Variation of plantaris muscle: a case report with clinical significance / Variación del músculo plantar: reporte de un caso con significado clínico

SUMMARY: The plantaris muscle is located between the soleus and gastrocnemius muscles, within the posterior calf group. Due to degeneration and its loss of plantar-flexion function, the muscle is vestigial in human beings, but it retains clinical significance. Few cases of variation in the plantaris muscle have been reported, and this, therefore, appears to be rare. Nonetheless, absence of this muscle was identified via the dissection of a left lower limb (male), which also indicated the absence of an attachment in the usual position. The present report, which addresses such variation, may provide both inspiration and reference points for the clinical treatment of so-called "tennis leg", and for the use of plantaris muscle for the purposes of clinical, autologous graft repair.

RESUMEN: El músculo plantar se ubica entre los músculos sóleo y gastrocnemio, dentro del grupo posterior de la pierna. Debido a la degeneración y la pérdida de la función de flexión plantar, el músculo es un vestigio en los seres humanos, pero conserva su importancia clínica. Se han informado pocos casos de variación en el músculo plantar y, por lo tanto, esto parece ser raro. No obstante, se observó la ausencia de este músculo durante la disección de un miembro inferior izquierdo (masculino). El presente informe, que aborda dicha variación, puede proporcionar puntos de referencia para el tratamiento clínico de la llamada "pierna de tenista" y para el uso del músculo plantar con fines de reparación clínica con injerto autólogo.

An accessory muscle of the posterior compartment of leg of clinical significance: a cadaveric case report / Un músculo accesorio del compartimento posterior de la pierna de importancia clínica: reporte de un caso cadavérico

SUMMARY: Accessory and anomalous muscles are common in humans, although their unique morphologic characteristics can make accurate identification difficult. In this case report, we attempt to identify an anomalous accessory muscle of the posterior compartment of the leg [Compartimentum posterius cruris] detected during cadaveric dissection and discuss its clinical significance. The muscle was found on the right lower limb of an 81-year-old female cadaver and extended from the distal femur to attach to the gastrocnemius muscle at the point where the medial and lateral heads fuse. At its origin, the muscle was found lateral to the popliteal vessels and crossed posterior to these vessels and tibial nerve. It displayed characteristics similar to both an accessory plantaris muscle and gastrocnemius tertius, thus making its ultimate identification difficult. Though the muscle displayed a morphologically similar appearance to the plantaris, we suggest that its common insertion with the gastrocnemius best identifies it as a gastrocnemius tertius. In addition, due to its relationship with the popliteal neurovasculature, it is possible that this muscle could have resulted in neurovascular entrapment although it is unknown whether or not this cadaver exhibited symptoms.

RESUMEN: Los músculos accesorios y anómalos son comunes en los seres humanos, aunque sus características morfológicas pueden dificultar la identificación precisa. En este reporte de caso, intentamos identificar un músculo accesorio anómalo del compartimento posterior de la pierna [Compartimentum posterius cruris] detectado durante la disección cadavérica y discutir su importancia clínica. El músculo fue encontrado en el miembro inferior derecho de una mujer de 81 años de edad y se extendía desde la parte distal del fémur para unirse al músculo gastrocnemio en la fusión de sus cabezas medial y lateral. En su origen, el músculo se encontraba lateral a los vasos poplíteos y cruzaba posteriormente a estos vasos y al nervio tibial, presentando características similares tanto al músculo plantar accesorio como al gastrocnemio tercero, lo que dificultaba su identificación final. Similar al músculo plantar, sugerimos que debido a su inserción común con el gastrocnemio lo identifica mejor como un músculo gastrocnemio tercero. Además, debido a su relación con la neurovasculatura poplítea, es posible que este músculo haya dado lugar a un síndrome de compresión neurovascular aunque se desconoce si este individuó presentó síntomas o no en vivo.

