Middle Trunk Research Articles

A Retrospective Analysis of 190 Patients With Scoliosis Referred to a Private Australian Clinical Advisory Service Between 2017 and 2020

ObjectiveThe aim of this study was to describe the demographic and clinical characteristics of patients with scoliosis from Australian primary care practices. MethodsA retrospective review of 190 patient records from August 2017 to April 2020 from a private Australian clinical advisory service database was performed. Deidentified demographic and clinical data were collated and analyzed, along with information regarding the referring practitioners and any accompanying clinical or paraclinical information. Numerical data were summarized with median and IQR, while categorical data were summarized with counts and percentages. Salient qualitative data from the advisory service records were also collated, coded, and summarized. ResultsPatients were aged between 3 and 87 years; the majority (71%) of patients were female, with a median age of 16 years (IQR, 13; range, 3-87 years). The most common type of spinal deformity seen in the sample was scoliosis (92%), with hyperkyphosis (7%) and other deformity (1%) making up the remaining cases. There was a wide variety of scoliosis presentations; however, curves were commonly (45%) located in the thoracic region of the spine. Observed scoliosis cases were of moderate severity with a median Cobb angle measuring 26.5° (IQR, 20°). Reports of pain were in the lower trunk/pelvis (46%), the middle trunk (16%), or throughout multiple bodily regions (27%). Alterations in normal spinal anatomy (eg, hemivertebrae) were common (55% of cases). The majority (86%) of patient cases came from chiropractors, whereas 9% were from osteopaths, 4% from physiotherapists, and 1% from other types of practitioners (eg, medical practitioners). ConclusionThe findings from this study suggest that patients presenting to practitioners in primary care settings in Australia present with a range of scoliosis and related spinal deformity presentations.

Characteristics of anti-contactin1 antibody positive autoimmune nodopathies combined with membranous nephropathy

BackgroundAutoimmune nodopathy (AN) is a very rare new disease entity, especially when combined with membranous nephropathy (MN). MethodsAntibodies against nodal-paranodal cell adhesion molecules in the serum were detected using cell-based assays. Antibody subtypes against contactin-1 (CNTN1) were confirmed. Cases of anti-CNTN1 antibody-positive AN with and without MN were retrieved through a literature search to compare clinical and electrophysiological characteristics. ResultsA 65-year-old male patient with MN developed limb numbness and weakness, along with walking instability. Serum CNTN1 antibodies were positive, primarily those of the IgG4 subtype. Electromyography showed prominent demyelination patterns in both the proximal and distal segments of the nerves compared to the middle nerve trunk. Magnetic resonance imaging revealed enlargement of the bilateral brachial and lumbosacral plexuses and local hyperintensity of the right C5-C6 nerve roots. Thirty-five cases with anti-CNTN1 antibody-positive AN with MN and 51 cases with anti-CNTN1 antibody-positive AN without MN were compared. Furthermore, the proportion of patients with MN combined with AN presenting with acute or subacute onset was higher than that observed in the MN without AN group. Nevertheless, no substantial differences were noted between the two groups concerning the clinical and electrophysiological characteristics, which were mainly elderly men, manifested as sensory ataxia, IgG4 antibody subtype, electrophysiological demyelination, and a certain effect on immunotherapy. ConclusionIn cases of electrophysiological manifestation of demyelinating peripheral neuropathy, especially in distal and poximal segments of nerves, AN should be considered, and further screening for renal function should be performed. Concomitant MN does not aggravate or alleviate peripheral nerve symptoms.

Variation in the Distribution of the Middle Trunk: Potential Contraindication for C7 Harvest?

Variation in the Distribution of the Middle Trunk: Potential Contraindication for C7 Harvest?

Cross-Sectional Area and Echogenicity Reference Values for Sonography of Peripheral Nerves in the Lithuanian Population.

