Lower Third Research Articles

From caustic soda ingestion to feeding jejunostomy

Abstract We present the case of a young woman who after ingestion of caustic soda for autolytic purposes presented diffuse stenosis in the middle and lower thirds of the esophagus and extensive and marked stenosis of the body, gastric antrum and duodenal bulb that required a feeding jejunostomy due to total intolerance to solids and liquids. Given the characteristic endoscopic and radiological findings, as well as its difficult subsequent management, it is a challenging clinical case.

A Case Study on Dushta Vrana w.s.r to Venous Ulcer

Vrana in Ayurveda is defined as a structural deformity in the skin and deeper structures, it’s of 2 types - Dushtavrana and Shudhavrana. Dushta Vrana with foul smell has abnormal color with profuse discharge from wound, intense pain and takes long period to heal is said to be Dushta Vrana. The features will vary according to the predominant Dosha. It can be correlated to Chronic wound based on underlying pathology. Chronic wounds are termed ulcers and can be defined as wounds with full thickness in depth and slow healing tendency. In this single case study Dusta Vrana is considered as venous ulcer is one among 4 types of Chronic wound. Venous Ulcer occurs due to abnormal hypertension in the lower third of the leg, ankle and dorsum of foot. Acharya Sushruta has mentioned Shashti Upakrama for the management of Vrana. Here to evaluate the combined effect of Shodhana and Shamana Chikitsa, Classical Virechana, Jalaukaavacharana as a Shodhananga, Shamanaushadi by Kaishora Guggulu, Triphala Guggulu, Gandhaka Rasayana, and Manjishtadi Kashaya, Sthanika Chikitsa by Panchavalkala Kashaya Pariseka and Jathyadi Ghrita. The medicines having Tridosha Shamaka, Vrana Shodhana, Ropana, Vedana Shamaka, Shothahara, Rasayana property showed successful result in treating Dushtavrana.

Advanced Malignant Melanoma of the Vulva in a 70 years old woman

Vulvar melanoma is a rare malignant tumor of the female genital tract tend to occur in older age women and a high tendency to metastasize because the diagnosis is usually delayed (1). In this case report, we present a 70-year-old para 8 woman who presented with progressively increasing vulvar swelling of 2 years and multiple visit to health institution. Examination revealed 7cm diameter multi-nodular mass with areas of dark and dark blue-violet color filling the introitus that involves the clitoris, labia minora, lower third of the anterior vagina and urethra. Incisional biopsy from the mass showed malignant melanoma. Imaging with CT scan revealed bilateral lung metastasis. Palliative chemotherapy was planned but the patient lost to follow up.

PATHOMORPHOLOGICAL AND PATHOHISTOLOGICAL CHARACTERISTICS OF PRIMARY VULVAR CARCINOMA

The purpose of the study was to determine pathomorphological and pathohistological characteristics of primary vulvar carcinoma. Materials, methods, and study design: A retro- and prospective comprehensive morphological study of 117 patients was conducted at Bondar Regional Cancer Research Center (Donetsk) over the period from 2002 to 2019. Out of 117 we identified 44 patients with primary vulvar cancer without previous inflammatory diseases (cancer de novo). The materials were fixed in formalin and examined using standard methods of histological staining and morphometry. Statistical analysis methods were used to process the data. Results and Discussion: The differentiated VIN type occurred in 61.2% of cases, the undifferentiated type – in 37.8%. VIN1 was characterized by basal cell hyperplasia, VIN2 – by abnormal vertical anisomorphy, VIN3 – by significant abnormal cell stratification and differentiation. Cell proliferative activity increased with VIN severity, with the highest mitotic index and nuclear-cytoplasmic ratio in VIN3. In VIN1, a positive reaction to nuclear proliferation antigen was observed in the lower third of the epithelial layer. In VIN2 and VIN3, the positive reaction covered most of the epithelium. Well-differentiated SCC (G1) was characterized by polymorphic cell complexes with a small number of pathological mitoses and apoptosis. Moderately differentiated SCC (G2) had a pronounced inflammatory reaction and necrosis, with disruption of the basement membrane. Poorly differentiated SCC (G3) demonstrated loss of vertical anisomorphy, high mitotic index and presence of tumor emboli in vessels. Conclusions: The study showed significant differences in the morphological and morphometric characteristics of different types of VIN and invasive vulvar carcinoma. The results will help to improve the diagnosis and treatment of primary vulvar cancer, especially in understanding its pathogenesis and prognostic factors.

