Fibrous Bands Research Articles

Pinch and stretch test to assess and categorize the severity of acne rolling scars

Acne scarring has been a troublesome clinical issue. Rolling scars, the most intractable acne scars, have sloped, shallow borders and a wide base resulting from tethering fibrous bands extending from the dermis to the subcutis. Although various treatments are available for rolling scars, few methods exist to assess the severity of these scars to identify optimal treatments and therapeutic responses.

Clinical observation of gonadal dysgenesis with surgical correction

Anomalies of sexual development, despite their low prevalence, are relevant both due to the rapid expansion of diagnostic capabilities at the genetic and genetic levels, and due to increasing attention to the social adaptation of such patients. This article is devoted to the description of clinical observation of a rare form of sexual rosette anomalies – Swyer syndrome, which consists in the underdevelopment male gonads in persons with 46XY karyotype. The most common and studied cause of male gonadal dysgenesis is a SRY gene mutation, which is responsible for testicular development. So far, several point mutations in genes involved in the development of male gonads have been identified. Genes are located in both autosomes and both sex chromosomes. One of the newest pathogenetic mechanisms of this syndrome is a MYRF gene mutation. The main consequence of this mutation is a violation of myelination, its role in disorders of sex differentiation has recently been shown. Patients with Swyer syndrome at birth have phenotypic traits of the female sex. Delayed sexual development is registered in adolescence; ultrasound reveals a hypoplasia of the uterus, gonads in the form of fibrous bands. Clinical observation of a 27-year-old patient with complaints of lack of menstruation, coarsening of the voice and facial hair growth is present. Examination revealed the female type structure of the external genitalia, clitoral hypertrophy, vaginal aplasia, 46XY genotype, MYRF mutation. Surgery was performed. It included cystoscopy (free urethra, ureteral stenting), laparoscopy (uterus and ovaries in the pelvic cavity are not visualized, gonads are found at the level of the inguinal ring and removed), transperitoneal tunneling of the vagina, dissection of the vertical membrane of the vagina, removal of the clitoris, resection of the labia minora. Patient underwent complete physiological and social adaptation 6 months after operation.

Demayo Sandra

Introduction: Usual sex determination and differentiation occurs progressively during the period of embryonic development, involving chromosomal differentiation, gonadal differentiation, and somatic or genital differentiation. Swyer syndrome is a disorder of sex chromosomes and sexual differentiation characterized by 46, XY pure gonadal dysgenesis in a phenotypically female person with primary amenorrhea, and a complete absence of functioning gonadal tissue. Gonadal malignancy occurs in 10-30% of cases, so gonadectomy is indicated at the time of diagnosis. The treatment includes, in addition to the gonadectomy, hormone replacement therapy, and psychological support. Objective: To present a case diagnosed and managed in our institution, in addition to reviewing the recent literature about this rare condition, but with a strong physical, psychological and social impact. Methods: Analysis of clinical history of a patient with Swyer's Syndrome, diagnostic and therapeutic management. Bibliographic review. Presentation of the clinical case: An 18-year-old patient attends our hospital presenting primary amenorrhea. She presents BMI: 22; Tanner stage PH III BD III, gynecological examination with vulva and vagina with normal characteristics. Hormone profile requested: FSH 96.8 mU/ml, LH 32.9 mU/ml, Estradiol <25 pg/ml; Total testosterone 0.15 ng/ml. TV ultrasound shows a hypoplastic uterus of 23x11x29 mm, ovaries are not visualized, and a heterogeneous solid image of 22x23x24 mm in the left adnexal region. 46XY karyotype. In the presence of these results, a diagnosis of Swyer's syndrome is made, so an MRI was requested, which shows a uterus of 14x20x26 mm, ovaries are not visualized, a solid lobulated oval image of 23x33x47 mm poorly vascularized standing out in the left adnexal region and free inguinal canals. It was decided to perform exploratory laparoscopy and gonadectomy. The intraoperative findings were: intrapelvic hypoplastic uterus, uterine tubes without any particularities, enlarged left gonad of approximately 3x4 cm pearly white with a hard elastic consistency, and a fibrous band in the right adnexa. Bilateral adnexectomy was performed, obtaining as a histological result well-differentiated left dysgerminoma SALL4 +, OCT3/4 +, negative Inhibin and CD 117 +, and right streak gonad. Conclusions: In the presence of a person with primary amenorrhea and absence or poor development of secondary sex characteristics, Swyer's syndrome should be suspected, and pertinent studies should be requested to arrive at the diagnosis. It is essential to perform gonadectomy at the time of diagnosis due to the risk of malignant transformation. The importance of a multidisciplinary approach and psychological accompaniment of patients and relatives is highlighted.

