Division Of Branches Research Articles

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report

BackgroundOpen injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise.Case presentationA 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases.ConclusionsThis clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.

Endovascular Management of Severe Arterial Haemorrhage After Radical Prostatectomy: A Case Series.

The aim of this study is to assess the safety, effectiveness and long-term outcome of endovascular management of arterial haemorrhage after radical prostatectomy (RP). Ten patients who received endovascular treatment for refractory bleeding after RP between January 2008 and December 2016 were retrospectively identified. Contrast-enhanced computed tomography (CT) was performed and followed by catheter-directed treatment by means of transarterial embolization (TAE) or stent graft placement. Follow-up included analysis of bleeding recurrence, embolization-related adverse events and tumour recurrence. Contrast-enhanced CT and catheter-directed angiography showed pelvic contrast extravasation in nine patients. Nine patients were successfully treated with TAE of the internal pudendal, superior and/or inferior vesical or (the anterior division or main branch of) the internal iliac arteries using microparticles in two patients, coils in two patients, a combination of microparticles and coils in three patients, glue in one patient and Gelfoam in one patient. The remaining patient was treated with stent graft placement in the external iliac artery, which was most likely injured during robot-assisted lymphadenectomy. One patient developed a puncture site pseudoaneurysm. No other complications related to the endovascular procedures occurred, in particular no pelvic ischaemic complications were identified. Mean follow-up period was 45months (range 22-80). The endovascular management of arterial haemorrhage after RP is safe and effective, without post-embolization ischaemic events.

Comments on “An Analytical Design Method for a Novel Dual-Band Unequal Coupler With Four Arbitrary Terminated Resistances”

IN the above paper [1], the authors proposed a dual-band unequal power division branch line coupler(BLC) with four arbitrary terminated resistance using dual-band impedance matching network (IMN) and BLC with complex port impedance. However the authors have not considered the transmission phase of the IMNs [2] and the BLC, which leads to non-quadrature phase difference (6 S21􀀀6 S31 6= 90) at the output ports when the termination resistances are unequal.

Military Commissions and the War on Terror: A Separation of Powers Tug-of-War

Much of the literature on the war on terror overstates the power of the presidency and overlooks the respective roles of Congress, the courts, and the bureaucracy. The creation and development of military commissions in the war on terror demonstrates that our system of separation of powers and checks and balances has in fact worked in complex and surprising ways to constrain the presidency during wartime, with consequences both positive and negative. In this article, two insights loom largest. First, internal executive branch divisions often interact with the separation of powers in ways that limit presidential dominance. Second, national security policy is now a heavily legalized area, with important consequences for the separation of powers.

Splenic flexure cancer optimum level of vessel ligation

Background: Incidence of splenic flexure carcinoma is very low in colorectal cancer but often time presented in an advanced stage with high risk of obstruction, contributing poor prognosis. Aim of the study was to investigate the adequacy of vessel ligation in SFC in term of overall survival.Methods: 35 patients diagnosed with splenic flexure carcinoma enrolled and analyzed, patients categorized based on the level of vessel ligation as group-A, left branch of middle colic (LMA) and left colic artery division (LCA) compared, group-B, LCA and marginal of middle colic artery (MMC).Results: CEA marker was not significantly changed post-operatively, as it was within normal range preoperatively at an average of 9-12 µg/ml. There is no significance in staging of tumors in all stages, and recurrence of tumor is present in 5 in group A. Radical margins both proximal and distal ends are not significant. Tumor clearance achieved successfully in both arms in term of proximal margin achieved at 7.9±3.5cm in groups B and 8.3±4.1 cm in group A, p = 0.312. Distal margin reported at 8.7±4.1 cm and 8.9±3.98cm, p = 0.58, respectively. Lymph nodes are positive in group-A and group-B without any significance. Tumor size or diameter ranging from 5.1±3.1 in group-A and 4.76±3.8 in group-B. According to the cell differentiation, majority of the tumor grade turned out to be moderately differentiated cancer, rated at 14 patients (40.1%) in group A and 13 patients (37.1%) in group B. one patients found to be well or poorly differentiated cell tumors in group-A. Overall p-values were insignificant in regards tumor cell differentiation in both groups, p = 0.213. Incidence of lympho-vascular invasion reached only 3 (8.5%) vs. 4 patients (11.2%), p = 0.562, in A and B group.Conclusions: Higher level of vessel ligation has no added significance in overall outcome, but has role to lower the risk of recurrence rate in Splenic flexure carcinoma patients.

