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Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The main extensor at the knee is the quadriceps muscle (L2, L3, L4), and flexion is carried out by the hamstring group comprising of the semimembranosus (L5), semitendinosus (L5), and biceps femoris muscle (S1). Testing for quadriceps femoris. The patient is seated on the edge of the table, with both legs hanging. The examiner stabilizes the thigh against the table. Ask the patient to extend the knee without rotating the thigh. Exert counter-pressure against the leg just above the ankle to oppose extension.Medial (semimembranosus and semitendinosus) and lateral hamstring (biceps femoris) group. The patient is in prone position on the table. The examiner stabilizes the thigh against the couch. For the medial group, instruct the child to flex the knee to 50–70° with the thigh in slight medial rotation, and the leg medially rotated on the thigh. For the lateral group, the thigh is rotated slightly laterally, and the leg laterally rotated on the thigh. In both situations, apply pressure against the leg above the ankle in the direction of knee extension.Sensation testing. The knee is covered by L2, L3, and L4 on the anterior aspect and S2 on the posterior aspect (Figure 10.9).
Skin and soft tissue
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Lymphatics accompany the LSV. The superficial inguinal nodes include the following: Vertical group along the termination of the LSV drains the leg.Lateral group below the lateral inguinal ligament drains the buttocks, flank, etc.Medial group below the medial part of the inguinal ligament drains the anterior abdominal wall below the umbilicus and the perineum.
Craniofacial trauma, including management of frontal sinus and nasoethmoidal injuries
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
While accepting the simple classifications of simple linear fractures of a given bone or fossa involved, a more useful working classification of fractures involving the frontobas- ilar region was suggested by Bernstein et al. who divided the injuries into central, lateral and complex groups. The central group includes fractures involving the central anterior skull base and cribriform region adjacent to the frontal, ethmoidal and sphenoidal sinuses (Figure 59.1). The lateral group include frontal bone fractures associated with the orbital roof, but lateral to the frontal sinus (Figure 59.2) and finally the complex group involving all areas often bilaterally (Figure 59.3).
Thalamic neuromodulation in epilepsy: A primer for emerging circuit-based therapies
Published in Expert Review of Neurotherapeutics, 2023
Bryan Zheng, David D. Liu, Brian B Theyel, Hael Abdulrazeq, Anna R. Kimata, Peter M Lauro, Wael F. Asaad
The thalami are paired structures abutting the midline and connected by a small strip of grey matter forming the inter-thalamic adhesion. Clusters of thalamic neurons have been grouped by several properties, including: the particular cortical regions with which they interact, whether they receive primary (sensory inputs from the periphery) versus secondary (cortical) inputs, or based on local anatomy and circuitry. The classic framework organizes the thalamus into various nuclei based on histological and anatomical features. Within the classical framework, nuclei are apportioned into lateral, medial, anterior, and midline groups, localized in reference to an intralaminar group and surrounded by the TRN (Figure 1)[18]. Among several further subdivisions, the lateral group of nuclei is segregated into ventral and dorsal tiers[19]. These nuclear subdivisions are almost universally accepted and broadly inform function. However, increasing evidence suggests that most nuclei do not have a single, neatly-circumscribed role. For example, the posteriorly-located pulvinar is classically associated with visual-attentional processing[20,21], but has also been implicated in other cognitive functions such as emotional processing[22], working memory[23], and decision-making[23]. Even despite further divisions of the primate pulvinar into distinct anatomical subgroups (e.g. lateral, inferior, and medial; PuL, PuI and PuM), there is evidence that these smaller areas nevertheless have multimodal functions[24,25].
Outcome and negative events in thoracic disc herniation surgery: a Danish registry study
Published in British Journal of Neurosurgery, 2021
Thea Overgaard Wichmann, Mindaugas Bazys, Gudrun Gudmundsdottir, Jakob Gram Carlsen, Peter Duel, Kestutis Valancius, Niels Katballe, Mikkel Mylius Rasmussen
Post-operative events post-discharge occurred in 28 (39%) patients (Defined as: revision surgery, hydrothorax, spondylodiscitis, pain and sensory deficits related to the area of surgery, i.e. broader than the standard definition of complications). More than one event per patient was less frequent compared to in-hospital events (25%). Post-discharge events were more likely to occur in patients undergoing a lateral approach (45 versus 40%). Revision surgery was carried out in 1 (5%) patient undergoing a lateral approach and in 5 (10%) patients undergoing posterior approaches. The causes for revision surgery were surgery at other than intended level and residual herniated disc material. One patient in the lateral group developed hydrothorax, while one patient in the posterior group developed spondylodiscitis. Post-operative pain and sensory deficits in relation to the surgery site were most abundant in patients in the lateral group (32% versus 12%; 36% versus 14%). Post-operative pain and sensory deficits accounted for the majority of post-operative events.
Antenatal diagnosis of thoracopagus conjoined twins with single heart and liver: a case report
Published in Journal of Obstetrics and Gynaecology, 2020
Conjoined twins were classified by Spencer (1996) and are named according to the most prominent site of fusion. The conjoined site may be in the ventral, dorsal or lateral groups. There are four types in the ventral group: cephalopagus (head), thoracopagus (chest), omphalopagus (umbilicus) and the ischiopagus (hip). The dorsal group includes three types: pygopagus (sacrum), rachipagus (spine) and the craniopagus (cranium). The lateral group defines parapagus (lateral) conjoined twins. Although the most common type is thoracopagus, it is difficult to treat conjoined twins due to shared cardiac formations (Tannuri et al. 2013). Nowadays, the diagnosis of conjoined twins is often done by ultrasound imaging, which is performed in the second trimester. Magnetic resonance imaging may play an important role in identifying the shared organs (Alkhateeb et al. 2015). After the diagnosis, counselling is provided to family and options are offered. These options include termination of pregnancy, selective fetocide and postpartum surgical separation. In this study, we present an extremely rare case of thoracopagus conjoined twins who shareds one heart and one liver.