Anatomical Preservation Research Articles

Intraoperative cone-beam and slot-beam CT: 3D image quality and dose with a slot collimator on the O-arm imaging system.

To characterize the 3D imaging performance and radiation dose for a prototype slot-beam configuration on an intraoperative O-arm™ Surgical Imaging System (Medtronic Inc., Littleton, MA) and identify potential improvements in soft-tissue image quality for surgical interventions. A slot collimator was integrated with the O-arm™ system for slot-beam axial CT. The collimator can be automatically actuated to provide 1.2° slot-beam longitudinal collimation. Cone-beam and slot-beam configurations were investigated with and without an antiscatter grid (12:1 grid ratio, 60 lines/cm). Dose, scatter, image noise, and soft-tissue contrast resolution were evaluated in quantitative phantoms for head and body configurations over a range of exposure levels (beam energy and mAs), with reconstruction performed via filtered-backprojection. Qualitative imaging performance across various anatomical sites and imaging tasks was assessed with anthropomorphic head, abdomen, and pelvis phantoms. The dose for a slot-beam scan varied from 0.02-0.06 mGy/mAs for head protocols to 0.01-0.03 mGy/mAs for body protocols, yielding dose reduction by ∼1/5 to 1/3 compared to cone-beam, owing to beam collimation and reduced x-ray scatter. The slot-beam provided an ∼6-7× reduction in scatter-to-primary ratio (SPR) compared to the cone-beam, yielding SPR ∼20-80% for head and body without the grid and ∼7-30% with the grid. Compared to cone-beam scans at equivalent dose, slot-beam images exhibited an ∼2.5× increase in soft-tissue contrast-to-noise ratio (CNR) for both grid and gridless configurations. For slot-beam scans, a further ∼10-30% improvement in CNR was achieved when the grid was removed. Slot-beam imaging could benefit certain interventional scenarios in which improved visualization of soft tissues is required within a fairly narrow longitudinal region of interest ( 7mm in )--for example, checking the completeness of tumor resection, preservation of adjacent anatomy, or detection of complications (e.g., hemorrhage). While preserving existing capabilities for fluoroscopy and cone-beam CT, slot-beam scanning could enhance the utility of intraoperative imaging and provide a useful mode for safety and validation checks in image-guided surgery. The 3D imaging performance and dose of a prototype slot-beam CT configuration on the O-arm™ system was investigated. Substantial improvements in soft-tissue image quality and reduction in radiation dose are evident with the slot-beam configuration due to reduced x-ray scatter.

Radiotherapy as nose preservation treatment strategy for cancer of the nasal vestibule: The Dutch experience

Background and purposePrimary radiotherapy is often preferred for early-stage cancer of the nasal vestibule (CNV), combining high disease control with preservation of nasal anatomy. However, due to practice variation and an absence of comparative trials, no consensus exists on preference for brachytherapy (BT) or external beam radiotherapy (EBRT). We compared these modalities in terms of disease control, nose preservation rates and toxicity. Materials and methodsMedical records of 225 patients with T1-T2 squamous cell carcinoma of the nasal vestibule treated with 3D image-guided primary radiotherapy between Jan 2010 and Dec 2016 in 6 Dutch institutions were reviewed retrospectively. Results153 of 225 patients were treated with BT, 65 with EBRT and 7 with other modalities. Median follow-up was 46 months. Overall 3-year local control (LC) and regional control (RC) were 87% and 89%. Five-year disease-specific survival (DSS) and overall survival (OS) were 94% and 82%. Three-year survival with preserved nose (SPN) was 76%.BT provided higher 3-year LC (95% vs 71%, p < 0.01) and SPN compared with EBRT (82% vs 61%, p < 0.01). Multivariable and propensity-score-matched cohort analyses confirmed better outcomes after BT. No difference was seen in DSS or OS. Five-year incidence of CTCAE 5.0 grade ≥2 toxicity was higher after BT (20% vs 3%, p = 0.03) and consisted mostly of radiation ulcers. 50% of all late toxicity recovered. ConclusionIn this largest-to-date multicenter analysis of T1-T2 CNV, BT achieved superior LC and SPN compared with EBRT. Grade 1–2 radiation ulcers occurred more frequently after brachytherapy, but were transient in half the cases. Considering these results, BT can be recommended as first-line treatment for T1-T2 CNV.

