Inferior Border Research Articles

Evaluation of the Anatomical Reference Point in Posterior Minimally Invasive Atlantoaxial Spine Surgery: A Cadaveric Anatomical Study.

Minimally invasive atlantoaxial surgery offers the benefits of reduced trauma and quicker recovery. Previous studies have focused on feasibility and technical aspects, but the lack of comprehensive safety information has limited its availability and widespread use. This study proposes to define the feasibility and range of surgical safety using the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique as a reference point. Dissection was performed on 10 fresh cadavers to define the anatomical reference point as the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique muscle. The study aimed to analyze the safety range of minimally invasive atlantoaxial fusion surgery by measuring the distance between the anatomical reference point and the transverse foramen of the axis, the distance between the anatomical reference point and the superior border of the posterior arch of the atlas, and the distance between the anatomical reference point and the spinal canal. Measurements were compared using Student's t test. The point where the occipital greater nerve intersects with the inferior border of the inferior cephalic oblique muscle was defined as the anatomical marker for minimally invasive posterior atlantoaxial surgery. The distance between this anatomical marker and the transverse foramen of the axis was measured to be 9.32 ± 2.04 mm. Additionally, the distance to the superior border of the posterior arch of the atlas was found to be 21.29 ± 1.93 mm, and the distance to the spinal canal was measured to be 11.53 ± 2.18 mm. These measurement results can aid surgeons in protecting the vertebral artery and dura mater during minimally invasive posterior atlantoaxial surgery. The intersection of the greater occipital nerve with the inferior border of the inferior cephalic oblique muscle is a safe and reliable anatomical landmark in minimally invasive posterior atlantoaxial surgery.

Jejunal vein tributary analysis and intraoperative clamp testing in avoiding congestion after pancreatoduodenectomy.

Although venous drainage of the jejunal loop may be maintained after sacrifice of jejunal vein tributaries during pancreatoduodenectomy, risk of severe jejunal mesenteric congestion following division of these tributaries can be difficult to predict. This study considered how best to predict safety of jejunal vein tributary dissection. Preoperative imaging findings and results of intraoperative clamp tests of jejunal vein tributaries during pancreatoduodenectomy were analyzed in 121 patients with hepatobiliary and pancreatic disease to determine whether this information adequately predicted safety of resecting superior mesenteric vein branches. Jejunal vein tributaries caudal to the inferior border of the pancreatic uncinate process tended to be fewer when tributaries cranial to this landmark were more numerous. Tributaries cranial to the border drained a relatively wide expanse of jejunal artery territory in the jejunal mesentery. The territory of jejunal tributaries cranial to the inferior border of the pancreas did not vary according to course of the first jejunal vein branch relative to the superior mesenteric artery. One patient among 30 (3%) who underwent intraoperative clamp tests of tributaries cranial to the border showed severe congestion in relation to a venous tributary coursing ventrally to the superior mesenteric artery. Jejunal venous tributaries drained an extensive portion of jejunal arterial territory, but tributaries located cranially to the inferior border of the pancreas could be sacrificed without congestion in nearly all patients. Intraoperative clamp testing of these tributaries can identify patients whose jejunal veins must be preserved to avoid congestion.

Which factors affect the lingual fracture pattern in sagittal split ramus osteotomy?

The purpose of this study was to elucidate the effects of mandibular anatomy and osteotomy technique on lingual fracture patterns in SSRO. The predictor variables were: length of horizontal medial osteotomy; type of border osteotomy; buccolingual width; and vertical length of the basal cortex. The outcome variable was the type of lingual split pattern. This was categorized into four types according to a lingual split scale (LSS): LSS 1, true Hunsuck; LSS 2, fracture line to posterior border of the ramus; LSS 3, through to mandibular canal; LSS 4, unfavorable fracture pattern.Data were analyzed using analysis of variance and the Pearson χ2 test. Values of p < 0.05 were considered statistically significant. The study sample comprised 312 lingual split patterns in 156 patients. The most common type of lingual split pattern was LSS 1 (n = 204). There was a significant relationship between inferior border osteotomy type and LSS type (p = 0.001). Whilst LSS 1 was the most common among all border osteotomy types. LSS 4 was most frequently observed in cases where the lower border osteotomy remained in the buccal surface.According to the results of this study, the likelihood of an unfavorable split pattern increases when the lower border osteotomy remains in the buccal surface.

