Parry Romberg Syndrome with contralateral iridocorneal endothelial syndrome: a unique case

Parry-Romberg syndrome (PRS) is a rare disorder which causes progressive hemifacial atrophy, with ocular manifestations like hypotony, enophthalmos and corneal edema on the ipsilateral atrophic side. This is a report of a unique case of PRS with contalateral manifestations like ectropion uvea, correctopia and endothelial deposits, along with polymegathism and pleomorphism seen on specular microscopy suggestive of Iridocorneal Endothelial (ICE) Syndrome. ICE syndrome and PRS have not been reported together in any literature so far. This case highlights the importance of a thorough glaucoma workup and corneal examination on the atrophic facial side as well as on the apparently normal side in all cases of PRS.

Effect of Rehabilitation with a New Ocular Prosthesis on Electromyography of the Occipitofrontalis, Temporal, Masseter, and Sternocleidomastoid

Objectives The aim of this study was to verify during facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) if: (1) there would be difference in the electromyography (EMG) of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles on the normal side (NS) compared with the affected side (AS) (without the use of an ocular prosthesis) in individuals with unilateral absence of the eyeball, and (2) the rehabilitation with a new ocular prosthesis would affect the EMG of the muscles studied on the AS in these individuals. Materials and Methods Thirteen individuals, without temporomandibular disorder, with good health, with unilateral absence of the eyeball (the eye must have been removed by evisceration or enucleation), and users or nonusers of an ocular prosthesis were included. EMG of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles was performed during rest and facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) before (T0) and 90 days after (T1) rehabilitation with a new ocular prosthesis. The analyses were performed in T0 on NS and AS (without the use of an ocular prosthesis), and in T1 on AS with the new ocular prosthesis. Statistical Analysis All data were submitted to the Student's t-test with p < 0.05. Results There was no statistically significant difference comparing the AS with the NS in T0 for all muscles studied, during all facial expressions evaluated (p > 0.05). There was no statistically significant difference comparing the AS in T0 with itself in T1 for all muscles studied, during all facial expressions evaluated (p > 0.05). Conclusion Eye loss did not affect the EMG of studied muscles when comparing NS with AS (without the use of an ocular prosthesis). The rehabilitation with ocular prosthesis was not capable of changing the EMG on AS.

Changes in muscle architecture on ultrasound in patients early after stroke

BACKGROUND: Early muscle changes are believed to occur in patients with stroke. However, there are insufficient data on the changes in muscle mass and architecture of these patients. OBJECTIVES: This study investigates differences in ultrasound-derived muscle architecture parameters of the hemiplegic upper and lower limbs in patients with subacute stroke. METHODS: This is a prospective observational study, which recruited 40 adult patients who had experienced a first ever unilateral stroke (ischemic or hemorrhagic), with a duration of < 1 month post stroke. The brachialis, vastus lateralis and medial gastrocnemius on both the hemiplegic and normal side were evaluated via ultrasound. We recorded clinical variables including Motricity Index, Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM)-walk. RESULTS: We found reduced mean muscle thickness (p < 0.001) and increased echo intensity (p < 0.001) in the brachialis muscle, increased echo intensity (p = 0.002) in the vastus lateralis muscle, and reduced muscle thickness (p < 0.001) with increased echo intensity (p < 0.001) in the medial gastrocnemius muscle compared to the normal side. There were no significant correlations between ultrasound findings and Motricity Index. CONCLUSIONS: We report changes in ultrasound-derived muscle architecture in the hemiplegic limbs of patients with subacute stroke, with consistent findings of decreased muscle mass and increased echo intensity.

Muscle volume evaluation using 3DCT for congenital clubfoot

Background In congenital clubfoot, the lower leg is very thin and the calf muscles are hypoplasic. However, there are few studies reporting real muscle volume. Purpose The purpose of this study is to assay the muscle volume in congenital clubfoot using 3DCT and to quantify the degree of the hypoplasia. Material and methods From January 2015 to December 2016, nine consecutive patients, seven male and two female, with unilateral congenital clubfeet were recruited for CT scans. Axial transverse sectional CT scans were acquired from the delineation of the fibular head to the tibial plafond. From the data, we rendered the entire muscle in 3D for muscle volume assay, and further segmented the posterior musculature for comparison between the normal and affected sides. Results The whole muscle volume on the normal side was 291.23 cm3 (181.23–593.49) and that on the affected side was 225.08 cm3 (120.71–429.08), for an affected side to normal side ratio of 0.79 (0.72–0.9), which was significantly smaller ( p < .01). Posterior muscle volume on the normal side was 175.81 cm3 (103.72–376.32) and that on the affected side was 106.52 cm3 (58.3–188.39). The ratio of posterior muscle to whole muscle on the normal side was 0.62 (0.46–0.75), and that on the affected side was 0.48 (0.4–0.55), such that the affected side was significantly smaller ( p < .01) Conclusion This study contributes quantitative data supporting the longstanding observations that the posterior calf muscles are significantly smaller on the affected side compared to the normal side in congenital clubfoot, and further underscores the importance of the extending the excursion of these muscles.