V13-05 NERVE-SPARING ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL NEOBLADDER IN MALE PATIENTS: SURGICAL TECHNIQUE, PERIOPERATIVE, ONCOLOGIC AND FUNCTIONAL OUTCOMES OF A SINGLE CENTER SERIES

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-05 NERVE-SPARING ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL NEOBLADDER IN MALE PATIENTS: SURGICAL TECHNIQUE, PERIOPERATIVE, ONCOLOGIC AND FUNCTIONAL OUTCOMES OF A SINGLE CENTER SERIES Gabriele Tuderti, Riccardo Mastroianni, Aldo Brassetti, Umberto Anceschi, Alfredo Maria Bove, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Gabriele TudertiGabriele Tuderti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We reported surgical technique, perioperative, oncologic and functional outcomes of our series of Nerve-sparing Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (iN) in male. METHODS: Prospectively maintained IRB approved bladder cancer database was queried for “male”, “RARC”, “iN” and “Nerve-sparing”. Inclusion criteria were: organ confined disease, without involvement of prostate, prostatic urethra or bladder neck, and strong motivation to preserve sexual function. Key surgical steps are: isolation of the ureters; preparation of Douglas space and athermal isolation of seminal vesicles; development of posterior intrafascial dissection plane, endopelvic fascia incision and antegrade intrafascial dissection of neurovascular bundles up to prostatic apex; assessment of distal ureter vascularity before and after LND with near-infrared fluorescence imaging. Hypogastric and presacral nodes were not involved in the dissection to avoid any injury to the pelvic plexus. Finally, intracorporeal Padua ileal neobladder was performed. Baseline demographic, clinical, perioperative, oncologic and functional data were reported. RESULTS: Overall, 17 pts underwent nerve sparing RARC with iN between February 2017 and January 2020. Median age was 55 yrs, median operative time was 315 mins, median hospital stay was 8 days. Low grade Clavien complications occurred in 5 patients (29.4%), while high grade complications were not observed. An organ-confined disease was detected in 64.7%, with 1 case of nodal involvement. Positive surgical margins were not detected. At a median follow-up of 21 months, DFS, CSS and OS were 82.3%, 94.1% and 94.1%, respectively; 1 patient had metastatic spread and died of disease. Median last eGFR was 73 ml/min, with one case of new onset of CKD stage 3b. One-yr day- and night-time continence recovery probabilities were 100% and 80.1%, respectively. Erectile function returned to normal, defined as IIEF-5 score ≥ 17, in 76.4 % of pts, with a median Post-operative IIEF-5 score of 21. CONCLUSIONS: In select population, nerve-sparing RARC-iN can be offered to male patients motivated to preserve erectile function, as an oncologically safe procedure, associated with favorable functional outcomes. As during robotic radical prostatectomy, a meticulous anatomical preservation of neurovascular bundles provides a quicker recovery of functional outcomes, both in terms of urinary continence and erectile function. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1079-e1079 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti More articles by this author Riccardo Mastroianni More articles by this author Aldo Brassetti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement Loading ...

Variations in Morphology and Anatomy of Breadfruit (Artocarpus altilis) Based on Differences in Altitude

Background: Breadfruit [Artocarpus altilis (Parkinson ex F.A.Zorn) Fosberg] is a versatile plant that can be used by humans. Breadfruit has morphological variations that are thought to be related to anatomical variations that are formed as an adaptation mechanism to survive in a different area. This plant has the ability to live in different altitude ranges, from coastal areas to upland areas. This research was conducted for eight months in areas with altitude ranges of &lt;350 masl, 350-700 masl, and &gt;700 masl in Banyumas, Purbalingga, and Cilacap Regencies. Sampling of plants was carried out randomly selected (purposive random sampling), then described their morphological characteristics. Furthermore, the leaves are made for anatomical preservation to determine the anatomical character. Breadfruit plants that grow at an altitude of less than 350 m above sea level have the characteristics of a higher, larger diameter stem, have a tighter branching, more sap production, a higher number of fruit and have a larger fruit size. The anatomical characteristics of breadfruit plants that grow at an altitude of less than 350 masl have stomata characters that are wider and longer than those of 350-700 masl and &gt; 700 masl. The highest stomata and trichomata density at an altitude &gt; 700 masl. The highest mean cuticle thickness, epidermis, palisade ratio and mesophyll thickness were highest in breadfruit leaves at altitudes &lt;350 masl.