Patients With Hypoplastic Left Heart Syndrome Have a Shorter Superior Vena Cava

BackgroundThe primary treatment for hypoplastic left heart syndrome (HLHS) is the Fontan pathway, which entails performing the Glenn procedure. We hypothesized that the superior vena cava in patients with HLHS was short. As the length of the superior vena cava influences the Glenn procedure, we compared its length between patients with HLHS and those with other congenital heart diseases. MethodsPatients with HLHS or its variant, patients with ventricular septal defects (VSD), and patients with pulmonary atresia with intact ventricular septum (PA/IVS)—including critical pulmonary stenosis—were enrolled in this study. The effective superior vena cava ratio (ESCVR), which is defined as the inferior border of the left brachiocephalic vein to the superior surface of the right pulmonary artery/height, was measured. ResultsThe median ESVCR of the HLHS, VSD, and PA/IVS patients was 12.54 mm/m, 17.96 mm/m, and 18.46 mm/m, respectively. ESVCR of the HLHS group was significantly smaller than that of the other groups (P = .0013 vs VSD group, P = .0002 vs PA/IVS group). ConclusionsPatients with HLHS have a relatively short superior vena cava, which may complicate the Glenn procedure.

Laparoscopic Dissection of Lymph Node Station 16-Why and How?

Dissection of para-aortic lymph nodes (Station 16) provides an important prognosticator for patients with gastrointestinal, colorectal, and hepatobiliary cancers.1-4 For example, a positive Station 16 lymph node has been shown to lead to 2-year survival of 3% in patients with pancreas adenocarcinoma, akin to stage IV disease.5,6 Thereby, Station 16 involvement can help with the risk/benefit stratification of the decision to move forward with radical surgery.7-9 Furthermore, it has been shown for gallbladder cancer that involvement of Station 16 cannot necessarily be predicted from the dissection of the hepatoduodenal ligament lymph nodes only.10,11 TECHNIQUE: With the patient in the French position, a complete Kocherization and a Cattel-Braasch maneuver is performed, allowing for visualization of LN station 16b. Station 16b is the inferior border of the station 16 compartment. The left renal vein (LRV) serves as an important landmark to identify the superior border of the dissection comprised by Stations 16a2 and 16b1. Station 16a2 dissection may be associated with a traction injury of the left renal vein or damage of right renal or suprarenal arteries and is dissected if there are specific concerns regarding involvement. While station 16 provides important prognostic information for risk stratification, a strategic and stepwise approach is needed for a safe sampling. This is accomplished by wide mobilization of the duodenum, implementation of thermal fusion to minimize chyle leak, and careful dissection below the left renal vein.

Three-Dimensional Mapping of Scapular Body, Neck, and Glenoid Fractures.

The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology. . Retrospective study, 2015-2021. Single, academic, Level 1 trauma center. Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae. Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns. Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous. The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.

Three-dimensional evaluation of mandibular lingula: Comparisons of skeletal angle classifications and growth patterns.