Rare Cause of Chronic Post Prandial Abdominal Pain: Median Arcuate Syndrome

Median arcuate ligament syndrome, is a rare anatomical and clinical entity characterised by chronic abdominal pain. This condition results from compression of the celiac trunk by a fibrous band of the diaphragm called the median arcuate ligament. generally of fortuitous discovery, its diagnosis is made on computed tomographic angiography. We report the case of a 40-year-old patient who was referred to us for atypical epigastric pain that increased after meals.

Imaging of Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome on MRI Examination in dr. Soetomo Hospital.

Introduction: MRKH syndrome represents total or partial agenesis of the uterus and the two-thirds portion of the vagina, with 46XX karyotyping and normal bilateral ovaries and a Fallopian tube. Despite the uterus agenesis, the Mullerian remnants, including uterine buds, fibrous bands, and midline triangular soft tissue, are visible. Magnetic Resonance Imaging (MRI) is a non-invasive modality with 100% accuracy, which is ideal for depicting Mullerian duct anomalies. Materials and Methods: This is a descriptive study using a retrospective approach done in Dr. Soetomo General Hospital Surabaya and has obtained ethical permission. Our samples included 38 data from pelvic MRI acquired from medical records in Dr. Soetomo General Hospital between May 2018 and January 2022. Results: The age group between 21 and 30 constituted a significant proportion of MRKH patients. The location of the right and left uterine buds relative to the ovarium were identified repeatedly in the anterior caudal, appearing isointense in the T2WI sequence. The right fibrous band was evident in 35 patients (94.7%), while the left fibrous band appeared in 35 patients (92.1%). Midline triangular soft tissue was visible in 35 patients (92.1%), showing a hypointense signal, 35 patients (92.1%) with intrapelvic right and left ovaries, and one patient (2.6%) with left endometrioma. The proximal vagina was not apparent in all patients, while 31 patients (81.6%) were shown to have the distal vagina. Conclusion: MRI can yield accurate information in describing anatomical abnormalities in MRKH. Although the findings of this study have been satisfactory, further research entailing larger samples is necessary to correlate the MRI features and surgery outcomes to assess its reliability.

P-36666236-311 - Abdominal dermal fat graft versus nasolabial flap in oral submucous fibrosis: A randomised clinical trial

<h3>Background</h3> The surgical management of oral submucous fibrosis (OSMF) includes intraoral release of fibrous bands and creating a raw area, usually covered by biological or non-biological materials. The abdominal dermal fat graft is easy to harvest, with sufficient bulk and is cosmetically better, while the nasolabial flap has good vascularity. This study compares the efficacy of abdominal dermal fat graft with nasolabial flap in OSMF. <h3>Method</h3> Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (Abdominal dermal fat graft) and Group B (Nasolabial flap). They were evaluated for graft uptake, mouth opening, time taken for mucosalization, pain and thickness of masseter muscle on ultrasonogram (USG) till 6 months. <h3>Findings</h3> At 6 months, the average mouth opening improved by 22.4mm (20- 24mm) and 36.2mm (32-37mm) in Group A and Group B respectively which was clinically and statistically significant. Graft uptake was 80% in group A and 100% in group B and time taken for mucosalization was 11 weeks for group A and 6 weeks for group B which was statistically significantly better (p<0.05) for group B. No statistical difference was noted in pre and post operative pain and thickness of masseter muscle in both groups. Intraoral hair growth, facial scar and accentuation of the nasolabial fold was seen in Group B. <h3>Conclusion</h3> Nasolabial flap holds better in terms of mouth opening, graft uptake and time taken for mucosalization as compared to abdominal dermal fat graft in the management of OSMF.

