Medial rectus disinsertion for management of chronic complete sixth nerve palsy

Purpose To report the outcomes of the medial rectus (MR) disinsertion procedure for the management of refractory esotropia (ET) with or without Abnormal head posture (AHP) in chronic complete sixth nerve palsy. Methods This is a retrospective case series of patients with sixth nerve palsy who suffered from residual ET and diplopia following the conventional strabismus surgeries and underwent MR disinsertion procedure between April 2017 and February 2020. This procedure was offered to the patients who declined to use prism and did not wish to perform surgery on the fellow eye. The demographic and clinical data, including sex, age, visual acuity, pre and postoperative angle of strabismus, duction limitations, results of forced duction and force generation tests, details of prior strabismus surgeries, orbital CT scan findings, and follow up duration were collected from the medical records. Results Six patients were enrolled in this study. Mean age was 35.0 ± 14.0 years, and mean follow-up was 15.3 ± 5.9 months. The ET at the Primary position (PP) was 35.0 ± 18.4 prism dioptre (PD) before MR disinsertion, which decreased to 14.2 ± 17.4 PD after MR disinsertion procedure. Four cases needed additional complementary surgeries to improve residual ET in PP. No case developed overcorrection. Abduction deficiency was −5.0 ± 1.3 before MR disinsertion, which improved to − 2.8 ± 0.5 units at last follow-up. The mean of induced adduction deficiency was − 2.9 ± 0.4 at last follow-up. Conclusions MR disinsertion can be considered in patients with chronic complete sixth nerve palsy and refractory diplopia when the conventional methods have failed.

Algorithm for torticollis diagnosis in children of younger age groups

BACKGROUND: Torticollis is a common term for abnormal head or neck positions. Torticollis can be due to a wide variety of pathological processes, from relatively benign to life-threatening. This syndrome is of particular relevance in pediatric practice and is often underestimated at the primary care level. AIM: To analyze the data of domestic and foreign literature on the etiopathogenesis and clinical features of various types of torticollis in children and develop algorithms for the differential diagnosis of torticollis in children of younger age groups. MATERIALS AND METHODS: A literature search was conducted in the open information databases of eLIBRARY and Pubmed using the keywords and phrases: torticollis, congenital muscular torticollis, non-muscular torticollis, acquired torticollis, and neurogenic torticollis, without limiting the depth of retrospection. RESULTS: Based on the literature data generalization, the classification of torticollis and the key directions of its differential diagnosis are systematized in tabular form. The range of differential diagnosis of torticollis is quite wide and has its characteristics in newborns and children of the first years of life, contrary to older children. The most common is congenital muscular torticollis. Concurrently, non-muscular forms of torticollis in the aggregate are not uncommon, more often with a more serious etiology, and require careful examination. Based on the analyzed literature, differential algorithms for torticollis diagnosis in children of younger age groups have been compiled. CONCLUSIONS: Increasing the level of the knowledge of pediatric clinicians in the etiopathogenesis of torticollis syndrome will improve the efficiency of early diagnosis of dangerous diseases that lead to pathological head and neck positions in children.

Structural Abnormalities of Spermatozoa in Triploid Gynogenetic Crucian Carp (Carassius auratus)

The spermatozoa of triploid gynogenetic crucian carp (Carassius auratus) (3nDTCC) possess a spermatogenesis process with a normal genetic background. However, the genetic materials of these spermatozoa do not completely inherit gynogenetic progeny in general. Understanding the intrinsic mechanism may be helpful for developing breeding strategies of gynogenetic fishes. In this study, the spermatozoa ultrastructure was systematically studied in diploid red crucian carp and 3nDTCC to demonstrate their cytological structural differences. In addition, the artificial breeding tests of 3nDTCC(♀) with different ploidy spermatozoa were performed to verify the contributions of genetic materials from 3nDTCC spermatozoa to the gynogenesis progeny. Furthermore, the mRNA expression of centriole-related genes (i.e., cep57, cetn1, rootletin, and nek2) involved in spermatozoa packaging was also determined by quantitative real-time PCR (qPCR) to illustrate the molecular expression characteristics of the spermatozoa packaging process in 3nDTCC. The results reveal the adaptive features of spermatozoa in 3nDTCC, including the loose midpiece structure, abnormal head structure, and abnormal expression of centriole-related genes, which may influence the motility of spermatozoa and make it not involved normally in the genetic composition of the gynogenesis offspring.

