Proprioception Analysis following Anterior Cruciate Ligament Reconstruction using Stabilometry: A Prospective, Longitudinal Study / Análise de propriocepção por estabilometria após a reconstrução do ligamento cruzado anterior: Um estudo prospectivo e longitudinal

Abstract Objective Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p < 0.001) and to the control group ( p = 0.01). There was asignificant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had asignificant correlation (r = 0.46) with post-operative proprioception ( p = 0.006). Conclusion Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.

Resumo Objetivo Os métodos comumente usados para medir a propriocepção resultaram em relatos conflitantes sobre a propriocepção do joelho com ruptura do ligamento cruzado anterior (LCA) e a influência da reconstrução do LCA. Métodos A propriocepção de 100 indivíduos (50 pacientes com ruptura unilateral do LCA confirmada à radiologia e artroscopia e 50 controles normais) foi avaliada por estabilometria postural dinâmica em apoio unipodal. A lassidão ligamentar do joelho instrumentado e suas pontuações de desfechos também foram medidas. Dos 50 pacientes do grupo LCA, 34 foram submetidos à reconstrução e reavaliados no período pós-operatório. Resultados O grupo LCA apresentou deficiência proprioceptiva significativa em relaçãoaojoelho contralateral ( p < 0,001) e ao grupo controle ( p = 0,01). A propriocepção do joelho melhorou de maneira significativa após a reconstrução do LCA em relação aos achados pré-operatórios ( p = 0,003). Não houve correlação entre as medidas de lassidão ligamentar e as pontuações de desfechos. Além disso, observamos uma correlação significativa entre as pontuações de desfechos e as medidas de propriocepção antes da cirurgia. Essa correlação não foi detectada no período pós-operatório. O teste pré-operatório de propriocepção teve correlação significativa ( r = 0,46) com a propriocepção pós-operatória ( p = 0,006). Conclusão Os pacientes com ruptura do LCA apresentaram déficit proprioceptivo que melhorou após a reconstrução ligamentar. As pontuações de desfecho do joelho tiveram melhor correlação à propriocepção do que a lassidão ligamentar. A proprio-cepção pode ser uma medida objetiva superior à lassidão ligamentar na quantificação de déficits funcionais e desfechos do joelho em pacientes com ruptura do LCA. Nível de Evidência III Estudo Terapêutico; Estudo de Caso-Controle Longitudinal Prospectivo.

A Low-Energy Patella Vertical Dislocation in an Adolescent: A Case Report

@#Intra-articular dislocation of the patella is considered a rare case where it was reported that limited cases are existing in the literature and the exact mechanism of the injury is still undetermined. Patellar dislocation is divided into extraarticular and intra-articular dislocation. We report a patient with vertical dislocation of the patella caused by a lowenergy injury that is very rare according to the previous study. The patient came with a deformity, skin tenting, and pain with pressure on the superior and medial sides of the patella. During the physical examination, a deformation of skin tenting was observed with the characteristic of a “dorsal-fin” appearance over the laterally displaced patella. This paper will discuss the dislocation of the patella, which can be further classified into extra-articular and intraarticular. Vertical patellar dislocation most commonly occurred in adolescence. The outcome was considered satisfactory, and this case provides further knowledge of the mode of injury of vertical dislocation and also the possible risk factors.

Yonishaithilya (Perineal Laxity) - A Comprehensive Review

Yonishaithilya is a common gynecological problem of women of contemporary era which has very important impact on female’s sexual function. This must not be taken lightly as they can adversely affect the quality of woman’s life. As per Brihatrayi, Yonishaithilya represents as a symptom of Mahayoni Yonivyapada, Vatala Yonivyapada, Phalini Yonivyapada and Karnini Yonivyapada, not as a separate disease. Etiology, sign, symptoms and treatment of Yonishaithilya resembles with perineal laxity. Perineal laxity is the condition where there is loosening of supporting structure of female pelvis, thereby allowing the descent of one or more pelvic organ through the lax vaginal introitus. Data Source: Brihatrayees and Laghutrayees, also from all contemporary textbooks, Relevant journals and Websites; Review method: Literary review; Objective:. This review article summarizes details of Yonishaithilya, current scientific researches and elaborates the various therapeutic procedure and drug formulations suggested in Ayurveda for the treatment of Yonishaithilya. Scope and Conclusion: Ayurveda gives various Panchakarma and Sthanik chikitsa like local application of Pichu, Snehana Swedana which are economical, easy and nonsurgical; many single plants; herbal formulations used traditionally which gives an eminent result in Yonishaithilya. Untreated Yonishaithilya may produces complications like pelvic organ prolapse, urinary incontinence and may convert into 2nd or 3rd-degree prolapse where conservative treatment is not beneficial. In some cases, a patient has been advised for a hysterectomy but the patient is reluctant to undergo surgery. So, it is preferred to try Ayurvedic medicine which may be the step to avoid hysterectomy. So, it is necessary to treat it as early as possible.