Safety and efficacy of perventricular device closure of ventricular septal defects in children

Abstract Objectives To evaluate safety and efficacy of perventricular device closure techniques for the closure of ventricular septal defects (VSD) in children in United Arab Emirates. Methods In the year 2023-24, 13 children underwent per-ventricular device closures of VSD under the guidance of transesophageal echocardiography without cardiopulmonary bypass(CPB). The mean age at operation was 3.76 years (range 3 months-14 years). The ventricular septal defect sizes ranged from 2.7-6 mm. The device sizes ranged from 5-12mm. All patients except two required symmetrical device. Eight defects were peri membranous, 3 were sub-aortic and 2 were muscular. Ventricular septal defect occlusion device (Memoport, Beijing, China) were used through a 3-cm skin incision in the lower third of the sternum. Results All patients underwent VSD device closure successfully. The mean procedural duration was 42 minutes. None of the patients required CPB. The mean ventilation time and ICU stay was 3 hrs. and 24 hrs. respectively. None of the patients required inotropic support or blood transfusions. There were no residual shunt (except small shunt through the device), arrhythmias including heart block post operatively. At follow up, (3 months-7 months) there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications. There was no mortality. Conclusions Perventricular device closure of VSD is highly successful, less invasive, safe and effective. It is associated with quick recovery, short length of stay and better cosmetic incision. Moreover, it avoids CPB.

Life-Threatening Spontaneous Hematoma in Unusual Sites in Patients with COVID-19 on Anticoagulant Therapy: A Case Series

Thromboembolic manifestations are a common phenomenon in patients affected by corona virus (SARS CoV-2). Recent studies have shown that patients with acute renal failure are also at a greater risk of venous and arterial thromboembolism, 15-30% in ICU, and 7% inpatient care. However, frequently unjudicial use of anticoagulants may develop severe life-threatening hematoma. In our hospital settings we had a dedicated COVID Unit with a Hemodialysis facility. Our Nephrology department had managed 381 patients being COVID positive along with renal impairment from March 2020 to January 2022. Among these patients, four patients developed spontaneous non traumatic hematoma in unusual sites. On admission all the patients received treatment according to our national guidelines for COVID-19. Cases: It is a retrospective analysis in a single-centered hospital. Four cases with confirmed COVID-19 with acute kidney injury and on anticoagulant therapy had developed sudden concealed bleeding. These patients had no previous history of anticoagulant therapy before admission. Case 1 developed hemorrhage in Right lower anterior paramedian deep parietal wall of abdomen, Case 2 had hematoma in retroperitoneal space and in lower third of Iliopsoas, Case 3 developed hemorrhage in left cerebral hemisphere, Case 4 had Intramuscular Hematoma in left rectus abdominis. Out of these four patients two of them required Hemodialysis and one of them went into shock. All patients included were male. The mean age was 57±19.64years. All the four patients were initially managed conservatively with keen monitoring and with proper volume resuscitation, blood transfusion and discontinuation of the anticoagulants. Three of the patients survived with conservative management and one patient died due to sudden massive cardiac arrest. The use of therapeutic anticoagulant can increase the risk of bleeding in atypical sites and may exhibit higher patient death with COVID-19 if not identified at early stage. So a risk-benefit ratio of usage of anticoagulants should be kept in mind and further clinical trials needed to justify its random use in COVID-19. J Bangladesh Coll Phys Surg 2024; 42: 393-400

Cut-off values for estimated cardiorespiratory fitness in terms of physical functioning among middle-aged to older adults.

