Oral Radiology

A case of venous malformation of the mandible Abstract Objective Vascular malformations occur more rarely in bones than in soft tissue, with 0.5–1.0% of all intraosseous tumors occurring in the mandible. We report a diagnostically challenging case of unilocular venous malformation of the mandible. Case report A 76-year-old man presented with a heterogeneous, unilocular, radiolucent lesion with a well-defined border. Panoramic radiography and computed tomography imaging revealed a continuous white line on the cortical bone at the inferior border of the left mandibular molar region. A spherical lesion with a well-defined border and a clear round region in the left mandible were revealed on magnetic resonance imaging. The lesion had the same signal intensity as muscles on T1-weighted imaging, a homogeneous high-intensity signal on short T1-inversion recovery imaging, and a well-defined low-signal intensity region surrounded by a high-intensity signal region on T2-weighted imaging. Pathological findings indicated that the lesion was a venous malformation. Discussion Although many studies have reported that venous malformations have a multilocular appearance, few have described the occurrence of unilocular lesions. Future investigations using magnetic resonance imaging and computed tomography are needed to increase the diagnostic accuracy for unilocular central vascular malformations of the jaw bone.

Schwannoma assumedly originating from the submandibular ganglion or glandular branches radiologically mimicking a submandibular gland tumor Abstract Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannomas originating from ganglia are rare, and schwannomas of the submandibular ganglion or glandular branches have not been reported to date. We present a case of a Japanese woman in her sixties with a submandibular schwannoma originating from the submandibular ganglion, mimicking a submandibular gland tumor on radiological findings. As the radiological findings were nonspecific, the key finding in the present case may be the characteristic location of the tumor suspended from the undersurface of the lingual nerve and situated above the deep portion of the submandibular gland.

Radiological features of synovial chondromatosis affecting the temporomandibular joint: report of three cases Abstract Synovial chondromatosis is a benign nodular cartilaginous proliferation that mainly occurs in large joints. The temporomandibular joint is considered to be rarely affected. Several cases of synovial chondromatosis of the temporomandibular joint have been reported with clinical and histological features. People with this disease may present with swelling, pain, intracapsular sounds, and limitation of mandibular movement. Radiographs are an important component in the diagnostic process for synovial chondromatosis. In this article, we report three cases of synovial chondromatosis occurring in the temporomandibular joint with a focus on the radiological features, including those on plain films, cone-beam computed tomography (CT) images, and conventional CT images. The three cases had totally different radiological features. The imaging differences were analyzed and compared to create combined diagnostic methods based on clinical features and examination techniques. The role of cone-beam CT examination in the diagnosis of the disease is discussed.

Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation Abstract Objective This cross-sectional study aimed to explore potential jawbone changes secondary to bisphosphonate (BP) treatment of osteoporosis using digital panoramic and periapical radiography. Methods Thirty-nine women, previously examined with dual-energy X-ray absorptiometry, were radiographed by digital panoramic and/or periapical radiography. On periapical radiographs, trabecular bone structure and fractal dimension analyses of the mandibular first molar and edentulous regions were performed. On panoramic radiographs, the mandibular cortical width (MCW) was calculated, and trabecular bone structure and fractal dimension analyses of the trabecular bone in the alveolar and basal bones were performed. The results were compared between patients treated or not treated with BP using linear regression analysis to adjust for potential confounding factors. Results The analyses of periapical and panoramic radiological images showed no statistical differences in the jawbones between groups after bisphosphonate use for mean intervals of 4.3 and 5 years; respectively. Although the mandibular cortical width on panoramic radiography was correlated with BP use, it was not noted to be statistically significant. Conclusions The trabecular parts of the alveolar and basal bones and the MCW were not significantly altered by BP treatment in patients with osteoporosis over 4.3–5 years, as detected by digital periapical and panoramic radiography. The low dosages of bisphosphonates used in the treatment of osteoporosis may explain this lack of change in MCW. Dental radiographs should not be considered as a method to monitor BP-induced jaw bone alterations among osteoporotic patients.

Reproducibility of CBCT image analysis: a clinical study on intrapersonal and interpersonal errors in bone structure determination Abstract Objective For correct implant planning based on cone-beam computed tomography (CBCT), the bone contour must be accurately determined. Identification of the contour is difficult in bones with incomplete mineralization. In this clinical study, we investigated the intrapersonal and interpersonal reproducibilities of manual bone contour determination on CBCT images using a semi-automated computerized process. Methods The bone surface level in the area of the socket in 20 patients who had undergone tooth extraction from the upper jaw at 10 ± 1 weeks previously was determined on CBCT images. Two investigators with different levels of experience determined the bone structure initially (T0) and repeated the procedure after 3 months (T1). The bone structure marked on CBCT images was converted into a surface data set. The resulting data sets were superimposed on one another. In the analyses, the shortest distances between the datasets were identified and measured. The average deviations were statistically evaluated. Results The intrapersonal evaluation resulted in an average deviation of 0.18 mm across both investigators. The interpersonal analysis comparing the two investigators resulted in average deviations of 0.15 mm at T0 and 0.26 mm at T1. Significant differences were not found. Conclusions The low intrapersonal deviation indicates that the procedure has satisfactory reproducibility. All deviations were within the range of the selected resolution of the CBCT device. Application of a semi-automated procedure to detect the bone border in areas with incomplete mineralization is a predictable process. Trial registration The study was registered in the German Clinical Trials Register and the International Clinical Trials Registry Platform of the WHO: DRKS00004769, date of registration: 28 February 2013; and DRKS00005978, date of registration: 09 November 2015.

Sonographic diagnosis in the head and neck region: from an educational lecture presented at the 56th General Assembly and Annual Scientific Congress of the Japanese Society for Oral and Maxillofacial Radiology Abstract Sonography is a simple, inexpensive, and non-invasive diagnostic modality. Although tissues behind bony structures and deep tissues are not delineated, sonography can depict superficial soft tissues very clearly. In the head and neck region, however, it has not yet been used widely, as the anatomical structures are complicated, and considerable experience is needed both to perform an examination and to make a diagnosis. To perform examinations efficiently, operators must be familiar with the sonographic system in use, and take images at standard planes. To make a correct diagnosis, operators require knowledge of the sonographic anatomy on standard planes, representative sonographic signs and artifacts, and common diseases and their typical sonographic findings. In this paper, we have explained the sonographic anatomy on standard planes, and the sonographic findings of common diseases in the oral and maxillofacial region.

Radiological analysis of the sella turcica and its correlations with body mass index in a North Indian population Abstract Objectives The sella turcica is an important component situated in the mid-third of the cranial fossa. Knowledge about its normal morphologies and dimensions may play a crucial role in diagnosing underlying pathologies. The present study aimed to analyze the principal morphological shapes of the sella turcica, measure its linear dimensions, and determine whether any correlations exist between its dimensions and body mass index (BMI) in subjects in a North Indian population. Methods The study was conducted on 100 subjects (50 men; 50 women) who underwent cone-beam computed tomography scans at our Oral Medicine and Radiology Department. The subjects had an age range of 20–60 years. The morphology of the sella turcica was examined according to age and various measurements were taken to determine its size. Possible correlations between the dimensions of the sella turcica and BMI were evaluated by statistical analysis. Results In the present study, 69% of the subjects had a normal morphology. No uniform increases in length, width, and depth of the sella turcica were observed with aging. When Pearson correlation coefficients were calculated, no strong correlations were found between the dimensions of the sella turcica and BMI. A mild correlation was seen between the length and width of the sella turcica. Conclusion No significant correlations were found between the dimensions of the sella turcica and BMI in the present study. These findings may have arisen through the small sample size, and thus further studies with larger groups of subjects are warranted.

Comparison of cone-beam computed tomography with bitewing radiography for detection of periodontal bone loss and assessment of effects of different voxel resolutions: an in vitro study Abstract Objective The aim of the study was to compare intraoral radiographs and CBCT images for detection of horizontal periodontal bone loss, and to investigate the diagnostic effect of different voxel resolutions in CBCT imaging. Methods A total of 240 sites with horizontal bone loss were measured on the buccal, lingual, mesial, and distal surfaces of 60 posterior teeth in four maxillary and six mandibular bones obtained from cadavers (dry skulls). Direct measurements on the dry skulls were accepted as the gold standard values. Measurements on CBCT images at two different voxel resolutions (0.250 and 0.160 mm3) and intraoral bitewing radiographs were compared with one another and with the gold standard values. Results The measurements on the CBCT images at two voxel resolutions and bitewing radiographs did not differ significantly (p > 0.05) from the direct measurements on the dry skulls. No significant difference was found between the bitewing radiographs and CBCT images for measurements in the mesial and distal regions (p > 0.05). There was no significant difference between the measurements on the buccal and lingual surfaces at the two different voxel resolutions (p > 0.05). Conclusions CBCT scans are recommended for evaluation of buccal and lingual bone loss to avoid intraoral radiographs that exceed routine examination of interproximal alveolar bone loss. Furthermore, instead of basing the voxel size on the required CBCT scans, it is recommended to select the smallest possible field of view to reduce the dose of radiation.

