Left Lateral Side Research Articles

The Sternocleidomastoid Muscle Reverse Pad: A "Safety Net" in Catastrophic Tracheal Surgery Situation.

This paper presents the outcomes of employing the inferiorly based rotated sternocleidomastoid muscle flap in complex tracheal reconstruction/repair scenarios, focusing on the key objectives of ensuring stable airway, functional digestive tract and patient survival. A retrospective analysis was performed for patients treated at two medical centers (A.O. San Camillo Forlanini, Rome, and A.O.U. Careggi, Florence) from 2011 to 2023, in which the sternocleidomastoid muscle (SCM) flap, detached from the mastoid and basicranium, was rotated on the lower pivot directly onto the repair site and pedicled to the sternal origin to ensure the continuity of the airway. Average postoperative hospital stay, follow-up period and patient survival were analyzed. Follow-up assessments encompassed bronchoscopies and CT scans conducted at intervals of 15 and 28 days, and subsequently at 3 and 9 months. A total of five patients were enrolled in this study. These cases included one patient with anterior tracheal wall lesions with abundant tissue loss, one patient with an anterior wall necrosis due to descending cervical mediastinitis and three patients with extra-long tracheoesophageal fistulas (TEFs) (greater than 4.5 cm or >30% of the total tracheal length). In the case of the direct repair of a TEF with a proximal tracheal stenosis, the sternocleidomastoid muscle was used to reconstruct the tissue deficit caused by extensive loss of substance in the left lateral side of the tracheal wall. In case of repair through exclusion of the TEF, the sternocleidomastoid muscle was interposed between the visceral sutures after exclusion of the TEF by an endomechanical device, in one case even substituting the membranous part of the tracheal wall. Our technique allows rotation on the sternal head of the sternocleidomastoid muscle with the lowest rotation radius, pedicled to the sternal origin, detached from the mastoid process and superior nuchal line, thus providing optimal vascularization from the superior thyroid artery/external carotid artery and accessory vasculature from the suprascapular artery. Patients exhibited uneventful postoperative recovery concerning airway and digestive patency. The mean postoperative hospitalization duration was 41 days. The follow-up assessments were negative for postoperative complications. The use of sternocleidomastoid muscle flap was proposed to ensure repair and protection of the suture margin or to constitute a portion, as a scaffold, of the wall by leveraging the muscle's vascularization and thickness. This technique may be considered a leading component in managing complex situations in tracheal surgery.

Dermatosurgical rounds: shark island pedicle flap for skin defect of the alar crease area after basal cell carcinoma removal

A 67-year-old female presented to the Dermatology Department with a tumor formation located on the left lateral side wall of the nose, measuring 1,5/1,2 cm in size, which had been slowly growing over the past few years. The tumor exhibited a shiny, pink-colored surface with a dome-shaped appearance, irregular borders, and superficial telangiectasias, raising clinical suspicion for basal cell carcinoma. Additionally, there was no reported history of skin cancer in any family member or painful sunburns during childhood. The patient was recommended surgical excision under local anesthesia for the suspected lesion.

Laparoscopic Ultralow Anterior Resection Using a New Articulating Device.

Laparoscopic surgery offers several advantages, but it can be challenging to perform in confined spaces, such as the narrow and deep pelvis, due to poor vision and instrument collisions. Conventional laparoscopic instruments are rigid and straight, which can restrict optimal access to the target organ. Although the use of robotic surgical platforms with flexible wrists has significantly reduced movement restrictions and surgeon fatigue, their high cost remains a barrier to widespread adoption. Recent technological advancements in laparoscopic instruments have led to the development of an articulating flexible hand-held device that enables greater dexterity and easier access to difficult anatomical locations. This technology has the potential to improve surgical outcomes by using multiple degrees of freedom to perform complex surgical procedures with greater precision. The ArtiSential® product line comprises over 30 end-effectors, such as scissors, hooks, and graspers. The benefits of this device are evident throughout the total mesorectal excision, especially when approaching the left lateral side of the mesorectum (the side opposite the surgeon) or the deepest part of the pelvis around the levator ani muscle. The Samsung Medical Center Institutional Review Board approved this study (2022-01-174). A 79-year-old male with rectal cancer located 9 cm from the anal verge underwent an laparoscopic ultralow anterior resection using ArtiSential®. There were no intraoperative complications. The pathologic results showed that the tumor was at pT3N0 stage. The patient was discharged without any complications. The articulating device can be effectively used for laparoscopic surgery, but has some challenges related to the bulky handpiece and learning curve. A multicenter prospective cohort study to compare the outcomes of articulating laparoscopic surgery and robotic surgery for patients with rectal cancer is oncoing (clinicaltrials.gov number: NCT05566249).

