraocular muscle cysticercosis is the most common type. Two children, a 12-year-old girl and an 8 year-old boy, presented with proptosis and pain in the left eye. Both were diagnosed with medial rectus cysticercosis based on computed tomographic scan and serologic report and treated with oral albendazole and prednisolone without any residual ocular motility restriction. We report 2 cases of medial rectus muscle enlargement caused by cysticercosis; describe its clinical importance, diagnosis, and treatment; and present a review of the literature.

  8. An animal model of recognition memory and medial temporal lobe amnesia: History and current issues

    PubMed Central

    Clark, Robert E.; Squire, Larry R.

    2010-01-01

    The medial temporal lobe includes a system of anatomically connected structures that are essential for declarative memory (conscious memory for facts and events). A prominent form of declarative memory is recognition memory (the ability to identify a recently encountered item as familiar). Recognition memory has been frequently assessed in humans and in the experimental animal. This article traces the successful development of an animal model of human medial temporal lobe amnesia, which eventually identified the structures in the medial temporal lobe important for memory. Attention is given to two prominent behavioral paradigms (delayed nonmatching to sample and tests of spontaneous novelty preference). PMID:20144894

  9. Effects of aripiprazole and terguride on dopamine synthesis in the dorsal striatum and medial prefrontal cortex of preweanling rats.

    PubMed

    Iñiguez, S D; Cortez, A M; Crawford, C A; McDougall, S A

    2008-01-01

    The purpose of this study was to determine whether aripiprazole, a D2-like partial agonist increasingly prescribed to children, alters DA synthesis via actions at autoreceptors in the dorsal striatum and medial prefrontal cortex (mPFC) of preweanling rats. The ability of dopaminergic agents to alter DOPA accumulation in the striatum and mPFC was measured after NSD-1015 on postnatal day (PD) 20. Dopaminergic tone was manipulated by administering reserpine, gamma-butyrolactone (GBL), or through amphetamine withdrawal. Results showed that the partial agonists aripiprazole and terguride increased striatal DOPA accumulation under normosensitive conditions, but decreased DOPA accumulation in states of low dopaminergic tone. A different pattern of results was observed in the mPFC, because terguride and haloperidol, but not aripiprazole, increased DOPA accumulation under normosensitive conditions. In conclusion, the present data show that aripiprazole affects striatal synthesis modulating autoreceptors in an adult-typical manner during the late preweanling period. Unlike in adult rats, however, the mPFC of preweanling rats appears to contain transitory synthesis modulating autoreceptors that are sensitive to drug manipulation.

  10. Partial disassembly of peroxisomes

    PubMed Central

    1985-01-01

    Rat liver peroxisomes were subjected to a variety of procedures intended to partially disassemble or damage them; the effects were analyzed by recentrifugation into sucrose gradients, enzyme analyses, electron microscopy, and SDS PAGE. Freezing and thawing or mild sonication released some matrix proteins and produced apparently intact peroxisomal "ghosts" with crystalloid cores and some fuzzy fibrillar content. Vigorous sonication broke open the peroxisomes but the membranes remained associated with cores and fibrillar and amorphous matrix material. The density of both ghosts and more severely damaged peroxisomes was approximately 1.23. Pyrophosphate (pH 9) treatment solubilized the fibrillar content, yielding ghosts that were empty except for cores. Some matrix proteins such as catalase and thiolase readily leak from peroxisomes. Other proteins were identified that remain in mechanically damaged peroxisomes but are neither core nor membrane proteins because they can be released by pyrophosphate treatment. These constitute a class of poorly soluble matrix proteins that appear to correspond to the fibrillar material observed morphologically. All of the peroxisomal beta-oxidation enzymes are located in the matrix, but they vary greatly in how easily they leak out. Palmitoyl coenzyme A synthetase is in the membrane, based on its co-distribution with the 22-kilodalton integral membrane polypeptide. PMID:2989301

  11. Partially solidified systems

    NASA Astrophysics Data System (ADS)

    The evolution of magmas is a topic of considerable importance in geology and geophysics because it affects volcanology, igneous petrology, geothermal energy sources, mantle convection, and the thermaland chemical evolution of the earth. The dynamics and evolution of magmas are strongly affected by the presence of solid crystals that occur either in suspension in liquid or as a rigid porous matrix through which liquid magma can percolate. Such systems are physically complex and difficult to model mathematically. Similar physical situations are encountered by metallurgists who study the solidification of molten alloys, and applied mathematicians have long been interested in such moving boundary problems. Clearly, it would be of mutual benefit to bring together scientists, engineers, and mathematicians with a common interest in such systems. Such a meeting is being organized as a North Atlantic Treaty Organization (NATO) Advanced Research Workshop on the Structure and Dynamics of Partially Solidified Systems, to be held at Stanford University's Fallen Leaf Lodge at Tahoe, Calif., May 12-16, 1986 The invited speakers and their topics are