Incidental findings during head and neck MRI screening in 1717 patients with temporomandibular disorders Abstract Objective Magnetic resonance imaging (MRI) plays an important role in the evaluation of temporomandibular disorders (TMDs). At our institution, we perform additional head and neck screening using head coils when performing MRI screening of the temporomandibular joint (TMJ) to detect lesions in areas other than the TMJ (lesions discovered by chance, or incidental findings; IFs) and to conduct a diagnosis of exclusion. The objective of this study was to determine the number and frequency of IFs detected during head and neck screening, according to sites and diseases. Materials and methods The study evaluated 1717 patients with clinically suspected TMDs who underwent MRI of the TMJ. IFs were assessed on horizontal sections of images of the craniofacial region obtained by the short tau inversion recovery imaging technique. Results The patients undergoing MRI of the TMJ comprised 433 males and 1284 females. Among the patients, at least one IF was detected on images in 461 patients. The most common IF site was the maxillary sinus. Based on diagnostic imaging, there were 21 IFs (1.2%) associated with TMD symptoms, or for which an association with TMD symptoms could not be ruled out. Conclusions Combination of conventional MRI imaging of the TMJ with craniofacial MRI screening may allow detection of lesions other than TMDs, thereby confirming the usefulness of MRI. Detection of IFs may require development of different therapeutic strategies than those for TMDs.

JAMA Otolaryngology–Head & Neck Surgery Mission Statement:JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician's understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our field; (2) forecast important advances within otolaryngology—head and neck surgery, particularly as they relate to the prevention, diagnosis, and treatment of disease through clinical and translational research, including that of the human genome and novel imaging techniques; (3) address questions of clinical outcomes and cost-effectiveness that result from clinical intervention, which grow in importance as health care providers are increasingly challenged to provide evidence of enhanced survival and quality of life; (4) provide expert reviews of topics that keep our readers current with true advances and also to provide a valuable educational resource for trainees in the several disciplines that treat patients with diseases of the head and neck; (5) serve as a forum for the concerns of otolaryngologists such as socioeconomic, legal, ethical, and medical issues; (6) provide helpful critiques that enable contributing authors to improve their submissions. We encourage a concise presentation of information and employ an abstract format that efficiently assesses validity and relevance from a clinical perspective. This approach promotes succinct yet complete presentation for our readers and electronic information resources. We believe this approach typifies the commitment of JAMA Otolaryngology–Head & Neck Surgery to providing important information that is easily interpreted by its diverse readership.

February Issue Highlights

Error in Figure Labels In the article titled "Is It Time to Rethink the Approach to Internal Nasal Valve Stenosis?," the 2 Figure labels (a and b) were transposed so that the labels corresponded to the incorrect descriptions in the Figure caption. The Figure has been corrected online.

Labels Reversed in Figure 1 In the Original Investigation titled "Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck" by Harris et al, the labels in Figure 1 were reversed. This article has been corrected online.

Traumatic Lower Lip Myiasis This is the report of a case of a homeless man in his 50s who presented with traumatic lower lip myiasis.

Aspiration in Infants With Laryngomalacia and Respiratory and Feeding Difficulties This study evaluates the medical records of infants with laryngomalacia and associated breathing and feeding difficulties to determine the prevalence of aspiration among this pediatric patient population.

Silent Aspiration in Laryngomalacia? Laryngomalacia is the most common laryngeal anomaly in infants, with a presentation of inspiratory stridor being nearly ubiquitous. In addition, young children with laryngomalacia can demonstrate feeding difficulty, dysphagia, aspiration, failure to thrive, apnea, cyanosis, and/or obstructive sleep apnea. Managing the balancing act between sucking, breathing, and swallowing is anticipated to carry additional challenge in infants with airway abnormalities, potentially leading to dysphagia, aspiration, and feeding difficulties. Somewhat unsurprisingly, infants with laryngomalacia may cough and choke during feeding, take their feeds slowly, or develop a worsening of their stridor during feeding. The association between laryngomalacia and feeding disorders is further strengthened by a biological gradient relationship, with more severe laryngomalacia cases shown to be more likely to have symptoms of feeding difficulty. In addition to dyscoordination, other proposed causes for feeding challenges in patients with laryngomalacia include decreased laryngeal sensation secondary to acid reflux and an alteration in the sensorimotor integrative function of the larynx. The association between acid reflux and laryngomalacia is well established, although evidence is lacking for causality or even direction of causality (ie, which is the chicken and which is the egg). Sensorimotor impairment in laryngomalacia is evidenced by the finding that children with laryngomalacia have higher rates of neurologic abnormalities such as hypotonia, central apneas and developmental disorders, and histopathologic nerve differences in their laryngeal mucosa.

Drug-Induced Sleep Endoscopy Findings in Supine vs Nonsupine Body Positions in Obstructive Sleep Apnea This cross-sectional study examines drug-induced sleep endoscopy findings in the supine vs nonsupine body positions in positional and nonpositional obstructive sleep apnea using VOTE classification criteria.

Adjuvant Radiation Therapy in Patients With Advanced CSCC of the Head and Neck This study examines the association of adjuvant radiation therapy vs surgery alone with survival in patients with advanced cutaneous squamous cell carcinoma and assesses which patients benefit the most from addition of adjuvant therapy to surgical treatment.

Variation in the Quality of US Head and Neck Cancer Care This evaluation of quality metrics uses data from the National Cancer Database to summarize hospital-level overall quality of care for patients with head and neck cancer in the United States.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

OrthopaedicS

Pasteurized osteo-articular autologous graft for the reconstruction of proximal humerus after resection of osteosarcoma Adel Refaat Ahmed The Egyptian Orthopaedic Journal 2018 53(2):89-95 Objectives For skeletal reconstruction in surgery for bone tumors, pasteurization of the bone has been used with favorable results over other methods of recycling. Patients and methods Ten patients with osteosarcoma of the proximal humerus were treated by wide margin resection and reconstruction with pasteurized osteo-articular autologous bone graft. They were seven females and three males, between 9 and 30 years of age who were followed up for at least 3 years (mean, 48 months). The International Society of Limb Salvage graft evaluation method was used for the evaluation of the radiographs. Results Six (60%) patients had complete incorporation of the graft and three (30%) patients had partial incorporation. The mean radiographic scoring rate was 84%. Viability of the grafts was evaluated by bone scintigraphy. Of the nine patients evaluated, uptake was detected in seven patients from ∼6 months postoperatively after which it increased gradually. The functional results were assessed by the system of the Musculoskeletal Tumor Society and the mean functional rating was 90%. Seven patients have been disease free and three have died of the disease. Resorption of the graft was seen in a single, 9-year-old patient (10%); no fractures or infections were seen. No local recurrence was detected. Conclusion These results indicate that pasteurization of the bone may be a useful option for reconstruction after resection of osteosarcoma of the proximal humerus. The advantages of extracorporeal pasteurization include convenience of use, avoidance of intraspecies infection and allogenic reactions, and satisfactory bone remodeling.

Minimally invasive percutaneous plate osteosynthesis for distal radius fractures with metaphysio-diaphyseal comminution Hosam Elsayed Farag, Ahmed Shawkat Rizk The Egyptian Orthopaedic Journal 2018 53(2):96-102 Background Distal radius fractures following high-energy trauma are common injuries, usually associated with metaphysio-diaphyseal comminution with marked soft tissue injury making effective treatment a real challenge with high risk of complications. Minimally invasive percutaneous plate osteosynthesis (MIPPO) is a fixation technique giving priority for soft tissues and vascularity of the bone fragments achieving a relatively stable fracture construct while preserving a biological environment insuring rapid bone healing. This study aims to evaluate the outcomes of the MIPPO technique for the treatment of distal radius fractures with metaphysio-diaphyseal comminution. Patients and methods This prospective, case series study comprised 11 cases of closed distal radial fractures with varying degrees of displacement and metaphysio-diaphyseal comminution following high-energy trauma. All fractures were treated by the MIPPO technique through two volar longitudinal incisions using a volar locking plate bridging the comminuted segment. The patients were followed up clinically and radiologically and the functional outcome was evaluated according to the Dienst wrist scoring system. Results All fractures united with a mean union time of 12.5±1.6 weeks (range, 11–16 weeks) with no reported loss of fixation with secondary displacement, implant failure, or deep wound infection. No cases needed any secondary surgical intervention to achieve union. The follow-up period extended for a mean duration of 16.7±3.2 months with satisfactory (excellent and good) clinical and radiological results compared with the other side achieved in all cases. The radiological results (radial inclination, radial height, and volar tilt) were excellent in eight cases and were good in three cases, but the clinical results (range of motion of the wrist and grip strength) were excellent in all the 11 studied cases. Conclusion The results are very satisfactory. MIPPO minimizes soft tissue compromise with preservation of vascularity of the comminuted fracture fragments, thus improving the healing rate, shortening the time for union with no need for initial or delayed bone grafting for such comminuted fractures with few potential complications.