Cadaveric study on anatomical variations of popliteal artery and its terminal branches: a clinical perspective

Introduction: Anatomical knowledge is very important for accurate diagnosis and proper treatment of the patient.The popliteal region presents a wide range of vascular anomalies. The correct diagnosis of these anatomicalvariations plays a key role in success of diverse procedures performed by orthopaedicians, vascular surgeonsand radiologists. In this context, the aim of our study was to gain knowledge on the origin, level and mode oftermination, course and relations of popliteal artery with surrounding structures, mainly the muscles, in poplitealfossa. The results obtained were compared with previous studies.Materials and methods: The study was carried out in 50 lower limbs of 25 well-embalmed cadavers. There wasno evidence of previous knee surgeries in any of the limbs. The specimens were collected from the department ofAnatomy, KVG Medical College, Sullia.Results: The femoral artery continued as popliteal artery, which terminated at the lower border of popliteusmuscle. Trifurcation pattern was observed in one specimen. 10% of specimens had hypoplastic/aplasticposteriortibial artery, distally replaced by peroneal artery. Another 4% of specimens had smaller posterior tibialand larger peroneal artery. Length of tibio peroneal trunk from the lower border of popliteus muscle was shorterthan normal (2.5 cm) in one specimen and longer in another specimen. The observation on course and relationsshowed that the popliteal artery passed beneath a bony tunnel of fibula before terminating in one specimen andin another specimen, popliteal artery was superficial to popliteal vein in the middle of popliteal fossa. In othertwo specimens, it coursed more medially towards medial head of gastrocnemius and another specimen presentedwith popliteal artery crossed by muscle belly of plantaris.Conclusion: This study adds up to the knowledge on vascular variations in the popliteal region, the awareness ofwhich is important to vascular surgeons while performing arterial reconstructions in femoro distal bypass graftprocedures and also to orthopaedicians during surgical clubfoot release.

Morphology of plantaris longus with special reference to its clinical importance

Background: Plantaris is small fusiform muscle, with its long, slender tendon. Actually it’s a vestigial muscle inhuman beings hence its rupture does not result in any significant loss of function. Muscle tear associated withbleeding and swelling leads to a posterior compartment syndrome. It can mimic other serious conditions likeDVT, ruptured baker’s cyst and calf neoplasms.The present study aims to find out the various patterns of proximal and distal attachment of plantaris muscle,which will help the clinician deciding in diagnosis and the plastic & orthopaedic surgeons for different types ofreconstructive surgeries.Materials and Methods: Forty-eight limbs from 24 embalmed cadavers of known sex(male) & age (40-75 years)were dissected in the department of anatomy of Lady Harding medical college, New Delhi during 2016-2017.Plantaris muscle identified with its proximal and distal attachment. Length of muscle belly & tendon wererecorded.Result: In the present study out of 48 limbs specimens, Plantaris muscle was absent in 12.5%. Its proximalattachment to lateral supracondylar ridges observed in 29% & with lateral head of gastrocnemius muscle &fibrous capsule in 58.3%. Its distal attachment deep to tendocalcaneus was noted in 25% and superficial totendocalcaneus in 62.4%. Length of muscle belly was 7- 9 cm in 37% and tendon length was 34- 36cm in 37.5%.Conclusion: The Morphological aspects of the attachment of plantaris play a significant role in the Pathologiesassociated with Calf & knee region. Their exact attachment is importance for reconstructive surgeries to therepair of ankle joint injury and flexor tendon replacement in hand.

