Left Lateral Side Research Articles

Post Stab Injury Subclavin Artery Pseudoaneurysm Excision

Figure 1: Stab wound in supraclavicular region already sewn at local hospital. Figure 2: CT angiography showing subclavin artery pseudoaneurysm with two openings in subclavin artery anterior and posterior. Figure 3: A) Supraclavicular inscision to expose proximal subclavin artery B) Exposed subclavin artery. Figure 4: A) Excised pseudoaneurysm B) Opening in subclavin artery closed with vein patch. Figure 5: Closed tranaxillary and supraclavicular surgical incision with negative suction drain in situ. Abstract A pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as a result of a leaking hole in artery. Hematoma was contained by the surrounding tissues. Also it must continue to communicate with the artery to be considered a pseudoaneurysm. Post stab injury subclavin artery pseudoaneurysm is rare entity with great significance because of risk of complications like thrombosis, rupture, gangrene, limb loss and should be operated early whenever diagnosed. Our case report has 24 year male patient with history of stab injury to left supraclavicular region followed by pulsatile swelling after two days due to subclavin artery pseudoaneurysm. We excised pseudoaneurysm with vein patch closure of opening in subclavin artery. Introduction According to the literature data, post traumatic pseudoaneurysm is rare entity [1]. Most common site is common femoral artery, followed by radial and brachial artery but subclavin artery is very rare because trauma to it is rare. Incidence of complications associated with such pseudoaneurysm is estimated around 2-6% [2]. We present a case of the patient in whom pseudoaneurysm of left subclavin artery developed after two days of stab injury by pointed object and was successfully treated by surgical excision and vein patch closure of opening in subclavin artery. Case Report A 24 -years-old male patient was admitted at our Institute with history of stab injury to left supraclavicular region lateral side that was closed at local hospital (Figure 1). After two days the patient noticed gradually increasing pulsatile swelling at closed stab injury site. Clinical examination revealed presence of pulsating mass at stab injury site of 10 by 10 cm in diameter. Left brachial, radial and ulnar artery pulsations are palpable. Ultrasonography and CT angiography verified presence of pseudoaneurysm connected by two opening in third part of left subclavin artery (10 cm in diameter) (Figure 2). After short preoperative preparation, the patient underwent surgical intervention under general anaesthesia. Left supraclavicular incision taken to access and loop the proximal subclavin artery (Figure 3A and 3B). Left side transaxillary incision taken to access and loop the axillary artery. Intravenous heparin (5000 IU) was administered. Proximal subclavin artery and axillary artery both clamped. Dissection and separation of pseudoaneurysm followed by excision was done with cautery along with its content the clotted blood (Figure 4A and 4B). The opening of pseudoaneurysm in left subclavin artery was closed with vein patch with prolene 6-0. The vein patch was prepared from small axillary vein tributary. After putting 14 number negative suction romovac drain n supraclavicular and axillary region, wound closed in layer (Figure 5). Skin closed with stappler. Radial and ulnar artery pulsation checked. Drain removed after 48 hours. On the tenth postoperative day the patient was discharged. Discussion Post traumatic pseudoaneurysm is rare. The most common cause for such pseudoaneurysm is itragenic like post av fistula dialysis needle puncture or invasive procedures like percutaneous coronary interventions. Most common site for such pseudoaneurysm is radial, brachial and common femoral artery. Post stab injury pseudoaneurysm is rare in that subclavin artery pseudoaneurysm was rarest. If such pseudoaneurysm became infected, the surgical treatment can be extremely difficult. Although recently published, meta-analyses showed no superiority of subclavin artery stenting in such pseudoaneurysm because even after closing the opening which connect subclavin artery with pseudoaneurysm, the already formed pseudoaneurysm is high risk of infection [3,4]. So excision of that pseudoaneurysm is must. If the subclavin artery is normal with clearly visible opening that connect with pseudoaneurysm then pseudoaneurysm can be excised without sacrificing the part of subclavin artery by just vein patch closure of that opening with prolene suture. Sometimes rarely excision of part of subclavin artery with interposition grafting may be required. Conclusion The pseudo aneurysm excision was simple and safe even in inexperienced hands by proper anatomical knowledge. Proximal and distal control of artery is must for safe excision of pseudoaneurysm. By proper anatomical dissection pseudo aneurysm can be excised without damaging the surrounding vital structure like brachial plexus and axillary vein. Timely management was important to prevent complications like infection, rupture and gangrene. If the subclavin artery is normal with clearly visible opening feeding pseudoaneurysm then pseudoaneurysm can be excised without sacrificing the part of subclavin artery by just vein patch closure of opening in subclavin artery with prolene. Sometimes rarely excision of part of subclavin artery with interposition grafting may be required.

