Lateral Tissue Research Articles

Mitral Isthmus Anatomy: Detailed Examination and Classification Proposal.

The aim of this study was to investigate the anatomical features of the mitral isthmus (MI) line, the vessels located there and their localisation in the MI line. MI length and wall thickness were measured in a total of 65 autopsied fresh hearts. The distances of the vessels at the level of MI to the left inferior pulmonary vein (LIPV), mitral annulus (MA), endocardium surface (ES) and lateral adipose tissue (LAT) were recorded. The mean linear length of MI and left atrial wall thickness were 49.6±9.9 mm and 3.9±1.2 mm, respectively. GCV and LCx are approximately 1 cm from MA, 4 cm from LIPV, 5-6 mm from ES and 7 mm from LAT. Great cardiac vein (GCV) was found to be located in the MI line in 100%, left circumflex artery (LCx) in 60%, and vein of Marshall (VOM) in 63.1% of cases. Presence of only GCV was recorded as Type-1 (18.5%), GCV and LCx as Type-2 (18.5%), GCV and VOM as Type-3 (21.5%) and presence of all three as Type-4 (41.5%). LCx located below the GCV was recorded as Type-A (59%), above the GCV as Type-B (25.6%), and at the same level but with LCx on the endocardial surface as Type-C1 (12.8%) and on the epicardial surface as Type-C2 (2.6%). This study proves that the anatomy of MI is far from standardised and helps to raise awareness of the vascular pattern that may be encountered prior to ablation intervention.

Case report: Benign lateral neck ectopic thyroid tissue mimicking cervical lymph node metastasis

AbstractWe herein report a rare case of benign lateral neck ectopic thyroid tissue that presentation micmicked cerivcal lymph node metastasis of follicular thyroid cancer and discuss its management pearl.

Lateral Meniscus Allograft Transplant With Capsulodesis and an Osteochondral Allograft to the Lateral Femoral Condyle

Background: Anterior cruciate ligament (ACL) injuries frequently present with lateral meniscal injuries, and when irreparable, this may lead to meniscectomy, increasing the risk for osteoarthritis. Lateral meniscal allograft transplant (LMAT) can restore knee function and proper contact pressures. When combined with osteochondral allograft (OCA) for chondral defects, results are highly positive. Indications: LMAT is indicated in relatively young patients (<50 years of age) with a symptomatic, meniscus-deficient knee that has failed conservative treatment. The knee must be stable, without articular cartilage damage that cannot be repaired, and patients should be able to adhere to postoperative rehabilitation and future care. Indications for OCA include young, active patients with posttraumatic osteochondral defects, osteonecrosis, osteochondritis dissecans, large focal defects, previous cartilage repair failure, or patellofemoral joint cartilage lesions. Technique Description: After a diagnostic arthroscopy is performed and concomitant injuries are ruled out, the lateral meniscal tissue is debrided to a 1- to 2-mm rim for the recipient site preparation. Tibial sockets for root fixation are created using tibial guides and passing sutures are placed. A capsulodesis is performed to reduce meniscal extrusion by securing the lateral capsule through a transtibial tunnel to the anteromedial tibial cortex with high-strength sutures. A meniscal allograft, prepared with bone plugs, is introduced through an enlarged anterolateral portal. After it is accurately positioned, it is stabilized using Fast-Fix Flex devices and circumferential sutures. The bone plug sutures are then fixed through the tibial tunnels to the anteromedial tibial cortex with a button. The large cartilage defect is addressed with an OCA transplant, involving defect measurement, careful reaming, and press-fit insertion of a donor plug, ensuring congruent articulation. Results: Patients can expect improved clinical outcomes and high patient satisfaction with LMAT and concomitant OCA. The use of bone plugs minimizes soft tissue dissection while achieving solid osseous fixation. Discussion/Conclusions: LMAT with OCA leads to restored contact pressures to near-physiological levels, a high patient satisfaction of over 85%, and mean allograft survival of 16 years. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Viscous shear is a key force in Drosophila ventral furrow morphogenesis.