Functional and radiological outcome of proximal femoral locking compression plates in the treatment of unstable trochanteric fractures Mohamed S. A. Mohamed Ismail, Mohamed A Ibrahim The Egyptian Orthopaedic Journal 2018 53(2):103-109 Introduction Intertrochanteric femoral fracture is extracapsular fracture of the proximal femur between the greater and lesser trochanters. They represent about 50% of all hip fractures. Considerable complications such as pulmonary embolism, deep venous thrombosis, and pneumonia are frequently seen with these fractures mainly due to prolonged immobilization and specifically in elderly patients. These fractures can be categorized into stable and unstable according to the bony construct displacement after a fracture. Approximately 35–40% will be classified as unstable three-part and four-part fractures; unstable fractures are difficult to manage with dynamic hip screw alone and are technically much more challenging and the treatment is more controversial. Patients and methods During the period from 1 July 2016 till 1 February 2017, 44 patients with unstable trochanteric fractures AO A2 and A3 who were admitted in the Causality Department in Kasralainy Hospital, Cairo University were randomly selected in our study to be treated by fixation with proximal femoral locking compression plate according to the standardized protocol. Results Patient demographics: 28 women and 16 men were included with a mean age of 61.75 years (SD 8.7); eight patients were diabetic; four patients were hypertensive, and three were cardiac. The total hospital stay was a mean of 8.95 days, mean preoperative period was 4.44 days, and the mean postoperative period was a mean of 4.73 days (SD 1.16).The mean operative time was 106 min; the mean blood loss intraoperative was 308 ml; postoperative infection was three (6.8%) cases; and all of them resolved with a single session of debridement. One case of deep venous thrombosis (DVT) was treated by conservative measures and four cases of varus malunion with no functional deficit. The mean time for fracture union was 17.9 weeks and the mean time till weight-bearing was 12 weeks. Mean harris hip score (HHS) at 6 months was 62.3 which is fair and 81.2 at 12 months which is good. Conclusion Proximal femoral locking compression plate was an effective treatment for unstable trochanteric fracture in terms of time to full weight-bearing. It can be used in these fractures with good functional outcomes and low complication rates. Level of Evidence: Level II randomized, prospective trial.

Percutaneous locked plating for complex distal tibial fractures Khaled M Balam The Egyptian Orthopaedic Journal 2018 53(2):110-114 Objective To evaluate the clinical outcome and advantages of percutaneous plate fixation for complex distal tibial fractures using locking compression plate-distal tibial plate (LCP-DTP). Design This is a prospective case series study. Setting Urban, level I trauma center. Patients and methods Twenty-seven adult patients, who met the inclusion criteria, with closed traumatic distal tibia with or without fibular fractures were treated using the minimally invasive plate osteosynthesis technique with LCP-DTP. According to the AO fracture classification, there were 12 AO 43A fractures and 15 AO 43B fractures. The fibula was fractured in 15 patients and it was fixed in all of them. Main outcome measurements Perioperative complications following percutaneous fixation of the distal tibia such as infection, deformity, leg length discrepancy, ankle joint function, bony union, and metal failure within 1 year after the surgery. Results This study included 27 adult patients with traumatic fracture distal third tibia, 21 of them were men and six were were women. They were followed up for a period ranging from 14 to 19 months with an average of 16. None of the patients developed early perioperative complications. Deep venous thrombosis occurred in three patients, who were treated medically, residual loss of a few degrees of ankle motion in six and late infection related to the proximal screws was also observed in three obese uncontrolled diabetic patients. Union was achieved in all of them within 12–20 weeks with an average of 16. Conclusion Minimally invasive plate osteosynthesis for the distal tibia using the LCP-DTP is safe and effective in the treatment of complex distal tibial fractures.

Subtalar extra-articular screw arthroereisis for the treatment of flexible flatfoot in children Amr El Gazzar The Egyptian Orthopaedic Journal 2018 53(2):115-118 Background Subtalar arthroereisis has been described as a minimally invasive, effective, and low-risk procedure for the treatment of flatfoot in children. Purpose To test the effectiveness of subtalar extra-articular screw arthroereisis procedure as a corrective measure for flexible flatfoot (FFF) in children. Patients and methods From 2012 till 2014, 12 feet of eight children with FFF were treated with subtalar extra-articular screw arthroereisis at Banha University and Banha Insurance Hospitals. With a mean age of 10.5 years and ranges between 5 and 16, five male and three female patients were selected and were required to follow-up every 18 months (range, 15–27 months). Results This technique offered worthy results to correct idiopathic flatfoot in children, due to its less invasive and less damaging nature for the structures of the sinus tarsi. On the basis of clinical inspections and radiographic measurements, there was clear improvement of foot function. Conclusion Subtalar arthroereisis is an effective procedure for FFF correction as it is simple and can be performed rapidly. Additionally, the screws mechanical and proprioceptive effect result in notable correction of the deformity.

Management of post-traumatic extra-articular proximal tibial nonunion by Ilizarov external fixation Wael S Mahmoud The Egyptian Orthopaedic Journal 2018 53(2):119-124 Background The Ilizarov technique has been used in Egypt for the past 20 years in the management of nonunion of long bones. This method uses fine wires and pins inserted percutaneously, which are attached to provide a strong frame construct. Most tibial and femoral nonunions can be treated successfully by internal fixation. However, proximal tibial nonunion can prove a difficult problem. The Ilizarov method can prove useful for treating these complex injuries. Objective The aim was to evaluate and analyze the clinical and radiological outcomes of Ilizarov external fixation in treatment of proximal tibial nonunion prospectively while focusing on its effectiveness, advantages and complication. Patients and methods A total of 16 patients (11 male and five female; average age: 33.5 years) who had post-traumatic extra-articular proximal tibial nonunion between April 2010 and October 2011 treated with the Ilizarov technique were included. Intervention method was Ilizarov technique, and main outcome measures include functional and radiological outcomes assessed using the Association for the Study and Application of Methods of Ilizarov criteria. Results All 16 patients showed union. None required amputation. According to the Association for the Study and Application of Methods of Ilizarov score regarding bone/radiological results, eleven were classed as excellent, four were good and one patient was fair. Functionally 10 patients were graded as excellent, five as good and one as fair. Conclusion The Ilizarov method is a reliable tool allowing early definitive treatment with a low complication rate and a good clinical outcome in treatment of patients with proximal tibial nonunion.

Arthroscopic acromioclavicular joint excision with subacromial decompression Ahmed O Youssef, Ahmed S. Abdel Fattah, Mohamed M. BahieElDin ElShafae, Khaled Abdel Salam Shohieb, Ahmed N.S. El Said The Egyptian Orthopaedic Journal 2018 53(2):125-131 Background Shoulder impingement syndrome and acromioclavicular joint (ACJ) osteoarthritis often occur simultaneously and are easily missed. Arthroscopic resection of the distal clavicle and subacromial decompression (SAD) can avoid complications arising from the open method. Patients and methods In this prospective study, arthroscopic SAD as well as ACJ resection was done in 15 patients with subacromial impingement syndrome and ACJ arthritis, who were treated between March 2009 and April 2013 at Minia University Hospital after failure of a minimum of 6 months of conservative treatment. The patients were followed up for 12 months. Results University of California at Los Angeles score is recorded preoperatively and at final follow-up 12 months after arthroscopic SAD concomitant with arthroscopic ACJ resection. The patients’ total University of California at Los Angeles score was significantly improved postoperatively (P<0.01) in relation to the preoperative one. Conclusion Arthroscopic SAD and ACJ resection gives best results in patients who failed conservative treatment and had persistent symptoms, and it helps in detection of any intra-articular pathology such as biceps tendon degeneration.

