Weight-Bearing Radiographic Analysis of the Tibiofibular Syndesmosis

2018 ◽  
Vol 12 (3) ◽  
pp. 211-217 ◽  
Author(s):  
Arsalan Amin ◽  
Cory Janney ◽  
Christopher Sheu ◽  
Daniel C. Jupiter ◽  
Vinod K. Panchbhavi
Keyword(s):  
Weight Bearing ◽  
Intraclass Correlation ◽  
Radiographic Evaluation ◽  
Tibiofibular Syndesmosis ◽  
Female Patients ◽  
Tibial Plafond ◽  
Significant Difference ◽  
Anteroposterior View ◽  
Male Patients ◽  
Orthopaedic Training

Background: Diagnosis of distal tibiofibular syndesmotic injuries includes assessment of radiographs; however, there exist no agreed on standard diagnostic criteria. Previous studies lack consistency with radiographic evaluation methods. The dynamic nature of the ankle joint supports analyzing anatomical parameters using weight-bearing films to assess for tibiofibular syndesmotic integrity. Methods: Weight-bearing tibiofibular syndesmosis radiographs of 39 male and 40 female patients were retrospectively analyzed by 3 investigators, at different levels of orthopaedic training. Measurements 1 cm above the tibial plafond for the anterior tibiofibular overlap (TFO) and tibiofibular clear space (TCS) were recorded and standardized by the fibular width (FW) at 2 time points. Data were compared to check for agreement between the sets of measurements for each rater and agreement between investigators, and to ascertain underlying gender differences. Results: There was good intraobserver correlation (intraclass correlation coefficient [ICC] > 0.90) among investigators for each parameter. A significant difference in the TFO was noted between genders (P < .05). We establish the following radiographic (anteroposterior view) parameters for an intact syndesmosis: male patients, TCS <4.57 mm or TCS/FW <29% and TFO >9.29 mm or TFO/FW > 57%; female patients, TCS <4.28 mm or TCS/FW <30% and TFO >7.41 mm or TFO/FW >51%. Conclusions: Our study provides a more objective approach by utilizing weight-bearing radiographs and performing all measurements 1 cm above the tibial plafond. Levels of Evidence: Level IV

Clinical Outcomes for “Suspicious” Category in Thyroid Fine-Needle Aspiration Biopsy: Patient's Sex and Nodule Size Are Possible Predictors of Malignancy

2009 ◽  
Vol 133 (5) ◽  
pp. 787-790
Author(s):  
Kirtee Raparia ◽  
Soo Kee Min ◽  
Dina R. Mody ◽  
Rose Anton ◽  
Mojgan Amrikachi
Keyword(s):  
Surgical Resection ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Cytologic Diagnosis ◽  
Fine Needle ◽  
Female Patients ◽  
Hürthle Cell ◽  
Significant Difference ◽  
Cell Neoplasm ◽  
Male Patients

Abstract Context.—Fine-needle aspiration (FNA) is recommended as an initial screening tool for the diagnosis of thyroid nodules. Approximately 10% of thyroid FNA diagnoses are “suspicious for neoplasm,” warranting surgical resection. Objectives.—To examine the role of a patient's age, sex, size of nodule, and morphologic features as possible predictors of malignancy in patients with cytologic diagnosis of “suspicious for neoplasm.” Design.—Cytopathology slides and reports of 402 consecutive thyroid FNAs from 2000–2005 interpreted as “suspicious” were reviewed. Of these, 180 cases that had subsequent surgical resection were selected. Results.—Of the 108 cases suspicious for follicular neoplasm on cytologic evaluation, histologic follow-up showed malignancy in 26 (24%). Of the 37 cases suspicious for Hürthle cell neoplasm, 15 (41%) had malignancy. Of the 35 cases suspicious for malignancy, 29 had malignant histologic diagnoses. Among cases with cytologic diagnoses of “suspicious for follicular or Hürthle cell neoplasm,” the rate of malignancy in female patients was 22% as compared to 43% in male patients (P = .02). The rate of malignancy in nodules less than 2 cm was 19% compared to 47% in nodules measuring 2 cm or larger (P &lt; .001). These differences were statistically significant. No statistically significant difference was noted between the age of the patient and the rate of benign versus malignant diagnosis. Conclusions.—Malignant tumors were more frequent in male patients with a cytologic diagnosis of “suspicious for follicular or Hürthle cell neoplasm” than in female patients. Risk of malignancy was higher in nodules measuring 2 cm or larger. Age of the patient was not a predictor of malignancy.