Numerical investigation of multiple affecting parameters on mixed convective heat transfer for arrays of buildings

This study aims to explore relationships between wind speed, wind direction, exterior surface roughness, temperature difference, plan area density and convective heat transfer coefficients (CHTCs) for external surfaces of arrays of buildings. The present investigation provides correlations for CHTCs at the windward, leeward, top, left, and right lateral surfaces. Three different plan area densities of 0.25, 0.111 and 0.027 are considered and 249 numerical simulations are conducted to investigate the influential parameters including density (λp), wind angle (θ), wind speed (U10), temperature difference (ΔT), and surface roughness (ε). Findings reveal that higher plan area density results in lower CHTC due to heightened airflow obstruction. Increase of the wind angle amplifies CHTC on leeward and right lateral facades while reduces it on the left lateral side. With increased wind speed, CHTC experiences significant increase. The results also shows that the temperature difference's impact is pronounced at lower air velocities, leading to heightened CHTC. Besides, increased surface roughness enhances heat transfer coefficients. Finally, the present study employs extensive simulations to present correlations for different facades of the buildings in the studied arrays offering insights into CHTC variations in terms of plan area density, wind angle, speed, temperature difference, and roughness height.

Cervical schwannoma: diagnosis and treatment

Schwannomas are benign, encapsulated, slow-growing, tumours deriving from the peri neural cells located in the nerve sheath. They can arise from any cranial, peripheral or autonomic nerves, and show a predilection for the head and neck region. They may produce secondary symptoms like nasal obstruction, dysphagia, and hoarseness of voice depending upon the location of the tumour. Preoperative diagnosis is difficult, relying on clinical suspicion, and confirmed by surgical pathology. Preoperative imaging or fine needle aspiration cytology may help to reveal diagnosis. The definitive diagnosis is made by histopathological examinations. A 28 years old female patient presented to the OPD with painless swelling on the left lateral side of the neck since 1 year. The swelling was mobile, non-tender, non-pulsatile firm in consistency measuring 4×3 cm with no bruit. MRI neck with contrast was done which revealed a moderately enhancing lesion of size 7×4×3 cm in the left carotid sheath. The tumour was approached by an anterior approach along the medial border of the sternocleidomastoid. Platysma and fascia were dissected followed by carotid sheath to reach the tumour. As the mass was seen arising from a branch of the ansa cervicalis, it had to be sacrificed.

Digital infrared thermal imaging of udder skin surface temperature: a novel non-invasive technology to monitor calving process in Murrah buffalo (Bubalus bubalis)

Quantifiable decline in the maternal body temperature during the pre-calving offers the possibilities for predicting the calving that can improve the calving management. As infrared thermography (IRT) is a simple non-contact tool for precise measurement of surface temperature, we investigated the use of IRT to establish thermal signatures around calving in the Murrah buffalo. The IRT of eye, right lateral, left lateral and rear side of udder skin surface temperature (USST) were recorded at 6 h interval from 96 h before the expected date of calving, at the time of calving and 24 h post-calving in Murrah buffaloes (n = 28). In parallel, blood samples were collected for progesterone (P4) assay. The results revealed that the IRT of the eye, right and left lateral and rear side of USST showed a significant decrease in the temperature from 48 h pre-calving till the onset of calving with a ΔT (°C) of 0.56, 0.91, 0.70, and 0.90, respectively. Mean USST significantly declined from 48 h pre-calving with a ΔT of 0.85 °C. The residual temperature of both eye and various ROI of the udder also followed a similar and significant declining trend from 48 to 0 h of calving indicating that circadian influence on the USST was minimum. Plasma P4 concentration significantly decreased from 72 h pre-calving till calving. It is concluded that a marked reduction in the IRT of the USST at 6–12 h pre-calving would be useful in predicting the onset of calving in the Murrah buffalo.