Parotid Branches of the Auriculotemporal Nerve: An Anatomical Study With Implications for Frey Syndrome.

The auriculotemporal nerve is one of the many branches of the mandibular division of the trigeminal nerve. Of these, its superficial temporal branch has been most described. Although the parotid branches, secretomotor fibers to the parotid gland, are well known as the cause of Frey syndrome, there have been almost no descriptions of their anatomy. In this study, the authors dissected the parotid branches of the auriculotemporal nerve to elucidate their anatomy. A total of 10 sides from 7 adult and embalmed cadaver heads were used in this study. The specimens were derived from 3 males and 4 females, the age of cadavers at death ranged from 65 to 92 years old. Measurements included their diameter and the distance of their branching point from the main trunk of the auriculotemporal nerve from the middle of the tragus. Three of 10 sides had 2 parotid branches and 7 sides were found to have 1 parotid branch. The vertical distance between middle of the tragus to branching point of the parotid branch ranged from 1.79 to 16.17 mm. The horizontal distance between middle of the tragus to branching point of the parotid branch ranged from 3.03 to 12.62 mm. The diameter of the parotid branch ranged from 0.31 to 0.49 mm. An improved knowledge of the parotid branch of the auriculotemporal nerve might decrease injury to these structures with the potential for postoperative.

PERANAN PASUKAN CAWANGAN KHAS POLIS DIRAJA MALAYSIA (PDRM) DALAM MENANGANI ANCAMAN KOMUNIS, 1968-1989

Malaysia was one of the countries that faced the security threat of communist insurgency; inflicted by the Communist Party of Malaya (CPM) since 1948. Although having been defeated by the Malayan Security Forces in 1960, the CPM took their second opportunity by reviving their armed struggle, prompting the Second Malaysia Emergency in 1968 which lasted for almost 40 years. The success of the Malaysian Security Forces in the Second Emergency was based on meticulous implementation of intelligence services by the Royal Malaysian Police Special Branch (SB) Division, known for their high reputation and efficiency in counter-intelligence in the 1970s. This study focuses on the roles and functions of the Special Branch, primarily its intelligence strategies and tactics, which led to the defeat of the CPM in 1989.

A study of the orbitofrontal branch of the middle cerebral artery in Northern India

IntroductionThe orbitofrontal branch of the middle cerebral artery (MCA) is responsible for blood supply to the orbitofrontal cortex along with the orbitofrontal branch of the anterior cerebral artery. Mostly, it is a branch of superior division of M2 segment of MCA; however, in this study, it was seen to arise more commonly from M1 segment of MCA. Though the orbitofrontal branch of ACA is researched by many authors, the orbitofrontal branch of MCA has gained less attention of the researchers. There is paucity of work on this branch of MCA in Indian literature specially in the northern part. Descriptions of the orbitofrontal branch of the middle cerebral artery, which we found in the literature, did not correlate with our observations. The aim of the study was to observe, record, and compare variations in origin and branching pattern of the orbitofrontal artery, hoping to find immediate application of our findings in the field of cerebrovascular surgery. Materials and methodsA total of 20 middle cerebral arteries were studied, which were obtained from 10 brains. Meticulous dissection was done, and the middle cerebral artery was exposed and cleaned in lateral sulcus on the inferior surface of the brain. Its orbitofrontal branch was studied in detail. Digital photographs were taken. ResultOut of the 20 MCAs studied, the orbitofrontal artery was found to arise from M1 segment in 15 cases. In the remaining 5 cases, it was found to originate from the superior trunk of M2 segment of the middle cerebral artery.

Impact of Training & Development on the Performance of the Employees of Silk Bank Limited—Karachi East Division Branches

This study explored the impact of training & development and modern training methods on the performance of the employees of Silk Bank Limited Karachi East Division Branches. The essentialness of training and change in the Banking Industry has been highlighted in the past works. The reason for this study is to take a gander at the effects of training and improvement and present day training systems on the performance of the representatives of Silk Bank. A well-structured questionnaire was designed and utilized for gathering the data. The outcomes reported in this study prescribe that preparation and change influence the execution of Silk Bank authorities as for their occupations. This result is broadly unsurprising with prior organization composing on get ready and change. Remembering the final objective to secure specific data of preparing and change from the example specialists, assorted request are acquainted with the respondents and in like manner broke down. Preparing and Development and modern training techniques have positive effect on the execution of the representatives of Silk Bank Limited. Talk of the considerable number of results demonstrates the speculations; there is an important relationship between Training & Development and performance of the workers implies that employees’ performance is expanding through training and advancement. There is a positive relationship between modern training methods and performance of the workers’ means that modern training methods are enhancing Silk Bank’s representative’s performance