Evaluation of hip joint laxity in crab-eating foxes (Cerdocyon thous)

ABSTRACT: Like canids, crab-eating foxes may probably be predisposed to similar orthopedic diseases of domestic dogs, such as hip dysplasia. However, for the adequate hip dysplasia diagnosis in wild animals, the normality characteristics of each species must be determined. This study aimed to estimate radiographic and computed tomographic (CT) values of hip joint laxity in healthy crab-eating foxes. Fifteen intact crab-eating foxes, eight males and seven females, ages 1 to 5 and mean body mass of 6.66kg were used. Norberg angle (NA) was calculated from ventrodorsal hip-extended radiographs. To calculate the dorsolateral subluxation (DLS) score, the center distance (CD) index, the lateral center edge angle (LCEA), and the dorsal acetabular rim angle (DARA), measurements obtained from transverse CT images were used. No statistically significant differences were observed between the right and left sides in the radiographic and tomographic parameters. The mean NA was 107.57°. The mean DLS score, the CD index, the LCEA, and the DARA were 60.79%, 0.16, 98.25° and 13.47°, respectively. The data obtained are helpful in characterizing mean values of the hip joint in healthy crab-eating foxes, and can contribute to the knowledge of the species.

RESUMO: Como canídeos, os cachorros-do-mato podem estar predispostos a doenças ortopédicas semelhantes aquelas de cães domésticos, tais como a displasia coxofemoral. No entanto, para o diagnóstico adequado da displasia coxofemoral em animais selvagens, os padrões de normalidade de cada espécie precisam ser determinados. Sendo assim, o presente estudo teve como objetivo estimar os valores radiográficos e tomográficos (TC) da lassitude da articulação coxofemoral em cachorros-do-mato hígidos. Foram utilizados quinze cachorros-do-mato não castrados, oito machos e sete fêmeas, com idades entre 1 e 5 anos e massa corporal média de 6,66kg. O ângulo de Norberg (NA) foi calculado a partir de radiografias na projeção ventrodorsal com os membros estendidos. Para calcular o escore de subluxação dorsolateral (DLS), o índice de distância central (CD), o ângulo da margem central lateral (LCEA) e o ângulo da borda dorsal acetabular (DARA), foram utilizadas as mensurações obtidas a partir de imagens transversais da TC. Não foram observadas diferenças estatísticas entre os lados direito e esquerdo nos parâmetros radiográficos e tomográficos. A média do NA foi de 107,57°. As médias do escore do DLS, do índice de CD, e dos ângulos LCEA e DARA foram, respectivamente, 60,79%, 0,16, 98,25° e 13,47°. Os dados obtidos são úteis para a caracterização dos valores médios referentes à articulação coxofemoral de cachorros-do-mato e podem contribuir para o conhecimento da espécie.

Evaluation of hip joint laxity in crab-eating foxes (Cerdocyon thous) / Avaliação da lassitude da articulação coxofemoral em cachorro-do-mato (Cerdocyon thous)

Like canids, crab-eating foxes may probably be predisposed to similar orthopedic diseases of domestic dogs, such as hip dysplasia. However, for the adequate hip dysplasia diagnosis in wild animals, the normality characteristics of each species must be determined. This study aimed to estimate radiographic and computed tomographic (CT) values of hip joint laxity in healthy crab-eating foxes. Fifteen intact crab-eating foxes, eight males and seven females, ages 1 to 5 and mean body mass of 6.66kg were used. Norberg angle (NA) was calculated from ventrodorsal hip-extended radiographs. To calculate the dorsolateral subluxation (DLS) score, the center distance (CD) index, the lateral center edge angle (LCEA), and the dorsal acetabular rim angle (DARA), measurements obtained from transverse CT images were used. No statistically significant differences were observed between the right and left sides in the radiographic and tomographic parameters. The mean NA was 107.57°. The mean DLS score, the CD index, the LCEA, and the DARA were 60.79%, 0.16, 98.25° and 13.47°, respectively. The data obtained are helpful in characterizing mean values of the hip joint in healthy crab-eating foxes, and can contribute to the knowledge of the species.(AU)