Flexible 3D printing of the mitral valve apparatus and left coronary artery for patients with complex anatomical variations in mitral valve surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Injury to the left circumflex artery (LCA) occurs in an estimated 2.7% of patients undergoing mitral valve (MV) surgery. The average distance from the LCA to the MV varies substantially between patients but is on average 3.1 ± 1.3mm. In unfavorable anatomical variations, a 3D print of relevant anatomical structures could be helpful for a surgeon to be aware of the situation and determine a surgical strategy. In this case such a 3D print is made of a 66 year old patient with mitral valve regurgitation and a P2 prolapse assessed in the heart team for MVS. Purpose To create a flexible heart model using Computed tomography (CT) and Transesophageal echocardiography (TEE) scans of this patient that utilizes the synergistic information derived from both modalities and provides an improved method for surgical preparation in cases with unfavorable anatomical variations. Method CT and TEE scans of the heart and mitral valve are acquired and fused using Mutual information registration. Both modalities are used in the print as TEE is the gold standard for evaluating the MV prior to surgery while on CT the LCA can be visualized and the ventricle can be imaged with a higher spatial resolution. The combined reconstructions are hollowed and smoothed using Meshmixer and the Poisson disk sampling tool of Meshlab to make the reconstruction suitable for 3D printing, enhance visibility of the relevant anatomy and achieve the desired flexibility of the model. Results A flexible 3D model of the left side of the heart of a patient is created. The model consists of reconstructions of the left coronary artery (CT), the left side of the heart (CT), and the mitral valve (TEE). To expose the LCA, an indent in the tissue surrounding the LCA was made. At the apex of the heart and at the left lateral side a small window in the ventricle was created for visibility. A flexibility resembling the flexibility of tissue was created by hollowing a with walls of 1.2mm thickness and printing with Agilus 30 Clear (with a shore A value of 30) . Conclusion To our knowledge this is the first 3D print for the planning of mitral valve surgery in which CT and TEE scans are combined into one flexible print. The flexible 3D print with exposed coronary arteries allows for assessment of the mitral valve regurgitation deficit and determine a surgical strategy because of the flexibility of the model, and as the LCA is exposed in this model, the surgeon can adapt his surgical approach based on the location of the LCA.

AYURVEDIC UNDERSTANDING AND MANAGEMENT OF ISOLATED SIXTH CRANIAL NERVE PALSY DUE TO GIANT ANEURYSM:A CASE REPORT

Isolated sixth cranial nerve palsy occurs due to the dysfunction of the nerve at any point from its transit in the pons to the lateral rectus muscle. The major causes of abducens nerve palsy are increased intracranial pressure, infections, uncontrolled diabetes, aneurysm etc.The etiology in this case is a giant aneurysm in the left cavernus ICA leading to compression of left abducens nerve resulting in binocular horizontal diplopia and restriction in the abduction of left eyeball. The case was diagnosed in Ayurveda considering the cause and the effect as Siragata Vata leading to Timira.The management was mainly focused on addressing the cause.Virechana followed by Yoga basthi along with murdhni taila was adopted in this case. There was signicant improvement in the movement of left eye ball towards the left lateral side and diplopia was completely absent at the time of discharge.

Application of branch-first technique in total thoracic aorta replacement: short and medium term effect of 11 cases

