Publications by authors named "Georgi P Georgiev"

53 Publications

Common trunk of the internal thoracic artery, inferior thyroid artery and thyrocervical trunk from the subclavian artery: a rare arterial variant.

Surg Radiol Anat 2022 Jul 6;44(7):983-986. Epub 2022 Jul 6.

Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland.

Purpose: In this article, we describe a complex and rare variant of the common trunk arising as a branch of the subclavian artery. This description highlights the clinical relevance of such a variation for medical practice.

Methods: A routine dissection was carried out on an adult 74-year-old female cadaver. After identification and preparation of the common trunk, measurements and photographs were taken.

Results: The dissection revealed a common trunk arising from the first part of the left subclavian artery. It divided into the left internal thoracic artery, the inferior thyroid artery, and the thyrocervical trunk. Further on, the branches of the thyrocervical trunk supplied blood to the trapezius muscle, the longus colli muscle and the supraspinatus muscle.

Conclusion: For the first time, we report the specific appearance of a common trunk from the left subclavian artery that includes the origin of the left internal thoracic artery, inferior thyroid artery, and thyrocervical trunk. Knowledge of the different variations of subclavian branches is essential because of the high frequency with which this region is involved in diagnostic and surgical procedures.

Level Of Evidence: II Basic Science Research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-022-02977-wDOI Listing
July 2022

Lateral epicondylitis: New trends and challenges in treatment.

World J Orthop 2022 Apr 18;13(4):354-364. Epub 2022 Apr 18.

Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia 1527, Bulgaria.

Lateral epicondylitis (LE) is a chronic aseptic inflammatory condition caused by repetitive microtrauma and excessive overload of the extensor carpi radialis brevis muscle. This is the most common cause of musculoskeletal pain syndrome in the elbow, inducing significant pain and limitation of the function of the upper limb. It affects approximately 1-3% of the population and is frequently seen in racquet sports and sports associated with functional overload of the elbow, such as tennis, squash, gymnastics, acrobatics, fitness, and weight lifting. Typewriters, artists, musicians, electricians, mechanics, and other professions requiring frequent repetitive movements in the elbow and wrists are also affected. LE is a leading causation for absence from work and lower sport results in athletes. The treatment includes a variety of conservative measures, but if those fail, surgery is indicated. This review summarizes the knowledge about this disease, focusing on risk factors, expected course, prognosis, and conservative and surgical treatment approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5312/wjo.v13.i4.354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048498PMC
April 2022

Three ipsilateral paracondylar processes with other skull base variations: case report.

Anat Cell Biol 2022 Jun 30;55(2):247-250. Epub 2022 Mar 30.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.

Variations of the skull base can affect surgical approaches and must be considered when viewing and interpreting radiological imaging. Here, we report a unique collection of bony anatomical variations found on a single adult skull. Three bony excrescences from the occipital bone were identified in the paracondylar region. The smallest of these processes was 7 mm long and was just medial to the mastoid process of the temporal bone and posterior to the styloid process. One bony process was attached to the occipital condyle and was 12 mm in length. The longest of these processes was 17 mm long and arose from the jugular process of the occipital bone. Paracondylar processes can be symptomatic. Knowledge of the bony variations at the skull base is important to those who operate in this region or review and interpret radiological imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5115/acb.22.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256483PMC
June 2022

Atavistic muscles in human anatomy: Evolutionary origins and clinical implications.

Anat Histol Embryol 2022 May 25;51(3):321-331. Epub 2022 Feb 25.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisina, USA.

The evolution and variations of human anatomy are of great interest to physicians and anatomists. Variations can be categorized as vestigial, accessory or atavistic structures. Vestigial muscles are frequently encountered structures that are normally present but have become rudimentary through evolution. Muscles that disappeared during evolution sometimes arise again, although rarely; such muscles are referred to as atavistic. They arise from failure of suppression of genetic loci. Some common atavistic muscles seen clinically are the extensor digitorum brevis manus, chondroepitrochlearis and plantaris. Atavistic muscles appear more frequently in the upper limb than in any other region of the human body. One explanation for the appearance of these muscles, mainly within the upper limbs, is based on the evolution of the complex upper extremities formed in humans today. Often, the presence of atavistic muscles is asymptomatic, but they can compromise the function of normal anatomical structures and complicate clinical situations if their presence is unknown. They can cause complications if they are confused with soft tissue pathology, if they compress or displace surrounding structures, or if they require an additional blood supply during times of exercise and stress. The purpose of this paper was to describe the common atavistic muscles, their hypothesized evolutionary origins, their potential complications and possible treatments for the diagnosing clinician.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ahe.12796DOI Listing
May 2022

Incidental Median Nerve Injury in the Hand by a High-Speed Drill.