Cardiorespiratory fitness is linked to various health outcomes. This study aimed to establish cut-off values for estimated cardiorespiratory fitness associated with poor physical functioning in middle-aged to older adults. A total of 2638 participants (1083 males), aged 40-69 years, performed a 6-min walking test (6MWT) to estimate cardiorespiratory fitness (VO<inf>2max)</inf> and completed a health-related questionnaire. Physical functioning was assessed using four outcomes: perceived health, perceived fitness, difficulties in 2-km walking, and difficulties in climbing several stairs. Receiver operator characteristics (ROC) curves were used to determine cut-off values for estimated VO<inf>2max</inf> and 6MWT distance linked to poor physical functioning based on the four outcomes. Analyses were done separately for males and females, and for 40- to 49-, 50- to 59-, and 60- to 69-year-old groups. Multinomial regression was used to analyze differences between fitness thirds in outcome variables. ROC analyses were significant for all outcomes (AUC 0.686-0.834, P<0.001). In the total group, cut-off values for estimated VO<inf>2max</inf> were 29.9-30.2 mL/kg/min, and for walking distance, 588.0-599.5 m. Cut-off values decreased with age, and mean differences between males and females were 3.3 mL/kg/min and 33 m. All cut-off values were within ±1.3 mL/kg/min of the lower fitness tertile. The odds ratios of having poor physical functioning in the middle and high fitness thirds were less than 0.50 compared to low fitness third. VO<inf>2max</inf> of 30 mL/kg/min and 600-m walking distance seemed reasonable cut-off values for poor physical functioning. Exceeding the currently proposed thresholds is a desirable goal to avoid consequences of insufficient fitness.

Transanal total mesorectal excision: Understanding indications, managing complications, and effective prevention methods

AbstractTransanal total mesorectal excision (TaTME) has emerged as a surgical method for treating rectal malignancies in the middle and lower third of the rectum over the past 15 years. This approach was adopted because of the challenges encountered in secure total mesorectal excision (TME). Patient selection criteria and the rationale for TaTME have evolved, leading to improved oncological outcomes and patient quality of life. The procedure includes inserting a unique platform through the anus, forming a purse‐string closure, and endoscopically sealing the lower rectum. The mesorectum is then removed laparoscopically following a ‘down‐to‐up’ approach, finalised with a transabdominal laparoscopic phase and anastomosis. Pelvic anatomy complexity poses challenges, including potential injuries to the urinary tract, surgical site leakage, sinus damage, sagittal vein harm, nerve injury, carbon dioxide embolism, bowel function disturbance, sphincter mechanism issues, and rectal abscess formation. Proficient anatomy knowledge, precise surgical techniques, and advanced technologies contribute to their prevention. In conclusion, TaTME offers a promising approach to rectal surgery with satisfactory oncological outcomes. However, vigilance is required to eliminate potential complications.

The use of argon plasma coagulation in ruptured hemorrhagic syndrome (Mallory-Weiss syndrome) complicated by ongoing bleeding

Objective: to evaluate the efficacy and safety of argon plasma coagulation for endoscopic hemostasis in Mallory-Weiss syndrome. Materials and methods: on the basis of a clinical observation of a patient admitted to the emergency department of the State Budgetary Healthcare Institution of the Moscow Region of the Children’s Central City Hospital with complaints of vomiting of scarlet blood, dark stools, weakness, dizziness. The patient underwent emergency EGDS. Results: According to the EGDS data, a linear mucosal rupture was detected in the lower third of the esophagus along the posterior wall with a transition to the stomach cardia along the lesser curvature, about 8-9 cm long (5 cm in the esophagus, 3-4 cm in the stomach), up to 2 cm deep. -3 mm, from the rupture there is a flow of scarlet blood of medium intensity, in the bottom of the defect, fibers of the submucosal and muscular layers were determined. Endoscopic hemostasis was performed: argon plasma coagulation of the rupture of the mucous membrane of the esophagus and stomach. Against the background of endoscopic treatment by argon plasma coagulation in a patient with a long rupture, hemostasis was achieved and surgical treatment was avoided, which could aggravate the condition and lengthen the treatment time. Conclusions: Argon plasma coagulation as a non-contact method of hemostasis has a limited penetration depth and is safer and more effective than other (contact) electrocoagulation methods, where, as a rule, it is difficult to control the depth of exposure. The use of this method improves the efficiency of endoscopic hemostasis, reduces economic costs, and reduces the patient’s stay in bed.

