Knowledge Of Anatomy Research Articles

Scapula harvest in the supine position for immediate mandibular reconstruction.

The scapula is the second most popular donor site for mandibular reconstruction after the fibula. Scapula harvest is generally performed in the lateral decubitus position and the requirement of positional changes hamper the widespread use of the scapula. This study compared scapula harvest for immediate mandibular reconstruction between the supine and lateral decubitus positions. We reviewed the outcomes of 16 patients who underwent segmental mandibulectomy and immediate reconstruction of the scapula based on the angular branch of the thoracodorsal artery. The scapula was harvested in the lateral decubitus (lateral decubitus group) or supine position (supine group) in eight patients each. Several perioperative parameters were compared between the two groups. One scapula was lost because of inadvertent injury of the angular branch in the supine group. The operative time was significantly shorter in the supine group than in the lateral decubitus group. Harvesting of the scapula in the supine position is a feasible option for immediate mandibular reconstruction. Although deep anatomic knowledge and technical expertise are necessary, this strategy can eliminate positional change and significantly reduce the operative time.

Deconfounded multi-organ weakly-supervised semantic segmentation via causal intervention

In weakly-supervised semantic segmentation, obtaining the class activation maps for pseudo masks is crucial. Since multiple organs appear in the same medical image, it is reasonable to obtain the activation maps of each organ by the organ-level features instead of the image-level features. The image-level features are decomposed into the organ-level features, yet the prior anatomical knowledge makes a spurious association between the image-level and organ-level features. To this end, we apply the causal intervention to cut off the spurious association and propose a novel deconfounded multi-organ weakly-supervised semantic segmentation (DeMos) method. Based on the original class activation mapping (CAM) method, the model is retrained to learn the deconfounded features of each organ via cross-attention, and we approximate the expectation of the intervention instead of the traditional likelihood. When the model converges, we extract the activation maps by CAM. Our method not only generates high-quality pseudo masks on the CHAOS, ACDC and ProMRI datasets, but is also applicable to other CAM variants. Furthermore, with the refinement, DeMos achieves the dice similarity coefficient of 93.26% on the task of the left ventricle segmentation, which outperforms the state-of-the-art methods.

Analysis of Domain Addressed and Subdivisions of Anatomy Emphasized in Spotting Stations in Anatomy Part of First Professional MBBS Examination

Introduction: Assessment of any educational program should implement purpose of the learning objectives. Learning objectives are prepared with the help of several models such as SOLO (Structure of observed learning Outcomes) taxonomy, Bloom’s Taxonomy etc. The most commonly used classification system is “Bloom’s taxonomy to develop learning objectives” which describes the domains of educational objectives and divides the domains into three categories a) cognitive domain b) psychomotor domain c) affective domain. Objectives: To observe the domains of the questions of soft part-portion of Spotting stations to fulfill the learning objectives set by the curriculum in Anatomy professional examination in the background of Bloom’s Taxonomy. The research also tries to find out the subdivisions of Anatomy preferred more and regions of Gross Anatomy more emphasized in soft part-portion of Spotting stations. Methods: This cross sectional study held in the Department of Anatomy in Armed Forces Medical College (AFMC) from August 2015 to December 2018. Data (questions of soft part-portion of Spotting stations and ‘answer key’s) are collected from seven different medical colleges affiliated under Dhaka University. A total fifty-two day’s questions with ‘answer key’s are taken for the study from the first professional examination held on May 2013 and May 2014. For the purpose of the study each question is divided into ‘Item’, ‘Part’s and ‘Segment’s. Moreover verbs of the segments are then analyzed in the form of ‘statement’, ‘list’ and ‘single name’ and Anatomy is subdivided into Gross Anatomy, Histology and Developmental Anatomy. Result: A total 774 items, 1571 parts, 2048 segments are analyzed. The verbs used to address the levels of cognitive domain in the questions reveals that ‘identification’ is mostly (76.62%) used in supplied figure followed by radiology (52.05%) model (41.89%) viscera (38.82%) and dissection (24.95%) stations. ‘Statement’ mostly used as verb by dissection (37.28%) and minimum in supplied figure (11.6%) stations. Similarly ‘list’ is mostly used in viscera (23.14%) and ‘single name’ is mostly used verb in dissection stations. Maximum (89.2%, 92.47%, 90.54% and 81.82%) questions are asked from Gross Anatomy subdivision in viscera, radiology, model and in supplied figure stations respectively. In case of viscera stations about one third (34.62%) and one fourth (25.62%) questions are from the thorax and abdomen proper respectively and around 15% questions cover pelvis, (10.54%) head neck, (12.34%) and brain (16.88%) respectively. Nearly half (46%) of the figure station use supplied figures as a ‘tool’. Maximum (39%) figures are used from brain where supplied figures are used as a ‘tool’ and no figure used from lower limb.  When instructed to ‘draw and label’, 50% are from region of brain and less than 20% from other regions.              Conclusion: From the findings it can be easily perceived that though Spotting examination is part of practical examination but in our country but it mainly involves in assessing factual knowledge of Anatomy which can hardly meet the demand of the objectives set by the curriculum. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 59-65

