Complex Anatomic Area Research Articles

Early experience with an artificial intelligence-based module for brain metastasis detection and segmentation.

- Accurate detection, segmentation, and volumetric analysis of brain lesions are essential in neuro-oncology. Artificial intelligence (AI)-based models have improved the efficiency of these processes. This study evaluated an AI-based module for detecting and segmenting brain metastases, comparing it with manual detection and segmentation. - MRIs from 51 patients treated with Gamma Knife radiosurgery for brain metastases were analyzed. Manual lesion identification and contouring on Leksell Gamma Plan at the time of treatment served as the gold standard. The same MRIs were processed through an AI-based module (Brainlab Smart Brush), and lesion detection and volumes were compared. Discrepancies were analyzed to identify possible sources of error. - Among 51 patients, 359 brain metastases were identified. The AI module achieved a sensitivity of 79.2% and a positive predictive value of 95.6%, compared to a 93.3% sensitivity for manual detection. However, for lesions > 0.1cc, the AI's sensitivity rose to 97.5%, surpassing manual detection at 93%. Volumetric agreement between AI and manual segmentations was high (Spearman's ρ = 0.997, p < 0.001). Most lesions missed by the AI (53.8%) were near anatomical structures that complicated detection. - The AI module demonstrated higher sensitivity than manual detection for metastases larger than 0.1cc, with robust volumetric accuracy. However, human expertise remains critical for detecting smaller lesions, especially near complex anatomical areas. AI offers significant potential to enhance neuro-oncology practice by improving the efficiency and accuracy of lesion management.

PREOPERATIVE AND POSTOPERATIVE TOMOGRAPHIC ASPECTS OF CONDYLE FIXATION AND MANDIBULAR FRACTURE: AN INTEGRATIVE LITERATURE REVIEW

Introduction: Computed tomography (CT) is crucial for the evaluation of mandibular fractures, especially in complex areas such as the condylar region. Its ability to provide detailed images in multiple planes has improved surgical planning and post-operative monitoring, offering precise information on the location and characteristics of fractures. Objective: This integrative review aims to analyze how tomographic aspects impact surgical planning and postoperative monitoring of condylar and mandibular fractures. The study discusses the advantages and limitations of tomographic techniques in order to understand how they influence the clinical outcome and rehabilitation of patients. Materials and Methods: An integrative literature review was carried out, without the need for submission to the Ethics Committee, in accordance with the guidelines of Normative Instruction No. 510/2016. The search was conducted in databases such as PubMed, Scopus and Web of Science, and expanded with Google Scholar. Results and Discussion: The analysis revealed that cone beam computed tomography (CBCT) provides high-resolution three-dimensional images, which are essential for the accurate assessment of fractures, especially in complex anatomical areas such as the mandibular condyle. Conclusion: Cone beam computed tomography (CBCT) is an indispensable tool for the management of condyle and mandible fractures. Its use in preoperative and post-fixation monitoring facilitates detailed visualization of anatomical structures, improving the precision of surgical interventions and contributing to superior functional and aesthetic results.

Orbital Structure Involvement in Midface Fractures Impacting Ocular Injury at a Tertiary Hospital in Eastern Indonesia

ABSTRACT Introduction: The midface is a complex anatomical area consisting of several areas. Although various factors protect the eye from trauma, such as orbital rim, blink reflex, elasticity of ocular structures, and protective eye movements by hands and head, ocular injuries remain common in patients with midface fractures, with an incidence rate of up to 90.6%. This study, the first of its kind conducted in Indonesia, aims to evaluate the characteristics and incidence of ocular injuries in midface fractures and to examine the relationship between the treatment. Methods: This observational analytic study employed a retrospective cohort design, utilizing medical record data of midface fracture patients. The independent variables included age, sex, cause, incidence, segment and severity of ocular injury, number of orbital wall involvements, and treatment options. The dependent variable was midface fracture patients. The Mann–Whitney and Fisher’s exact tests were employed to analyze the multivariate data. Results: Individuals aged 32–37 were most commonly affected due to accidents, with the anterior ocular segment and maxilla bone frequently affected. There are no special factors that differentiate a person from experiencing an ocular injury in a midface fracture (P &gt; 0.05). Ocular injuries correlated with orbital wall injury (P = 0.008) at least one discontinuity. Impaired functions included movement and visual disturbances, diplopia, and dystopia (P = 0.134). Conclusions: No significant relationship was found between age, sex, and cause of trauma with ocular injuries in patients with midface fractures. However, a significant relationship was observed between the amount of orbital rim involvement and at least one wall discontinuity occurring in midface fracture patients.