Ventral furrow (VF) formation in Drosophila melanogaster is an important model of epithelial folding. Previous models of VF formation require cell volume conservation to convert apically localized constriction forces into lateral cell elongation and tissue folding. Here, we have investigated embryonic morphogenesis in anillin knockdown (scra RNAi) embryos, where basal cell membranes fail to form and therefore cells can lose cytoplasmic volume through their basal side. Surprisingly, the mesoderm elongation and subsequent folding that comprise VF formation occurred essentially normally. We hypothesized that the effects of viscous shear may be sufficient to drive membrane elongation, providing effective volume conservation, and thus driving tissue folding. Since this hypothesis may not be possible to test experimentally, we turned to a computational approach. To test whether viscous shear is a dominant force for morphogenesis in vivo, we developed a 3D computational model incorporating both accurate cell and tissue geometry, and experimentally measured material parameters. Results from this model demonstrate that viscous shear generates sufficient force to drive cell elongation and tissue folding in vivo.

6645 Paraganglioma or Benign Ectopic Thyroid Tissue?

Abstract Disclosure: J.A. Dower: None. R. MacLeod: None. B. Cardoso: None. C. Matouk: None. S. Mehra: None. G. Riccio: None. L. Williams: None. S.K. Majumdar: None. Introduction: During gestation, cells destined to form the thyroid descend through the thyroglossal duct; ectopic thyroid tissue may deposit anywhere along this route from tongue base to mediastinum (1). Less commonly, thyroid tissue can be found lateral to the duct, either alone or in association with a lymph node (2). We present a case of lateral ectopic thyroid tissue mimicking paraganglioma. Clinical Case: A healthy 32-year-old woman presented to ENT with cervical adenopathy persisting for several months after a flulike illness. FNA showed no evidence of malignancy. A neck CT with contrast ordered for further evaluation revealed a 3.2 x 2.3 x 1.5 cm enhancing mass within the right carotid space, splaying the external and internal carotid artery branches, most concerning for paraganglioma. A second, smaller lesion was noted inferiorly. Neck MRI confirmed these findings and revealed a subcentimeter T2 lesion within the right thyroid lobe. The patient was referred to endocrine for further workup. She had no symptoms of sympathetic hyperactivity and no family history suggestive of pheochromocytoma or paraganglioma. Biochemical workup was largely within normal limits: plasma metanephrines 53 pg/mL (57), normetanephrines 94 pg/mL (148), calcitonin <2 pg/mL, TSH 1.210 uIU/mL (0.27-4.2), FT4 1.52 ng/dL (0.8-1.7). Follow-up 24-h urine studies were also unremarkable: metanephrines 166 mcg (36-190), normetanephrines 159 mcg (35-482). Brain MRI, chest CT, and abdomen/pelvis MRI were negative for additional masses. DOTATATE PET/CT was completed to determine if the thyroid lesion was another potential paraganglioma requiring resection versus a nodule amenable to biopsy; uptake was confined to the carotid space lesions, so FNA of the thyroid nodule was considered safe. Thyroid FNA revealed FLUS with genetic testing indicating low likelihood of malignancy. The patient underwent tumor embolization followed by neck dissection with successful removal of both the larger and smaller masses identified on imaging. Frozen and permanent tissue section revealed that both masses consisted of benign thyroid tissue without associated lymphoid tissue. The patient experienced jaw pain with eating after surgery and is under consideration for Botox injection. Conclusion: Benign thyroid tissue can deposit in unexpected places, mimicking malignancy and paraganglioma, alike. Even a very thorough workup can mistake the identity of a mysterious mass; only the tissue itself can make the diagnosis.

A customized nasal dilator and breather for patient with deviated nasal septum

Nasal obstruction due to deviated nasal septum (DNS) is commonly defined as patient discomfort manifested as a sensation of insufficient airflow through the nose. The definitive treatment for a DNS is septoplasty, this customized nasal device can be used as an adjunct to treatment. And can be used as a breather until The patient receives or underwent definitive treatment. This device contains a nasopharyngeal airway tube and a customized nasal dilator, the nasopharyngeal airway tube is made of soft and elastic medical plastics, with good biocompatibility, without skin damage and allergy, which will be inserted inside. which will be inserted inside the affected nostril and it fits accurately between the septum and the lateral endonasal tissue, the nasal dilator which is composed of heat-cure acrylic resin helps to keep the nasopharyngeal airway in position withoutdislodging. The device also has an elastic band on both sides which can be worn like a mask by the patient. The nasopharyngeal tube of this device has a stopper that prevents the nasopharyngeal tube to go inside the nostril accidentally and the said tube is sterilizable and easily replaceable (even by the patient).