Supracondylar Process of Humerus – Report of Two Cases

Supracondylar process of the humerus is a congenital bone projection seen on the distal humerus on the anteromedial surface. A fibrous band called ligament of Struthers’ connects the supracondylar process of humerus with medial epicondyle. It is mainly asymptomatic but rarely can present as supracondylar process syndrome due to neurovascular compression. Although isolated median nerve injuries are most common they can also present with fractures and vascular complications. The ulnar nerve is rarely involved. The median nerve can be trapped at several sites proximal to the carpal tunnel. Potential sites where the median nerve can be trapped are bicipital aponeurosis, two heads of pronator teres, flexor digitorum superficialis, aponeurotic arch and Gantzer muscle.[1]&#x0D; Supracondylar process of the humerus is a hook-like bony process seen about 5 cm proximal to the medial epicondyle and has a pointed apex. It is curved downwards and forwards and is commonly seen in climbing mammals. Vinilla et al. published a comparison of measurements of the supracondylar process of the humerus in different studies. The length of the process varied from 0.3 cm to 1.6 cm, breadth 1cm to 1.5 cm and distance from the medial epicondyle varied from 4.4 cm to 6.5 cm. They concluded that the supracondylar process had to be differentiated from osteochondroma and myositis ossificans.[2]

Fibrolamellar hepatocellular carcinoma: A rare but unpleasant event.

Fibrolamellar carcinoma (FLC) is a rare variant of hepatocellular carcinoma (HCC), comprising 1%–9% of all HCCs. FLC is a poorly understood malignancy, which seems to be more prevalent in young patients with no underlying liver diseases. The term “fibrolamellar” is derived from thick fibrous collagen bands surrounding the tumor cells. Unlike HCC, cirrhosis and viral hepatitis infection are not predisposing to FLC, and it is not associated with elevations in serum alpha-fetoprotein. FLC patients often present with vague abdominal pain, nausea, malaise, and weight loss. Most cases present are at an advanced stage at the time of initial diagnosis. However, curative treatment options can still be offered to up to 70% of patients. Surgery (resection/liver transplantation) is the mainstay of treatment and the only potentially curative option. FLCs have been less chemo-responsive than the conventional HCC, however, in advanced cases, multimodality treatments can be effective. Recent advances in molecular studies of FLC have found a unique DNAJB1–PRKACA fusion transcript in most of the cases studied. The review aims to describe clinical characteristics, diagnostic methods, and therapeutic modalities for this rare tumor to raise awareness among clinicians and surgeons.

Comparison between Dura-Splitting Technique with Duraplasty in Symptomatic Patients with Chiari Malformation Type I: A Systematic Review and Meta-analysis

BACKGROUND: There are many surgical procedures for CIM patients, posterior fossa decompression with fibrous band excision, with additional duraplasty, or syringosubdural shunt for syringomyelia related CIM. Prospective studies have been carried out but yet no conclusion, on which one is the best option. The objective of this study was to assess qualitatively the outcome of posterior fossa decompression with dura-splitting (PFDDS) technique compared to posterior fossa decompression with duraplasty (PFDDP) for treating CIM patients. AIM: This study aimed to give us a preference while conducting surgery in a patient with Chiari malformation type I (CIM) between posterior fossa decompression with incision of the fibrous band of the dura (dura-splitting/DS) technique and duraplasty (DP) technique. METHODS: The analysis conducted using PRISMA flowchart with PICO framework (Patient: Chiari malformation type I patient over preschool age; Intervention: Dura-splitting; Comparison: Duraplasty; and Outcome: Complication rate, length of stay, reoperation rate, syrinx reduction, symptomatic improvement, and operation time) and already registered for meta-analysis study with database searching from PubMed, the Cochrane Library, and Google Scholar that following inclusion criteria: (1) Original study; (2) study that compares DS and DP in CM- I; and (3) patient age over preschool age. RESULTS: A review of five included studies involving 458 patients met the inclusion criteria, in which 319 patients treated with DS surgery and 139 for DP surgery for this study. Significantly DS technique correlated lower rate of complication (RR = 0.20; p &lt; 0.0001), shorter length of stay (MD = −3.53; p = 0.0002), and shorter operation time (MD = −58.59; p = 0.0004). No significant differences in reoperation rate (RR = 1.90; p = 0.22), symptom improvement (RR = 1.12; p = 0.44), and syrinx reduction (RR = 1.11; p = 0.56) were noted. CONCLUSIONS: Posterior fossa decompression using the DS technique is associated with a lower rate of complication, shorter length of stay, and shorter operation time. However, no significant differences were found in the reoperation rate, symptom improvement, and syringomyelia reduction between these two techniques.