MRI presentation and pathogenesis of tennis legs / 中华放射学杂志

Objective To evaluate the imaging features of MRI of tennis legs and to explore the pathogenesis of tennis legs. Methods A retrospective analysis was made on the MRI images of 38 patients with tennis legs which met the criteria and were clinically diagnosed in our hospital from May 2014 to June 2018. All patients underwent non?enhanced MRI. Coronal T1WI、T2WI fast spin echo (TSE) and transverse proton density weighted imaging (PDWI) were performed. The signs of fluid collection between gastrocnemius muscle (GM) and soleus muscle (SM),muscle and tendon injuries, superficial vein dilatation of calf were observed and recorded. Results Coronal T1WI, T2WI TSE and transverse PDWI sequences showed 30 (75.0%) places fluid collection (hematoma or effusion) between medial head of the gastrocnemius muscle (MCM) and SM, 11 (27.5%) places fluid collection (hematoma or effusion) between lateral head of gastrocnemius muscle(LGM)and SM,7 (17.5%) places fluid collection (hematoma or effusion) in MGM and 2 (5.0%) placesin SM. There were 17 (42.5%) places that hematoma or effusion spread around the fascia of the lower leg. The diameter and thickness of hematoma or effusion are about 1.7-22.3 cm and 0.2-3.5 cm, respectively. Rupture of the GM was seen in 37 (92.5%) places,including 37 places rupture of the MGM at the myotendinous junction, 15 places rupture of the LGM at the myotendinous junction, 24 places tendonrupture of MGM,3 places tendon rupture of MGM and LGM,and 2 places tendon rupture of LGM. The maximum diameter of tendon rupture was 1.2-27.0 mm. The muscle rupture of MGM was seen in one place, and muscle rupture of MGM and LGM was seen in one place at the same time. Rupture of the SM was seen in 15 (37.5%) places, including 15 places rupture of the SM at the myotendinous junction, 2 places muscle rupture of SM, 6 places tendonrupture of SM. The maximum diameter of tendon rupture was 2.5-14.9 mm. Rupture of plantaris tendon (PT) was seen in 4 (10.0%) places. Superficial vein dilatation was seen in 3 (7.5%) places. Conclusion This study shows that the rupture of the MGM at the myotendinous junction and the tendon is the main responsibility of tennis leg.

Coix-seed Reactive Derivatives(CRD): An Observational study / 日本補完代替医療学会誌

Functional food research encompasses several types of study designs, including observational studies and randomized clinical trials (RCTs). To clarify the functions of Coix-seed Reactive Derivatives(CRD), we observed 7 refractory skin diseases: case1 Pustulosis palmaris et plantaris, case2 atopic dermatitis, case3 hand eczema, case4 contact dermatitis, case5 wrinkles of a face, case6 acne vulgaris and case7 lentigo senilis(senile pigment freckle). Although CRD intake seemed to be effective in all cases, further studies are needed to define the optimal dose and duration.

Anatomical popliteal artery entrapment syndrome

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.

Psoriasis pustulosa palmar unilateral: A propósito de un caso / Unilateral palmar pustular psoriasis: A clinical case

La psoriasis pustulosa palmoplantar (PPP) es una enfermedad inflamatoria crónica y recurrente, caracterizada por la presencia de pústulas estériles, sobre una base eritematosa en palmas y plantas. Es de gran importancia, debido a que ocasiona tanto limitación funcional como disminución en la calidad de vida, siendo en la mayoría de los casos refractaria al tratamiento. Se presenta un caso de PPP, donde fueron necesarias aplicar terapias combinadas: tópica y sistémica (esteroides de alta potencia y ciclosporina), con evolución satisfactoria en cuatro semanas de tratamiento. Se realizó una revisión exhaustiva en los motores de búsqueda como: Latindex.org, Scielo.org y Google académico, de las publicaciones más representativas hasta la actualidad y las palabras clave, a través de la web de Medical Subject Headings.

Palmoplantar Pustular Psoriasis (PPP) is a chronic and recurrent inflammatory disease, characterized by the presence of sterile pustules on an erythematous base in palms and soles. It is important because it causes both functional limitation decreasing quality of life. In most cases refractory to treatment. We present a case of PPP with topical and systemic combined therapy (high potency corticoids and cyclosporine) with satisfactory outcomes at four weeks of treatment. An exhaustive review in search engines as Scholar Google, Latindex and Scielo was made for the last 30 years and key words in Medical Subject Headings.

Keratoderma-like T cell dyscrasia: A report of 13 cases and its distinction from mycosis fungoides palmaris et plantaris.

