Horizontal Fissure Research Articles

Absence of Horizontal Fissure, Middle Lobe Fusion and Anomalous Appearance of Mediastinal Surface of Right Lungs: A Rare Case Report

Anatomical variations of lungs in the form of presence of any extra lobe or absence of anatomical lobe, fissures of lungs are important to know to avoid injuries during surgeries related to lungs and associated structures. In this case report absence of middle lobe and horizontal fissure in two right lungs extracted from male cadaver during routine dissection in the Anatomy department, Adesh institute of medical sciences and research, Bathinda, Punjab, India was noted and reported. Every anatomical structure in left side lung of same cadaver was found normal. Also in one abnormal right lung, gross appearance of right lung was looked like left lung. Anatomical knowledge and statistics of every type of variations are important for anatomists for teaching purposes and for surgeons while performing lobectomies, surgical resections of segments of lungs and for radiological interpretations.

Anatomical Variations of Human Pulmonary Fissures: A Cadaveric Study Conducted in Western Kenya

Aim and Objective: This cadaveric study was done to describe the variations in the pattern of pulmonary fissures in Western Kenyan population. Data were sourced from 68 lungs fixed in formalin in gross anatomy laboratory of the Department of Human Anatomy, Uzima University. The fissures were studied and the results compared with the previous studies. Results: In this study 83.82% of lungs had a classical appearance a “textbook” lung: three major fissures that were complete without any accessory fissure. Out of the 31 right lungs examined, the horizontal fissure was absent in 0% lungs, incomplete in 6 lungs (16.13%), and complete in 25 lungs (80.64%). Out of the 37 left lungs, the oblique fissure was incomplete in 4 lungs (10.70%) and complete in 29 lungs (86.30%). The fissure was absent in one of the lungs (2.70%). Four right lung accessory fissures were observed (12.90%). Six left lungs (16.67%) had accessory fissures. Conclusion: Incidence of complete of oblique fissure was greater in our present work when compared our results with other authors. The incomplete oblique fissure and incomplete horizontal fissure in our study varied compared with other studies. Our study recorded a prevalence of absent oblique fissure in the left lung that was greater in relation to absent horizontal fissure. The superior accessory fissure was higher in our study compared to other studies as well as compared the inferior accessory fissure in our study. The left minor fissure was the most frequently appearing accessory fissure in our study. Anatomists should note that lung fissure anatomy is more variable than orthodoxly presented. Clinicians must be warranted towards the depth and occurrence of these variations. Considering these variants we recommend more explorative research should be done on this topic to cast more light on this.

Indigenous Cadaveric Variations in Lung Fissures and Lobes

Introduction: Lung fissures are responsible for uniform expansion. These fissures may be complete, incomplete or absent causing lobar variation. A detailed knowledge of variations of classical and accessory fissures is necessary for proper pulmonary radiological interpretation. Patients benefit from accurate assessment of integrity of pulmonary fissures during cardiothoracic surgery as surgeons can perform segmental lung resections and lobectomies safely to have an uncomplicated perioperative outcome. So, the cadaveric study was done to note the morphological variation of the fissures of lung in Pakistan cadaveric population and compare it with the previous study.
 Aims & Objectives: To determine the frequency of variations in fissures and lobes of the lungs on cadaveric Pakistani population.
 Place and duration of study: Anatomy Departments of KEMU and AIMC, Lahore. Duration of study was from 2020 to 2022
 Material & Methods: An observational cross-sectional study was conducted on 160 cadaveric lung specimens from AIMC and KEMU Anatomy Departments. They were preserved in 10% formalin and were studied for morphological details of their lung lobes and fissures. Data was collected and graded using Craig and Walker classification. Data was analysed using SPSS 22 version. p value ? 0.05 was taken as significant
 Results: Out of 160, 77% of the left lung and 75% of the right lungs were normal. Among the variations, horizontal fissure had shown to be more variable as compared to oblique fissure .18% of the right-side specimens were shown to have incomplete horizontal fissures and in 4% of the specimen, they were totally absent. 15% of the left side specimen had incomplete oblique fissures whereas only 2% of the right-side specimen had incomplete oblique fissures. Accessory fissures were more common in the left side specimens as compared to the right-side specimens.
 Conclusion: Morphological variations do occur in normal population, and they must be kept in mind during radiological and surgical interventions.

