Anterior Traumatic Lumbosacral Dislocation: A Case Report.

Traumatic dislocation of the lumbosacral joint is a rare and severe lesion usually caused by high-energy trauma. The literature on traumatic spondylolisthesis is limited, and most published papers are sporadic case reports. By presenting the case of an anterior traumatic L5-S1 spondylolisthesis without neurological deficits caused by a 6-meter fall, we discuss the anatomopathological mechanism of this injury, clinical and radiological evaluation, and current management options. The patient was treated surgically with a combined posterior instrumented reduction and transforaminal interbody fusion. At the final follow-up after seven years, the radiological evaluation showed an unchanged spondylolisthesis reduction with reliable fusion healing. In addition, the patient had good functional results and resumed recreational activities and work. Traumatic lumbosacral spondylolisthesis requires a careful and well-documented initial clinical and radiological assessment. Most authors advocate surgical treatment as the mainstay of management. However, the long-term prognosis remains unclear and unpredictable.

Relevance of the video capsule as a tool for learning Schöber Index measurement in medical students.

INTRODUCTION: Medical education has progressed considerably. Information and communication technologies have been adopted as a learning tool. AIM: We aimed to evaluate the contribution of an educational video in the acquisition of knowledge on the measurement of the Schöber index in young medical students. METHODS: This is a prospective study, spread over 4 months (February 2022-May 2022) and conducted in the rheumatology and orthopedics departments of the Charles Nicolle Hospital in Tunis. We included medical students during their externship at the mentioned services. We compared the realization of the steps of the Schöber test (testing the flexibility of the lumbar spine) before and after the visualization of an educational video. RESULTS: A total of 32 students (6 men and 26 women) were enrolled. There were 18 students (56%) in DCEM1 and 14 students (44%) in PCEM2. Our study showed that the number of students who correctly performed the different steps of the Schöber test increased after viewing the instructional video compared to the beginning, but this increase was not significant. There were some differences between the PCEM2 and DCEM1 groups before viewing the video, but this difference decreased after viewing the video. CONCLUSION: Our study has demonstrated the value of an educational video in improving the knowledge of medical students. This work needs to be applied on a larger scale in different medical specialties.

Fortuitous discovery of isolated tuberculosis of the tenth and eleventh costotransverse joints: A case report.

Involvement of posterior elements of the spine in spinal tuberculosis is rare. We report a case of a 56-year-old woman who presented with asymptomatic tuberculosis of the tenth and eleventh costotransverse joints. The latter was discovered with a CT scan made to look for a pulmonary embolism. Magnetic Resonance Imaging (MRI) showed liquid in the costotransverse joints with a paravertebral abscess. The patient was managed conservatively. Although rare, posterior tuberculosis of the spine should be known by spine surgeons. MRI is the key to the diagnosis. Conservative treatment is the standard treatment, and surgery is reserved for patients with neurological deficit.

Initial description of the TEKTONA® technique for tibial plateau depression fractures.

Reduction of depressed tibial plateau fractures with TEKTONA® is a percutaneous technique done with fluoroscopy guidance whose aim is to preserve the soft tissues and avoid hemorrhage. The anatomical result is close to that of open reduction with benefits such as reduced pain and early motion. This procedure was first described for vertebral compression fractures but has recently been applied to intra-articular long bone fractures. It consists of reducing depressed fragments with a system of expandable strips mounted on a rigid clamp. Fixation of the reduced fragments is done with cement; percutaneous fixation can be added. This technique is an interesting alternative to standard treatments. Mastery requires good knowledge of the various steps and comprehensive analysis of the depression on CT scan.

Bladder exstrophy in adulthood: About a case report.

Bladder exstrophy is a severe malformation characterized by the lack of the anterior sub-umbilical abdominal wall, and the front wall of the bladder. We present a rare case of a 26-year-old woman without any previous medical or surgical history, that we treated for bladder exstrophy. We performed an iliac osteotomy, bladder enlargement using the ileum and a Monti-type continent urinary derivation and a Promentofixation. A vesico-cutaneous fistula was diagnosed after surgery and we failed to manage it after two surgical revision. Therefore, we performed a cystectomy and a non-continent Bricker external urinary derivation.