Synovial fluid does not retard fluid exudation during stress-relaxation of immature bovine cartilage

Interstitial fluid load support (FLS) is a dominant mechanism of lubrication in cartilage, producing a low friction coefficient while enhancing the tissue’s load bearing capabilities. Due to its viscosity, synovial fluid (SF) may retard loss of FLS by slowing the exudation of interstitial fluid from the cartilage. This study tested this hypothesis by comparing the stress-relaxation (SRL) response of immature bovine articular cartilage immersed either in phosphate buffered saline (PBS) or in healthy mature bovine SF, under unconfined compression (fluid exudation across cut lateral tissue boundary) and indentation testing (fluid exudation across articular surface). To investigate the influence of diffusion of SF molecular constituents into cartilage, the effect of incubation time in SF on SRL was also investigated. The SRL response in unconfined compression was not significantly different in PBS versus SF when compared directly (p = 0.98) and had a slope ofm = 1.00 ± 0.04 (R2 = 0.989 ± 0.007). Samples tested in PBS exhibited characteristic relaxation times, τPBS=42.6 ± 5.3 s andτSF = 40.8 ± 4.7 s, that were not significantly different (p = 0.40). Incubation time of 24 h in SF resulted in no significant difference in the SRL response (p = 0.39, m=1.03 ± 0.12; R2=0.983 ± 0.011, andτPBS = 43.4 ± 10.7 s versusτSF = 41.5 ± 4.8 s, p = 0.59). Indentation testing showed some statistically significant, but functionally insignificant, difference in SRL responses in PBS versus SF with a slope ofm = 0.958 ± 0.060 (R2 = 0.957 ± 0.020, p = 0.029, andτPBS = 16.9 ± 2.6 s versusτSF = 19.4 ± 3.3 s, p = 0.073). Based on these results, we reject the hypothesis that healthy SF can retard the loss of FLS in cartilage due to its viscosity.

Reliability of Chest Wall Perforator Flaps for Breast Reshaping following Massive Weight Loss

Abstract Background Breast deformity following massive weight loss poses a unique challenge inadequately managed by traditional methods. Patients also have considerable lateral and posterior upper trunk tissue surplus. Multiple studies have used chest wall flaps for auto-augmentation with mastopexy to tackle this problem. However, the outcome measures did not include any objective tools to assess the reliability of these flaps. Hence, in this study sono-mammography and breast anthropometric measurements are used for evaluation of the added volume and long-term sustainability of chest wall perforator flaps. Methodology Twenty massive weight loss patients with Pittsburgh Rating Scale score 2-3 underwent mastopexy with autologous augmentation through perforator flaps encompassing lateral chest wall skin. Outcome measures were breast volume, and the presence of fat necrosis on mammography, and direct breast anthropometry. Conclusion All patients showed a consistent increase in volume postoperatively and no fat necrosis in postoperative mammography, reflecting flap reliability over one year of follow-up. All postoperative anthropometric measurements showed improvement in the breast deformities addressed. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Abdominoplasty in a patient after bariatric surgery – case study

Introduction: Up to 96% of patients after bariatric surgery struggle with excess skin, which negatively affects their daily functioning due to frequent skin infections, difficulties with sexual activity and physical exercise, as well as discomfort, especially in social situations. Abdominoplasty is a surgical procedure that allows post-bariatric patients to resolve these problems. At the same time, like any surgical intervention, the incidence of complications is relatively low. These potential complications after surgery include mainly superficial wound dehiscence or other minor complications. Purpose of the work: This study aims to detail the stages of abdominoplasty performed on a post-bariatric surgery patient and to demonstrate the outcomes achieved. Materials and methods: In this study, the individual case study method was used. The subject of the study was a 36-year-old woman after bariatric surgery who, having lost more than fifty kilograms and already having a normal BMI= 23.88 kg/m², applied for an abdominoplasty procedure. For practical reasons, despite indications for a circular abdominoplasty, the patient underwent a classic abdominoplasty complemented by liposuction. Results: During the abdominoplasty procedure, liposuction of the lateral fat tissue was performed, along with the removal of a skin-fat fold weighing over 1 kilogram, reinforcement of the abdominal muscles, and repositioning of the navel. The patient left the clinic without any drainage in place. After 8 days, the sutures placed during the operation were removed and after 4 weeks, the effects of the surgery were also verified by photo documentation. The abdominoplasty performed in the post-bariatric patient allowed for the successful removal of the excess skin after a considerable amount of weight loss. The procedure required meticulous planning and adaptation of surgical methods and techniques to the patient's living situation.