Abstract 19582: Placement of the Left Side AED Pad is Poor: Training on the Left Compared to the Right Side of a Manikin Does Not Improve Pad Placement

Introduction: Placement of automated external defibrillators (AED) pads is poor, especially placement of the left apical pad is rarely achieved. Sitting on the right side of a victim in cardiac arrest may interfere with correct left side pad placement because the rescuer has to bend over the victim to reach the left mid-axillary line. In addition, the left arm of the victim may hamper access to the left lateral side of the thorax. Hypothesis: Training automated external defibrillation sitting on the left side of a manikin improves AED pad placement compared to sitting to the right. Methods: Laypeople participating in a first aid course were randomized to learn automated external defibrillation sitting on the left or right side of a manikin during AED training. After course completion participants operated a training AED (Lifepak® CR-T AED Trainer, PhysioControl) and placed AED pads according to instructions from the AED. Pads were placed on an anatomically realistic male resuscitation torso with arms (AMBU® Man, AMBU). Participants were instructed to sit on the same side of the manikin as trained. The distance from the center of AED pads to the recommended pad position was measured. Results: In total, 30 volunteers were included and randomized to AED training on the left (n=14, 43% male, age: 47.9 years) and right (n=16, 25% male, age: 46.7 years) side of a manikin. There was no difference in left pad placement when trained on the left or right side (distance to recommended left apical pad position (mean±sd): 5.8±2.1 cm vs 7.0±2.4, p=0.15). The left apical electrode was in all cases placed too medial. Only a minor part of participants (left trained (36%); right trained (31%)) moved the left arm of the manikin to place the left apical pad. No difference was observed with respect to right pad placement when trained on the left or right side respectively (distance to recommended right sternal pad position (mean±sd): 2.7±1.7 cm vs 1.8±0.8 cm, p=0.10). Conclusion: Training automated external defibrillation on the left side of a manikin does not improve pad placement compared to training on the right side. Placement of the left apical pad is poor and future training should emphasize correct left lateral pad placement.

Πάλη, ἔφεδρος in λαμπαδηδρομία na grobnici spektatijev v Šempetru?

Upodobitev na reliefu na levi bočni strani edikulne grobnice družine Gaja Spektatija Priskijana v Šempetru je bila doslej deležna različnih interpretacij. Po ne najbolj posrečeni razlagi z ugrabitvijo neke ženske, verjetno Helene, je bil prizor bolj prepričljivo razložen kot izsek iz sveta športnih tekmovanj. Par na sredini naj bi predstavljal nadvse priljubljeno rokoborbo v palestri (πάλη), figura na levi pa dodatnega atleta (ἔφεδρος), ki z zanimanjem sledi dvoboju in čaka, da bo prišel na vrsto, medtem ko naj bi efeb na desni predstavljal nosilca bakle (λαμπαδηδρόμος), tekmovalca v grškem agonu λαμπαδηδρομία. To razlago so ovrgle nesporne podobnosti z atiškim sarkofagom iz Tespij, ki so relief razložile kot boj Oresta in Pilada s Tavrijci.

Photoelastic analysis of stresses transmitted by complete dentures lined with hard or soft liners.