  12. Removable partial denture occlusion.

    PubMed

    Ivanhoe, John R; Plummer, Kevin D

    2004-07-01

    No single occlusal morphology, scheme, or material will successfully treat all patients. Many patients have been treated, both successfully and unsuccessfully, using widely varying theories of occlusion, choices of posterior tooth form, and restorative materials. Therefore, experience has demonstrated that there is no one righ r way to restore the occlusion of all patients. Partially edentulous patients have many and varied needs. Clinicians must understand the healthy physiologic gnathostomatic system and properly diagnose what is or may become pathologic. Henderson [3] stated that the occlusion of the successfully treated patient allows the masticating mechanism to carry out its physiologic functions while the temporomandibular joints, the neuromuscular mechanism, the teeth and their supporting structures remain in a good state of health. Skills in diagnosis and treatment planning are of utmost importance in treating these patients, for whom the clinician's goals are not only an esthetic and functional restoration but also a lasting harmonious state. Perhaps this was best state by DeVan [55] more than 60 years ago in his often-quoted objective. "The patient's fundamental need is the continued meticulous restoration of what is missing, since what is lost is in a sense irretrievably lost." Because it is clear that there is no one method, no one occlusal scheme, or one material that guarantees success for all patients, recommendations for consideration when establishing or reestablishing occlusal schemes have been presented. These recommendations must be used in conjunction with other diagnostic and technical skills.

  13. [Post traumatic partial seizures].

    PubMed

    Carvajal, P; Almárcegui, C; Pablo, M J; Peralta, P; Bernal, M; Valdizán, J R

    Post traumatic epilepsy represents 4% of the prevalence of the disorder and is one of the sequelas which is most difficult to prevent. Risk factors have been described to predict the appearance of seizures. A seven year old boy with a severe head injury was admitted to the Intensive Care Unit. On neuroimaging studies there were multiple foci of contusion, mainly in the left hemisphere, and blood in the III and IV ventricles and frontal horn of the left lateral ventricle. The patient had severe sequelae of head injury with a right spastic hemiplegia and hemiparesia with hypertony of the left side, together with complete blindness of both eyes due to bilateral atrophy of the optic nerve. Serial EEG were done, in which a recording showed alternating periods of hypervoltage grapho elements superimposed on a trace of very low voltage, with continuous activity of low voltage and low frequency. There were no grapho elements with acute morphology. However, the patient had a first partial seizure a year and a half after his head injury. On the EEG an epileptogenic focus was identified in the left hemisphere. Within two years of his head injury he had seven seizures. He had not received prophylactic antiepileptic treatment after the head injury. We report a case of epilepsy secondary to a head injury, in which the first seizure occurred one and a half years after injury. In view of the risk factors, we discuss whether prophylactic anti epileptic treatment might have been beneficial.

  14. [Volumetric measurement and digital electroencephalography in patients with medication-resistant medial temporal lobe epilepsy submitted to surgery].

    PubMed

    Trápaga-Quincoses, O; Morales-Chacon, L M

    To assess the value of volumetric measurement by means of magnetic resonance imaging (MRI) and interictal electroencephalogram (EEG) in pre- and post-operative assessment of patients with medication-resistant medial temporal lobe epilepsy (MTLE) who were submitted to surgery. We evaluated 12 volumetric studies carried out using MRI and 24 digital EEG records for six patients suffering from complex partial seizures that were resistant to medical treatment and had their origin in the temporal lobe. A volumetric analysis was performed using MRI to study the epileptogenic region and the frequencies at which interictal epileptiform discharges (IED/minute) appeared before, at six months and at one year after surgery were calculated; a correlation was observed between the volumetric analysis and the irritative and epileptogenic region. The volumes of both the ipso and contralateral hippocampuses were smaller in comparison to the increased frequency of the IED in the mesial regions. The inferior temporal lobes and the parahippocampal cortex have reduced volumes ipsolateral to the epileptogenic region. At six months after performing the temporal lobectomy, the IED frequency decreased with respect to the pre-operative IED. A negative correlation was found between the resected volume of the parahippocampal cortex and the inferior temporal lobe, and the post-operative IED frequency at one year. In patients with medication resistant MTLE the volumes of other structures in the medial temporal lobe are diminished, in addition to the hippocampus, and they are seen to have a smaller volume on the side that is ipsolateral to the epileptogenic region. There is a relation between the volume of the resected hippocampus and the post-operative IED frequency in patients with MTLE who successfully underwent a temporal lobectomy. Volumetric analysis of the epileptogenic lesion using MRI provides localising information that is valuable in the pre-operative assessment of patients with

  15. Partial breast radiation therapy - external beam

    MedlinePlus

    Carcinoma of the breast - partial radiation therapy; Partial external beam radiation - breast; Intensity-modulated radiation therapy - breast cancer; IMRT - breast cancer WBRT; Adjuvant partial breast - IMRT; APBI - ...