Como canídeos, os cachorros-do-mato podem estar predispostos a doenças ortopédicas semelhantes aquelas de cães domésticos, tais como a displasia coxofemoral. No entanto, para o diagnóstico adequado da displasia coxofemoral em animais selvagens, os padrões de normalidade de cada espécie precisam ser determinados. Sendo assim, o presente estudo teve como objetivo estimar os valores radiográficos e tomográficos (TC) da lassitude da articulação coxofemoral em cachorros-do-mato hígidos. Foram utilizados quinze cachorros-do-mato não castrados, oito machos e sete fêmeas, com idades entre 1 e 5 anos e massa corporal média de 6,66kg. O ângulo de Norberg (NA) foi calculado a partir de radiografias na projeção ventrodorsal com os membros estendidos. Para calcular o escore de subluxação dorsolateral (DLS), o índice de distância central (CD), o ângulo da margem central lateral (LCEA) e o ângulo da borda dorsal acetabular (DARA), foram utilizadas as mensurações obtidas a partir de imagens transversais da TC. Não foram observadas diferenças estatísticas entre os lados direito e esquerdo nos parâmetros radiográficos e tomográficos. A média do NA foi de 107,57°. As médias do escore do DLS, do índice de CD, e dos ângulos LCEA e DARA foram, respectivamente, 60,79%, 0,16, 98,25° e 13,47°. Os dados obtidos são úteis para a caracterização dos valores médios referentes à articulação coxofemoral de cachorros-do-mato e podem contribuir para o conhecimento da espécie.(AU)

Correlation between Global Wrist Laxity and Movement of the Scaphoid and the Lunate in Various Places During Radio Ulnar Deviation of the Wrist

Introduction: In the intact wrist, three dimensional motionsof the carpal bones has been reported as a screw displacementaxis representation of the motion as the angular motion ofthe bones or as translations between the bones, however thelatter has frequently been quantified as a displacement in thedirection of the screw axis. Current research aimed to establishcorrelation between global wrist laxity and movement of thescaphoid and the lunate in various places during radio ulnardeviation of the wrist.Material and methods: The proposed study was a prospectivestudy conducted in the Department of Orthopedics, RMCH,Bareilly, UP, comprising 100 healthy volunteers with equal sexration who never had any symptoms pertaining to their wristjoint. An informed written consent was obtained. Standardposterolateral and true lateral radiograph of wrist were madeto exclude any radiological abnormality. PA and lateralradiograph were obtained in full radial and ulnar deviation.A custom-made positioning device was used to ensure properplacement of the hand and wrist during the examination.Results: We observed that the age varied from 21 years to 40years. Radial deviation varied from 10 to 25 degree with meanof 18.06 degree. Ulnar deviation varied from 25 to 60 degreewith mean of 36.51 degree. Laxity score varied from 31 to 100with mean of 64.20.Conclusion: Within the limitations of the present study,it can be concluded that the ulnar deviation of the wrist isseen to cause radial translation ad dorsal rotation of theproximal carpal row. Similarly, the radial deviation was seento cause ulnar translation and volar rotation of the proximalcarpal row.

Rotational Shift of Proximal Carpal Row and it's Correlation with Global Wrist Joint Laxity

Introduction: As the wrist moves to ulnar deviation, theproximal carpal row undergoes radial translation, dorsalrotation and supination. Similarly, the radial deviationinvolves ulnar translation of the proximal carpal row, its volarrotation and pronation. These combined movements of theproximal carpal row are called rotational shift of the carpus.Study aimed to quantify the rotational shift of the proximalcarpal row during ulnar or radial deviation of the wrist.Material and methods: The proposed study was a prospectivestudy conducted in the Department of Orthopedics, RMCH,Bareilly, UP comprising 100 healthy volunteers with equal sexration who never had any symptoms pertaining to their wristjoint. PA and lateral radiograph were obtained in full radialand ulnar deviation. A custom-made positioning device wasused to ensure proper placement of the hand and wrist duringthe examination.Results: In the present study, we observed that theradioscaphoid angle in radiation deviation varied from 50to 85 degree with mean of 68.96 degree. Radioulnate anglein radial deviation varied from -2 to 45 degree with mean of17.79 degree. Radioscaphoid angle in ulnar deviation variedfrom 10 to 70 degree with mean of 39.97 degree. Radioulnateangle in ulnar deviation varied from -3 to -38 degree withmean of -17.15 degree.Conclusion: Within the limitations of the present study, itcan be concluded that the ulnar deviation of the wrist is seento cause radial translation ad dorsal rotation of the proximalcarpal row. Similarly, the radial deviation was seen to causeulnar translation and volar rotation of the proximal carpal row.