An Innovative Palatoplasty for Primary Cleft Palate Repair

Summary: Many surgical techniques have been developed to restore function in patients with cleft palate. Despite the development of many surgical techniques for primary cleft palate repair there is no standard procedure that ensures palatal function as that in normal children. Furlow’s and intravelar veloplasty are the most common methods for velar repair in patients with cleft palate; however, some limitations have been described by different authors. The objective of this study was to present an innovative method for primary cleft palate repair that addresses the shortcomings of conventional methods. Since 2017, 88 consecutive patients with nonsyndromic unilateral cleft palate have undergone primary anatomical repair of palatal deformity using this technique. This method combines nasal mucosa Z plasty and muscular overlapping with the use of one hemiuvula for uvular repair (unilateral uvuloplasty). The nasal mucosa Z plasty produces velar lengthening by transposition of nasal mucosa and myomucosal flaps. The unilateral uvuloplasty reduces anatomically the velopharyngeal gap and increases the velar length, thus reducing velopharyngeal distance. This innovative palatoplasty, achieves proper anatomical and functional reconstruction of the repaired palate. Only four patients (4.54%) developed mild or severe hypernasality and one patient (1.13%) had postoperative palatal fistula in this group of patients. This innovative technique results in low rates of nondesirable outcomes, improving limitations of conventional methods. Reduced oral mucosa incisions, limited velar muscle dissection, and preservation of the tensor veli palatini anatomy are some of the benefits of this technique.

Paraspinal muscle damage in intermuscular and conventional lumbar spinal fixation: A comparative study

BackgroundThe conventional approach for lumbar fixation involves subperiosteal muscle dissection, and disruption of normal blood and nerve supply of the back muscles. Different transmuscular approaches, have been described for better preservation of normal neurovascular structures. This leads to less muscle damage and atrophy and consequently less postoperative pain. PurposeCompare between transmuscular approach and conventional approach for lumbar spine fixation. Study DesignA prospective comparative study carried at Neurosurgery Department, Zagazig University, during the period from February 2018 to February 2019. Patients and methods60 patients with degenerative lumbar instability were included in this study and randomly assigned to one of the two groups, Group A (transmuscular group) and Group B (conventional group). Outcome was assessed, using postoperative Visual Analogue Score (VAS) for back pain, change in pre and postoperative levels of Creatine Phospho-Kinase (CPK), and the postoperative change in the cross-sectional area of multifidus muscle, measured using axial CT cuts. ResultsAs regards the hospital stay, it was 1.5 days less in Group A than Group B (P<0.001). The serum CPK increased by only 3 folds in Group A in comparison to 15 folds increase in Group B, indicating less muscle damage (P<0.001). Postoperative Visual Analogue Scale (VAS) for back pain was higher in Group B than Group A (P<0.001). Decrease in cross-sectional muscle area in Group B (40%) was more than the decrease in cross-sectional area in Group A (10%), (P<0.001), which means more muscle atrophy in Group B than in Group A. ConclusionUsing the transmuscular approach for lumbar spine fixation is a more conservative approach, than the conventional approach, with less muscle atrophy, better preservation of anatomy, and less postoperative pain.