We aimed to provide data of nerve sizes and echogenicity reference values of the Lithuanian population. High-resolution ultrasound was bilaterally performed according to the Ultrasound Pattern Sum Score and Neuropathy ultrasound protocols for healthy Lithuanian adults. Cross-sectional area (CSA) measurement and echogenicity were used as the main parameters for investigation. Echogenicity was evaluated using ImageJ, and nerves were categorized in classes according to echogenicity. Of 125 subjects enrolled, 63 were males (mean age 47.57 years, range 25-78 years) and 62 were females (mean age 50.50 years, range 25-80 years). Reference values of nerve sizes and values of echogenicity as a fraction of black in percentage of cervical roots, upper and middle trunks of the brachial plexus and the following nerves: vagal, median, ulnar, radial, superficial radial, tibial, fibular, and sural in standard regions were established. Mild to moderate correlations were found between nerves CSA, echogenicity values and anthropometric measurements with the differences according to sex. Inter-rater (ICC 0.93; 95% CI 0.92-0.94) and intra-rater (ICC 0.94; 95% CI 0.93-0.95) reliability was excellent. Reference values of nerve size and echogenicity of Lithuanians were presented for the first time as a novel such kind of publication from the Baltic countries.

Origin and distribution of the brachial plexus in red-necked wallaby (Notamacropus rufogriseus, Marsupialia: Macropodidae).

Notamacropus rufogriseus (red-necked wallaby) are in the family Macropodidae, which is the second largest family of marsupials after the family Didelphidae. This study was conducted with the aim of providing a detailed description of the origin and distribution of the brachial plexus in N. rufogriseus. Two-year-old male and 3-year-old female red-necked wallabies were used for the study. The brachial plexus was formed by ventral rami of C4, C5, C6, C7, C8, and T1 spinal nerves. It is composed of three trunks that give rise to 12 principal nerves. The cranial trunk is formed by the combination of the rami C4-C7; the middle trunk is formed by the combination of the rami C6 and C7; and the caudal trunk is formed by the combination of the rami C8 and T1. Differences between left and right side of the plexus brachialis were not observed. C6 ventral spinal rami contribute the most to brachial plexus nerve formation, while C4 contributes the least. The formation and distribution of the plexus in N. rufogriseus exhibited more resemblance to the patterns observed in marsupial animals rather than placental mammals. Marsupial mammals demonstrate the involvement of C4 in the development of the brachial plexus. The formation and branching of the brachial plexus sequentially adapt in accordance with changes in their thoracic limb activities and innervation points. Anatomical data from brachial plexus studies optimizes thoracic limb clinical and surgical treatments. This work can provide baseline data for future marsupial brachial plexus studies and fill gaps in the scarce literature.

Pyrolysis of oil palm trunk biomass using a fixed bed reactor to produce raw material for bio-carbon black

The abundance of palm oil plantation waste in Indonesia can be utilized as a raw material for making carbon black, which currently relies on fossil fuel-based raw materials. Out of the five types of palm oil biomass waste, including empty fruit bunches (EFB), palm kernel shells (PKS), palm mesocarp fibers (PMF), oil palm fronds (OPF), and oil palm trunks (OPT), one will be chosen as the raw material for carbon black production. Palm oil biomass waste typically has a relatively high ash content. To reduce the ash content, the biomass must first undergo pyrolysis to transform it into pyrolysis oil. The higher the carbon content and the lower the oxygen content, the more the pyrolysis oil meets the criteria for replacing crude oil. Among the criteria mentioned, the lowest ash content is found in palm kernel shells (1.4%). The highest carbon content is in palm trunks (55.8%), while the lowest oxygen content is also in palm kernel shells (34.5%). Palm kernel shells are the best palm oil biomass that can be used as a raw material for carbon black. However, because palm kernel shells are commonly used as boiler fuel, the second choice is palm trunks due to their high carbon content. Pyrolysis experiments were conducted using palm trunk biomass to produce bio-oil, which would be further processed into carbon black. The palm trunks were divided into three parts: outer trunk, middle trunk, and core trunk. The biomass size was also varied, with sizes of 20 mesh and 40 mesh. The pyrolysis process used a fixed bed reactor with a heating rate of 3°C/minute, reaching a pyrolysis temperature of 600°C, and maintaining that temperature for 1.5 hours. The highest yield of bio-oil obtained was from the outer trunk with a biomass size of 40 mesh (36.8%). Similarly, for a size of 20 mesh, the highest yield was also from the outer trunk (35.7%).