scholarly journals Gender and Quality of Life After Cerebral Stroke

2010 ◽  
Vol 10 (2) ◽  
pp. 94-99 ◽  
Author(s):  
Amra Zalihić ◽  
Vedran Markotić ◽  
Dino Zalihić ◽  
Mirela Mabić
Keyword(s):  
Quality Of Life ◽  
Life Quality ◽  
Female Gender ◽  
Cerebral Stroke ◽  
Female Patients ◽  
Negative Prognostic Factor ◽  
Significant Difference ◽  
Medium Range ◽  
Male Patients

The aim of this work is to investigate the influence of gender on recovery after cerebral stroke.It is believed that functional outcome of cerebral stroke (CS) depends on gender. Female gender is mildly negative prognostic factor in after stroke results. Two hundred and two patients who had first ischemic cerebral stroke were questioned with help of, HADS and WHOQOL-Bref questionnaires, looking for differences in recovery depending on gender. Average patients' age was 72+/-13 (ME+/-IR) years. The youngest patient had 40 years, and the oldest 92 years, and medium range was 52 years. There were 112 males and 90 females. Quality of life was equally graded by both male and female after CS (p=0.208). Male patients had significantly better results in physical (p=0.035) and psychological (p=0.020) domain of life quality. After CS, male patients had better results only in memory dimension (p=0.003). Anxiety was statistically more frequent among female patients (p=0.009). Gender did not influence frequency of metabolic syndrome in patients with CS. Quality of life after CS was better in male patients, and statistically significant difference has been shown in physical, psychological domain and memory dimension. Female patients were more anxious then male after CS.

Subanalysis of the StiL NHL 1–2003 Study: Achievement of Complete Response with Bendamustine-Rituximab (B-R) and CHOP-R in the First-Line Treatment of Indolent and Mantle Cell Lymphomas Results in Superior Survival Compared to Partial Response.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2724-2724 ◽  
Author(s):  
Mathias J. Rummel ◽  
Norbert Niederle ◽  
Georg Maschmeyer ◽  
G.-Andre Banat ◽  
Ulrich von Grünhagen ◽  
...  
Keyword(s):  
Complete Response ◽  
Line Treatment ◽  
First Line ◽  
Female Patients ◽  
Significant Difference ◽  
Mantle Cell ◽  
Male Patients ◽  
The Impact ◽  
First Line Treatment

Abstract Abstract 2724 Background: The NHL 1 study, a prospective, multicenter, randomized, phase 3 study which compared B-R and CHOP-R as first-line treatment in indolent lymphomas and mantle cell lymphoma (MCL), demonstrated a significant benefit in progression-free survival (PFS) as well as improved tolerability for B-R compared with CHOP-R. Here we present an analysis of the impact of response quality on outcome. Methods: 514 patients (pts) with indolent or MCL were randomized to receive B-R or CHOP-R for a maximum of 6 cycles. Results: The overall response rate in the 514 pts (261 B-R; 253 CHOP-R) was 92.7% and 91.3% in the B-R and CHOP-R arms, respectively (as presented at the last ASCO meeting, J Clin Oncol 30, 2012 (suppl; abstr 3). A complete response (CR) was observed in 39.8% in the B-R arm and in 30% in the CHOP-R arm (p=0.021). The achievement of CR was associated with a significantly prolonged PFS and overall survival (OS) (Table 1). Analysis by treatment arm revealed a trend for superior PFS and a significantly improved OS for patients achieving CR following treatment with B-R. In the CHOP-R arm, patients in CR had a significantly superior PFS compared to those in PR with a trend to superior OS. Regardless of the quality of response, PFS was superior with B-R versus CHOP-R: For patients in CR, the median PFS was not reached with B-R, whereas for CHOP-R it was 53.7 months (p=0.0204). In patients achieving PR, treatment with B-R resulted in a median PFS of 57.2 months, and this was 30.9 months with CHOP-R (p=0.0002). We noted a statistically significant difference in CR rates between male (n=272, median age 63 years) and female (n=242, median age 64 years) patients. The CR rate was 28.6% in male patients and 42.1% in female patients (p=0.0016). Female patients had a longer median PFS (51.4 months) compared to male patients (38.6 months), however, this difference was not statistically significant (p=0.0866). Conclusions: Patients in CR following first-line treatment in our study had a significantly longer PFS and OS compared to those achieving a PR. Therefore, our results strongly suggest an association between quality of response and outcome. Disclosures: No relevant conflicts of interest to declare.

