Anatomical Construction Research Articles

Introduction and adaptive capacity of pittosporum tenuifolium gaertn. in conditions of protected soil

The aim of the research – to study the complex of biological parameters and physiological specificity of plants of P. tenuifolium Gaertn variety as criteria of their adaptive possibilities under new conditions. Many researchers considered problems of adaptation under conditions of industrial interiors of separate varieties and groups of plants. Information, concerning the adaptive potential of varieties of Pittosporum genus is very limited. There are only brief reports about biological peculiarities of separate varieties of the genus under conditions of introduction (Tumak, Palamar 2007; Bojko, 2015, 2016, 2018; Larsen, 1979; Tranguillini, 1964).As far as such studies for P. Tenuifolium variety are practically absent, problems of studying adaptive abilities of plants of this variety become especially urgent. In this connection plants of this variety were chosen as the object of the research. The phonological, comparative, morphological and anatomic research methods of were used in this work.According to the results of phonological observations, plants of Pittosporum tenuifolium variety demonstrated adaptive changes, characterized by the period of forced rest and variation of terms and duration of this period, conditioned by keeping conditions.The comparative analysis of morphometric parameters of a sprout and leaf of plants, growing in interiors with different microclimatic conditions, revealed morphological changes, manifested in rates of annual growth, number of young leaves and their sizes, internode length. The anatomic construction of a leaf demonstrated the thickness increase of the adaxial epidermis by 32,5 %; thickness decrease of a leaf by 8 %. There was established the unessential increase of palisade coefficient, accompanied by redistribution between spongy and columnar mesophyll to the latter side. Adaptation at the physiological-biochemical level was manifested by changes of the quantitative content of pigments and their ratios under conditions of industrial interior.Conclusions. The assessment of ecological-biological, morphological-anatomical and physiological peculiarities of plants of Pittosporum tenuifolium variety revealed adaptive changes, characterized by forced rest, variation of occurrence terms and duration of this period; morphological-anatomical changes in the sprout and leaf construction; change of the quantitative content of pigments and their ratios. The established changes favored the resistance increase of Pittosporum tenuifolium plants under changed keeping conditions

ЭПИДЕМИОЛОГИЯ ПЕРЕЛОМОВ СТЕНОК ОРБИТ. РЕТРОСПЕКТИВНОЕ ИССЛЕДОВАНИЕ

Midfacial fractures are presented by wide range of different patterns and severity. Orbital walls fractures have a special place in the structure of traumatic craniofacial injuries. Referring foreign authors, fractures of external rims and internal orbital walls are presented in more than 40 % of all bony injuries of facial skeleton. And referring Russian authors frequency of zygomaticomaxillary complex and isolated maxillary fractures presented by 12 and 8 % respectively. Furthermore complex anatomy of the orbit and proximity of the globe can occur some difficulties in diagnostics and treatment process of these patients. Today there are two main mechanisms of orbital walls fractures development – Blow-out, when fracture caused by increasing of intraorbital pressure, and Force-transmission, when force applied to external orbital rims transmits to a weaker orbital walls. Moreover in young patients Trapdoor mechanism is actual, which results in entrapment of soft tissues in the fracture line. Often there is an inferior rectus muscle entrapment and that is serious complication, when immediate surgery is required.
 The article deals with issues of anatomical construction of orbit and orbital trauma epidemiology based on statistics of neurosurgical department of Central city clinical hospital № 23, Yekaterinburg, for 2017.

Defining the anatomy of the neonatal lingual frenulum.

The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered "normal" lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal "band" or "string" and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824-835, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Measuring Patient-Reported Health-Related Quality of Life in Velopharyngeal Insufficiency: Reliability and Validity of the Brazilian Portuguese Version of the VELO Instrument.