Objective: To examine the short and medium term effect of branch-first technique in total thoracic aorta replacement. Methods: The clinical data of eleven patients with ascending aortic aneurysms or type A aortic dissection+Crawford Ⅰ or Ⅱ total thoracoabdominal aortic aneurysm who were treated at Department of Cardiovascular Surgery in Henan Province Chest Hospital from January 2018 to July 2021 were retrospectively analyzed. There were 7 males and 4 females, aging (38±5) years (range: 28 to 45 years), 7 cases of whom were diagnosed with Marfan syndrome, 1 case was diagnosed with coarctation of aorta. Operations were performed under mild hypothermic and branch-first technique. Firstly, the middle and small incision in the chest was combined with the 6th intercostal incision in the left posterior lateral side. Secondly, four branches artificial blood vessels were anastomosed with the brachiocephalic artery to ensure the blood supply to the brain. After the circulation was blocked, intracardiac and aortic proximal operations were performed. Intercostal artery reconstruction and thoracic descending aorta replacement were completed after opening circulation. Results: The operative time of this group was (645.9±91.7) minutes (range: 505 to 840 minutes). One case had cerebral infarction and 1 case had chylothorax. The patients were followed up 4 to 47 months, 1 patient underwent thoracic and abdominal aorta+iliac artery resection and replacement due to the progression of abdominal aortic aneurysm 3 months after operation. Intercostal artery obstruction occurred in 2 cases, and the rest lived well. Conclusions: One-stage whole thoracic aorta replacement with branch-first technique has satisfactory results in the short and medium term, with no risk of residual aortic aneurysm rupture. It is an effective treatment for young and organs function well patients with complex aortic lesions.

Evaluation of the Hybrid Tracer Indocyanine Green- 99m Tc-Nanocolloid for Sentinel Node Biopsy in Bladder Cancer-A Prospective Pilot Study.

RationaleIn muscle-invasive bladder cancer (MIBC), lymph node invasion has proven to be an independent predictor of disease recurrence and cancer-specific survival. We evaluated the feasibility of targeting the sentinel node (SN) for biopsy in MIBC patients using the hybrid tracer indocyanine green (ICG)–99mTc-nanocolloid for simultaneous radioguidance and fluorescence guidance.MethodsTwenty histologically confirmed cN0M0 MIBC patients (mean age, 63.3 years; range, 30–82 years), scheduled for radical cystectomy with SN biopsy and extended pelvic lymph node dissection (ePLND), were prospectively included. Twelve patients were operated on following neoadjuvant chemotherapy. The patients received lymphoscintigraphy as well as SPECT/CT after 4 transurethral injections of ICG-99mTc-nanocolloid (mean, 208 MBq; range, 172–229 MBq) around the tumor/scar in the detrusor muscle of the bladder on the day before radical cystectomy. Sentinel node resection was performed under radioguidance and fluorescence guidance.ResultsNineteen patients could be analyzed. On preoperative imaging, SNs could be identified in 10 patients (53%; mean, 1.6 SN/patient), which revealed drainage pathways outside the ePLND in 20% of the patients. Interesting to note is that 2 patients (10%) with preoperative nonvisualization displayed fluorescent and radioactive SNs during surgery. Location of the primary tumor near the left lateral side of the bladder seemed to be a factor for nonvisualization. Nodal harvesting with ePLND varied among patients (mean, 23.3). Histopathology confirmed tumor-positive nodes in 4 (21%) of all patients. In the 2 patients where an SN could be identified, the ePLND specimens were tumor-negative. All patients with tumor-positive nodes had advanced disease (stage III).ConclusionSentinel node biopsy in bladder cancer using the hybrid tracer ICG-99mTc-nanocolloid is feasible, and preoperative imaging is predictive for the ability to perform SN biopsy in 83% of the patients who displayed an SN. In patients with a successful preoperative SN mapping using lymphoscintigraphy and SPECT/CT, the intraoperative SN guidance and detection were effective, even outside the ePLND area. As such, this study underscores the critical role that preoperative imaging plays in challenging image-guided surgery applications.

Left lateral flank approach for spaying in cats.

Background:Spaying is considered a reliable surgical method for birth control and preventing potential feline reproductive diseases.Aim:This experiment was carried out to evaluate the suitability of the left lateral flank approach for routine spaying in cats.Methods:Twenty-seven queens of 7–24 months old and 1.5–3.5 kg body weight (BW) were spayed through flank laparotomy on the left lateral side of the abdomen. The cats were categorized into two groups: Group A (n = 12; cats did not yet give birth) and Group B (n = 15; cats gave birth before). The studied variables included age, BW, vaccination history, skin incision length, total surgical duration, the time needed for ligating ovarian pedicles and uterine body, suture materials, postoperative complications, and healing duration.Results:There were no significant differences (p < 0.05) in age, BW, and vaccination history of the cats between the two groups. The mean incision length and total duration of surgery were greater in the case of Group B than in Group A. The ease of entering into the peritoneal cavity, duration of ligating the ovarian pedicles, and transfixing the uterine body did not vary significantly (p < 0.05) between the groups although a longer time was taken for Group B than Group A. 62.96% spayed cats were found with no postoperative complication. The observed complications included wound site infection (7.41%), dehiscence of suture lines (11.11%), bleeding (3.70%), and oozing (14.82%) from wounds which were further treated successfully for complete recovery.Conclusion:Left lateral flank approach can be an effective method of spaying in queens without any life-threatening complications.

