Anterior Third Research Articles

Description of three new species of Moenkhausia (Teleostei, Characiformes, Characidae) with the definition of the Moenkhausia jamesi species complex.

From the examination of extensive comparative material currently identified as M. jamesi we verified that there are, at least, three new species under this name. These, along with M. jamesi and M. justae, form what we herein called the M. jamesi species complex, by sharing the following group of characters: a short maxilla, with its distal margin not exceeding anterior third of the second infraorbital; first through third teeth of the inner row of premaxilla and first and second dentary teeth with cusps arranged in a pronounced arch, humeral spot positioned between the fourth and seventh scales of the lateral line and extending up to four scale rows above the lateral line and one scale row below the lateral line, and a vertically oval to round spot at the base of the caudal fin rays. Moenkhausia ischyognatha sp. n., from Rio Xingu basin, differs from the other species of the complex by its lower head depth. Moenkhausia alesis sp. n., from the river system Tocantins-Araguaia, differs from M. jamesi, M. ischyognatha, and M. sthenosthoma by the number of scale rows above the lateral line. Moenkhausia sthenosthoma sp. n., from the Rio Madeira basin, differs from M. jamesi by the number of scale rows between the lateral line and the midventral scale series. Moenkhausia justae can be diagnosed from the other species of the complex by having a tri to pentacuspidate tooth on the maxilla.

Glotoplastia de Wendler y tratamiento logopédico en la feminización de la voz en transexuales: resultados de la valoración pre- vs. poscirugía

IntroductionWith the development of new ENT techniques, many male transsexuals who wish to become women usually request a surgical procedure to raise the fundamental frequency of the voice (feminization). The ENT specialist and the voice-therapist have to use an interdisciplinary approach to this growing social demand. The aim of this study was to show the results in a group of transsexual patients after Wendler's anterior synechiae, with additional voice-therapy treatment. MethodsTen male transexulas who wish to become women patients who had Wendler glottoplasty and voice-therapy were assessed. The surgical procedure consisted of a de-epithelialization of the anterior third of both vocal folds; this area was sutured and the surface of both vocal folds was vaporised with laser diode. Pre- and postsurgery voice assessment consisted of measuring fundamental frequency (Fo) and maximum phonation time, administering the transgender self-assessment questionnaire (TSEQ) and obtaining perceptual voice assessment by inter-rater agreement. ResultsAll the male transsexuals who wish to become women patients significantly increased their Fo (106Hz on average) after the treatment. Furthermore, significant improvements were shown in self-reported satisfaction and in the degree of voice feminization. No improvements in the maximum phonation time were observed. ConclusionsWendler glottoplasty is a surgical procedure to contribute to feminising the voice, with good medium-term results and without noteworthy medical complications. The increase in vocal tone was observed using several pre- and post-surgery control measures and voice therapy.

Dynamic changes in anterior third supraspinatus tendon—relations of a muscle and muscle-tendon transition at rest and in abduction