Composition of encephalic arteries and origin of the basilar artery are different between vertebrates.

Intracranial arterial anatomy is lacking for most mammalian and non-mammalian model species, especially concerning the origin of the basilar artery (BA). Enhancing the knowledge of this anatomy can improve animal models and help understanding anatomical variations in humans. We have studied encephalic arteries in three different species of birds and eight different species of mammals using formalin-fixed brains injected with arterial red latex. Our results and literature analysis indicate that, for all vertebrates, the internal carotid artery (ICA) supplies the brain and divides into two branches: a cranial and a caudal branch. The difference between vertebrates lies in the caudal branch of the ICA. For non-mammalian, the caudal branch is the origin of the BA, and the vertebral artery (VA) is not involved in brain supply. For mammals, the VA supplies encephalic arteries in two different ways. In the first type of organization, mostly found in ungulates, the carotid rete mirabile supplies the encephalic arteries, the caudal branch is the origin of the BA, and the VA is indirectly involved in carotid rete mirabile blood supply. The second type of encephalic artery organization for mammals is the same as in humans. The caudal branch of the ICA serves as the posterior communicating artery, and the BA originates from both VAs. We believe that knowledge of comparative anatomy of encephalic arteries contributes to a better understanding of animal models applicable to surgical or radiological techniques. It improves the understanding of rare encephalic variations that may be present in humans.

New Perspectives in Third Molar Auto-Transplantation: Literature Review and a Case Report of Clinical, Financial and Forensic Implications.

Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.

Dissections or prosections: Which method has a better impact on sustainable gross anatomy knowledge?

Background Assessing the level of knowledge of anatomy of undergraduate students four years after their primary anatomy training will give a better indication as to which system of teaching is more effective. We aimed to ascertain which method was more effective at establishing a core of anatomy knowledge that could be recalled after a considerable amount of time. Methods We tested two groups of medical students in their final year on the key concepts of gross anatomy using a question paper that included true–false type questions and identification of anatomical line diagrams. These two batches of students followed a dissection-based curriculum and a newly introduced prosections-based curriculum at the beginning of their medical education. The prosections- based curriculum brought with it a reduction in the in-class teaching and learning activities when compared to the old curriculum. This would in turn reflect how much anatomy knowledge one would possess when they start to practise medicine as a newly qualified doctor and also embark on a postgraduate training programme. The two groups were subjected without prior warning to a question paper that had six questions, each with five true–false statements and four questions on identification and labelling of anatomical line diagrams. Results There was no statistically significant difference in the marks obtained for the true–false type questions between the two groups (p=0.08), but the prosections group obtained higher marks for the diagram identification questions (p=0.02). Conclusion A prosection-based curriculum when compared to a dissection-based curriculum was equally effective at establishing a core of gross anatomy knowledge.

A Cadaveric Study Using Anatomical Cross-Section and Computed Tomography for the Coelomic Cavity in Juvenile Cory's Shearwater (Aves, Procellariidae, Calonectris borealis).

