Giant rhinolith: Still a neglected entity in modern era

Word rhino- and - lith, literally meaning “nose & stone”. So, it is basically a stone that forms inside the nasal cavity. It is an uncommon disease that may present asymptomatically or as an accidental finding. Rhinolith itself is a rare condition out of which giant rhinolith case is extremely rare. If left undiagnosed or untreated it can cause rhinosinusitis, erosion of the nasal septum & medial wall of maxillary sinus & palatal perforation.

The orbit and its contents

The function of the orbit is to protect and accommodate the globe in order to maximise its function. The bony orbits are paired four-sided conical cavities within the skull each comprising seven bones – ranging from the paper thin ethmoid and lacrimal plate medially to the buttress thick zygoma laterally. The conical shape consists of an apex posteriorly and a base anteriorly forming the outer margin. The medial wall and floor begin to blend towards the apex forming a posteromedial bulge as the orbit takes on a three-walled pyramidal structure. The walls are lined by periosteum (periorbita), which is continuous with the periosteal layer of the dura mater at the apex, the orbital septa and the fascial sheaths of the extraocular muscles. There are five principal openings of the orbit – three principal foramina located at the apex that transmit the neurovascular supply of the orbit and two lesser foramina located on the medial wall.

3D Mapping of Intra-articular Calcaneal Fractures

Background: The management of intra-articular calcaneal fractures (ICFs) still faces a challenge. Available research about the anatomic patterns of ICFs is lacking. We aimed to define the pattern of ICFs by a three-dimensional (3D) mapping and determine whether there are consistent fracture patterns and comminution zones. Methods: 67 patients of ICFs with available computed tomographic (CT) scans were identified. The calcaneal fractures fragments on CT were multiplanar reconstructed and virtually reduced. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a standard calcaneal template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes were performed. Results: The cohort included 26 (38.8%) left calcaneal fractures, 27 (40.30%) right calcaneal fractures, and 14 (20.9%) cases with bilateral fractures. Comminuted fractures accounted for 92.5% of all fractures. Sagittal 3D mapping demonstrated that fracture lines were concentrated in the critical angle of Gissane and extended posteriorly to the rear of the tuberosity of the lateral wall and the anterior of the medial process of the calcaneus tuberosity but with more significant variation in the medial wall. The mean angle of fracture lines concerning the long axis of the calcaneal (LAC) was 29.1°and 19.2° in the lateral wall and medial wall, respectively. Axial 3D mapping demonstrated that fracture lines were primarily concentrated in the area anterior to the posterior joint facet and extended along the posterior joint facet and calcaneus sulcus to the posteriorly of the tuberosity. The mean angle of fracture lines concerning the LAC was 11° in the axial wall. 3D mapping demonstrated that the comminution zones are closely related to the internal structure and fracture mechanism. Conclusion: The data presented have elucidated there are consistent characteristic fracture patterns and comminution zones for ICFs. This study provides visual guidelines to understand fracture morphology, which may assist with fracture classification, preoperative planning, fixation concepts development, and internal structure analysis.

Transnasal Surgical Treatment Of Patients With A Fracture Of The Medial Wall Of The Orbit

The article presents the method of transnasal surgical treatment of patients with a fracture of the medial wall of the orbit using the Volkov elevator as a repositioning tool and an iodine tampon as a fixation material, which allows efficient fixation of the medial orbit wall fragments and its soft tissue components, allowing to reduce the trauma of surgical intervention, to restore the eyeball position, and to eliminate the cause of emphysema and dynamic correction of postoperative diplopia in one-time operation.

