Vertebra prominence in women: significance in clinical practice and in surface topography.

A sexual dimorphism (SD) of the "vertebra prominens" was found, namely the 7th cervical vertebra (C7) spinous process (SP) is more frequently longer in men and the 1st thoracic (T1) SP in women.[1] We assume that the cause of this SD is the different anatomy of the anterior upper thoracic region (AUTR) between men and women, due to the presence of the breast. One-hundred forty-two women aged 48.1Âs17 years old, who visited the OPD for neck complaints, were studied. Measures included the age, the relationship of C7 and T1 SP length, documented in three types (type 1= [C7>T1], 2 = [C7 = T1], 3 = [C7 < T1]), the breast size, (small, medium and large), the length ratio of C7/T1 SP and the BMI. Breast size and SP length relationship between C7 and T1 was found to be significantly correlated. The results confirm that the cause of the SD of the SP length of C7 and T1 seems to be the different female AUTR anatomy due to the presence of the breast and it is probably the result of the need of the posterior cervical anatomical structures to compensate for the higher torque created by the female AUTR anatomy. These original findings are useful in clinical examination, in breast oncology, for the plastic surgeons, in terms of implantation of the proper breast size implant, after mastectomies for malignancies but also for aesthetic reasons and the software of all surface topography devices should be adjusted accordingly.

A novel surgical tool for the revision hip arthroplasty due to neck stem's fracture.

During revision surgery of total hip arthroplasties, surgeons may come across the challenging complication of a proximally fractured femoral stem, which however maintains sufficient distal fixation. Such cases, although rare, are extremely demanding due to lack of available attachments that would assist surgical explantation of the broken implant. It is herein presented a metal sterilisable surgical tool designed for the removal of the femoral stem broken at the level of the "neck". Hippokratia 2015; 19 (4): 352-355.

Actual evidence in the medical approach to adolescents with idiopathic scoliosis.

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with IS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Recently, a controlled prospective trial including a randomised arm gave more strength to this conclusion. Another Cochrane review shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the Scoliosis Research Society (SRS) criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agreement among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is their main goal. A systematic review shows that there are no studies on manual treatment. The SOSORT Guidelines offer the actual standard of conservative care.

Subchondral cyst development and MMP-1 expression during progression of osteoarthritis: an immunohistochemical study.

BACKGROUND: Subchondral bone cyst (SBC) formation is often identified in patients with osteoarthritis. Furthermore, several studies have shown that expression of matrix metalloproteinases (MMPs) is elevated in patients with OA. OBJECTIVES: The aim of our study is to correlate the presence of SBCs and MMP-1 expression with the osteochondral alterations during OA progression. METHODS: We studied the cartilage and subchondral bone of 15 patients who had undergone total knee or hip replacement due to primary OA. As controls, we used the femoral heads of three patients without macroscopic OA changes. We evaluated three specimens per patient. RESULTS: Specimens were divided in four groups based on the Mankin histological severity score. Using immunohistochemistry, we noted SBCs at the site of greatest disease severity. Specifically, these were present more frequently in group III (Mankin score: 6-7) and IV (Mankin: ≥ 8), compared with group I (Mankin: 1-3) and II (Mankin: 4-5). Mild OA stages (Mankin: 1-6) were characterized by degeneration and thinning of the cartilage, followed by increased osteoblast and osteoclast activity of the subjacent bone and the subsequent appearance of SBCs. Simultaneously, we observed expression of MMP-1 in groups I and II in the cartilage and III and IV in both the cartilage and the subchondral bone. Moreover, osteoblast-like cells in the lining of the SBCs showed an increased expression of MMP-1 in stages III and IV. CONCLUSION: Our study provides immunohistological evidence that SBCs accumulate in advanced OA and contain activated cells, which express MMP-1, suggesting that they may thus participate in the osteochondral changes of OA. LEVEL OF EVIDENCE: Level III; prospective comparative study.

Giant lipoma of the thenar--case study and contemporary approach to its aetiopathogenicity.

Giant lipomas of the thenar are rare tumours of the adipose tissue of the hand, with a benign prognosis. Apart from the cosmetic problems they may cause, their most frequent complications include a compromise in functionality and pressure upon the nerves, mainly on the radial nerve. The first step in their management is their differential diagnosis from well-differentiated liposarcomas (WDLPS), as they require a different therapeutic approach. This step is completed with the aid of MRIs, biopsies and modern immunohistochemical methods, which offer high specificity and sensitivity. Our paper presents a case of giant lipoma of the thenar, with a review of the relevant literature, focusing on the disease's molecular genetics, which is a very important field of research today.