408 Nerve to Subclavius for Neurotization Procedures: An Anatomical Feasibility Study

INTRODUCTION: Injuries to the inferior trunk (IT) of the brachial plexus and its components can be debilitating. As such injuries are prioritized by surgeons during repair, an additional nerve transfer is considered. METHODS: 13 adult cadavers (26 sides) underwent dissection of the nerve to subclavius and proximal brachial plexus. Once the nerve was isolated from origin to termination, the C8 and T1 roots and IT were identified. The distal end of the nerve to subclavius was transected and swung to these roots and the IT. Once the nerves to subclavius were transposed and in a tension-free manner, the length of excess nerve following being brought to each of these nerves was measured. RESULTS: A nerve to subclavius originated from the superior trunk and traveled anterior to the middle and inferior trunks on all sides. The mean diameter of the nerve to subclavius was 0.8 mm and the mean length was 57 mm. After cutting the nerve to subclavius at its entrance into the subclavius muscle, the distal nerve could be transferred tension free to the IT of the brachial plexus and T1 ventral ramus on all sides. The distal nerve to subclavius reached the T1 ventral ramus with an average of 18 mm of additional length and to the C8 ventral ramus with an average of 19 mm. The nerve also could be transferred to the IT of the brachial plexus with an average of 20 mm of additional length. The nerve to subclavius was found to have approximately 3,000 axons. CONCLUSIONS: To our knowledge, use of the nerve to subclavius has previously not been used for nerve transfer procedures. Based on our cadaveric study, this often-overlooked nerve can be easily transposed to other regional nerves such as the IT of the brachial plexus.

НОВАЯ ГИБРИДНАЯ ФОРМА КАК КЛЮЧЕВОЙ ЭЛЕМЕНТ В СЕЛЕКЦИИ СТОЛОВЫХ СОРТОВ ВИНОГРАДА

This article presents the results of observations and varietal study of a new hybrid form of grapevine of private breeding under the work-ing title Hudozhnik in the conditions of the Experimental Field of ARRIV&W – Branch of the FSBSI FRARC. In the course of the study, an ampelographic description of the hybrid form was made according to the leading fea-tures, the flower type was determined as transi-tional. Hybrid Hudozhnik stands out for its size characteristics of bunches (average weight for the years of observation was 612 g) and berries (average weight of 15.8 g), high yield (112.7 c/ha), very high marketability due to the size characteristics in combination with good dense pulp and balanced flavor without aromas. Hy-brid Hudozhnik is distinguished by a very good pollination of bunches, as well as a very attrac-tive pink-red color of berries, which practically does not change even with a long stay of the crop on the bushes. The vineyards are non – irrigated, grafted, uncovered, shaped like a fan on the middle trunk, planting scheme 3×1.5 m, pruning is medium. During the varietal study were used generally accepted in viticulture methods and standard technology of cultiva-tion of vineyards. Hybrid Hudozhnik has an early ripening period (116 days from bud breaks to full maturity of berries), middle re-sistance to downy mildew, powdery mildew and botrytis, good winter hardiness and fruit-fulness in uncovered culture. Hybrid Hudozh-nik can be recommended for use in further breeding of colored table grapevine varieties as a source of size characteristics of bunches and berries, as well as a stable table grape for culti-vation in industry and home gardening.

Anatomical variations of artery of angular gyrus

Context: Angular gyrus is an anatomical structure of the brain located in the parietal lobe, taking part in writing and reading, language-use, memory and attention and spatial recognition. It is supplied by the angular gyrus artery, which is one of the caudal branches of the middle cerebral artery. One of the clinical pathologies of the angular gyrus artery is the ischemic stroke of the angular gyrus in the dominant hemisphere, responsible for the presence of Gerstmann Syndrome: left-right disorientation, agraphia, alexia, acalculia and finger agnosia. This systematic review aims to present the variety of anomalies of the main cerebral artery and the angular gyrus artery.
 Objective: Preparing a systematic review of papers describing the course anomalies of the angular gyrus artery.
 Materials and methods: PubMed and Google Scholar electronic databases was searched for phrases: ‘Angular gyrus artery’, ‘Artery of angular gyrus’, ‘Middle cerebral artery branches’, ‘Branches of middle cerebral artery’, ‘Gerstmann Syndrome’ published between years 2015 and 2023. Also 3 papers published before 2000 were used. From the selected 30 papers, 6 were used to prepare this analysis.
 Results: The middle cerebral artery, from which arises the angular gyrus artery, is marked by a significant variety of its division, mainly the number of the dividing trunks of the artery. Depending on the type of the division, the angular gyrus artery can arise from the upper, middle or lower trunk and vary in sizes. It can also appear as a singular or two separate branches. Instances of the anomaly of both the angular gyrus artery and posterior parietal artery are rare, but reported.
 Conclusions: The angular gyrus artery is characterised by a number of anomalies in its course, separation from the middle cerebral artery, diameter and branching.