Birds play a crucial role in ecosystems, engaging in key functions such as pollination, pest control, and seed dispersal. The anatomical understanding of these species is essential to addressing emerging challenges, including climate change and habitat loss, which directly impact their survival. Detailed knowledge of avian anatomy is fundamental for research across various disciplines, ranging from ornithology to veterinary medicine. Therefore, this study aims to disseminate the understanding of avian anatomy and the application of computed tomography (CT) for visualizing the coelomic cavity in Cory's Shearwater (Calonectris borealis). Recent advances in comprehending the anatomical structures of this region in avian species are highlighted, with a specific focus on Cory's Shearwater as a study model. Various anatomical cross-sections and transverse CT images were described and analyzed in detail, offering a comprehensive insight into the coelomic cavity from different perspectives. The correlation between anatomical cross-sections and CT images is emphasized as crucial for a profound understanding of avian anatomy. This research contributes to the broader knowledge of avian anatomy, with potential implications for conservation efforts and veterinary practices.

Anatomical and ultrasonographic landmarks of the manus nerves in camel (Camelus dromedarius)

This study aims to describe the anatomical and ultrasonographic features of manus nerves to establish a guideline approach for manus nerve block in camel practice. Twelve distal parts of the forelimbs cadavers of freshly slaughtered adult dromedary camels were used in this study. Six manus cadavers were used for anatomical morphology and the other six were used for ultrasonographic examination of the manus nerves. The gross anatomical study revealed the manus of the camel including, the third and fourth metacarpus and digits receives nerve supply from the ulnar, radial, and median nerves. These nerves continued along the camel manus as lateral and medial palmar metacarpal nerves and the axial and abaxial palmar proper digital nerves of the digits III and IV. Ultrasonographic evaluation of each nerve in the manus of the dromedary camel revealed proper localization and tracking of these nerves from the surrounding structures. In conclusion, the present study provides anatomical and ultrasonographic imaging knowledge tracking of the manus nerves in camels. This is important for determining the areas of the nerve block to attain successful regional anesthesia of this region in case of manus injuries in camel.

Systematic Review and Meta-analysis of Suprascapular Notch Morphological Variability: Do We Know Everything?

The suprascapular notch represents a depression on the lateral part of the superior border of the scapula, medially to the coracoid process. The current paper presents a systematic review with a meta-analysis of the suprascapular notch morphological variability. Related clinical implications were further discussed as well to emphasize the value of the topic. A total of 31 articles were included in the meta-analysis, which depicted great heterogeneity. Thus, due to the different classification systems, difficulties were faced in creating a complete and united classification. All the problems and pitfalls that arise from each classification system were discussed, and we concluded with the most complete one. The knowledge of the suprascapular notch morphological anatomy is of great importance, especially for orthopedic surgeons, due to its relationship with the suprascapular nerve. Thus, further research in this area is adequate.

Cortical incisions and transcortical approaches for intra-axial and intraventricular lesions: A scoping review

Background: Transcortical approaches, encompassing various surgical corridors, have been employed to treat an array of intraparenchymal or intraventricular brain pathologies, including tumors, vascular malformations, infections, intracerebral hematomas, and epileptic surgery. Designing cortical incisions relies on the lesion location and characteristics, knowledge of eloquent functional anatomy, and advanced imaging such as tractography. Despite their widespread use in neurosurgery, there is a noticeable lack of systematic studies examining their common lobe access points, associated complications, and prevalent pathologies. This scoping review assesses current evidence to guide the selection of transcortical approaches for treating a variety of intracranial pathologies. Methods: A scoping review was conducted using the PRISMA-ScR guidelines, searching PubMed, EMBASE, Scopus, and Web of Science. Studies were included if ≥5 patients operated on using transcortical approaches, with reported data on clinical features, treatments, and outcomes. Data analysis and synthesis were performed. Results: A total of 50 articles encompassing 2604 patients were included in the study. The most common primary pathology was brain tumors (60.6%), particularly gliomas (87.4%). The transcortical-transtemporal approach was the most frequently identified cortical approach (70.48%), and the temporal lobe was the most accessed brain lobe (55.68%). The postoperative course outcomes were reported as good (55.52%), poor (28.38%), and death (14.62%). Conclusion: Transcortical approaches are crucial techniques for managing a wide range of intracranial lesions, with the transcortical-transtemporal approach being the most common. According to the current literature, the selective choice of cortical incision and surgical corridor based on the lesion’s pathology and anatomic-functional location correlates with acceptable functional outcomes.