Rare Cases of PLOD1-Related Kyphoscoliotic Ehlers-Danlos Syndrome in a Korean Family Identified by Next Generation Sequencing

Kyphoscoliotic Ehlers-Danlos syndrome (kEDS) is an autosomal recessive connective tissue disorder characterized by muscular hypotonia, hyperextensible skin, skin fragility, joint hypermobility, and progressive kyphoscoliosis. The disorder results from a deficiency of the enzyme collagen lysyl hydroxylase 1 due to mutations in the gene PLOD1. We describe the rare cases of kEDS in Korean siblings with two novel compound heterozygous variants, c.926_934del (p.Leu309_Leu311del) and c.2170_2172del (p.Phe724del) in the PLOD1 gene. They had congenital hypotonia, joint laxity, skin hyperextensibility, Marfanoid habitus, high myopia and atrophic scarring. The younger sibling had an early-onset progressive kyphoscoliosis, while the older sibling showed mild scoliosis during childhood. Intrafamilial variability of the clinical severity and age of kyphoscoliosis onset observed in our cases.

Short-term effectiveness of arthroscopically capsular vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity / 中国修复重建外科杂志

Objective: To evaluate the short-term effectiveness of arthroscopically capsular vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity. Methods: A retrospective analysis was performed on 6 shoulder recurrent anterior dislocation patients combined with joint laxity treated with arthroscopically capsular vertical mattress suturing between January 2017 and December 2018. There were 5 males and 1 female with an average age of 20.8 years (range, 19-24 years). The number of shoulder dislocation was 3-18 times, with an average of 9.5 times. The disease duration ranged from 2 to 60 months, with an average of 25.3 months. The preoperative Beighton score was 4-7, with an average of 5.8; the Instability Severity Index Score (ISIS) was 2-5, with an average of 3.5. There were 5 cases of simple Bankart injury and 1 case of bony Bankart injury. The range of motion of shoulder joint (including active flexion and lifting, external rotation, abduction and external rotation, and internal ratation) was recorded before operation and at last follow-up; Oxford shoulder instability score, Rowe shoulder instability score, and Simple Shoulder Test (SST) score were used to evaluate shoulder joint function before operation, at 6 months after operation, and at last follow-up, and complications were recorded. Results: All patients were followed up 16-28 months (mean, 19.3 months). During the follow-up, all patients had satisfactory motor function, and no re-dislocation and postoperative neurovascular complications occurred. At last follow-up, the activities of active external rotation and abduction and external rotation were significantly improved when compared with those before operation ( P0.05). The Oxford shoulder instability score, Rowe shoulder instability score, and SST score at 6 months after operation and at last follow-up were significantly improved when compared with those before operation ( P0.05). Conclusion: The treatment of shoulder recurrent anterior dislocation combined with joint laxity by arthroscopically vertical matress suturing can achieve good short-term effectiveness.

Efficacy and safety of monopolar radiofrequency for the improvement of facial skin laxity and rhytides: A systematic review of clinical trials / The Health Sciences Journal

INTRODUCTION: There is a consistent increase in the interest and demand for non-invasive modalities toimprove facial skin laxity and rhytides. Monopolar radiofrequency is one of such non-invasive modalities.This systematic review aimed to determine the efficacy and safety of monopolar radiofrequency inimproving facial rhytides and skin laxity.METHODS: Clinical studies that assessed the efficacy of monopolar radiofrequency to address clinicallyobservable facial rhytides and skin laxity were included. Outcome measures included improvementin rhytides and skin laxity as documented by patient satisfaction scores, and investigator and third-personobserver ratings based on clinical photographs and clinical scales.RESULTS: Three studies involving 29 participants were included in this review. All studies reported 25-50% improvement in facial rhytides and skin laxity. Participants from the three studies were satisfiedwith the results. Transient erythema was reported in several patients.CONCLUSION: Monopolar radiofrequency appears to be beneficial and safe for patients with facialrhytides and skin laxity. However, the evidence is inconclusive due to problems in the methodologicalquality of each trial and the heterogeneity of the studies included in this review.