Cureus 2022 Jan 14;14(1):e21243. Epub 2022 Jan 14.

Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Sofia, BGR.

Traumatic injuries of the peripheral nerves can be easily overlooked in the emergency department. In these cases, extensive knowledge of anatomy, a high index of suspicion and correct evaluation of neurological status could maintain the proper diagnosis. Median nerve injury in the region of the hand is commonly due to glass material. However, extremely rare, other causes of injury, such as pieces of wood, acupuncture needle-fracture bodies, metallic foreign bodies, and migration of K-wires, have been reported. In the current report, a case of median nerve injury in a 35-year-old man treated with a high-speed drill was reported to my knowledge for the first time in the current literature. Early and correct diagnosis for nerve injury is crucial for improved functional outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.21243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8841128PMC
January 2022

A new variety of chondrocoracoideus muscle, or an additional head of pectoralis major muscle.

Surg Radiol Anat 2022 Feb 21;44(2):233-237. Epub 2022 Jan 21.

Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.

The pectoralis major and pectoralis minor muscles are located in the anterior chest wall. This region is characterized by high morphological variability. During dissection an additional muscle was found, originating from the lateral border of the pectoralis major muscle. After fusion it passed into the tendinous part coursing under the insertion of the pectoralis major muscle, then formed a common junction with the short head of the biceps brachii muscle, the distal attachment of which is on the coracoid process. Such an accessory structure could lead to neurovascular compression and cause thoracic outlet syndrome, of which pain is usually the first symptom. This muscle has not been described in the literature so far and for that reason we can name the present case as an unique structure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-022-02887-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831266PMC
February 2022

The novel epiligament theory: differences in healing failure between the medial collateral and anterior cruciate ligaments.

J Exp Orthop 2022 Jan 14;9(1):10. Epub 2022 Jan 14.

Department of Anatomical Sciences, St. George's University, True Blue, Grenada.

According to current literature, 90% of knee ligament injuries involve the medial collateral ligament or the anterior cruciate ligament. In contrast to the medial collateral ligament, which regenerates relatively well, the anterior cruciate ligament demonstrates compromised healing. In the past, there were numerous studies in animal models that examined the healing process of these ligaments, and different explanations were established. Although the healing of these ligaments has been largely investigated and different theories exist, unanswered questions persist.Therefore, the aim of this article is 1) to review the different historical aspects of healing of the medial collateral ligament and present the theories for healing failure of the anterior cruciate ligament; 2) to examine the novel epiligament theory explaining the medial collateral ligament healing process and failure of anterior cruciate ligament healing; and 3) to discuss why the enveloping tissue microstructure of the aforementioned ligaments needs to be examined in future studies.We believe that knowledge of the novel epiligament theory will lead to a better understanding of the normal healing process for implementing optimal treatments, as well as a more holistic explanation for anterior cruciate ligament healing failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40634-021-00440-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758860PMC
January 2022

Re: Wang CK, Ng CY. Accessory flexor carpi ulnaris: a rare cause of distal ulnar nerve compression. J Hand Surg Eur. 2021, 46: 197-9.

J Hand Surg Eur Vol 2021 11;46(9):1014-1015

Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/17531934211003791DOI Listing
November 2021

Clinical importance of variability in the branching pattern of the internal iliac artery - An updated and comprehensive review with a new classification proposal.

Ann Anat 2022 Jan 1;239:151837. Epub 2021 Oct 1.

Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland. Electronic address:

The main aim of this study is to present, describe and compare the most significant anatomical classifications of the internal iliac artery (IIA) and its branches, their pros and cons, to relate them to clinical practice and note their clinical importance, and to offer a new classification based on number of main vessels origins. Many classifications covering the detailed morphology of the IIA have been developed, focusing on the destination of vessels making it possible to determine the name and type of branching precisely. However, because the allocation criteria are overdetailed and of doubtful accuracy, these classifications have become impractical for clinical practice and advanced statistical calculations. The argument of this research paper is that highly variable vascularized regions should be classified from either an anatomical point of view to determine detailed morphology aspects or a clinical perspective. Presented classification proposes unification of many branching types presented among various classifications, which look identical when determining the origin pattern from the main vessel and differ only in the destination point of the vessel, what brings clarity and increases the statistical usefulness of the collected data. This should translate into better cooperation between scientists and clinicians and thus benefit patients. The paper proposes a new, clinically useful classification based on the model of vessel origins from the main stem. The IIA is the main vascular supply to the pelvic region, so precise knowledge of origin and its branching pattern is essential for all clinicians, especially for general and orthopaedic surgeons, gynecologists, obstetricians and urologists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.aanat.2021.151837DOI Listing
January 2022

The clinical anatomy of variations of the pectoralis minor.

Surg Radiol Anat 2021 May 9;43(5):645-651. Epub 2021 Mar 9.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.

Shoulder pathology is a very common medical presentation and can be due to anatomical variations. Therefore, knowledge of variants is important for the clinician treating patients with such complaints so that misdiagnosis is minimized and iatrogenic injury prevented. A review of the literature was performed of the variant anatomy of the pectoralis minor muscle. The aim of this review is to better inform clinicians who might treat patients with shoulder pathology so that if identified, variants of the pectoralis minor muscle are better appreciated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-021-02703-yDOI Listing
May 2021

Is a big lateral loop of internal carotid artery rare and unique or well-known entity?

Surg Radiol Anat 2021 Jun 12;43(6):1023-1024. Epub 2021 Jan 12.

Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, 8 Bialo More Str., 1527, Sofia, Bulgaria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-021-02680-2DOI Listing
June 2021

Giant Cell Tumor of Bone in the Talus Treated by Extended Curettage and Synthetic Bone SubstituteReport of a Rare Case.

Bull Hosp Jt Dis (2013) 2020 12;78(4):277-280

Giant cell tumor of bone is extremely rare in the talus and is usually observed in the third decade of life. Herein, we report a case of a 19-year-old male with a giant cell tumor of bone in the talus mimicking a simple bone cyst that was treated by intralesional curettage and, for the first time, bone grafting with a synthetic bone substitute. The patient had no evidence of recurrence at 7-year follow-up but did have non-progressing mild degenerative joint disease and slightly limited range of movement at the ankle joint.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2020

Translation and Validation of the Bulgarian Version of the Boston Carpal Tunnel Questionnaire.

Cureus 2020 Oct 11;12(10):e10901. Epub 2020 Oct 11.

Orthopaedics and Traumatology, Medical University of Sofia, Sofia, BGR.

Background and Objective: Carpal tunnel syndrome (CTS) is the most common mononeuropathy in humans. Despite the continuous improvement of diagnostic and treatment methods, difficulties remain in the evaluation and quantification of such symptoms as pain, paresthesias, hypesthesia, and hyperesthesia. Numerous tests and questionnaires have been developed for patients with upper limb disease, but the most specific for CTS and the most commonly used is the Boston Carpal Tunnel Questionnaire (BCTQ). BCTQ has been translated and validated for use in many languages, but there is no valid version in Bulgarian yet. The purpose of this work is to create and validate a Bulgarian version of BCTQ, with a recommendation for its use in Bulgarian patients.

Methods: The process was divided into two parts. The first part included a translation and a cultural-linguistic adaptation of the Bulgarian version of BCTQ. In the second part, verification of the psychometric properties of the Bulgarian BCTQ, we investigated the reliability, validity and responsiveness of the Bulgarian version of BCTQ. We evaluated BCTQ's construct validity by comparing its results with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The study was performed on a group of 64 patients with a confirmed diagnosis of CTS. All patients were evaluated using the BCTQ and DASH questionnaires. A subgroup of 26 patients underwent open surgical decompression of the carpal canal using a mini-incision technique. The subgroup was evaluated through BCTQ and DASH questionnaires preoperatively and through BCTQ postoperatively at the third month after the intervention.