CLINICAL PROFILE OF FEMALE PATIENTS WITH INVOLUTIONAL CHANGES IN THE FACIAL AND NECK SKIN

Objective. To assess the clinical profile of female patients with complaints of involutional changes in the face and neck planning to undergo contouring surgery for facial/neck correction. Materials. This study is based on a prospective analysis of 210 fe-male patients with involutional changes in the face and neck who consulted an aesthetic surgeon. Results. The mean age of the patients was (52.51±4.94) years (range 36-65). The majority were middle-aged (46-65 years) – 92.86%. Women aged 36-45 years most often considered the upper third of the face as problematic, those aged 46-55 years focused on the middle/lower third of the face, and those aged 56-65 years identified the middle part of the face and neck as problem areas. The average score for subjective assessment of facial involution was 3.35 points (range 2-4). Younger patients rated the severity of their facial changes with lower scores, while patients over 55 years old tended to choose a score of four. Four typical morphotypes of facial aging were identified: tired or gravitational morphotype (27.14%), fine-wrinkled morphotype (17.14%), deformational morphotype (35.71%), and combined morphotype (20.0%). Conclusions. The majority of patients (88.6%) indicated that problematic areas involved various thirds of the face: the middle third of the face (60.47%), the lower third of the face (43.81%), and the neck (24.28%). Younger patients rated the severity of involutional changes in their face with lower scores, whereas a significant number of patients over 55 years old chose a score of four. The first type of Glogau aging was most common among patients with a fine-wrinkled morphotype, the second type with a gravitational morphotype, and the third and fourth types with a deformational morphotype.

Joint associations of handgrip strength and physical activity with incident cardiovascular disease and overall mortality in the UK Biobank

Background & aimsQuestions remain whether higher handgrip strength confers additional health advantages beyond adherence to current physical activity guidelines. We aimed to evaluate prospective associations of joint objectively measured handgrip strength and physical activity with incident cardiovascular disease (CVD) and all-cause mortality. MethodsWe analysed the UK Biobank study in a cohort of participants who wore accelerometers for one week, with follow-up based on hospital records until 2022. Patterns of physical activity were compared: participants who met current moderate-vigorous physical activity guidelines (150 minutes per week) and those who did not. Handgrip strength was classified into sex- and age-specific tertiles. CVD events were identified as primary or secondary by examination of inpatient records and data extracted from the death registry. CVD-related deaths were also identified from the death registry. We examined prospective associations of moderate-vigorous physical activity with incident CVD and all-cause mortality by level of handgrip using Cox regressions, adjusted for confounding factors. ResultsA total of 76 074 persons were included (mean 55.2 years). Meeting physical activity guidelines is necessary to reduce all-cause mortality in those at the lower and middle thirds of handgrip strength. However, meeting physical activity guidelines did not confer additional reduction of all-cause mortality of those with high handgrip strength. Those with the lowest handgrip strength showed the greatest benefit from meeting physical activity guidelines for reducing all-cause mortality (HR 0.74; 95% CI 0.65-0.85). ConclusionOur results indicate that, while following physical activity guidelines does not reduce mortality in individuals with high handgrip strength, it is essential for preventing cardiovascular disease across all levels of handgrip strength. This underscores the importance of these guidelines for cardiovascular health.

Laparoscopic and thoracoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation for esophageal cancer: a prospective multicenter case-series outcome

IntroductionTo mitigate gastroparesis as well as other post-operative complications, we undertook a prospective multicenter study to assess the feasibility, safety, and efficacy in the short-term outcomes of laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation.MethodsA prospective descriptive study on 37 patients with laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation from January 2019 to March 2023. The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated.ResultsIn our study, all patients were male, with dysphagia as the predominant symptom (45.9%). Esophageal cancer incidence was similar between middle and lower thirds. Nodules were the primary finding on esophagoscopy (48.6%). Preoperative pyloric dilation averaged 31.2 min without complications. Surgical duration ranged from 225 to 400 min (mean 305). Gastric tube fluid volume averaged 148.9 ± 110.66 ml per day. Among 34 post-operative cases underwent gastric transit scans, most had non-dilated stomachs with efficient pyloric drug circulation. Three cases required prolonged ventilation, precluding pyloric circulation scans. Four patients developed chylous fistula, one requiring chest tube embolization. Recurrent laryngeal nerve damage occurred in 10.8% of cases.ConclusionAfter evaluating esophageal cancer patients undergoing laparoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation, it was found that this procedure is safe, effective, and significantly reduces postoperative gastroparesis and related complications.