Motion preservation surgery for scoliosis with a vertebral body tethering system: a biomechanical study

PurposeThere is a paucity of studies on new vertebral body tethering (VBT) surgical constructs especially regarding their potentially motion-preserving ability. This study analyses their effects on the ROM of the spine.MethodsHuman spines (T10-L3) were tested under pure moment in four different conditions: (1) native, (2) instrumented with one tether continuously connected in all vertebrae from T10 to L3, (3) additional instrumented with a second tether continuously connected in all vertebrae from T11 to L3, and (4) instrumented with one tether and one titanium rod (hybrid) attached to T12, L1 and L2. The instrumentation was inserted in the left lateral side. The intersegmental ROM was evaluated using a magnetic tracking system, and the medians were analysed.Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct. The mentioned information is correctResultsCompared to the native spine, the instrumented spine presented a reduction of less than 13% in global ROM considering flexion–extension and axial rotation. For left lateral bending, the median global ROM of the native spine (100%) significantly reduced to 74.6%, 66.4%, and 68.1% after testing one tether, two tethers and the hybrid construction, respectively. In these cases, the L1-L2 ROM was reduced to 68.3%, 58.5%, and 38.3%, respectively. In right lateral bending, the normalized global ROM of the spine with one tether, two tethers and the hybrid construction was 58.9%, 54.0%, and 56.6%, respectively. Considering the same order, the normalized L1-L2 ROM was 64.3%, 49.9%, and 35.3%, respectively.ConclusionThe investigated VBT techniques preserved global ROM of the spine in flexion–extension and axial rotation while reduced the ROM in lateral bending.

Leiomyosarcoma of the bladder: A case report

Leiomyosarcomas (LMSs), malignant soft tissue tumor deriving from the mesoderm, account for &lt;0.1% of all bladder malignancies. Conventionally, radical cystectomy with lymph node dissection has been advocated, though some series report that partial cystectomy is acceptable if a negative surgical margin is achieved. Here, we describe a 20-year-old young female presenting with LMS bladder. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a lobulated mass of 2.5 X 3.0 cm on the left lateral side of the bladder. The rest of the bladder appeared normal, with no gross pelvic lymphadenopathy. She performed with transurethral resection of bladder tumor (TURBT). She was diagnosed as LMS though histopathology and immunohistochemistry. Repeat-TURBT was implemented 30 days after the first surgery. Adjuvant chemotherapy was given (Ifosfamide 120 mg/m2 and Doxorubicin 20 mg/m2), and she has been doing well for 12 months of follow-up.

The mandibles of the Honamli and Hair goat (Capra hircus); a geometric morphometric study

The aim of the study was to analyze mandible of the Honamli and Hair goats according to the sex factor by geometric morphometric methods. A total of 36 adult goat mandibles including 9 males and 9 females for each breed, were used in the study. After the mandibles were photographed from the left lateral side, 10 homolog landmarks were marked. Generalized Procrustes, Relative Warp, and Principal Component Analysis were performed for the data of landmark coordinates. In the study, the first principal component explained 28.752% and 37.325% of the total shape difference in the Honamli and Hair goat, respectively. In the analysis made among goat breeds according to the sex factor, the first principal component explained 40.809% of the total shape difference in females and 30.486% of the total shape difference in males. Consequently, the Hair goat showed a significant sex difference compared to the Honamli goat. Besides, it was remarkable that male goats clustered clearly compared to female goats in terms of the breed factor.