Possibilities of prismatic correction in the treatment of congenital horizontal nystagmus

Purpose. Analysis the effectiveness of prismatic correction in the treatment of congenital horizontal nystagmus. Material and methods. The study included 20 patients with congenital horizontal nystagmus. Depending on the type of nystagmus and compensatory mechanisms to reduce its amplitude, two groups were identified: 10 patients with pendular nystagmus and nystagmus blockage syndrome (mean age, M±sd, 5.8±1.9 years) and 10 patients with jerky nystagmus and abnormal head posture and a null zone (5.7±2.1 years). Fresnel prisms were used to select and prescribe prismatic correction. Patients were under dynamic control from 6 months to 2 years with an assessment of the results every 3 months. Results. During treatment (using prism correction), uncorrected visual acuity had a statistically significant increase of 1.8 and 1.5 times both in the first (p=0.004) and the second (p=0.001) group, respectively. A similar, and even more pronounced, change in visual acuity was observed for corrected visual acuity – in the first group it increased 3 times (p=0.001) and in the second group 2.2 times (p=0.001). Conclusion. Prismatic correction in pendular nystagmus and esotropia allows to simulate (eliminate) nystagmus blockage syndrome and, thereby, to improve the quality of vision of the patient. In its turn, prismatic correction in jerky nystagmus with abnormal head posture allows to move null zone into the primary position of gaze, increase visual acuity due to the optimal optical correction and improve the patient's quality of life. Key words: nystagmus blockage syndrome, convergence fusion, abnormal head posture, null zone, Fresnel prisms

Hif1α-Dependent Hypoxia Signaling Contributes to the Survival of Deep-Layer Neurons and Cortex Formation in A Mouse Model

Hypoxia-inducible factor 1 a (Hif1α) plays a crucial role in brain development. To study the function of Hif1α in early brain development, we generated neuroepithelial cell-specific Hif1α-knockout mice. Hif1α-knockout mice died soon after birth; these mice exhibited an abnormal head shape, indicating the presence of brain defects. Morphological analysis revealed that Hif1α ablation reduced the overall size of the brain, especially affecting the telencephalon. Neuronal apoptosis predominantly occurred in deep-layer neurons, consequently the alignment of cortical layers was severely disorganized in Hif1α knockout mice. Furthermore, we demonstrated that Vegf signaling contributes to the survival of deep-layer neurons as a downstream effector of Hif1α-dependent hypoxia signaling. Taken together, our findings demonstrate that Hif1α plays a critical role in the early stages of telencephalon development.

Hip Instability Leading to Metallosis, Polyethylene Wear, and Failure of an Oxinium Femoral Head: A Case Report and Review of Literature

Oxinium is a zirconium metal alloy with an oxidized (ceramicized) surface that aims to mimic the superior wear properties of a ceramic femoral head while maintaining the high strength of metal-bearing surfaces. There are several reports that illustrate the wear and/or failure of Oxinium femoral heads following abnormal head contact with metal cup, with only a few studies reporting on the occurrence of metallosis. We present a case of metallosis and failure of Oxinium femoral head following two incidents of hip instability and one closed reduction. Successful revision was performed with cemented cup and metal femoral head, with 68 months of follow-up. We aimed to highlight the importance of achieving stable and well-oriented hip components when using Oxinium-bearing surfaces and to present a short literature review regarding the wear of oxidized zirconium-bearing surfaces in hip arthroplasty.

Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group

OBJECTIVE The diagnosis of single-suture craniosynostosis can be made by physical examination, but the use of confirmatory imaging is common practice. The authors sought to investigate preoperative imaging use and to describe intracranial findings in children with single-suture synostosis from a large, prospective multicenter cohort. METHODS In this study from the Synostosis Research Group, the study population included children with clinically diagnosed single-suture synostosis between March 1, 2017, and October 31, 2020, at 5 institutions. The primary analysis correlated the clinical diagnosis and imaging diagnosis; secondary outcomes included intracranial findings by pathological suture type. RESULTS A total of 403 children (67% male) were identified with single-suture synostosis. Sagittal (n = 267), metopic (n = 77), coronal (n = 52), and lambdoid (n = 7) synostoses were reported; the most common presentation was abnormal head shape (97%), followed by a palpable or visible ridge (37%). Preoperative cranial imaging was performed in 90% of children; findings on 97% of these imaging studies matched the initial clinical diagnosis. Thirty-one additional fused sutures were identified in 18 children (5%) that differed from the clinical diagnosis. The most commonly used imaging modality by far was CT (n = 360), followed by radiography (n = 9) and MRI (n = 7). Most preoperative imaging was ordered as part of a protocolized pathway (67%); some images were obtained as a result of a nondiagnostic clinical examination (5.2%). Of the 360 patients who had CT imaging, 150 underwent total cranial vault surgery and 210 underwent strip craniectomy. The imaging findings influenced the surgical treatment 0.95% of the time. Among the 24% of children with additional (nonsynostosis) abnormal findings on CT, only 3.5% required further monitoring. CONCLUSIONS The authors found that a clinical diagnosis of single-suture craniosynostosis and the findings on CT were the same with rare exceptions. CT imaging very rarely altered the surgical treatment of children with single-suture synostosis.

Grisel’s syndrome – case report

Introduction: By definition from the literature, Grisel’s syndrome is described as non-traumatic rotational atlantoaxial instability between C1 and C2 vertebrae. It can occur during an infection of a soft tissue in the cervicocranial region or after an operation in the ENT region. Because of the frequent occurrence after operations, we inclined to the definition which includes a traumatic subluxation as a cause of origin, and it’s not defined as non-traumatic only. The instability manifests itself with abnormal head posture that is called torticollis. Increased incidence in adolescence is more common because of a greater ligamentous laxity of the joint capsules, increased perfusion of antlantoaxial regions and longer alar ligaments. In this article, the case of a child with Grisel’s syndrome after adenotomy is described. The pathophysiology, symptomatology, diagnostic management and treatment are discussed. Keywords: Grisel’s syndrome – torticollis – atlantoaxial instability – adenotomy

A single inferior rectus muscle surgery for treatment of congenital superior oblique palsy with small deviation in primary position

Purpose: To evaluate outcomes of one muscle surgery for treatment of congenital superior oblique palsy (SOP) with Knapp Class V. Methods: Medical records were retrospectively reviewed for the patients with the congenital SOP type V who underwent surgical treatment through one muscle surgery between July 2015 and September 2020. The surgical procedure was resection-recession on the contralateral inferior rectus muscle of the hypertrophic or paretic eye. Vertical alignment at nine cardinal gaze positions, and resolution of the abnormal head posture were evaluated pre- and postoperatively. The follow-up was scheduled regularly at postoperative day 1, 1 week, 1 month, and followed by 2-month intervals until 18 months. Results: Twelve patients were included in this study, with a mean age of 6.4 years (range from 3 to 10 years). The mean follow-up period was 10.5 months after surgery (range from 6 to 18 months). The average vertical deviation at primary position was 6.33△ ± 2.93△ preoperatively and 0.75△ ± 1.14△ postoperatively ( p < 0.05). The average vertical deviation at downgaze was 23.33△ ± 4.75△ preoperatively and 1.92△ ± 1.62△ postoperatively ( p < 0.05). All patients had an abnormal head position preoperatively. Postoperative results indicated that the patients’ abnormal head position had been improved significantly. Conclusions: The surgical procedure of resection-recession on a single inferior rectus muscle is a successful intervention for the correction of superior oblique palsy (SOP) with Knapp Class V.