Accessory Plantaris Muscle: Anatomy and Prevalence

Accessory and anomalous muscles have been described in humans, but only a few at the level of the knee. The aim of this retrospective cohort analysis was to determine the prevalence of a new accessory muscle located at the level of the knee detected with magnetic resonance imaging (MRI). The accessory muscle is designated an accessory plantaris muscle in this study due to its intimate origin with the normal plantaris muscle. Retrospective review of 1,000 consecutive MRI exams of the knee performed on patients presenting with acute or chronic knee symptoms revealed an accessory plantaris muscle in 63 of the 1,000 patients (6.3%)—38 males (7.5%) and 25 females (5.1%). Origin of 62 of 63 of the accessory plantaris muscles merged with the origin of the normal plantaris muscle, and one of 63 merged with the origin of the lateral head of the gastrocnemius muscle. These accessory plantaris muscles inserted into the iliotibial band, the lateral patellar retinaculum, or the iliotibial tract.     

Variability in the position of the retropharyngeal internal carotid artery

The retropharyngeal internal carotid artery (ICA) is a well‐described arterial anomaly with important implications for patients undergoing pharyngeal approach surgical procedures. Existing clinical and imaging classification schemes for a retropharyngeal ICA take into account arterial distance to the pharyngeal mucosal wall. We describe a case of mobility of a retropharyngeal ICA between short‐interval imaging studies. The possibility of respiratory variability or other etiologies causing such changes in retropharyngeal carotid position have not been described previously. Our findings suggest that imaging findings from a single study alone may not be sufficient to confidently exclude this clinically significant arterial anomaly.     

Functional independence score in hemophilia: A cross‐sectional study assessment of Mexican children

Background

The Functional Independence Score in Hemophilia (FISH) is a performance‐based assessment tool used to measure the patients functional ability so far only used in patients with severe hemophilia. Its aim is to determine if FISH is useful in patients with mild and moderate disease.

Procedure

In a cross‐sectional study 90 children 60 hemophilic and 30 sex‐, race‐, and age‐matched healthy males were assessed. Patients between 5 and 16 years of age were selected each patient was evaluated in seven activities under three categories: self‐care (grooming and eating, bathing, and dressing), transfers (chair and squat), and locomotion (walking and step climbing). Each activity was graded from 1 to 4 according to the amount of assistance required to perform the activity with total scores ranging from 7 to 28.

Results

As a whole, the mean age of the patients was 10.0 ± 3.4 years with a mean FISH of 25.8 ± 3.6 (range 15–28). There were no differences in the FISH between healthy males and patients with mild hemophilia; however, the score was significantly higher in patients with mild hemophilia (28 ± 0) than patients with moderate (26.2 ± 2.5; P = 0.004) or severe hemophilia (24.0 ± 4.7; P = 0.0006). The most affected activities were squatting, walking, and step climbing.

Conclusions

A significant decrease in functional ability was demonstrated according to the severity of hemophilia, especially for those activities involving weight‐bearing demands like locomotion and step climbing. Of seven activities evaluated, changes were observed in the group with moderate and severe hemophilia, but no changes detected in patients with mild disease. Pediatr Blood Cancer 2010;54:394–397. © 2009 Wiley‐Liss, Inc.     

Radiotherapy Options for Localized Prostate Cancer Based Upon Pretreatment Serum Prostate-Specific Antigen Levels and Biochemical Control: A Comprehensive Review of the Literature

Purpose: To review all the available radiotherapy (RT) literature on localized prostate cancer treatment where serum prostate-specific antigen (PSA) levels were used to both stratify patients and evaluate outcome and determine if any conclusions can be reached regarding an optimal radiotherapeutic management for this disease.

Methods and Materials: A MEDLINE search was conducted to obtain all articles in English on prostate cancer treatment employing RT from 1986–1997. Studies were considered eligible for review only if they met all the following criteria: 1) pretreatment PSA values were recorded and grouped for subsequent evaluation, 2) posttreatment PSA values were continuously monitored, 3) definitions of biochemical control were stated, and 4) the median follow-up was given.

Results: Of the 246 articles identified, only 20 met the inclusion criteria; 4 using conformal external beam RT, 8 using conventional external beam RT, and 8 using interstitial brachytherapy (4 using a permanent implant alone, 3 combining external beam RT with a permanent implant, and 1 combining a conformal temporary interstitial implant boost with external beam RT). No studies using neutrons (with or without external beam RT) or androgen deprivation (combined with external beam RT) were identified where patients were stratified by pretreatment PSA levels. Results for all therapies were extremely variable with the 3–5-year rates of biochemical control for patients with pretreatment PSA levels ≤4 ng/ml ranging from 48 to 100%, for PSA levels >4 and ≤10 ng/ml ranging from 44 to 90%, for PSA levels >10 and ≤20 ng/ml ranging from 27 to 89%, and for PSA levels >20 ranging from 14 to 89%. The median Gleason score, T-stage, definition of biochemical control, and follow-up were substantially different from series to series. No RT option consistently produced superior results.

Conclusions: When data are reviewed from studies using serum PSA levels to stratify patients and to evaluate treatment outcome, no consistently superior RT technique was identified. These data suggest that standard definitions of disease stage (combining clinical, pathologic, and biochemical criteria) and a common definition of biochemical cure (as developed by the American Society for Therapeutic Radiology and Oncology Consensus Panel) need to be adopted to evaluate treatment efficacy and advise patients on the most appropriate radiotherapeutic option for their disease.