Clinical Profile of Cirrhosis of Liver with Special Reference to Bacteriological Profile of Patients at a Government Tertiary Care Center in Maharashtra

Background: Cirrhosis is defined as the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury that leads to portal hypertension and end stage liver disease. The exact prevalence of cirrhosis worldwide is unknown. Cirrhosis prevalence was estimated at 0.15% or 400,000 in the USA where it accounted for more than 25,000 deaths and 373,000 hospital discharges in 1998. This may be an underestimation as we recognize the high prevalence of undiagnosed cirrhosis in both NASH and hepatitis C. Similar numbers have been reported from Europe, and numbers are even higher in most Asian and African countries where chronic viral hepatitis B or C are frequent. Since compensated cirrhosis often goes undetected for prolonged periods of time, a reasonable estimate is that up to 1% of populations may have histological cirrhosis. Aim: To study clinical profile of cirrhotic patients. Material and Methods: A cross-sectional observational study was carried out at Inpatient Department of Medicine of tertiary care hospital. Total 100 cases were studied. Registration of patients was from October, 2019 to March 2021. They were registered when admitted under Medicine department. At the time of registration, the patients with exclusion criteria were not enrolled for study. The main objective of this study is to study the biochemical and bacteriological profile of cirrhotic patients. At the time of registration, the baseline information was taken especially with respect to sociodemographic factors, clinical findings, and other investigations. The data thus collected was analysed to study clinical profile of cirrhotic patients. Results: Mean age in years was 55.1 +15.06, ranging from 24 to 75. Majority 40% were in age group of 40 to 60 years. Majority 68% were males and 32% were females. Mean SBP was 150.15+21.54 ranging from 100 to 210. 66% had increased SBP i.e.&gt;140 mm of Hg and Mean DBP was 91.64+11.87, ranging from 60 to112. ...........

Nodular Lymphocyte-predominant Hodgkin Lymphoma With Nodular Sclerosis: An Underrecognized Feature Associated With Pattern D.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) with unusual features, including some that can overlap morphologically with classic Hodgkin lymphoma (CHL), have been described. Herein, we describe 12 cases of NLPHL with fibrous bands and capsular fibrosis resembling, in part, nodular sclerosis (NS) CHL. Seven of 12 cases harbored Reed-Sternberg-like cells, further suggestive of CHL, but all cases lacked associated eosinophils and/or plasma cells in the background. In this cohort, all cases had areas of so-called pattern D (nodular T-cell rich) as a sole component in 7 (58%) cases or as a hybrid pattern along with pattern E (diffuse T-cell/histiocyte-rich) in 5 (42%) cases. The immunophenotype of the large neoplastic cells in these cases supported their being lymphocyte predominant cells of NLPHL, positive for CD20, CD79a, and OCT2, and negative for CD15 and CD30. However, PAX5 was weak in 9 of 11 cases similar to Hodgkin/Reed-Sternberg cells in CHL. We conclude that some cases of NLPHL are associated with fibrous bands and capsular fibrosis and resemble, in part, NS CHL. In our experience, NLPHL with NS-like features occurs in 10% to 15% of cases of NLPHL and is associated with a variant pattern (D and/or E). In addition, all patients in this cohort were not treated before biopsy, suggesting that the prominent sclerosis in these cases is inherent to disease biology. Recognition of NLPHL with NS-like features further expands the morphologic spectrum of NLPHL and helps avoid potential misdiagnosis as CHL.

Analysis Of Serum Iron And Heamoglobin Level In Patients With Oral Submucous Fibrosis.