Retrospective evaluation of condylar morphology using panoramic radiography in a sample of Turkish population.

The temporomandibular joint is one of the most complex anatomic structures. It takes a great role in masticatory system and helps to make possible some functions such as speaking, chewing and swallowing. Clinicians should have sufficient anatomical knowledge to assess relationships of the hard and soft tissues, including the mandibular condyle, glenoid fossa, articular eminence of the temporal bone, the articular disc and its attachments. The aim of this study was to evaluate the frequency of different types of mandibular condyles and its distribution according to the age and gender. It was also evaluated whether the condyle types were bilaterally symmetrical or not. A total of 1315 digital panoramic images which obtained from the patients suffering from the dental problems were assessed. Demographic data, condylar morphology were noted. All obtained data were analysed by using descriptive statistics. Morphology of mandibular condyles were classified into four shapes as identified in other studies, namely: type I - oval shape, type II - diamond shape, type III - bird beak shape, type IV - crooked finger shape. Two independent examiners, who have 19 and 7 years of experience in oral and dentomaxillofacial radiology, made a consensus and evaluated all images. A total of 1315 digital panoramic images were assessed. Seven hundred sixty-seven [58.3%] the patients were female and 548 [41.6%] were male. The age range of patients was from 18 to 84 years. Right-left condyle types were found to be symmetrical in the range of 67% of the subpopulation examined in the study. For the consensus, 'oval' condyle was common on both the right and left, while 'crooked finger' condyle was the rarest. The temporomandibular joint is the most important structure for all jaw functions such as speech, swallowing. In order for all these functions to continue in a healthy way, the anatomical structure should be known very well down to the finest detail. Identification of anatomical structures and their variations can play an important role in implant dentistry. Clinicians commonly prefer conventional radiologic methods to evaluate dentomaxillofacial region. Although the most of the variations are asymptomatic and require no treatment,correct identification of these findings will reduce unnecessary further diagnostic assessments and will provide more appropriate treatment plans.

CT based 3D reconstruction of the forefoot’s blood supply in a white rhinoceros

BackgroundThe white rhinoceros (Ceratotherium simum) is close to extinction, listed as “Near Threatened”, with a decreasing population on the Red List of Threatened Species of the International Union for Conservation of Nature. In at least 50% of the specimens in captivity, podiatric diseases, such as osteitis, osteomyelitis, chip fractures, enthesophytes, fractures and osteoarthritis were found during necropsy. These osteal deformations cause further pathogenic alterations in the soft tissues, particularly in the digital cushion. The literature provides good description of the skeleton of the rhino’s limbs, but similar for the vascular system is non-existent. In order to recognize the symptoms in an early state and for a successful surgical treatment, precise knowledge of the vascular anatomy is essential. The purpose of our study was to provide detailed anatomical description of the blood supply of the digits and that of the digital cushion.ResultsThe blood supply of the distal foot, digits and digital cushions were perfectly visible on the reconstructed and coloured 3D models. The deep palmar arch provided not only the blood supply to the digits but had a palmaro-distal running branch which developed a trifurcation proximal to the proximal sesamoid bones of the third digit. Two of its branches participated in the blood supply of the digits’ proximal palmar surface, while the major branch supplied the digital cushion from proximal direction.ConclusionsOur findings show a unique blood supply: the main vessels of the digital cushion stem both directly from the deep palmar arch and from the digits’ own arteries. The detailed description of vessels may be useful in planning surgery of the region and also in cases where the veins of the ear are not accessible.

Human anatomy curriculum reform for undergraduate nursing students: An exploratory study.