Specifics of regional recurrences in lateral tissue of the neck after surgical treatment of highly differentiated thyroid cancer

Introduction: Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27 %. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection. Aim: Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence. Materials and methods: The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N. N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia. Results: Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p = 0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p = 0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p = 0.014). In 35.7 % of cases, recurrent nodes were localized in the level V. Conclusion: Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.

Outcomes and Complications of Sole Reconstruction Using Lateral Thoracic Free Tissue Transfer.

The complex structure of the sole of the foot makes the repair of extensive defects challenging. The present study, therefore, aimed to address a gap in current research by evaluating the potential of the lateral thoracic free flap, including perforator options and chimeric configurations, to be used as an advanced solution for comprehensive sole reconstruction. We retrospectively collected the following data from the charts of patients with sole defects, due to various causes, who underwent lateral thoracic free tissue transfers: patient demographics; etiologies; comorbidities; flap types and dimensions; pedicle length; operative time; follow-up period; complications; and management. The present study included 54 patients who underwent lateral thoracic free tissue transfer, citing infection, trauma, tumor, and posttraumatic sequelae as the major etiologies. We used the following techniques for the reconstruction of sole defects: thoracodorsal artery perforator free flap (83.3%); latissimus dorsi musculocutaneous free flap (1.9%); and various chimeric pattern flaps (14.8%). Free tissue transfer in the lateral thoracic region offers versatility for reconstruction, as well as low donor site morbidity. Complications observed in the present study included wound dehiscence (9.3%), partial necrosis (9.3%), and pressure ulcers (22.2%), although most patients healed favorably without flap loss. The lateral thoracic free flap is a viable option for the reconstruction of the sole of the foot and allows for the effective reconstruction of complex defects. It contains a sustainable skin paddle, and multiple components can be easily included as a chimeric type. Further studies should seek to identify ways to prevent pressure ulcers, which was the only known long-term complication in the present study.

The efficacy of vitamin E in preventing arthrofibrosis after joint replacement.

Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues. Vitamin E is an antioxidant with potential anti-fibroblastic effect. The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis. We simulated knee replacement in 16 male Sprague-Dawley rats. We immobilized the surgical leg with a suture in full flexion. The control groups were killed at 2 and 12 weeks (n = 5 per group), and the test group was supplemented daily with vitamin E (0.2 mg/mL) in their drinking water for 12 weeks (n = 6). We performed histological staining to investigate the presence and severity of arthrofibrosis. Immunofluorescent staining and α2-macroglobulin (α2M) enzyme-linked immunosorbent assay (ELISA) were used to assess local and systemic inflammation. Static weight bearing (total internal reflection) and range of motion (ROM) were collected for functional assessment. The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups. Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue. Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels. The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group. This model is viable for simulating arthrofibrosis after joint replacement. Vitamin E may benefit postsurgical arthrofibrosis, and further studies are needed for dosing requirements.

Medial Patellofemoral Ligament and Lateral Patellofemoral Ligament Reconstruction after Tibial Tuberosity Transposition in a Young Woman with Patellar Instability

In patients with reccurent lateral and medial patellar instability, isolated medial patellofemoral ligament (MPFL) reconstruction may be insufficient due to poor lateral retinacular tissue quality. In this report, we describe a case of a patient that underwent simultaneous MPFL and lateral patellofemoral ligament (LPFL) reconstruction on the left knee due to chronic bidirectional patellar instability. A 29-year-old female patient presented with first-time lateral patellar dislocation five years ago due to acute strain. She underwent a tibial tuberosity transposition in another hospital. After the surgery, she suffered from recurrent medial and lateral patellar dislocation and presented to our center. MPFL and concomitant LPFL reconstruction on the left knee was simultaneously performed due to bilateral patellar dislocation. The patella was stable postoperatively, and the patient underwent physiotherapy with successful results to date. Single-time patellar dislocation should be treated conservatively. Surgical treatment after the first episode of dislocation can magnitude the risk of postoperative complications. The simultaneous reconstructing of the LPFL yields patellar fixation indistinguishable from the native LPFL. These grafts provide separate tensioning depending on body anatomy, allowing for individualized stability. Anatomical MPFL reconstruction is supported by well-established high-quality research. Reconstructing the LPFL anatomically yields patellar fixation indistinguishable from the native LPFL.