scholarly journals PARATHYROID HORMONE AND BIOCHEMICAL METABOLIC BONE MARKERS IN PATIENTS WITH β-THALASSEMIA MAJOR IN MISAN PROVINCE / IRAQ

2020 ◽  
Vol 17 (35) ◽  
pp. 65-72
Author(s):  
Noor AL-Huda Salah AL-ZUHAIRY ◽  
Zainab Abdul Jabbar Ridha AL-ALI
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Thalassemia Major ◽  
Control Group ◽  
Female Patients ◽  
Metabolic Bone ◽  
Significant Difference ◽  
Calcium Phosphorus ◽  
Male Patients ◽  
Serum Pth

Beta-thalassemia is a heterogeneous group of hereditary blood disorders characterized by defects in the synthesis of the β- chains of hemoglobin, resulting in variable phenotypes ranging from severe anemia to clinically asymptomatic individuals. This study aims to assess the serum PTH, vitamin D, calcium, phosphorus, alkaline phosphatase, and magnesium levels in β-thalassemia major patients. A total of 50 (30 male and 20 female) patients with β- thalassemia major with ages range 11- 16 years and an equal number of sex-matched healthy adolescents as a control group were included in this study. A total of 52% of patients were lived in an urban area, and there was no significant difference between patients and the control group regarding residency. Male patients showed low statistically significant (P 0.05) mean serum PTH, vitamin D, and calcium levels, but mean serum phosphorus and alkaline phosphatase levels were significantly higher (P 0.05) as compared to the male control group. However, female patients had low, but without statistical significant (P>0.05) mean serum PTH level, whereas vitamin D and calcium levels were highly significant (P 0.05) reduced. The phosphorus and ALP levels were highly significantly (P 0.05) increased as compared to female controls. Regarding β- thalassemia major group, the current study showed male patients had non-significant (P 0.05) higher levels of PTH, calcium, phosphorus, and ALP. In contrast, vitamin D level was non-significantly (P 0.05) low in male patients as compared to female patients. Mean serum level of PTH had a negative correlation with phosphorus, but it had a positive association with vitamin D, calcium, ALP, and magnesium. In conclusion, this study demonstrated that β-thalassemia major patients have a markedly deranged biochemical metabolic bone profile. Regular monitoring of PTH and biochemical mineral profile is also recommended.

Investigation of Biliary Canal Variations as a Cause of Stone Formation in the Choledochal Canal

2020 ◽  
Vol 2 (2) ◽  
pp. 77-85
Author(s):  
Yusuf Atakan Baltrak ◽  
M. Sabri Medişoğlu ◽  
Çolak Tuncay ◽  
Yalnız Ahmet ◽  
Çam İsa ◽  
...  
Keyword(s):  
Gall Bladder ◽  
Surgical Procedures ◽  
Stone Formation ◽  
Age Group ◽  
Female Patients ◽  
Duct Diameter ◽  
Significant Difference ◽  
Group A ◽  
Male Patients ◽  
Choledochal Duct

The present study aimed to investigate if there is an association between the diameter of the choledochal duct and choledochal duct stone formation. The present study consisted of 79 patients who had endoscopic interventions and MRCP procedure with surgery history. Some followed due to disorders of the liver, gall bladder, and biliary tract and some of whom presented hepatobiliary complaints between 2017 and 2019. The choledochal duct diameter measured from MRCP images and choledochal duct stone had examined; the type classified according to Huang classification. Among the cases classified, 29 patients, was Huang Type A1, 27 patients were Huang Type A2, 16 patients were Huang Type A3, and seven patients were Huang Type A4. There was not any statistically significant association in terms of choledochal diameter regarding the types. Choledochal duct diameter was statistically higher in female patients than male patients (p<0.05). According to the age group, a statistically significant difference detected for choledochal duct stone formation; individuals over 45 years of age present an increase for choledochal duct stone (p<0.05). The choledochal duct diameter was found higher in female patients compared with male patients; stone formation has found increased in both gender over 45 years of age. It should consider before surgical procedures and radiological tests.