Microneurosurgical Anatomic Study of the Horizontal Fissure of the Cerebellum.

The horizontal fissure of the cerebellum, which is the largest and most prominent fissure, has received less interest from anatomists and neurosurgeons. Hence, the current study aims to provide comprehensive detail about the horizontal fissure and its anatomic and surgical relationship with deeper structures such as the dentate nucleus and middle cerebellar peduncle for the benefit of the neurosurgeon. Ten whole formalin-fixed human cadaveric cerebellar hemispheres were obtained from human cadavers donated to the institution. Different parameters of the horizontal fissure were studied, such as length, depth (medial end, lateral end, and middle), sulcal and gyral variations (superficial and deep), and its close relationship, especially at depth, with the dentate nucleus and middle cerebellar peduncle. The total length of the horizontal fissure on the right and the left side was 64.3 ± 7.9 mm (range, 53-77 mm) and 65.6 ± 8.01 mm (range, 53-79 mm), respectively. The medial third of the horizontal fissure, with the fewest vessels, was the most suitable place to puncture or start the dissection of the horizontal fissure. The surface projection of the center of the posterior border of the dentate nucleus lies within 20-21 mm on either side of the posterior midline along the horizontal fissure and is only approximately 4 mm deep from the horizontal fissure. The anatomic measurements and relationships provided in this description of the horizontal fissure will serve as a tool for surgery selection and planning, as well as an aid to improve microneurosurgical techniques, with the final goal being better patient outcomes.

A study of morphological variations of fissures and lobes of formalin fixed cadaveric lungs

Background: Variation of morphology of lung fissures and lobes affects the interpretation of results of radiological examination as well as line of action in cardiothoracic surgical procedures. A research was done to find out the incidence of variations of fissures and lobes in embalmed cadaveric lungs.
 Materials and methods: This is a cross sectional study. All the formalin fixed lung specimens present in dissection halls and museums of the Anatomy Departments were observed for any abnormal fissures that are adding accessory lobes to lungs. Data was entered and analyzed by using SPSS 22.0. Descriptive analysis was applied by using frequencies and percentages for qualitative variables.
 Results: Total 80 formalin-fixed specimens of lungs were examined and a total of 29 (36.25%) (%) were found to have incomplete fissures. It was observed that 14 (17.5 %) out of 80 lungs had incomplete oblique fissures, and out of these 6 (17.65%) were found in right lungs and 08 (19.05%) were present in left lungs, whereas 15 (39.47%) right lungs showed incomplete horizontal fissure. Among 80 lungs, 6 (7.5%) presented unusual accessory fissures and lobes, whereas 5 (14.7%) showed absent horizontal fissure reducing the number of lobes to two in right lung specimen.
 Conclusion: There is a prevalent incidence of incomplete horizontal fissure that must be kept in mind when investigating and treating any lung pathology.

Experimental Study on Uniaxial Compression Mechanics and Failure Characteristics of Non-Through Fractured Rock

The stability of damaged rock mass is a critical problem in the control of surrounding rock in underground engineering. As the main macroscopic defect of rock surrounding engineering, it is of great significance to study its propagation mechanism and the experimental characteristics of rock mechanics. Surface-fractured rock mass is a typical representative of three-dimensional fracture. To reveal the failure mechanism of surface-fractured rock mass, a three-dimensional mechanical failure model of a surface-fractured rock specimen was established, including the initiation, crack propagation, and cooperative deformation of the rock micro-element. Taking the depth of the surface horizontal fissure as a variable, standard rock specimens with surface horizontal fissures of different depths were prepared, and an experimental study of surface-fractured rock specimens was carried out. The RMT rock mechanics test system was used to perform uniaxial compression tests on standard specimens containing fractured rock specimens of different depths. The complete stress–strain curves of samples with different fracture depths were obtained, and the influence of different fracture depths on rock strength and deformation characteristics was analyzed. The crack initiation, propagation, and failure modes of the specimens under uniaxial compression were analyzed based on high-speed camera technology. Through the combination of 3D image processing and acoustic emission monitoring, differences between failure before and after the peak in both asymmetrically damaged rock specimens and symmetrically damaged rock specimens were found. The mechanism of weak strength and weak stability of asymmetrically damaged rock specimens after the peak was explained theoretically. The research results showed that the existence of the horizontal joint plane directly led to a significant reduction in the strength of the jointed rock sample, and the fracture depth played an important role in controlling the failure mode of the jointed rock specimens. The uniaxial compression of rock specimens with horizontal non-penetrating surface fissures produced three-dimensional failure modes, and the depth of surface fissures changed the failure mode of the specimens under uniaxial compression. As the crack depth increased, the failure mode of the specimen changed from tensile failure to shear failure. The surface crack sample showed regional asymmetric failure and poor structural stability.