Health-Related Anxiety in the Management of Oral Soreness in an HIVSeropositive Patient

The number of people living with HIV (PLHIV) has been increasing since the first known case in the early 1980s. However, PLHIV can also experience comorbidities, such as health anxiety. In the oral cavity, anxiety is often associated with the etiology of parafunctional habits. Anxiety can be measured using self-administered instruments, such as the Hospital Anxiety and Depression Scale (HADS) and Short-Health Anxiety Inventory (SHAI), which is specifically used in the medical setting. Objectives: We are describing a case of HIV positive patient with health anxiety who presented to the oral medicine clinic in our hospital with a complaint of discomfort on his lateral sides of the tongue. Case Report: A 35-year-old male patient came to the oral medicine clinic complaining of discomfort on his tongue, which presented for one week. The patient was alarmed by two bumps seen on the right lateral side of his tongue and soreness on the left lateral side. Nystatin oral suspension was prescribed by a medical doctor but discontinued by the patient. The patient was positive for HIV and took ART routinely. Extraoral and intraoral examinations showed unremarkable findings except slightly enlarged and erythematous foliate papillae on the left lateral side of the tongue. The patient was prescribed an antiseptic mouth rinse. After several days, his symptoms had dissipated. Since the patient reported anxiety regarding his health and HIV status, we asked the patient to complete the HADS and SHAI self-assessment tools to measure his level of anxiety. The patient was shown to have anxiety using the SHAI (total score = 21). Conclusion: Health anxiety is a condition that an individual misinterprets as a benign bodily sensation. The management of this type of patient involves addressing the local predisposing factor of the oral complaint and maintaining oral hygiene, followed by an evaluation of health anxiety for the basis of referral to a psychological expert.

Cranial size and shape sexual dimorphism in the Kangal dog from Turkey

This study has so far been the first attempt to characterize and quantify skull sexual variation in Kangal dog, by means of geometric morphometric techniques. A sample of 16 adult Kangal crania has been analyzed with this purpose. To obtain a full image of morphological pattern, digital pictures were taken from the ventral, left lateral, and dorsal sides of each skull, and a total of 16, 15, and 16 landmarks respectively were obtained on each image. Skull size and shape differed significantly in all aspects among different sexes, male skulls being bigger. Shape differences were observed mainly on zygomatic arch and muzzle on the dorsal view, pterygoid bone and articular surface to mandibular condyle in the lateral aspect, and cranial width and maxillary bone on the ventral view. Although the sample was comparatively small in number, being the first geometric morphometric approach applied on the Kangal dog, the obtained results will add vital information particularly to understand the cranial shape sexual dimorphism of this unique dog breed in Turkey.

Comparing the Ultrasonography Diagnostic Value with Standard Radiography in Detecting Nasal Fractures

Background: Nasal bone fractures are the most typical kind of facial injuries. In recent years, ultrasonography has been suggested as an alternative method for detecting maxillofacial fractures. It can eliminate the risk of radiation exposure, especially in children and pregnant women. The objective of present study was to compare the diagnostic competency of conventional radiography with ultrasonography in the diagnosis of nasal injuries specially, fractures. Method: In prospective research, 331 patients with a history of midfacial trauma were enrolled. Following clinical examination, radiographs were obtained in lateral and occipitomental views. Ultrasonography was performed by an experienced sonologist, blinded to clinical findings in right and left lateral sides in addition to nasal dorsum. Images were analyzed by an experienced radiologist. Sensitivity, specificity and predictive values of radiology and US were determined by comparing their results with findings of the clinical examination as the gold standard. Results: In assessment of nasal fractures the sensitivity and specificity of ultrasonography were 97.79% and 97.66%, respectively; while for radiography these two factors were 81.21% and 86.66%, respectively. Based on the Chi-square test, ultrasonography was notably greater to radiography in diagnosing nasal fractures (P&lt;0.001). Conclusion: Compared with radiography, ultrasonography had a higher sensitivity and specifity in detecting nasal fractures and seems to be an adequate method for the diagnosis of nasal fractures.&#x0D;

