Georgi P. Georgiev

Histological and ultrastructural evaluation of the early healing of the lateral collateral ligament epiligament tissue in a rat knee model

BackgroundIn this study, we evaluated the changes which occurred in the epiligament, an enveloping tissue of the ligament, during the ligament healing. We assessed the association of epiligament elements that could be involved in ligament healing.MethodsThirty-two 8-month old male Wistar rats were used in this study. In twenty-four of them the lateral collateral ligament of the knee joint was surgically transected and was allowed to heal spontaneously. The evaluation of the epiligament healing included light microscopy and transmission electron microscopy.ResultsAt the eight, sixteenth and thirtieth day after injury, the animals were sacrificed and the ligaments were examined. Our results revealed that on the eight and sixteenth day post-injury the epiligament tissue is not completely regenerated. Till the thirtieth day after injury the epiligament is similar to normal, but not fully restored.ConclusionOur study offered a more complete description of the epiligament healing process and defined its important role in ligament healing. Thus, we provided a base for new strategies in ligament treatment.

An Aberrant Flexor Digiti Minimi Brevis Manus Muscle

During routine anatomical dissection in the right volar wrist region of a 43-year-old female cadaver, we discovered a unique flexor digiti minimi brevis (manus) muscle. The aberrant muscle arose from the medial edge of the flexor carpi radialis tendon and passed obliquely, distally and ulnarward, crossing over the median nerve and then the ulnar artery and nerve at the Guyon canal. The aberrant muscle inserted to the anteromedial surface of the base of the fifth proximal phalanx. The deep branch of the ulnar nerve innervated this muscle. The potential clinical implications of the variant flexor digiti minimi brevis muscle are briefly described.

Comparative investigation of neuronal nitric oxide synthase immunoreactivity in rat and human claustrum

We compared the distribution, density and morphological characteristics of nitric oxide synthase-immunoreactive (NOS-ir) neurons in the rat and human claustrum. These neurons were categorized by diameter into three main types: large, medium and small. In the human claustrum, large neurons ranged from 26 to 40μm in diameter, medium neurons from 20 to 25μm and small neurons from 13 to 19μm. In the rat claustrum, large neurons ranged from 19 to 23μm in diameter, medium neurons from 15 to 18μm and small neurons from 10 to 14μm. The cell bodies of large and medium neurons varied broadly in shape - multipolar, elliptical, bipolar and irregular, consistent with a projection neuron phenotype. The small neurons were most seen as being oval or elliptical in shape, resembling an interneuron phenotype. Based on a quantitative comparison of their dendritic characteristics, the NOS-ir neurons of humans and rats displayed a statistically significant difference.

Symptomatic Os Subtibiale Associated with Chronic Pain Around the Medial Malleolus in a Young Athlete

Abstract An os subtibiale is a rare accessory bone located below or behind the medial malleolus. Herein we present a rare case of a painful os subtibiale in a young triathlete who presented with pain, redness and swelling below his left medial malleolus. Plain radiographs and three-dimensional computed tomography revealed a well-defined oval bone distal to the left medial malleolus. After conservative treatment failed, the ossicle was excised in an open surgery with complete resolution of symptoms. This case report emphasizes the need for clinical awareness of different anatomical variations of the bones of the foot.

Palmaris Longus Muscle Variations: Clinical Significance and Proposal of New Classifications

Abstract Background: The palmaris longus muscle is one of the most variable muscles in the human body and there have been numerous variations reported. The different palmaris longus variations are interesting not only from an anatomical point of view, but they could also have definite clinical significance. Aim: The aim of this study was to examine the different types of variations of palmaris longus muscle in the Bulgarian population. Materials and methods: Over a period of 15 years, 56 formol–carbol fixed human cadavers were studied to investigate the different variations of palmaris longus muscle (PLM). Results: Various anatomical variations of PLM have been reported: absence (2.68%); reversed palmaris longus coexisting with an additional abductor digiti minimi muscle (0.89%); digastric (0.89%); palmaris longus with intermediate muscle belly (1.79%) and duplication (1.79%). Conclusions: To reveal the wide variety of the types of palmaris longus muscle and their importance for clinical practice, we make a brief literature review concerning the different types of variations, their role in the median and ulnar neuropathy in the wrist or as structures simulating a soft tissue tumour and the application of palmaris longus tendon in plastic and reconstructive surgery as grafting material. We also present new systematic anatomical and clinical classifications of palmaris longus variations by dividing them into two simple groups.