This study aims to cultivate students' independent learning capacity, promote the interdisciplinary integration of "nursing + anatomy," and establish a curriculum system to enhance applied nursing abilities based on project-based teaching reform of everyday clinical nursing operations. A total of 151 second-year (class of 2021) undergraduate nursing students at a Chinese university were selected for this study. By adjusting the curriculum, reconstructing the teaching contents, employing the "hybrid + flip" teaching method based on BOPPPS (bridge-in, outcomes, preassessment, participatory learning, post-evaluation, summary), and implementing a teaching system based on the "three re-three linkage," a Human Anatomy curriculum with a focus on basic anatomical knowledge was developed and connected with nursing clinical operation practice. The restructuring of the course content received unanimous recognition from both the teaching staff and the students. Notably, students in the class of 2021 achieved significantly higher grades than did students in the class of 2020, who received traditional face-to-face instruction (p < 0.01). These results indicate enhanced clinical application skills among the former group of students. following the implementation of instructional reforms during one semester, students exhibited notable improvements in motivation, program implementation, self-management, and interpersonal communication. A statistically significant increase in overall scores for self-directed learning capacities over the preinstructional period was observed (p < 0.05). Furthermore, the findings of the student satisfaction surveys reflected highly favorable perceptions of the enriched instructional format, high levels of course engagement, frequent faculty-student interactions, and augmented overall competence. The practical implementation of the reform in the context of a Human Anatomy course for undergraduate nursing students led to significant positive outcomes, thereby enhancing the effectiveness of teaching and learning. Students' clinical application abilities and self-directed learning capacities notably improved, while overall satisfaction with the course remained high.

Adaptive Fusion of Deep Learning with Statistical Anatomical Knowledge for Robust Patella Segmentation from CT Images.

Knee osteoarthritis (KOA), as a leading joint disease, can be decided by examining the shapes of patella to spot potential abnormal variations. To assist doctors in the diagnosis of KOA, a robust automatic patella segmentation method is highly demanded in clinical practice. Deep learning methods, especially convolutional neural networks (CNNs) have been widely applied to medical image segmentation in recent years. Nevertheless, poor image quality and limited data still impose challenges to segmentation via CNNs. On the other hand, statistical shape models (SSMs) can generate shape priors which give anatomically reliable segmentation to varying instances. Thus, in this work, we propose an adaptive fusion framework, explicitly combining deep neural networks and anatomical knowledge from SSM for robust patella segmentation. Our adaptive fusion framework will accordingly adjust the weight of segmentation candidates in fusion based on their segmentation performance. We also propose a voxel-wise refinement strategy to make the segmentation of CNNs more anatomically correct. Extensive experiments and thorough assessment have been conducted on various mainstream CNN backbones for patella segmentation in low-data regimes, which demonstrate that our framework can be flexibly attached to a CNN model, significantly improving its performance when labeled training data are limited and input image data are of poor quality.

(224) Women's Expectations and Representations of Breast Surgery Impact on their Sexual and Reproductive Life