Multiscale structural characterizations of anisotropic natural granite residual soil

While the anisotropy of sedimentary soil—particularly the underlying role of soil structure—is well understood, similar knowledge about granite residual soil formed by weathering is scarce. In particular, the evolution of soil structure during the hollow cylinder torsional shear tests (among the most appropriate for studying soil strength anisotropy) remains largely unknown. This study systematically investigates the multiscale structural properties of granite residual soil using stereo microscopy, scanning electron microscopy, energy-dispersive spectrometry, and computed tomography. Furthermore, the structural evolution during hollow cylinder torsional shear tests is traced. Results indicate the strength anisotropy of residual soil is associated with horizontal fissures which cause low shear strength when the soil is sheared with a principal stress direction of 45°. The cementation via Fe is characterized by a uniform distribution. Different evolutionary patterns are observed for soils within the shear band, inside the necking area, and in other regions. It is not always the case that particles are rearranged with their long axis perpendicular to the major principal stress. This study improves the understanding of natural residual soil structure and provides some insights into its anisotropic behavior.

Prevalence of anatomical variations in children with congenital lung malformations investigated by video recordings of thoracoscopic lobectomy

Background: Sufficient knowledge of anatomy including normal patterns and aberrant variations is crucial in thoracoscopic lobectomy for congenital lung malformations (CLMs). This study aimed to investigate the prevalence of anatomical variations and their correlations with surgical outcome. Methods: Video-recordings of thoracoscopic lobectomy performed for CLMs between 2009 and 2021 were reviewed. The incidences of surgically relevant variations, including abnormal branches of pulmonary arteries and veins, aberrant systemic arteries, and incomplete fissures (as classified by Craig) were assessed in comparison with the previously published reports. Moreover, multiple univariate analyses were performed to seek correlations between surgical finding and prolonged operative times and postoperative drainage. Results: Fifty-six lobectomies were reviewed. Variations of pulmonary arteries were more commonly seen in the left lung (29.6%) compared to right (10.7%). The prevalence of atypical pulmonary venous branches was similar between the right (13.8%) and left (18.5%). The right upper oblique fissure was frequently associated with Grade 2 incomplete fissure (44.8%). Grade 3 incomplete fissure was rare (3.4%) in the right lower oblique fissure but relatively common (14.3 – 18.5%) in other locations. Grade 4 incomplete fissure was limited to the right horizontal fissure (1.7%). Multiple univariate analyses demonstrated a significant correlation between any degree of incomplete fissure and prolonged operative time (p < 0.05), whereas no factor was identified to affect need for postoperative drainage. Conclusions: The incidence of anatomical variations in CLM patients was similar to that reported in adults. Review of intra-operative video footage was useful to closely evaluate and understand anatomical variations.

Using Artificial Intelligence to Quantify Sexual Dimorphism in Aesthetic Faces: Analysis of 100 Facial Points in 42 Caucasian Celebrities.