Transstyloid radiocarpal dislocation: A case report.

INTRODUCTION AND IMPORTANCE: Transstyloid radiocarpal dislocation is a rare injury. It is due to high-energy trauma. It usually associates a radiocarpal dislocation, a fracture of the radial and/or cubital styloid process, and a cortical volar/dorsal margin avulsion. CASE PRESENTATION: We present a case of a 31-year-old male who sustained a fell from a 4 m height causing a transstyloid radiocarpal dislocation. He was treated with a radial styloid process pinning and wrist arthrorisis with and splint immobilization. CLINICAL DISCUSSION: Different treatment options can be available for this type of injury with or without ligaments reconstruction. CONCLUSION: Although it is rare, the transstyloid radiocarpal dislocation has a good outcome with different types of treatment.

Salmonella osteomyelitis complicating aseptic osteonecrosis: Don't forget about the antiphospholipid syndrome.

Osteonecrosis in antiphospholipid syndrome is a diagnostic challenge for clinicians. Early diagnosis and intervention are important for better prognosis.

Epidemiological and therapeutic aspects of acetabular fractures in elderly.

INTRODUCTION: Management of acetabular fracture in the elderly patients is becoming an increasingly topic of debate. Data from different parts of the world specified particularities of their patients. AIM: To describe patterns of these fractures in the Tunisian patients aged > 60, which can contribute to management and preventive plans. METHODS: We performed a retrospective review from 1997 to 2016 treated at the Charles Nicolle university hospital. Information regarding demographics, co morbidities, mechanism of injury, Injury Severity Score (ISS), types and levels of injury, treatment type, and mortality were collected. RESULTS: The mean age of our patients was 68,6 years (range 60-94 years). The male to female ratio was 3:85.Main causes were motor vehicle accident. Most of our patients were in good health. The associated lesions were very frequent and present in 64.7% of cases with a clear predominance of cranio-fascial trauma, with a median of the ISS score at 11. According to the Judet and Letournel classification, 18 elementary fractures and 16 complex fractures were reported with predominance of the anterior column-posterior hemitransverse fracture pattern. Posterior wall fracture in the elderly is often associated with comminution and / or marginal impaction and / or posterior dislocation of the hip. Fractures of the anterior segment are often associated with hip protrusion and / or quadrilateral plate involvement and / or the superomedial roof impaction or "Gull sign". CONCLUSION: As our population continues to age, traumatic acetabular fractures will become more prevalent. Appropriate screening strategies, treatment and prevention plans will need to be developed to improve outcomes in this devastating injury.

Genetic structure of the date palm (Phoenix dactylifera) in the Old World reveals a strong differentiation between eastern and western populations.

Since the publication of this paper, it has become apparent that an error was made in the legend to Fig. 3 and the colours referring to occidental and oriental are the wrong way round. The authors apologise for this error, and a correct version of the legend to Fig. 3 is given below.

Genetic structure of the date palm (Phoenix dactylifera) in the Old World reveals a strong differentiation between eastern and western populations.

