Horizontal Fissure Research Articles

Ophthalmic diagnostic tests and ocular findings in healthy adult cockatiels (Nymphicus hollandicus)

Cockatiels (Nymphicus hollandicus) are a common companion psittacine for which little ophthalmic data has been gathered. The goal of this study was to establish normal ocular parameters in healthy cockatiels and evaluate whether intraocular pressure (IOP) varies by restraint method. Twenty-five cockatiels free of ophthalmic disease underwent complete ophthalmic examination including slit-lamp biomicroscopy, indirect ophthalmoscopy, and measurement of palpebral fissure diameter, tear production by absorbent paper point tear test (PPTT) and rebound tonometry. IOP measurements were obtained with birds held in two different body positions (vertical and dorsal recumbency). Cockatiel eyes are atapetal, anangiotic, and possess robust filoplumes, brown irises, pleated pecten, and circular pupil. There was no significant difference for horizontal palpebral fissure diameter, vertical palpebral fissure diameter, PPTT or IOP when comparing dorsal to vertical recumbency. For all eyes (50 eyes from 25 cockatiels), the mean (range) of horizontal palpebral fissures was 5.45 (5.0–6.0) mm, PPTT was 9.39 (6–14) mm/15s, and IOP (both recumbencies) was 13 (8.0–24.0) mm Hg. Described data can be used to improve diagnosis and management of ocular alterations in this species.

Single-triangle technique for congenital ptosis repair with a frontalis sling in blepharophimosis patients.

The purpose of this study was to describe the single-triangle technique for congenital ptosis repair with a frontalis sling in blepharophimosis patients. The single-triangle technique was used in 40 eyes of 20 patients of blepharophimosis syndrome. The center point of the lid is marked. The desired base length is calculated depending on the available horizontal fissure width. Two marks are inked 2 mm above the lid margin, equidistant from the central mark. A single brow mark is placed in such a way that it is directly above the center point of the lid. These are now joined to complete the triangle. In blepharophimosis patients, the mean preoperative margin reflex distance (MRD1) was 1.0 ± 1.1 mm which increased to 4.1 ± 1.6 mm after surgery. The MRD1 increased by 3.1 ± 1.7 mm. Cosmetic outcome was graded with a score of 0, 1, or 2 to indicate poor, good, and excellent results, respectively. Out of the 40 eyes that were operated, 33 eyes had a score of 2, 5 eyes had a score of 1, and 2 eyes were scored 0. The single-triangle technique has several advantages over both the Fox pentagon technique and modified Crawford technique in severe blepharophimosis patients. It is not only a much simpler procedure to perform but also has a better control over the curvature of the lid without any central focal notching, thus providing better cosmesis and esthetic results.

Translobar Phenomenon of Pulmonary Veins and Its Clinical Significance in Lobectomy

背景与目的肺叶切除术是早期肺癌的主要治疗方式，然而肺部解剖变异繁多，尤其是部分肺静脉会脱离正常解剖位置，甚至跨越肺叶边界进入相邻肺叶，这增加了手术的难度和风险。本研究旨在全面分析肺跨叶静脉的类型和发生频率，并进一步探究其在肺叶切除术中的临床意义。方法纳入南京医科大学第一附属医院2018年12月-2019年11月期间行肺部手术的患者916例，筛选出术前行胸部增强计算机断层扫描（computed tomography, CT）检查的病例310例，应用这些患者的胸部增强CT和三维CT支气管血管成像（three-dimensional computed tomography bronchography and angiography, 3D-CTBA）对跨叶静脉的类型及频率进行分析。进一步从916例手术病例中筛选出行肺叶切除术且手术区域涉及到跨叶静脉的病例共48例（切断组36例，保留组12例），通过手术录像观察两种不同的处理方式对余肺叶的影响。结果共发现26种肺跨叶静脉模式，总发生率为82.26%，右肺远大于左肺（80.65% vs 11.94%）。右肺中主要类型（频率 > 5%）包括：中间支气管后方汇入下肺静脉的VX2（5.48%）、汇集上、下叶静脉属支的叶间静脉V3b（58.39%）、水平裂内汇入V2（13.23%）或V3（12.58%）的VX4、中叶支气管下方汇入左心房的VX4（8.71%）或VX5（7.42%）、肺裂内汇入V2的VX6（29.68%）；左肺中主要类型为整支上肺静脉汇入下肺静脉形成共干的左肺静脉（9.36%），其中共干长度 > 1 cm的占4.84%。观察手术录像发现：与保留组相比，切断组中患者其余肺叶的血液循环功能受到影响（表现为受影响区域停止通气后长时间无法萎陷），术后咯血（13.89% vs 0.00%）和肺漏气（19.44% vs 8.33%）发生率增加，术后住院时间[(4.72±1.86) d vs (3.92±1.62) d]较长，术后3 d引流量[(705.42±265.02) mL vs (604.92±229.64) mL]较多，但差异无统计学意义（P > 0.05）。结论肺静脉跨叶现象种类繁多，且部分类型发生率较高。然而大部分跨叶静脉在手术中被忽视，这可能对手术安全和患者术后恢复产生不利影响。