Reoperatif tiroid cerrahisinde nüks ve morbidite oranı için risk faktörleri: farklı bir bakış açısı

Correspondence: Georgi P. Georgiev, University Hospital of Orthopaedics, Medical University Sofia, 56 Nikola Petkov Blvd., 1614 Sofia, Bulgaria Email: georgievgp@yahoo.com Received: 28.07.2013, Accepted: 04.11.2013 Copyright

Bilateral hypoplasia of the long head of the biceps brachii muscle

In this report, we present a rare case of bilateral hypoplasia of the long head of the BB found during the anatomical dissection of a 58-year-old female cadaver. In both arms, the most remarkable findings were the strange-looking long heads [Figure 1 a-b], composed of abnormally long proximal tendons and small muscular bellies in the lower third of the brachium. The tendons had nearly equal lengths (right 12.2 cm, left 12.4 cm) but different widths – the left tendon (4.7 mm) was wider than the right one (3.4 mm). Proximally, both tendons were attached to the greater and lesser tuberosities of the humerus in the intertubercular sulcus (bicipital groove). Distally, the tendons continued in weak fusiform muscular bellies of similar size (length 11 cm, width 1.5 cm). In contrast, the short heads of BB on both sides were well developed. Each one arose as usual by a thick, flattened tendon from the apex of the coracoid process. Distally, the long and the short heads of both BB inserted to the radial tuberosities. Additionally, on the left side, the short head had a small supernumerary origin from the tendon of the pectoralis major [Figure 1b].

Extensor indicis proprius muscle and its variants together with the extensor digitorum brevis manus muscle: a common classification. Clinical significance in hand and reconstructive surgery

PurposeThe extensor indicis proprius (EIP) is a muscle of the forearm that originates from the posterior surface of the ulna and the adjacent interosseous membrane and attaches to the index finger. Many anatomical variations of this muscle have been reported in the literature. The extensor digitorum brevis manus (EDBM) is a variant muscle found on the back of the wrist and hand. These muscle variants should be considered in the context of clinical syndromes and reconstructive hand surgery. The aim of the present study was to describe in detail the normal and variant anatomy of these muscles and propose new systematic classifications.Materials and methodsFormol–carbol-fixed Europid upper limbs (n = 176) were examined in the Department of Anatomy, Histology and Embryology at the Medical University of Sofia for variations of the EIP and occurrences of the EDBM.ResultsWe found normal anatomy in 147 (84%) of the specimens examined and we measured the length and width of the muscle belly and tendon of the EIP. Variations of the EIP in the other 29 upper limbs (16%) included replacement of the EIP by an EIB, coexistence of the EIP and EIB, presence of accessory tendons, and additional muscles.ConclusionsKnowledge of anatomical variations of forearm muscles is important because they can cause clinical syndromes or have implications for reconstructive surgery, most often as tendon transfers in response to functional loss of other forearm muscles.

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Purpose Many randomised controlled trials and meta-analysis studies have presented the efficacy of tranexamic acid (TXA) without an increase of complications. However, questions still remain about the type of administration, optimal dose and secondary outcomes of TXA in total hip arthroplasty and total knee arthroplasty. The aim of this review is to summarise the existing information in literature concerning the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use. Methods A literature review containing 63 articles from the PubMed data starting from the first description of tranexamic acid until now was made in trying to present the existing information in a simple and effective way. Results TXA leads to statistically significant reduction of peri and postoperative bleeding and in that way decreases blood transfusion rates and the infection risk. Topical and intravenous (IV) use of TXA revealed similar results, with no increase of deep venous thrombosis. Therefore, topical TXA could be a reasonable alternative in patients with contraindications for IV application of TXA. Conclusions Blood loss control with TXA, a synthetic analogue of the amino acid lysine, may be an excellent and safe alternative to allogeneic blood transfusion after total hip arthroplasty and total knee arthroplasty. Further studies are needed to establish the efficacy of combined IV and topical administration of TXA with regard to diminishing blood loss and reducing hospital stay. The Translational Potential of this Article This review briefly presents the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use with regard to diminishing blood loss and reducing hospital stay for better therapeutic strategies in orthopaedics.

Osteoid Osteoma of the Middle Phalanx of the Third Finger in a Child Mimicking a Malignancy

Abstract Osteoid osteoma is a rare occurrence in the hand, especially in children. We report here a rare case of a 12-year-old boy complaining of growing painful swelling of the middle phalanx of the third finger that had started 3 months earlier and had not responded to anti-inflammatory medication. Based on the clinical findings and plain radiographs, osteomyelitis or Ewing’s sarcoma was suspected. However, MRI revealed the typical characteristics of osteoid osteoma. The lesion was excised, and the histological examination confirmed the diagnosis. We make a brief review of the literature concerning this uncommon localization and discuss the differential diagnosis and treatment modalities.