Outcome of management of Kienböck disease by limited carpal fusion Bahaa Z.M Hasan, Ahmed A.I.W Salam The Egyptian Orthopaedic Journal 2018 53(2):132-139 Objectives To evaluate the clinical and radiological outcome of Kienbӧck’s disease treatment by scaphocapitate fusion in 20 patients. Background Kienböck’s disease remains a difficult entity to treat till understanding the etiology and natural history of the disease. Treatment will continue to be based on trails to decrease load across the lunate or revascularizing it. Patients and methods This study was retrospectively performed on 20 patients, with age of 19–59 years. All of the patients presented with Kienböck disease grades II and IIIa and with no evidence of arthritis. They were treated with scaphocapitate arthrodesis using the dorsal approach. The mean follow-up period was 6 months. Complications and adverse events were recorded. Results The clinical results were classified on subjective base and were graded as excellent outcome in six (30%) patients, good in 10 (50%) patients, and fair in 4 (20%) patients. Conclusion Scaphocapitate arthrodesis is a good procedure that mechanically decompresses the lunate and prevents progressive carpal instability with minimal complications.

Primary arthrodesis for treatment of special types of Lisfranc fracture dislocation Mohamed Ebrahim Ali Al-Ashhab The Egyptian Orthopaedic Journal 2018 53(2):140-146 Background Lisfranc fracture dislocation is a devastating trauma affecting usually young active age group, with a high rate of missing or misdiagnosis, resulting in prolonged recovery and significant long-term morbidity. Objective This study describes the indications, contraindications, technique, and results of treating severe Lisfranc fracture dislocation by primary arthrodesis. Patients and methods A prospective study was conducted on 10 patients with closed Lisfranc fracture dislocation, who had been treated at Benha University Hospital and Benha Insurance Hospital between January 2010 and March 2013. Mechanism of injury was high-velocity injury in five patients, fall from a height in four patients, and a hyperplanterflexion foot trauma during descending stairs in one patient. Mean age at time of surgery was 27.7 years (range, 19–38 years). All patients were followed up with a follow-up period of 21.3 months (range, 6–36 months). Results According to the American Orthopedic Foot and Ankle Society scale, the clinical outcome was 81.7 (range, 79–84). Complications met in this study were as follows: three patients had a postoperative Sudeck’s atrophy, one patient developed superficial wound problem, and two patients had forefoot stiffness and difficulties in shoe wearing. Conclusion Open reduction and internal fixation of severe Lisfranc fracture dislocation with screws and primary arthrodesis is the treatment of choice, as these fracture dislocations are known for their affinity for post-traumatic arthritis and subsequent need for a second operation. The level of evidence for this article was case series type IV.

Split versus full tibialis anterior tendon transfer in treatment of residual dynamic supination in treated idiopathic clubfoot by Ponseti method Sameh M. Abo El-Fadl The Egyptian Orthopaedic Journal 2018 53(2):147-152 Background Dynamic supination is a common sequelae following successful nonoperative treatment of clubfoot with the Ponseti technique. It is resulted from a strong tibialis anterior muscle and weak antagonists, particularly the peroneal and tibialis posterior muscles. Tendon-balancing procedure is the most reasonable solution. Use of tibialis anterior tendon transfer (TATT) in recurrent clubfoot deformities has been described since 1940. Patients and methods Through this study, we compare the results of split versus full TATT in the treatment of residual dynamic supination in treated idiopathic clubfoot by Ponseti method. Patients were divided into two groups. The first group (nine patients with 10 feet) (group I) consists of the patients who were managed with split tendon transfer and the second group (nine patients with 10 feet) (group II) consists of the patients who managed with full tendon transfer. Garceau and Palmer’s clinical criteria and a grading system proposed by Thompson and colleagues were used for evaluation of the results of tendon transfer either split or full. Results A total of 18 children (13 males and five females) were involved in this study. The average of the age of the children in group I was 4.3 years and in group II was 4 years at the time of surgery. According to Garceau and Palmer’s clinical criteria, in group I, the preoperative ratings of 10 feet were as follows: four feet were good and six feet were fair, with scores of 3 points and 2 points, respectively. The postoperative ratings were five feet were excellent and five feet were good, with scores of 4 points and 3 points, respectively, with a statistically significant improvement (P<0.05). In group II, the preoperative ratings of 10 feet were six feet were good and four feet were fair, with scores of 3 points and 2 points, respectively. The postoperative ratings were six feet were excellent and four feet were good, with scores of 4 points and 3 points, respectively, with a statistically significant improvement (P<0.01). In comparing the results of both groups, no statistically significant relation could be found (P>0.05). According to the grading system proposed by Thompson and colleagues for restoration of muscle balance, in group I, eight feet achieved good results and two feet achieved fair results, whereas in group II, seven feet achieved good result and three feet achieved fair results. In comparing the results of both groups, we found there was no statistically significant relation (P>0.05). Conclusion TATT is an excellent method of correcting residual dynamic clubfoot deformity and there is no significant difference in the results by either full transfer or split transfer, and the surgeon’s preference plays a major role in selection of the procedure.

Occupational Therapy

OTICON' 2019 and the all India occupational therapists' association's forthcoming academic activities in 2019–2020 Anil K Srivastava The Indian Journal of Occupational Therapy 2019 51(1):1-2

To investigate the association between sleep and happiness among nurses with different personality traits: A cross-sectional study Sushant Deepak Sarang, Rakesh Bharat Shitole, Arthi Govardhan Karnam The Indian Journal of Occupational Therapy 2019 51(1):3-7 Background: Sleep and happiness play an important role in the functioning of a person. This study investigated the association between sleep and happiness among nurses and also studied if individual personality traits play a role. Objectives: To measure perceived stress, sleep, happiness and personality trait among nurses & To analyze the relationship between the sleep, happiness and personality trait. Study Design: A cross-sectional study design was chosen for the research. Methods: Thirty nursing staff (females, aged 22–53 years) were selected for the study. The Perceived Stress Scale (PSS) was used for screening stress. Those who scored low (0–13) on the PSS were included in the study. Written informed consent was obtained. Sleep quality, happiness, and personality traits were measured using the Pittsburgh Sleep Quality Index, Oxford Happiness Questionnaire, and Big Five Personality Test, respectively. Scores were analyzed using MedCalc Statistical Software. Results: The mean age of nursing staff with good sleep was 28 years and that with poor sleep was 36 years. It was found that 63% of nursing staff had poor sleep and 37% had good sleep. Among nursing staff with good sleep, 36% were unhappy and 64% were happy. Among nursing staff with poor sleep, 47.7% were unhappy and 52.6% were happy. The mean score for neuroticism was higher in patients with poor sleep (t-test, P = 0.003, 95% confidence interval: -7.96 to -1.76). Conclusions: Nursing staff with good sleep were happier compared to nurses with poor sleep though the difference was not significant. Sleep disturbances increased with age among nurses. The personality trait of neuroticism was higher in patients with poor sleep.

Occupational therapists' perception of efficacy of sensory integration in Tamil Nadu, India: A Statewide Survey Karthik Mani The Indian Journal of Occupational Therapy 2019 51(1):8-13 Background: Perception regarding efficacy of any intervention may influence clinical reasoning and treatment choice. Despite the fact that the current evidence on the effectiveness of sensory integration (SI) interventions is equivocal, practitioners use them widely in practice. This could be due to the perceived effectiveness. Objectives: This study aimed to gain an understanding of Tamil Nadu (TN) occupational therapy (TNOT) practitioners' perception of the efficacy of SI interventions in pediatric practice. Study Design: The survey research design was used to conduct this study. A ten-item electronic survey was developed based on the research question. Methods: The survey was e-mailed to 295 occupational therapists in TN identified through convenience sampling. The survey link was also shared on three WhatsApp Messenger groups (TNAIOTA Official Group, OTist Group, and OT Friends Group) with a large number of TN occupational therapists (snowball sampling). Data were collected between March 30, 2018, and April 30, 2018. Results: Forty-nine occupational therapists responded to the survey. Many respondents believed that SI interventions are effective, citing positive therapeutic outcomes and the child-centric nature of the interventions as the reasons behind their beliefs. Respondents also believed that for SI interventions to be effective, therapists' knowledge and skill on SI are critical. Gender, years of experience, additional training on SI, and level of education did not have any influence on practitioners' perceptions regarding the efficacy of SI. Conclusion: Pediatric OT practitioners in TN have a favorable attitude toward SI interventions and use them in practice. Although practitioners report perceived positive therapeutic outcomes, they need validation through clinical research. TNOT practitioners must collaborate with researchers to add to the scientific evidence base of SI.