This study aimed to evaluate the position of the mandibular lingula (ML) in adult patients (aged between 18 and 35 years old) with different skeletal and growth patterns using cone-beam computed tomography (CBCT). Cross-sectional. Dentistry department of University. Subjects comprised CBCT images of 150 adult patients, including 300 rami. In total, 150 CBCT aged between 18 and 35 were selected and divided into three main groups of 50 samples based on their skeletal relationships (classes I, II and III). Patients were subdivided based on their growth pattern (vertical vs. horizontal), resulting in 25 samples per subgroup. Distances between the mandibular lingula and occlusal plane (ML-OP), sigmoid notch (ML-SN), external oblique ridge (ML-EOR), internal oblique ridge (ML-IOR), posterior border of the ramus (ML-PBR), inferior border of the ramus (ML-IBR), and horizontal and vertical distances to the mandibular foramen (ML-hMF and ML-vMF). One-way ANOVA variance analysis was employed to compare different angle classifications, and Bonferroni analysis was used for multiple comparisons. The Student's t-test was also used to compare growth patterns within each main group and genders within the subgroup. The study revealed statistically significant differences in the position of the mandibular lingula between different angle classifications, growth patterns, and genders. Class II samples showed a more anterior position of the ML, whereas Class III samples displayed a more posterior position of the ML. Patients with horizontal growth patterns and Angle Class III had a more posteriorly positioned ML. Gender differences were observed, particularly in Class I and Class III classifications, suggesting that gender may influence the variability of ML position in these specific classifications. The position of the mandibular lingula showed high variability among individuals with different angle classifications, growth patterns and genders.

The Relation of Maxillary Posterior Teeth Roots to the Maxillary Sinus Floor Using Panoramic and Computed Tomography Imaging in a Sample of Kurdish People

The relation of maxillary posterior teeth roots to the maxillary sinus floor is important for diagnosing and planning of many surgical procedures. In order to determine of this relation two imaging technique were used in this study.Paired panoramic radiographs and computed tomography images of maxilla from 27 subjects were taken and analyzed in the teaching hospitals of Sulaimani city during the period from Jan to Aug 2009. For both imaging modalities a total of 146 maxillary teeth were grouped according to their topographic relationship to the inferior border of the maxillary sinus followed Kwak et al. classification, were 0 indicated no contact between the root and inferior border of the maxillary sinus); 1 indicated that the root is in contact with the inferior border of the maxillary sinus; 2 indicated that the root is projecting laterally on the maxillary sinus cavity but its apex is outside the sinus boundaries; 3 and 4 indicated that the teeth roots that projected on the maxillary sinus cavity. Then roots were measured according to their projection lengths in the sinus cavity.Results of this study show that there was a high correlation between the two imaging technique for classification 0 and 1 relations. The OPG showed statistically significant (P&gt;0.001) longer root projection in the sinus cavity in comparison with the root protrusion into the sinus measured by using CT images.As conclusion; for the majority of the roots projecting on the sinus cavity in panoramic radiographs, no vertical protrusion into the sinus was observed in CT images. Roots protrude into the sinus in the CT showed shorter projection length in comparison with panoramic radiography. Panoramic radiographs can provide adequate assessment about relation of the maxillary sinus floor. CT is indicated to provide the information about the relation to the maxillary sinus floor when there is protrusion detected in panoramic images.

A study of splenic notches in human cadavers and its clinical implications

: Spleen is the largest and secondary lymphoid organ with high vascularity which has important role in immunological and haematological functions of human body. Spleen developes from mesoderm and in the initial stages of development, different lobules are formed, which fuses later. The lobulated structure of spleen disappears, but is indicated by the presence of notches in superior border in adults. The aim of study was to find morphological variations of spleen with respect to its number of notches in borders and anomalous fissure on its surfaces.: The study was done on 40 formalin fixed cadaveric spleens from the department of Anatomy, Sri Siddhartha Medical College, Tumkur, and Karnataka. Out of 40 spleens studied, the various shapes such as wedge shaped, tetrahedral, oval and triangular were found. The number of spleen showing notches in superior border was 28(70%) and in the inferior border it was 3(7.5%). Absence of Splenic notches was observed in 5(12.5%) and 2(5%) spleens had notches in both borders. The anomalous fissure was found in 2(5%) spleen on its diaphragmatic surface.: The knowledge of variations in morphology of spleen are essential for physician, surgeon, radiologists and forensic surgeon to differentiate from the splenic pathology and splenic injury. Morphological variations of spleen and its clinical importance need to be discussed at dissection tables during routine anatomy dissection hours.