Retrospective Comparison of Outcomes between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6–24 Months

Background: This study aimed to compare the early outcomes between closed reduction (CR) and open reduction (OR) in children aged 6–24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed method.Methods: We retrospectively reviewed the medical records of 77 patients who underwent CR or OR treatment for DDH from August 2012 to October 2017. Fifty-one patients (56 hips) underwent CR, while 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification, and acetabular index (AI) before reduction were analysed. The centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer’s migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between the CR and OR groups at the final follow-up. The percentages of avascular necrosis (AVN), residual acetabular dysplasia (RAD), HWI < 0.357, RMI > 33%, AA > 81˚, and coxa magna > 15% of the normal side were calculated.Results: At the final follow up, the mean AA in the CR and OR groups were 77.66˚ (60˚–89˚) and 81.97˚ (73˚–91˚) (p=0.001), respectively, and there were 32.14% and 58.62% of the hips with an AA > 81˚ (p=0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p<0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI at the final follow-up. The percentages of RAD, HWI < 0.357, RMI > 33%, and AVN were not statistically different.Conclusion: In children aged 6–24 months with DDH, if a stable and safe CR can be obtained but with a widening joint space, an OR may not benefit acetabular remodelling more than a CR procedure, and thus, CR should be attempted.

Aesthetical and Accuracy Outcomes of Reconstruction of Maxillary Defect by 3D Virtual Surgical Planning

BackgroundReconstruction of maxillary defect resulting from trauma or oncology surgery is of great importance for patients with physical and psychological complications. The virtual surgical planning (VSP) and 3D printing technics had been used in recent years which simplified the surgical procedure and promoted success and accuracy. To assess the accuracy and outcome of VSP surgery, here we report our experience in maxillary reconstruction retrospectively.MethodPatients who received maxillary defect reconstruction from 2013 to 2020 were analyzed retrospectively. These patients were divided into two groups. Group 1 received VSP and 3D printed guiding plates in the surgery, while group 2 underwent free-hand surgery (FHS). Patients with different vertical and horizontal defects were classified according to Brown and Shaw classification. Clinical information and postoperative complications of all patients were collected. For patients with unilateral maxillary defect, orbit volume, orbit height, and the contour of the reconstructed side were compared with the normal side.ResultThirty-four patients who achieved the criteria were analyzed, of which 20 patients underwent VSP surgery. There were primary and secondary reconstruction cases in both two groups. Vascularized iliac crest flap was used in three cases, and fibula flap was performed in the other cases. One flap collapse occurred in FHS group. Seven patients in VSP group received dental implants, while the number in FHS group was 0. In vertical class III cases, the differences in orbit height (ΔD) and orbit volume (ΔV) between normal side and reconstructed side were measured and compared in the two groups. The mean ΔD is 1.78 ± 1.33 mm in VSP group and 4.25 ± 0.95 mm in FHS group, while the mean ΔV is 2.04 ± 0.85 cm3 in VSP group and 3.25 ± 0.17 cm3 in FHS group. The alterations of orbit height and volume in VSP group were much smaller than that in FHS group with statistical significance. From the perspective of aesthetics, the color-gradient map indicates a more symmetric and smoother curve of post-operation appearance in VSP group.ConclusionCompared with traditional free-hand surgical technics, VSP and 3D printing guiding plates can allow for a more accurate maxillary reconstruction with improved aesthetics.

The rule of two in Radiology: An Update

There are 10 rules used in medicine/radiology that taught to students so they can remember certain points that they have to do to have an accurate diagnosis. These rules are:- 1- Two views: One view is too few; 2- Two joints: Above and below the injured bone; 3- Two sides: Compare with the other normal side; 4- Two abnormalities:Find a second abnormality; 5- Two occasions: Compare the current x-ray with a previous one (especially in CXR); 6- Two visits: Repeat after an interval or a procedure; 7- Two opinions: Ask for a second opinion or use the red dot system; 8- Two records: Write down the radiographic and clinical finings; 9- Two specialists: Get a radiology report; 10- Two examinations: Ask for CT, MRI, US, NM, etc.