Visual-perceptual training for handwriting legibility and speed in children with handwriting difficulties: A single-arm interventional study Pooja Pankaj Mehta, Hemant Parshuram Nandgaonkar The Indian Journal of Occupational Therapy 2019 51(1):14-20 Background: Empirical evidence relating motor-free visual-perception (VP) skills and handwriting (HW) legibility and speed is sparse, despite the theoretical belief that VP is necessary for letter recognition and is an essential component of HW. Therefore, the study was carried out to investigate the effect of VP training on scanning skills, motor-free VP skills, and HW legibility and speed. Objectives: The main objective is to study the effect of VP training on HW legibility and speed; motor-free VP skills and scanning skills. Study Design: This was a single-arm interventional study design was chosen for the research. Methods: Single arm of 10 children of either gender between 6 and 10 years of age, with HW difficulties meeting the inclusion and exclusion criteria, was recruited by convenience sampling. They were assessed pre- and post-training (6th and 12th week) using the letter cancellation test (LCT), Test of VP Skills-3rd Edition (TVPS-3) and Evaluation Tool of Children's Handwriting (ETCH). The intervention included individualized VP training weekly twice along with home program. Results: The mean scores of LCT, TVPS-3, and Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M) of n = 10 were analyzed. Post 12-week intervention, statistically significant improvement were found in mean scores of LCT (P < 0.05, 95% confidence interval [CI] [0.411,0.699]) and on TVPS-3 subtests (P < 0.05, 95% CIs [13.14, 17.46], [11.60, 15.60], [11.46, 14.14], 11.73, 15.87], [11.33, 15.27], [11.66, 15.44] and [11.56, 15.44] sequentially) and on overall mean scores (P < 0.05, 95% CI [12.67, 16.13]). Statistically significant improvements were calculated on ETCH-M subtests- total letter, number, and word legibility scores (P < 0.05, 95% CIs [88.91, 95.69] [100,100] and [79.01, 93.19] respectively); and on near-point copying speed (P < 0.05, 95% CI [35.98, 55.42]) but non-significant improvement was seen on far-point copying speed (FPS) (P = 0.103, 95% CI [23.69, 36.31]). Conclusion: VP training, without HW practice, has an effect in improving scanning skills, motor-free VP skills, and HW legibility and speed (except FPS). Thus, VP training may influence HW legibility and speed.

Severity of cerebral palsy and its impact on level of stress in the caregivers: A correlational study Kiran Kriti, Ankita Pradhan, Saba Tufel The Indian Journal of Occupational Therapy 2019 51(1):21-25 Background: Cerebral palsy (CP) is the leading cause of chronic disability in children making them physically and mentally challenged and socially aloof. CP children also experience a range of comorbidities such as seizures disorder and visual and hearing impairments. Parenting is inherently stressful at times, and studies have shown that being a caregiver of a disabled child is more stressful. Objectives: The objectives of the study were (1) to evaluate the correlation between the level of severity of CP children and its impact on stress on their caregivers, (2) to find the effect of co-morbid factors on the level of stress in caregivers, and (3) to evaluate the relationship between the socioeconomic status (SES) of caregivers and their stress. Study Design: This was correlation study. Methods: One hundred caregivers with the age group between 21 and 62 years participated in the study, of them 13 were male and 83 were female. CP children aged between 1 and 12 years were included in the study. The Gross Motor Function Classification System (GMFCS) for assessing severity level, the Parental Stress Scale (PSS) for parental stress, and the Kuppuswamy Scale for SES were utilized for objective assessment. Results: Weak nonsignificant correlation found between GMFCS and PSS (P = 0.943, 95% of confidence interval [CI] of difference: −2.04–4.01). Strong significant positive correlation between comorbid factors and parental stress (P = 0.000, 95% CI of difference: 4.5–13.2 for visual impairment, P = 0.000, 95% CI of difference: 2.1–15.1 for hearing impairment, and P = 0.000, 95% CI of difference: 4.4–13.3 for seizure disorder); however, a negative nonsignificant correlation was found between parental stress and SES (P = 0.634, 95% CI of difference: 1.4–0.6). Conclusion: The severity of the child's disability had no influence over the degree of parenting stress. Total family income was found to be weakly and inversely correlated with the degree of parenting stress. However, there was a strong relationship between comorbid factors and parental stress.

Biofeedback as an adjunct to conventional stress management and relaxation techniques in substance abuse disorders: A randomized controlled interventional study Anand Manohar Ghadse, Lokesh Kumar Ranjan, Pramod Ramlakhan Gupta The Indian Journal of Occupational Therapy 2019 51(1):26-30 Background: Biofeedback has been employed in substance abuse disorder over the last three decades. Stress, anxiety, and depression are commonly seen in patients with substance abuse disorders. Biofeedback employed in conjunction with other relaxation therapies may be useful in enhancing certain outcome of therapy. Biofeedback either alone for alcoholism or in combination with other relaxation techniques for stimulant and mixed substance abuse and combined with residential treatment program is probably efficacious. Objectives: This study is aimed at assessing effectiveness of biofeedback-assisted relaxation techniques and stress management for substance abuse population. Study Design: A randomized controlled interventional study design was chosen for the research. Methods: The study sample consisted of 60 in-patient males aged 18–55 years, diagnosed with mental and behavioral disorders due to multiple drug use and use of other psychoactive substance, according to the International Classification of Diseases-10, Diagnostic Criteria for Research (1992) criteria (30 in biofeedback and 30 in control groups). The patients were first screened for inclusion criteria and then recruited from CIIMHANS Mental Health Institute of Central India using lottery method for random allocation. A randomized controlled interventional study design was chosen for the research. Sociodemographic data and clinical details of all the patients were assessed using Depression-Anxiety-Stress Scale followed by biofeedback-assisted relaxation techniques, which was conducted for 30 days. Results: The present study shows that there was significant difference in the stress (t = 3.841, P < 0.01, 95% confidence interval [CI]: 3.06–9.73), anxiety (t = 3.849, P < 0.01, 95% CI: 2.06–6.53), and depression (t = 2.03, P < 0.05, 95% CI: 0.03–0.67) among patients of substance abuse disorders in the biofeedback group as compared to control group. Conclusion: The present study found that the biofeedback-assisted relaxation technique is efficacious in decreasing level of depression, anxiety, and stress in patients with substance abuse disorders.

Play-based occupational therapy intervention on social skills in children with autism spectrum disorder and attention deficit hyperactivity disorder: A case series Kinkuri Sahib Kaur, Ranjit Pathak The Indian Journal of Occupational Therapy 2019 51(1):31-36 The profound deficit in social reciprocity skills is the core underlying feature of the autism spectrum disorder. Inattention and impulsivity of attention deficit hyperactivity disorder children interferes with their ability to accurately identify, imitate, and model appropriate social behaviors. Social skill is any skill that facilitates interaction and communication with others, and evidence suggests that they can be acquired with specific training, opportunities, and practices. Literature suggests that in a developmental approach to social skills training, play is used as the primary medium for intervention, especially with younger children. Three children in the age group of 4–5 years were selected for the study. Socialization domain of the Vineland adaptive behavior scales-second edition was used to get the baseline scores. The children participated in the play-based occupational therapy intervention and each session was carried out for 60 min, twice a week. The children were reassessed after 6 months. The scores' data showed an upward trend and the socialization score of child 1, 2, and 3 improved by 11.6%, 14.8%, and 8.3%, respectively.

News and information The Indian Journal of Occupational Therapy 2019 51(1):37-39

Dermatologie Vénéréologie

Dermite de rappel induite par le vémurafénib Publication date: Available online 10 April 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): A. Greliak, A. Le Guern, M. Bataille, D. Lebas, T. Wiart, P. Modiano Résumé Introduction La dermite de rappel est une réaction inflammatoire survenant sur un site précédemment irradié et provoquée par l'administration d'un traitement. Dans de rares cas, il s'agit d'un traitement par inhibiteurs de BRAF ou de MEK. Cas clinique Nous rapportons le cas inhabituel d'une dermite de rappel survenue trois mois après l'introduction de l'association vémurafénib/cobimétinib. Discussion La dermite de rappel est une réaction cutanée qui doit être connue et qui peut exceptionnellement, comme dans notre observation, survenir tardivement après la fin de la radiothérapie. Summary Introduction Radiation recall dermatitis is an uncommon inflammatory reaction of the skin appearing after several days to several years at the site of previous irradiation; it is precipitated by the use of triggering drugs, although rarely by BRAF or MEK inhibitors. Patients and methods We report an unusual case of recall dermatitis induced 3 months after initiation of vemurafenib and cobimetinib therapy. Discussion Radiation recall dermatitis is a cutaneous reaction that must be known and which in rare cases such as ours may occur a long time after the end of radiotherapy.