OSMF is chronic underlying disease. The disease is well recognized and had an importance due to high malignant transformation rate. Multiple etiological factors are found responsible in the pathogenesis of the disease course. The effect of areca-nut is mainly causing trismus of the oral cavity. This may compromise the food intake of the patients who are facing this precancerous disease. Total one hundred and 28 patients were selected and equally distributed into two groups. It is an observational, cross- sectional study. Sixty four patient with OSMF were selected on the basis of fibrous band formation and mouth opening. The etiological factors such as chewing habit had been denoted in forms. The heamoglobin and iron levels were analyzed from laboratory using automated machines used for blood analysis. The OSMF group showed insignificant variation when the two groups were compared. Whereas the sub-groups of OSMF are showing moderately significant correlation for the serum iron and heamoglobin levels. The outcome of the present study emphases on the assessment of heamoglobin and serum iron for OSMF patients. The patients must be prescribed with the micronutrients therapy so that any deficiency which may contribute in the disease course can be intercepted at the beginning. Further the patients must be educated in term of quitting the chewing habit so that his/ her life not get compromised due to OSMF.

Comparison of the Efficacy of Amniotic Membrane Versus Buccal Fat Pad in Treatment of Oral Submucous Fibrosis.

Oral and maxillofacial surgery deals with wide range of oral defects, wound closure, tissue resection, and tissue reconstruction. The purpose of our study is to use amniotic membrane for closure of post surgery defect in patient of oral submucous fibrosis to utilize its growth factor and scaffold nature for effective healing and to evaluate effectiveness of amniotic membrane in treatment outcome. The objectives are to compare post-operative mouth opening, healing of amniotic membrane and buccal fat pad. Diagnosed patients with OSMF are divided into two surgical site Group I (n = 5patients)-Left side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with BFP. Group II-Right side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with freeze dried irradiated amniotic membrane. This study suggested that in comparison to buccal fat pad flap, the HAM graft is a better option for oral reconstruction in terms of infection, graft failure, MMO, inflammation, pain. Outcome indicated that the HAM is biologically ideal graft for oral wounds and could be used as clinical alternative for various repair surgery for oral defects. The amniotic membrane was found easy to handle and easy to use with inherent hemostatic property which is observed in all patients. No patients had shown any evidence of any complications. Good pain control observed in patients throughout postoperative period.

Clinical evaluation of the buccal fat pad vs nasolabial flap as an interposition graft material in oral submucous fibrosis patients

AIM: Aim of the study is to evaluate efficacy and compare the surgical outcome of buccal fat pad and nasolabial flap in increasing postoperative mouth opening in reconstruction of the defect created after excision of fibrous bands in surgically treated cases of OSMF. Materials and Methods: this study included 10 patients who came in our department at karnavati school of dentistry between the years 2017 and 2020, out of which 5 patients underwent closure of surgical defect using buccal fat pad (Group I) and 5 patients underwent closure of surgical defect using nasolabial flap (Group II). Clinically proven cases of OSMF with mouth opening no more than 20 mm were included in this study. Mouth opening of patients were documented preoperatively, intraoperatively and at 6 months of follow up. Results were tabulated and were analysed by paired t test. Results: in group I and II, there was substantial difference in mouth opening at all periods of follow-up. At 1 month follow-up, mean mouth opening was 29.4 mm in group 2 compared with 28.25 mm in group I.

A Modern View of Morphological Changes in the Gums in the Course of Inflammatory Processes