Variations in the Human Pulmonary Fissures and Lobes: A Cadaveric Study

The objective of this study was to describe the variations in human pulmonary fissuration in a cadaveric Kenyan population. Data were collected from 48 formalin-fixed cadavers in the department of Human Anatomy, University of Nairobi, Kenya; with 38 right and 32 left lungs meeting the study’s inclusion criteria. The fissures were studied irrespective of the cadaver’s sex and were classified anatomically as proposed by Craig and Walker (1997). Out of the 38 right lungs examined, the horizontal fissure was absent in 4 lungs (10.5%), incomplete in 16 lungs (42.1%), and complete in 18 lungs (47.3%). Out of the 32 left lungs, the oblique fissure was incomplete in 11 lungs (34.4%) and complete in 21 lungs (65.6%). An accessory fissure was observed in 3 right lungs (7.9%); 2 of which were inferior accessory fissures and 1 being an azygous fissure. Twelve left lungs (37.5%) had an accessory fissure; all of which were left minor fissures. The present study details important variations in the anatomy of the human pulmonary fissure in Kenya. Knowledge and awareness of these findings are paramount, due to their implications in clinical practice, such as in the interpretation of thoracic images by radiologists and preoperative planning by thoracic surgeons.

Triple trouble: Congenital nasolacrimal duct obstruction, cleft palate, and sensorineural hearing loss - A rare association of blepharophimosis-ptosis-epicanthus inversus syndrome

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is autosomal dominant disorder affecting 200 families worldwide. It is marked by bilateral ptosis with poor levator function, shortened horizontal palpebral fissures, and epicanthus inversus. We report a case of 7-month-old female child who presented to us with watering of both eyes since birth and failure to thrive. Examination revealed peculiarities of BPES with bilateral congenital nasolacrimal duct obstruction (CNLDO) and associated findings of bilateral sensorineural hearing loss (SNHL) and cleft palate. Initially, conservative management followed by probing, cleft palate correction, and V-Y plasty was advised and ptosis correction planned at later age. There are several ocular and nonocular associations with BPES, but CNLDO, cleft palate, and SNHL together have never been reported to the best of our knowledge.

Transcriptomic Gradients Of The Human Cerebellum

In the past decade, there has been major interest in understanding the role of transcriptomics in the functional and anatomical layout of the brain. To date, almost all of the work linking transcriptomics to human brain function and structure has been restricted to the cerebral cortex. The culmination of this work has identified transcriptomics as an important shared principle that can tie together function, structure, and gene expression. However, largely missing from this work is the subcortex, namely the cerebellum. Here we investigate whether transcriptomics offer a link between function and structure in the human cerebellum, using gene expression data from post-mortem cerebella and multi-modal brain atlases. We find that transcriptomic gradients from a sparse subset of genes align with a macroanatomical rather than a functional parcellation of the cerebellum, and the transition of the main gradient occurs at the horizontal fissure for the group, as well as individual cerebella.

Freeze-thaw impact on macropore structure of clay by 3D X-ray computed tomography

The change of soil macropores, especially fissures, due to freeze-thaw (F-T) has important implications for soil engineering properties such as hydraulic conductivity and compressibility. This paper describes a quantitative study of the soil macropore changes due to F-T by using three-dimensional (3D) X-ray Computed Tomography (CT). Saturated lean clay specimens were subjected to unidirectional F-T under different water-supply conditions for acquiring 3D X-ray CT images before and after F-T. The CT imagery data were filtered and processed for obtaining parameters such as transverse-sectional macro-porosity, macropore size, transverse-sectional fissure porosity, and longitudinal-sectional fissure orientation frequency distribution. It was found that F-T alters the transverse-sectional macro-porosity and macropore size significantly, the changes are different across the specimen height. Moreover, the changes in the transverse-sectional fissure porosity and longitudinal-sectional fissure orientation frequency distribution vary along with the specimen height. More horizontal fissures form in the unfrozen zone or near the freezing front, depending on water-supply conditions. Pore water pressure data confirm that, besides water migration, soil particles also migrate from the unfrozen zone to the freezing front during freezing with water-supply due to piping. The macropore structural changes help understand the F-T impact on soil engineering properties such as hydraulic permeability and compressibility.