Arterial Tortuosity Syndrome in a Neonate

Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive connective tissue disease characterized by generalized elongation and tortuosity of the medium- to large-sized arteries, and other systemic connective tissue manifestations. To date, this disease entity has not been reported in Korea. We report a case of ATS diagnosed in a neonate who presented with severe elongation and tortuosity of the aorta and its major branches, as well as the intracranial arteries. Additionally, the patient presented with a tortuous dilatation of the inferior vena cava, an aneurysmal dilatation of the extra-hepatic bile ducts, and an inguinal and sliding hiatal hernia. The diagnosis was confirmed using DNA sequencing analysis, and the patient demonstrated a compound heterozygosity for two novel mutations (c.738delG [p.Gln247Serfs*33] and c.362T>C [p.Ile121Thr]) in exon 2 of the SLC2A10 gene. Genetic analysis also confirmed that both parents were heterozygous carriers of the responsible mutations. Owing to such clinical manifestations, ATS is often misdiagnosed as other connective tissue diseases including Loeys-Dietz syndrome, Marfan syndrome, and Ehlers-Danlos syndrome. In patients presenting with a high index of suspicion, thorough clinical evaluation and screening for ATS including computed tomography or magnetic resonance angiography and target gene analysis are necessary for early diagnosis and management.

Clinical features of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the clinical characteristics of secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation, and to analyze the influence of operation on visual acuity and intraocular pressure (IOP). ·METHODS:Totally 38 cases (38 eyes) of the secondary glaucoma caused by lens suspensory ligament laxity or occult subluxation in ophthalmology department of our hospital from December 2014 to December 2016 were enrolled and their medical records were analyzed retrospectively to observe the clinical characteristics of glaucoma. Preoperative mydriasis was carried out and surgical methods were chosen according to the lenses location and extent of suspensory ligament. Preoperative and postoperative anterior chamber depth, corneal endothelial cell density, IOP, visual field, visual acuity and complications were analyzed. ·RESULTS:The average intraocular pressure was 18.17± 1.43mmHg at postoperatively 10d,which was significantly lower than 38. 77 ± 2. 45mmHg before operation, the difference had statistical significance (P<0.05). The IOP of 25 eyes returned to normal (≤21mmHg) at 3d after surgery. The IOP of 34 eyes with the usage of IOP lowering medication returned to normal at postoperative 10d. The IOP of 4 eyes came to normal after undergoing glaucoma drainage valve implantation again. There were 5 eyes with visual acuity ranged 0.1 to <0.2,17 eyes 0.2 to <0.5,16 eyes≥0.5 preoperatively,and 2 eyes,17 eyes and 19 eyes postoperatively, the difference was not significant (P>0.05). The postoperative anterior chamber depth was 2.45 ± 0.44mm, which was significantly higher than 1.23 ± 0.35mm before operation, the difference had statistical significance (P < 0. 05). The postoperative corneal endothelial cell density was 878.34 ± 322.12/mm2 and decreased significantly, compared with 1735.32 ± 340. 32/mm2before operation, the difference had statistical significance (P<0.05). There were 8 eyes with corneal edema,4 eyes with iris adhesion or varying degrees of atrophy,3 eyes with anterior chamber hemorrhage,and 2 eyes with pupil exudate at 3d after surgery. · CONCLUSION: Clinical symptoms and signs of secondary glaucoma in patients with lens suspensory ligament laxity or occult subluxation are more complex, which needs to be distinguished with other types of glaucoma in clinical treatment, and its surgical methods shall be chosen according to different suspensory ligament site and lens subluxation scope.