Psoriasis de l'enfant vu en milieu libéral : les aspects cliniques et épidémiologiques diffèrent des données habituellement publiées Publication date: Available online 4 April 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): E. Mahé, F. Maccari, M. Ruer-Mulard, N. Bodak, H. Barthelemy, C. Nicolas, E. Pépin, M. Pillette-Delarue, C. Buzenet, P.-L. Delaire, M. Nadaud, F. Bouscarat, D. Drouot-Lhoumeau, C. Lepelley-Dupont, A. Acher, A. Beauchet, F. Corgibet, Fédération française de formation continue et d'évaluation en dermatologie-vénéréologie et le GEM Resopso Résumé Introduction Le psoriasis touche 0,2 à 0,7 % des enfants et est associé à l'obésité. Les études publiées ont été réalisées en milieu hospitalier. L'étude PsoLib a évalué le psoriasis de l'enfant consultant dans des cabinets privés en évaluant les aspects épidémiologiques et cliniques, ainsi que les comorbidités. Méthodes Il s'agissait d'une étude multicentrique, transversale et non interventionnelle d'enfants (0 à 18 ans) atteints de psoriasis, réalisée par 41 dermatologues travaillant dans des cabinets privés. Les aspects cliniques et thérapeutiques et les comorbidités ont été évalués de manière systématique. Nous avons comparé les données à l'étude χ-Psocar réalisée avec la même méthodologie dans des hôpitaux français. Résultats Au total, 207 enfants (filles : 60,4 % ; âge moyen : 10,5 ± 4,2 ans) ont été inclus. Le psoriasis du cuir chevelu (40,6 %) était le type clinique le plus fréquent, tandis que le type en plaques généralisées ne représentait que 26 % des cas. L'atteinte des ongles ou de la langue et le rhumatisme psoriasique étaient rarement observés. Moins de 1 % des enfants souffraient d'hypertension, de diabète de type 1 ou de dyslipidémie, mais 16,4 % étaient en surpoids et 7,0 % étaient obèses. La gravité (PGA maximum ≥ 4) était associée au surpoids (p = 0,01). Conclusion Le psoriasis du cuir chevelu est le type clinique de psoriasis le plus fréquent chez l'enfant. Les comorbidités et la localisation extracutanée sont rares. Même dans les cabinets privés, la gravité de la maladie est associée au surpoids. Summary Background Psoriasis affects 0.2–0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. Patients and methods This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. Results In all, 207 children (girls: 60.4 %; mean age: 10.5 ± 4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG ≥ 4 at peak) was associated with excess weight (P = 0.01). Conclusion Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.

Réponse des auteurs à la correspondance à propos de l'article : « Maladie de Paget sur sein surnuméraire » Publication date: Available online 3 April 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): M.-H. Jegou, E. Lorier-Roy, Groupe Dermatolist, I. Roche

Engelures unilatérales associées à une monoparésie : 2 observations Publication date: Available online 29 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): P. Couture, P. Moguelet, F. Chasset, A. Barbaud, P. Senet, J.-B. Monfort Résumé Introduction Les engelures sont des lésions dermiques inflammatoires liées à une hypersensibilité au froid, qui siègent de manière bilatérale et symétrique sur les extrémités. Leur survenue lors de pathologies pro-thrombogènes ou de pathologies auto-immunes est bien décrite mais leur association à des causes locorégionales favorisantes est peu connue. Observations Cas 1 : un homme de 57 ans, tabagique à 80 paquets-années, qui souffrait d'un déficit des releveurs du pied droit séquellaire d'une lombosciatique paralysante L5, consultait pour des lésions nécrotiques unilatérales des orteils, récidivant chaque hiver uniquement sur le membre paralysé. Cas 2 : un homme de 60 ans avait eu un liposarcome de cuisse droite traité par radiothérapie et chirurgie, qui s'étaient compliquées d'une monoparésie séquellaire et d'une artérite post-radique. Il présentait des macules purpuriques unilatérales des orteils du pied droit, sans évolution nécrotique, récidivant chaque hiver. Dans les deux cas l'examen clinique, le recul évolutif, l'histologie et les examens complémentaires confirmaient le diagnostic d'engelures idiopathiques. Conclusion Les hypothèses physiopathologiques expliquant l'unilatéralité des engelures en cas de paralysie sont une diminution du flux sanguin dans le membre paralysé, un déséquilibre des neuromédiateurs, un dysfonctionnement du système nerveux autonome, une atrophie cutanée avec hypertrophie des tissus mous sous-jacents et enfin une hypoesthésie qui vient aggraver les troubles trophiques. Summary Background Chilblains are inflammatory dermal lesions associated with hypersensitivity to cold, and they occur on the extremities bilaterally and symmetrically. Their onset during the course of pro-thermogenic and autoimmune diseases has been widely reported, but the association with predisposing locoregional causes is not well known. Patients and methods Case 1: a 57-year-old man, who smoked 80 packets per year, presenting a deficit of the levator muscles in his right foot following lumbar sciatica with paralysis of L5, consulted for unilateral necrotic lesions of the toes recurring each winter in the paralysed limb only. Case 2: a 60-year-old man had a previous history of liposarcoma of the right side treated with radiotherapy and surgery, resulting in sequelae of monoparesis and radiation-induced arteritis. Each winter, he presented recurring unilateral purpuric macules of the toes on his right foot, with no necrotic progression. In both cases, clinical examination, disease progression over time, histology and laboratory tests confirmed the diagnosis of idiopathic chilblains. Conclusion The physiopathological hypotheses posited to account for the unilateral appearance of chilblains in the event of paralysis include decreased blood flow to the paralysed limb, imbalance in neuromodulators, dysfunction of the autonomous nervous system, cutaneous atrophy with hypertrophy of underlying soft tissues, and finally, hypoesthesia aggravating the trophic disorders.

Actualisation des recommandations françaises de traitement du pemphigus Publication date: Available online 29 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): L. Jelti, C. Prost-Squarcioni, S. Ingen-Housz-Oro, F. Caux, P. Bernard, C. Bedane, M. Alexandre, O. Dereure, G. Quereux, E. Le Bidre, J. Plée, C. Picard-Dahan, C. Le Roux-Villet, S. Duvert-Lehembre, M.-A. Richard, E. Delaporte, S. Debarbieux, D. Jullien, M. D'Incan, M.-P. Konstantinou

Myopathie nécrosante auto-immune à anticorps anti-HMGCR induite par les statines et révélée par un tableau évocateur de dermatomyosite Publication date: Available online 29 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): M. Merlant, C. Fite, D. Kottler, L. Maisonobe, A. Dossier, L. Deschamps, V. Descamps Résumé Introduction Les myopathies nécrosantes auto-immunes (MNAI) induites par les statines ont été récemment individualisées. Nous rapportons le troisième cas de MNAI se présentant avec une éruption cutanée évocatrice de dermatomyosite (DM). Observation Une femme de 61 ans présentait une éruption cutanée des régions photoexposées touchant le visage, le décolleté et le dos des mains, associée à une faiblesse musculaire proximale bilatérale. Un traitement par rosuvastatine avait été introduit 8 mois auparavant. Le taux de créatinine phosphokinase (CPK) était augmenté. L'histologie cutanée était compatible avec un lupus ou une dermatomyosite (DM). L'histologie musculaire montrait des fibres musculaires nécrosées avec des zones de régénération, sans inflammation ni atrophie périfasciculaire. Les anticorps anti-3-hydroxy-3-méthylglutaryl-coenzyme A réductase (HMGCR) étaient présents au taux de1658 UA/ml (normale < 13,0 UA/mL). Le diagnostic de MNAI était retenu. Discussion La MNAI est une myopathie auto-immune caractérisée par une faiblesse musculaire proximale bilatérale et symétrique. Les anticorps anti-HMGCR, connus depuis 2011, sont spécifiques de la MNAI. Peu de signes extra-musculaires ont été décrits. Nous rapportons ici la troisième description d'éruption cutanée évoquant une DM survenant au cours d'une MNAI induite par les statines. Dans notre cas, l'éruption cutanée était évocatrice de connectivite et le diagnostic a été porté sur les résultats immunologiques et la biopsie musculaire. Conclusion La MNAI avec présentation cutanée est une entité rare. Les dermatologues doivent pouvoir évoquer le diagnostic devant un tableau de « pseudo-dermatomyosite », arrêter les statines le cas échéant et poursuivre les investigations avec la biopsie musculaire et les explorations immunologiques. Summary Background Statin-induced necrotizing autoimmune myopathy (NAM) has been recently characterized. Herein we report an accurate description of the clinical and histological characteristics of cutaneous rash associated with NAM. Patients and methods A 61-year-old woman presented a skin rash involving the face, the chest and the back of the hands with heliotropic distribution coupled with proximal symmetrical muscle weakness. Rosuvastatin had been introduced 8 months earlier. Creatinine kinase levels were dramatically raised. Screening for lupus and dermatomyositis antibodies were negative. The cutaneous histology was consistent with neutrophilic lupus while a muscle biopsy revealed no inflammation but showed necrotic and regenerative myofibres. Finally, antibodies directed against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) were found at high levels (1658 UA/ml vs. normal < 13.0 UA/ml), resulting in diagnosis of necrotizing autoimmune myopathy (NAM). Intensive immunosuppressive therapy resulted in excellent improvement. Discussion NAM is a severe acquired autoimmune myopathy characterised by severe proximal weakness and specific positive antibodies (anti-HMGCR or anti-signal recognition particle). It is classically associated with statin use. Some extra-muscular symptoms have been described in previous studies. We report the third accurate description of cutaneous rash associated with statin-induced NAM involving HMGCR antibodies. The skin rash was evocative of connective tissue disease and our diagnosis was based on immunology and muscle histology. Conclusion Dermatologists must be able to recognise this rare entity of "pseudo-dermatomyositis" and then discontinue statin intake if present and carry out further investigations consisting of muscle biopsy and serological tests.