Background: Atypical epitheliotropic T cell lymphocytic infi ltrates are commonly encountered in routine and consultative dermatopathology practices and typically do not represent mycosis fungoides. Other conditions can mimic certain light microscopic and phenotypic fi ndings encountered in mycosis fungoides, comprising a diverse spectrum of conditions including the lymphomatoid drug reaction, collagen vascular disease, viral hypersensitivity reactions and cutaneous T cell dyscrasia. Aims: To examine biopsies obtained from cutaneous T cell dyscrasia localized to the palms and soles and to evaluate whether it exhibits a morphologic and pathogenetic continuum with mycosis fungoides plantaris et palmaris. Methods: We examined 13 biopsies showing an epidermotropic superfi cial lymphocytic infi ltrate from thirteen patients who presented with a palmar and/or plantar keratoderma without other sites of cutaneous involvement. Conventional light microscopy, immunophenotyping and clonality studies were carried out. The clinical features were recorded. Results: Biopsies showed a variably dense, superfi cial, angiocentric CD4 or CD8 dominant lymphocytic infi ltrate accompanied by a non-destructive pattern of epidermotropism. Low-grade cerebriform atypia along with variable diminution in the expression of CD7 and CD62L was noted. In three cases, statins were suspected to be the cause. Due to lack of familiarity with the entity, treatment interventions were inconsistent and not aggressively pursued. There was no evidence of disease progression to mycosis fungoides in any case. Limitations: The limitations of this study include the lack of long-term follow up and information on the nature of the therapeutic interventions and responses to treatment. Conclusion: The spectrum of cutaneous lymphoid dyscrasias should be expanded to include cases manifesting as palmo-plantar keratoderma. These cases are to be distinguished from mycosis fungoides palmaris et plantaris. As with other forms of cutaneous lymphoid dyscrasia, the lesions tend to be persistent. The course however, is indolent in most cases.

Detection of tumor necrosis factor-α, interleukin-17,-22 and-17F in sera from patients with palmoplantar pustulosis / 中华皮肤科杂志

Objective To determine the serum levels of tumor necrosis factor (TNF)-α,interleukin (IL)-17,IL-22 and IL-17F in patients with palmoplantar pustulosis (PP),and to estimate their relationship with disease activity in PP.Methods Venous blood samples were collected from 30 patients with PP at both active stage and stationary stage and from 20 healthy human controls.Enzyme-linked immunosorbent assay (ELISA) was conducted to determine the serum levels of TNF-α,IL-17,IL-22 and IL-17F.The paired Wilcoxon signed rank test was carried out to compare the serum levels of cytokines between patients at active stage and at stationary stage,and the Mann-Whitney U test to compare those among different groups.Results The median serum levels of TNF-α,IL-17 and IL-22 in patients with PP at active stage were 186.35 (range,113.48-412.69) ng/L,420.45 (range,278.55-748.73) ng/L and 106.48 (range,69.13-251.86) ng/L respectively,significantly higher than those at stationary stage (42.52(18.83-95.37) ng/L,48.11 (36.43-80.04) ng/L,20.32 (10.55-48.75) ng/L,respectively,all P ＜ 0.05) and those in the controls (24.30 (12.0-61.56) ng/L,10.49 (6.24-24.44) ng/L,2.58 (1.41-5.78) ng/L,respectively,all P ＜ 0.05).Moreover,the patients at stationary stage showed a significant elevation in serum levels of TNF-α,IL-17 and IL-22 compared with the controls (u =2.71,3.53,2.18,respectively,all P ＜ 0.05).No statistical difference was noted in the serum level of IL-17F among the patients at different stages and controls (P ＞ 0.05).Conclusion The circulating levels of TNF-α,IL-17 and IL-22 were associated with disease activity in PP,hinting that they may be involved in the development of PP.