Comparison of Efficacy between Three-Dimensional Printing and Manual-Bending Implants for Inferomedial Orbital Fracture: A Retrospective Study

The purpose of reconstruction of an orbital fracture is restoration of normal structure and volume without visible or functional complications. In a previous study, orbital implants were created using three-dimensional (3D) printing technology to restore orbital fractures. In the present study, the authors compared the efficacy of the conventional manual-bending implant and the 3D-printed standardized implant in order to verify the clinical utility of the fabricated 3D printed orbital implant. In this single-center, retrospective study, the authors evaluated medical records and 3D-CT scans of patients with inferomedial orbital fracture. Selected patients were divided into two groups. Group A underwent surgery with the 3D-printed standardized implant, while group B was treated using a manual technique to mold and trim the implant. A total of 32 patients was included in this study, 16 in each group. The volume of the preoperative lesion side was significantly different from that of the normal side or postoperative lesion side within each group. The volume of the postoperative lesion side was not statistically different from that of the normal side in Group A, but this volume was significantly different from that of the normal side in Group B. The 3D-printed standardized implant provides surgical efficacy to restore inferomedial orbital fracture and has superior surgical outcomes to the manual-bending implant.

Artery-Only Fingertip Replantation Distal to the Lunula: A Retrospective Analysis of Clinical Results

Background: Both arterial and venous repair are crucial for optimal results in digital replantation. However, anastomosis of veins becomes challenging in very distal fingertip amputation. This study aimed to report the clinical results of an artery-only replantation without vein repair for a distal fingertip amputation and to analyze the survival rate and clinical outcomes based on the amputation level. Methods: We performed a retrospective review of 47 digits in 38 patients who had undergone fingertip replantation with a mean follow-up period of 12 months. All patients had complete fingertip amputation distal to the lunula. Only one central artery repair distal to the arch was performed. All patients received the postoperative protocol including external bleeding and anticoagulation therapy. Results: By Ishilawa’s classification, 12 digits in subzone I, and 35 digits in subzone II. 31 of the 47 fingertip replantations (66%) were successful, and a significantly higher survival rate was observed in subzone I than in subzone II. The mean total active motion of surviving digits was 86% of normal side. The mean grip strength was 82% of normal side. The sensory recovery according to modified Highet and Saunders’ classification was S4, S3+, S3, and S2 in fingers 19, 2, 5 and 3, respectively. Conclusions: 66% of survival rate was achieved in fingertip replantation distal to lunula which including large number of crushing/avulsion injury. The result of comparison for the survival rate based on amputation level, a significantly higher survival rate was observed in subzone I compared to subzone II. Therefore, the artery-only fingertip replantation had a better indication for distal amputation, and an aggressive attempt for venous anastomosis or drainage, including a secondary surgery for proximal amputation could be attributed to a higher success rate.

Magnetic resonance imaging reconstruction algorithm under complex convolutional neural network in diagnosis and prognosis of cerebral infarction

This study was to explore the application value of magnetic resonance imaging (MRI) image reconstruction model based on complex convolutional neural network (CCNN) in the diagnosis and prognosis of cerebral infarction. Two image reconstruction methods, frequency domain reconstruction network (FDRN) and image domain reconstruction network (IDRN), were introduced based on the CCNN algorithm. In addition, they were integrated to form two new MRI image reconstruction models, namely D-FDRN and D-IDRN. The peak signal to noise ratio (PSNR) value and structural similarity index measure (SSIM) value of the image were compared and analyzed before and after the integration. The MRI images of patients with cerebral infarction in the dataset were undertaken as the data source, the average diffusion coefficient (DCavg) and apparent diffusion coefficient (ADC) values of different parts of the MRI image were measured, respectively. The correlation of the vein abnormality grading (VABG) to the infarct size and the degree of stenosis of the responsible vessel was analyzed in this study. The results showed that the PSNR and SSIM values of the MRI reconstructed image of the D-IDRN algorithm based on the CCNN algorithm in this study were higher than those of other algorithms. There was a positive correlation between the VABG and the infarct size (r = 0.48 and P = 0.002), and there was a positive correlation between the VABG the degree of stenosis of the responsible vessel (r = 0.58 and P < 0.0001). The ADC value of the central area of the infarct on the affected side was significantly greatly lower than that of the normal side (P < 0.01), and the DCavg value of the central area of the infarct was much lower in contrast to the normal side (P < 0.05). It indicated that an image reconstruction algorithm constructed in this study could improve the quality of MRI images. The ADC value and DCavg value changed in the infarct central area could be used as the basis for the diagnosis of cerebral infarction. If the vein was abnormal, the patient suffered from severe vascular stenosis, large infarction area, and poorer prognosis.