Background: It is said that the anterior third of the supraspinatus tendon controls the upward movement of the humeral head, and we have reported that the anterior third is changed by disease or symptoms. However, there are few studies demonstrating dynamic changes in the shoulder joint. Studies using ultrasonography allow real-time evaluation of soft tissue. Purpose: To clarify the change in thickness of the anterior third of the supraspinatus tendon and the thickness of supraspinatus muscle during rest and exercise, and the relationship between these parts in healthy individuals. Methods: The study assessed 30 shoulders of 15 healthy volunteers (15 males, mean age 23.4± 3.3 years, height 172.7± 5.5 cm, body weight 67.1± 11.1 kg). One person was excluded with a history of fracture of the shoulder girdle. The thickness of the anterior third of the supraspinatus tendon and the thickness of the supraspinatus muscle were measured in 30◦ shoulder joint abduction and at rest. The measurement position at rest was chair sitting, 0◦ shoulder flexion, 0◦ abduction, internal and external rotation midposition, 90◦ elbow joint flexion, and forearmmid-pronation. One assessor measured using a 7.5MHzB-mode linear ultrasonograph (VIAMO, Toshiba, Japan). The probe was placed on the anterior third of the supraspinatus tendon and the direction of the long axis of the supraspinatus muscle fibers of the scapular spine upper 30 cm for measurement site. To determine the reliability of the measurements, we calculated an intraclass correlation coefficient (ICC 1.1) from the four measurements at each site. For the statistical treatment, we used the Wilcoxon rank sum test to compare the difference between the thickness of the supraspinatus tendon at rest and in abduction, and the paired t-test for the difference in muscle thickness. The Pearson product-moment correlation coefficient was used to look for relationships between increases in the thickness of the supraspinatus muscle and the thickness of the anterior third of the supraspinatus tendon. Results: The mean anterior third of the supraspinatus tendon thickness was 4.9± 0.6mm (ICC= 0.91) at rest, 5.6± 0.6mm (ICC= 0.81) in abduction. The muscle thickness was 17.5± 2.8mm (ICC= 0.82) at rest, 19.0± 3.1mm (ICC= 0.87) in abduction. Comparing abduction and rest, there was a significantly increase in the thickness of both the tendon (p< 0.01) and the muscle (p< 0.01) during abduction. There was no correlation between the increases in tendon and muscle thickness (r= 0.01, p= 0.63). Conclusion(s): The thickness of the anterior third of the supraspinatus tendon increased with abduction means that a rotator cuff, joint capsule, and ligament act complexly. Then that the increase in thickness reduced the space between the humeral head and acromion is considered. Implications:Bymeasuring the thickness of anterior third supraspinatus tendon in abduction, it may become to understand that the supraspinatus tendonworks as a spacer. And the abduction of the shoulder may contribute toward the development or exacerbation of symptom due to compression.

Sensory Flask Cells in Sponge Larvae Regulate Metamorphosis via Calcium Signaling.

The Porifera (sponges) is one of the earliest phyletic lineages to branch off the metazoan tree. Although the body-plan of sponges is among the simplest in the animal kingdom and sponges lack nervous systems that communicate environmental signals to other cells, their larvae have sensory systems that generate coordinated responses to environmental cues. In eumetazoans (Cnidaria and Bilateria), the nervous systems of larvae often regulate metamorphosis through Ca(2+)-dependent signal transduction. In sponges, neither the identity of the receptor system that detects an inductive environmental cue (hereafter "metamorphic cues") nor the signaling system that mediates settlement and metamorphosis are known. Using a combination of behavioral assays and surgical manipulations, we show here that specialized epithelial cells-referred to as flask cells-enriched in the anterior third of the Amphimedon queenslandica larva are most likely to be the sensory cells that detect the metamorphic cues. Surgical removal of the region enriched in flask cells in a larva inhibits the initiation of metamorphosis. The flask cell has an apical sensory apparatus with a cilium surrounded by an apical F-actin-rich protrusion, and numerous vesicles, hallmarks of eumetazoan sensory-neurosecretory cells. We demonstrate that these flask cells respond to metamorphic cues by elevating intracellular Ca(2+) levels, and that this elevation is necessary for the initiation of metamorphosis. Taken together, these analyses suggest that sponge larvae have sensory-secretory epithelial cells capable of converting exogenous cues into internal signals via Ca(2+)-mediated signaling, which is necessary for the initiation of metamorphosis. Similarities in the morphology, physiology, and function of the sensory flask cells in sponge larvae with the sensory/neurosecretory cells in eumetazoan larvae suggest this sensory system predates the divergence of Porifera and Eumetazoa.

Microsurgical anatomy of the inferior limiting insular sulcus and the temporal stem.