Exit point of the external nasal nerve- cadaveric study

This study aims to confirm how the external nasal nerve exits from the internal surface of the nasal bone to the dorsum of the nose and to determine the exact point of nerve emergence by macroscopic examination. Twenty external nasal nerves of both sexes from the elderly and adult age groups were dissected. The exit point of the external nasal nerve, the width of the nasocartilaginous joint, and the inferior border of the nasal bone from the midline to the nasomaxillary suture were measured. The nerve was classified according to its branching pattern. In this study, in the elderly group, the external nasal nerve enters the dorsum of the nose through the pyriform ligament and exits laterally to the nasocartilaginous joint. But in the adult age group the external nasal nerve exits between the nasal bone and the upper nasal cartilage. We observed mainly three types of nerve but did not find any subtypes or variations in the branching pattern. Among this main classification of nerves, more cases (70%) of type I were observed. However, based on our study, we concluded that the external nasal nerve enters the dorsum of the nose either between the nasal bone and the upper nasal cartilage, or it passes through the pyriform ligament and exits lateral to the nasocartilaginous joint. In rhinoplasty, knowledge about the course, exit point, branching pattern, and variations of the external nasal nerve is unavoidable.

Choroidal Nevus Associated with Vitelliform Deposition in a Patient with Autosomal Dominant Best Dystrophy.

To describe the clinical, optical coherence tomography (OCT), fundus autofluorescence and ultrasound findings of a patient with a choroidal nevus actively exuding vitelliform material in the setting of Autosomal Dominant Best dystrophy (BD). The patient's clinical course was followed over time with ophthalmic examinations and multimodal imaging. A 71-year-old male with BD was referred for evaluation of a choroidal nevus in the right eye. Dilated fundoscopic exam showed a small pigmented choroidal nevus in the temporal periphery. Over a 3-year period the nevus developed progressive deposition of vitelliform material along its inferior border. Meanwhile, OCT and fundus photography showed only slight growth. Ultrasound showed no change in height; basal measurements were confounded by the increased vitelliform deposits. Genetic testing confirmed a heterozygous mutation in the BEST1 gene and electrophysiology was consistent with BD. Dysfunction of the retinal pigment epithelium associated with BD may cause novel presentations of other conditions such as choroidal nevi. The implications for malignant transformation of a choroidal nevus associated with vitelliform deposit accumulation in this context is unknown.

Comparative cephalometric study of the airways between different ethnic groups with normal occlusion.

This study aimed to compare the nasopharynx and oropharynx airway dimensions of Caucasians, Blacks, Japanese, Japanese Brazilians, and Black Caucasians. A sample of 216 lateral radiographs of untreated young Brazilian subjects (mean age of 12.94 years; SD 0.88) were divided into five groups: Black Caucasian, Black, Caucasian, Japanese, and Japanese Brazilian. Lateral radiographs were used to measure the oropharynx (from the midpoint on the soft palate to the closest point on the anterior pharyngeal wall) and the nasopharynx (from the intersection of the posterior border of the tongue and the inferior border of the mandible to the closest point on the posterior pharyngeal wall). Analyses of variance (ANOVA) and Tukey's test were performed (p< 0.05). The linear dimension of the oropharynx was similar among the different ethnic groups. Caucasian individuals presented a significantly greater linear dimension of the nasopharynx than Black Caucasian and Black individuals. All the groups had similar buccopharyngeal values. However, Caucasian individuals had significantly higher values when compared to Black Caucasians and Black individuals.

Relación entre el plano oclusal y tres niveles diferentes de la línea ala-trago en una muestra de adultos sudaneses