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure.

The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery. Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted. LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs. This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures.

CT imaging and pathological basis of linear shadow connecting pulmonary segmental artery to horizontal fissure.

To investigate the computed tomography (CT) imaging and pathological basis of the linear shadows connecting pulmonary segmental arteries to horizontal fissure (hereinafter referred to as “linear shadow”) on thin-slice CT.Collect 127 clinical cases to analyze the display and morphology of linear shadows on the thin-slice CT and to measure their length, thickness, and angle. Collect 11 autopsy specimens of coal worker's pneumoconiosis to conduct an imaging and pathology basis control study for the linear shadows.There is no correlation between the linear shadow and gender, age, and smoking history. Linear shadows are observed in 54.33% of patients. 93.33% of those linear shadows are straight lines. Generally, the lengths are less than 10 mm, the thicknesses are around 1 mm, and the scopes of angles are wide, range from acute angles to obtuse angles. The linear shadow is a banded structure consisting of loose connective tissue, small blood vessels, and small lymphatic vessels due to the visceral pleura recessed and fused into the lung.Linear shadows are intrinsic to the lung. The linear shadows consist of loose connective tissue, small blood vessels, and small lymphatic vessels.

The hanging technique using the superior petrosal vein in surgical transposition for trigeminal neuralgia

BackgroundRecently, transposition of the offending vessel has become the gold standard technique in microvascular decompression for trigeminal neuralgia. Teflon felt is the main material used, and the effectiveness of transposing the offending vessel to the cerebellar tentorium using Teflon felt has been widely demonstrated. However, foreign body reaction occurs in some cases causing granulation tissue formation and recurrence of trigeminal neuralgia. We investigated an alternative technique where the offending vessel (superior cerebellar artery) is transposed to the superior petrosal vein without use of Teflon felt for treating trigeminal neuralgia. MethodsThis study involved 12 patients who underwent surgery using the hanging technique for trigeminal neuralgia in which the superior cerebellar artery was the offending vessel. Surgery was performed using the retrosigmoid approach. The horizontal fissure of the cerebellum was opened, the root entry zone of the trigeminal nerve was accessed via the infratentorial supracerebellar approach, and the superior cerebellar artery was detached and released. The artery was then moved to the tentorium, formed into a loop, hung on the superior petrosal vein, and affixed with fibrin glue. ResultsFacial pain improved in all cases and sufficient decompression of the trigeminal nerve was confirmed on imaging postoperatively. ConclusionThis hanging technique is expected to have low risk of recurrence of trigeminal neuralgia because it does not use foreign materials potentially causing granulation tissue formation and adhesion around the trigeminal nerve. This simple practical technique using existing anatomical structures and no foreign materials appears promising, although long-term follow-up is required.

Horizontal fissuring at the osteochondral interface: a novel and unique pathological feature in patients with obesity-related osteoarthritis

ObjectivesObesity is a well-recognised risk factor for osteoarthritis (OA). Our aim is to characterise body mass index (BMI)-associated pathological changes in the osteochondral unit and determine if obesity is the...

Types of pulmonary fissures and its surgical implications: A cadaveric study

Being the essential organs of respiration, pair of lungs are situated on either side of the mediastinum. Each lung is divided into lobes by the fissures. These fissures allow for proper expansion of lungs and on the other hand fissures may have a role in restricting infection to a particular lobe. Fissures may be complete, incomplete or absent.To study the variations in the fissures of lung, compare the results with the available data and to discuss the surgical importance of this study. 37 pairs of lungs (37 right and 37 left) from formalin fixed cadavers were observed and classified into different grades of fissures ( as per Craig and Walker criteria). Presence of accessory fissures was noted.Out of the 37 right lungs, 3 showed absence of horizontal fissure and the same fissure was incomplete in right sided 17 lungs. Among the left lungs, 9 had incomplete oblique fissure. Accessory fissure were found in 2 right and 1 left lungs.The current study showed that right lung may be without horizontal fissure or fissures may be incomplete. Thus, a light on these variations by the cardiothoracic surgeons will help in better planning of surgeries like lobectomy. Knowledge about the fissures will aid in arriving at better diagnosis for the clinicians and radiologists.