The purpose of this study was to describe the location of each white matter pathway in the area between the inferior limiting insular sulcus (ILS) and temporal horn that may be crossed in approaches through the temporal stem to the medial temporal lobe. The fiber tracts in 14 adult cadaveric cerebral hemispheres were examined using the Klingler technique. The fiber dissections were completed in a stepwise manner, identifying each white matter pathway in different planes and describing its position in relation to the anterior end of the ILS. The short-association fibers from the extreme capsule, which continue toward the operculae, are the most superficial subcortical layer deep to the ILS. The external capsule fibers are found deeper at an intermediate layer and are formed by the uncinate fasciculus, inferior frontooccipital fasciculus, and claustrocortical fibers in a sequential anteroposterior disposition. The anterior commissure forms the next deeper layer, and the optic radiations in the sublenticular part of the internal capsule represent the deepest layer. The uncinate fasciculus is found deep to the anterior third of the ILS, whereas the inferior frontooccipital fasciculus and optic radiations are found superficial and deep, respectively, at the posterior two-thirds of this length. The authors' findings suggest that in the transsylvian approach, a 6-mm incision beginning just posterior to the limen insula through the ILS will cross the uncinate fasciculus but not the inferior frontooccipital fasciculus or optic radiations, but that longer incisions carry a risk to language and visual functions.

Rhythmicity in the emergence of Cercaria tondoni sp., a gymnocephalus cercaria from Lymnea stagnalis (Linnaeus, 1758)

Emerging pattern of Cercaria tondoni sp., a distome (possessing a ventral sucker lying some distance from the posterior end and approximately at anterior third of the body) belonging to gymnocephalus group (having an oval body and tail devoid of stylets or spines), shows a daily rhythm, being greater during the light phase (0630:1830 h) – similar to that found in a freshwater snail Lymnea stagnalis, Linnaeus, 1758. The peak time of emergence 1230–1430 h has been measured, and there is a high risk for invertebrate or vertebrate hosts and other diurnal animals to acquire infection during this period. However 20% of total shedding in a population of cercariae has also been recorded during the dark phase (0630–1830 h) but there was no significant rhythmicity within this period. An attempt has been made to record cercarial emergence throughout the year, which is of great importance for human welfare. It was observed that the months of April, May, and June are those where frequency of emergence was highest. Implications of this rhythmicity are considered.

Management of superior sagittal sinus injury encountered in traumatic head injury patients: Analysis of 15 cases.

Background:Significant dural sinus injury occurs in 1.5- 5% of all head injuries and injury to superior sagittal sinus accounts for 70-80% of these. Its management is also a challenging issue to every neurosurgeon.Materials and Methods:In a period of one year (Aug 2011 to july2012) out of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have superior sagittal sinus injury. Three dimensional reconstruction of skull bone during CT scan helped us to diagnose possible dural sinus injury pre-operatively.Results:SSS injury was due to direct impact of fracture segment (5 cases), extension of fracture line over sinus area (4 cases) or due to coronal suture diastases (6 cases). Injury to anterior third of sagittal sinus occurred in 12 cases (80%) and injury to middle third occurred in 3 cases (20%). Small tear over superior sagittal sinus was found in 7 cases (46.66%) and was managed with Gelfoam® compression only and in two cases (13.33%) were large tear, which was managed with sinoraphy. In four cases (36.34%) hitch stitches over Gelfoam® to adjacent bone given and in rest two cases (13.33%) a strip of bone was left over the sinus area and bilateral hitch stitches were applied.Conclusion:Injury to SSS in traumatic head injury patient though rarely encountered during surgery, the management is challenging to every neurosurgeon. Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate.

Cytoarchitecture of the human lateral occipital cortex: mapping of two extrastriate areas hOc4la and hOc4lp.

The microstructural correlates of the functional segregation of the human lateral occipital cortex are largely unknown. Therefore, we analyzed the cytoarchitecture of this region in ten human post-mortem brains using an observer-independent and statistically testable parcellation method to define the position and extent of areas in the lateral occipital cortex. Two new cytoarchitectonic areas were found: an anterior area hOc4la and a posterior area hOc4lp. hOc4la was located behind the anterior occipital sulcus in rostral and ventral portions of this region where it occupies the anterior third of the middle and inferior lateral occipital gyri. hOc4lp was found in caudal and dorsal portions of this region where it extends along the superior and middle lateral occipital gyri. The cytoarchitectonic areas were registered to 3D reconstructions of the corresponding brains, which were subsequently spatially normalized to the Montreal Neurological Institute reference space. Continuous probabilistic maps of both areas based on the analysis of ten brains were generated to characterize their inter-subject variability in location and size. The maps of hOc4la and hOc4lp were then used as seeds for meta-analytic connectivity modeling and quantitative functional decoding to identify their co-activation patterns and assignment to functional domains. Convergent evidence from their location, topography, size, functional domains and connectivity indicates that hOc4la and hOc4lp are the potential anatomical correlates of the functionally defined lateral occipital areas LO-1 and LO-2.

