Rotational Instability after Anterior Talofibular and Calcaneofibular Ligament Section: The Experimental Basis for the Ankle Pivot Test

The clinical diagnosis of the anterior talofibular ligament (ATFL) rupture is based on the findings from the medical history and the anterior drawer test, a maneuver that allegedly pushes the talus and rearfoot anteriorly, although with great variability in its sensitivity. We consider that an ATFL rupture is best evaluated by a rotational vector (i.e., a pivot test) owing to the uncompromised medial ligaments that will block any pure anterior translation of the talus underneath the tibia. We idealized a constrained ankle cadaver model that only allows talar movements in the axial plane. Our hypothesis was that progressive sectioning of the lateral ankle ligaments in this model would cause a progressive and significant angular laxity in internal rotation. Our results showed 3.67 degrees ± 1.2 degrees of talus rotational laxity in the intact ankle, 9.6 degrees ± 3.2 degrees after ATFL sectioning, and 13.43 degrees ± 3.2 degrees after ATFL and calcaneofibular ligament sectioning, indicating almost threefold increase in internal talocrural rotation after single ATFL sectioning and an almost fourfold increase after double (ATFL and calcaneofibular ligament) sectioning. We consider this evidence of rotational ankle laxity to be a major step in defining the correct movement to diagnose an ATFL rupture and propose a new term to avoid further inconsistencies and variability, “the pivot test.”     

Comparison of symptomatic unstable ankle with and without os subfibulare

BackgroundThis study aimed to compare the patients background, clinical scores, condition of the lateral ligament, mechanical instabilities, and chondral lesions in ankles with symptomatic os subfibulare compared to those in ankles with chronic lateral instability without os subfibulare.MethodsOf the 212 ankles with a chronic lateral instability that were surgically treated, 72 ankles had an os subfibulare. All ankles were examined by arthroscopy during surgery. Age, sex, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Scale scores, remnant condition of the lateral ligaments, and chondral lesions were compared between ankles with symptomatic os subfibulare and ankles with chronic lateral instability without os subfibulare.ResultsThere were no statistically significant differences between the groups in terms of the sex ratio (males: females, 35:37 vs. 53:87, n.s.) and the AOFAS Ankle–Hindfoot Scale scores (median; 75 vs. 77, n.s.). There were statistically significant differences in patient age (median: 20 vs. 24.5 years, p < 0.01), talar tilt angle (median: 9.0° vs 12.0°, p < 0.01), anterior drawer distance (6.2 vs. 7.0 mm, p < 0.01), chondral lesions (G0:G1:G2:G3, 35:21:66:5 vs. 40:44:27:29, p < 0.01), condition of the anterior talofibular ligament (intact: repairable remnant: poor remnant, 0:70:2 vs. 1:112:27, p < 0.01), and condition of the calcaneofibular ligament (intact: repairable remnant: poor remnant, 44:26:2 vs. 77:35:28, p < 0.01) between the groups.ConclusionThis study suggests that the condition of the lateral ligaments including mechanical instability and cartilage of the ankle were less severe in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The patients’ age was lower in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The clinical scores and gender ratio were not statistically different between the group.     

Anterior superior iliac spine distraction for severe and recalcitrant diabetic foot ulcers

PurposeThe study aimed to introduce anterior superior iliac spine distraction to treat severe and recalcitrant diabetic foot ulcers. For comparison, we also included another group of diabetic foot ulcers treated with proximal tibial cortex transverse distraction.MethodsFrom February 1998 to February 2020, 87 patients (87 feet) with severe and recalcitrant diabetic foot ulcers were treated. The mean age of patients at surgery was 64 years (range, 47 to 87 years). The severity of the narrowed artery was assessed using the ankle-brachial index test. For comparison, another group of 91 patients (91 diabetic foot ulcers) treated with proximal tibial cortex transverse distraction was included.ResultsThe mean preoperative ankle-brachial indexes of the two groups were 0.41±0.07 and 0.39±0.05 (OR 0.65 [95% CI -0.77 to 1.58]; P=0.62), respectively. The mean preoperative limb pain was 3.42±2.84 cm and 3.52±3.11 cm (OR 1.54 [95% CI -077 to 1.35]; P=0.083), respectively. At the 2-year follow-up visit, ulcers healed in 72 (83%) and 74 (81%) patients, respectively (P=0.188). The mean postoperative limb pain was 0.52±0.23 cm and 0.49±0.41 cm (OR 2.32 [95% CI -0.27 to 1.66]; P=0.078), respectively. Pin-site infection occurred in 2 patients and 8 patients (P=0.09), respectively. Ulcer recurrence occurred in 13 (15%) patients and 15 (16%) patients (P=0.205), respectively.ConclusionsAnterior superior iliac spine transverse distraction may be an effective alternative treatment for severe and recalcitrant diabetic foot ulcers. It may be associated with fewer distraction-site complications than proximal tibial cortex transverse distraction.Level of evidenceTherapeutic study, Level IIa.     