Five steps to open the horizontal fissure and expose the segment hilum

Five steps to open the horizontal fissure and expose the segment hilum

Classification for treatment urgency for the microphthalmia/anophthalmia spectrum using clinical and biometrical characteristics.

PurposeCurrent clinical classifications do not distinguish between the severity of the MICrophthalmia/Anophthalmia (MICA) spectrum with regard to treatment urgency. We aim to provide parameters for distinguishing mild, moderate and severe MICA using clinical and biometrical characteristics.MethodsWe performed a single‐centre, cross‐sectional analysis of prospective cohort of 58 MICA children from September 2013 to February 2018 seen at the Amsterdam University Medical Center, The Netherlands. All patients with a visible underdeveloped globe were included. We performed full ophthalmic evaluation including horizontal palpebral fissure length, axial length by ultrasound and/or MRI measurements, paediatric and genetic evaluation. Cases were subdivided based on clinical characteristics. Biometrical data were used to calculate the relative axial length (rAL) and the relative horizontal palpebral fissure length (rHPF) compared with the healthy contralateral eye for unilateral cases.ResultsIn previously untreated patients, a strong correlation exists between rAL and rHPF, distinguishing between severe, moderate and mild subjects using rAL of 0–45%, 45–75% and 75%–100%, respectively. Clinical subgroups were randomly dispersed throughout the scatterplot.ConclusionCurrent classifications lack clinical implications for MICA patients. We suggest measuring eyelid length and axial length to classify the severity and determine treatment strategy. The ‘severe’ group has obvious asymmetry and abnormal socket configuration for which therapy should quickly be initiated; the ‘moderately’ affected group has normal socket anatomy with a microphthalmic eye with disturbing asymmetry for which treatment should be initiated within months of development; the ‘mild’ group has a slightly smaller axial length or less obvious eyelid asymmetry for which reconstructive correction is possible, but expansive conformer treatment is unnecessary.

Biomechanical study of medial meniscus after posterior horn injury: a finite element analysis

We established an effective finite element model of knee joint for observation of stress and displacement of meniscus related changes after medial meniscus injury. Different types of medial meniscus injury can lead to varied meniscus stress and displacement changes. Stress and displacement concentration were found in fissure tip of meniscus tear compared to normal meniscus. The posterior horn injury of medial meniscus may initiate combined injury of medial meniscus posterior horn (MMPH) and that of medial meniscus body, and combined injury of MMPH and that of lateral meniscus anterior horn; fissure expansions regarding horizontal fissure, longitudinal fissure and grip-shaped fissure of MMPH were spotted.

Numerical Simulation of Strength, Deformation, and Failure Characteristics of Rock with Fissure Hole Defect

Using discrete element software, namely, particle flow code as two‐dimensional program (PFC2D), two types of models were established: vertical fissure hole combination and horizontal fissure hole combination with ratios of major and minor axis of ellipse being 1, 1.2, 1.5, 2, and 3, which corresponded to a total of ten samples. The failure mode, mechanical behavior, and stress state before and after crack generation in elliptical hole crack combination models with different ratios of major and minor axis were analyzed. The crack development, stress field evolution, and acoustic emission characteristics of the vertical fissure model and horizontal fissure model were studied at the optimized ratio of major and minor axis of ellipse being 1.5. The results showed that elliptical hole fissure with different ratios of major and minor axis resulted in the decrease in the strength and elastic modulus of rock and increase in the peak strain of rock. The effect of the horizontal fissure model on the peak strength, peak strain, and elastic modulus of rock was found to be greater than that of the vertical fissure hole model. Ellipses with different ratios of major and minor axis in various models slightly influenced the rock failure modes, and their failure modes corresponded to tensile shear failure and tensile failure. Before crack formation, the tensile stress concentration areas of each model were, respectively, distributed at the upper and lower ends of the vertical fissure and the major axis of ellipse, and the compressive stress concentration areas were distributed at both ends of the major axis of ellipse and the fissure in the horizontal direction. After the model failed, the compressive stress concentration areas of the vertical fissure model and the horizontal fissure model transferred to the left upper part and the right upper part of the model along the left end of the hole and the right end of the fissure, respectively. When the ratio of major and minor axis of ellipse was 1.5, cracks in the vertical model and the horizontal model of fissure developed along the axial direction at the ends of cracks and holes, respectively, and then secondary cracks were generated at the ends of left and right sides. The maximum compressive stress in each stage of the vertical fissure model was greater than that of the horizontal fissure model, and when the model was damaged, its stress release was more.