Stresses transmitted on the alveolar bone ridge by lined conventional complete mandibular dentures can decrease the bone absorption level. The aim of this in vitro study was to evaluate the stresses induced on the alveolar bone ridge of lined conventional complete mandibular dentures by using photoelastic analysis. One maxillary and three mandibular conventional dentures were developed for the following treatments: 1 - Unlined denture (control), 2 - Denture lined with resin-based material, and 3 - Denture lined with silicone-based material. The photoelastic analysis took place with the dentures in the position of maximum intercuspation, and the mandibular photoelastic models were axially loaded with 10 kgf (98 N). Unlined denture (control) presented stresses along the model, especially on the anterior and left lateral sides with less stresses on the right side. On the left lateral side, the denture base lined with resin-based material demonstrated similar stresses to that of the control; however, lower stresses occurred in the premolar and retromolar regions. Denture bases lined with silicone-based material showed decreased fringe orders and homogeneous distribution of induced stresses. Both lined dentures exhibited lower stresses when compared to unlined dentures. Silicone-based material provided a more homogeneous distribution of stresses.

White-eyed medial orbital wall fracture with oculocardiac symptoms.

White-eyed medial orbital wall fracture with oculocardiac symptoms.

Panoramic Laparoscopic View of Transverse Testicular Ectopia

Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes migrate toward the same hemiscrotum. We present a case of TTE in a 33-year-old man. Laparoscopy showed the left spermatic vessels, accompanied by parietal peritoneum, which formed a septum that divided the pelvic space into two, were extending transversely from the left lateral side of the descending colon toward the right internal inguinal ring over the sigmoid colon. A panoramic laparoscopic view of the spermatic vessels in TTE can clearly demonstrate the descending pathway and partly contribute to our understanding of the etiologic mechanisms of TTE.

Adapted step length estimators for patients with Parkinson's disease using a lateral belt worn accelerometer.

Parkinson's disease (PD) is a neurodegenerative disease that predominantly alters patients' motor performance. Reduced step length and inability of step are important symptoms associated with PD. Assessing patients' motor state monitoring step length helps to detect periods in which patients suffer lack of medication effect. Evaluate the adaption of existing step length estimation methods based on accelerometer sensors to a new position on left lateral side of waist in 28 PD patients. In this paper, a user-friendly position, the lateral side of the waist, is selected to place a tri-axial accelerometer. A newly developed step detection algorithm - Sliding Window Averaging Technique (SWAT) is evaluated in detecting steps using signals from this location. The detected steps are then used to estimate step length using four proposed correction factors for Zijlstra's, Gonzalez's and Weinberg's methods that were originally developed for the signals from lower back. Results obtained from 28 PD patients are discussed and the effects of calibrating in each motor state are compared. A generic correction factor is also proposed and compared with the best method to use instead of individual calibration. Despite variable gait speed and different motor state, SWAT achieved overall accuracy of 96.76% in step detection. Among the different step length estimators, the Zijlstra method performs better with multiplying individual correction factors that consider left and right step length separately providing average error of 0.033 m. Zijlstra's method with individual correction factor that considers left and right step length separately and obtained from during ON state of a PD patients provide most accurate estimation among the others. As training session is during ON state, data from induced OFF state to train the methods are not required. A generic correction factor is also proposed to apply with Zijlstra's method to avoid individual calibration process.

Comments on Case Report-Post B-Lynch Uterine Rupture: Case Report and Review of Literature.

Dear Editors, I read with interest the article ‘Post B-Lynch Uterine Rupture: Case Report and review of Literature’ by Date S et al. published in September–October 2014 issue. Mechanical uterine compression sutures are hysterectomy saving emergency procedure for atonic post partum hemorrhage and these are quite safe with minimal complications. B-Lynch suture was first reported in 1997 in which two parallel sutures are applied, starting from just above the bladder reflection, and are tied after taking over the fundus of the uterus from posterior wall [1]. As mentioned by the authors, there is one case report of spontaneous uterine rupture at 32 weeks after B-Lynch suture where PDS suture was used [2]. After reviewing that case, it is seen that the site of rupture was vertical, at the fundus on left lateral side, and a deep vertical groove was present on posterior wall, which is the position of the compression suture which might have eroded the uterus thus leading to weakening of myometrium. The case reported by the authors Date S et al. is 23-year-old G4P1L1A2 with uterine rupture at four month of gestation. As clear from the figure, the rupture is transverse and at fundus of uterus [3]. It is pertinent to note that this patient is also having history of two abortions. In this patient, other causes of rupture could be either weakening of myometrium due to the evacuation of the uterus for abortions or some uterotonic drug given for illegal abortion in second trimester, which is still common in India. Taking into account the transverse fundal rupture that too at 4 months of gestation the other causes of uterine rupture should be ruled out before labeling B-Lynch suture (which is quite safe and has minimal complications) as a cause for uterine rupture.