To test the Brazilian Portuguese velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for reliability and validity. Cross-sectional methodological study. Tertiary craniofacial medical center. Participants with VPI (VPI group, n = 60), with cleft and without VPI (no VPI/cleft group, n = 60), and with no cleft nor VPI (no VPI/no cleft group, n = 60) and their parents (n = 180). All patients with VPI 8+ years old and their parents completed the Brazilian-Portuguese VELO instrument and other questionnaires (Pediatric Quality of Life Inventory4.0, PedsQL4.0; Pediatric Voice-Related Quality of Life, PVRQOL; and Intelligibility in Context Scale, ICS) at baseline; patients with VPI and their parents completed the VELO instrument again 2 weeks later. The VELO instrument was tested for internal consistency, test-retest reliability, discriminant validity (participants with VPI against participants with no VPI), concurrent validity against other questionnaires, criterion validity against hypernasality severity, and construct validity against nasal air emission and overall velopharyngeal competence (speech construct) and velopharyngeal gap (anatomic construct). The VELO had excellent internal consistency (Cronbach α 0.99 for parents and 0.98 for participants with VPI) and test-retest reliability (all intraclass correlation coefficient > 0.87). The VELO discriminated well between VPI group and unaffected groups (all P < .05). The VELO was significantly correlated with the PedsQL4.0, PVRQOL, and ICS (-r > 0.75; P < .001). The VELO met criterion validity, speech construct validity, and anatomic construct validity (r > 0.7; P < .001). The Brazilian-Portuguese VELO instrument demonstrated reliability (internal consistency and test-retest) and validity (discriminant, concurrent, criterion, and construct).

Tail Weaponry in Ankylosaurs and Glyptodonts: An Example of a Rare but Strongly Convergent Phenotype.

The unusual clubbed tails of glyptodonts among mammals and ankylosaurines among dinosaurs most likely functioned as weapons of intraspecific combat or interspecific defense and are characterized by stiffening of the distal tail and, in some taxa, expansion of the distal tail tip. Although similarities in tail weaponry have been noted as a potential example of convergent evolution, this hypothesis has not been tested quantitatively, particularly with metrics that can distinguish convergence from long-term stasis, assess the relative strength of convergence, and identify potential constraints in the appearance of traits during the stepwise, independent evolution of these structures. Using recently developed metrics of convergence within a phylomorphospace framework, we document that convergence accounts for over 80% of the morphological evolution in traits associated with tail weaponry in ankylosaurs and glyptodonts. In addition, we find that ankylosaurs and glyptodonts shared an independently derived, yet constrained progression of traits correlated with the presence of a tail club, including stiffening of the distal tail as a precedent to expansion of the tail tip in both clades. Despite differences in the anatomical construction of the tail club linked to lineage-specific historical contingency, these lineages experienced pronounced, quantifiable convergent evolution, supporting hypotheses of functional constraints and shared selective pressures on the evolution of these distinctive weapons. Anat Rec, 303:988-998, 2020. © 2019 Wiley Periodicals, Inc.

What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum.

Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in‐situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a “cord” or “submucosal band” of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in‐situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo‐documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm‐like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749–761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Application of "three lines and one plane" as anatomic landmarks in laparoscopic surgery for bile duct stones.

To investigate the clinical application ofthe “three lines and one plane” concept as the anatomic landmarks during laparoscopic common bile duct exploration (LCBDE).From January 2014 to February 2017, 148 cases of LCBDE performed in the General Surgery Department of the 2nd affiliated Hospital of Anhui Medical University were recruited, and analyzed in this study. “Three lines and one plane” was applied as anatomical landmarks during LCBDE, and the perioperative clinical outcomes were analyzed.No serious operational complications occurred in all the patients in this study. Two cases (1.4%) was converted to open operation. Two other cases (1.4%) suffered post-operative bile leakage and were cured by conservative treatment. All patients recovered uneventfully.Anatomical landmarks of “three lines and one plane” is benefit in helping surgeons to build a three-dimensional (3D) anatomical construction, and avoiding the operative injury of the bile duct, and vessels.

Elliptical Fourier descriptors of outline and morphological analysis in caudal view of foramen magnum of the tropical raccoon (Procyon cancrivorus) (Linnaeus, 1758)

To evaluate sexual-size dimorphism and attempt at categorization of inter-individual shapes of foramen magnum outlines using Fourier descriptors which allow for shape outline evaluations with a resultant specimen character definition. Individual characterization and quantification of foramen magnum shapes in direct caudal view based on elliptical Fourier technique was applied to 46 tropical raccoon skulls (26 females, 20 males). Incremental number of harmonics demonstrates morphological contributions of such descriptors with their relations to specific anatomical constructions established. The initial harmonics (1st to 3rd) described the general foramen shapes while the second (4th to 12th) demonstrated fine morphological details. Sexual-size dimorphism was observed in females (87.1%) and 91.7% in males, normalization of size produces 75% in females and 83% in males. With respect to foramen magnum dimorphism analysis, the result obtained through elliptic Fourier analysis was comparatively better in detail information of outline contours than earlier classical methods. The first four effective principal components defined 70.63% of its shape properties while the rest (22.51%) constituted fine details of morphology. Both size and shape seems important in sexual dimorphisms in this species, this investigation suggest clinical implications, taxonomic and anthropologic perspectives in foramen characterization magnum characterization and further postulates an increased possibility of volume reduction cerebellar protrusion, ontogenic magnum shape irregularities in the sample population with neurologic consequences especially among females.

