'Absolute' inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray.

PURPOSE: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. METHODS: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel's classification systems. RESULTS: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer's classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer's classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. CONCLUSION: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Anosognosia and default mode subnetwork dysfunction in Alzheimer's disease.

Research on the neural correlates of anosognosia in Alzheimer's disease varied according to methods and objectives: they compared different measures, used diverse neuroimaging modalities, explored connectivity between brain networks, addressed the role of specific brain regions or tried to give support to theoretical models of unawareness. We used resting-state fMRI connectivity with two different seed regions and two measures of anosognosia in different patient samples to investigate consistent modifications of default mode subnetworks and we aligned the results with the Cognitive Awareness Model. In a first study, patients and their relatives were presented with the Memory Awareness Rating Scale. Anosognosia was measured as a patient-relative discrepancy score and connectivity was investigated with a parahippocampal seed. In a second study, anosognosia was measured in patients with brain amyloid (taken as a disease biomarker) by comparing self-reported rating with memory performance, and connectivity was examined with a hippocampal seed. In both studies, anosognosia was consistently related to disconnection within the medial temporal subsystem of the default mode network, subserving episodic memory processes. Importantly, scores were also related to disconnection between the medial temporal and both the core subsystem (participating to self-reflection) and the dorsomedial subsystem of the default mode network (the middle temporal gyrus that might subserve a personal database in the second study). We suggest that disparity in connectivity within and between subsystems of the default mode network may reflect impaired functioning of pathways in cognitive models of awareness.

Cyst volume changes measured with a 3D reconstruction after decompression of a mandibular dentigerous cyst with an impacted third molar.

The aim of this article is to describe a large mandibular cyst treated with decompression followed by surgical enucleation. Furthermore, we described the utility of cyst volume measurements by using a 3D reconstruction on Cone Beam Computed Tomography (CBCT). The dentigerous cyst is the most common cyst type of epithelial origin, arising from remnants of odontogenic epithelium, asymptomatic and associated with the crown of an unerupted or partially or completely impacted tooth. However, after a long duration and extension of the cyst volume it may provoke significant bone resorption, cortical expansion, tooth displacement and the vitality of neighboring teeth may be affected. The regular treatment of this lesion is enucleation and extraction of the involved tooth. Marsupialization and decompression are proposed when the volume of the cyst is well developed to release the cystic pressure and allow the bone cavity to progressively decrease in volume with the gradual apposition of bone. This report presents a large dentigerous cyst related to impacted mandibular third molar of a 21-year-old male patient. The cyst was treated successfully by decompression and later by surgical enucleation with surgical extraction of the related molar. In conclusion, the combination of decompression and surgical approach showed on the three-dimensional CBCT investigation a significant correlation between the treatment and volume reduction of the cyst. The clinical case described allows us to observe bone formation after decompression and surgical enucleation was performed with less risk on vital anatomic elements.

Fascitis Plantar: Opciones terapéuticas / Plantar Fasciitis: Treatment strategies

La talalgia es la causa más frecuente de consulta a los especialistas en pie y tobillo, entre un 11% y un 15%. En la mayoría de los casos se debe a un proceso de degeneración fibrosa en la inserción fascial de la tuberosidad medial del calcáneo al que llamamos fascitis plantar. Existen multitud de tratamientos que se han mostrado efectivos para la fascitis plantar, desde el uso de plantillas o taloneras hasta la fasciotomia quirúrgica, pasando por las infiltraciones articulares o los suplementos de colágeno en la dieta. Después de analizar la evidencia científica de los diferentes tratamientos utilizados, no se ha encontrado ninguna opción de la que se haya demostrado evidencia fuerte del beneficio en la que basar la práctica clínica, por ello diseñamos un estudio prospectivo en el que establecimos en pacientes que tenían el diagnóstico de fascitis plantar 4 líneas de tratamiento diferentes. El objetivo del presente estudio es conocer los resultados de 4 líneas terapéuticas diferentes en pacientes en los que iniciamos un primer escalón de tratamiento, para conocer si alguna de estas líneas nos aporta beneficios en la eliminación del dolor, la recuperación de la funcionalidad o ambas

Heel pain is the most common cause of medical consultation in foot and ankle specialists, constituting between 11% and 15% of them. In most cases it is due to a process of fibrous degeneration in the fascial insertion of the medial tuberosity of the calcaneus, the plantar fasciitis. Many treatmens have been shown to be effective for plantar fasciitis, starting with the use of orthotics to other more aggressive procedures as surgical fasciotomy passing through other terapies as joint infiltrations or collagen supplements. After a scientific review of the different treatments, no option has demonstrated strong evidence of benefit on which to base clinical practice, thus we designed a prospective study in which we established 4 different lines of treatment in patients who had the diagnosis of plantar fasciitis. Objetive: To analyze the effectiveness of the interventions in the management of plantar fasciitis