Outcome of Surgery of Vestibular Schwannomas in a Tertiary Care Hospital in Bangladesh

Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. Methods: Seventy patients presented with VS who had undergone operative procedures performed in our unit from 2017 to 2019. The facial nerve function and hearing assessment was done according to House-Brackmann [HB] grading and pure tone audiometry (PTA) respectively. All patients were operated by retro-mastoid suboccipital approach. Results: Most patients had large tumors and had no useful hearing (85%), had disabling cerebellar ataxia (92.86%) and presented with features of raised intracranial pressure (48.57%). Large sized tumors were in 32.86% and giant sized tumors were in 57.14% cases. Complete tumor excision was carried out 92.86% and anatomical preservation of facial nerve was achieved in 73.85% cases. Hearing preservation was achieved in 4 patients. Cerebrospinal fluid leak with or without meningitis and transient lower cranial nerve paresis were common complications. The mortality rate was 7.14%. Conclusions: Complete tumor excision with good facial nerve preservation can be achieved in large vestibular schwannomas. Hearing preservation is difficult in larger tumors. Primary microsurgical resection is an appropriate management option for large VS. In our experience, this goal can be achieved safely and successfully by using the retrosigmoid approach. Bang. J Neurosurgery 2021; 10(2): 175-181

Tricky Diagnosis and Robot-laparoscopic Surgical Approach to Disseminated Peritoneal Leiomyomatosis

To show the challenging diagnosis of, and safe robotic surgical approach to, a rare case of disseminated peritoneal leiomyomatosis (DPL). A clinical case shown by a sequential demonstration of investigation, diagnosis, and surgical approach, with narrated video footage. DPL is a rare disease, with only a little more than 150 cases reported in the literature [1]. It is defined by subperitoneal proliferation of benign smooth muscle cell nodules, macroscopically mimicking peritoneal carcinomatosis [2]. The etiology remains unclear, but different hypotheses have been put forward, such as subperitoneal mesenchymal stem cell metaplasia and iatrogenic origin after myomectomy [3]. Despite its usual benign behavior, DPL can rarely present with malignant degeneration, and therefore a complete resection of multiple lesions is recommended [4]. This case involves a 45-year-old patient presenting with dysmenorrhea, abdominal pain, and major abnormal uterine bleeding, requiring previous blood transfusion and no response after 2 years of clinical treatment. She had a previous cesarean delivery, with no reproductive desire at present and no history of other pelvic surgeries. Pelvic examination showed an enlarged mobile uterus at the height of the pubic symphysis, and both ultrasonography and magnetic resonance imaging confirmed an enlarged uterus due to multiple myomas. (1) Diagnostic laparoscopy with implant biopsies and uterine curettage for investigation of DPL and its differential diagnoses, followed by robot-assisted laparoscopic approach, with key strategies for a safe performance. (2) Radical hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and wide pelvic peritoneal resection were performed. (3) For this complex procedure, the identification and preservation of important landmarks and pelvic anatomy were mandatory, as well as removal of all surgical specimens in monobloc. Final pathology report: disseminated leiomyomatosis with no evidence of malignancy. The patient had no complications after surgery and was discharged on the second postoperative day with mild abdominal pain. DPL diagnosis can be tricky owing to its macroscopic similarity to peritoneal carcinomatosis and the difficulty of identification in imaging examinations. Moreover, the robotic platform can be a helpful and safe tool for the surgical treatment of DPL and complete resection of all peritoneal lesions.

Arthroscopic Distal Tibial Allograft Reconstruction for Anterior Shoulder Instability

Arthroscopic distal tibial allograft (DTA) reconstruction has recently gained attention for treatment of anterior shoulder instability. Glenoid grafting using the DTA confers more anatomic glenoid reconstruction and recent studies have shown good clinical outcomes similar to the Latarjet procedure, and with negligible complication rates. Patient profile and glenoid assessment using computed tomography (CT) reconstruction images are most important in selecting eligible patients. The inherent advantages of anatomic arthroscopic glenoid reconstruction (AAGR) are: the safety profile of this technique, the quick learning curve, the preservation of subscapularis anatomy and the absence of donor site morbidity. There are no major adverse events reported with arthroscopic DTA. However, graft availability and cost remain a limitation to this graft option. The current chapter describes the surgical technique for AAGR using a distal tibia allograft.