Evaluation of cardiac electrophysiological features in patients with premature adrenarche.

This study aimed to analyze the cardiac effects of hyperandrogenism in premature adrenarche (PA) and evaluate the risk of arrhythmia development. Fifty patients with PA and 50 healthy children from a pediatric endocrinology outpatient clinic were included in the study. The patients underwent echocardiography and electrocardiographic evaluations. Conventional echocardiography, tissue Doppler echocardiography, repolarization time, and repolarization dispersion time were evaluated. The median age in the PA and control groups was 7.91 years (5.83-9.25), 8.08 years (5.75-9.33), respectively. Thirty percent of patients in the PA group were male. While mitral early diastolic velocity deceleration time (DT), isovolumetric relaxation time (IRT), and E/e' ratio were significantly higher in the PA group than in the control group, mitral lateral annulus tissue Doppler early diastolic velocity was significantly lower (p=0.0001, 0.0001, 0.003, 0.0001). While P wave dispersion (PWD), Tpe, and QT-dispersion (QT-d) values were significantly higher in the PA group than in the control group, the P minimum value was significantly lower in the PA group (p=0.0001, 0.02, 0.004, and 0.0001, respectively). Early subclinical diastolic dysfunction was observed in the PA group. There was an increased risk of atrial arrhythmia with PWD and an increased risk of ventricular arrhythmia with increased Tpe and QT-d. There was a correlation between testosterone levels and diastolic function parameters. The increased risk of atrial arrhythmia is closely related to diastolic function.

Study of the localization of pigment cells in the skin of scaly carp of various ages (Cyprinus carpio L.)

Morphological methods of fish research provide an opportunity to study their biological systems – cells, tissues, and organs in normal and pathological conditions – in depth at all levels of structural organization. The work aimed to investigate the morphological features of localization of skin pigment cells in scaly carp (Cyprinus carpio L.) of different ages. The study was conducted in the laboratory of complex ichthyopathological studies at the Department of Ichthyology and Zoology of the Belotserkiv National Agrarian University. One-, two-, and three-year-old scaly carp from the feeding ponds of PJSC “Chernigivrybhosp” were used. From which the scales were removed, skin samples of scaly carp (Cyprinus carpio L.) were used as material for research. Tissue samples were taken from freshly caught fish for the research. Our study established that pigment cells in carp of different ages were localized in the upper and lower layers of the dermis and hypodermis and in the lateral connective tissue septum at the level of the lateral line that divides the lateral muscles. In addition, in the carp of the same age, in contrast to the older age groups, isolated clusters of pigment cells were observed in the loose connective tissue between the muscle fibers of the superficial lateral muscle. During the histological examination, we also discovered the presence of pigment cells in the skin, particularly melanophores. Thus, the skin of peers of scaly carp was located in single clusters and had a rounded shape and a concentrated distribution of melanin pigment. Many melanophores were observed in the lower layer of the dermis at the border with the hypodermis. In the area of the lateral line, in the connective tissue septum, at the level of the deep lateral muscle, large strands of melanophores were detected.

S-100β level is closely associated with myocardial work in patients with acute ischemic stroke