Sexual dimorphism has been studied in the faces of average populations and worldwide celebrities; however, a focused analysis of attractive Caucasian faces has not been conducted. The study harnesses the power of artificial intelligence (AI) to efficiently analyze these facial patterns in attractive Caucasian male and female celebrities. Twenty-one male and 21 female Caucasian celebrities were selected based on popular editorial rankings, modeling agencies, and casting directors from 2017 to 2022. Frontal photographs of celebrities aged 23 to 42 without facial animation were selected. One hundred facial landmarks were identified using semi-automatic image analysis software consisting of modified Apple Vision (Cupertino, CA) machine-learning algorithms with additional custom landmarks. Measurements were converted to absolute distances by fixing subjects' white-to-white corneal diameters to the validated average in Caucasians. Attractive females had significantly greater upper and middle facial proportions, more uniformly divided facial thirds, and greater canthal tilt compared with males. Attractive males had significantly greater facial height, bizygomatic and bigonial widths, medial and total brow lengths, and alar width than females. The golden ratio (1.618) was observed in the ratio of facial height to bigonial width in females (1.613), and attractive males closely approximated that ratio (1.566). There were no significant differences in interpupillary distances, eyebrow angles, or horizontal palpebral fissure lengths. No faces in either sex exhibited scleral show. The study is the first to utilize AI in quantifying key sexual dimorphisms among Caucasian celebrity faces. Identifying these contemporary patterns may provide valuable considerations in planning facial aesthetic and gender affirmation surgery.

Qualitative and Quantitative Investigations on the Failure Effect of Critical Fissures in Rock Specimens under Plane Strain Compression.

To investigate the failure effects of critical fissures in rock specimens subjected to plane strain compression (PSC), five types of internal fissures in rock specimens were designed and twelve PSC tests were conducted for two lithologies based on the discrete element method (DEM). The results were analyzed in terms of the fracture mode, data characteristics, and crack evolution. The results indicated the following. (1) The rock samples with a critical fissure under PSC showed a weak face shear fracture mode, which was influenced by lithology, fissure angle, and fissure surface direction. (2) There were four critical expansion points (CEPs) of axial stress of the rocks under PSC, which were the stage signs of rock materials from local damage to complete fracture. The rock-bearing capacity index (RockBCI) was further proposed. (3) The bearing capacity of rock samples with horizontal fissures, fissures whose angles coincided with the fracture surface, and fissures whose surface was perpendicular to the lateral confine direction was the worst; their BCI2 values were found to be 80.6%, 70.8%, and 56.9% of the rock samples without any fissures, respectively. The delayed fracture situation under PSC was identified and analyzed. (4) The crack evolution followed the unified law of localization, and the fissures in the rocks changed the mode of crack development and the path of the deepening and connecting of crack clusters, as well as affecting the time process from damage to collapse. This research innovatively investigated the behavior characteristics of rock samples with a fissure under PSC, and it qualitatively and quantitatively analyzed the bearing capacity of rock mass from local damage to fracture.

Anatomical study of pulmonary fissures

The lungs have three main fissures: in the right lung, the oblique and horizontal fissure, and in the left lung the oblique fissure. These can be complete, incomplete or absent. “Classical anatomy” textbooks frequently describe pulmonary fissures as complete, although knowledge of their variations is important both for thoracic surgery and to understand the spread of disease. The objective of this study is to assess the frequency and extension of the main pulmonary fissures, as well as to determine the frequency and location of accessory fissures in cadaveric material. An observational descriptive study was carried out and consisted of the dissection of 86 ex-situ lungs (43 right and 43 left lungs) of adult corpses from both sexes previously fixed in formaldehyde solution. The presence of complete, incomplete or absent main fissures and the presence of accessory fissures were assessed. For incomplete fissures, the integrity percentage of the fissure was calculated. In both lungs, incomplete fissures predominated; the oblique fissure of the right lung with a percentage of 65%, the horizontal fissure of 79% and the oblique fissure of the left lung of 58%. Regarding accessory fissures, the overall prevalence was 6%. The anatomy of pulmonary fissures is highly variable. In our study, incomplete fissures predominated in both lungs. There are differences between the studies regarding the prevalence of the completeness of the fissures because, actually, the literature is not concluding.

Application of topical rocuronium bromide dosing by ocular size in four species of wild birds.

