The phylogenetic affinities and morphological peculiarities of the bird-like dinosaur Borogovia gracilicrus from the Upper Cretaceous of Mongolia

Borogovia gracilicrus is a small-bodied theropod dinosaur from the Maastrichtian (Upper Cretaceous) Nemegt Formation of southern Mongolia. The taxon is based on a single fragmentary specimen preserving only the distal part of the hindlimbs. The morphology of Borogovia shows a peculiar combination of features, some of which are traditionally considered troodontid synapomorphies and others which are unusual for Troodontidae but are shared with other maniraptoran clades. In particular, the second toe of B. gracilicrus differs from other troodontids in lacking some of the features which contribute to the specialized ‘sickle-clawed’ second toe, here termed the ‘falciphoran condition’, shared with dromaeosaurids and some other paravians, such as the strongly compressed and falciform ungual. Phylogeny reconstructions intended to explore the affinities of Borogovia consistently support its referral within a subclade of troodontids including all Late Cretaceous taxa. The placement of Borogovia is not significantly affected by its unusual combinations of hindlimb features or by the homoplasy of the elements forming the falciphoran condition. Borogovia is supported as a valid taxon and is distinct from the other Nemegt troodontids, Tochisaurus and Zanabazar. The lack of a falciform ungual, and the distinctive morphology of the second toe in B. gracilicrus are interpreted as a derived specialization among Troodontidae and not as retention of the plesiomorphic condition of non-paravian theropods.

New method of surgical correction of lesser toes deformity

Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes.

Cytologic Analysis of a Glomus Tumor in the Left Second Toe: Case Report

Introduction/Objective Glomus bodies reside in the stratum reticularis of the dermis as well as in visceral organs. Their functions involve temperature and blood pressure regulation. The incidence of glomus tumors is approximately 1.5%, occur more frequently in women, and generally manifest during the third to fifth decade of life. A majority of glomus tumors are diagnosed by biopsy and excision. At least 19 case reports exist in the literature where glomus tumors are diagnosed by fine-needle aspiration (FNA). We add to this growing literature by discussing a case report involving the cytologic findings of an FNA-diagnosed glomus tumor. Methods/Case Report A 66-year-old female presented with left second toe pain for 41 years but worsening in the past several months. Physical exam revealed 5/5 muscle strength in her toes without loss of sensation. There was no edema, erythema, nor ecchymosis. Pain was notably out of proportion when palpating her second nailbed. Magnetic resonance imaging (MRI) with contrast was performed revealing a 1.1 x 1.0 x 0.9 cm circumscribed, ovoid mass involving the dorsal aspect of the second toe distal phalanx along its dorsal margin (Figure 1). The patient underwent fine needle aspiration and biopsy. Cytologic findings included clusters of uniform cells with round to oval nuclei and scant cytoplasm. There was spindling of cells noted in some of the clusters. Cells were surrounded by thick wisps of magenta colored myxoid material reminiscent of a pleomorphic adenoma (Figure 2). Biopsy showed uniform cells surrounding capillaries. Immunohistochemistry performed on the biopsy showed that lesional cells were positive for alpha-smooth muscle actin (SMA). A diagnosis of glomus tumor was made. Amputation was performed with clear margins. Results (if a Case Study enter NA) NA Conclusion Glomus tumor is a rare tumor that is usually diagnosed on biopsy; however, it has distinct cytologic features that can aid in its diagnosis on fine needle aspirations.

Laser Doppler Measurements of Systolic Blood Pressure on the First and Second Toe in Patients with Peripheral Arterial Disease

Laser Doppler was used to measure toe blood pressure (TBP) in 40 consecutive patients with various degree of peripheral arterial disease. The aim of this methodological study was to increase the usefulness of TBP by exploring the interchangeability between TBP from the first and second toe and by investigating daily routine reproducibility and measurement variability. According to our study design pressure values were based on three measurements that were averaged. At simultaneous measurements, TBP of the first toe was 71 mm Hg (standard deviation [SD] 25) compared with 70 mm Hg (SD 25) on the second toe. The correlation (r) between first and second toe pressure measurements was 0.84 and intraclass correlation coefficient (ICC) was 0.84. The difference between TBP on the first and second toe was not related to gender, diabetes, or magnitude of the pressures. Repeated TBP measurements of the right first toe after disconnection of cuffs, 5 to 10 minutes rest, and reconnection of cuffs had a coefficient of variation (CV) of 9% and an ICC of 0.93. CV for toe-brachial index (TBI) was 8%. Our results show that measurements of TBP from the second toe to a large extent are interchangeable with those assessed from the first toe and can be used in clinical situations where measurements from the first toe are not feasible. Flow detection with three averaged laser Doppler measurements generates TBP and TBI with low variability.

Subungual Exostosis: A Case Series of 48 Patients

<b><i>Background:</i></b> Subungual exostosis is an unusual benign nail tumor, mostly located on the big toe. It generally affects young people and manifests as uncomfort during footwear. <b><i>Method:</i></b> A monocentric retrospective study was conducted at the outpatient consultation for nail disorders at the Department of Dermatology of the University of Casablanca, Casablanca, Morocco, between April 2006 and October 2019. <b><i>Results:</i></b> We diagnosed subungual exostosis in 48 patients, including 25 men and 23 women, with an average age of 20 years. The subungual exostosis was located on the hallux in 34 cases, the second toe in 10 cases, and the index finger in 2 cases. Nail trauma was found in 27 patients. The tumor was entirely excised in all the patients. <b><i>Conclusion:</i></b> Large series of subungual exostosis are reported by orthopedic surgeons. However, our outpatient consultation for nail disorders allowed the diagnosis and appropriate management of subungual exostosis.

Functional Restoration of a Midforearm Level Amputation using the Second Toe Transfer

Unilateral midforearm level amputation is a severely debilitating situation. The present solution for this problem is either restoration of function using a prosthetic hand, or a vascularized composite allotransplant (VCA) in some very selected cases. In cases of distal forearm level amputations, even vascularized second toe transfer could be done on the radial side of the hand to achieve good functional restoration. We present a case of midforearm level amputation in which the second toe transfer has been done above the level of insertion of pronator teres muscle to achieve meaningful function. This report highlights the fact that a single toe transfer could be helpful in achieving meaningful prehension, even at this proximal.

Schwannoma of the medial plantar nerve: a case report

We report the case of a 60-year-old woman with a schwannoma of the medial plantar nerve. She presented with the complaint of pain for about 2 years and a painful lesion in the medial plantar region of the left forefoot and on the second toe. Physical examination showed well-defined, firm tumor masses painful to palpation on the medial and plantar surface of the left forefoot and second toe. We surgically explored the area and excised 3 lesions, resulting in complete pain relief and no aesthetic complaints. Schwannomas of the medial plantar nerve are rare tumors, with only a few reports of cases extending to the forefoot. The finding of multiple schwannomas may be a red flag for the possible existence of local, painful, nerve lesions despite a negative Tinel sign. Appropriate surgical planning contributed to our successful intervention, without aesthetic, painful, or functional sequelae for the patient. Level of Evidence V; Therapeutic Studies; Expert Opinion.