The prevalence of absent anterior facet of the calcaneus and a suggested convention for the naming of the configuration of the superior facets of the calcaneus

Background: The superior surface of the human calcaneus will frequently demonstrate 3 articular facets for articulation with the talus: the posterior, middle and anterior facets. All calcanei possess a posterior and middle facet. However, not all calcanei possess an anterior facet. The main purpose of this article is to identify by literature review the prevalence of calcanei which do not have an anterior facet. With review, the discrepancy by authors in nomenclature for the various types of facets on the superior surface of the calcaneus becomes quite evident. Thus, a secondary purpose of this article is to recognize the need for a standard naming convention and propose an intuitive naming scheme for the calcaneal facet types. Results: Of the 41 articles reviewed which are written in the English language and which describe absent anterior facet as a calcaneal facet type, the prevalence of calcanei lacking an anterior facet ranges from 3.3% to 4.9%. This difference in prevalence reporting depends on whether one allows “small anterior facet” specimens to be included in the total Type 3 (absent anterior facet) count. The prevalence also depends on whether data is included if an article could be considered an outlier. The total range of prevalence of absent anterior facet varies by article from 0% to 18%. Conclusion: The prevalence of absent calcaneal anterior facet is approximately 4%. Studies in the future are needed to determine whether the absent anterior facet is 1) a normal finding, 2) is helpful for the foot, or 3) is pathologic for the foot. A visually intuitive naming system of the types of calcaneal facets is proposed so as to reduce confusion in this field of study, therefore likely reducing errors. KEY WORDS: Absent anterior facet, calcaneal facet configuration, calcaneal facet types, subtalar joint.

The Role of MR Imaging and MR Angiography in the Evaluation of Patients with Headache

BACKGROUND: Headache is one of the most common complaint in medical practice and the most often neurological symptom. AIM: The aim of our study was to estimate the frequency of abnormal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) findings in patients with non-acute headache without focal neurological abnormalities. MATERIAL AND METHODS: The results of the MRI and MRA were retrospectively analyzed. As major abnormalities, we took into account tumor, stroke, extraaxial collection, Chiari malformations, and vascular pathology (aneurysm and arterial-venous malformation). RESULTS: Two hundred twenty-five patients fulfilled the criteria. Out of 225 patients with median age of 37 (18–85) years, 78% of the patients were female and 22% were male. In total, we found 8.4% of major abnormalities. On MRI head scan without MRA analysis, we found 50.7% of normal finding, 47.1% of minor abnormalities and 2.2% of major abnormalities. On MRA scan, we found we found 52.9% of normal finding, 40.9% of minor abnormalities, and 6.2% of major abnormalities. CONCLUSION: Our study demonstrates a low but important diagnostic yield of MRI and MRA examination for patients with non-acute headache without focal neurological abnormalities.

Psychomotor Retardation, Low Set Ears, Retrognathia, Facial Dysmorphism and Schizencephaly: A New Dysmorphic Syndrome

Background: Schizencephaly is a rare primary congenital brain defect of heterogeneous nature resulting from abnormal morphogenesis with a very early disruption of the grey matter migration during embryogenesis. Braga et al (2018) reviewed 156 articles including 734 patients with schizencephaly, and none of them had facial dysmorphism, low set ears or micrognathia Patients and methods A dysmorphic male infant who was referred to the neuropsychiatric consultation clinic of the Children Teaching hospital of Baghdad medical city was studied. Results Four month male infant presented with psychomotor retardation with no interaction with the mother and no recognition of her face. He had low set ears, retrognathia, and facial dysmorphism with narrow and upslanting palpebral fissures and thin upper lips. Family history was negative for a similar condition. Brain CT-scan showed open limb bilateral schizencephaly and karyotype showed normal finding. Conclusion: A new dysmorphic syndrome associated with schizencephaly, facial dysmorphism, low set ears and micrognathia is reported.

Quantification of fat in the posterior sacroiliac joint region: fat volume is sex and age dependant

Fat is appreciated as a structural component of synovial joints. It may serve a shock-absorbing function for the incongruent surfaces, vessels and ligaments, but has not been investigated in the posterior sacroiliac joint (PSIJ). Sixty-six cadaveric hemipelves were serially-sectioned and photographed. The amount of visible fat in the PSIJ was quantified using a modified version of Cavalieri’s method. Total volume, fat volume and fat percentage of the PSIJ were calculated in predefined sub-regions. Fat is consistently present in the PSIJ (1.9 ± 1.3 cm3). Fat volume correlates with the PSIJ total volume (p < 0.0001; r = 0.73) and age (p = 0.024; r = 0.24), and is smaller in males (1.4 ± 0.8 cm3) than females (2.4 ± 1.5 cm3). Fat volumes in the middle and inferior sub-regions of the PSIJ show side- (p < 0.0001) and sex-differences (p = 0.013 females, middle sub-region). Age and PSIJ total volume correlate between sexes in various sub-regions (p = 0.05 females superior sub-region; males inferior sub-region). Fat percentage differs between sexes and sub-regions (p = 0.018 females, superior sub-region) but is independent of age and sides. The presence of fat within the PSIJ is a normal finding and shows sex-dependant and age-related differences. It is unclear whether fat is linked to age-related degeneration or has a shock-absorbing role in stress- and load-dissipation in the PSIJ.

A paradigm shift: “Defect of the fontanel” instead of “Accessory ostium” and classified nasal septal deformities instead of “septal deviation”

OBJECTIVES. The purpose of this article is to highlight some terms which have been ingrained in the rhinosinusology literature. MATERIAL AND METHODS. It regards the term “accessory ostium” and the term “septal deviation”. The well-known and deeply ingrained term “accessory ostium” has been widely used for decades, but essentially it is absolutely incorrect. “Septal deviation” is an inadequate term for the changes of the nasal septum form. RESULTS. From the linguistic point of view, “accessory” means something (or someone) which (or who) helps someone or gives support (to something or someone) in some process. We recommend the use of the term “defect of the fontanel” instead of “accessory ostium”. The use of the term “septal deformity” (from Latin: de forma, meaning the change in the shape) is etymologically much more appropriate. Septal deformities appear in man in several, well defined shapes and, therefore, can be correctly classified. The classification contributes to the further scientific conversations regarding the clinical issues connected to the changes of the nasal septum form. CONCLUSION. The usual term “accessory ostium” suggests almost a normal finding on the lateral nasal wall, but, on the contrary, it clearly signalizes that the respective maxillary sinus is chronically inflamed. The usual term “septal deviation” is not at all specific and only suggests that something is wrong with the position of the nasal septum. It does not at all imply any of the six well known types of septal deformities in man.

Asymptomatic levo uterine torsion of 90 degrees during caesarean section

Uterine torsion is defined as a rotation of uterus more than 45 degrees along it’s long axis. Some degree of dextrorotation in the gravid uterus can be a normal finding, however rotation greater than 45 degrees along the longitudinal axis of the uterus which is described as uterine torsion is a rare pathological condition in obstetrical practice. We report a case of levotorsion of the uterus by 90 degrees wherein patient had presented with pre term labour at 35W5D POG and levotorsion was encountered and managed intraop during caesarean. Uterine torsion of 90 degrees was encountered with the round ligament and tubo ovarian complex along with the uterine artery lying anteriorly at the incision site and lower segment of uterus rotated laterally onto the right side. The surgery was handled diligently resulting in average blood loss. Blood loss during the surgery was average. After the delivery of the baby, uterus returned to anatomical position and levotorsion corrected spontaneously.