Rocuronium bromide has been evaluated as a mydriatic agent in birds, but the species applied were limited and the dose and effect were variable. This study aims to evaluate the efficacy of topical rocuronium bromide as mydriatics in 4 species according to horizontal palpebral fissure length: Feral pigeon (Columba livia), Common kestrel (Falco tinnunculus), Northern boobook (Ninox japonica), and Eurasian eagle owl (Bubo bubo). A total of 32 birds (8 for each species) were included as pre-releasing examination. Rocuronium bromide was instilled in one randomly selected eye of each bird based on palpebral fissure length criteria (0.5 mg/50 µL for pigeons, 1 mg/100 µL for kestrels and boobook owls, and 2 mg/200 µL for eagle owls). The contralateral eye was used as control and treated with normal saline. After instillation of the drug, pupil diameter, pupillary light reflex, intraocular pressure, heart rate, and respiratory rate were evaluated at 10 min intervals up to 180 min and at 30 min intervals up to 360 min. Statistically significant mydriasis was obtained in all birds (p < 0.001). However, in boobook and eagle owls, marked mydriasis persisted until 360 min. Side effects including corneal erosion and lower eyelid paralysis were common, which was observed in 26/32 birds. Blepharospasm was also noted during this study. No systemic adverse signs were observed. Rocuronium bromide could be a good mydriatics option for 4 species of birds, however, further studies are needed to find lowest effective dose to reduce drug-related side effects.

Kombinasi Injeksi Triamsinolon Asetat Intralesi dan Propanolol Oral pada Kasus Hemangioma Kapiler Palpebra

Capillary hemangioma is a benign tumor developed from the abnormal proliferation of blood vessels. This tumor appears on eyelids and orbit. Around 75% of hemangioma resolves spontaneously in the first 4-5 years of life. Intervention is needed in hemangioma that obstructs the visual axis. It has been reported that a two-year-old girl came to Polyclinic with a mass on the left superior eyelid 1,5 years ago. At first, the left superior eyelid looked puffy, then developed slowly until it covered the left eye. On the examination of the left eye, visual acuity assessment was hard to perform. Mass in superior palpebral was 8mm x 8mm x 8mm, reddish colored (different with adjacent skin), consistency supple, mobile, painful (-), edema (+), horizontal palpebral fissure (FPH) 30 mm, vertical palpebral fissure (FPV) 0 mm. CT scan showed suspected hemangioma. The patient was diagnosed with capillary hemangioma and given an injection of triamcinolone acetate intralesional and oral propranolol under the supervision of a pediatrician. Significant clinical improvement was observed after 40 days of injection, where the mass was resolved completely. The FPV and FPH of the left eye had improved to 9 mm and 30 mm, respectively, with the patient finally able to follow the object. The combination of intralesional triamcinolone acetate and oral propranolol in this case is quite effective in providing complete resolution of capillary hemangioma.Keywords: capillary hemangioma, triamcinolone acetate injection, propanolol

PARK2 microdeletion in a multiplex family with Autism Spectrum Disorder.

PARK2 (PRKN; MIM*602544) encodes Parkin protein, an ubiquitin-protein ligase required for proteasomal degradation and operating in the synaptic compartments. Copy Number Variations (CNV) involving PARK2 have been associated with autism spectrum disorder (ASD). We report on a family with ASD (multiplex family) harbouring a microdeletion at chr. 6q26 causing PARK2 disruption. CNV analyses was performed using CGH/SNP-array platforms and the detected microdeletion was confirmed by real-time quantitative PCR. Standardized psychometric evaluation was used for neurobehavioral characterization. We found an intragenic ~ 157 kb microdeletion of the chromosomal region 6q26 causing PARK2 disruption in two male sibs with ASD and syndromic phenotype. They both had dysmorphic facial features with coarse faces, deeply set eyes with long horizontal palpebral fissures, long eyelashes and thick eyebrows, fleshy lips, and mild skeletal problems. We found an intra-familial clinical heterogeneity owing to different severity of the autism symptoms between the affected sibs: the younger one had minimally verbal autism and severe intellectual disability while his older brother presented high-functioning autism and preserved speech. Parental analysis and real-time PCR using a PRKN fragment mapping within the deletion demonstrated that the deletion was inherited from their father having subthreshold features of ASD consisting with broad autism phenotype. The study corroborates the hypothesis that PARK2 aberrations may be associated with ASD and highlights correlations between CNV affecting PARK2 and ASD in a multiplex family. We show remarkable intrafamilial variability in the severity of inherited ASD associated with PARK2 microdeletion.

Anatomical Variations in Pulmonary Fissures on Computed Tomography (CT).