Development and migration of the C. elegans Q neuroblasts and their descendants.

During the first stage of larval development, the Q neuroblasts and their descendants migrate to well-defined positions along the anteroposterior body axis, where they differentiate into sensory neurons and interneurons. The two Q neuroblasts are initially present at similar positions on the left and right lateral side, but this symmetry is broken when the Q neuroblast on the left side (QL) polarizes towards the posterior and the Q neuroblast on the right side (QR) towards the anterior. This left-right asymmetry is maintained when the descendants of the two Q neuroblasts migrate to their final positions in the posterior and anterior. The mechanisms that establish this asymmetry and control the migration of the Q descendants along the anteroposterior axis are surprisingly complex and include interplay between Wnt signaling pathways, homeotic genes, and the basic cell migration and polarity machinery. Here, we will give an overview of what is currently known about the mechanisms that mediate and control the development and migration of the Q neuroblasts and their descendants.

Endochondral ossification in a case of progressive osseous heteroplasia in a young female child

Progressive osseous heteroplasia (POH) (OMIM 166350) is a rare autosomal dominant condition, characterized by heterotopic ossification of the skin, subcutaneous fat, and deep connective tissue. This condition is distinct from Albright's hereditary osteodystrophy or McCune Albright syndrome (OMIM 103580) and fibrodysplasia ossificans progressiva (OMIM 135100). We present an unusual presentation of POH in a 7-year-old female child. The clinical features included a painful swelling on the left foot, with mechanical complaints. There was no congenital hallux valgus. Family anamnesis was positive in the father. There were subcutaneous ossifications of his left upper arm, right-sided thorax, and lateral side of the right ankle. The father did not allow any radiographs or further examinations. Radiographic examination of the patient revealed ossified subcutaneous plaques on the left foot, lumbar spine, and left scapulae. Additional blood samples were analyzed, revealing no pseudohypoparathyroidism. Sequence analysis of the gene associated with POH, the GNAS1 gene, revealed the heterozygote mutation c.565_568del, previously found in Albright's hereditary osteodystrophy. Histopathological examination of the subcutaneous ossification showed presence of chondrocyte clusters, a feature usually found in fibrodysplasia ossificans progressiva. The combination of the clinical features, the absence of pseudohypoparathyroidism, histology revealing chondrocyte clusters, and the specific GNAS mutation in this patient makes this a truly unusual presentation of POH. The findings in the described case might denote subdivisions of POH. The condition is associated with progressive superficial to deep ossification, progressive restriction of range of motion, and recurrence if excised. We hope to inform pediatricians and orthopedic surgeons to create more awareness of this disorder so that unnecessary treatments can be avoided and proper counseling offered.

Axis ring fractures due to simulated head impacts

BackgroundWe investigated mechanisms of axis ring fractures due to simulated head impacts. MethodsOur model consisted of a human upper cervical spine specimen (occiput through C3) mounted to a surrogate torso mass on a sled and carrying a surrogate head. We divided 13 specimens into 3 groups based upon head impact location: upper forehead in the midline, upper lateral side of the forehead, and upper lateral side of the head. Post-impact fluoroscopy and anatomical dissection documented the injuries. Average occurrence times of the peak loads and accelerations were statistically compared (P<0.05) using ANOVA and Bonferroni pair-wise post-hoc tests. FindingsOf the 13 upper cervical spines tested, 5 specimens sustained axis ring fractures with the most common mechanism being impact to the upper left lateral side of the forehead. The first local force peaks at the impact barrier and neck and all peak head accelerations occurred between 18.0 and 22.8ms, significantly earlier than the absolute force peaks. The average peak neck loads reached 1761.2N and the axis ring fractures occurred within 50ms. InterpretationWe observed asymmetrical fractures of the axis ring including fractures of the superior and inferior facets, laminae, posterior wall of the vertebral body, pars interarticularis, and pedicles. The fracture patterns were related to the morphology of the axis as a transitional vertebra of the upper cervical spine. Understanding the mechanisms of axis ring fractures may help in choosing the optimal reduction technique and stabilization method based upon the specific fracture pattern.