3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review

BackgroundThree-dimensional-printed anatomical models (3DPAMs) appear to be a relevant tool due to their educational value and their feasibility. The objectives of this review were to describe and analyse the methods utilised for creating 3DPAMs used in teaching human anatomy and for evaluating its pedagogical contribution.MethodsAn electronic search was conducted on PubMed using the following terms: education, school, learning, teaching, learn, teach, educational, three-dimensional, 3D, 3-dimensional, printing, printed, print, anatomy, anatomical, anatomically, and anatomic. Data retrieved included study characteristics, model design, morphological evaluation, educational performance, advantages, and disadvantages.ResultsOf the 68 articles selected, the cephalic region was the most studied (33 articles); 51 articles mentioned bone printing. In 47 articles, the 3DPAM was designed from CT scans. Five printing processes were listed. Plastic and its derivatives were used in 48 studies. The cost per design ranged from 1.25 USD to 2800 USD. Thirty-seven studies compared 3DPAM to a reference model. Thirty-three articles investigated educational performance. The main advantages were visual and haptic qualities, effectiveness for teaching, reproducibility, customizability and manipulability, time savings, integration of functional anatomy, better mental rotation ability, knowledge retention, and educator/student satisfaction. The main disadvantages were related to the design: consistency, lack of detail or transparency, overly bright colours, long printing time, and high cost.ConclusionThis systematic review demonstrates that 3DPAMs are feasible at a low cost and effective for teaching anatomy. More realistic models require access to more expensive 3D printing technologies and substantially longer design time, which would greatly increase the overall cost. Choosing an appropriate image acquisition modality is key. From a pedagogical viewpoint, 3DPAMs are effective tools for teaching anatomy, positively impacting the learning outcomes and satisfaction level. The pedagogical effectiveness of 3DPAMs seems to be best when they reproduce complex anatomical areas, and they are used by students early in their medical studies.

Step-by-Step Dissection of the Mediastinum: A Training Protocol

The understanding of mediastinal anatomy represents a real challenge because of the vital structures inside it and due to its complex relationships with surrounding anatomical regions. Human anatomical specimens are always used both for the teaching of anatomy and the training of young surgeons, thus providing a deep understanding of the most complex anatomical regions and allowing less experienced surgeons to become familiar with surgical instruments and their use on actual human tissues. Despite the spread of these learning practices, there are no principles of dissection to follow for a young physician interested in the anatomy of the mediastinum. Therefore, the main objective of this study is to define a reliable and reproducible protocol for the dissection of the mediastinum. A stratigraphic anatomical dissection on three embalmed human specimens was performed. All steps were documented by high-quality photographs, taken with a professional digital reflex camera, and subsequently edited. A step-by-step anatomical dissection guide was created, detailing every phase, guiding the dissection of the mediastinal anatomy, and leading to the correct identification of its main anatomical structures. We present a step-by-step dissection guide to the mediastinal anatomy with point-by-point explanations and dedicated images, providing an additional tool for the comprehension of this complex anatomical area.

Imaging of Skull Base Tumors.

The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.

Endoscopy Assisted Removal of Post Traumatic Impacted Foreign Body in the Nose Extending into Opposite Parapharyngeal Space.

The head and neck region is a complex anatomical area with vulnerable nervous and vascular structures, auditory and visual organs and upper aero-digestive tract. Penetrating foreign bodies of head and neck region are not uncommon and pertain mostly to wood, metal and glass (Levine et al. in Am J Emerg Med 26:918-922, 2008). This case report describes an airborne high velocity foreign body blown off from a lawn mower penetrating the left side of the face, penetrating deep into nasopharynx and opposite parapharyngeal space through paranasal sinuses. A multidisciplinary team managed this case successfully, avoiding injuries to adjacent vital skull base structures.

Surgical Management of Polymethylmethacrylate-Collagen Gel Complications in the Lower Eyelid: A Case Series.

