The aim of this study was to compare the X-ray diagnosis with a non-invasive method for spine alignment assessment adopting a visual scan analysis with a plumb line and simetograph in middle-school students. The sample of this study was composed of 31 males and 50 females with an average age of 14.23 (± 3.11) years. The visual scan analysis was assessed at a school; whereas, the X-ray was performed in a hospital. The Wilcoxon signed-rank test was used to assess the differences between methods and scoliosis classifications (non-accentuated <10º and scoliosis >10º), and the Kappa was used to assess the agreement between methods. The comparisons between the methods revealed non-significant differences (z = −0.577; p = 0.564), with almost perfect agreement between tests (K = 0.821; p < 0.001). Moreover, no statistical significance was observed between methods by the scoliosis classification (z = −1.000; p = 0.317), with almost perfect agreement between tests (K = 0.888; p < 0.001). This research supports the conclusion that there are no significant differences between the two methods. Therefore, it should be highlighted that this field test should be used by physical education teachers in their classes, or in a school context, in order to determine misalignments or scoliosis prevalence among middle-school students. Int. J. Environ. Res. Public Health 2020, 17, x FOR PEER REVIEW 4 of 9 revealed an almost perfect agreement (K = 1.00, p < 0.001; please report to the statistical analysis 122 section) for both the alignment versus misalignment, and for the scoliosis degree visualization. 123 124 Figure 2. Left panel depicts the distance between evaluator and the instrument. The column's left 125 asymmetries are presented on the above right panel (equivalent for right misalignment) and bilateral 126 misalignment, at right below panel.127 2.3. X-ray method (clinical test) 128 After the visual scan assessment, the students were forwarded to a hospital for X-ray 129 analysis. They were evaluated by a spine surgeon in a standing position for long radiographies, 130 in the exact same position aforementioned, with the wood base for the foot position (Figure 3). 131 A specialist medical doctor carried out blind evaluations with column radiographies with a 132 Philips X-ray machine (Philips, System Medical -CYT9890, 010/87431 SN 14001512, 133 Amsterdam). The evaluation permitted the assessment of neck, shoulders, scapulae, thoracic, 134 and pelvic asymmetries.135 136 Figure 3. Philips X-ray machine with the wood base for the foot position.127 2.3. X-ray method (clinical test) 128 After the visual scan assessment, the students were forwarded to a hospital for X-ray 129 analysis. They were evaluated by a spine surgeon in a standing position for long radiographies, 130 in the exact same position aforementioned, with the wood base for the foot position (Figure 3). 131 A specialist medical doctor carried out blind evaluations with column radiographies with a 132 Philips X-ray machine (Philips, System Medical -CYT9890, 010/87431 SN 1400...
Complex dorsal metacarpophalangeal (MCP) joint dislocations as a result of hyperextension injuries are uncommon in the pediatric population and irreducible to closed maneuvers. Treatment of these complex lesions is invariably surgical, and dorsal or volar approaches are traditionally used. The authors describe a case of a 16-year-old male who suffered a fall onto his outstretched right hand in a soccer game. The patient presented to the ER with pain and deformity of the index finger MCP joint. Radiographs confirmed a complex MCP dislocation with a small osteochondral fragment. A lateral surgical approach was made, and interposition of the volar plate and an osteochondral fragment blocking the reduction were found. This versatile approach allowed access to volar and dorsal structures, minimizing the risk of surgical scarring and mobility arch limitation. To our knowledge, there are no reported cases regarding a lateral surgical approach.
Objective: To evaluate the results from subcutaneous anterior transposition of the cubital nerve for treating cubital tunnel syndrome (CTS) and the influence of prognostic factors such as preoperative McGowan stage, age and duration of symptoms. Methods: 36 patients with CTS who underwent subcutaneous anterior transposition of the cubital nerve between 2006 and 2009 were evaluated after an average follow-up of 28 months. Their mean age was 41.6 years. Nine patients were in McGowan stage I, 18 in stage II and nine in stage III. Results: There was a statistically significant improvement in sensory and motor deficits. 78% of the patients with severe neuropathy improved after surgery. According to the modified Bishop score, 21 patients (58.3%) had excellent results, seven (19.4%) good, six (16.7%) satisfactory and two (5.55%) poor. The satisfaction rate was 86% and 72% of the patients recovered their daily activities without limitations. Conclusion: The severity of neuropathy and preoperative duration of symptoms, but not age, had a negative influence on the outcome. The subcutaneous anterior transposition of the cubital nerve is safe and effective for treating CTS of different degrees of severity. Given the major prognostic factors identified, surgical treatment should be advised as soon as axonal loss has become clinically evident.
Bilateral adrenal neuroblastomas fit neither into stage 4 s nor into stage 4. Their clinical behavior is exceptional with a number of multicystic forms, variable MYCN amplification, widespread metastases and a high mortality. Bilateral adrenalectomy is sometimes unavoidable, but unilateral removal with contralateral enucleation, partial resection or observation are valid alternatives. Mortality is higher than in regular stage 4 s cases. This particular group of neuroblastomas required individually tailored therapeutic strategies based on the size, extent and prognostic markers.
Objective The objective of this study is to evaluate leg length discrepancy in adolescent idiopathic scoliosis. Methods A retrospective study of 80 subjects with adolescent idiopathic scoliosis (AIS) was conducted. The inclusion criteria were patients aged 10 to 18 years old with posteroanterior (PA) and lateral full-length radiographs. The exclusion criteria were patients subjected to surgery or orthotic treatment, those with other spinal disease, and those with poor quality x-rays. The parameters evaluated were: age, sex, Risser stage (RS), triradiate cartilage (TC), scoliotic curvatures, differentiated according to Lenke classification, sagittal (SB) and coronal balance (CB), and leg length discrepancy, which was assessed through the difference between the femoral heads (LLD) and through the assessment of pelvic obliquity (PO). Results The majority of patients with AIS demonstrated a mild LLD (<1 cm). The mean LLD was significantly different (p<0.01) between the scoliotic population with a main thoracolumbar curvature and those with a main lumbar curvature. When there was an LLD, it was the left limb that was shortened in most cases. The side of the longer lower limb had a direct influence on the CB (p=0.052). Conclusions This study demonstrates that in an AIS population with small LLD values, the extent of the shortening has a stronger impact on coronal balance and location than on the dimension of the main scoliotic curvature. These results demonstrate the importance of a more in-depth study on the effects of LLD <1 cm in the development of AIS and coronal imbalance. Level of evidence IV; Case Series.
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