Results: In the first part of the study, the final version of the questionnaire was presented. Cronbach's alpha coefficient was 0.88 for the Symptom Severity Scale (SSS) and 0.87 for the Functional Status Scale (FSS). The reproducibility of scores showed an extremely high degree of correlation between the two consecutive BCTQ scores at one-week interval (SSS r=0.99, p<0.0001; FSS r=1, p<0.0001). The criterion validity of the Bulgarian version of BCTQ revealed a strong correlation between the results of the BCTQ and the DASH questionnaires. (SSS r(62)=0.569, p<0.00001; FSS r(62)=0.605, p<0.00001). There was a statistically significant decrease in BCTQ results after surgery for both the SSS (t=-9.43, p<0.00001) and the FSS (t=-9.82, p<0.00001).

Conclusion: Our study created a translated and culturally adapted version of BCTQ. The Bulgarian version of BCTQ is reliable, valid, and responsive for measuring symptoms and functional deficits in patients with CTS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.10901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654980PMC
October 2020

The co-occurrence of a four-headed coracobrachialis muscle, split coracoid process and tunnel for the median and musculocutaneous nerves: the potential clinical relevance of a very rare variation.

Surg Radiol Anat 2021 May 26;43(5):661-669. Epub 2020 Sep 26.

Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland.

The coracobrachialis muscle (CBM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. Both the proximal and distal attachment of the CBM, as well as its relationship with the musculocutaneus nerve demonstrate morphological variability, some of which can lead to many diseases. The present case study presents a new description of a complex origin type (four-headed CBM), as well as the fusion of both the short biceps brachii head, brachialis muscle and medial head of the triceps brachii. In addition, the first and second heads formed a tunnel for the musculocutaneus and median nerves. This case report has clear clinical value due to the split mature of the coracoid process, and is a significant indicator of the development of interest in this overlooked muscle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-020-02580-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105253PMC
May 2021

Langer's axillary arch-a term used through the years, but is it correct? : Re: Rajakulasingam R, Saifuddin A. Fullness in the left axilla-answer: Langer's axillary arch. Skeletal Radiol (2020). https://doi.org/10.1007/s00256-020-03467-z.

Skeletal Radiol 2020 10 11;49(10):1681. Epub 2020 Jul 11.

Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, 8, Bialo More Str., 1527, Sofia, Bulgaria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-020-03544-3DOI Listing
October 2020

An unusual finding of the pectoralis major muscle: decussation of sternal fibers across the midline.

Anat Cell Biol 2020 Dec;53(4):505-508

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

Variations of the pectoralis major muscle are commonly seen. However, during the routine dissection of an adult male cadaver, an apparently uncommon muscular variant was identified. In this cadaver, the sternal heads of the left and right pectoralis muscles crossed the midline and interdigitated with one another. In addition, the clavicular heads of both pectoralis major muscles were separated from the remaining parts of the muscles. Such anatomical variants such be kept in mind by clinicians and surgeons during patient evaluation and treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5115/acb.20.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769107PMC
December 2020

A Non-ossifying Fibroma and a Stress Fracture of the Femur Mimicking Bone Malignancy in a Child.

Cureus 2020 Apr 12;12(4):e7652. Epub 2020 Apr 12.

Orthopaedics and Traumatology, University Hospital Queen Giovanna, Sofia, BGR.

Herein, we report a rare case of a stress fracture through a pre-existing non-ossifying fibroma (NOF) of the femur of a 12-year-old child that raised suspicion of a malignancy. Although NOFs are very frequent, in the vast majority of cases, they are completely asymptomatic. When encountered in a painful area, especially if combined with atypical radiographic features, they may mimic a malignancy. We discuss the radiographic findings, the differential diagnosis, and the relevant points of the patient's history that helped to establish the diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.7652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217586PMC
April 2020

Physical Therapy and Rehabilitation Approaches in Patients with Carpal Tunnel Syndrome.

Cureus 2020 Mar 3;12(3):e7171. Epub 2020 Mar 3.

Physical Medicine and Rehabilitation, Medical Univeristy of Sofia, Sofia, BGR.