Anatomical Popliteal Artery Entrapment Syndrome Caused by an Aberrant Plantaris Muscle

PURPOSE: We report on cases of anatomical popliteal artery entrapment syndrome (PAES) caused by an aberrant plantaris muscle and highlight the involvement of this muscle in PAES. MATERIALS AND METHODS: Seven symptomatic PAES legs in six patients treated at The Division of Vascular Surgery, Asan Medical Center, Seoul, Korea, between 1995 and 2011 were included in this study. We retrospectively analyzed patient records, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans of the knee joint, Doppler pressure studies, CT angiographies, and conventional femoral arteriographies. RESULTS: Five males and one female patient with a median age of 32 (18-53) years old were enrolled in the study. All patients complained of intermittent claudication of the affected leg. All aberrant plantaris muscles were higher and more medially located than normal plantaris muscles, causing occlusion of the popliteal artery upon forced plantar flexion of the ankle. For arterial lesions, five occlusions of the popliteal artery and two patent popliteal arteries with positive provocation were noted. As for treatment, myotomy of the aberrant plantaris muscle was done for two non-occlusive PAES legs. For occlusive PAES legs, one thrombectomy, one saphenous vein graft interposition of the popliteal artery followed by myotomy, and two below-knee femoro-popliteal bypasses were performed. The median follow-up period was 88 (7-148) months. CONCLUSION: An aberrant plantaris muscle can cause anatomical PAES. Classification or diagnosis of PAES should be based on axial studies using CT scans or MRI using various reconstruction methods. Treatment, including myotomy of the plantaris muscle, should be individualized.

Morphological Variations of Muscle Plantaris: Anatomical and Clinical Insight.

Background: Plantaris is the largest muscle in mammals other than primates. Plantaris muscle has been a subject of much confusion and Evolutionists have speculated on its phylogenetic significance, as a vestigial organ, while surgeons have removed it ‘useless vestige’ to employ its tendon as a spare part for the surgical repair. In humans it is reduced greatly in size, power, and function and may even be absent. Aim: With this background the aim of the present work is to study morphology, describe the observed variations of the Plantaris muscle, and to discuss the functional significance of Plantaris muscle. Methodology: For the present work 84 limbs available in the department of Anatomy were dissected. The posterior aspect of the knee was dissected using standard surgical equipment and dissection techniques. The Plantaris muscle was isolated and length of fleshy belly and tendon were measured. Any variations in origin, insertion and size were recorded. Result: Variation in insertion of the Plantaris has observed like insertion along medial margin of tendocalcaneus on to calcaneus, in front of tendocalcaneus on to calcaneus, fused to tendocalcaneus and insertion of the Plantaris on deep fascia of leg at the level of ankle. Other variations noted were two bellies of the Plantaris one from lateral supracondylar ridge and other from deep surface of Gastrocnemius, two heads of Plantaris: Both bellies were fused in the lower part producing bipennate arrangement, thin & thick belly of the Plantaris muscle. Variations also observed in relation to origin that the muscle is originating from deep surface of lateral head of Gastrocnemius & in other case origin from capsule. Bicipital Plantaris was seen where one head was originating from capsule of knee joint and other from lateral condyle. Conclusion: In order to avoid any inadvertent injury during surgical operations, variation of the Plantaris must be borne in mind. Awareness of the insertion pattern of the Plantaris tendon is also important for clinicians in the diagnosis of muscle tears and for surgeons performing reconstructive procedures. Considering the above facts, the existence and importance of the Plantaris muscle cannot be undermined.

Prediction of the presence of plantaris tendon through examination of palmaris longus tendon: is there a link? / Predicción de la presencia del tendón del músculo plantar mediante el examen del tendón del músculo palmar largo: ¿hay una relación?

The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.

El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro.

Unilateral third/accessory head of the gastrocnemius muscle: a case report / Tercera cabeza unilateral del músculo gastrocnemio: reporte de un caso

The superficial muscle group of the posterior compartment of leg forms a powerful muscular mass in the calf. The two-headed gastrocnemius is the most superficial muscle of this group, and forms the proximal, most prominent part of the calf. Gastrocnemius muscle exhibits numerous variations in the origin and/or insertion. The present report describes the incidental occurrence of the third/accessory head of gastrocnemius muscle in the left lower limb. During routine educational dissection of a 54-year old American female cadaver in the Anatomy lab of the Medical University of the Americas, Nevis, West Indies, we found an unusual 10.8 cm long muscle in the left popliteal region, attached proximally to the lateral aspect of the popliteal surface of femur, and distally terminated as a tendon which was attached at the junction of the medial and lateral heads of gastrocnemius muscle. No such variation was found on the right side. This is described as a case of third / accessory head of gastrocnemius muscle...