Abdominal Pregnancy After Hysterectomy: A Rare Cause of Hemoperitoneum

BackgroundPregnancy after hysterectomy is an extremely rare event. However, if not diagnosed and managed properly, it may result in life-threatening consequences. Case ReportWe report the case of a 28-year-old woman with a history of cesarean hysterectomy 3 years prior who was referred to our institution for evaluation of abdominal pain. Transvaginal ultrasonography revealed a 15-week live fetus in the left pelvic region and normal-appearing bilateral ovaries. Laparotomy showed a 15-week live fetus with its placenta attached to the left adnexal region and the left lateral side of the cervix, including bowel loops. ConclusionThe possibility of pregnancy should be considered in the differential diagnosis of abdominal pain in women with intact ovaries despite a history of hysterectomy. A pregnancy test should be a part of the diagnostic work-up of these patients when they present in the emergency department.

Acute lower gastrointestinal bleeding originating from an arteriovenous fistula of superior rectal artery

Dear Editor: The most common acute causes of lower gastrointestinal (GI) hemorrhage are diverticulosis and angiodysplasia [1]. Arteriovenous fistula (AVF) of the intestine is an uncommon cause of GI hemorrhage [2]. AVF originating from the distal branch of superior rectal artery has never been described before and up to date as a cause of lower GI bleeding. Herein, we report a case of embolization of an AVF originated from the superior rectal artery end branch as a cause of acute lower GI bleeding. An 80-year-old man, with prior history of acute lower GI bleeding episode resolved with supportive treatment 6 months ago, was admitted to our hospital with bright red blood per rectum bleeding. Flexible colonoscopy revealed proximal fresh bleeding without any specific bleeding site. The patient was then referred for a computed tomography (CT) scan. The CT initially suspected an abnormal vessel on the left lateral side wall of the rectum. However, as the patient’s condition remained stable the hemoglobin value decreased despite transfusion, the patient was transferred to the interventional radiology suite for a mesenteric angiography with possible embolization. Angiography showed left superior rectal artery-originated AVF with the suspicion of bleeding. The superior rectal artery branch of AVF was superselectively catheterized with a 2.7 Fr Progreat microcatheter (Terumo, Tokyo, Japan) and embolized with microcoils. Complete hemostasis was achieved after embolization. Very rare cases of inferior mesenteric AVFs have been reported, and a few of them were responsible of acute GI bleeding in the literature [2]. Most of the cases of acute lower GI hemorrhage are controlled with supportive treatment. Persistent bleeding with hemodynamic instability requires further investigation and management [1, 3]. The major risk of embolization is bowel ischemia. As advancements in microcatheter technology have allowed embolization of distal arteries smaller than 1 mm in diameter, thus, the reported rate of colonic ischemia has reduced to approximately 3–4 % in recent studies [1]. Here, we have presented a very rare case of embolization of an intestinal AVF originated from the end branch of superior rectal artery. We suggest that superselective embolization may be a more safe treatment option in some types of acute lower GI bleeding.