Training in Flap Harvesting using Corrosion Casted Pig Latissimus Dorsi Muscle Flaps Choosing the Optimal Plastic Compound for Corrosion Casting

Plastic compounds have been used for several decades to generate anatomical constructs for the training of new surgeons and medical students alike. The present study seeks to highlight the advantages and disadvantages of two different plastic compounds (Technovit 7143 and Epoxi BIODURÒE12) used to create corrosion casts of the vascular branching patterns in free muscle flaps. Porcine latissimus dorsi muscle free flaps were used in this study to create corrosion casts of their vascular branching tree by injecting the two different plastic compound into the main arterial supply. The casts generated by Epoxy BIODURÒ E12 have superior qualities compared to the casts injected with Technovit 7143, because the injection process is smoother at all branching levels, without dilation, strictures or intramuscular extravasation of the injectable plastic compound. The corrosion casts resulted from injecting Epoxy BIODURÒ E12 exhibit better elasticity and better resistance to mechanical handling compared to the ones injected with Technovit 7143.

The Use of 3D Prints to Compare the Efficacy of Three Different Calcaneal Osteotomies for the Correction of Heel Varus

Category: Hindfoot Introduction/Purpose: There are multiple surgical osteotomies described for the correction of heel varus. An adequately powered clinical comparison of these osteotomies has not been published. In this study we used 18 identical 3D prints of a patient with heel varus to compare the surgical correction obtained with a Dwyer, oblique or Z osteotomy. The adequately powered statistical results of this study quantify the unique advantages and limitations of these osteotomies. Methods: A CT scan of a patient with heel varus (16 degrees) from Charcot-Marie-Tooth disease was selected for 3D modeling. Eighteen identical 3D prints were created of an anatomical construct of the talus, calcaneus and cuboid. Coordinate frames were added to the talus and calcaneus to evaluate rotation. Six of the prints were CT scanned to establish baseline data measurements (Uncut Control Group). All 18 prints were then divided into 3 groups of 6 models each. A custom jig was used to precisely and accurately replicate a different osteotomy in each group( Dwyer, oblique or Z). A 1 cm wedge was removed from each osteotomy. Following the simulated surgeries, all 18 models were CT scanned using the same parameters as had been used for the uncut models. Anatomic and coordinate measurements were calculated using multiplanar reconstruction image processing. Coordinate measurements were established as the rotation of the calcaneal coordinate frame with respect to the talar coordinate frame. Results: A standard 1-way analysis (ANOVA) was performed on the initial data. Additionally, a Tukey Studentized Range test was run using the raw data to compare the uncut model, Dwyer, oblique and Z osteotomies for all variables that showed statistically significant differences using the ANOVA. Coronal angle correction (Figure 1): The overall ANOVA test is significant (p &lt; 0.001). Tukey post-hoc comparisons demonstrate that Z is significantly different from Oblique (mean difference = 8.8; 95pct CI [5.5,12.0]; p &lt; 0.001) and Dwyer (mean difference = 10.4; 95pct CI [7.1, 13.6]; p &lt; 0.001), but Oblique and Dwyer are not significantly different from each other (mean difference = 1.6; 95 pct CI [-1.6, 4.9]; p=0.422). Calcaneal shortening (Figure 2): The overall ANOVA test is significant (p &lt; 0.001). All group comparisons are significant except for the Z vs Uncut (p=0.919). Lateral translation (Figure 3): The overall ANOVA test is significant (p &lt; 0.001). All group comparisons are statistically significant from one another. Conclusion: The Z osteotomy provided significantly more correction in the coronal plane (varus/valgus), with no significant shortening of the calcaneus, compared to the Dwyer and oblique osteotomies. The Z osteotomy, however, produced much less correction than anticipated, with only 3 degrees of final heel valgus. The Dwyer and Oblique osteotomies remained in varus. None of the osteotomies provided more than 6mm lateral translation of the tuberosity. These results have significant application to the appropriate choice of a calcaneal osteotomy for heel varus.