El grupo muscular superficial del compartimento posterior de la pierna forma una poderosa masa muscular. El músculo gastrocnemio de dos cabezas es el más superficial de este grupo y forma la parte proximal, más prominente de la pantorrilla. El músculo gastrocnemio presenta numerosas variaciones en el origen y/o inserción. El informe describe la presencia de una tercera/accesoria cabeza del músculo gastrocnemio, encontrada. durante una disección de rutina en un cadáver de una mujer americana de 54 años, en el Laboratorio de Anatomía de la Medical University of the Americas, Nevis, West Indies. La variación muscular inusual medía 10,8 cm de longitud y se originaba en la región poplítea izquierda, proximalmente en la cara lateral de la superficie poplítea del fémur, y se insertaba en un tendón que se adhería a la unión de las cabezas medial y lateral del músculo gastrocnemio. La variación no se encontró en el lado derecho. Este hallazgo se describe como un caso de tercera/accesoria cabeza del músculo gastrocnemio...

Intramuscular Baker's Cyst in Plantaris: A Case Report / 대한골관절종양학회지

Baker's cyst is found as most frequent cystic mass around the knee occurring between medial head of gastrocnemius muscle and semimembranosus muscle. The proximal or posterolateral extension of the cyst had been rarely reported and the cyst into the surrounding muscular tissue extremely rare. Intramuscular Baker's cyst that we report was found between lateral head of gastrocnemius muscle and popliteus tendon, and then extended into the plantaris muscle. With review of the literature, we here report a very rare case of plantaris muscular extension of Baker's cyst.

Mycosis Fungoides Palmaris et Plantaris in Children / 대한피부과학회지

Mycosis fungoides palmaris et plantaris (MFPP) is a rare form of mycosis fungoides that is confined to the palms and soles. The clinical manifestation of MFPP is often confused with inflammatory palmoplantar dermatoses. Mycosis fungoides is usually considered as a disease of middle age, but it is rarely developed at any age. A 10-year-old girl was referred to us with a 2-year history of recalcitrant palmoplantar dermatoses. Other clinics had treated her for more than 2 years, but all medical treatments turned out to have had no effect, despite her young age. She had not had any atopic dermatitis or allergic contact dermatitis. Histopathologic findings showed inflammatory cell infiltration and lymphocytic epidermotrophism. Monoclonal TCR-rearrangement was positive, so we diagnosed her as having MFPP. We tried to treat her with topical PUVA therapy and she improved within 3 months. Herein, we report on a case of mycosis fungoides Palmaris et plantaris in a 10-year-old girl that was treated successfully with topical PUVA.

Unilateral double plantaris muscle: a rare anatomical variation / Músculo plantar doble unilateral: una rara variación anatómica

The occurrence of a unilateral second plantaris muscle was discovered during the anatomical dissection of a 47 year old female with Huntington Chorea Disease. The cadaver was found to possess bilateral plantaris muscles and a distinct anomalous muscle morphologically resembling a second plantaris on the medial right leg. The inner and outer bellies of the anomalous plantaris arose proximally from the medial condyle of the femur and formed a short tendon that fused distally with the tendon of the lateral plantaris muscle.

Un segundo músculo plantar unilateral fue descubierto durante una disección anatómica de rutina, en una mujer de 47 años de edad con Enfermedad de Huntington Chorea. En la cara medial de la piena derecha, el cadáver presentaba, bilateralmente, el músculo plantar y un músculo anómalo, morfológicamente distinto, que se asemejaba a un segundo músculo plantar. Los vientres medial y lateral del músculo plantar anómalo se originaban del cóndilo medial del fémur y formaban un tendón corto que se fusionaba con el tendón del músculo plantar lateral.