Defining reference values for the normal tibiofibular syndesmosis in adults using weight-bearing CT

2019 ◽  
Vol 101-B (3) ◽  
pp. 348-352 ◽  
Author(s):  
S. Patel ◽  
K. Malhotra ◽  
N. P. Cullen ◽  
D. Singh ◽  
A. J. Goldberg ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Weight Bearing ◽  
Cone Beam ◽  
Syndesmotic Injury ◽  
Tibiofibular Syndesmosis ◽  
Cross Sectional ◽  
Female Patients ◽  
Normal Ranges ◽  
Anteroposterior Translation ◽  
The Mean

Aims Cone beam CT allows cross-sectional imaging of the tibiofibular syndesmosis while the patient bears weight. This may facilitate more accurate and reliable investigation of injuries to, and reconstruction of, the syndesmosis but normal ranges of measurements are required first. The purpose of this study was to establish: 1) the normal reference measurements of the syndesmosis; 2) if side-to-side variations exist in syndesmotic anatomy; 3) if age affects syndesmotic anatomy; and 4) if the syndesmotic anatomy differs between male and female patients in weight-bearing cone beam CT views. Patients and Methods A retrospective analysis was undertaken of 50 male and 50 female patients (200 feet) aged 18 years or more, who underwent bilateral, simultaneous imaging of their lower legs while standing in an upright, weight-bearing position in a pedCAT machine between June 2013 and July 2017. At the time of imaging, the mean age of male patients was 47.1 years (18 to 72) and the mean age of female patients was 57.8 years (18 to 83). We employed a previously described technique to obtain six lengths and one angle, as well as calculating three further measurements, to provide information on the relationship between the fibula and tibia with respect to translation and rotation. Results The upper limit of lateral translation in un-injured patients was 5.27 mm, so values higher than this may be indicative of syndesmotic injury. Anteroposterior translation lay within the ranges 0.31 mm to 2.59 mm, and -1.48 mm to 3.44 mm, respectively. There was no difference between right and left legs. Increasing age was associated with a reduction in lateral translation. The fibulae of men were significantly more laterally translated but data were inconsistent for rotation and anteroposterior translation. Conclusion We have established normal ranges for measurements in cross-sectional syndesmotic anatomy during weight-bearing and also established that no differences exist between right and left legs in patients without syndesmotic injury. Age and gender do, however, affect the anatomy of the syndesmosis, which should be taken into account at time of assessment. Cite this article: Bone Joint J 2019;101-B:348–352.

scholarly journals Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

2018 ◽  
Vol 32 (2) ◽  
pp. 119-124
Author(s):  
NK Majumder ◽  
MR Khan ◽  
Nupur Kar ◽  
M Akhtaruzzaman ◽  
TA Choudhury ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Female Group ◽  
Male Counterpart ◽  
Factors Affecting ◽  
Female Patients ◽  
Significant Difference ◽  
Male Patients ◽  
Gender Based

Background: In-hospital mortality in female patients with acute myocardial infarction (AMI) and factors affecting this may be different from those of their male counterpart. The aim of the current study was to compare the in-hospital mortality between female and male patients with AMI and to compare the differences in age, risk factors, treatment given and complications between them.Methods: Total 200 nonrandomised patients with a definite diagnosis of AMI admittedover a period of one year (January 2008 - December 2008) were enrolled in the study, in which 100 female patients were considered as cases and 100 male patients as controls. Both groups were studied prospectively.Datawere collected in prefixed questionnaire and data sheet and were analysed using SPSS software.Results: mean age of the female patients was significantly higher than that of their male counterpart (57.0±10.1 years and 53.3±10.3 years respectively, p=0.029). Diabetes mellitus and hyperlipidemia were significantly higher in females than those in males (39% vs 24%, p=0.022 and 45% vs 32%, p=0.040 respectively), while smoking was staggeringly higher among the males (59%) compared to the females (4%) (p<0.001). However, no significant difference was observed between the groups in terms of hypertension (p=0.666).Pre-hospital delay (more than 12 hours after onset of chest pain) was significantly higher in the female group than that in the male group (72% vs 58%,p=0.038). Streptokinase was significantly underused in females (15.6%) compared to that used in males (32.2%) (p=0.011). The use of b-receptor blockerswas also significantly less in females than that in males (63% vs 75%, p=0.046).Death was significantly higher in the females (21%) than that in the males (10%) (p=0.032). Unstable angina, re-infarction and congestive heart failure were somewhat higher in the female subjects compared to their male counterparts (40% vs 34%, 2% vs 1% and 32% vs 23% respectively) though the differences did not seem significant (p=0.380, p=0.561 and p=0.154 respectively). Arrhythmias did not differ significantly between the groups (p1>0.05).Conclusion: Female patients with AMI had significantly higher in-hospital mortality. Early hospitalization and optimal treatment are crucial to decrease mortality in female patients.Bangladesh Heart Journal 2017; 32(2) : 119-124

scholarly journals Association of serum uric acid levels with COVID-19 severity

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fang Hu ◽  
Yifan Guo ◽  
Jianghong Lin ◽  
Yingjuan Zeng ◽  
Juan Wang ◽  
...  
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Linear Regression Analysis ◽  
Healthy Controls ◽  
Time Points ◽  
Female Patients ◽  
Significant Difference ◽  
Severe Group ◽  
Male Patients