Objective To determine the frequency of anatomical variations in lung fissures using computed tomography (CT) at a tertiary care hospital in Karachi, Pakistan. Methods A cross-sectional study was conducted in the department of Radiology and Imaging Services at Memon Medical Institute Hospital, Karachi, between November 2021 to April 2022. Patients aged between 15 to 92 years with a completed high-resolution CT scan chest were included. Subjects with no significant structural lung disease that could alter the anatomy were analyzed. Baseline data was gathered using a pre-designed questionnaire, and two qualified radiologists assessed the CT chest images. Results A total of 382 subjects participated in this study, out of which 57.1% were males whilst 42.9% were females.The right horizontal fissure was absent in 10 (2.6%) cases. Accessory fissures were seen in 7.33%. The most common fissural variation was azygos fissure (14; 3.7%), followed by superior accessory fissure (six; 1.6%), inferior accessory fissures (four; 1%), and left horizontal fissure (four; 1%). These variations were more common in males. The significant difference was only seen in the superior accessory fissures with respect to gender (P-value<0.05). Conclusion This study showed the presence of accessory fissures in 7.33% of patients, the most common being the azygos fissure, irrespective of gender. The absence of normal right horizontal fissures was observed in 2.6% of cases.

Experimental investigation on mechanical, acoustic, and fracture behaviors and the energy evolution of sandstone containing non-penetrating horizontal fissures

Flaws are the weakest part of rock mass, which directly determine the stability of underground engineering. Existing investigations on the mechanical behaviors of flawed rock mainly emphasize on the geometric parameters of the fissure, such as inclination, width, and length, but few works have been conducted on the effect of fissure location on rock properties. This study explores the influences of two fissure layouts (distance between horizontal single fissure and specimen end, and horizontal double fissures spacing) on the sandstone properties under uniaxial compression. The properties studied include strength and deformation, failure mode, acoustic emission (AE) characteristics, and energy evolution. The findings indicated that pre-existing fissures significantly reduced the rock's strength, elastic modulus, and peak strain, and the rock's mechanical properties decreased as the distance between the horizontal single fissure and the specimen end decreased and as the double fissures spacing increased. Furthermore, it was observed that intact specimens mainly underwent shear failure and the flawed rocks under uniaxial compression experienced splitting failure or both. The flawed specimens presented multiple higher AE counts before the peak stress, corresponding to crack initiation, propagation and coalescence, which were distinctly distinct from the intact specimen. The energy evolution characteristics of the fissured sandstone reflected their damage process. The findings are promising to improve the understanding of mechanical mechanisms and energy evolution of flawed rock engineering.

Prenatal diagnosis of vermian cyst: a new type of posterior fossa cyst.

Prenatal diagnoses of cystic malformations of the posterior fossa mainly encompass arachnoid cysts, Blake's pouch cysts and Dandy-Walker syndrome. To date, vermian cysts have not been reported prenatally. To report a series of fetuses with a vermian cyst. This was a single-center retrospective study conducted from 2012 to 2021. We included all fetuses presenting with a vermian cyst and excluded all other types of posterior fossa cyst. The cyst was visible at prenatal ultrasound (US) and/or magnetic resonance imaging (MRI). Postnatal imaging and/or clinical outcome data were available. Sixteen fetuses fulfilled the inclusion criteria with a strong female predominance (n=13). US and MRI were performed at a mean gestational age of 29+5 and 33+1weeks, respectively. In all patients, the cyst was in the vermian horizontal fissure. The mean longest dimension was about 10mm. The vermis and other posterior fossa structures were otherwise normal. At postnatal imaging, 13 children underwent brain imaging including 11 MRIs with complete regression (n=9), stability (n=1) and increase in size (n=3) of the cyst. Psychomotor development was normal in 14 children. One child (with an inner ear malformation) showed a slight delay in walking and language acquisition. Slight walking ataxia was present in another child. We report 16 fetuses with posterior fossa cysts located within the vermis at the level of the horizontal fissure, diagnosed at US and/or MRI and carrying an overall excellent neurological prognosis.