Correspondance à propos de l'article : « Maladie de Paget sur sein surnuméraire » Publication date: Available online 28 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): C. Perrin

Psoriasis and male sexuality Publication date: Available online 28 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): J.-N. Dauendorffer, S. Ly, M. Beylot-Barry Summary Since sexual satisfaction is a key factor in quality-of-life scores, the aim of this review article is to examine current knowledge concerning the impact on male sexuality of psoriasis, particularly genital psoriasis. Risk factors for sexual dysfunction, and more specifically erectile dysfunction, demonstrated to date include severity of psoriasis, genital psoriasis, psoriatic arthritis, smoking, psychological disorders (anxiety-depression), cardiovascular comorbidities and side effects of psoriasis treatments. Studies evaluating the burden of genital psoriasis on male sexuality are contradictory: while the link between genital psoriasis and global sexual functioning has been clearly established in relation to question 9 of the DLQI, discrepancies exist between the scoring systems used concerning sexual satisfaction. Finally, psoriasis patients have expressed a wish to receive more care from their dermatologist in terms of their genital psoriasis and its impact on their sexual activity. Résumé La satisfaction sexuelle étant un des éléments de la qualité de vie, cet article se propose de faire le point sur les connaissances actuelles concernant le retentissement sur la sexualité masculine du psoriasis en général, et du psoriasis génital en particulier. Les facteurs de risque de dysfonction sexuelle globale et de dysfonction érectile chez les hommes psoriasiques sont la sévérité du psoriasis, l'atteinte psoriasique génitale ou articulaire, l'impact psychologique du psoriasis (anxiété-dépression), les habitudes de vie (tabagisme), les comorbidités cardio-vasculaires et la iatrogénie. Les résultats des études évaluant le retentissement du psoriasis spécifiquement génital sur la sexualité masculine sont contradictoires: si le lien entre psoriasis génital et fonction sexuelle globale évaluée par la question 9 du DLQI est bien démontré, les résultats sont divergents lorsque la satisfaction sexuelle est évaluée par des scores spécifiques. Enfin, les patients psoriasiques souhaitent une attention accrue de leur dermatologue vis-à-vis de leur psoriasis génital d'une part et du retentissement sexuel de leur psoriasis d'autre part, qu'il soit génital ou extra-génital.

Pityriasis rubra pilaire : trois cas traités par biothérapie Publication date: Available online 28 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): C. Sarles, A. Valois, S. Abed, T. Boyé, B. Fouet, J.-J. Morand

Place de l'Androcur® dans le traitement de l'alopécie féminine diffuse Publication date: Available online 27 March 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): A.-D. Pham, B. Guillot, M. Beylot-Barry, O. Chosidow, P. Reygagne, P. Joly

Ophthalmic and Vision Research

Visual impairment in kurdistan and trend of epidemiologic eye studies in Iran Per Kallestrup Journal of Ophthalmic and Vision Research 2019 14(2):123-124

Indications and surgical techniques for corneal transplantation at a tertiary referral center Hossein Jamali, Ahmad Reza Gholampour Journal of Ophthalmic and Vision Research 2019 14(2):125-130 Purpose: The study aimed to review the indications and techniques for corneal transplantation at a tertiary referral center over a 5-year period. Methods: Records of patients who underwent corneal transplantation at Khalili Medical Center, Shiraz, Iran from September, 2012 to September, 2017 were reviewed. Results: A total of 1149 eyes of 956 patients underwent corneal transplantation. The most common indication was infectious corneal ulcers (n = 296, 25.8%), followed by keratoconus (n = 243, 21.1%), bullous keratopathy (n = 219, 19.1%), failed grafts (n = 117, 10.2%), non-herpetic corneal scars (n = 113, 9.8%), corneal stromal dystrophies (n = 33, 2.9%), pellucid marginal degeneration (n = 31, 2.7%), and trauma (n = 26, 2.3%); other indications included thin descemetocele, post-herpetic corneal scar, endothelial corneal dystrophies, anterior segment dysgenesis, corneal ectasia after laser in situ keratomileusis, and corneal fibrosis. Corneal transplantation techniques included penetrating keratoplasty (PKP, n = 789, 68.7%), deep anterior lamellar keratoplasty (DALK, n = 187, 16.3%), Descemet's stripping automated endothelial keratoplasty (n = 171, 14.9%), and keratolimbal allograft (n = 2, 0.1%) in descending order. In children (aged ≤18 years), the most common indication was keratoconus (n = 32, 41.6%), and the most common technique was PKP (n = 50, 64.9%). In patients aged 19-27 years, the most common indication was keratoconus (n = 89, 64.5%), and the most common technique was PKP (n = 75, 54.4%). Conclusion: Infectious corneal ulcer was the most common indication, and PKP was the most prevalent technique in patients undergoing corneal transplantation. DALK was an emerging alternative surgical treatment in patients with corneal disorders in which corneal endothelium is spared.

Autologous platelet-rich plasma eye drops accelerate re-epithelialization of post-keratoplasty persistent corneal epithelial defects Shaban Alizadeh, Sahar Balagholi, Alireza Baradaran-Rafii, Siamak Delfaza-Baher, Sare Safi, Hamid Safi, Rasul Dabbaghi, Mozhgan Rezaei Kanavi Journal of Ophthalmic and Vision Research 2019 14(2):131-135 Purpose: To investigate whether autologous platelet-rich plasma (PRP) eye drops accelerate re-epithelialization of post-keratoplasty persistent corneal epithelial defects (PEDs). Methods: A total of 34 eyes with PEDs after keratoplasty (24 penetrating keratoplasty and 10 deep anterior lamellar keratoplasty) that were refractory to conventional medical treatments were treated with PRP eye drops every 3 hours. PRP eye drops were prepared with a low- and high-speed centrifugation method and final platelet counts were 700,000-800,000 plt/μl. The mean treatment duration for complete re-epithelialization was compared with the mean treatment duration of conventionally treated corneal defects before the PRP treatment by paired t-test. The mean treatment duration was also statistically analyzed between age groups, gender, indications for keratoplasty, and types of keratoplasty using analysis of variance (ANOVA). Results: Treatment with autologous PRP eye drops led to rapid re-epithelialization in all eyes. The mean treatment duration for complete re-epithelialization was 2.47 ± 1.21 weeks, which was significantly shorter than the mean treatment duration of conventionally treated corneal defects before PRP treatment (6.82 ± 1.24 weeks) (P = 0.0001). There was no significant correlation between re-epithelialization time and patients' age, sex, indications for keratoplasty, and techniques of corneal transplantation. Conclusion: Treatment with autologous PRP eye drops is an effective and reliable approach that accelerates re-epithelialization of post-transplantation PEDs.