Physical therapy involves a set of factors and methods that affect the biological processes in the body. It is widely used, relatively inexpensive, non-invasive, and easy to apply. Physiotherapy is also used in the treatment of patients with carpal tunnel syndrome (CTS). This syndrome represents the most common compressive mononeuropathy of the upper limb and leads to significant disability. Hence, its successful treatment leads to significant benefits for both the patient and society. There is no established algorithm for the use of physical therapy in these patients. In this publication, we present the physiotherapeutic methods used for the treatment of CTS both before and after surgical treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.7171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117610PMC
March 2020

Variant pronator teres muscle and supracondylar process: interesting for anatomists and surgeons but a well-known variation.

Surg Radiol Anat 2020 08 26;42(8):909. Epub 2020 Feb 26.

Department of Anatomy, St. George's University, St. George's, Grenada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-020-02445-3DOI Listing
August 2020

Reversed palmaris longus muscle: a popular object of anatomical and surgical studies and some misdescriptions.

Surg Radiol Anat 2020 03 28;42(3):297-298. Epub 2020 Jan 28.

Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, 8 Bialo more str., 1527, Sofia, Bulgaria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-020-02424-8DOI Listing
March 2020

Hypothenar muscles-A popular object of anatomy and surgery and some misdescriptions.

Clin Anat 2020 Apr 6;33(3):326. Epub 2020 Jan 6.

Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia, Bulgaria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ca.23537DOI Listing
April 2020

Klippel-Feil Syndrome with Sprengel Deformity.

J Radiol Case Rep 2019 May 31;13(5):24-29. Epub 2019 May 31.

Department of Diagnostic Imaging, University Hospital St. Ekaterina, Medical University of Sofia, Sofia, Bulgaria.

Coexistence of Klippel-Feil syndrome with Sprengel deformity and omovertebral bone is a rare complex bone abnormality with unknown incidence and etiology. Herein, we report a case of a 6-year-old girl with coexistence of these congenital abnormalities evaluated by three-dimensional computed tomography. We also make a brief review and discuss in details the role of this imaging modality in the evaluation of such complex cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3941/jrcr.v13i5.3565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742447PMC
May 2019

Cytoarchitecture of the dorsal claustrum of the cat: a quantitative Golgi study.

J Mol Histol 2019 Oct 13;50(5):435-457. Epub 2019 Jul 13.

Department of Anatomy, Histology and Embryology, Medical University of Sofia, 2, Zdrave St, 1431, Sofia, Bulgaria.

The claustrum is a subcortical nucleus, found in the telencephalon of all placental mammals. Earlier Golgi studies have mostly focused on a qualitative description of the types of neurons. The aim of the present study was to describe the types of neurons found in the dorsal claustrum of the cat using the Golgi impregnation method and to perform a quantitative analysis of the following morphometric parameters: number of terminals (ends), total dendritic length, dendritic complexity, spine density (in spiny projection neurons), varicosity density (in aspiny interneurons). We used specimens from 5 healthy male cats stained according to the Golgi-Cox method. The dendritic trees of the studied neurons were then reconstructed through the Neurolucida software. Values of the studied quantitative parameters were obtained automatically and tested for statistically significant differences. Five types of spiny neurons were observed-large, medium-sized and small multipolar, bipolar and pyramidal-like. In addition, we described three types of aspiny neurons. The quantitative values and the statistical analysis were presented with tables and diagrams. In conclusion, we have presented a detailed analysis of the cytoarchitecture of the DC of the cat and have reported the first quantitative data on a number of morphometric parameters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10735-019-09839-7DOI Listing
October 2019

Neoadjuvant and Adjuvant Treatment with Denosumab in Aggressive Giant-cell Tumor of Bone in the Proximal Fibula: a Case Report.

Folia Med (Plovdiv) 2018 Dec;60(4):637-640

Department of Orthopedics and Traumatology, Queen Giovanna University Hospital - ISUL, Medical University of Sofia, Sofia, Bulgaria.