Stem diversity of the marattialean tree fern family Psaroniaceae from the earliest Permian Wuda Tuff Flora

This paper investigates the taxonomic diversity of marattialean stems from the family Psaroniaceae preserved in-situ within the Wuda Tuff Flora. Three species of the permineralized stem Psaronius and eight species of the compression/impression stem Caulopteris are documented, but it has not been possible to associate the anatomically preserved species with the compression/impression ones due to preservational limitations. The higher diversity of Caulopteris species may relate to anatomical features that could distinguish additional species of Psaronius not being preserved, or it may reflect the rarity of anatomical preservation in the flora limiting the available dataset and it is also possible that a “generalized” Psaronius anatomy was common to several stem species showing distinct leaf scars (Caulopteris) and distinct leaves (Pecopteris). The eight species of Caulopteris recorded are very close to the previously reported diversity of nine species of the vegetative leaf Pecopteris from the Wuda flora, which also indicates a high diversity within the family. However, intraspecific variation makes the identification of species of Pecopteris and Caulopteris rather difficult, potentially inflating the taxonomic diversity of these genera. We show that Psaronius stems from the Wuda flora include one species from the Psaronius blicklei-group, one species that shares characters with both Psaronius blicklei and Psaronius panxianensis groups, and one species that shares characters with Psaronius blicklei-group but possesses a unique one different from both Psaronius blicklei and Psaronius panxianensis groups. These species appear to represent transitional forms evolved from the Carboniferous–Cisuralian (early Permian) Psaronius blicklei-group that are on the evolutionary lineage leading to the Lopingian (late Permian) Psaronius panxianensis-group. In addition, a single occurrence of a stem of Psaronius in organic attachment to a tri-pinnate frond of Pecopteris orientalis (Schenk) Pot. is documented, representing an important starting point for future Psaroniaceae whole-plant reconstructions within the Cathaysian flora.

Calcite-Mineralized Fossil Wood from Vancouver Island, British Columbia, Canada

Calcite-mineralized wood occurs in marine sedimentary rocks on Vancouver Island, British Columbia at sites that range in age from Early Cretaceous to Paleocene. These fossil woods commonly have excellent anatomical preservation that resulted from a permineralization process where calcite infiltrated buried wood under relatively gentle geochemical conditions. Wood specimens typically occur in calcareous concretions in feldspathic clastic sediment. Other concretions in the same outcrops that contain abundant mollusk and crustacea fossils are evidence that plant remains were fluvially transported into a marine basin. Fossiliferous concretions commonly show zoning, comprising an inner region of progressive precipitation where calcite cement developed as a concentric halo around the organic nucleus. An outer zone was produced by pervasive cementation, which was produced when calcite was simultaneously precipitated in pore spaces over the entire zone.

Trigger electromyography in endoscopic transnasal surgery of skull base tumors

Introduction . The development of minimally invasive technologies in recent decades has expanded the indications for the use of endoscopic transnasal transsphenoidal approaches in surgery of skull base tumors. It became possible to perform surgical interventions aimed at removing tumors of the base of the skull that spread to the area of the passage of cranial nerves (cavernous sinus, clival area, cerebello-pontine angle), which is associated with the risk of damage to certain cranial nerves. The study objective is to evaluate the effectiveness of trigger electromyography in providing anatomical and functional preservation of cranial nerves during endoscopic endonasal transsphenoidal removal of skull base tumors. Materials and methods . The study is based on statistical analysis and comparison of the results of surgical treatment of two groups of patients with various tumors of the base of the skull: the main group (30 patients with using trigger electromyography to identify cranial nerves intraoperatively) and the control group (43 patients without using this method). The effectiveness and safety of using the method of intraoperative identification of cranial nerves was evaluated based on a comparison of basic characteristics, treatment outcomes, and factors potentially affecting them. Results . Fifty-seven (57) cranial nerves were identified intraoperatively in the main group. The frequency of radical removal was 1.6 times higher in the main group (70 % vs 44.2 %, p = 0.03). When analyzing the dynamics of the state of motor cranial nerves after surgery in the main and control groups, it was shown that negative dynamics prevailed in the control group — 37.2 % vs 13.3 % (p = 0.03), and positive dynamics prevailed in the main group (37.3 % vs 13.9 %), 2.8 times (p = 0.08). Conclusion . The obtained data indicate that the use of the intraoperative identification method in endoscopic transnasal surgery of skull base tumors can positively affect the radical removal of tumors and the preservation of cranial nerve function in the postoperative period.