Morphological and Molecular Characterization of Three New Azadinium Species (Amphidomataceae, Dinophyceae) from the Irminger Sea

Some species of the planktonic dinoflagellate genus Azadinium produce azaspiracids (AZAs), a group of lipophilic phycotoxins causing human poisoning after mussel consumption. We describe three new species from the North Atlantic, all of which shared the same Kofoidean plate pattern characteristic for Azadinium: Po, cp, X, 4', 3a, 6″, 6C, 5S, 6'″, 2″″. Azadinium trinitatum sp. nov. was mainly characterized by the presence of an antapical spine and by the position of the ventral pore at the left distal end of the pore plate in a cavity of plate 1'. Azadinium cuneatum sp. nov. had a conspicuously formed first apical plate, which was asymmetrically elongated and tapered on its left lateral side with a ventral pore located at the tip of this elongated 1' plate. Azadinium concinnum sp. nov. was of particular small size (< 10μm) and characterized by an anteriorly elongated anterior sulcal plate and by large and symmetric precingular plates. The ventral pore was located inside the apical pore plate on the cells' right lateral side. Molecular phylogenetics as inferred from concatenated SSU rRNA, ITS, and LSU rRNA sequence data supported the distinctiveness of the three new species. None of the new species produced any known AZAs in measurable amounts.

Madanidinium loirii gen. et sp. nov. (Dinophyceae), a new marine benthic dinoflagellate from Martinique Island, Eastern Caribbean

A new benthic phototrophic dinoflagellate is described from sediments of a tropical marine cove at Martinique Island and its micromorphology is studied by means of light and electron microscopy. The cell contains small golden-brown chloroplasts and the oval nucleus is posterior. It is laterally compressed, almost circular in shape when viewed laterally. It consists of a small epitheca tilted toward the right lateral side and a larger hypotheca. In the left view, the cingulum is more anterior and the epitheca is reduced. The cingulum is displaced and left-handed. This organism is peculiar in having no apical pore and its thecal plate arrangement is 2′ 1a 7′′ 5c 3s 5′′′ 1′′′′. The plates are smooth with small groups of pores scattered on their surface. An area with 60–80 densely arranged pores is found near the centre of the 2′′′ plate, on the left lateral side. Morphologically, these features are different from all other laterally compressed benthic genera. In addition, molecular genetic sequences of SSU and partial LSU form a distinct and well-supported clade among dinoflagellates and support the erection of a new genus. However, molecular phylogenies inferred from ribosomal genes failed to confirm any clear relationship with other benthic taxa and affinity with other laterally compressed dinoflagellates has not been demonstrated. Hence, the taxonomic affinity of Madanidinium loirii with a defined order and family is unclear at the moment.

Parameatal cyst in a 4-year-old boy

A 4-year-old boy presented a translucent cyst on the left lateral side of the urethral meatus. The lesion was excised. Histological examination showed features of a cystic lesion within the dermis surrounded by a thin epithelium of columnar cells with a round apical pole. Immunohistochemical staining was positive for pan-cytokeratins (AE-1/AE-3) and negative for actin. These findings led to a diagnosis of urethral parameatal cyst. this entity is a rare congenital malformation and consists of a parameatal benign cyst occurring in prepubertal males. Treatment consists of complete resection of the cyst.

Unusual suicide with a chainsaw

A 39-year-old male, with a history of multiple suicidal attempts and psychiatric pathology, a professional lumberjack, was found dead at the meadow with his throat cut and a chainsaw beside him. Autopsy revealed that all physical injuries were confined to the head, neck and left shoulder. Two major (long and wide) wounds were found and documented on both sides of the neck and head. A wound on the posterior and right lateral side of his neck and head was noted. Medical examiner noted an irregular rupture on the posterior-right side of the atlanto-occipital joint with impaired bone, but without any damage on the spinal cord. Another gaping cut was noted in the lower part on the left lateral side of his neck. Medical examiner noted that muscles of the left side of the neck, left common carotid artery, left internal jugular vein and left vagus nerve were completely cut off. The body of the C5 and C6 vertebra, with the spinal cord at that level, was completely cut. Also, there were multiple linear and striped parallel abrasions on the outer side of the left shoulder and one abrasion on the left lateral side of the neck. The conclusion of inquiries was “suicide by chainsaw”.