Giant cell tumor of bone is a histologically benign but locally aggressive osteolytic lesion, capable of spreading 'benign' metastases mainly to the lungs. Since its description as a separate entity, surgery has been the mainstay of treatment. Recently, target therapy has been introduced using denosumab - an inhibitor antibody for the receptor activator of nuclear factor kappa B ligand with dramatic eff ect on the natural course of the tumor. Herein, we report a rare case of an aggressive stage 3 giant cell tumor of bone of the proximal fibula that was successfully downstaged using neoadjuvant denosumab treatment and then treated by surgical excision followed by adjuvant target therapy. The clinical characteristics and treatment modalities of giant cell tumor of bone, the indications for target therapy, therapy response, and histological changes are also briefly discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2478/folmed-2018-0067DOI Listing
December 2018

A comparative study of the epiligament of the medial collateral and the anterior cruciate ligament in the human knee. Immunohistochemical analysis of collagen type I and V and procollagen type III.

Ann Anat 2019 Jul 22;224:88-96. Epub 2019 Apr 22.

Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria.

Background: Recent reports in rat models have shown that fibroblasts in the epiligament, an enveloping tissue of the ligament, are not static cells and play an important role during the early ligament healing of isolated grade III injury of the collateral ligaments of the knee. Fibroblasts produce collagen types I, III and V and infiltrate within the ligament body via the endoligament. In addition, similarities have been reported between the structure of the epiligament of the medial collateral ligament and anterior cruciate ligament of the knee in rat and in human. In line with the ascribed role of the epiligament tissue and the synthesis of these collagens and their role in ligament healing, the aim of this study was to determine their presence in the normal epiligament of the aforementioned ligaments in humans, to compare their differential expression and to present a novel hypothesis about the failure of healing of the anterior cruciate ligament in contrast to the medial collateral ligament.

Materials And Methods: We used samples from the mid-substance of the medial collateral and the anterior cruciate ligament of the knee joint, acquired from 12 fresh knee joints. Routine histological analysis was performed through hematoxylin and eosin stain, Mallory's trichrome stain and Van Gieson's stain. The immunohistochemical analysis was conducted using monoclonal antibodies against collagen type I and V and procollagen type III. The number of cells in the epiligament, endoligament and the ligament tissue was assessed quantitatively through a computerized system for image analysis NIS-Elements Advanced Research and Statistica software.

Results: Our observations revealed certain differences in the morphology of the epiligament, as well as variations in the expression of the investigated molecules. Expression of collagen type I was mostly low-positive (1+) in the epiligament and positive (2+) in the ligament tissue of both ligaments. Expression of procollagen type III was mostly positive (2+) in the epiligament and ligament tissue of the medial collateral ligament, low-positive (1+) in the epiligament and negative (0) in ligament tissue of the anterior cruciate ligament. Expression of collagen type V was predominantly low-positive (1+) in the epiligament and negative (0) in the ligament tissue of both ligaments. The immunoreactivity for all three molecules was always higher in the epiligament of the medial collateral ligament than that of the anterior cruciate ligament.

Conclusions: The results of our study illustrate for the first time that fibroblasts in the human epiligament are indeed responsible for the synthesis of the main types of collagen participating in the early ligament healing, thus corresponding to previous data of the medial collateral ligament healing in animal models. The differences between the epiligament of the investigated ligaments could add a novel explanation for the failed anterior cruciate ligament healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.aanat.2019.04.002DOI Listing
July 2019

Comparison between Operative and Non-Operative Treatment of the Medial Collateral Ligament: Histological and Ultrastructural Findings during Early Healing in the Epiligament Tissue in a Rat Knee Model.

Cells Tissues Organs 2018 15;206(3):165-182. Epub 2019 Mar 15.

Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, Bulgaria.