Recurrent pyogenic granuloma with satellitosis in a 5-year-old child

A 5-year-old male child presented with multiple asymptomatic red raised lesions over the left lateral side of his abdominal wall since 2 years. Cutaneous examination revealed multiple bright red, nontender, dome-shaped papules, and nodules arranged discretely. At few places, the lesions coalesced to form plaques with crusting on the surface. The lesions appeared to be arranged in a peculiar manner; with an increased concentration of the lesions in the vicinity of an atrophic central scarred area (of previous surgery) and few satellite discrete papules and nodules away from it. The differential diagnoses of pyogenic granuloma (PG), epithelioid hemangioendothelioma, and bacillary angiomatosis were considered. Histopathological examination from a nodule revealed angiomatous tissue composed of dilated thin-walled capillaries and groups of poorly canalized vascular tufts located in the upper and mid dermis suggestive of PG. A diagnosis of recurrent PG with satellitosis in a 5-year-old child was made. This case is described for the rarity of the condition in children and to emphasize the alarming presentation of a benign condition.

Watch out for the special location of intraventricular silicone oil following an intraocular tamponade - a 10-year follow-up case report based on CT/MRI

BackgroundIntraventricular silicone oil is a relatively rare complication resulted from silicone oil tamponade to treat retinal detachment. It is occasionally reported in previous literature. To the best of our knowledge, the long-term longitudinal comparisons of silicone oil both in the brain and in the postoperative eyeball based on CT/MRI were lacking, and intraventricular silicone oil accumulation beside lesions has been reported rarely.Case presentationA 63-year-old male patient underwent an intraocular tamponade with silicone oil in June 2009. Eight CT examinations and 2 MRI examinations were acquired between 2011 and 2018.The changes of silicone oil in the brain in CT/MRI as below: Silicone oil initially migration to bilateral lateral ventricular anterior horn was found in November 2011, it was aslo found at right side of suprasellar cisterna, and there was no change in location 6 h later; Silicone oil at the anterior horn of right lateral ventricle disappeared but remained at left lateral ventricle and right side of suprasellar cisterna in July 2014, and there was no change in location in a short-term reexamination. It was found at the middle of left lateral ventricle (adjacent to the real cause) in march 2018, but disappeared 3 months later, while remained at anterior horn of left lateral ventricular and right side of suprasellar cisterna all the time. There was no change in location in the next 2 follow-up (September and October in 2018). The CT values of silicone oil distributed throughout the brain were dynamically changed with time.ConclusionIt is important to recognize intraventricular silicone oil in a particular location.More important is to discover “the real murderer”, which is the main cause of symptoms in the vicinity of special location. Moreover, the migration of silicone oil between eyeball and brain may not be always in a single direction.

Right ventricle may be involved in regional diastolic dysfunction earliest in primary hypertension patients.

Impaired ventricular diastolic function is common in hypertensive patients and is one of the major causes of heart failure. Both left and right ventricle diastolic dysfunction have been reported, but the order of involvement is not clear. A total of 161 primary hypertensive patients and 40 healthy volunteers were enrolled. Pulsed wave tissue Doppler was used to measure regional diastolic dysfunction (defined as early peak diastolic [Em] and late diastolic [Am] velocity ratios (Em/Am) < 1) at right ventricular tricuspid valve annulus lateral side (RAVP1), right ventricular tricuspid valve annulus septum side (RAVP2), left ventricular mitral valve annulus septum side (LAVP1) and left ventricular mitral annulus lateral side (LAVP2). The prevalence of regional diastolic dysfunction at RAVP1, RAVP2, LAVP1, and LAVP2 was all higher in the hypertensive group (P < .001 for all). In both the hypertensive group and the control group, more cases were presented with RAVP1 diastolic dysfunction, while the least number of cases had LAVP2 diastolic dysfunction. In patients with stage 1 hypertension, most cases had RAVP1, or RAVP1 and RAVP2/LAVP1 diastolic dysfunction, while in patients with more advanced hypertension stages, significantly more cases had both RAVP1 and LAVP2, or all four locations diastolic dysfunction (P < .001). A similar trend was observed in patients with longer hypertension duration (duration of 6-9.9 years and 10-18 years compared with 2-5.9 years of duration, P < .001). With a more advanced stage and longer duration of hypertension, the range of regional diastolic dysfunction increased, showing a trend from the right ventricular wall, to the septum and left the ventricular wall. In primary hypertension, regional diastolic dysfunction in the right ventricle might happen earlier than that in the septum and the left ventricle.