Fascicular Ventricular Arrhythmias: Pathophysiologic Mechanisms, Anatomical Constructs, and Advances in Approaches to Management.

Ventricular arrhythmias involving the fascicular system may be seen in both structurally normal and abnormal hearts. Idiopathic fascicular ventricular tachycardia represents almost 10% to 15% of idiopathic ventricular tachycardia related to the left ventricle.1,2 Cohen et al3 and subsequently Zipes et al4 first described these arrhythmias in the 1970s as relatively narrow right bundle left axis arrhythmias that arose close to the posterior fascicle and could be induced with atrial pacing. Belhassen et al5 later described the responsiveness of these arrhythmias to verapamil. Although initial studies focused on arrhythmias related to the left posterior fascicle, it is possible for arrhythmias to arise from any portion of the fascicular system and in both structurally normal and abnormal hearts. Furthermore, when approaching the patient presenting with arrhythmias arising from the His-Purkinje system, it is important to consider the unique complexities related to mapping and ablation. In this review, we will focus on the mechanisms of such arrhythmias, relevant embryology, anatomy and physiology, and approaches to management in both the presence and absence of other structural heart disease. Broadly, fascicular ventricular tachycardia in the absence of other structural heart disease will be termed idiopathic fascicular ventricular tachycardia (IFVT), whereas that related to structural disease will be discussed in the context of the relevant disease state. Generally, IFVT is separated into 3 types—left posterior fascicular with a right bundle branch block pattern and left axis deviation, left anterior with a right bundle branch block and right axis deviation pattern, and left upper septal fascicular with a narrow QRS and normal axis but often with a right bundle branch block morphology. There are rare reported cases of left bundle branch block pattern, V3–V4 transition IFVT with a normal axis arising from the right bundle branch. In …

SP 10. Innsbruck experience in neuropathic pain syndromes: Re-think and re-construct old methods for better results

Introduction In the last 25 years neuromodulation by deep brain stimulation gained widely acceptance starting in the field of movement disorders and getting further indications in pain syndroms and mood disorders. Surgical interventions should only be considered being a treatment option after proving ineffectiveness of conservative therapy forms. The highly acclaimed success of deep brain stimulation in Parkinsons disease, essential tremor, dystonia, chorea huntington, tourette syndrome, cannot be translated 1:1 to neuropathic pain syndromes. The EFNS guidelines on neurostimulation therapy for neuropathic pain published in the European Journal of Neurology 2007; 14: 952–970 revealed DBS against pain to be less effective than in movement disorders. The publication identified several reviews and one meta-analysis, which conclude that DBS is more effective for nociceptive pain than for neuropathic pain (63% vs. 47% long-term success). In patients with neuropathic pain, moderately higher rates of success were seen in patients with peripheral lesions. Because neuropathic pain syndromes are a complex compilation of missing information in different pathways to and within the brain resulting in the different aspects of pain consisting of sensation, perception, mood, emotion and vegetative aspects. Material and methods We will demonstrate different neuropathic pain syndromes following neurosurgical stereotactic interventions for neuromodulation. We were able to enhance the reduced input to the consciousness of man and women by modulation of the two main input areas namely the sensory thalamus and the posterior limp of the internal capsule. We modified the implantation site in the internal capsule because of ineffectiveness of the historical target and an anatomical chaos in the literature on the anatomical construction of the posterior limp of the internal capsule. By doing so we are able to cover all essential afferent fibers to the sensori-motor and the parietal cortex. In comparison to all other methods or other implantation centers a minimum of 2 stimulation electrodes have to be implanted per cerebral hemisphere. 30 patients were treated by neuromodulation against neuropathic pain syndromes. Without motor cortex stimulation and deep brain stimulation against cluster headache we operated 18 patients against neuropathic pain syndromes with our two electrode method. 6 trigeminal neuropathia (5 analgesia dolorosa) patients, 4 peripheral nerve injury patients and 8 post stroke patients. Results All patients had at least 60% up to 100% pain reduction. Some patients developed a decrease of the stimulation effect by “overstimulation”. Intermittent stimulation and our method of intensity modulation is able to reduce habituation of stimulation effects. The anterior cingulate gyrus stimulation according to T. Aziz will complete the armentarium of deep brain stimulation against neuropathic pain syndromes. Prospective randomized double blind studies in neuromodulation against neuropathic pain are still missing and will be conducted in the near future.