Modified medial approach for the treatment of fractures of the lower third of the humeral shaft: An anatomical study

BackgroundThe anatomical study of the modified medial approach for addressing fractures of the distal third of the humeral shaft aimed to elucidate the benefits of this method in providing optimal exposure for surgical intervention. MethodsSixteen upper limb specimens from eight cadavers, obtained from the Anatomy Teaching Department of Fujian Medical University, were dissected. Three-dimensional anatomical structures were mapped onto a two-dimensional coordinate system. Key anatomical structures relevant to the modified medial approach, including the medial cutaneous nerve, musculocutaneous nerve, ulnar nerve, basilic vein, brachial artery, superior ulnar collateral artery, and inferior ulnar collateral artery, were documented in detail. ResultsThe average humeral shaft length measured (29.22 ± 2.78) cm, with its medial surface being flat and well-suited for plate fixation. The basilic vein, located superficially in the upper arm's first quadrant, measured (1.35 ± 0.35) cm from the most prominent point of the medial epicondyle of the humerus, with the deep fascia being penetrated at (12.41 ± 1.71) cm. The basilic vein serves as a key landmark for the modified medial approach. The nervi cutanei antebrachii medialis, running along the medial biceps humerus, closely accompanies the basilic vein, perforating the deep fascia above the medial epicondyle and extending anterior external and posterior medial branches. These branches are positioned (0.80 ± 0.17) cm and (0.45 ± 0.29) cm, respectively, from the basilic vein. Additionally, all nervi cutanei antebrachii medialis pass anteriorly to the basilic vein before continuing distally to the forearm. The ulnar nerve initially accompanies the basilic vein in the upper arm but diverges posteriorly without branching at (14.75 ± 1.74) cm, with the maximum separation from the basilic vein measuring (2.28 ± 0.59) cm. The brachial artery bifurcates into the superior and inferior ulnar collateral arteries along the humeral shaft. The superior collateral ulnar artery primarily supplies the ulnar nerve, positioned (14.14 ± 1.27) cm from the medial epicondyle, which ensures a sufficient blood supply for operative procedures. The musculocutaneous nerve and radial nerve branch are located in the lateral region of the brachial muscle, with minimal postoperative impact on muscle strength when splitting the brachial muscle by one-third. ConclusionsThe modified medial approach, as revealed by anatomical studies, focuses on the fracture site with a straight skin incision aligned between the most prominent point of the medial epicondyle and the midpoint of the axilla, positioned one transverse finger from the radial side. Using the basilic vein as a reference, major vessels and nerves remain undisturbed, ensuring a safe operative zone. This technique allows for significant exposure of both the anterior and external humeral shaft fracture site and the ulnar side butterfly fragment while minimizing tissue damage and facilitating rapid recovery. The approach offers notable clinical value due to its reduced invasiveness and accelerated postoperative rehabilitation.

Deep learning-based detection of affected body parts in Parkinson’s disease and freezing of gait using time-series imaging

We proposed a deep learning method using a convolutional neural network on time-series (TS) images to detect and differentiate affected body parts in people with Parkinson’s disease (PD) and freezing of gait (FOG) during 360° turning tasks. The 360° turning task was performed by 90 participants (60 people with PD [30 freezers and 30 nonfreezers] and 30 age-matched older adults (controls) at their preferred speed. The position and acceleration underwent preprocessing. The analysis was expanded from temporal to visual data using TS imaging methods. According to the PD vs. controls classification, the right lower third of the lateral shank (RTIB) on the least affected side (LAS) and the right calcaneus (RHEE) on the LAS were the most relevant body segments in the position and acceleration TS images. The RHEE marker exhibited the highest accuracy in the acceleration TS images. The identified markers for the classification of freezers vs. nonfreezers vs. controls were the left lateral humeral epicondyle (LELB) on the more affected side and the left posterior superior iliac spine (LPSI). The LPSI marker in the acceleration TS images displayed the highest accuracy. This approach could be a useful supplementary tool for determining PD severity and FOG.