The purpose of the study was the analysis of literature sources with the study of a modern view of morphological changes in the gums in the course of inflammatory processes. Materials and methods. Review and analysis of scientific and medical literature based on databases such as Scopus, Web of Science, MedLine, PubMed, NCBI, the study of which does not exceed 10 years, including literature reviews and clinical trial results. Results and discussion. The analysis of the literature indicates significant morphological changes in the gums in the course of chronic catarrhal gingivitis, which occurs in both the epithelium and their own plate. Thus, the epithelium responds with signs of keratinization disorders. In the course of inflammatory processes in gums, changes of the morphological organization both in epithelial and connective tissue component have been observed. The cytoplasm of the cells of the spiny layer contains granularity, the nuclei are pyknotic and hyperchromic, the boundaries between the cells lose clarity. There is a sharp increase in the amount of glycogen in the cells of the spiny layer. Connective tissue undergoes changes in the form of disorganization, which manifests itself in focal or diffuse gamma metachromasia. The focus of inflammation is clearly separated from the surrounding connective tissue by fibrous bands, which is accompanied by the accumulation of PAS-positive substances and glycosaminoglycans. Changes in the microcirculatory tract of the gums are manifested by dilation of capillaries, venules with diapedetic hemorrhages, endothelial proliferation, swelling of the basement membrane, and the appearance of pericellular oedema. There is moderate fibrosis of the own plate of a mucous membrane in deep layers and the phenomenon of sclerosis. There is also leukocyte infiltration with localization of cells between epitheliocytes, their necrobiotic changes in the form of accumulations of granular basophilic substance. Conclusion. Based on the literature sources, it should be noted that there are only a few sources that characterize the change of the epithelium and its own plate in the course of inflammatory processes, and they are not enough to fully understand the morphological rearrangement of gums at the histological and ultrastructural levels. Special studies of mast cells and their impact on the occurrence and course of the inflammatory process in the gums have not been conducted. Until now, the question of the secretion type of tissue basophils in the course of inflammatory processes in the gums remains open

Bilateral Carotid Stenosis in a Patient with Previous Neck Surgery: Difficulties in Endarterectomy

Carotid stenosis is an important cause of recurrent transient ischemic attacks and stroke. Carotid stenting and endarterectomy are considered equally effective in treating this condition. We report a patient with recurrent TIA and bilateral carotid stenosis who had undergone anterior cervical diskectomy and fusion and who was found to have fibrous bands encasing the right carotid artery. He was treated with endarterectomy on the left side and carotid stenting on the right side. With the widespread availability of procedures like carotid endarterectomy, more older people would undergo this surgery, who might have undergone anterior cervical surgery. Prior neck surgery and adhesions may lead to altered anatomy, risk of increased blood loss, and surgical complications. In such cases, carotid stenting could be an alternative to endarterectomy.

Endoscopic Sciatic Neurolysis for Deep Gluteal Space Syndrome

Background: Deep gluteal syndrome (DGS) encompasses a spectrum of pathologies causing symptomatic sciatic nerve compression deep to the gluteus maximus muscle. Endoscopic sciatic neurolysis is an option for management of DGS when conservative treatment fails. Indications: Endoscopic sciatic neurolysis is indicated for retro-trochanteric pain, sciatica-like burning in the posterior thigh, and sitting discomfort that is reproducible on physical examination after failing conservative management. Technical Description: The technique presented here introduces a standard endoscopic sciatic neurolysis technique with an accessory posterolateral portal placed distally and in line with the sciatic nerve. Use of a switching stick through an accessory distal posterolateral portal can allow for in-line protection and retraction of the sciatic nerve while it is carefully released from compressive fibrous bands using an arthroscopic shaver. It is important that the accessory portal be placed under direct visualization with caution not to injure the sciatic nerve. An arthroscopic radiofrequency device can be used for hemostasis and further release of fibrous bands. At the end of the procedure, the sciatic nerve should be visualized fully released and freely mobile from the piriformis muscle to the level of the lesser trochanter. Results: In properly selected patients, the procedure is very successful. In a series of 35 cases, the procedure reduced sitting pain (present in 97% of patients preoperative, 17% of patients postoperative), reduced narcotic use, improved visual analog scale (VAS) pain scores, and improved modified Harris hip scores without major complications. Discussion: Although rare following hip arthroscopy, postoperative scarring and fibrous bands are a common cause of DGS which can be effectively treated by endoscopic sciatic nerve decompression. Results of endoscopic sciatic neurolysis have thus far been encouraging with improvements in patient reported outcome scores and high rates of satisfaction. However, complications do occur and can result in neurologic deficits. Nevertheless, with careful patient selection and meticulous sciatic nerve dissection, endoscopic sciatic neurolysis for DGS is a safe and effective technique for decompression of fibrous bands and adhesions that can lead to sciatic neuralgia.