Anatomical study of the superficial temporal branches of the auriculotemporal nerve: Application to surgery and other invasive treatments to the temporal region

The auriculotemporal nerve (ATN) is one of the branches of the mandibular division of the trigeminal nerve, which gives rise to many branches to the retromandibular and temporal regions. Of these, the superficial temporal branch can occasionally be the cause of migraine headaches and auriculotemporal neuralgia. The purpose of this study was to elucidate the anatomy of the superficial temporal branch, which has never been described in detail. A total of 14 sides of cadaveric heads were used for this study. The number of superficial temporal branch was counted, and the horizontal and vertical distances from the middle of the tragus to the branching point were measured. Three of 14 sides had two main trunks, and 11 sides had one main trunk. Each of the duplicated ATN had already branches into two main trunks as they left the retromandibular space. The number of superficial temporal branches ranged from two to seven. The vertical and horizontal distances from the middle of the tragus to the branching point of the superficial temporal branch ranged from 6.19 to 25.65mm and from 3.45 to 11.88mm, respectively. The communicating branches occasionally formed a loop or so-called "ansa," and a double ansa was identified in one case. These data can provide surgeons a better view of the course of these distant branches, so that skin incisions can be better planned.

High variability of facial muscle innervation by facial nerve branches: A prospective electrostimulation study.

To examine by intraoperative electric stimulation which peripheral facial nerve (FN) branches are functionally connected to which facial muscle functions. Single-center prospective clinical study. Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial and neck movements were video recorded simultaneously and evaluated independently by two investigators. A uniform functional allocation of specific peripheral FN branches to a specific mimic movement was not possible. Stimulation of the whole spectrum of branches of the temporofacial division could lead to eye closure (orbicularis oculi muscle function). Stimulation of the spectrum of nerve branches of the cervicofacial division could lead to reactions in the midface (nasal and zygomatic muscles) as well as around the mouth (orbicularis oris and depressor anguli oris muscle function). Frontal and eye region were exclusively supplied by the temporofacial division. The region of the mouth and the neck was exclusively supplied by the cervicofacial division. Nose and zygomatic region were mainly supplied by the temporofacial division, but some patients had also nerve branches of the cervicofacial division functionally supplying the nasal and zygomatic region. FN branches distal to temporofacial and cervicofacial division are not necessarily covered by common facial nerve monitoring. Future bionic devices will need a patient-specific evaluation to stimulate the correct peripheral nerve branches to trigger distinct muscle functions. 4 Laryngoscope, 127:1288-1295, 2017.

Anatomical variation of the alveolar inferior nerve: a case report

Abstract Introduction: The mandibular nerve is the third and inferior division of the trigeminal nerve. One of its branches, the inferior alveolar nerve, is one among the three branches of the posterior division of the mandibular nerve, it supplies the lower jaw and teeth. However, variations of the inferior alveolar nerve branches have been of major concern in the performance of surgical procedure and anesthesia in dental and maxillofacial practice. Method and Results: A variant branch arising from the alveolar inferior nerve before it enters in the mandibular foramen were discovered during a dissection routine. The branch can be described as a variation referring to inferior alveolar nerve as a recurrent branch towards superior, posterior and medial entering in the lateral pterygoid muscle, leaving inferior alveolar nerve before the nerve for mylohyoid muscle. The nerve were found in the in both infratemporal fossa. Conclusion: Knowledge of the variations of the mandibular nerve, its branches and communications are clinically important especially for dental surgeons to understand the effectiveness of the nerve block and complications following regional anesthesia.

Cluster headache in Greece: an observational clinical and demographic study of 302 patients.