The medial collateral ligament of the knee joint is one of the most commonly injured ligaments of the knee. Recent data have shown that the thin layer of connective tissue covering the ligament, known as the epiligament, is essential for its nutrition and normal function, as well as its healing after injury. The aim of the present study was to investigate and compare the changes in the epiligament of the medial collateral ligament which occurred during operative and non-operative treatment throughout the first month after injury. We used 27 male Wistar rats randomly allocated to three groups. In the 9 rats belonging to the first group, the medial collateral ligament was fully transected and left to heal spontaneously without suture. In the 9 rats belonging to the second group, the transected ends were marked with a 9-0 nylon monofilament suture. The 9 rats in the third group were used as normal controls. Three animals from each group were sacrificed on days 8, 16, and 30 after injury. Light microscopic analysis was performed on semi-thin sections stained with 1% methylene blue, azure II, and basic fuchsin. Transmission electron microscopy was used to study and compare the ultrastructural changes in the epiligament. The statistical analysis of the obtained data was performed using the Kruskal-Wallis H test and Mood's median test. The normal structure of the epiligament of the medial collateral ligament was presented by fibroblasts, fibrocytes, adipose cells, mast cells, collagen fibers, and neuro-vascular bundles. On days 8 and 16 postinjury, the epiligament appeared hypercellular and returned to its normal appearance on the thirtieth day postinjury. The electron microscopic study revealed the presence of different types of fibroblasts with the typical ultrastructural features of collagen-synthetizing cells. The comparative statistical analysis on the respective day showed that there was no statistically significant difference in the number of cells between spontaneously healing animals and animals recovering with suture application. These data further prove that spontaneous healing of the medial collateral ligament yields similar results to surgical treatment and may be used as a basis for the development of treatment regimens with improved patient outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000496985DOI Listing
September 2019

Correction: Epiligament Tissue of the Medial Collateral Ligament in Rat Knee Joint: Ultrastructural Study.

Cureus 2019 03 7;11(3):c19. Epub 2019 Mar 7.

Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR.

[This corrects the article DOI: 10.7759/cureus.3812.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.c19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405240PMC
March 2019

Epiligament Tissue of the Medial Collateral Ligament in Rat Knee Joint: Ultrastructural Study.

Cureus 2019 Jan 2;11(1):e3812. Epub 2019 Jan 2.

Orthopaedics, Medical University of Sofia, Sofia, BGR.

Introduction Recent studies stressed the importance of the epiligament in ligament nutrition and healing. While ligaments of the knee joint have been the subject of extensive research, the epiligament of the medial collateral ligament has received only limited attention. The aim of our study was to present the ultrastructural morphological features of the epiligament of the medial collateral ligament in a rat knee joint. Materials and methods For the present study, we used eight eight-month-old male Wistar rats. A transmission electron microscopic study of the epiligament was conducted according to standard protocol. Results In the epiligament, we described the presence of fibroblasts with the typical features of protein-synthesizing cells, as well as fibrocytes and adipocytes. We noted an abundance of blood vessels and nerve elements. Collagen fibers were organized in multidirectional bundles. Conclusions Our findings confirm that the cells and structures of the epiligament play an important role in the nutrition and healing of the medial collateral ligament.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.3812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402729PMC
January 2019

Ultrastructure of the dorsal claustrum in cat. II. Synaptic organization.

Acta Histochem 2019 May 4;121(4):383-391. Epub 2019 Mar 4.

Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria.

The claustrum is a bilateral subcortical nucleus situated between the insular cortex and the striatum in the brain of all mammals. It consists of two embryologically distinct subdivisions - dorsal and ventral claustrum. The claustrum has high connectivity with various areas of the cortex, subcortical and allocortical structures. It has long been suggested that the various claustral connections have different types of synaptic contacts at the claustral neurons. However, to the best of our knowledge, the literature data on the ultrastructural organization of the different types of synaptic contacts in the dorsal claustrum are very few. Therefore, the aim of our study was to observe and describe the synaptic organization of the dorsal claustrum in the cat. We used a total of 10 adult male cats and conducted an ultrastructural study under a transmission electron microscope as per established protocol. We described a multitude of dendritic spines, which were subdivided into two types - with and without foot processes. Based on the size and shape of the terminal boutons, the quantity and distribution of vesicles and the characteristic features of the active synaptic zone, we described six types of synaptic boutons, most of which formed asymmetrical synaptic contacts. Furthermore, we reported the presence of axo-dendritic, axo-somatic, dendro-dendritic and axo-axonal synapses. The former two likely represent the morphological substrate of the corticoclaustral pathway, while the remaining two types have the ultrastructural features of inhibitory synapses, likely forming a local inhibitory circuit in the claustrum. In conclusion, the present study shares new information about the neuropil of the claustrum and proposes a systematic classification of the types of synaptic boutons and contacts observed in the dorsal claustrum of the cat, thus supporting its key and complex role as a structure integrating various information within the brain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acthis.2019.02.009DOI Listing
May 2019
-->