Effect of tear location on propagation of isolated supraspinatus tendon tears during increasing levels of cyclic loading.

The morphology of the supraspinatus tendon may affect tear propagation. It was hypothesized that tears located in the anterior third of the supraspinatus tendon would propagate more readily and would require lower loads to reach critical amounts of tear propagation than those located in the middle third of the supraspinatus tendon. Twenty-three fresh-frozen human cadaveric shoulders were tested under increasing levels of cyclic loading. Tears were created in the anterior third (Group A, n=10) or the middle third (Group M, n=13) of the supraspinatus tendon. The maximum load at which a critical tear retraction was reached and the tear area for the final loading set were compared between groups. A correlation analysis was also performed for age compared with maximum load. No significant differences were found between the anterior-third tear group (Group A) and the middle-third tear group (Group M) in maximum load (p=0.09) or tear area (p=0.6). However, Group A first reached a 100% increase in tear size at a significantly lower load than Group M (p=0.03). Strong negative correlations were detected between age and maximum load in Group A (τ=-0.82) and Group M (r=-0.63). Other factors being equal, tears in the anterior supraspinatus tendon may propagate more readily than tears in the tendon's middle part. Age may be a factor for tear propagation. Older patients and patients with tears in the anterior supraspinatus should be followed especially carefully.

A case report of bilateral trigeminal sensory neuropathy as one of the initial manifestation of systemic scleroderma (the difficulties of early diagnosis of the primary disease)

The article describes the case of a patient with bilateral trigeminal sensory neuropathy (TSN), as a possible neurological manifestation of systemic scleroderma (SS). In this patient, intense non-paroxysmal facial pain caused by TSN, subjectively dominated over other manifestations of SS, including Raynaud's syndrome, for at least 1.5 years, thus hampering the diagnosis of the primary disease. In addition to pain, which was not relieved by analgesic medication, TSN was manifested by marked sensory deficit on the face (hypoesthesia / anesthesia) and bilateral sensory deficits in the oral cavity, including the anterior third of the tongue. TSN was also combined with disorders of taste perception. The assumption of rheumatic origin of TSN occurred during a primary neurological examination: a standard examination revealed generalized sensory polyneuropathy with bilateral involvement of the trigeminal nerve; the additional study identified no neurological signs of rheumatic diseases, including Raynaud's phenomenon. SS met all the criteria for the diagnosis (2013), high titers of nuclear ribonucleoprotein were determined as well. Thus, TSN as early and subjectively dominant manifestation of SS can complicate the diagnosis of primary rheumatic diseases. Therefore, in cases of distal sensory polyneuropathy with bilateral involvement of the trigeminal nerve, it is necessary to conduct an additional survey to identify the signs of possible rheumatic diseases: signs of vascular lesion (Raynaud's syndrome), lesions of skin, joints and muscles.

Giant Intracranial and Extracranial Meningioma of the Falx Cerebri: Surgical Management and Case Report

Meningiomas are usually benign growths that rarely invade the substance of the brain, thus presenting the potential for curative surgery. Their sometimes difficult locations and propensity to recur if not completely excised represent formidable problems for the patient and the neurologic surgeon. This report describes a case of giant intracranial and extracranial meningioma of the falx cerebri. The tumor had displaced the anterior third of the superior sagittal sinusand a massive extracranial protrusion was eroding the calvarium, left supraorbital rim, frontal sinus and the left maxillary sinus. We present the surgical approach.