Abstract Introduction Breast surgery is a difficult experience, whether for benign or malignant diseases. It concerns all women, regardless of their ethnic origin or socio-demographic condition. Due to the life-altering nature of this experience, patients' expectations before surgery can sometimes become unrealistic regarding their body image, sexuality, quality of life, and even fertility and reproduction. The diversity of these expectations is influenced by clinical, socio-demographic, and psychological factors. Objective The main objective of this study is to assess the factors responsible for the variability of female patients' expectations before breast surgery. The secondary objectives of this survey are to evaluate the representations of female patients of the potential impact of breast surgery on their body image, reproduction, and their sexuality. Methods We conducted a one-year cross-sectional study (2022). We included all female patients over the age of 18, with a breast disease, scheduled for elective breast surgery at our department, except those with a history of previous breast surgery. The data collection was by filling in a pre-established 9-item form including the validated translated versions of the standardized following scales: the Female Sexual Function Index (FSI), the Hospital Anxiety and Depression Scale (HADS), and the Body-Esteem Scale for Adolescents and Adults (BESAA). Patients' expectations were divided into 4 sub-categories: • Expectation on body image: 3 Items, concerning patients' perceived ideas regarding their femininity, their partner's reaction to them, and their body. • Expectations about sexuality: 9 items concerning patients' perceived ideas regarding their sex life, desire, partner's desire, excitement, lubrication, orgasm, sexual satisfaction, frequency of sexual intercourse, and dyspareunia. • Expectations on quality of life: 4 items, concerning the patients' perceived ideas regarding their daily, professional, family, and marital life. • Expectations on fertility and menopause: 8 items concerning the patients' perceived ideas regarding their fertility, menstrual cycle, contraception, early menopause, menopausal symptoms, and hormone therapy. Patients' expectations are defined as unrealistic if the expectations of two of the 4 subcategories are unrealistic. Results We included 103 participants. Patients' general expectations were unrealistic in 30.1% of cases (n=31) focusing on sexuality (unrealistic in 30.1% of cases) and body image (unrealistic in 28.2% of cases). The risk factors for developing unrealistic expectations with regard to body image were a surgery delay greater than 2 months (p=0,004; OR=8,143), a radical breast surgery (mastectomy)(p=0,006; OR=11,972), good anatomical knowledge (p=0,012; OR=9,615), and pathological HADS-A levels (p=0,032; OR=8,693). A breast surgery delay that exceeds two months was an independent risk factor for unrealistic expectations regarding sexuality (p=0,019; OR=4,273). Concerning the independent risk factors related to general unrealistic expectations, work at the time of the surgery (p=0,049; OR=4,081), a radical breast surgery (p=0,045; OR=4,757), good anatomical knowledge (p=0,037; OR=5,12), and a pathological HADS-A level (p=0,04; OR=6,698) were statistically significant. No independent risk factors were associated with quality of life and reproduction. Conclusions Our results emphasize the importance of a good knowledge of the risk factors that can promote unrealistic sexual and body image expectations prior to breast surgery. It allows for targeting high-risk patients and implementing the necessary preventive interventions. Disclosure No.

The Vertebrobasilar Trunk and Its Anatomical Variants: A Microsurgical Anatomical Study.

The trunk of the basilar artery has not been included in microanatomy studies. Anatomical variants of the perforant branches of the vertebrobasilar trunk and their relationship with neural structures are very important in surgical approaches. Surgical dissection for the treatment of vascular lesions requires a perfect knowledge of the microsurgical anatomy. We conducted a descriptive analysis of 50 brains, which were fixed with formalin at 10% for 2 weeks, and the arterial system was injected with colored latex. After microsurgical dissection, it was divided into three segments: the lower portion went from the anterior spinal artery to the anteroinferior cerebellar artery, the middle segment was raised from the upper limit of the lower portion to the origin of the superior cerebellar artery, and the upper segment ranged from the previous portion until the origin of the posterior cerebral artery. The basilar artery had an average length of 30 mm. The average diameter at its junction with the vertebral arteries was 4.05 mm. The average middle segment was 3.4 mm in diameter and 15.2 mm in length. The diameter of the upper segment was 4.2 mm, and its average length was 3.6 mm. The average number of bulbar arteries was three, and their average diameter was 0. 66 mm. The number of caudal perforator arteries were five on average, with a diameter of 0.32 mm. We found three rare cases of anatomical variants in the vertebra-basilar junction. The basilar artery emits penetrating branches in its lower, middle, and upper portions. The origin of penetrating branches was single or divided after forming a trunk. However, we observed long branches from perforant arteries.

[Selection of Appropriate Approaches to Preserve Brain Function for Deep Seated Brain Tumors:Our Experience of Two Posterior Thalamic Cases].

What is the most important factor to achieve successful surgery for deep-seated brain tumors with preservation of brain functions? Definitely, it is to identify the tumor origin site at which a tumor arose and select appropriate surgical approaches that immediately lead directly to the site in the early stage of surgery, minimizing damages of cortices and important white matter bundles, and controlling main arterial supply to the tumor. For this, neurosurgeons must have thorough knowledge of brain anatomy and function, and tailor the best surgical approach for each patient, based on three-dimensional anatomical simulation. For lesions situated in the posterior and lower part of the thalamus and extending to the lateral part, two "cross-court" approaches; the occipital transtentorial/falcine and infratentorial supracerebellar transtentorial approaches, provide a wide corridor to even the lateral aspect of the thalamus and early access to the posterior choroidal arteries, usually main feeders of this territory tumors, without damaging any cerebral cortices and major white matter bundles. Here, we describe the selection of approaches for two representative cases and demonstrate surgical procedures and postoperative courses.