  16. Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study.

    PubMed

    Roussignol, X; Gauthe, R; Rahali, S; Mandereau, C; Courage, O; Duparc, F

    2015-09-01

    Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment opening after pie-crusting release (PCR) of the superficial medial collateral ligament (sMCL) at its distal insertion on the tibia. The secondary objective was to describe the anatomic relationships at the site of PCR (saphenous nerve, medial saphenous vein). We studied 10 cadaver knees with no history of invasive procedures. The femur was held in a vise with the knee flexed at 45°, and the medial aspect of the knee was dissected. PCR of the sMCL was performed under arthroscopic vision, in the anteroposterior direction, at the distal tibial insertion of the sMCL, along the lower edge of the tibial insertion of the semi-tendinosus tendon. Continuous 300-N valgus stress was applied to the ankle. Opening of the medial tibiofemoral compartment was measured arthroscopically using graduated palpation hooks after sequential PCR of the sMCL. The compartment opened by 1mm after release of the anterior third, 2.3mm after release of the anterior two-thirds, and 3.9mm after subtotal release. A femoral fracture occurred in 1 case, after completion of all measurements. Both the saphenous nerve and the medial saphenous vein were located at a distance from the PCR site in all 10 knees. PCR of the sMCL is chiefly described as a ligament-balancing method during total knee arthroplasty. This procedure is usually performed at the joint line, where it opens the compartment by 4-6mm at the most, with some degree of unpredictability. PCR of the sMCL at its distal tibial insertion provides gradual opening of the compartment, to a maximum value similar to that obtained with PCR at the joint space. The lower edge of the semi-tendinosus tendon is a valuable landmark

  17. Removable partial dentures without rests.

    PubMed

    Meinig, D A

    1994-04-01

    Ever since Bonwill recommended the use of rests on removable partial dentures in 1899, rests have been universally considered inviolate and have gone unchallenged and untested. The author claims that removable partial dentures without rests may not cause the adverse conditions usually predicted, such as gingival stripping, gingival inflammation, mutilated residual ridges, or extensive and rapid resorption of the alveolar ridges. In removable partial dentures made by the author for several patients, the residual ridge remained stable and in physiologic equilibrium when rests were not used. A history of the long-term effect on patients wearing partial dentures with and without rests is presented.

  18. Trigonometric Integrals via Partial Fractions

    ERIC Educational Resources Information Center

    Chen, H.; Fulford, M.

    2005-01-01

    Parametric differentiation is used to derive the partial fractions decompositions of certain rational functions. Those decompositions enable us to integrate some new combinations of trigonometric functions.

  19. Trigonometric Integrals via Partial Fractions

    ERIC Educational Resources Information Center

    Chen, H.; Fulford, M.

    2005-01-01

    Parametric differentiation is used to derive the partial fractions decompositions of certain rational functions. Those decompositions enable us to integrate some new combinations of trigonometric functions.

  20. Medial Temporal Lobe Activity Predicts Successful Relational Memory Binding

    PubMed Central

    Hannula, Deborah E.; Ranganath, Charan

    2009-01-01

    Previous neuropsychological findings have implicated medial temporal lobe (MTL) structures in retaining object-location relations over the course of short delays, but MTL effects have not always been reported in neuroimaging investigations with similar short-term memory requirements. Here, we used event-related functional magnetic resonance imaging to test the hypothesis that the hippocampus and related MTL structures support accurate retention of relational memory representations, even across short delays. On every trial, four objects were presented, each in one of nine possible locations of a three-dimensional grid. Participants were to mentally rotate the grid and then maintain the rotated representation in anticipation of a test stimulus: a rendering of the grid, rotated 90° from the original viewpoint. The test stimulus was either a “match” display, in which object-location relations were intact, or a “mismatch” display, in which one object occupied a new, previously unfilled location (mismatch position), or two objects had swapped locations (mismatch swap). Encoding phase activation in anterior and posterior regions of the left hippocampus, and in bilateral perirhinal cortex, predicted subsequent accuracy on the short-term memory decision, as did bilateral posterior hippocampal activity after the test stimulus. Notably, activation in these posterior hippocampal regions was also sensitive to the degree to which object-location bindings were preserved in the test stimulus; activation was greatest for match displays, followed by mismatch-position displays, and finally mismatch-swap displays. These results indicate that the hippocampus and related MTL structures contribute to successful encoding and retrieval of relational information in visual short-term memory. PMID:18171929