BackgroundThe more severe the acute stroke is, the more serious myocardial damage is. This study aimed to determine the relationship between myocardial work and S100β, a quantitative biomarker of active cerebral lesions, in patients with acute ischemic stroke (AIS). MethodsA total of 63 patients with AIS were examined by myocardial work echocardiography, 4D echocardiography with the measurement of left ventricular (LV) myocardial work, volume and function within 24-48 h of symptom onset, respectively. Their plasma S100β was measured from a peripheral blood sample within 2-6 h of symptom onset. ResultsPatients with elevated S-100β level had significantly increased ratios of peak early diastolic transmitral filling velocity to peak early diastolic lateral mitral annulus tissue velocity(E/e’) and global longitudinal strain (GLS), and significantly reduced global work index(GWI) and global constructive work (GCW) compared with those with normal S-100β level (p < 0.05). S-100β positively correlated with E/e’(r = 0.878, p < 0.0001) and GLS (r = 0.511, p = 0.002) but negatively correlated with GWI(r = −0.409, p = 0.034) and GCW(r = −0.353, p = 0.041). S-100β showed an excellent ability to differentiate if a reduced GWI [cut-off value, 120.79 pg/mL; area under receiver operating characteristic curve (AUC), 1.000; sensitivity, 100%; specificity, 100%], GCW (cut-off value, 120.79 pg/mL;AUC,1.000; sensitivity,100%; specificity, 100%) and an increased E/e’ (cut-off value, 91.1 pg/mL;AUC,0.913; sensitivity,80%; specificity, 100%) or not, but poor ability to differentiate if an increased GLS(cut-off value, 91.1 pg/mL; AUC,0.576; sensitivity,63.64%; specificity, 83.33%) or not. ConclusionS-100β level is closely associated with LV function. It is highly competent in determining an impaired myocardial work in patients with AIS.

Ectopic thyroid tissue presenting as a carotid body paraganglioma

Ectopic thyroid tissue is a rare developmental abnormality, typically presenting with midline ectopia due to incomplete embryological migration via the thyroglossal duct. The presence of ectopic thyroid tissue lateral to the midline is very rare, accounting for 1–3% of all ectopic thyroid tissue. Clinically, these lesions are often mistaken for other diagnoses including enlarged lymph nodes or metastatic tumours. We present a case of lateral ectopic thyroid tissue presenting as a presumed carotid body paraganglioma in a middle-aged woman. The patient presented with a slow-growing lateral neck mass which was clinically and radiologically consistent with a carotid body paraganglioma. She subsequently underwent tumour excision after which histological analysis identified ectopic thyroid tissue with no evidence of malignancy.

Role of Lateral Extra-articular Tenodesis in Restraining Internal Tibial Rotation: In Vitro Biomechanical Assessment of Lateral Tissue Engagement

Background: The way in which force increases in the anterolateral tissues and the lateral extra-articular tenodesis (LET) tissue to resist internal rotation (IR) of the tibia after anterior cruciate ligament (ACL) reconstruction in isolation and after LET augmentation, respectively, is not well understood. Purpose: (1) To compare in a cadaveric model how force increases (ie, engages) in the anterolateral tissues with IR of the tibia after isolated ACL reconstruction and in the LET tissue after augmentation of the ACL reconstruction with LET and (2) to determine whether IR of the tibia is related to engagement of the LET tissue. Study Design: Controlled laboratory study. Methods: IR moments were applied to 9 human cadaveric knees at 0°, 30°, 60°, and 90° of flexion using a robotic manipulator. Each knee was tested in 2 states: (1) after isolated ACL reconstruction with intact anterolateral tissues and (2) after LET was performed using a modified Lemaire technique with the LET tissue fixed at 60° of flexion under 44 N of tension. Resultant forces carried by the anterolateral tissues and the LET tissue were determined via superposition. The way force increased in these tissues was characterized via parameters of tissue engagement, namely in situ slack, in situ stiffness, and tissue force at peak applied IR moment, and then compared (α < .05). IR was related to parameters of engagement of the LET tissue via simple linear regression (α < .05). Results: The LET tissue exhibited less in situ slack than the anterolateral tissues at 30°, 60°, and 90° of flexion (P≤ .04) and greater in situ stiffness at 30° and 90° of flexion (P≤ .043). The LET tissue carried greater force at the peak applied IR moment at 0° and 30° of flexion (P≤ .01). IR was related to the in situ slack of the LET tissue (R2≥ 0.88; P≤ .0003). Conclusion: LET increased restraint to IR of the tibia compared with the anterolateral tissue, particularly at 30°, 60°, and 90° of flexion. IR of the tibia was positively associated with in situ slack of the LET tissue. Clinical Relevance: Fixing the LET at 60° of flexion still provided IR restraint in the more functionally relevant flexion angle of 30°. Surgeons should pay close attention to the angle of internal and/or external tibial rotation when fixing the LET tissue intraoperatively because this surgical parameter is related to in situ slack of the LET tissue and, therefore, the amount of IR of the tibia.