Efficacy of autologous serum in fixing conjunctival autografts of various sizes in different types and grades of pterygium Shreya Thatte, Ankita B Dube, Stuti Sharma Journal of Ophthalmic and Vision Research 2019 14(2):136-143 Purpose: To evaluate the efficacy of autologous serum in fixing conjunctival autografts of various sizes in different grades and types of pterygium and to determine the largest successfully secured graft size. Methods: This prospective interventional study comprised 151 eyes of 151 patients belonging to age group of 21 to 64 years with different grades and types of primary and recurrent pterygium that underwent excision with inferior conjunctivo - limbal autograft secured with autologous serum. The autografts were measured with calipers and were grouped by size into three categories: Group A, small (5 × 5 mm); Group B, medium (5–7 × 5 mm); and Group C, large (>7 × 5 mm). The adhesive fixation power of autologous serum for the various conjunctival autograft sizes was determined for each group using the following criteria: graft stability, cosmetic appearance and complications in the immediate ( first week) and two-months postoperative follow-up visits. Descriptive statistical analysis was used to calculate the percentage frequency of the variables. Results: The groups A, B, and C included 48%, 22%, and 30% of the autografts, respectively. Overall, 93.34% of the grafts were stable with good cosmetic appearance. However, subconjunctival hemorrhage (36%), graft edema (36%) and graft retraction (13.5%) were the most common complications. The largest successfully fixed graft was 14 × 5 mm in size. Conclusion: Autologous serum is efficient in securing conjunctival autografts of various sizes with minimal complications and satisfactory results, including good cosmesis.

Modified deep sclerectomy for the surgical treatment of glaucoma Farideh Sharifipour, Shahin Yazdani, Mona Asadi, Azadeh Saki, Kouros Nouri-Mahdavi Journal of Ophthalmic and Vision Research 2019 14(2):144-150 Purpose: To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma. Methods: This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6–15 mmHg and/or a 30% reduction in IOP. Results: All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001). Conclusion: The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.

Effect of intravitreal bevacizumab injection on corneal in vivo biomechanics: A pilot study Nasser Shoeibi, Mohammad-Reza Ansari-Astaneh, Mohammad Reza Sedaghat, Saeed Shokoohi Rad Journal of Ophthalmic and Vision Research 2019 14(2):151-156 Purpose: To evaluate the effect of intravitreal bevacizumab (IVB) injection on corneal biomechanical parameters as measured by the ocular response analyzer (ORA) and Corneal Visualization Scheimpflug Technology (CorVis). Methods: In this prospective pilot study, ORA and CorVis parameters were recorded before and after a three-month course of IVB injection therapy in 16 patients in the injected and the contralateral non-injected control eyes. The changes in the recorded parameters in each group and the differences between the two groups were evaluated and compared. Results: None of the changes in ORA parameters were statistically significant in the injected and non-injected groups before and three months after injection, except for corneal resistance factor (CRF) in injected eyes (paired t-test, P = 0.039). The differences in corneal hysteresis (CH) and CRF were not statistically significant between the two groups (P = 0.441 and 0.236, respectively), but significant differences were noted between corneal compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) (P = 0.045 and 0.047, respectively). None of the changes in CorVis parameters were statistically significant in the groups before and at the end of study, except for the time of first corneal applanation (TAp1 ms) in the injected group (P = 0.040, paired t-test). Differences in TAp1, length of the second corneal applanation (LAp2 mm), velocity of the second corneal applanation (VAp2 m/s), intraocular pressure (IOP), and central corneal thickness (CCT) also showed borderline significance between the two groups. Conclusion: In this pilot study IVB injection could change CRF, IOPcc, IOPg, and TAP1 as measured by ORA and CorVis.

The effect of panretinal photocoagulation (PRP) versus intravitreal bevacizumab (IVB) plus prp on peripapillary retinal nerve fiber layer (RNFL) thickness analyzed by optical coherence tomography in patients with proliferative diabetic retinopathy Ramak Roohipour, Elahe Sharifian, Sasan Moghimi, Masoud Aghsaei Fard, Fariba Ghassemi, Mohammad Zarei, Samaneh Davoodi, Fatemeh Bazvand, Bobeck S Modjtahedi Journal of Ophthalmic and Vision Research 2019 14(2):157-163 Purpose: The current study aimed to evaluate changes in peripapillary retinal nerve fiber layer (RNFL) thickness in diabetic patients with bilateral proliferative diabetic retinopathy (PDR) after receiving panretinal photocoagulation (PRP) or intravitreal bevacizumab (IVB) with PRP. Methods: Ocular examination and peripapillary optical coherent tomography (OCT) were performed for each patient at baseline, 1, 3, 6, and 10 months after treatment. Both eyes of each patient were randomized into either PRP or PRP + IVB group. Results: Sixty-four eyes (32 patients) were enrolled in this randomized clinical trial. In the PRP group, global RNFL thickness initially increased and reached statistical significance in the third month (from 105.9 ± 21.4μm at baseline to 119 ± 41.6μm at 3 months, P = 0.03). Subsequent decline was observed with no significant difference from baseline at 10 months (106 ± 19.3μm, P = 0.914). There were no statistically significant changes in the PRP + IVB group (from 101.7 ± 22.2μm at baseline to 109.3 ± 26.9μm at 3 months, P = 0.996 and 101.9 ± 16.5μm at 10 months, P = 0.999). In the latter group, slight increase in RNFL thickness was observed in the first month (107.7 ± 21.1μm). RNFL thickness was similar to baseline in the two groups at month 10, with the exception of significant increase in superior-temporal sector in the PRP group (145.3 ± 13.4μm vs. 127.2 ± 17.3μm, P = 0.045). Conclusion: Compared to eyes treated with PRP, eyes treated with adjunctive IVB showed less significant post-treatment changes in RNFL thickness.

Evaluation of choroidal layer thickness in central serous chorioretinopathy Daren Hanumunthadu, Elon H C van Dijk, Sunila Dumpala, Bindu Rajesh, Ayesha Jabeen, Asiya Jabeen, Momin Ansari, Pooja Mehta, Shilpi Shah, Chintan Sarvaiya, Catherine Meyerle, Lihteh Wu, Alay Banker, Camiel J Boon, Jay Chhablani Journal of Ophthalmic and Vision Research 2019 14(2):164-170 Purpose: To evaluate medium and large choroidal vessel layer thickness (MCVT and LCVT, respectively) in eyes with acute and chronic central serous chorioretinopathy (CSC) in comparison with age-matched controls. Methods: The study included 96 eyes of 96 patients with CSC, including 53 eyes with acute CSC, 43 eyes with chronic CSC, and 30 eyes of 30 age-matched normal subjects. Manual measurements of subfoveal choroidal thickness (SFCT), MCVT, and LCVT at subfoveal and 750 μm nasal and temporal to the fovea locations were made on enhanced depth imaging optical coherence tomography (EDI-OCT) of the macula in all subjects using ImageJ software (National Institutes of Health, Bethesda, MD, USA). Results: SFCT in acute CSC was significantly larger than that in healthy eyes (P = 0.0001). SFCT in acute CSC did not differ significantly from that in chronic CSC eyes. Subfoveal LCVT and MCVT in acute CSC eyes were greater than those in healthy eyes (P = 0.02 and P = 0.03, respectively). Mean SFCT and MCVT in chronic CSC eyes were significantly larger than those in control eyes (P = 0.01 and P = 0.04, respectively). No significant difference in LCVT was observed between chronic and control eyes. Conclusion: Choroidal vasculature is altered in both acute and chronic CSC. SFCT, MCVT, and LCVT are higher in eyes with acute CSC. The thickening of medium choroidal vessels is still detectable in chronic CSC compared to control eyes.

Detection of FZD4, LRP5 and TSPAN12 genes variants in Malay premature babies with retinopathy of prematurity Siti Zulaikha Nashwa Mohd Khair, Abdul Salim Ismail, Zunaina Embong, Abdul Aziz Mohamed Yusoff Journal of Ophthalmic and Vision Research 2019 14(2):171-178 Purpose: To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community. Methods: A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP). Results: We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3′UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively). Conclusion: Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.

Rapid assessment of avoidable blindness in Kurdistan, Iran Elham Ashrafi, Seyed-Farzad Mohammadi, Marzieh Katibeh, Ebrahim Ghaderi, Cyrus Alinia, Naser Nourmohammadi, Alireza Lashay, Ramin Beiranvand, Mahsa Yousefpour Marzbali, Ali Sadeghi Tari Journal of Ophthalmic and Vision Research 2019 14(2):179-184 Purpose: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. Methods: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. Results: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). Conclusion: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.