Results of operative management of radial head fractures by internal fixation and excision and conservative management: A study of 60 cases

Radial head fractures are the most frequent fracture type reported around the elbow. Fractures have been documented to occur in isolation or with other associated osseous and soft tissue injuries, with awareness for the potential patterns of injury essential in determining the appropriate management to attain restoration of elbow function. Radial head fractures are seen in 33% of elbow fractures. It may involve the radial head, radial neck or both. Treatment depends on the type of fracture, amount of displacement, comminution and associated injuries. Previously radial head excision was a popular treatment, now it is being replaced by open reduction and internal fixation or radial head replacement. The assessment of these common fractures and treatment have evolved with better understanding of the anatomy and biomechanics of radial head and the development of evidence based guidelines. Aim and Objective: To study the clinical and functional outcome of radial head fractures managed conservatively and by mean of internal fixation and by mean of radial head excision. Material and Methods: For prospective study Sample will be taken from the patients treated in P.D.U. Medical College and Hospital having radial head fracture on basis of plain radiograph and CT scan, classified according to Mason classification and treatment plan will be decided accordingly. Results will be assessed on basis of functional classification system at 1 month, 3 months and 6 months. Results: In Our study of 60 cases, 30 patients having a Mason type 1 variety radial head fractures treated conservatively by mean of plaster application and 26 patients of Mason type 2 radial head fracture treated by mean of open reduction and internal fixation and 4 patient of Mason type 3 radial head fracture treated by mean of excision. Out of all the patients treated by different modality 20% of patients present with stiffness of elbow joint and 2% of patients presented with infection. Conclusion: From our objective, functional assessment perspective open reduction internal fixation of radial head fracture when technically possible appears to be provide function superior to excision. Furthermore open reduction and internal fixation provides results similar to those obtained in less severe injuries where non-operative management is possible. Such improvement results from preservation of anatomy with maintenance of the normal load bearing characteristic of elbow joint.

SEVOFLURANE REQUIREMENT TO ATTENUATE STRESS RESPONSE TO PNEUMOPERITONEUM AND POST-OPERATIVE ANALGESIA DURING LAPAROSCOPIC CHOLECYSTECTOMY: INTRATHECAL DEXMEDETOMIDINE VS. FENTANYL. A PROSPECTIVE RANDOMISED STUDY

Background and aims: Laparoscopic cholecystectomy is considered as the gold standard for cholelithiasis with better preservation of surgical anatomy, early recovery and post-operative analgesia but haemodynamic instability due to pneumo-peritoneum is a concern. This study was contemplated to assess the effect of intrathecal dexmedetomidine or fentanyl on end-tidal inhalation agent concentration requirement as an indirect measure of haemodynamic stress response during the creation of pneumo-peritoneum and on post-operative analgesia. Methods: This prospective, randomized, comparative study was conducted in 75 ASA I and II patients with three groups of 25 each. The patients in group-1 received 10µg of intrathecal dexmedetomidine, group-2 50µg fentanyl and group-3 equal volume of normal saline before administration of general anesthesia. We assessed the vital parameters and end-tidal concentration of sevourane requirement before and 10minutes after creation and immediately after deation of pneumo-peritoneum. Post-operative pain scores were measured using Visual analogue scale(VAS) for 24hrs and rescue analgesia was 0.5µg/kg fentanyl in the immediate post-operative period and paracetamol 15mg/kg if the score was ≥4 in the post-operative period. Results: Demographic data were comparable in all the groups. Systolic blood pressure before onset of pneumo-peritoneum(P=0.03),endtidal inhalation agent concentration to maintain stable haemodynamics post-pneumoperitoneum were signicantly low(P=0.036) in group-1 as compared to group-3. Immediate bolus dose requirement of fentanyl after extubationwas signicantly low, and the duration of post-operative analgesia was prolonged(P=0.009) in group-1.Conclusion: Intrathecal dexmedetomidine may be a safe and effective method in alleviating haemodynamic stress response during pneumo-peritoneum and provides adequate post-operative analgesia in laparoscopic cholecystectomy.

Urethra-sparing minimally invasive simple prostatectomy: an old technique revisited.