Do Not Forget the Spine MRI in Children With Arthrogryposis Multiplex Congenita: High Prevalence of Tethered Spinal Cord and Preliminary Clinical Findings Following Detethering.

Arthrogryposis multiplex congenita (AMC) encompasses congenital conditions with joint contractures in 2 or more joints. Patients with AMC may have scoliosis and neural axis malformations. The study aimed to determine the prevalence of tethered spinal cord (TSC), characterized by a low-lying conus medullaris, and secondarily, present preliminary findings following surgical untethering in children with AMC. Patients 18 years of age and younger with a diagnosis of AMC and a spine MRI were identified. The presence of a TSC was defined as a low-lying conus with termination at or below the lower third of the L2 vertebral body. A pediatric neurosurgeon and a pediatric orthopaedic surgeon independently reviewed MRIs. The medical records of patients with AMC who underwent untethering were examined to evaluate preoperative and postoperative clinical findings. The prevalence of TSC in our AMC patients was compared with published normative data using χ2 analysis. Forty-two of 105 AMC patients (40%) had TSCs. There was a greater percentage of patients with AMC and a TSC compared with the unaffected population (P<0.0001). Sixteen patients underwent detethering through filum terminale sectioning. Nine patients had preoperative neurological deficits in addition to their AMC. There were no postoperative complications. All patients had improvement in their bowel and bladder symptoms within 3 months after their detethering procedure. TSC is more prevalent in the pediatric population with AMC compared with those without AMC. MRI is recommended for all patients with AMC due to its high prevalence. Although not a benign procedure, surgical detethering may have potential benefits for children with AMC. Level IV-therapeutic study.

Phrenoplasty Techniques for the Reconstruction of Basal Chest Wall Defects

Background: Primary and secondary tumors of the abdominal lower third of the bony thorax are relatively rare. Therefore, indications and techniques for chest wall reconstructions in this area are not well defined. Methods: The techniques for reconstructing basal chest wall defects using the diaphragm are described. Indications for phrenoplasty are limited to reconstruction after full-thickness resection of at least two of the last four ribs in the midaxillary line. The diaphragm can be used for reconstructive purposes both if it is intact and if it is partially involved in the resection of the chest wall. Results: At our institution, the abovementioned reconstructive technique was successfully performed in five patients with an uneventful post-operative course. Conclusions: The main advantages of these methods are the use of promptly available, high-quality autologous tissue and the exclusion of the pleural space from the defect area, thus transforming a thoracic defect into an abdominal one. The disadvantage is a variable reduction in the volume of the hemithorax. These techniques could be compared with other reconstruction techniques using pre-/post-operative respiratory functional tests.

Frequency, risk factors and time to resolution of exposure keratopathy in patients in the Pediatric Intensive Care Unit

Background and objectiveExposure keratopathy (EPK) is characterized by punctate erosions of the corneal epithelium, mainly located in the lower third of the cornea. In the Pediatric Intensive Care Unit (PICU), an incidence of 19-25% has been reported. The objective of this study was to describe the frequency, risk factors, and time to resolution of exposure keratitis in PICU patients. Materials and methodsDescriptive, observational, longitudinal, prospective study. The association of keratitis due to exposure to risk factors was evaluated using the Chi square test and determining the OR and 95% confidence interval. Results81 patients admitted to the PICU between March and September 2023 were included, 46 (56.79%) developed PEK, 67.39% (31/46) grade 1 and 26.08% (12/46) grade 3. The median time Resolution was 3 days, interquartile range (2–5). A significant difference was observed between patients with and without PEK in the requirement for mechanical ventilation 86.13% vs., 54.29% p = 0.01, OR = 6.905(2.20-21.64), sedation 100% vs., 85.71%, p = 0.02, in the duration of sedation 5 days vs. 2.5 days (p = 0.024), neuromuscular relaxation 21.74% vs., 0%, p = 0.002, Lagoftalmos 86.94% vs., 31.43% p < 0.00001, OR = 13.33 (4.42-40.17), chemosis 15.21% vs., 0%, p = 0.014 and days of stay in the PICU median 7 (5–11) vs. 3 (2–6), p < 0.00001. ConclusionsThe frequency of QPE observed was 56.79%, higher than that previously reported in the literature in the pediatric population. Mechanical ventilation, sedation, duration of sedation, Lagoftalmos chemosis and days of stay in the PICU were identified as risk factors.