Microagulhamento associado a fatores de crescimento e vitamina C no tratamento de estrias, fibro edema gelóide e flacidez tissular na região glútea / Microneedling associated to growth factors and ascorbic acid in the treatment of cellulite, striae distensae and skin laxity in the gluteal region

O microagulhamento é usado no tratamento de diversas afecções estéticas promovendo estímulo de colágeno. O objetivo deste trabalho foi averiguar a eficácia da associação do microagulhamento a fatores de crescimento e a vitamina C em diferentes afecções estéticas na região glútea. Foram realizadas 4 sessões de microagulhamento com intervalo de 21 dias entre as sessões. Percebeu-se significativa melhora na flacidez tissular, no fibro edema gelóide (FEG) e nas estrias e o microagulhamento mostrou-se uma técnica segura e eficaz para tratementos dessas disfunções estéticas. (AU)

The microneedling is used in the treatment of several aesthetic affections promoting collagen stimulation. The objective of this study was to verify the efficacy of the association of microneedling, growth factors and ascorbic acid in aesthetic affections in the gluteal region. Four sessions of microneedling were performed with a 21-day interval between the sessions, in which a significant improvement on skin laxity, cellulite and striae distensae was observed in the result and proved that the microneedling is to be a safe and effective technique for treating these aesthetic dysfunctions. (AU)

Síndrome de Morquio, enfermedad de interés para la odontopediatría: presentación de un caso / Morquio syndrome, a disease of interest for pediatric dentistry: case report

El Síndrome de Morquio es un trastorno de almacenamiento de mucopolisacáridos se caracteriza principalmente por estatura corta y afectación ósea grave, pero el coeficiente intelectual es normal. La prevalencia es rara se estima que afecta a uno de cada 200.000 nacimientos hombres y mujeres por igual. La MPS IV A y B son enfermedades autosómicas recesivas con esto queremos decir que ambos progenitores son portadores del mismo gen afectado el cual se encuentra alterado produciendo así una deficiencia en la producción de la enzima. Las manifestaciones esqueléticas en esta displasia son retardo en el crecimiento, hipoplasia del odontoides, cifosis toracolumbar, displasia de cadera, genu valgo, manchas cutáneas y laxitud articular, en cuando a cuestiones dentales tenemos: el esmalte es delgado, rugoso e hipoplásico afectando dientes deciduos como permanentes. Se presenta el caso de un paciente masculino de 8 años 3/12 presentando MPS el cual requiere un protocolo de rehabilitación lo cual se realiza en el área de odontopedriatría del Hospital del Niño DIF.

Morquio syndrome is a mucopolysaccharide storage disorder is mainly characterized by short stature, severe bone involvement, but IQ is normal. The prevalence is rare is estimated to affect one in every 200,000 births men and women alike. The MPS IV A and B are autosomal recessive diseases with this we mean that both parents are carriers of the same gene affected which is altered thus producing a deficiency in the production of the enzyme. The skeletal manifestations in this dysplasia are growth retardation, hypoplasia of the odontoid, thoracolumbar kyphosis, hip dysplasia, genu valgus, skin blemishes and joint laxity, then dental issues are: the enamel is thin rugged and hypoplastic affecting deciduous theeth as permanent. The case of a male patient presenting eight years 3/12 MPS which requires a rehabilitation protocol which is done in the dental area of Hospital del Niño DIF is presented.

Causes of Residual Pain after Open Excision of Wrist Ganglion / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to verify the relationship between the residual pain and preoperative carpal instability, as well as the generalized laxity after open excision of wrist ganglion. MATERIALS AND METHODS: Sixty-four patients, who received open excision of wrist ganglion, were retrospectively enrolled. The relationships between residual pain (visual analogue scale, VAS) and postoperative function (quick disabilities of the arm, shoulder and hand, quick-DASH), between residual pain and preoperative carpal instability, as well as generalized laxity were evaluated. The carpal instability was assessed from radiologic carpal instability (dorsal intercalated segment instability and volar intercalated segment instability) and Watson scaphoid shift test. The generalized laxity was assessed by the Beighton hypermobility score. RESULTS: Pain VAS and quick-DASH were significantly improved postoperatively. There was a significant difference in postoperative residual pain between those with (n=6) and without carpal instability (n=58) (+: 2.50±1.76 vs. −: 1.18±1.24; p=0.022), but there was no correlation between carpal instability and postoperative quick-DASH. Both postoperative residual pain and quick-DASH had no correlation with generalized laxity (n=18). CONCLUSION: Patients with preoperative carpal instability had greater residual pain after excision of wrist ganglion than those without.