As nonsurgical rejuvenation with fillers continues to grow in popularity, patients are increasingly interested in more durable results. Polymethylmethacrylate (PMMA)-collagen gel is unique among fillers in that the PMMA microspheres are not completely absorbed and phagocytosed by the body. This durability coupled with the biophysical properties of PMMA makes it a poor choice for periorbital rejuvenation, an unforgiving and highly complex anatomic area. Between 2011 and 2018, 14 patients with PMMA granulomas in various facial areas self-referred to the senior author's practice. Of these patients, 11 were managed nonsurgically; however, all 3 patients who presented with granulomas in the infraorbital area required surgery to remove the filler and restore a natural aesthetic. The 3 patients with significant swelling and PMMA filler nodules in the infraorbital area with unacceptable cosmetic appearance were females between the ages of 50 and 55 years. Nonsurgical protocols were unsuccessful, and surgical removal was required. All subjects have been followed for a minimum of 2 years with no immediate- or long-term postoperative complications secondary to PMMA removal. Patients remain satisfied with the outcome of the surgery. Despite the evidence that the periorbital area is prone to adverse events when injected with particulate fillers, misguided enthusiasm for PMMA-collagen gel as a durable treatment continues to lead to unnecessary and severe complications in patients. The case studies presented here highlight that this product should not be introduced into the periorbital area. We also describe a surgical treatment approach for its removal if complications arise.

Basal Cell Carcinoma of the Head and Neck-A Retrospective Single-Centre Comparison of the Recurrence Rate after R0 or R1 Resection.

The treatment guidelines for basal cell carcinoma (BCC) postulate complete surgical excision using microscopically controlled resection (MOHS) as the gold standard. The need to obtain a small safety margin in the complex anatomical area of the head and neck is very challenging due to the individual characteristics (localization, histology, and size) of tumors and the fact that the postoperative loss of quality of life depends on the surgical defect size. The R1 status is histopathologically defined when the safety margin is less than 1 mm even if there are no tumor cells actually infiltrating the resection margin. Therefore, some studies have already favored a watch-and-wait-strategy in R1 situations. We aimed to evaluate the outcome and recurrence rate of resected BCCs of the head and neck, especially in a histologically proven R1 situation. The outcomes of all resected BCCs observed during a 5-year period (January 2009-December 2013) in a tertiary care center were analyzed. Our standard operating procedure was microscopically controlled surgical excision with reresections until an R0 situation was achieved. In selected patients, an R1 status has been accepted after at least two resections. From the included 191 BCCs, the R1 status was accepted as the final result in 46 (24.1%) cases which had surgically clear margins and were closely followed-up. From 54 patients in the R0 and 40 patients in the R1 group who completed the follow-up (2.4 ± 0.4 years), we observed 0 and 2 local recurrences, respectively (p = 0.19). In cases where frequent follow-up can be secured and the surgical area is delicate, a surgical closure at R1 status can be justified as the recurrence rate is not significantly higher compared with R0.

Ultrasound Guided Hysteroscopy in the Complex Uterine Isthmus

<h3>Study Objective</h3> To demonstrate clinical considerations, operative setup and techniques for a reproducible method of achieving safe hysteroscopic access to the endometrial cavity using multimodal imaging techniques to navigate the complex uterine isthmus. <h3>Design</h3> Educational and stepwise instructional narrated surgical video. <h3>Setting</h3> Community Gynecologic Surgery Referral Practice <h3>Patients or Participants</h3> A 31-year-old G1P1 patient with severe cervical stenosis and high-grade isthmocele is referred for assistance with cervical dilation prior to planned embryo transfer. <h3>Interventions</h3> The patient underwent combined simultaneous hysteroscopic and ultrasonographic visualization to safely access the endometrial cavity. <h3>Measurements and Main Results</h3> A reproducible procedural setup and workflow is described in depth including positioning of patient, assistants and technology as well as detailed stepwise procedure instructions to obtain endometrial access without perforation. <h3>Conclusion</h3> As recognition of isthmocele and other anatomic pathology increases alongside high rates of cesarean section, the gynecologic surgeon must command careful perioperative planning, multimodal imaging techniques and a firm grasp of instrumentation safety parameters as part of the advanced endoscopic skill set required to navigate this complex anatomic area.