Impact of Canthal Height on Horizontal Upper Eyelid Peak Position: A Guide for Blepharoptosis Surgery.

This study was aimed at examining the relationship between the horizontal upper eyelid peak position (Δpeak-pupil) and the difference between the medial and lateral canthal heights (Δcanthi) in Japanese individuals. Images of the left eyelid of 71 participants without eyelid disease were acquired with a camera with a slit-lamp microscope. Multivariate linear regression analysis was performed to determine the influence of age, sex, distance from the pupil center to the upper eyelid margin (margin reflex distance-1), Δcanthi, and palpebral fissure width on Δpeak-pupil. In addition, Δpeak-pupil distribution in participants with Δcanthi <3 (Group A), 3 to 6 (Group B), and >6 mm (Group C) was calculated as the average±2x the standard deviation. The mean Δpeak-pupil was 1.12 ± 1.29 mm (range: -1.44 to 6.12) and the mean Δcanthi was 4.50 ± 1.71 mm (1.02-7.96). Δcanthi was a significant determinant factor of Δpeak-pupil (P < 0.0001), whereas age (P = 0.62), sex (P = 0.88), margin reflex distance-1 (P = 0.29), and the horizontal palpebral fissure width (P = 0.65) were not related to Δpeak-pupil. The normal Δpeak-pupil ranges were -1.47 to 1.52, -0.95 to 3.22, and -0.84 to 4.73 mm in Groups A, B, and C, respectively. There was a statistically significant difference between the Group A and B ranges and between the Group A and C ranges (Kruskal-Wallis test, P < 0.01). It was concluded that the normal eyelid peak position differs according to medial-to-lateral canthal positional difference. This finding may help intraoperative determination of the upper eyelid peak position in blepharoptosis surgery.

Simulation for Propagation of Horizontal Fissures in Rail Squats

Simulation for Propagation of Horizontal Fissures in Rail Squats

A Study on Morphological Variations of Fissures and Lobes of Human Lungs with its Clinical Significance

Background: Fissures of lungs facilitate the movement of lobes which helps in expansion of lungs during breathing. The fissures may be complete, incomplete or absence. Sometime the accessory fissures may also present. Awareness of variations is essential during segmental resections as well as during radiological interpretation of lungs. Hence, the present study was aimed to study the morphological variations in fissures and lobes.&#x0D; Material and Methods: This study was consisted of sixty nine human lungs with irrespective of sex which were available in the department of anatomy of various medical colleges. All lung specimens were carefully observed and recorded for the presence of any variations in fissures and lobes.&#x0D; Results: The present study revealed that the absence of horizontal fissure was observed in 7.89%, while no specimen showed absence of oblique fissure on both sides. 35.48% of left lungs had incomplete oblique fissure compared to 28.95% of the right lungs. In addition, 22.58% of right lungs and 23.68% of left lungs showed presence of accessory fissure and lobes. From above, the incomplete and absent horizontal fissure was the most common abnormalities observed in this study. The accessory fissures were more common in lower lobe of right lung whereas in left lungs it was more common in upper lobe.&#x0D; Conclusion: The present study showed the wide range of variations in fissures and lobes of lungs. The knowledge of variations in morphology of lungs would be helpful for clinical diagnosis and pulmonary surgical procedures.

Variations in pulmonary fissural anatomy: a medicolegal autopsy study of 256 cases.

We aimed to document the anatomical variations of pulmonary fissures found during routine forensic autopsies. A total of 256 pairs of lungs were investigated. Presence of any variant and accessory fissures was noted. Seventy-seven percent of the lungs had anatomical variations. In about 2/3 of the cases, oblique fissures were incomplete on both sides. The horizontal fissure was incomplete in 68.4%, and absent in 4.3% of the lungs. Twelve left lungs (4.7%) had a horizontal fissure. Accessory fissures were observed in 35 lungs (13.7%). Azygos lobe variations were detected in 1.7% of the lungs. A superior accessory fissure was present in 6.2% and 2% of right and left lungs, respectively. This and previous similar studies demonstrate the existence of several different anatomical fissural variations in the lungs. Clinicians, radiologists and surgeons should keep these in mind to better evaluate and treat their patients.