Optimizing Nerve Sparing in Robotic-Assisted Radical Prostatectomy: A Comparative Investigation of Traditional and Modified Endopelvic Fascia Preservation Techniques.

Prostate cancer (PCa) is the second most common cancer and the sixth leading cause of cancer-related mortality in men. In 2000, Abbou performed the first robot-assisted radical prostatectomy, and radical prostatectomy has developed rapidly. Robot-assisted radical prostatectomy (RARP) is a valuable therapeutic option for the management of localized Pca. To present the functional outcome of robot-assisted laparoscopic radical prostatectomy using traditional and modified endopelvic fascia preservation methods in a single center in Vietnam. We prospectively analyzed a series of 65 patients diagnosed with prostate cancer from 2020 to 2023. All of those were operated by DaVinci Si system robot-assisted laparoscopic prostatectomy. Twenties patients were applied with a modified nerve-sparing technique, intrafascial dissection, and lateral prostatic fascia preservation, leaving the lateral tissue, including the neurovascular bundle, untouched and covered. We used the traditional approach, intrafascial nerve-sparing with open endopelvic fascia and lateral prostatic fascia in 45 cases. Patients were followed up to 12 months to assess the continence and erectile function by using IIEF-5 and EPIC questionnaires. The study sample included 65 cases; the mean patient age was 64.21 ± 6.68, erection rate after surgery at six months in bilateral NS was 36.58% (15/41) in the traditional group, and 68.42% (13/19) in the modified group (p=0.028). The patient did not recover erectile ability in the group of elderly patients (>65 years old) and unilateral nerve-sparing group. The continence rate six months after surgery was 86.66 % in the conventional group and 85% in the modified group, with no significant difference between the two groups. In the potency group, the IIEF-5 score was 13 ± 4.9, and the EPIC-26 score was 62.20 ± 10.04. Erectile ability in the modified group was better than the traditional group at six months after surgery. Our results showed better potency recovery in the modified group. These results should be tested in future research with randomized studies.

Evaluating the Efficacy of a Novel Side-Support Surgical Tray Stand for Endoscopic Transnasal Skull Base Surgery: A Prospective Study.

Objective Endoscopic transnasal skull base surgery is a valuable technique used in the surgical treatment of various skull base pathologies. In such surgeries, the reconstruction of the skull base is crucial for surgical success and minimizing complications. This study presents a new side-support surgical tray designed to improve the exposure of the lateral femoral surgical area during surgery, enhancing surgical efficiency and reducing the risk of surgical complications. The study compared this innovative tray stand with the conventional double-sided support tray stand to evaluate its impact on surgical procedures and complications. Materials and methods The study prospectively analyzed 248 endoscopic transnasal skull base surgeries requiring lateral femoral autologous tissue harvesting. One hundred fifty-eight cases were performed using the side-support surgical tray stand (experimental group), while 90 cases used the conventional double-sided support tray stand (control group). Various parameters were evaluated, including satisfaction scores of surgeons, circulating nurses, instrument nurses, and anesthetists, as well as objective outcomes such as surgical duration and the incidence of complications. Results Surgeons in the experimental group expressed higher satisfaction with the surgical field exposure and the portability of the surgical tray stand compared to the control group. Likewise, circulating nurses in the experimental group reported greater satisfaction with the installation and portability, surpassing that of the control group (p< 0.01). Although the stability of instrument nurses in the experimental group was slightly less than that of the control group, it had no discernible impact on surgical cooperation. Anaesthesiologists in the experimental group exhibited higher satisfaction regarding the convenience of intraoperative monitoring and management than their counterparts in the control group. The average duration required for intraoperative autologous tissue harvesting in the experimental group was significantly shorter than in the control group (p< 0.01). Furthermore, the incidence of postoperative wound infections and intracranial infections in the experimental group was notably lower than in the control group (would infections,p= 0.046; intracranial infection,p= 0.025). Conclusion The novel side-support surgical tray stand effectively improves surgical exposure, convenience, and safety while reducing the risk of surgical site and intracranial infections. It also shortens surgical duration and lowers complication rates, making it a suitable choice for clinical application.