Aim: Correct orientation of the occlusal plane plays a vital role in achieving the perfect occlusal balance and function of complete dentures. This study aimed to evaluate the most reliable posterior reference point of the ala-tragus line (ATL) concerning occlusal plane (OP) in a sample of the dentate Sudanese population. Materials and Methods: A total of 150 subjects with healthy and well-aligned permanent teeth were randomly selected. Right lateral profile photographs were taken with subjects having a fox plane placed intra-orally, contacting the occlusal plane. Reference points corresponding to inferior, middle, and superior borders of the tragus and inferior border of the ala of the nose were marked on photographs. The angles between the lines were measured using the Auto-CAD software program, and the most parallel relationship was determined. Descriptive statistics in terms of means and standard deviations were presented. Independent t-test and one-way ANOVA tests were used to compare as appropriate. A p-value &lt; 0.05 was considered significant. Results: The mean angle formed by the OP and ATL was 8.5±3.69º for the superior level, 4.68±3.13º for the middle line, and 2.89±2.57º for the inferior line. A significant difference was found between the means of the three angles (p&lt; 0.001), while no significant difference (p&gt; 0.05) was found between both genders regarding the measured angles. Conclusions: The line joining the inferior border of the ala of the nose with the inferior border of the tragus of the ear was the most reliable line in terms of parallelism to determine the occlusal plane orientation. Keywords: Occlusal plane; Denture, complete; Prosthodontics; Anatomic landmarks; Cephalometry; Sudan.

The Effect of an Increasing Subglottal Stenosis Constriction That Extends From the Vocal Folds to the Inferior Border of the Cricoid Cartilage.

Acquired subglottal stenosis is an unpredicted complication that can occur in some patients who have undergone prolonged endotracheal intubation. It is a narrowing of the airway at the level of the cricoid cartilage that can restrict airflow and cause breathing difficulty. Stenosis is typically treated with endoscopic airway dilation, with some patients experiencing multiple recurrences. The study highlights the potential of computational fluid dynamics as a noninvasive method for monitoring subglottic stenosis, which can aid in early diagnosis and surgical planning. An anatomically accurate human laryngeal airway model was constructed from computerized tomography (CT) scans. The subglottis cross-sectional area was narrowed systematically using ≈10% decrements. A quadratic profile was used to interpolate the transformation of the airway geometry from its modified shape to the baseline geometry. The numerical results were validated by static pressure measurements conducted in a physical model. The results show that airway resistance follows a squared ratio that is inversely proportional to the size of the subglottal opening (R∝A-2). The study found that critical constriction occurs in the subglottal region at 70% stenosis (upper end of grade 2). Moreover, removing airway tissue below 40% stenosis during surgical intervention does not significantly decrease airway resistance.

Clinical and Cephalometric Changes in Long-face Patients With Retrogenia Following the Novel B-genioplasty Technique.

The chin plays a fundamental role in facial attractiveness. Accordingly, several surgical procedures have been proposed for chin contouring. This study aimed to introduce "B-genioplasty" as a novel genioplasty technique and assess the clinical and cephalometric changes in long-face patients with retrognathia following the novel B-genioplasty. This is a cross-sectional study. Subjects with class I occlusion increased lower facial height and retrognathia underwent B-genioplasty in this prospective experimental study. Soft and hard tissue cephalometric measurements were made, and the depth of the notch in the lower border of the mandible was measured on lateral cephalograms at 6 months postoperatively and compared with baseline. Patient satisfaction with the outcome was also assessed. Seventeen subjects were studied. Ten (58%) patients underwent rhinoplasty plus genioplasty. All patients were satisfied with the outcome. The step/notch in the lower border of the mandible was not detected in clinical examination in any patient. The mean notch depth was 0.5±0.83 mm on lateral cephalograms. The change in all soft and hard tissue cephalometric parameters was significant at 6 months postoperatively compared with baseline ( P <0.001 for all). B-genioplasty caused satisfactory clinical and cephalometric changes in long-face patients with retrognathia, including prevention of step/notch in the inferior border of the mandible, significant reduction of gonial angle, correction of the mandibular plane, and reduction of lower facial height.