Lateral ventricular liponeurocytoma: Review of literature and case illustration

BackgroundLiponeurocytoma is an uncommon tumor of the central nervous system. It is very rare for this tumor to originate within the lateral ventricle. In the context of the rarity of this tumor entity, this review article aims to summarize the clinical, radiological, and pathological features of lateral ventricular liponeurocytoma to facilitate its diagnosis and management.MethodsHere, we conduct a systematic literature review using the Pubmed, Scopus, and Cochrane Library database for all cases of lateral ventricular liponeurocytoma. A case illustration complements this review.ResultsThe described cases from 1997 onward include 14 cases that have been published in full papers in the English literature. Six additional cases are reported in short English abstracts in full non-English papers, and one case was described in a central neurocytoma report. There is a definite male predominance of 70% (14 male) and a mean age of 37 years (range 24–62). Heterogenous enhancement and signals in magnetic resonant images (MRI) are the radiological characteristics. In all reported cases, the presence of lipocytes and fat vacuoles is considered the paramount histopathological feature. Total surgical resection was achieved in 80% (12 out of 15) of the cases. Only two cases (including ours) received radiation therapy. Recurrence was seen in two patients during follow-up that was treated by radiation therapy in one and surgery in the other. The proliferation index is mostly below 5% in all cases, with the Ki-67 range between < 1% to 10%.ConclusionsLateral ventricular liponeurocytoma has been treated effectively by surgical resection in a limited number of cases. The decision for radiation therapy is based on a high proliferation index and tumor recurrence.     

Difference in Survival in Early Kidney after Liver Transplantation Compared with Simultaneous Liver-Kidney Transplantation: Evaluating the Potential of the “Safety Net”

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Comparison of clinical efficacy between retention and removal of the vertebral bony endplate in anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy

BackgroundAnterior cervical discectomy and fusion (ACDF) have a history of more than 60 years to treat cervical spondylotic myelopathy. This study is based on the original classic surgical procedure to remove the bony endplate to expand the range of vertical decompression to analyze and compare the clinical efficacy of two different ACDF in treating cervical spondylotic myelopathy.MethodsThe inpatients in hospital were randomly divided into two groups A and B. Patients in Group A received ACDF surgery with bony endplates preserved, and patients in group B received ACDF surgery with bony endplates removed. All patients were followed-up for three years, and then compared the clinical efficacy from the following aspects, blood loss statistics during and after the operation, Japanese Orthopedic Association's scoring (JOA) standard for cervical spondylotic myelopathy, Cervical curvature index, cervical flexion and extension range, intervertebral bone graft fusion time and fusion rate.Results1. The operative time and intraoperative (postoperative) blood loss in group A were significantly better than that in group B, with statistical significance (P < 0.05)0.2. There was no significant difference in postoperative neurological function recovery, cervical curvature index, cervical flexion and extension activity, and Intervertebral fusion time between two groups (P > 0.05), while group A was superior to group B in terms of bone graft fusion rate (P < 0.05). 3. Four patients (6.7%) in group B suffered from dyspnea due to neck hematoma caused by drainage tube blockage, but all of them were cured immediately and no death occurred.ConclusionsDuring the 3-year follow-up period after the operation, six patients in group B have subsidence and loosening of the internal fixator due to bone subsidence around the implant. Although immediate surgical treatment is not required, renovation surgery is inevitable in the long term.     