BackgroundCluster headache (CH) is considered the most excruciating primary headache syndrome; although much less prevalent than migraine, it is not rare as it affects more than 1/1000 people. While its clinical presentation is considered stereotypic, atypical features are often encountered. Internationally, cluster headache is often misdiagnosed, undertreated and mistreated.MethodsWe prospectively studied 302 CH patients, all examined by the same headache specialist. The aim of our study was to describe the demographic and clinical characteristics of CH patients in Greece and draw attention to under-management, under-treatment and mis-treatment often encountered in clinical practice; our purpose is to improve recognition and successful treatment of cluster patients by Greek neurologists and other physicians.ResultsIn the present cohort, clinical characteristics of CH are similar to those described in other populations. Beyond the standard clinical characteristics, features like side shifts (12.6 %), location of maximal pain intensity outside the first trigeminal branch division (10.2 %), lack of autonomic features (7 %), presence of associated features of migraine and aggravation by physical activity (10 %) were encountered. Four out of five patients had consulted a physician prior to diagnosis. The median number of physicians seen prior to diagnosis was 3 and the median time to diagnosis was 5 years, though it improved for patients with recent onset. Chronic cluster headache, side shifts, pain location in the face or the back of the head and aggravation by physical activity were found, among others, to be statistically significantly related to delayed diagnosis or more physicians seen prior to diagnosis. Even properly diagnosed patients were often undertreated or mistreated.ConclusionsCluster headache, in a large cohort of Greek patients, has the same phenotypic characteristics as described internationally. Uncommon clinical features do exist and physicians should be aware of those, since they may eventuate in diagnostic problems. Most CH patients in Greece remain misdiagnosed or undiagnosed for rather lengthy periods of time, but time to diagnosis has improved recently. Even after diagnosis, treatment received was suboptimal.

The Effectiveness and Safety of Thermocoagulation Radiofrequency Treatment of the Ophthalmic Division (V1) and/or Maxillary (V2) and Mandibular (V3) Division in Idiopathic Trigeminal Neuralgia: An Observational Study

Background: Trigeminal neuralgia (TN) is a pain appearing in the ophthalmic (V1), maxillary (V2), and mandibular (V3) trigeminal branches. Pharmacologic treatment is the first line for TN; however, many patients prefer to receive minimally invasive treatment rather than medicine because of intolerable side effects. Thermocoagulation radiofrequency (TRF) is a minimally invasive treatment that has been shown to effectively treat the maxillary (V2) and mandibular (V3) divisions, but the safety of TRF treatment of the ophthalmic (V1) division has been controversial. Objective: This study was to observe the effectiveness and safety of TRF treatment of the ophthalmic (V1) division of trigeminal branches in idiopathic TN patients. Study Design: An observational study. Setting: All of patients received temperature controlled TRF, the effectiveness and safety of TRF was assessed by VAS and complications. Methods: Eighty patients with ophthalmic division (V1) or ophthalmic division (V1) combined with maxillary (V2) or mandibular (V3) divisions of idiopathic TN were treated with step-increased temperature TRF for 6 minutes. At a pulse width of 20 ms, the temperature was titrated up 2 degrees from 60 degrees to 66 degrees every 60 seconds, and then another 66 degrees or 68 degrees for 2 minutes. Meanwhile, the tip of the cannula was turned 180 degrees with each temperature titration. Patients were assessed for pain relief and corneal reflex, numbness, and masticatory muscle weakness at one week, one month, and 3 months after the procedure. Results: Eighty patients were successfully treated with temperature controlled TRF for ophthalmic (V1) division. Excellent pain relief was achieved in 79 of 80 patients (98.75%) after one week, one month, and 3 months, and 78 of 80 patients (97.5%) patients experienced tolerable numbness. Only one patient lost the corneal reflex, 14 experienced a corneal reflex that was mildly decreased, and 2 patients felt a foreign body sensation in the ipsilateral eye after TRF, but there were no corneal ulcers, incidences of blindness, or other complications. Limitations: This study is limited by being an observation study and a non-prospective trial with a short-term follow-up period. Conclusion: Temperature controlled TRF to the ophthalmic division (V1) of the semilular ganglion is effectiveness and safe in TN. Key words: Thermocoagulation radiofrequency, pulsed radiofrequency, trigeminal neuralgia, ophthalmic division, trigeminal ganglion, pain, numbness, corneal reflex

Histology and morphometry of ulnar artery, inferior epigastric artery and coronary arteries – Implication for coronary artery bypass grafting

The orbitofrontal branch of the middle cerebral artery (MCA) is responsible for blood supply to the orbitofrontal cortex along with the orbitofrontal branch of the anterior cerebral artery. Mostly, it is a branch of superior division of M2 segment of MCA; however, in this study, it was seen to arise more commonly from M1 segment of MCA. Though the orbitofrontal branch of ACA is researched by many authors, the orbitofrontal branch of MCA has gained less attention of the researchers. There is paucity of work on this branch of MCA in Indian literature specially in the northern part. Descriptions of the orbitofrontal branch of the middle cerebral artery, which we found in the literature, did not correlate with our observations. The aim of the study was to observe, record, and compare variations in origin and branching pattern of the orbitofrontal artery, hoping to find immediate application of our findings in the field of cerebrovascular surgery.A total of 20 middle cerebral arteries were studied, which were obtained from 10 brains. Meticulous dissection was done, and the middle cerebral artery was exposed and cleaned in lateral sulcus on the inferior surface of the brain. Its orbitofrontal branch was studied in detail. Digital photographs were taken.Out of the 20 MCAs studied, the orbitofrontal artery was found to arise from M1 segment in 15 cases. In the remaining 5 cases, it was found to originate from the superior trunk of M2 segment of the middle cerebral artery.