The role of the intervertebral disc in correction of scoliotic curves. A theoretical model of idiopathic scoliosis pathogenesis.

Wedging of the scoliotic inter-vertebral disc (IVD) was previously reported as a contributory factor for progression of idiopathic scoliotic (IS) curves. The present study introduces a theoretical model of IVD's role in IS pathogenesis and examines if, by reversing IVD wedging with conservative treatment (full- and night-time braces and exercises) or fusionless IS surgery with staples, we can correct the deformity of the immature spine. The proposed model implies the role of the diurnal variation and the asymmetric water distribution in the scoliotic IVD and the subsequent alteration of the mechanical environment of the adjacent vertebral growth plates. Modulation of the IVD by applying corrective forces on the scoliotic curve restores a close-to-normal force application on the vertebral growth plates through the Hueter-Volkmann principle and consequently prevents curve progression. The forces are now transmitted evenly to the growth plate and increase the rate of proliferation of chondrocytes at the corrected pressure side, the concave. Application of appropriately directed forces, ideally opposite to the apex of the deformity, likely leads to optimal correction. The wedging of the elastic IVD in the immature scoliotic spine could be reversed by application of corrective forces on it. Reversal of IVD wedging is thus amended into a "corrective", rather than "progressive", factor of the deformity. Through the proposed model, treatment of progressive IS with braces, exercises and fusionless surgery by anterior stapling could be effective.

Suggestions for improvement of school screening for idiopathic scoliosis.

There is skepticism and the worth of school screening for the purposes of health care has been challenged. Numerous reasons are raised by the negativists to abandon these programs, even though the value of school screening is well documented in the literature. The aim of the present study is to update the evidence based recommendations for the improvement of school screening effectiveness, in order to support its continuation. All the relative research papers which originated from our scoliosis school screening program were analyzed. Specific suggestions for a) the organization, b) the optimal age of screening according to the geographical latitude, c) the best examined position, d) the standardization of referrals, e) the follow up of younger referrals with trunk asymmetry and f) the reduction of the financial cost are made. Today there is evidence that the incidence of surgery can significantly be reduced in areas where idiopathic scoliosis can be detected at an early stage through these programs. The introduction of these recommendations to all the existing school screening programs is strongly suggested, to reduce the negative impact they may have on families and on the health system and to improve their effectiveness.

School screening in the heavily industrialized area--Is there any role of industrial environmental factors in idiopathic scoliosis prevalence?

INTRODUCTION: School-screening programs contributed greatly to the study of idiopathic scoliosis (IS) prevalence. A similar program confined to a highly industrialized area is being performed in our Department. Thus the comparison of the findings of IS prevalence of this program with those of programs performed in non-industrialized areas of the same country could imply the significance of special industrial environmental factors on IS aetiology. MATERIALS AND METHODS: 3039 schoolchildren (1506 boys, 1533 girls), aged 5,5 to 17,5 years, have been screened for IS. These children comprise 20% of a total population of 20000 schoolchildren, who live in the region. The detection of the scoliotic children was attained utilizing the criterion of the angle of trunk inclination (ATI). The Prujis scoliometer was used to assess ATI. A cut off point of > or = 7 degrees ATI was used as a criterion for children's referral to hospital. 262 (8,6%) were referred for further evaluation, whereas 118 (3,9%) among these children underwent radiological examination. RESULTS: 90 children were found to have a Cobb angle of > or = 10 degrees at their standing PA spinal radiographs (2,9 % of the screened population). A Cobb angle of 10 degrees -20 degrees was found in 74 (2,4%) children. Sixteen (0,5%) children, who had scoliotic curves with a Cobb angle of > or = 20 degrees, underwent conservative treatment by means of spinal orthosis. Relatively to their location on the vertebral column, 20% of the scoliotic curves were thoracic, 26,7% thoracolumbar, 20% lumbar, 24,4% double and 8,9% miscellaneous. DISCUSSION: The screened area represents a place of particular interest because it experienced considerable environmental pollution during the past decades without any improvement of the available Health Services. A quite diverse population in relation to its occupation and its origin inhabits this area as well. The scoliosis incidence found in this area is similar to the incidence observed (2,9%) at other non-industrialized geographical departments of this country (2,6%). This implies that industrial environmental factors probably do not significantly influence the prevalence of AIS.