Brain, Spinal Cord and Labyrinthine Concussion in Sports

In this paper, we discuss the 3 types of concussion that occur in sports; brain concussion, spinal concussion (spinal cord neurapraxia), and labyrinthine (inner ear) concussion. Brain concussion data was collected from professional ice hockey players (Tohoku Free Blades, Japan) during 9 consecutive seasons. Spinal cord concussion and Labyrinthine concussion data was collected from athletes who sustained the injury in various sports including ice hockey. Material and methods The average incidence of brain concussion in professional ice hockey players was 2.0 per season. All 13 cases of spinal cord concussion were cervical cord concussion. Seven cases showed evidence of spinal cord compression; six cases had no radiological abnormality observed. All cases of labyrinthine concussion were sustained through a traumatic blow to the lateral aspect of the head. Results In any sports injury, all three of these concussions can co-exist and requires the team doctor to be at the site in order to fully assess the injury.

Ultrasound-guided Hydrodissection of Sural Nerve for Foot Pain

Background: Sural nerve entrapment is an impor­tant but infrequent cause of pain. The sural nerve provides sensation to the posterolateral aspect of the leg, lateral foot and fifth toe. Sural nerve entrapment can be challenging to treat and can cause significant limitation. We present a case of sural nerve entrapment resistant to conservative management that was effectively treated by percutaneous ultrasound guided hydrodissection of the sural nerve. Case Report: A 57 year old male came with complaints of pain and tingling sensation on both lower limbs with 50% decrease in sensation to touch (right > left) in lateral aspect of both foot. The patient had tried several conservative modalities with no success. We performed percutaneous ultrasound guided hydrodissection of the sural nerve and the patient reported complete improvement in his pain. Conclusion: Percutaneous ultrasound guided hydrodissection of the sural nerve, is a safe and effective treatment for patients with sural nerve entrapment that does not respond to conservative therapy. However, studies are needed to elucidate its effectiveness and safety profile.

Tolosa-Hunt Syndrome Presenting as Cluster-Like Headache

A 48-year-old man came with a left-sided headache that was compatible with diagnostic criteria of cluster headache. Left oculomotor nerve palsy developed 2 weeks after headache onset. Magnetic resonance imaging showed wall thickening and enhancement by contrast material in the lateral aspect of the left cavernous sinus, consistent with a possible inflammatory lesion. The patient reported the almost complete remission of the pain and diplopia after steroid therapy. We speculate that Tolosa-Hunt syndrome should be included as a cause of cluster-like headaches.

Role of Radiographs and Ultrasound in Diagnosing Calcific Tendinitis and Periarthritis in the Wrist and Hand with Ultrasound-Guided Barbotage as Management Tool

Aim To demonstrate the role of radiographs and ultrasound (USG) in the diagnosis of calcific tendinitis and periarthritis in the wrist and hand and the efficacy of USG-guided barbotage for its management. Materials and Methods A retrospective chart review was performed in six patients who presented with acute-onset pain in the wrist and hand varying from 3 days to 2 weeks. Four patients had tenderness over pisiform and two patients had pain along the lateral aspect of the wrist and thumb. Radiographs and USG revealed calcific focus corresponding to the site of pain. USG-guided calcific barbotage and injection was performed for the same and pain relief was assessed immediately and through telephonic follow-up at 6 months using subjective satisfaction score. Data were analyzed using Microsoft Excel 2013. Results Four patients with tenderness over pisiform had flexor carpi ulnaris calcific tendinitis and two patients with pain along the lateral aspect of the wrist and thumb had first metacarpophalangeal calcific periarthritis and abductor pollicis brevis calcific tendinitis on radiographs as well as USG. In post-USG-guided calcific barbotage and injection, all patients had significant immediate and 6 months delayed relief in symptoms with excellent satisfaction scores. Conclusion Acute calcific tendinitis/periarthritis is a benign and self-limiting inflammatory condition. Radiographs are extremely helpful in identifying calcific focus. Ultrasonography in experienced hands is the best modality to identify, confirm the symptomatic calcific focus, and perform USG-guided intervention. USG-guided calcific barbotage is the simplest, quickest, and effective way to treat this condition and avoid compromised functional capacity.

Morphological ontogeny of Limnozetes schatzi sp. nov. (Acari: Oribatida: Limnozetidae) from Norway

The morphological ontogeny of Limnozetes schatzi sp. nov. from Norway is described and illustrated. The adult of this species is the most similar to that of L. rugosus (Sellnick, 1925), but differs from it mainly by the body shape (it is stockier in dorsal aspect and less convex in lateral aspect than L. rugosus), longer prodorsal seta in and notogastral setae, lack of seta c3, which in some individuals of L. rugosus is present, and sculpture of notogaster. Moreover, in L. schatzi seta l' on femur III is absent, but in L. rugosus it is present. Seta d on femora I–III and seta l' on femora I and II have relatively long barbs, covered often with debris. The juveniles of L. schatzi have all gastronotal setae short, whereas the latter species has some setae longer (lm and lp in larva, lp in nymphs).