Intergenerational and genetic influences on physical activity: family data from the HUNT study, Norway

ObjectivesThe objectives of this study are to examine the association of physical activity in parents with physical activity in their adult offspring and explore if the offspring’s genetic liability (ie,...

Double Anterior Interventricular Arteries: Prevalence and Morphological Types-A Dissection Study.

This study aimed to evaluate the prevalence of double anterior interventricular artery using the dissection method. A retrospective study was conducted between 2010 and 2024 at the Anatomy and Embryology Laboratory of the Victor Babes University of Medicine and Pharmacy in Timisoara. Eighty cases were analyzed for morphological variants of the coronary arteries, especially the anterior interventricular artery. Two cases of double anterior interventricular arteries were identified. In the first case, the two anterior interventricular arteries originated from the anterior interventricular branch of the left coronary artery. In the second case, an additional anterior interventricular artery with an aortic origin was found running along the lower third of the two interventricular grooves. This shape has not been described before in the specialized literature. Knowing the potential variations of the double left anterior descending artery is critical for interpreting cardiac imaging and choosing and planning percutaneous and surgical reperfusion strategies.

Effectiveness of results of complex treatment of pathological wear of hard tissues of teeth

Background:Tooth wear is a multifactorial condition that results in the loss of hard dental tissue. Physiological wear does not usually result in any subjective symptoms. Pathological abrasion of hard dental tissues is accompanied by both morphological and functional disorders of the dental system Objective: To evaluate the functional and aesthetic results of complex treatment of pathological abrasion of dental hard tissues. Materials and methods: This is a prospective controlled study that included 82 patients with a clinically confirmed diagnosis of Increased tooth wear of the first and second degree of severity (from 2020 to 2024). The age of the patients ranged from 34 to 68 years (48 men, 34 women). The examination of patients included: collecting complaints and identifying concomitant somatic diseases, X-ray examination, photographs of the patient's face, bite height, and nasolabial folds. Distribution of the group: Group 1 included patients with the first degree of hard tissue loss 47 (29 men, 18 women) Group 2 included patients with the second degree of hard tissue damage 35 (21 men, 14 women). During examination, patients complained of aesthetic defects caused by tooth wear and discoloration, discomfort when closing, chewing and phonetic disorders, typical symptoms of TMJ dysfunction, such as pain and crunching in the joints, fatigue of the masticatory muscles and muscle pain, displacement of the lower jaw to the side during vertical movements, a feeling of distension in the ears, headaches and bruxism. In patients of group 1: tooth wear was restored with orthopedic structures. In patients of group 2: temporary prosthetic structures and occlusal splints were used to normalize occlusal relationships in case of TMJ and masticatory muscle dysfunction. Gradual raising of the bite was carried out by means of a set of kappa-splints for 14 days, 1 month and 3 months from 1.0 to 5.0 mm until complete restoration of the occlusal height depending on the severity of pathological abrasion of teeth, abrasion of teeth restored by orthopedic structures. Dynamic observation of the clinical condition of the prosthesis structure was carried out in the following periods: 1 week, 1, 6, 12, 24 months,assessment of the condition of the performed restorations were recorded in the medical record of the dental patient. Results:Clinical radiological results showed satisfactory results and are encouraging in patients of groups 1 and 2. After treatment in patients of groups 2, according to the analysis of the lateral teleroentgenogram of the head, an increase in the height of the lower third of the face is noted, in 28 patients the nasolabial folds were smoothed out. Patients were satisfied with the aesthetic and functional results of the treatment Conclusions: The results of the study showed that treatment using occlusal splints at the preparatory stage in patients of group 2 with occlusion disorders due to pathological abrasion of hard dental tissues and restoration with orthopedic structures is relevant for normalizing the occlusal relationships of the jaws and this complex treatment method provides a good aesthetic and functional result.