  1. Medial frontal white and gray matter contributions to general intelligence.

    PubMed

    Ohtani, Toshiyuki; Nestor, Paul G; Bouix, Sylvain; Saito, Yukiko; Hosokawa, Taiga; Kubicki, Marek

    2014-01-01

    The medial orbitofrontal cortex (mOFC) and rostral anterior cingulate cortex (rACC) are part of a wider neural network that plays an important role in general intelligence and executive function. We used structural brain imaging to quantify magnetic resonance gray matter volume and diffusion tensor white matter integrity of the mOFC-rACC network in 26 healthy participants who also completed neuropsychological tests of intellectual abilities and executive function. Stochastic tractography, the most effective Diffusion Tensor Imaging method for examining white matter connections between adjacent gray matter regions, was employed to assess the integrity of mOFC-rACC pathways. Fractional anisotropy (FA), which reflects the integrity of white matter connections, was calculated. Results indicated that higher intelligence correlated with greater gray matter volumes for both mOFC and rACC, as well as with increased FA for left posterior mOFC-rACC connectivity. Hierarchical regression analyses revealed that DTI-derived FA of left posterior mOFC-rACC uniquely accounted for 29%-34% of the variance in IQ, in comparison to 11%-16% uniquely explained by gray matter volume of the left rACC. Together, left rACC gray matter volume and white matter connectivity between left posterior mOFC and rACC accounted for up to 50% of the variance in general intelligence. This study is to our knowledge the first to examine white matter connectivity between OFC and ACC, two gray matter regions of interests that are very close in physical proximity, and underscores the important independent contributions of variations in rACC gray matter volume and mOFC-rACC white matter connectivity to individual differences in general intelligence.

  2. Medial olivocochlear efferent reflex inhibition of human cochlear nerve responses.

    PubMed

    Lichtenhan, J T; Wilson, U S; Hancock, K E; Guinan, J J

    2016-03-01

    Inhibition of cochlear amplifier gain by the medial olivocochlear (MOC) efferent system has several putative roles: aiding listening in noise, protection against damage from acoustic overexposure, and slowing age-induced hearing loss. The human MOC reflex has been studied almost exclusively by measuring changes in otoacoustic emissions. However, to help understand how the MOC system influences what we hear, it is important to have measurements of the MOC effect on the total output of the organ of Corti, i.e., on cochlear nerve responses that couple sounds to the brain. In this work we measured the inhibition produced by the MOC reflex on the amplitude of cochlear nerve compound action potentials (CAPs) in response to moderate level (52-60 dB peSPL) clicks from five, young, normal hearing, awake, alert, human adults. MOC activity was elicited by 65 dB SPL, contralateral broadband noise (CAS). Using tympanic membrane electrodes, approximately 10 h of data collection were needed from each subject to yield reliable measurements of the MOC reflex inhibition on CAP amplitudes from one click level. The CAS produced a 16% reduction of CAP amplitude, equivalent to a 1.98 dB effective attenuation (averaged over five subjects). Based on previous reports of efferent effects as functions of level and frequency, it is possible that much larger effective attenuations would be observed at lower sound levels or with clicks of higher frequency content. For a preliminary comparison, we also measured MOC reflex inhibition of DPOAEs evoked from the same ears with f2's near 4 kHz. The resulting effective attenuations on DPOAEs were, on average, less than half the effective attenuations on CAPs.

  3. Anatomical segmentation of the human medial prefrontal cortex.

    PubMed

    Córcoles-Parada, M; Müller, Ncj; Ubero, M; Serrano-Del-Pueblo, V M; Mansilla, F; Marcos-Rabal, P; Artacho-Pérula, E; Dresler, M; Insausti, R; Fernández, G; Muñoz-López, M