Sculpting life: Studying the intricacies of human fetal spleen morphology during development

Introduction: The spleen, a crucial lymphoid organ, plays a significant role in blood cell production and regulation. Emerging from mesodermal cells in the dorsal mesogastrium during the fourth embryonic week, the spleen is located in the left upper quadrant alongside the tenth rib. This study investigates morphological variations in human fetal spleens, serving as blood filters and storage sites for iron, erythrocytes, and platelets. This study aimed to assess morphological measurements of human fetal spleen development. Materials and Methods: Sixty formalin-preserved fetuses (33 male, 27 female) of varying gestational ages were examined over a three-year period (2020-2023) at the Anatomy Department, Govt. Medical College Srinagar Garhwal, ensuring adherence to ethical guidelines. Gross characteristics such as position, shape, relations, notches &amp; fissures, and ligaments were assessed and statistically analyzed. Results: All fetal spleens were located in the left hypochondrium, with 50% exhibiting a wedge shape. The stomach consistently associated with the spleen, while no relationship was observed between the kidney, left colic flexure, and spleen in early fetal stages. The liver exhibited connections with the fetal spleen. Notches were most prevalent along the superior border, followed by the inferior border and lateral pole, with 27 spleens showing fissures. Conclusions: Studying prenatal spleen development aids in understanding organ pathologies, thereby enhancing diagnostic and preventive techniques. Keywords: Fetal Spleen, Wedge Shape, Notches, Fissures

Developing an anatomically valid segmentation protocol for early tau regions: the anterior medial temporal lobe cortices

AbstractBackgroundThe anterior portion of the medial temporal lobe (MTL) is one of the earliest regions showing tau deposition in Alzheimer’s disease (AD) and hence a key focus area for AD imaging biomarkers. However, the anatomical variability of the anterior MTL presents a challenge for segmentation protocols. Leveraging a novel postmortem dataset with histology and MRI, we aimed to develop a histologically‐informed segmentation protocol for the anterior entorhinal cortex (ERC), Brodmann Area (BA) 35 (approximates transentorhinal cortex), and BA36 for in vivo 3 tesla (T) MRI.MethodDigitized 50‐µm thick MTL Nissl‐stained coronal histology sections from 20 cases (Table 1) were annotated by expert neuroanatomists. Cases with and without neurodegenerative diseases were included to ensure broad generalizability of the protocol. The histology sections were registered to same‐subject 0.2×0.2×0.2‐mm3 9.4 T postmortem MRI and were analyzed together to determine the location of the histological borders of the MTL cortices in relation to anatomical landmarks observable on MRI.ResultThe distance between the anterior histological border of ERC, BA35 and BA36 was assessed in relation to different anatomical landmarks observable on MRI. The distance relative to the hippocampus was chosen, as there was relatively low between‐subject variability in distance (low SD in Table 2) and this region is easily identifiable on MRI. The ERC starts 4.75 mm (median) anterior to the hippocampus, BA35 9.25 mm and BA36 10.25 mm. There was no significant difference in distances between patients with and without neurodegenerative disease. Next, we analyzed the location of the ERC on histology sections. We determined that regardless of the depth of the collateral sulcus (CS) (contrary to more posterior regions), the inferior border of the ERC is on average at the edge of the CS and the superior border at the superior edge of the parahippocampal gyrus (Figure 1a), but at the halfway point for the first section with ERC. These segmentation rules for ERC can be applied to T1‐MRI (Figure 1b).ConclusionSegmentation rules for anterior BA35 and BA36 are under development. This histologically‐informed segmentation protocol is expected to improve the efficacy of imaging biomarkers for tau deposition in AD.

The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study.

Cadaveric anatomical studies. This study aims to investigate the anatomical relationship between bony landmark "V point", dural sac, nerve roots, and intervertebral disc for improving operative outcomes and decreasing post-operative complications in posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD). 10 soft adult cadavers were studied. We measured the distance of the V point to the lateral margin of dural sac, V point to the inferior border of intervertebral disc, and the inferior border of cervical nerve root to the inferior border of intervertebral disc. Then we calculated the mean of distance from V point to the inferior border of cervical nerve root. The mean distance from the V point to the lateral margin of dural sac from C3/4 to C7/T1 ranged from 3.1 ± 1.38mm to 3.37 ± 1.46mm. The mean distances from V point to the inferior border of intervertebral disc from C3/4 to C7/T1 were .19 ± 1.16mm at C3/4, .45 ± 1.23mm at C4/5, .43 ± 1.01 at C5/6, -.43 ± 1.86mm at C6/7 and -1.5 ± 1.2mm at C7/T1. The mean distance between V point and the inferior border of cervical nerve root from C3/4 to C7/T1 showed all positive value, ranging from .06 ± 1.18mm to 4.45 ± 2.57mm, increasing caudally. In performing PECF or PECD, a 3-4mm radius of bone removal should be enough for exposure and neural decompression at C3/4 to C5/6. At C6/7 and C7/T1 a more extensive bone cut of more than 4mm is recommended, especially in cranial direction.