BACKGROUND AND AIMS: Date palms (Phoenix dactylifera, Arecaceae) are of great economic and ecological value to the oasis agriculture of arid and semi-arid areas. However, despite the availability of a large date palm germplasm spreading from the Atlantic shores to Southern Asia, improvement of the species is being hampered by a lack of information on global genetic diversity and population structure. In order to contribute to the varietal improvement of date palms and to provide new insights on the influence of geographic origins and human activity on the genetic structure of the date palm, this study analysed the diversity of the species. METHODS: Genetic diversity levels and population genetic structure were investigated through the genotyping of a collection of 295 date palm accessions ranging from Mauritania to Pakistan using a set of 18 simple sequence repeat (SSR) markers and a plastid minisatellite. KEY RESULTS: Using a Bayesian clustering approach, the date palm genotypes can be structured into two different gene pools: the first, termed the Eastern pool, consists of accessions from Asia and Djibouti, whilst the second, termed the Western pool, consists of accessions from Africa. These results confirm the existence of two ancient gene pools that have contributed to the current date palm diversity. The presence of admixed genotypes is also noted, which points at gene flows between eastern and western origins, mostly from east to west, following a human-mediated diffusion of the species. CONCLUSIONS: This study assesses the distribution and level of genetic diversity of accessible date palm resources, provides new insights on the geographic origins and genetic history of the cultivated component of this species, and confirms the existence of at least two domestication origins. Furthermore, the strong genetic structure clearly established here is a prerequisite for any breeding programme exploiting the effective polymorphism related to each gene pool.

Convex-relaxed kernel mapping for image segmentation.

This paper investigates a convex-relaxed kernel mapping formulation of image segmentation. We optimize, under some partition constraints, a functional containing two characteristic terms: 1) a data term, which maps the observation space to a higher (possibly infinite) dimensional feature space via a kernel function, thereby evaluating nonlinear distances between the observations and segments parameters and 2) a total-variation term, which favors smooth segment surfaces (or boundaries). The algorithm iterates two steps: 1) a convex-relaxation optimization with respect to the segments by solving an equivalent constrained problem via the augmented Lagrange multiplier method and 2) a convergent fixed-point optimization with respect to the segments parameters. The proposed algorithm can bear with a variety of image types without the need for complex and application-specific statistical modeling, while having the computational benefits of convex relaxation. Our solution is amenable to parallelized implementations on graphics processing units (GPUs) and extends easily to high dimensions. We evaluated the proposed algorithm with several sets of comprehensive experiments and comparisons, including: 1) computational evaluations over 3D medical-imaging examples and high-resolution large-size color photographs, which demonstrate that a parallelized implementation of the proposed method run on a GPU can bring a significant speed-up and 2) accuracy evaluations against five state-of-the-art methods over the Berkeley color-image database and a multimodel synthetic data set, which demonstrates competitive performances of the algorithm.

Active curve recovery of region boundary patterns.

This study investigates the recovery of region boundary patterns in an image by a variational level set method which drives an active curve to coincide with boundaries on which a feature distribution matches a reference distribution. We formulate the scheme for both the Kullback-Leibler and the Bhattacharyya similarities, and apply it in two conditions: the simultaneous recovery of all region boundaries consistent with a given outline pattern, and segmentation in the presence of faded boundary segments. The first task uses an image-based geometric feature, and the second a photometric feature. In each case, the corresponding curve evolution equation can be viewed as a geodesic active contour (GAC) flow having a variable stopping function which depends on the feature distribution on the active curve. This affords a potent global representation of the target boundaries, which can effectively drive active curve segmentation in a variety of otherwise adverse conditions. Detailed experimentation shows that the scheme can significantly improve on current region and edge-based formulations.

Multiregion image segmentation by parametric kernel graph cuts.

The purpose of this study is to investigate multiregion graph cut image partitioning via kernel mapping of the image data. The image data is transformed implicitly by a kernel function so that the piecewise constant model of the graph cut formulation becomes applicable. The objective function contains an original data term to evaluate the deviation of the transformed data, within each segmentation region, from the piecewise constant model, and a smoothness, boundary preserving regularization term. The method affords an effective alternative to complex modeling of the original image data while taking advantage of the computational benefits of graph cuts. Using a common kernel function, energy minimization typically consists of iterating image partitioning by graph cut iterations and evaluations of region parameters via fixed point computation. A quantitative and comparative performance assessment is carried out over a large number of experiments using synthetic grey level data as well as natural images from the Berkeley database. The effectiveness of the method is also demonstrated through a set of experiments with real images of a variety of types such as medical, synthetic aperture radar, and motion maps.