The aim of this study was to review recent development in urethra and ejaculation preserving laparoscopic and robotic simple prostatectomy. Since Madigan prostatectomy original description in 1990, to recent reports of robotic-assisted surgery using this urethra-sparing technique, many studies have suggested the advantages of the preservation of urethra, bladder neck and ejaculatory ducts, when removing adenomatous tissue in benign prostatic obstruction (BPO) surgery. Allying anatomical preservation of this structure with the well known benefits of minimally invasive procedures seems to reduce postoperative haematuria, obviating the need for bladder irrigation, with shorter catheterization and hospitalization times, less risk of urethral stricture and, of utmost importance, reducing rates of retrograde ejaculation. Urethra and bladder neck sparing techniques, especially in minimally invasive simple prostatectomy procedures, seem to provide real benefits, not only in the maintenance of preoperative potency and antegrade ejaculation but also accomplishing better perioperative outcomes, with faster patient recovery, and less complications. These techniques might well be the future standard techniques for sexually active men with large benign prostatic hyperplasia (BPH) requiring surgery.

Anatomical preservation of silicified Corylites J.S.Gardner leaves from the Paleocene maar lake of Menat (Puy-de-Dôme, France)

Uhl D., Jasper A. & Wuttke M. 2020. — Anatomical preservation of silicified corylites J.S.Gardner leaves from the Paleocene maar lake of Menat (Puy-de-Dôme, France). geodiversitas 42 (26): 485-492. http://geodiversitas.com/42/26The late Paleocene fossil lagerstätte Menat in France is well known for its wealth of excellently preserved fossil plants and insects. Although the flora from this locality is regarded as characteristic for the late Thanetian in Western and Central Europe, there is a noteworthy lack of modern paleobotanical studies on this locality. The few existing studies on plant megafossils utilized only the gross morphology of leaves and carpological material for taxonomic questions, whereas anatomical data (i.e. from cuticles and permineralizations) have been completely neglected. The present study provides the first data on anatomically preserved internal tissues of leaves assigned to Corylites macquarrii (Forbes) Heer from this locality. Cell walls are preserved as silicates, whereas cell lumina are mostly empty. On occasion, cell lumina are filled with foam-like, porous silica. Anatomical preservation of these tissues is probably related to early diagenetic silicification of plant cell walls. Although at the moment nothing can be said about the source of the SiO2 it is likely that it is related to the volcanic origin of the Menat maar and/or volcanic activities in the vicinity of the lake during deposition of the sediments.

Electrical stimulation therapy of the lower esophageal sphincter in GERD patients—a prospective single-center study

Summary Background Electrical stimulation therapy (EST) of the lower esophageal sphincter (LES) for gastro esophageal reflux disease (GERD) treatment increases LES pressure through chronic stimulation, with a low risk for gastrointestinal side effects and preservation of hiatal anatomy. The aim of this study was to evaluate the efficacy and safety of this novel technique in a high-output specialized reflux center. Methods This is a prospective single-center study including GERD patients indicated for anti-reflux therapy who consented to undergo LES-EST. Patients underwent prospective scheduled follow-up visits including interrogation of the stimulation device, clinical examination, and assessment of health-related quality of life (HRQL). Results Within a 4-year period, 37 LES-EST implantations were performed. The majority of patients were male (54.1%), mean BMI was 25.8 (SD 4.4), and mean age was 54.0 (SD 15.8). The median GERD HRQL composite score was 41 (IQR 21–49). Median total % of pH &lt;4 was 10.1 (IQR 4.4–17.3). Six (16.2%) individuals underwent explantation of the entire system (IPG and leads) due to technical defect (n = 4) or failure of therapy (n = 2). HRQL score improved from 41 (IQR 21–49) to 8.50 (IQR 4.25–20.5, p &lt; 0.001) and 9 (23.7%) patients were on at least occasional PPI treatment. Conclusion Due to the low rate of GI side effects and its minimal invasive character preserving the hiatal anatomy, this novel technique might find its place in anti-reflux surgery. However, the considerably high rate of device dysfunction needs further investigation.