Aerodynamic drag control by pulsed jets on simplified car geometry

Aerodynamic drag control by pulsed jets is tested in a wind tunnel around a simplified car geometry named Ahmed body with a rear slant angle of 35°. Pulsed jet actuators are located 5 × 10−3 m from the top of the rear window. These actuators are produced by a pressure difference ranging from 1.5 to 6.5 × 105 Pa. Their excitation frequency can vary between 10 and 550 Hz. The analysis of the control effects is based on wall visualizations, aerodynamic drag coefficient measurements, and the velocity fields obtained by 2D PIV measurements. The maximum drag reduction is 20 % and is obtained for the excitation frequency Fj = 500 Hz and for the pressure difference ∆P = 1.5 × 105 Pa. This result is linked with a substantial reduction in the transverse development of the longitudinal vortex structures coming from the left and right lateral sides of the rear window, with a displacement of the vortex centers downstream and with a decrease in the transverse rotational absolute values of these structures.

A small stone column of the altar screen from the treasures of St Archangel Michael's monastery in Prevlaka

Amongst exhibited fragments of carved stone decorations in the monastery of St Archangel Michael in Prevlaka, Boka Kotorska, situated on the ground floor of the monastery's accommodation quarters, there is a segment of stone liturgical furnishings which is, among other things, distinguished by its monumental dimensions, the high level of its craftsmanship, and the important artistic value of its carved decorations. This small stone column was found by chance as a surface-level find on the neighbouring island of St Gavrilo. This stone column is made from a monolithic piece of high- quality, light-grey marble. It is 96 cm in height, 20 cm wide at the front, 18.5 cm wide at the side, and 13cm wide at the rear. These dimensions indicate that the fragment has the form of an elongated hexahedron, with sides of unequal width. Only the front of this stone fragment is marked with relief decorations, comprising a regularly shaped two-part curled sprouting vine. Moving with its undulating rhythm, its arc defines a space in which is located the central motif of the decoration. This comprises the motif of a bud in the form of stylised crinoline flower, composed of two lateral leaves with a pronounced bulge in the middle. These tightly bent lateral leaves with sharp ends, together with the root of the formed shoot, leave an empty space filled with an offshoot in the form of a regularly formed volute. The left lateral side of the stone column is marked by a long but relatively shallow channel, created around its axis, with a width of 7.5 cm. Its rear side is divided by its own height into two vertical fields, of almost the same width - 6 and 7 cm respectively - one slightly elevated compared to the other. The right lateral side of the column is slanted and only lightly sculptured. On the upper surface of the pillar, a relatively shallow circular hole with a small span is visible, intended as a connection point for other segments that would have been placed on it. The material, size, characteristic shape, together with its special personal details, such as the channel around the whole height of its left lateral side, as well as the shallow hole on its upper surface, without doubt show that it was one of the original stone columns of a particular stone altar screen. Analysis of the motif's source, decorative forms, and the quality of its carving confirm that this segment of the altar screen represents one more parts of the same sculptors' workshop which produced one preserved part of the stone altar screen of St Triphon in Kotor, which received the same decorative and sculptural treatment, also undoubtedly originating from no before than the 11th century. The possibility of completely resolving the dilemma of which sacred complex the column originally belonged to will only be resolved when archaeological excavation and investigation of the site of the monastery of St Archangel Michael in Prevlaka, in whose treasury it stands, together with the neighbouring island of St Gavrilo, on which the pillar was found, takes place. The possibility of precisely dating this stone altar screen will only occur with the expected full understanding of the whole altar screen of the Cathedral church of St Triphon in Kotor. However, this segment of the stone altar screen also represents a reason to better comprehend the morphological characteristics and variety of stylistic expression present and specifically applied in the decorative elements of early-medieval sculpture on the southern-eastern Adriatic coast.

Opalski Syndrome Caused by Vertebral Artery Compression of the Lateral Surface of the Medulla Oblongata

A 55-year-old man presented with vertigo, nystagmus, and gait ataxia followed by left hemiparesis (Opalski syndrome). T2-weighted magnetic resonance imaging revealed vascular compression of the left lateral side of the medulla oblongata by the left vertebral artery. On diffusion tensor imaging, the level of fractional anisotropy (FA) in the left corticospinal fibers caudal to the pyramidal decussation was lower than that observed in the right corticospinal fibers. Opalski syndrome caused by vascular compression is very rare. This is the first reported case of Opalski syndrome that was imaged on FA.