Sarcocystis sp. parasites in the Mexican Great-tailed Grackle (Quiscalus mexicanus), Bronzed Cowbird (Molothrus aeneus), and Stripe-headed Sparrow (Aimophila ruficauda)

The objective of this study was to describe the morphological and ultraestructural characteristics, the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) results, the sequences and the phylogenetic analysis of a specific fragment of internal transcribed spacer 1 (ITS-1), amplified using the 25/396 primers, of the Sarcocystis sp. parasites identified in the muscles of wild great-tailed grackles, bronzed cowbirds, and stripe-headed sparrows in Mexico. Fifteen birds with sarcocystosis in their skeletal muscles were studied: 7 great-tailed grackles (Quiscalus mexicanus), 6 bronzed cowbirds (Molothrus aeneus), and 2 stripe-headed sparrows (Aimophila ruficauda). Histopathological analysis revealed thin-walled mature parasite cysts. Ultrastructurally, the cyst wall consisted of a granular layer with villar protrusions and numerous microtubules. The bradyzoites measured 4.1 × 1.6 µm, and micronemes appeared in the anterior third of the conoid. For molecular identification, PCR-RFLP was performed using sequences of a specific fragment of internal transcribed spacer 1 (ITS-1) using the primers 25/396 and Hinf I. Hind III did not cut this fragment. The sequencing results indicated a 100% similarity among the Sarcocystis parasites from the three bird species, and a BLAST search revealed 96% sequence similarity with S. neurona. The phylogenetic analysis shows that the sequences studied are topologically distant to those sequences reported for S. neurona in the United States and in South America and are not related to any group previously reported. Although our morphological and molecular analysis data provide strong evidence that S. neurona uses these bird species as intermediate hosts, future molecular studies with additional DNA fragments, combined with biological studies, will ultimately allow us to convincingly identify these parasites. This is the first report of a Sarcocystis sp. parasite in wild birds in Mexico that may be S. neurona.

A Vocal Cord Polyp in a Pediatric Patient

Objective: To present a case of vocal cord polyp in a pediatric patient and discuss its differential diagnosis, assessment and management.&#x0D; &#x0D; Methods:&#x0D; Study Design: Case Report&#x0D; Setting: Tertiary Public Hospital&#x0D; Participant: One&#x0D; &#x0D; Results: A seven-year-old girl presented with hoarseness and a benign, unilateral mass seen at the junction of anterior and middle third of the vocal cord. The hoarseness resolved after excision, and histopathology confirmed an inflammatory vocal cord pseudo polyp.&#x0D; &#x0D; Conclusion: Vocal cord polyps occur infrequently in children and adolescents. These cases are seldomly seen and reported and may arise from chronic abuse of the larynx, vocal cord trauma or phonotrauma. Hoarseness is the most common presenting symptom. Differential diagnoses include recurrent respiratory papillomatosis, laryngeal cyst and laryngeal nodule. The management of vocal cord polyps involves surgical removal followed by speech therapy.&#x0D; Keywords: hoarseness, phonotrauma, vocal cord polyp, recurrent respiratory papillomatosis, vocal cord nodule, vocal cord cyst, flexible laryngoscopy, speech therapy&#x0D;

Superior laryngeal nerve block: an anatomical study comparing two techniques

Study ObjectiveTo determine whether an anterior approach is as successful as the conventional posterior approach to superior laryngeal nerve block. DesignProspective observational study. SettingUniversity anatomy laboratory. Patients20 formalin-fixed adult human cadavers. MeasurementsSimulated superior laryngeal nerve blocks were performed by a single operator using 3 mL of 0.01% analine blue dye with a 23-gauge Quincke tip needle. Two different landmark techniques were used on each undissected cadaver: 1) the conventional posterior approach using the hyoid bone as a palpable landmark, with injection at the posterior third of the thyrohyoid membrane; and 2) the anterior approach, using the anterior thyroid notch of the thyroid cartilage, with injection at the anterior third of the thyrohyoid membrane. The spread of analine dye was observed. An injection was deemed successful if the entire paraglottic space was stained or the superior laryngeal nerve stained as it entered the paraglottic space. Main ResultsBoth techniques were equally successful after 40 injections. ConclusionThere was no significant difference in success in staining the superior laryngeal nerve in human cadavers between the conventional posterior approach and an anterior approach.