Left Atrial Appendage Function Assessment by Tissue Doppler Transesophageal Echocardiography in Acute Ischemic Stroke Patients

Background: Strokes due to Cardioembolic causes are the most severe in ischemic stroke subtypes. LAA flow patterns and function could be assessed accurately by TEE. The study aimed to present the importance of Transesophageal echocardiography in the assessment of LAA function and its relation to cardioembolic stroke. Methods: 120 patients were enrolled in the study and were subdivided into 3 subgroups, each group included 40 patients. Group A; patients had a stroke with normal sinus rhythm, Group B; patients had a stroke with atrial fibrillation, and Group C; normal control subjects. The study participants were evaluated by medical history, physical examination, standard 12-leads electrocardiogram, a transesophageal echocardiographic detailed evaluation of the LAA, and brain CT and/or MRI for patients with stroke. Results: both stroke patients with AF and sinus rhythm had significantly higher LAA mean orifice diameter and higher LAA length than control patients, significantly lower mean LAA medial wall tissue Doppler upward and downward motion velocities than control patients and that patients with stroke and AF had significantly lower mean LAA pulsed wave emptying and filling velocities than both patients with stroke and sinus rhythm and control patients. Presence of LAA thrombi, spontaneous echo contrast, and stroke recurrence were higher in stroked AF patients than stroke patients with sinus rhythm. Conclusion: increased LAA orifice diameter, LAA length, and reduced filling and emptying velocities and upward and downward motion velocities of the medial wall of LAA as detected by TEE are associated with stroke and cardio embolization.

Choice-relevant information transformation along a ventrodorsal axis in the medial prefrontal cortex

Choice-relevant brain regions in prefrontal cortex may progressively transform information about options into choices. Here, we examine responses of neurons in four regions of the medial prefrontal cortex as macaques performed two-option risky choices. All four regions encode economic variables in similar proportions and show similar putative signatures of key choice-related computations. We provide evidence to support a gradient of function that proceeds from areas 14 to 25 to 32 to 24. Specifically, we show that decodability of twelve distinct task variables increases along that path, consistent with the idea that regions that are higher in the anatomical hierarchy make choice-relevant variables more separable. We also show progressively longer intrinsic timescales in the same series. Together these results highlight the importance of the medial wall in choice, endorse a specific gradient-based organization, and argue against a modular functional neuroanatomy of choice.

The medial condylar wall is a reliable landmark to kinematically align the femoral component in medial UKA: an in-silico study

Purpose Kinematic alignment (KA) aligns the femoral implant perpendicular to the cylindrical axis in the frontal and axial plane. Identification of the kinematic axes when using the mini-invasive sub-quadricipital approach is challenging in unicompartmental knee arthroplasty (UKA). This study aims to assess if the orientation of condylar walls may be suitable for use as an anatomical landmark to kinematically align the femoral component in medial UKA. It was hypothesised that the medial wall of the medial condyle would prove to be a reliable anatomical landmark to set both the frontal and axial alignment of the femoral component in medial UKA. Methods 73 patients undergoing medial UKA had pre-operative CT imaging to generate 3D models. Those with osteophytes that impaired visualisation of the condylar walls were excluded. 28 patients were included in the study. The ideal KA was determined using the cylindrical axis in the frontal and axial plane. Simulations using the medial wall of the medial condyle (MWMC) and the lateral wall of the medial condyle (LWMC) were performed to set the frontal alignment. To set the axial alignment, the MWMC, LWMC, medial wall of the lateral condyle (MWLC), and medial diagonal line (MDL) anatomical landmarks were investigated. Differences between the ideal measured KA values and values obtained using landmarks were investigated. Results Use of the MWMC let to similar frontal alignment compared to the ideal KA (2.9° valgus vs 3.4° valgus, p = 0.371) with 46.4% (13/28) of measurements being $$\le $$ ≤ 1.0° different from the ideal KA and only 1 simulation with greater than 4.0° difference. Use of the MWMC led to very similar axial alignments compared to the ideal KA (0.5° internal vs 0.0°, p = 0.960) with 75.0% (21/28) of measurements being $$\le $$ ≤ 1.0o different from the ideal KA, and a maximum difference of 3.0°. Use of the MWLC and MDL was associated with significant statistical differences when compared to the ideal KA (p < 0.001 for both). Conclusions The native orientation of the medial condylar wall seems to be a reliable anatomical landmark for aligning the femoral component in medial KA UKA in both the axial plane and frontal planes. Other assessed landmarks were shown to not be reliable. Clinical and radiographic assessments of the reliability of using the MWMC to set the frontal and axial orientation of the femoral component when performing a medial KA UKA are needed.