Treating Sunken Upper Eyelid With Hyaluronic Acid: Recommendations and Results.

Supraorbital hollowness is a feature that gives an unesthetic, aged, and cadaveric aspect to the eyelids. This complex anatomic area is affected by different variables. Treating this area with fillers poses a real challenge in terms of reducing risks and predicting natural results. We aimed to report outcomes observed in patients treated with injections of hyaluronic acid (HA) soft tissue fillers. Additionally, we have reviewed sunken upper eyelid (SUE) anatomy, etiology, and pathophysiology with the objectives of describing a new classification of SUE, showing a lower risk technique to fill the area, and explaining the importance of using a high cohesivity HA product. We included 32 adults (96.9% female) without previous fillers in the area, who were injected with HA (Belotero Balance) with a 25 G, 40 mm blunt cannula. The procedure was fractionated in 2/3 visits. The assessment was performed at day 0, day 14, day 30, and day 365 with standard camera and Vectra H2 (Canfield). All patients treated with HA showed natural results without significant edema on day 30. Only 1 patient (3.1%) required hyaluronidase injections to dissolve overcorrection of the area on day 14. No severe complications were observed. For most patients, obtained results remained stable on day 365. As SUE is one of the most prominent signs of aging, the desire for rejuvenation and the popularity of non-surgical solutions have increased. We present our results with a cohesive HA as a highly suitable filler for SUE. Given the high patient satisfaction, long-lasting results, and reduced complication risk, our presented approach may represent a safe and effective novel treatment strategy.J Drugs Dermatol. 2022;21(9):1002-1008. doi:10.36849/JDD.6745R1.

The capsular head of the proximal rectus femoris muscle: a review of the imaging anatomy of proximal muscle injury in professional athletes - early experience.

The detailed anatomy of the rectus femoris and corresponding injury appearances were first described in 1995. Since then, there has been little published to change our understanding of this complex anatomical area. More recent anatomical dissection work in 2004 and 2006 alluded to the presence of an altered configuration of the proximal tendon anatomy. Whilst widely accepted that the proximal rectus femoris muscle has two distinct tendon slips, the authors in 2006 described a third separate tendon slip arising from the anterior femoral capsule and this has been widely termed the 'capsular head'. We provide evidence that imaging features corroborate this revised anatomical concept. Whilst the clinical relevance of these findings is yet to be established, it remains important that our understanding of the radiological anatomy in this area advances with the forward growth of imaging clarity. In this review, we revisit anatomical concepts and present atypical injury cases that may be explained by the presence of a separate capsular head.

Oncogenic osteomalacia/phosphaturic mesenchymal tumor: clinical case and literature review

Phosphaturic mesenchymal tumor inducing development of phosphopenic osteomalacia is manifested as deformations and multiple fractures of the bones which decreases patients’ quality of life and leads to disability. Insufficient awareness about this pathology among doctors and absence of symptoms allowing its diagnosis cause late diagnosis of the disease despite application of up-to-date high-tech diagnostic methods. The optimal treatment of phosphaturic mesenchymal tumors is radical resection. However, strong connection of the tumor with the surrounding tissues and, in many cases, absence of a capsule or sclerosis (if located in the bones) complicate surgery leading to high recurrence rate. Radical resection of phosphaturic mesenchymal tumors is especially complicated in cases of localization in complex anatomical areas of the lower limbs.The disease is characterized by long timespan between first clinical signs, diagnosis, and start of treatment (sometimes, several years). Diagnosis confirmation and visualization of the details of phosphaturic mesenchymal tumor requires magnetic resonance imaging. This method allows to examine connection between the tumor and surrounding tissues and the presence of a capsule. Magnetic resonance imaging also allows to accurately determine the area of surgical intervention. Radical tumor resection leads to normalization of blood and urine biochemistry in the span of several weeks. Restoration of bone density and muscle function requires 3–6 months after the operation.