Metastatic Calcification of the True Vocal Folds in the Setting of Renal Failure

Objectives: (1) Present a case of metastatic calcinosis of the true vocal cords. (2) Discuss the pathogenesis, diagnosis, and treatment strategies for this condition. Methods: This is a case report of a 52-year-old male with a history of end-stage renal disease and tobacco abuse who presented to clinic with complaints of dysphagia, cough, and subtle voice changes. Transnasal fiberoptic laryngoscopy revealed bilateral patches of leukoplakia on the anterior third of the vocal cords. After a 3-month period of conservative management with a proton pump inhibitor and serial scope examinations, the lesions were noted to be slowly enlarging. It was determined that an excisional biopsy should be performed to rule out malignancy. The patient underwent micro-suspension direct laryngoscopy with microflap excision of the bilateral vocal cord lesions. Results: Surgical pathology revealed benign squamous mucosa with calcinosis, parakeratosis, and submucosal hyalinization. These findings were characteristic of metastatic calcification. Review of the patient’s medical records confirmed ongoing phosphorous dysregulation. Metastatic calcinosis of the true vocal fold is a very rare finding, with only 2 other reported cases in the literature. Conclusions: In patients suffering from end-stage renal disease, dysregulation of calcium and phosphate levels may lead to deposition of calcium in many types of soft tissue, including the true vocal cords. Examination findings may mimic dysplastic lesions, and this diagnosis should be considered in patients with chronic kidney disease.

Two-Part Parasagittal Craniotomy: Technical Note.

Introduction: Craniotomy along the midline can be done in a variety of ways. Methods include single piece craniotomy with burr holes on the midline, crossing the midline with footplates of drills using drilled troughs or bilateral burr holes, and craniotomies in multiple pieces. The authors describe a two-part parasagittal craniotomy useful for safely exposing the midline for parasagittal and inter-hemispheric lesions. Methods: The two-part parasagittal craniotomy begins with anterior and posterior burr holes 1.5 cm lateral to the midline. Once the first bone flap is removed, the dura is dissected under direct vision from the inner table of the skull crossing the midline over to the contralateral side for the second part bone flap. In this way, the superior sagittal sinus (SSS) is dissected and protected. Bony reconstruction and closure is straightforward using recessed screws and plates as well as hydroxyapatite for filling in gaps in the bone. Results: The two-part parasagittal craniotomy has been used in more than 200 patients in the last 24 years. During this time, no direct significant laceration of the SSS has occurred due to a dural tear in the anterior, middle, or posterior thirds while completing the craniotomy. The authors recommend this technique as an option for craniotomy around the midline of the supratentorial cranial vault. Conclusions: The two-part parasagittal craniotomy is an option for opening the skull around the midline of the cranial vault for pathologies along the midline and inter-hemispheric fissure. Surgeons can consider this as an option to a one piece bone flap crossing midline.

Objectification of the severity of Reinke's edema

According to the severity, Reinke's edema (RE) of the vocal folds can be divided into three stages as classified by Yonekawa. We evaluated open and closed quotients of vocal folds vibratory cycles using Videostrobokymography (VSK) in a cohort of patients with RE. Parameters were measured from the anterior, medial and posterior third of the vocal folds. Mean values from RE group were OQ (0.44; 0.46; 0.52); CQ (0.56; 0.54; 0.48). Results from the whole glottis OQ and CQ in RE were: OQ=0.48 and CQ=0.52. Significant differences were found for OQ and CQ mean values as well as values measured from each third of the glottis between the control group and patients with RE. In the first Yonekawa group no statistically significant differences were found compared to the control group, but there were significant differences in the remaining two groups. The correlation between the stage of edema on the Yonekawa classification and the mean values of OQ and CQ was 70%.