The occurrence of the plantaris muscle and its muscle-tendon relationship in adult human cadavers / Presencia de músculos plantares y su relación musculotendinosa en cadáveres humanos adultos

Twenty legs from adult male cadavers were examined to analyze the anatomical relationships between the component parts of the plantaris muscle. This muscle was present in all of the cadavers and it was found that the length of the muscle in relation to its belly was approximately three times greater than in relation to the tendon.

Se estudiaron 20 miembros inferiores de cadáveres de adultos do sexo masculino con el fin de analizar la relación anatómica de los músculos plantares y sus partes constitutivas. En todos las piezas estudiadas este músculo estaba presente y fue observado que la longitud del músculo en relación a su vientre era aproximadamente tres veces superior a la del tendón.

End Stage Ankle Arthritis with Ankle Instability Patients Treatment Results Using Autograft Ligament Reconstruction with Total Ankle Arthroplasty / 대한족부족관절학회지

PURPOSE: We report the clinical and radiographic result of ligament reconstruction using plantaris and total ankle replacement in end-stage ankle arthritis with ankle instability. MATERIALS AND METHODS: The study is based on the 9 cases among total 48 patients of end-stage ankle arthritis that were treated with total ankle prosthesis and ligament reconstruction from 2007 to 2009 at least 12 months follow-up. We evaluated the VAS (Visual analogue scale) pain score, AOFAS (American orthopedic foot and ankle society) score and radiographic measurements. RESULTS: Average age was 59.4 years (53~67 years) old. VAS pain score improved from preoperative average 8.2+/-0.9 (range, 7~10) to 2.7+/-1.7 (range, 0~6) and the AOFAS score improved from 46.4+/-14.6 points (range, 23~69) to 80.1+/-9.3 points (range, 65~95) at final follow-up. Anterior draw test improved 15.2+/-3.4 mm (range, 12~23 mm) to 8.8+/-2.6 mm (range, 6~13mm),varus stress test improved from 13.9+/-4.6degrees (range,10-18degrees) to 6.2+/-4.7degrees (range,2-18degrees) at final follow up. CONCLUSION: Plantaris ligament reconstruction is good option as part of the management of ankle instability with end-stage ankle arthritis. We achieved good clinical and radiographic results.

Seven Casees of Local PUVA-bath Therapy in Nagoya City Midori Municipal Hospital / 日本温泉気候物理医学会雑誌

<B>Objective</B><BR>  PUVA therapy (combination of 8-methoxypsoralen and UVA irradiation) is commonly applied for treatment of psoriasis, pustulosis palmaris et plantaris and atopic dermatitis among dermatologists. PUVA bath therapy (PUVA soak therapy) is an arranged method of topical PUVA therapy, irradiate UVA just after soaking bath with 8-methoxypsoralen aqueous solution. It's speculated to cause less carcinogenesis and less general side effects than oral or classical topical PUVA therapy. The local PUVA bath therapy is an applied method of PUVA bath therapy which uses a wash-basin to soak hands or feet. This time 7 patients were treated with this method.<BR><B>Methods</B><BR>  Prepared in a wash-basin 0.0001% 8-methoxypsoralen in 37-40°C water and soaked lesion area for 15 minutes and irradiate UVA immediately after soaking. The UVA-radiation was done once every week. Started with UVA-dose of 0.5J/cm<SUP>2</SUP> for all patients, and increase doses by 0.5J/cm<SUP>2</SUP> for each therapy up to maximum single UVA-dose of 2.5 or 3.0J/cm<SUP>2</SUP>. 7 patients (age 41-76 years, 3 men and 4 women, 3 psoriasis vulgaris and 4 pustulosis palmaris et plantaris) treated with this therapy and total UVA-dose was ranging from 22.1to 63.5J/cm<SUP>2</SUP>.<BR><B>Results</B><BR>  One patient dropped out. Among the the remaining six patients, one patient showed no improvement and one other patient showed improvement but was relapsed just after the end of treatment. Four patients showed improvement and one of them (pustulosis palmaris et plantaris) have kept good condition over two years after treatment.<BR><B>Discussion</B><BR>  Local PUVA bath therapy is good treatment because it can be done easily to ambulatory patients if a UVA-lump is available, and some patients gain long-term remission.