Socket expansion with conformers in congenital anophthalmia and microphthalmia

To report the outcomes of acrylic conformer-assisted socket expansion in congenital anophthalmia and microphthalmia. In this noncomparative, interventional case series, the medical records of 24 eyes of 18 consecutive patients with congenital anophthalmia (n = 3), clinical anophthalmia (n=8), and microphthalmia (n = 13) were reviewed retrospectively. Twelve cases were unilateral; 6 were cases bilateral (3 clinical anophthalmia and 3 microphthalmia). Serial socket expansion with progressively larger acrylic conformers was managed in clinic. Horizontal palpebral fissure (HPF) width was graded as good (final HPF ≥20 mm, or interocular difference ≤2 mm for unilateral cases), fair (17-19 mm, or 3 mm interocular difference), or poor (<17 mm, or ≥4 mm difference). The mean initial lid lengths in anophthalmia, clinical anophthalmia, and microphthalmia were 11.0, 12.4, and 16.9, increasing to 21.0, 19.9, and 22.2, respectively, over a mean period of 51 months. Mean age at the initiation of treatment was 19 months (range, 1-78). Percentage increases in lid length were 90.9%, 61.2%, and 31.3% in anophthalmia, clinical anophthalmia, and microphthalmia, respectively, with an average 7 conformer exchanges. For unilateral cases, the mean final lid length of involved eyes was 22.3 mm, comparable to 23.5 mm in normal contralateral eyes. Good outcomes were achieved in 18 orbits (75%); fair outcomes, in 6 (25%) cases. None of the sockets had poor expansion at final follow-up. All cases had good cosmesis with acceptable prosthesis wear at last visit. In our patient cohort, good socket expansion was achieved with acrylic conformers alone in congenital anophthalmia and microphthalmia, with acceptable prosthesis wear.

Morphometric Study of Fissures of Lung with its Clinical Implications

Background: Complete or incomplete fissures divide the lung into lobes. Fissures can also be absent in the lung. Quantitative assessment of the completeness of fissures can be helpful for surgeons and radiologists during invasive procedures related to the lung. Hence, the present study was undertaken to record the extent of completeness of fissures, contour of the fissural surface of lobes, and accessory fissures. Methodology: The present study was done on 78 (right-40 and left-38) formalin-fixed random lung specimens obtained from adult cadavers. Results: Majority of oblique oblique fissures were incomplete (left-60.5% and right-60%). The absence of fissures was mainly seen in horizontal fissures (25%). Quantitative assessment for the degree of pulmonary fissure completeness showed that G0 and G3 were found more in the right oblique fissure (ROF) and horizontal fissure, G1 and G2 more in the left and ROF, respectively. Fissural surface of lower lobe was concave in the upper part and convex in the lower part, whereas fissural surface of middle lobe was convex in the majority of cases. Accessory fissures were found in 21.8%. Azygos fissure was present in two right lungs. A strong correlation was found between the depth of oblique fissure and the thickness of left lung. Conclusion: High frequency of incomplete fissures was found. Accessory fissures were commonly observed in the right lung. A wide range of variations in the completeness of fissures was noticed between the present and previous studies. Hence, surgeons and radiologists should be alert of these variations for surgical planning and interpretation of radiological images.

Thoracoscopic S2 segmentectomy by a posterior approach for a central metastasis: a case report

: Central metastases are an ideal indication for anatomic sublobar resection. This allows adequate, safe resection, with preservation of lung function and decreased morbidity. This paper illustrates a case of S2 segmentectomy for a central metastasis and highlights key technical considerations. The author finds that a direct posterior approach to S2 facilitates the operation, minimizing dissection and allowing sparing of the horizontal fissure which may reduce the potential for prolonged air leak. Sparing tissue planes may also facilitate redo-surgery and increase therapeutic options in the event of future metastatic disease. Anatomic sublobar resection requires attention to detail. Planning is very important, and advanced imaging including 3D reconstruction and 3D printing is increasingly being considered for this purpose. Intraoperatively, correct positioning of trocars and deliberate, purposeful retraction are key. Finally, a challenge specific to the resection of central S2 segment lesions is the requirement for sufficient space at the base of the segment to allow parenchymal division with negative margins. Methodical identification, dissection, and division of the segmental venous drainage is an important step that allows the space at the base of the segment to open up. This space can then be dissected widely in order to position the stapler and complete the resection, even for lesions at the very root of the segment.