Neovascular growth in an experimental alkali corneal burn model

ObjectiveTo analyze the length and area of corneal surface occupied by vessels, and their location in an experimental model of alkali burn-induced corneal neovascularization. MethodsAn injury to the central cornea of the right eye in 91 Sprague-Dawley rats was induced using a silver nitrate pencil. The rats were divided into seven groups that were sacrificed 2, 4, 6, 8, 10, 12 and 14 days post-injury, and then perfused with a mixture of Chinese ink in PBS (phosphate buffer saline). Corneas were flat-mounted processed and divided into four quadrants. Corneal neovascular growth parameters (length and area) and the location of these vessels were performed blind. The results were statistically analyzed. ResultsNeovascular growth was observed from day 2, reaching its maximum peak in length and area on the 12th day post-injury. A slight reduction in corneal neovascularization was observed after this day. The vessels were initially located in the middle third of the stroma and tended to be observed in the anterior third during the course of the experiment. ConclusionsNeovascularisation was observed on day 2 post-injury in all sectors of corneal surface. Neovascular growth was uniform during the experiment. Neovessels were located in the middle and anterior third of the cornea.

Two new species of Syrphidae (Diptera) from Chukotka(Northern Russian Far East).

Two new species, Platycheirus beringiensis sp. n. and Cheilosia chukotana sp. n., are described from Chukotka (northern part of Russian Far East). The new Platycheirus is close to Platycheirus immarginatus (Zetterstedt), but differing by the following characters: fore tibia with a black stripe on posterior side; mid-femur without fine black curved hairs directed to the base of the femur; mid-tibia without long anteroventral hairs; abdomen black with fine brownish lustre on tergites. The new Cheilosia species is close to Ch. semifasciata Becker, but differs by its characteristic sharply raised central knob, and by lack of transversal stripe and indentation in anterior third of frons.

Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty: a technical report

Background contextAbsence or inadequate filling of cement in the fractured vertebrae can cause unsatisfactory results in a vertebroplasty. Repeated needle insertion can reduce the incidence of recollapse at the cemented vertebrae. However, when inserting the second needle in the usual method, it takes the same time and radiation exposure as the first needle. PurposeTo report a Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty that can make the procedure simple, effective, and, most importantly, reduce the radiation exposure. Study designDescription of a modified surgical technique with retrospective data analysis. Patient sampleFrom January 2012 to December 2012, 87 percutaneous vertebroplasties were performed in our department to treat painful osteoporotic compression fractures. Seven adult patients (five women, two men; mean age: 75.7 years) had inadequate cement filling in the treated vertebrae that required the insertion of a second needle. Outcome measuresBack pain was measured using the visual analog scale (VAS). The post-vertebroplasty anterior vertebral height and local kyphotic angle were used as the radiologic parameters. Intraoperative procedure time and fluoroscopy shots and postoperative complication were also evaluated. MethodsThe stylus of the first needle was inserted into the trocar to push the cement out of the trocar. The stylus was removed, a small diameter K-wire was inserted into the trocar, and the trocar was then removed. A second (new) trocar was inserted into the vertebral body following the track of the K-wire. When the new trocar reached the posterior 1/4 of the vertebral body, the K-wire was removed, the stylus was inserted, and the new needle was advanced to the anterior third of the vertebra. Cement was then injected into the new area until the filling was adequate. ResultsThe immediate post-vertebroplasty anterior vertebral height was 23.31±1.95 mm, changed to 22.20±3.72 mm at final follow-up. The VAS decreased from a mean of 8.4 before vertebroplasty to 1.6 at the final follow-up. The follow-up duration ranged from 6 to 15 months (mean 12.6 months). There was no case of recollapse of the cemented vertebrae and no procedure-related complications. The procedure time of historical controls was 153.5 seconds, which reduced to 47.9 seconds by using this technique. The fluoroscopy shots of historical controls were 9.7 shots, which reduced to 2 shots by using this technique. ConclusionsThis report suggests that Kirschner wire-guided technique for inserting a second needle during vertebroplasty could make the procedure simple, effective, and, most importantly, reduce the procedure time and radiation exposure.