Novel Chimeric Immuno-Oncolytic Virus CF33-hNIS-antiPDL1 for the Treatment of Pancreatic Cancer

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Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department

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Association Between the Economic Environment and the Living Organ Donation Rate: Evidence and Implications

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Comparison of conventional magnetic resonance imaging and diffusion-weighted imaging in the differentiation of bone plasmacytoma from bone metastasis in the extremities

PurposeTo compare conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the differentiation of bone plasmacytoma from bone metastasis in the extremities.Materials and methodsA total of 65 patients with 27 bone plasmacytomas (11 men; mean age, 63.6 ± 8.2 [SD] years) and 38 patients with bone metastases (20 men; mean age, 64.1 ± 11.5 [SD] years) were retrospectively included. Plasmacytomas and metastases were compared for size, peritumoral edema, signal intensity (SI), SI pattern, apparent diffusion coefficient (ADC) values and standard deviation (SD) of ADC. Receiver operating characteristic analysis with area under the curve (AUC) was used to calculate sensitivity, specificity, and accuracy of MRI and DWI for the diagnosis of plasmacytoma according to a defined cut-off value.ResultsOn conventional MRI, plasmacytomas showed less peritumoral edema (22% vs. 71%; P < 0.001), were more often hyperintense on T1-weighted image (48% vs. 18%; P = 0.022) and more homogeneous on T2-weighted image (78% vs. 26%; P < 0.001) and contrast-enhanced T1-weighted images (70% vs. 25%; P = 0.001) than bone metastases. Mean ADC value and SD of ADC were significantly lower in bone plasmacytomas (760.1 ± 196.9 [SD] μm²/s and 161.5 ± 62.7 [SD], respectively) than in bone metastases (1214.2 ± 382.6 [SD] μm²/s and 277.0 ± 110.3 [SD], respectively) (P < 0.001). Using an ADC value ≤ 908.3 μm²/s, DWI yielded 88% sensitivity and 78% specificity for the diagnosis of plasmacytoma. ADC value yielded best area under the curve (AUC = 0.913), followed by SD of ADC (AUC = 0.814) and homogeneity on T2-weighted images (AUC = 0.757). The combination of conventional MRI and DWI (AUC = 0.894) showed improved diagnostic performance over conventional MRI alone (AUC= 0.843) for discriminating between plasmacytoma and metastasis.ConclusionConventional MRI in combination with DWI can be useful to discriminate between bone plasmacytoma and bone metastasis in the extremities.     

Population-Based Analysis of Hepatocellular Carcinoma in Children: Identifying Optimal Surgical Treatment

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Adding Supra-Aortic Trunk Surgical Reconstruction to Carotid Endarterectomy: Implications on Risk of Stroke and Death

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Outcomes of Vascularized Lymph Node Transplantation for Treatment of Lymphedema

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Instability of the extensor digitorum tendons in Jaccoud arthropathy assessed by semi-dynamic MRI of the metacarpophalangeal joints

PurposeThe purpose of this study was to test the hypothesis that Jaccoud arthropathy (JA) in patients with systemic lupus erythematosus (SLE) is associated with instability of the extensor digitorum (ED) tendons during flexion of the metacarpophalangeal (MCP) joints by comparing the position of the ED tendons between SLE patients with JA and control subjects on hand MRI obtained with flexed and extended MCP joints.Materials and methodsThirty-two hands of SLE patients with JA (13 women and 3 men; mean age, 50.0 ± 12.2 [SD] years; age range: 26–68 years) and 24 hands of sex- and age-matched control subjects (20 women and 4 men; mean age, 50.1 ± 13.0 [SD] years; age range: 24–68 years) were included in the study. Axial spin echo T1-weighted MRI images of the second to fifth MCP joints in flexion and in extension were obtained. Two radiologists (R1 and R2) separately measured the amplitude and assessed the direction of the displacement of the ED tendons with respect to the midline at the level of each MCP joint. Statistical analysis included two-way ANOVA with random effects to assess differences in amplitude and Fisher–Freeman–Halton exact test to assess differences in direction with P-values < 0.0083 and < 0.0063 considered as statistically significant respectively.ResultsAmplitude of the displacement of the ED tendons was statistically significantly greater in SLE patients with JA than in control subjects in flexion for both readers (median 58°, 95% confidence interval [CI]: 50°–65° vs. 20°, 95% CI: 16°–24°; P < 0.0001 for R1 and 54°, 95% CI: 47°–61° vs. 25°, 95% CI: 22°–28°; P < 0.0001 for R2) and in extension for one reader (17°, 95% CI: 15°–20° vs. 14°, 95% CI: 11°–16°; P = 0.0048 for R1 and 20°, 95% CI: 15°–25° vs. 16°, 95% CI: 12°–18°; P = 0.0292 for R2). Ulnar deviation of the ED tendons was statistically significantly more frequent in SLE patients with JA than in control subjects in flexion and in extension for both readers (P < 0.0001).ConclusionJA is associated with instability of the ED tendons in patients with SLE best depicted when MCP joints are flexed.     

Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy

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