Techniques, Tricks, and Stratagems of Oral Cavity Computed Tomography and Magnetic Resonance Imaging

The oral cavity constitutes a complex anatomical area that can be affected by many developmental, inflammatory, and tumoural diseases. MultiSlice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI) currently represent the essential and complementary imaging techniques for detecting oral cavity abnormalities. Advanced MRI with diffusion-weighted imaging (DWI) and dynamic contrast-enhanced perfusion-weighted imaging (DCE-PWI) has recently increased the ability to characterise oral lesions and distinguish disease recurrences from post therapy changes. The analysis of the oral cavity area via imaging techniques is also complicated both by mutual close appositions of different mucosal surfaces and metal artifacts from dental materials. Nevertheless, an exact identification of oral lesions is made possible thanks to dynamic manoeuvres and specific stratagems applicable on MSCT and MRI acquisitions. This study summarises the currently available imaging techniques for oral diseases, with particular attention to the role of DWI, DCE-PWI, and dynamic manoeuvres. We also propose MSCT and MRI acquisition protocols for an accurate study of the oral cavity area.

Discovery of Muscle-Tendon Progenitor Subpopulation in Human Myotendinous Junction at Single-Cell Resolution.

The myotendinous junction (MTJ) is a complex and special anatomical area that connects muscles and tendons, and it is also the key to repairing tendons. Nevertheless, the anatomical structure and connection structure of MTJ, the cluster and distribution of cells, and which cells are involved in repairing the tissue are still unclear. Here, we analyzed the cell subtype distribution and function of human MTJ at single-cell level. We identified four main subtypes, including stem cell, muscle, tendon, and muscle-tendon progenitor cells (MTP). The MTP subpopulation, which remains the characteristics of stem cells and also expresses muscle and tendon marker genes simultaneously, may have the potential for bidirectional differentiation. We also found the muscle-tendon progenitor cells were distributed in the shape of a transparent goblet; muscle cells first connect to the MTP and then to the tendon. And after being transplanted in the MTJ injury model, MTP exhibited strong regenerative capability. Finally, we also demonstrated the importance of mTOR signaling for MTP maintenance by in vitro addition of rapamycin and in vivo validation using mTOR-ko mice. Our research conducted a comprehensive analysis of the heterogeneity of myotendinous junction, discovered a special cluster called MTP, provided new insights into the biological significance of myotendinous junction, and laid the foundation for future research on myotendinous junction regeneration and restoration.

Three-dimensional (3D) Visualization Educational Modeling for Ophthalmology Residents' Training: Viewpoints.

Background: Three-dimensional models are used to guide residents and physicians in accessing specific anatomical areas and types of fractures and better diagnosis of anomalies. These models are useful for illuminating complex anatomical areas, such as orbit, especially limited space with sensitive access. The aim of this study was to design a three-dimensional visualization educational modeling for ophthalmology residents' training. Methods: This study is a product-oriented application that uses radiological images of anatomy, anomalies, and orbital fractures based on actual CT scans of patients. These CT scans were carefully selected from the Picture Archiving and Communication System of Ghaem Hospital of Mashhad University of Medical Sciences. Results: To produce twelve 3D models, the CT scan files were converted to 3D printer output. Then, the models were presented to residents at a training session by an ophthalmologist. These models created all major fractures associated with the orbit area and most disorders, anomalies of this area and several normal anatomical. The features of 3D models were mentioned. The strengths and weaknesses of the educational modeling, the level of satisfaction with the use of three-dimensional models, suggestions and criticisms were assessed qualitatively by the residents. Satisfaction was reported 100% by residents. Suggestions for future 3D models were presented, and the only criticism was fear of exams and grades. Conclusion: Real-size 3D modeling help to understand the spatial and mental imagery of anatomy and orbital pathology and to touch different anatomical areas creates a clear image in the minds of residents, especially in the orbit.

Сучасні хірургічні методи лікування одонтогенних кіст щелеп (огляд літератури та власні дані)