Study of variations in the origin of obturator artery

Introduction: Obturator artery is the branch of anterior division of internal iliac artery. Variations in its origin are quite common and are very important from surgical point of view. Methods: To study the variations in the origin of the obturator artery 35 dissected vessels were studied. Results: Commonest variation of its origin from the posterior division of internal iliac artery was found in five cases. Other variations like its origin from internal pudendal artery or from inferior gluteal artery were also found, which are also discussed along with its embryological basis and clinical significance. Conclusions: Knowledge of anomalous origin of obturator artery from posterior division is helpful to vascular surgeons while planning endovascular treatment.

Pengaruh Budaya Kerja terhadap Komitmen Karyawan PT Indofood CBP Sukses Makmur Tbk Cabang Bandung Divisi Noodle

<p class="Default"><em>PT Indofood CBP Sukses Makmur Branch Bandung Noodle Division is a company that realizes the importance of work culture and commitment. It is proven by the work culture that the company have implemented in order to guarantee better quality work result, and increase the satisfaction of employees’ work.The objectives of this study are 1) identifying the work culture at PT. Indofood CBP Sukses Makmur Branch Bandung Noodle Division; 2) identifying work commitments on PT. Indofood CBP Sukses Makmur Branch Bandung Noodle Division; and 3) analyzing the influence of work culture with respect to the commitment of employees in PT Indofood CBP Sukses Makmur Branch Bandung Noodle Division. This research shows that Noodle Divsion of the company in Bandung applies excellent work culture and the employees commit. The work culture that is based on excellent, discipline, integrity, innovative, and respect gives positive and significant impacts on employees’ commitment, while unity doesn’t give significant impact on employees’ commitment.</em></p><em>Keyword: </em><em>work culture, employee commitment, PT Indofood CBP Prosperous Successes Tbk Bandung branch division of the noodle</em>

Pengaruh Budaya Kerja terhadap Komitmen Karyawan PT Indofood CBP Sukses Makmur Tbk Cabang Bandung Divisi Noodle

<p class="Default"><em>PT Indofood CBP Sukses Makmur Branch Bandung Noodle Division is a company that realizes the importance of work culture and commitment. It is proven by the work culture that the company have implemented in order to guarantee better quality work result, and increase the satisfaction of employees’ work.The objectives of this study are 1) identifying the work culture at PT. Indofood CBP Sukses Makmur Branch Bandung Noodle Division; 2) identifying work commitments on PT. Indofood CBP Sukses Makmur Branch Bandung Noodle Division; and 3) analyzing the influence of work culture with respect to the commitment of employees in PT Indofood CBP Sukses Makmur Branch Bandung Noodle Division. This research shows that Noodle Divsion of the company in Bandung applies excellent work culture and the employees commit. The work culture that is based on excellent, discipline, integrity, innovative, and respect gives positive and significant impacts on employees’ commitment, while unity doesn’t give significant impact on employees’ commitment.</em></p><em>Keyword: </em><em>work culture, employee commitment, PT Indofood CBP Prosperous Successes Tbk Bandung branch division of the noodle</em>

The Creation of the Center of Metrological Assurance of Nanotechnologies and Assessment of the Compliance of the Products of the Nano Industry

Preconditions for the creation and process of development of the Center of Metrological Assurance and Assessment of Compliance of Nanotechnologies and the output of the nano industry are considered. The organizational structure of the Center as well as the structure and function of its regional and branch divisions are described.

Manifestations cardiaques de la maladie de Takayasu: à propos d’une observation et revue de la littérature

La maladie de Takayasu est une maladie vasculaire inflammatoire rare, touchant préférentiellement la jeune femme avec une atteinte prépondérante de l'aorte et ses premières branches de divisions. Nous rapportons le cas d'une atteinte ostiale du tronc commun gauche au décours d'un syndrome coronarien aigu ST négatif révélant une maladie de Takayasu et nous détaillerons les différentes manifestations cardiovasculaires de cette maladie.