Relación entre hiperlaxitud articular, dismetría de miembros inferiores y control postural con los trastornos posturales / Relationship between joint hypermobility, lower limb asymmetry and postural control with postural abnormalities

Objetivos: Determinar si existe relación entre hiperlaxitud articular, dismetría de miembros inferiores y la estabilidad ocontrol postural en bipedestación con los trastornos posturales en adolescentes. Material y métodos: Estudio relacional transversal,realizado en el Instituto Nacional de Rehabilitación “Dra. Adriana Rebaza Flores” Amistad Perú-Japón,Chorrillos-Perú. Participaron todos los estudiantes del 5º año de secundaria de un colegio privado de la ciudad deLima. La hiperlaxitud articular (HA) se evaluó con el score de Beighton; la dismetría de miembros inferiores (DMI),con medición en ortoradiografía; el control postural (CP) con posturografía estática usando una plataforma ISTFOOTWORK; el apoyo plantar (pie plano y pie cavo) con baro-podometría; la escoliosis e hiperlordosis lumbar conmedición radiográfica del ángulo de COBB y de lordosis...

Objectives: To determine an association between joint hypermobility, lower limb asymmetry and postural control withpostural abnormalities in adolescents. Methods: Cross-sectional study conducted at the National Rehabilitation Institute“Dra. Adriana Rebaza Flores” Amistad Perú-Japón, Chorrillos-Perú. All students of the 5th year of a private secondaryschool in Lima participated in the study. Joint hypermobility (JH) was assessed with the Beighton´score; lower limbasymmetry (LLA) was evaluated with X-ray; postural control (PC) was evaluated with static posturography using ISTFOOTWORK platform; plantar surface (flat foot and cavus foot) was evaluated with baro-podometry; scoliosis andlumbar hyperlordosis were measured with X-ray measuring the COBB angle...

Cutaneous asthenia (Ehlers-Danlos syndrome) in a Korean short-haired cat

A 1-year-old Korean domestic short-haired cat presented with skin hyperextensibility and a severely macerated wound on the skin of the dorsal part of the neck. Diagnostic studies including histopathology and skin extensibility index revealed congenital cutaneous asthenia (Ehlers-Danlos syndrome). In this cat, the skin wounds and defects were successfully managed with standard wound management and cosmetic surgery. Although skin hyperextensibility is persistent, the cat has lived well without other complications to date. To the best of our knowledge, this is the first report of cutaneous asthenia in a cat in Korea.

Two Cases of Reconstruction with Modified Keystone Flap on the Lower Extremity / 대한피부과학회지

Even though several techniques are available for repairing lower extremity skin defects, it is hard to challenge the advantages of local flaps (advancement, rotation, or transposition) due to lack of skin laxity of lower extremities. Modified keystone flap (MKF) is a simple and effective method of closing a large skin defect. It is especially useful for wound closure in circumstances where the defects show limited skin laxity. Compared to the keystone flap (KF), MKF has many advantages, including quick healing time, high flap viability, minimal postoperative pain, and excellent aesthetic results. Here, we report two cases of reconstruction of large skin defects of the lower extremities using MKF with satisfactory results.

High-Intensity Focused Ultrasound for the Treatment of Wrinkles and Skin Laxity in Seven Different Facial Areas

BACKGROUND: High-intensity focused ultrasound (HIFU) treatment has recently emerged in response to the increasing demand for noninvasive procedures for skin lifting and tightening. OBJECTIVE: This study was aimed at evaluating the clinical efficacy of and patient satisfaction with HIFU treatment for wrinkles and laxity in seven different areas of the face in Asian skin. METHODS: Twenty Korean patients with facial wrinkle and laxity were analyzed after a single session of HIFU treatment. Two independent, blinded clinicians evaluated the clinical improvement in seven areas of the face by comparison of standardized photographs obtained before, and at 3 and 6 months after treatment. Assessment of subjective satisfaction and adverse effects of treatment were done by using questionnaires. RESULTS: The physicians' evaluation and patients' satisfaction with the clinical effects of HIFU in each area were similar regardless of the number of treatment shots. The jawline, cheek, and perioral areas were the sites where HIFU was most effective, in decreasing order. The adverse effects included erythema and swelling in six cases, and purpura and bruising in two cases. However, the adverse effects were mild and transient. CONCLUSION: HIFU could be a safe, effective, and noninvasive procedure that can be used to improve facial wrinkles and skin laxity in Asian skin. It is particularly effective for clinical improvement in the jawline, cheek, and perioral areas.