A novel perspective on constipation secondary to sigmoidocele: a retrospective study.

Sigmoidocele, which is a type of obstructed defecation syndrome (ODS), is a peritoneal hernia of the pelvic floor that has been seldom studied individually. This study investigated the anatomic characteristics of sigmoidocele based on imaging features. This retrospective cohort population comprised adult patients with ODS who underwent defecography between December 2017 and July 2020. Sigmoidocele was classified based on existing criteria. Novel radiological parameters including the vertical distance descended by the sigmoid colon from rest to maximum straining (RMS) and from the inferior border of the sigmoid colon to the superior border of the rectum at maximum straining (MSR) were measured. Among 275 patients with sigmoidocele, 251 (91.6%) were female. The mean age was 51.53±12.99 years. We classified 26, 205, and 44 cases as grades I, II, and III, respectively. Patients with more severe sigmoidocele had greater sigmoid colon mobility (RMS: 19.13±8.54 mm, 34.45±14.51 mm, and 48.70±20.05 mm for grades I, II, and III, respectively; p < 0.001) and more pronounced compression of the rectum by the sigmoid colon at maximum straining (MSR: 35.23±8.44 mm, 26.33±13.29 mm, and 15.18±18.00 mm, respectively; p < 0.001). We regrouped the patients based on sigmoid colon alignment. Type L patients had the most severe constipation. Our study presents a novel sigmoidocele classification. The anatomic appearance and location of the herniated sigmoid colon observed using fluoroscopy during defecation may help improve the clinical awareness of ODS caused by sigmoidocele.

Distribution of triggers in the left atrial posterior wall in AF patients undergoing catheter ablation

Abstract Introduction Having a common embryologic origin with the pulmonary veins (PVs), left atrial posterior wall (LAPW) is considered to be a source of non-PV triggers that facilitate maintenance of atrial fibrillation (AF). However, the benefits of electrical isolation of the posterior wall (PWI) is still debated with contradictory data originating from different ablation approaches. Purpose We report the distribution of triggers in the LAPW area in AF patients undergoing repeat ablation. Methods Consecutive AF patients undergoing catheter ablation between 2015 and 2022 were included in this analysis. PVs were isolated first. Next, high-dose isoproterenol challenge (up to 30µg/min) was used to disclose triggers in the PW by moving the circular mapping catheter along the PW down to the level of coronary sinus, which were targeted using additional RF energy. We defined lower part of LAPW as the area between the line joining the inferior borders of the inferior PV-encircling lesions and the coronary sinus. The endpoint was to achieve electrical isolation, as documented by absence of any electrical activity in the PW. Results Of the 10,963 AF ablations performed during the specified time period, 6249 (57%) had triggers mapped and ablated in the LAPW area. Triggers were seen to be originating from the part of the PW between the PVs in 4124 (66%) and from the lower part of the PW in 2125 (34%) patients. Of these, 1624 (26%) patients had focal triggers detected in both the area between the PVs and the lower PW. All triggers from in between PVs were targeted for ablation, whereas lower PW sites were ablated in 1296 (61%) and not targeted for ablation the remaining 829 (39%). Figure 1 demonstrates the triggers arising from lower PW. At 1 year, amongst patients with lower PW triggers, 1049/1296 (81%) vs 326/829 (39.3%) (p&amp;lt;0.001) were arrhythmia-free. Conclusion Ectopic triggers in the LAPW were documented to be arising from the lower part of the PW in approximately 1/3rd of cases and ablation of those sites resulted in significantly higher success rate.