Glenohumeral Resurfacing in Young, Active Patients With End-Stage Osteoarthritis of the Shoulder

Treatment of end-stage glenohumeral arthritis in young patients is a challenge; however, there is a lack of consensus on optimal treatment algorithms. A thorough history and physical examination are essential. Nonoperative treatments should first be attempted, whereas surgical options range from arthroscopic debridement to arthroplasty. One arthroplasty option is glenohumeral resurfacing with the objective of maintaining more native anatomy and bone stock. The described treatment includes a hemi-cap implant for the humerus and inlay polyethylene glenoid. While hemi-caps have been successfully used for decades, inlay glenoid implants are a more modern treatment, with the objective of less glenoid loosening, the typical complication and failure method in young patients. With the potential for greater longevity and preservation of anatomy, glenohumeral resurfacing for end-stage shoulder arthritis is an important treatment option to consider before total shoulder arthroplasty. This Technical Note describes resurfacing of the glenohumeral joint in a young, active patient presenting with extensive osteoarthritis on both the glenoid and humerus after a previous failed Trillat stabilization.

CALIBER-PERSISTENT LABIAL ARTERY: REPORT OF A CASE WITH EMPHASIS ON HISTOPATHOLOGIC FINDINGS

Caliber-persistent labial artery consists of an expanded part of the main branch of the labial artery that penetrates the submucosal tissue without loss of caliber. A 67-year-old woman presented a lesion on the upper lip, pulsating with no painful symptomatology, with implantation in the submucosa. The patient had no history of allergies and systemic diseases. At histopathologic analysis, a thick artery with a stenotic lumen was seen, where there was anatomic preservation of all structures. At the periphery of the adventitial layer, structures suggestive of primary and secondary lymphoid follicles with apparent formations of germinal centers were observed. Immunohistochemical staining for CD20, CD68, CD4, desmin, and CD34 was performed to confirm the structures suggestive of lymphoid follicles, and histochemical staining for Verhoeff was performed. The histopathologic and immunohistochemical findings escape the normality pattern, provoking discussions about what would they represent in the pathogenesis of this lesion.

Classification and surgical strategy of Work Ⅰ congenital first branchial cleft anomaly based on adjacent anatomy

Objective:To explore the adjacent anatomic relationship and classification of Work Ⅰ congenital first branchial cleft anomaly（CFBCA） in order to guide clinical practice. Method:The data of 48 cases of Work Ⅰ CFBCA with complete data were analyzed retrospectively. Result:All 48 lesions were completely resected. 48 sides（100.0%） were anatomically preserved facial nerve, partial parotidectomy was performed on 33 sides（68.8%）, superficial lobe+deep lobe partial parotidectomy was performed on 9 sides（18.8%）, and 6 sides（12.5%） was not performed parotidectomy. External auditory canal reconstruction was performed on 32 sides（66.7%）; 43 sides（89.6%） underwent the anatomical preservation of the auricular lobe branch of the great auricular nerve; 9 sides（18.8%） was performed selective cervical lymphadenectomy at the same time. 45 sides of Work Ⅰ CFBCA presented irregular cystic or lobulated structure, the lesion was located below and behind the junction of the external auditory meatus bone and cartilage and distributed along the longitudinal axis of the external auditory canal; 3 sides were isolated in superficial lobe parenchyma of parotid gland. All lesions were located on the superficial surface of the main trunk and branches of the facial nerve. The average value of the shortest vertical distance between the lower edge of the lesion and the outlet of the main trunk of the facial nerve at the stylomastoid foramen was 7.2 （0-13.4 ）mm. Based on preoperative images and intraoperative findings, according to the adjacent relation with external auditory meatus , parotid gland and facial nerve, the classification of Work Ⅰ congenital first branchial cleft anomaly is proposed, which is specifically divided into 4 types: C1（posterior wall of the external auditory meatus） 17 cases（35.4%）, C2（inferior wall of the external auditory meatus） 13 cases（27.1%）, C3 （multi wall of the external auditory meatus） 15 cases（31.3%）, C4（isolated from parotid gland parenchyma） 3 cases（6.3%）. Conclusion:Work Ⅰ CFBCA has a close relationship with the adjacent anatomy of the region, and familiar with the classification of Work Ⅰ congenital first branchial cleft anomaly is helpful for the treatment of type and accurate resection.