    2017-03-20

    The medial prefrontal areas 32, 24, 14, and 25 (mPFC) form part of the limbic memory system, but little is known about their functional specialization in humans. To add anatomical precision to structural and functional MRI data, we aimed to identify these mPFC subareas in histological preparations of human brain tissue, determine sulci most consistently related with mPFC areal boundaries, and use these sulci to delineate mPFC areas in MRIs. To achieve this, we obtained 3D MRI data from 11 ex vivo hemispheres and processed them for cyto- and myelo-architectonic analysis. The architectonic boundaries of mPFC areas were identified in histology and cortical surface length and volumes were measured. Unfolded maps of histologically determined boundaries were generated to identify the association of mPFC areal boundaries with sulci across cases. This analysis showed that cingulate and superior rostral were the sulci most consistently related to mPFC areal boundaries. Based on presence/absence and anastomosis between such sulci, 6 sulci patterns in the 11 hemispheres were found. A further analysis of 102 hemispheres of in vivo MRI scans (N=51 males, mean±sd 24.1±3.1 years of age) showed similar sulci patterns, which allowed us to delineate the mFPC areas in them. The volumes of mPFC areas across histological, ex vivo and in vivo MRI delineations were comparable and probabilistic maps generated from the MRIs of the102 hemispheres. Probabilistic maps of mPFC areas were registered to MNI space and are available for regional analysis of fMRI data. This article is protected by copyright. All rights reserved.

  4. Visualization of the medial forebrain bundle using diffusion tensor imaging

    PubMed Central

    Hana, Ardian; Hana, Anisa; Dooms, Georges; Boecher-Schwarz, Hans; Hertel, Frank

    2015-01-01

    Diffusion tensor imaging is a technique that enables physicians the portrayal of white matter tracts in vivo. We used this technique in order to depict the medial forebrain bundle (MFB) in 15 consecutive patients between 2012 and 2015. Men and women of all ages were included. There were six women and nine men. The mean age was 58.6 years (39–77). Nine patients were candidates for an eventual deep brain stimulation. Eight of them suffered from Parkinson‘s disease and one had multiple sclerosis. The remaining six patients suffered from different lesions which were situated in the frontal lobe. These were 2 metastasis, 2 meningiomas, 1 cerebral bleeding, and 1 glioblastoma. We used a 3DT1-sequence for the navigation. Furthermore T2- and DTI- sequences were performed. The FOV was 200 × 200 mm2, slice thickness 2 mm, and an acquisition matrix of 96 × 96 yielding nearly isotropic voxels of 2 × 2 × 2 mm. 3-Tesla-MRI was carried out strictly axial using 32 gradient directions and one b0-image. We used Echo-Planar-Imaging (EPI) and ASSET parallel imaging with an acceleration factor of 2. b-value was 800 s/mm2. The maximal angle was 50°. Additional scanning time was < 9 min. We were able to visualize the MFB in 12 of our patients bilaterally and in the remaining three patients we depicted the MFB on one side. It was the contralateral side of the lesion. These were 2 meningiomas and one metastasis. Portrayal of the MFB is possible for everyday routine for neurosurgical interventions. As part of the reward circuitry it might be of substantial importance for neurosurgeons during deep brain stimulation in patients with psychiatric disorders. Surgery in this part of the brain should always take the preservation of this white matter tract into account. PMID:26581828

  5. Cellular components of the human medial amygdaloid nucleus.

    PubMed

    Dall'Oglio, Aline; Xavier, Léder L; Hilbig, Arlete; Ferme, Denise; Moreira, Jorge E; Achaval, Matilde; Rasia-Filho, Alberto A

    2013-02-15

    The medial nucleus (Me) is a superficial component of the amygdaloid complex. Here we assessed the density and morphology of the neurons and glial cells, the glial fibrillary acidic protein (GFAP) immunoreactivity, and the ultrastructure of the synaptic sites in the human Me. The optical fractionator method was applied. The Me presented an estimated mean neuronal density of 1.53 × 10⁵ neurons/mm³ (greater in the left hemisphere), more glia (72% of all cells) than neurons, and a nonneuronal:neuronal ratio of 2.7. Golgi-impregnated neurons had round or ovoid, fusiform, angular, and polygonal cell bodies (10-30 μm in diameter). The length of the dendrites varied, and pleomorphic spines were found in sparsely spiny or densely spiny cells (1.5-5.2 spines/dendritic μm). The axons in the Me neuropil were fine or coarsely beaded, and fibers showed simple or notably complex collateral terminations. The protoplasmic astrocytes were either isolated or formed small clusters and showed GFAP-immunoreactive cell bodies and multiple branches. Furthermore, we identified both asymmetrical (with various small, clear, round, electron-lucent vesicles and, occasionally, large, dense-core vesicles) and symmetrical (with small, flattened vesicles) axodendritic contacts, also including multisynaptic spines. The astrocytes surround and may compose tripartite or tetrapartite synapses, the latter including the extracellular matrix between the pre- and the postsynaptic elements. Interestingly, the terminal axons exhibited a glomerular-like structure with various asymmetrical contacts. These new morphological data on the cellular population and synaptic complexity of the human Me can contribute to our knowledge of its role in health and pathological conditions.