Histomorphometric, Immunohistochemical and Microtomographic Comparison between Autogenous and Xenogenous Bone Blocks for Mandibular Lateral Augmentation in Rabbits

Background: The volumetric and biological behaviors of equine block grafts compared with autogenous block grafts have not yet been assessed. Hence, the aim of the present study was to compare—by means of histomorphometry, immunohistochemistry and microtomography—the graft incorporation and remodeling processes of autogenous and equine xenogenous bone blocks used for mandibular lateral augmentation in rabbits. Methods: Autogenous bone grafts harvested from the iliac bony crest and equine block grafts were secured to the lateral aspect of the mandible angle of eighteen rabbits. The healing after 7, 20 and 60 days was assessed in six animals each period. Results: After 60 days, new bone was present 24.2 ± 11.2% and 31.6 ± 13.3% in the autograft and xenograft groups, respectively. A better integration to the recipient sites was observed in the autogenous compared with the xenogenous blocks. Conclusions: Both xenogenous and autogenous bone blocks presented similar percentages of newly formed bone over time. However, bone volume, the quality of the grafted area and graft incorporation to the recipient sites were superior in the autogenous compared with the equine xenogenous graft sites.

HYDATIC CARDIAC SYST: AN EXCEPTIONAL LOCATION

Hydatid cyst is a parasitic disease endemic in different regions of the world. Cardiac localization represents only 0.5 to 2% of all attacks, characterized by clinical, paraclinical and especially radiological polymorphism. Its spontaneous development is serious because of the risk of endocavity rupture. The diagnosis is facilitated by means of non-invasive imaging, in particular echocardiography, thoracic computed tomography and magnetic resonance imaging. Given the lack of alternative treatment options, cystectomy and pericystectomy are the only surgical techniques capable of offering chances of recovery with acceptable morbidity and mortality. Antiparasitic treatment comes in addition to surgery. Eradication of hydatid disease mainly involves effective collective and individual preventive measures. We present a clinical case of a 54-year-old patient who presented with asthenia followed by precordial pain, who has a normal EKG and chest x-ray. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. We present a clinical case of a 54-year-old patient who presented with asthenia followed by precordial pain, who has a normal EKG and chest x-ray. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. We present a clinical case of a 54-year-old patient who presented with asthenia followed by precordial pain, who has a normal EKG and chest x-ray. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery.

Repair of Fractures of the Lateral Aspect of the Humeral Condyle in Skeletally Mature Dogs with Locking and Non-Locking Plates

Objective The aim of this study was to report the functional outcome and complications following transcondylar screw and epicondylar plate fixation of skeletally mature dogs with fractures of the lateral aspect of the humeral condyle using a string of pearls, limited contact dynamic compression plate (LC-DCP) or locking compression plate (LCP). Study Design This study was a retrospective review of clinical records, radiographic images and canine brief pain inventory evaluation with a supplementary non-validated questionnaire. Results Thirty-one fractures in 29 dogs were included. The majority of dogs were Spaniels (23/29). Thirty fractures had evidence of humeral intracondylar fissure. Sixteen fractures had string of pearls, eight LCP and seven LC-DCP. There were two minor complications and three major complications. Perioperative (median: 6 weeks, range: 6–12) outcome was considered fully functional for 24 fractures and acceptable for 6 fractures. One dog had an unacceptable outcome due to the failure of an LCP that healed following revision surgery. Fractures with radiographic follow-up had a persistent visible intracondylar fracture line in 20/26. Twenty-six of twenty-seven owners perceived an excellent outcome (median: 135 weeks, range: 25–246). Conclusion Repair of fractures of the lateral aspect of the humeral condyle with a transcondylar screw and epicondylar plate has a good perioperative, mid- and long-term outcome with 10% major complication rate, despite incomplete or non-union of the intracondylar fracture in 20/26 elbows.

Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty

Case. A 62-year-old man presented with persistent lateral knee pain 15 months following an uncomplicated total knee arthroplasty. There was a tendinous snapping structure over the lateral aspect of the knee in deep flexion with positive Tinel’s sign over the fibular head. The patient underwent an uncomplicated flabella excision. The patient was cleared to return to work and full duty at two months postoperatively. Conclusion. Flabella syndrome is a rare but increasingly common mechanism of persistent lateral knee pain following total knee arthroplasty. Surgeons should be aware of this etiology of persistent lateral knee pain and offer treatment modalities to address this pathology.