The purpose of the study was to analyze the data of modern domestic and foreign professional literature, which are devoted to new surgical methods of treatment of odontogenic cysts, to highlight the results of own clinical studies on the effectiveness of developed methods of cystectomy in jaw bones and their anesthesia. Materials and methods. Analytical and bibliosemantic methods were used in the research. The search for scientific information on medical topics for the period from 2010 to 2021 was carried out in the databases of electronic searching systems. Results and discussion. The use of standard techniques of conduction anesthesia of the trigeminal nerve is not always effective during cystectomy in the lateral parts of the mandible, due to the variability of branching of the trigeminal nerve, the possibility of additional innervation of the jaw branch from the superficial cervical plexus. Taking into account these anatomical factors, it is painless to perform a cystectomy of odontogenic cysts on the mandible. During oronasal cystectomy of odontogenic cysts that have grown into the nasal cavity it is advisable to block the nasopalatine nerve in the middle nasal passage. Modified methods of marsupialization can be used as an independent method of treatment of odontogenic cysts of large size, or be combined with radical removal of the cyst membrane. The use of ultrasound medical techniques reduces the risk of damage to adjacent soft tissues during enucleation of bone membranes in complex topographic and anatomical areas. The use of modern laser technologies and medical radiophysical equipment can increase the effectiveness of surgical treatment of odontogenic jaw cysts. The use of endovideosurgery techniques reduces the percentage of intraoperative complications. The introduction of computer spatial imaging of anatomical objects in dental practice has made it possible to develop new surgical technologies for precision-guided osteotomy and resection of the tips of the roots of masticatory teeth adjacent to the shells of radicular jaw cysts. Conclusion. In modern clinical practice, technical developments are used, which are based on the latest advances in laser optics, radio physics, bioacoustics, computer technology, which minimizes injuries during cystectomy operations, reduces the frequency of intraoperative complications. Individual-anatomical features of innervation of the maxillofacial area should be taken into account during local anesthesia, cystectomy and cystotomy operations in the jaw bones

Quantitative Anatomic Comparison of Microsurgical Transcranial, Endoscopic Endonasal, and Transorbital Approaches to the Spheno-Orbital Region.

The spheno-orbital region (SOR) is a complex anatomic area that can be accessed with different surgical approaches. To quantitatively compare, in a preclinical setting, microsurgical transcranial approaches (MTAs), endoscopic endonasal transpterygoid approach (EEA), and endoscopic transorbital approaches (ETOAs) to the SOR. These approaches were performed in 5 specimens: EEA, ETOAs (superior eyelid and inferolateral), anterolateral MTAs (supraorbital, minipterional, pterional, pterional-transzygomatic, and frontotemporal-orbitozygomatic), and lateral MTAs (subtemporal and subtemporal transzygomatic). All specimens underwent high-resolution computed tomography; an optic neuronavigation system with dedicated software was used to quantify working volume and exposed area for each approach. Mixed linear models with random intercepts were used for statistical analyses. Anterolateral MTAs offer a direct route to the greater wings (GWs) and lesser wings (LWs); only they guarantee exposure of the anterior clinoid. Lateral MTAs provide access to a large area corresponding to the GW, up to the superior orbital fissure (SOF) anteriorly and the foramen rotundum medially. ETOAs also access the GW, close to the lateral portion of SOF, but with a different angle of view as compared to lateral MTAs. Access to deep and medial structures, such as the lamina papyracea and the medial SOF, is offered only by EEA, which exposes the LW and GW only to a limited extent. This is the first study that offers a quantitative comparison of the most used approaches to SOR. A detailed knowledge of their advantages and limitations is paramount to choose the ideal one, or their combination, in the clinical setting.

Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study.

The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called "sports groin," which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin. This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998-2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction. Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment. Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.

Imaging Review of Pediatric Benign Osteocytic Tumors and Latest Updates on Management.

Pediatric benign osteocytic tumors include osteoma, enostosis, osteoid osteoma, and osteoblastoma. In pediatric populations, benign bone tumors are more common than malignancies. Benign osteocytic tumors may have a unique clinical presentation that helps narrow the differential diagnosis. A systemic imaging approach should be utilized to reach the diagnosis and guide clinicians in management. Radiographs are the most prevalent and cost-effective imaging modality. Cross-sectional imaging can be utilized for tissue characterization and for evaluation of lesions involving complex anatomical areas such as the pelvis and spine. Computed Tomography (CT) is the modality of choice for diagnosis of osteoid osteoma. CT scan can also be utilized to guide radiofrequency ablation, which has been found to be highly effective in treating osteoid osteoma and osteoblastoma. Enostosis is a no-touch lesion. Osteoma is commonly located in the paranasal sinuses. Osteoma needs an excision if it causes complications due to a mass effect.