Quadrangular Space Decompression

Background: The quadrangular (or quadrilateral) space is defined by its anatomical borders and is the passageway for the axillary nerve and posterior circumflex humeral artery (PCHA). Quadrangular space syndrome (QSS) can present due to various compressive pathologies but is commonly seen in overhead athletes. Quadrangular space syndrome can present with neurogenic symptoms including pain and paresthesias, as well as vascular complications from compression of the PCHA including thrombosis, aneurysm formation, and distal emboli. Indications: Surgical decompression of the quadrangular space is indicated for severe neurogenic or vascular compromise in the case of QSS refractory to nonoperative treatment. Technique Description: After appropriate preoperative physical examination findings and trial of nonoperative treatment, including physical therapy and injections, surgical decompression was indicated. The posterior border of the deltoid was marked, and an incision centered over the posterior border of the deltoid lateral to the axillary fold was made. Posterior border of deltoid was identified and retracted, revealing the interval of the teres minor and major. The nerve to the teres minor was identified, protected, and fibrous bands compressing the nerve were released. The nerve to the teres minor was tracked deep to find the axillary nerve. This was identified and fibrous bands around the nerve were decompressed. The circumflex vessels were protected throughout. Following decompression of the nerves, there was free movement of the nerves indicating adequate surgical decompression. Results: Adequate surgical decompression of the axillary nerve and PCHA achieved with resolution of neurogenic symptoms of pain and paresthesias at first postoperative visit. Discussion/Conclusion: Quadrangular space syndrome is a rare disorder, can be difficult to diagnose, and is the cause of significant morbidity, particularly in overhead athletes. If symptoms persist after nonoperative treatment, operative decompression of the quadrangular space may be indicated. Adequate surgical decompression results in relief of neurogenic and vascular symptoms.

Congenital muscular torticollis in young adultpatient: A neglected case.The efficiency of bipolar release

Congenital muscular torticollis (CMT) is a common postural deformity evident shortly after birth characterized by ipsilateral cervical lateral flexion and contralateral cervical rotation due to unilateral shortening of the sternocleidomastoid muscle. Untreated, the sequelae include facial asymmetry, tight bands, ophthalmic abnormalities, and altered neck posture. To report a neglected CMT in 17-year-old female treated surgically by bipolar muscle release technic. The surgery was made via a double incision above the clavicular and mastoid with the liberation of the fibrous bands followed by intensive physiotherapy program. The patient was very satisfied after management. Neglected CMT adult’s patients can benefit from surgical treatment. Bipolar release is an adequate and complication-free method with postoperative physiotherapy program.

The Role of Hypericum Perforatum (St. John's Wort Oil) and Olive Oil in the Prevention of Peritoneal Adhesion in a Rat Model: An Animal Study

Objective: We aimed to investigate Hypericum Perforatum (St. John's Wort Oil) and pure olive oil with respect to their effect on preventing intra-abdominal adhesions after abdominal surgery.Methods: This was an animal study carried out by the Giresun Faculty of Medicine, Department of General Surgery between August 10, 2020, and September 10, 2020. In the study, intra-abdominal adhesion development was examined macroscopically and microscopically on the 14th day after experimental abdominal surgery in three groups [(i) Control, (ii) olive oil application, (iii) St. John's Wort oil application] each consisting of 7 female Wistar Albino rats. Majuzi classification and Zuhlke's microscopic adhesion classification was used to evaluate adhesions.Results: Macroscopically, fibrous bands were not observed in 1 rat in the control group, 2 rats in olive oil recipients, and 1 rat in St. John's Wort oil recipients. A significant difference between the groups was identified in terms of Zuhlke's microscopic adhesion scores (p = 0.026). Accordingly, the adhesion level was significantly reduced in olive oil recipients compared to controls (p = 0.002). There was no significant difference in terms of adhesion between all groups (p&amp;gt;0.05). The Majuzi adhesion classifications in the control group, olive oil group and St. John's wort groups were also similar (p = 0.308).Conclusion: In rats who underwent abdominal surgery, it was determined that intra-abdominal olive oil application reduced the level of adhesion, while St. John's Wort oil application had no effect on adhesion formation.