Cerebellar fastigial nucleus: from anatomic construction to physiological functions.

Fastigial nucleus (FN) is the phylogenetically oldest nucleus in the cerebellum, a classical subcortical motor coordinator. As one of the ultimate integration stations and outputs of the spinocerebellum, the FN holds a key position in the axial, proximal and ocular motor control by projecting to the medial descending systems and eye movement related nuclei. Furthermore, through topographic connections with extensive nonmotor systems, including visceral related nuclei in the brainstem, hypothalamus, as well as the limbic system, FN has also been implicated in regulation of various nonsomatic functions, such as feeding, cardiovascular and respiratory, defecation and micturition, immune, as well as emotional activities. In clinic, FN lesion or dysfunction results in motor deficits including spinocerebellar ataxias, and nonmotor symptoms. In this review, we summarize the cytoarchitecture, anatomic afferent and efferent connections, as well as the motor and nonmotor functions of the FN and the related diseases and disorders. We suggest that by bridging the motor and nonmotor systems, the cerebellar FN may help to integrate somatic motor and nonsomatic functions and consequently contribute to generate a coordinated response to internal and external environments.

Antigen sampling in the fish intestine

Antigen uptake in the gastrointestinal tract may induce tolerance, lead to an immune response and also to infection. In mammals, most pathogens gain access to the host though the gastrointestinal tract, and in fish as well, this route seems to be of significant importance. The epithelial surface faces a considerable challenge, functioning both as a barrier towards the external milieu but simultaneously being the site of absorption of nutrients and fluids. The mechanisms allowing antigen uptake over the epithelial barrier play a central role for maintaining the intestinal homeostasis and regulate appropriate immune responses. Such uptake has been widely studied in mammals, but also in fish, a number of experiments have been reported, seeking to reveal cells and mechanisms involved in antigen sampling. In this paper, we review these studies in addition to addressing our current knowledge of the intestinal barrier in fish and its anatomical construction.

Outlines and Outcomes of Instrumented Posterior Fusion in the Pediatric Cervical Spine: A Review Article

Context: The most common source of cervical spine arthrodesis in the pediatric populace is the instability related to congenital or traumatic damage. Surgery of cervical spine can be challenging given slighter anatomical constructions, fewer hardened bone, and upcoming growth potential and growth. Evidence Acquisition: Trainings in adult patients recommended that consuming screw constructs results in enhanced consequences with inferior amounts of instrumentation catastrophe. But, the pediatric literature is inadequate for minor retrospective series. Authors reviewed the existing pediatric cervical spine arthrodesis literature. They studied 184 abstracts from January 1976 to December 2014. An entire of 883 patients in 82 articles were involved in the evaluation. Patients were characterized as taking either posterior cervical fusion with wiring or posterior cervical fusion with screws or occipitocervical fusion. Results: The etiologies faced most frequently were inherited abnormalities (54%) shadowed by trauma (28%), Down syndrome (8%), and infectious, oncological, iatrogenic, or mixed causes (10%). The mean duration of follow-up was 32.5 months. Conclusions: The consequences of this training are restricted by deviations in construct policy, usage of orthoses, follow-up period and fresher adjuvant produces stimulating fusions. But, a literature review recommend that instrumentation of the cervical spine in children may be harmless and more effective than using screw concepts rather than wiring methods.

뇌졸중 환자에서 재발성 턱관절 탈구의 관리 : 증례보고

Temporomandibular joint dislocation causes considerable pain, discomfort, and swelling. The anatomic construction of the articular fossa and the eminentia articularis may predispose to dislocation, and weakness of the connective tissue forming the capsule is believed to be a predisposing factor. The capsule may be stretched and, more rarely, torn. Dislocation may be unilateral or bilateral and may occur spontaneously after stretching of the mouth to its extreme open position, such as during a yawn or during a routine dental operation. Manual reduction with the patient under muscle-relaxing condition or anesthesia is recommended method. After the reduction of an acute dislocation, immobilization of the jaw is recommended to allow the stretched and sometimes torn capsule to heal, thus preventing recurrence. A Barton's bandage may be applied for 2 to 3 weeks to prevent the patient from opening the jaw too wide. But, it results in recurrent dislocation in the neurologically disabled patient, because of loose intermaxillary fixation. This is a case report about management of recurrent temporomandibular joint dislocation by multiple loop wirings and intermaxillary elastics in cerebrovascular accident patient.