Clinical study of mesh repair in ventral hernia with comorbidities (diabetes mellitus and/or obesity and/or hypothyroidism) in a tertiary care hospital

Background: Ventral hernias comprise the second-most common hernia presentation, or 21–35% of all hernia types in the surgical world. Ventral hernias include incisional, umbilical, epigastric, and spigelian hernias, among others. This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Aims and Objectives: This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Materials and Methods: Forty-five cases of ventral hernias treated were studied prospectively from January 2021 to June 2022, in which each patient was evaluated thoroughly and surgery was planned to obtain a satisfactory outcome. The distribution of ventral hernias with respect to age, sex, comorbidities, and risk was recorded. Common presenting symptoms of ventral hernias, diagnosis, and complications were studied. The data collected was entered in a proforma, tabulated, and statistically analyzed. Results: Females were affected much more than males. Out of the three types of hernia that were studied, umbilical hernia showed more incidence (n=23/51%), followed by incisional hernia (n=15/33%), and epigastric hernia (n=7/16%). The most common age presentation was in the fourth and fifth decades. The most common type of mesh repair was pre-peritoneal repair in 28 (62%). The pain was relatively more common post-surgery complications, as noted in 11 (24%). In 100% of the cases, swelling was the complaint, followed by pain (18.8%). Obesity was the most common etiological factor in the development of ventral hernias (60%), followed by diabetes (35%). Conclusion: The most common ventral hernia was an umbilical hernia. Ventral hernias are more common in females. Obesity and diabetes are observed to be the major predisposing risk factors. Good pre-operative evaluation and preparation, sound anatomical knowledge, and meticulous attention to surgical detail are the most important factors for the prevention of postoperative complications. In view of the limited period of follow-up, we were not in a position to comment on recurrence rates, but when proper surgical procedures are adopted along with pre-operative correction of comorbid factors, results will always be excellent.

Segmental femoral fracture malunion: evidence and prognostic analysis of medical intervention in the third century BC

We examined the remains of an individual who was unearthed from the Tuchengzi site and was believed to be from the Warring States period in China. The remains exhibited segmental femoral fracture. We aimed to deduce the cause of fracture, medical interventions, healing process, and motion behavior after fracture healing using several techniques, including macroscopic observation, computed tomography (CT), and finite element analysis. Based on the morphology of the long bones, it appeared that the individual was male. The fractures resulted in an adduction angle of 5.47° and an anterior flexion angle of 21.34° in the proximal femur, while the femoral neck anteversion angle had been replaced by a retroversion angle of 10.74°. Additionally, the distal femur formed an abnormal anterior convex angle of 144.60°. CT revealed mature callus formation and visible trabecular bundles. The finite element analysis indicated that the maximum von Mises stress in the femur was 17.44 MPa during standing and 96.46 MPa during walking. We suggest that medical practitioners in the Warring States period possessed a good knowledge of thigh anatomy, enabling them to perform fracture reduction and fixation. Reasonable medical intervention facilitated fracture healing and load recovery. Satisfactory fracture healing ensured that the individual could engage in normal standing and walking activities after rehabilitation.

Glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia: a case report.

Glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia is a rare form of neuropathic pain and presents with diagnostic and therapeutic challenges. A 67-year-old man presented with severe burning pain in the left oral cavity, with no explanatory findings during dental and ENT evaluations. TMJ examination revealed tenderness, and panoramic radiographs showed a non-contributory periapical radiolucency. MRI/MRA revealed abnormally tortuous vertebral arteries compressing the glossopharyngeal nerves and the brainstem. Topical lidocaine reduced pain, confirming glossopharyngeal neuralgia (GPN). Carbamazepine was initially ineffective, but at 200 mg pain reduced from 90 to 20 on the visual analog scale. The patient requested and underwent microvascular decompression (MVD) surgery, which eliminated his pain. When the vertebral artery compresses the glossopharyngeal nerve, the pain is more intense, attributed to its thicker vascular structure. Local anesthetic testing aids in identifying GPN. Dentists must be skilled in diagnostics and possess anatomical knowledge for accurate evaluation and referral of throat and ear pain.