Abstract Aims Hyperuricemia has attracted increasing attention. However, limited concern has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in patients with COVID-19. Therefore, we aim to explore whether patients with COVID-19 had SUA lower than normal and the relationship of SUA and the severity of COVID-19. Methods This was a case–control study based on 91 cases with COVID-19 and 273 age- and sex-matched healthy control subjects. We first compared SUA levels and uric acid/creatinine (UA/Cr) ratio between patients with COVID-19 and the healthy controls. Then, we examined the association of SUA levels and UA/Cr ratios with COVID-19 severity in COVID-19 cases only, defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19. Results SUA levels in patients with COVID-19 were 2.59% lower, UA/Cr ratios 6.06% lower at admission compared with healthy controls. In sex stratified analysis, levels of SUA and UA/Cr were lower in male patients with COVID-19 while only level of SUA was lower in female patients with COVID-19. Moreover, SUA and UA/Cr values were 4.27 and 8.23% lower in the severe group than that in the moderate group among male COVID-19 patients. Bivariate and partial correlations analysis showed negative correlations between SUA or UA/Cr ratio and COVID-19 after adjusting for age, sex, BMI and eGFR. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent risk factors associated with lower SUA levels. Male patients with COVID-19 accompanied by low SUA levels had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11, 14.72) at admission. Comparing SUA and UA/Cr ratio at three time points (admission, discharge, and follow-up), we found that male patients experienced severe symptoms had lower SUA and UA/Cr ratio levels comparing to moderate patients, but no significant difference between three time points. On the contrary, female patients had lower SUA and UA/Cr ratio at discharge than those at admission, but no significant difference of SUA and UA/Cr ratio between moderate and severe group. Conclusion Patients with COVID-19 had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher crude risk of developing severe symptoms than those with high SUA levels. During disease aggravation, the level of SUA gradually decreased until discharge. At the follow-up exam, the level of SUA was similar to the levels at admission.

scholarly journals Digital templating for the implantation of a curved short hip stem with an anterolateral MIS approach shows gender differences in digital templating

2021 ◽  
Author(s):  
Matthias Luger ◽  
Rainer Hochgatterer ◽  
Matthias C. Klotz ◽  
Günter Hipmair ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Short Stem ◽  
Consecutive Series ◽  
Acetabular Cup ◽  
Digital Templating ◽  
Stem Size ◽  
Female Patients ◽  
Straight Stem ◽  
Significant Difference ◽  
Male Patients

Abstract Purpose Digital templating shows reliable accuracy for straight stem systems. In recent years, the implantation of short stems through minimally invasive approaches has gained more popularity. Minimally invasive approaches (MIS) show the risk of undersizing femoral components. Therefore, we questioned the planning adherence for a curved short stem and a bi-hemispherical acetabular cup implanted through an anterolateral MIS approach. Methods A consecutive series of 964 hips (index surgery between 2014 and 2019) with Fitmore® curved short stem and Allofit/-S® acetabular cup (both ZimmerBiomet Inc, Warsaw, IN) were included. Preoperative digital templating was conducted anterior–posterior (AP) digital radiographs of the hip using mediCAD® version 5.1 (Hectec GmbH, Altdorf, Germany). The templates of acetabular and femoral components (offset option and stem size) were retrospectively evaluated for general adherence, and according to sex, BMI and planner’s experience. Results Planning adherence for the exact offset option was 70.6 and 21.6% for exact offset option and stem size. Adherence for acetabular cup  ± 1 size was 74.8%. A significant difference between male and female patients for the offset option could be found (p = 0.03, z = −2983). In 22.5% of male patients, an offset option one size higher and in 12.3% of female patients an offset option one size smaller than templated was used intraoperatively Conclusion Digital templating for the Fitmore® stem in cementless THA with a minimally invasive anterolateral approach shows comparable planning adherence to the existing literature for this cementless short stem. However, a lower planning adherence was detected compared to conventional straight stem systems. In male patients, the femoral offset is frequently undersized and in female patients frequently oversized compared to the preoperative plan. Surgeons should be aware of this difficulty in digital templating for Fitmore® hip stem.

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