Reply to: What Causes Late Perforation of the Jejuno-jejunal Anastomosis After Roux-en-Y Gastric Bypass Surgery?

The authors report a case of late jejuno-jejunal (JJ) anastomotic perforation 11 months following Roux-enY gastric bypass. As they correctly state, this is a rare phenomenon, occurring in less than 1 % of cases. It is therefore sporadically reported. It is possible, though unlikely, that it is an under-reported event. Being such a rare occurrence, it is difficult, if not impossible, to draw meaningful conclusions as to its cause, and all attempts are purely speculative. Common general surgical practice teaches us that small to small bowel anastomoses are among the safest of possible intestinal connections. This is due to the excellent small intestinal blood supply, the anatomic construct of the small bowel wall, and ample mobility, preventing tension. They are therefore not prone to perforate late in the postoperative course, and this is true in bariatric surgery as well. As to the second question posed—in any of the cases reported—ulceration (ischemic or other) was not mentioned as the root of the perforation. Ischemia, as the cause of anastomotic breakdown, occurs within 5– 10 days and not a likely cause in the late phase. Mesenteric events, thromboembolic or low-flow related, may happen anywhere along the small bowel, but would not Btarget^ the JJ site. Again, in all reported cases, mesenteric ischemia was not implied. The change in gut flora following bariatric surgery has been recently implied as a possible contributory mechanism for the metabolic effect of these procedures. There is indeed a Bshift^ of the gut microbiota from an Bobese^ to a Blean^ distribution. It is doubtful that this change could be the cause of late JJ perforation. To conclude, late perforation of the JJ anastomosis is a very rare complication. No specific cause or risk factor has yet been found, but awareness of this potentially lethal complication is important to both bariatric and general surgeons.

Effect of excessive body weight on foot arch changes in preschoolers a 2-year follow-up study.

A stable standing posture, and effective and aesthetic gait, depend heavily on correct anatomical construction of the feet, thanks to which they can play their important role. The shape and height of the foot arches are already formed in the preschool and early school years; therefore, abnormalities and disorders in children's feet, and correlations between foot formation and somatic build, are still crucial and interesting issues for orthopedists, pediatricians, physiotherapists, and podiatrists. This study deals with changes in the height of the longitudinal and transverse arches of the foot in 4- to 6-year-old children. A total of 102 boys and 105 girls took part in a 24-month study in which their body weight, height, body mass index, and Clarke's and gamma angles were measured. The analysis also focused on correlations among sex, nutritional status, and changes in foot arch height. It was discovered that sex did not considerably affect Clarke's and gamma angle values. However, it was found that between ages 4 and 6 years, the proportion of overweight and obese boys and girls increased, and the medial longitudinal arch of the foot had a tendency to collapse in those with excessive body weight. The effect of nutritional status on the transverse arch of the foot is rather dubious. In light of these findings, therapeutic programs for preventing foot deformities in children should also focus on body weight control.

Basket-Weave Technique for Medial Patellofemoral Ligament Reconstruction

The anatomy of the medial patellofemoral ligament (MPFL) has been well defined, with parts of its uppermost fibers having a soft-tissue insertion onto the vastus intermedius. Bone tunnels and implants on the patellar side therefore cannot replicate this anatomic construct precisely. Because of implants and tunnels, complications have been reported with bone tunnel fracture. Similarly, on the femoral side, rigid fixation with implants can result in over-constraint with compromised results. Moreover, bone tunnels cannot be used in skeletally immature cases. To overcome issues related to bone tunneling and implants, as well as to reconstruct the MPFL in a precise anatomic manner, an all–soft-tissue fixation technique was devised. Bony landmarks were used as reference points instead of radiologic markers to achieve a more precise construct and to eliminate intraoperative radiography. Hamstring graft was used to reconstruct the MPFL. Special suturing techniques were used to achieve optimal graft fixation with minimal suture knots. A special tissue elevator–suture passer device was designed to facilitate graft passage and ease in performing the procedure. This technique permits differential tensioning, and therefore one achieves stability throughout the range of motion.

Image Processing in Radiation Therapy

This article reviews Image Processing in Radiation Therapy by Kristy Brock Editor: Series Editor: William R. Hendee , Boca Raton, FL, 2013. Hardcover 286 pp. Price: $103.96. ISBN: 9781439830178.