Direct Repair of Ruptured Nerve Stump to Middle Trunk for Restoration of Extrinsic Finger Extension in Total Brachial Plexus Injuries.

Attempts to restore independent hand function in total brachial plexus injuries (TBPIs) have often failed due to inconsistent results of finger extension reconstruction. An innovative technique is described to achieve this effect by direct neurorrhaphy of residual (ruptured) roots with the middle trunk. Direct coaptation of the ruptured roots to the middle trunk and, simultaneously, transferring the anterior division of the middle trunk to the posterior division of the lower trunk was performed in 64 patients with TBPI. The return of extension of the elbow, wrist, and fingers was monitored. Excellent and good muscle strength of finger extension were noted in 45.3% of cases. The patients were divided into group A (>32 years) and group B (≤32 years) according to receiver operating characteristic curve analysis. The difference of excellent and good rates of finger and wrist extension muscle strengths between the 2 groups was statistically significant (χ 2 = 4.635, P = 0.031; χ 2 = 6.615, P = 0.010). Direct neurorrhaphy of ruptured nerve root stumps with the middle trunk could achieve satisfactory results for finger extension in TBPI for patients ≤32 years old. Long nerve defects (4 to 6.5 cm) could be overcome by freeing the nerve and adducting the arm against the trunk. Risk, III.

Modified transmanubrial approach for complicated type 1 cervical rib resection requiring subclavian artery reconstruction.

The transmanubrial musculoskeletal sparing approach (TMA) is commonly used for resecting apical lung tumours with vascular involvement. Non-neoplastic conditions which might require surgical exploration of the thoracic outlet include the 'cervical rib', a clinical condition consisting of an additional rib forming above the first rib and growing from the base of the neck just above the clavicle. Type 1 cervical rib-when a complete cervical rib articulates with the first rib or manubrium of the sternum-is the most challenging scenario where the subclavian artery can be damaged by continuous compression due to the narrow space between clavicle, first rib and supernumerary cervical rib, requiring prosthetic reconstruction of the involved tract. Here, we describe a modified TMA in which the incision in the neck is conducted posteriorly to the sternocleidomastoid muscle, thus allowing safe dissection of the superior and middle trunk of the brachial plexus.

Total hepatectomy during living donor liver transplantation at 108 Military Central Hospital

Objective: To evaluate the results and summarizing the experiences of total hepatectomy in living donor liver transplantation. Subject and method: A cross-sectional, descriptive study, over 165 cases of living donor liver transplantation at 108 Military Central Hospital from January 2019 to April 2023. Result: The average age of patients was 51.57 ± 13.19 years old, HBV infection rate was 70.9%. Indications for liver transplantation include acute liver failure (2.4%), acute on chronic liver failure (34%), decompensated cirrhosis (24.8%), hepatocellular carcinoma (37%), intrahepatic cholangiocarcinoma (1.2%), liver metastases from colon cancer (0.6%). High hilum dissection of the hepatic artery in continuity with the bile duct rate was 95.2%, individual dissection in 3% and total occlusion in 1.8% of cases. The left and middle hepatic veins trunk was divided before segment 1 dissection in 95.8% of patients. Average time of total hepatectomy was 148.12 ± 38.9 minutes, average blood loss during total hepatectomy was 867 ± 442ml. Conclusion: High hilum dissection of the hepatic artery in continuity with the bile duct combined with left and middle hepatic veins trunk divided before dissecting of the segment 1 is safe and feasible for total hepatectomy during living donor liver transplantation.

Anatomical variations and coding of the intra-trunk pathways in the thoracodorsal nerve

Aim. To study anatomical variations of the intra–trunk pathways in the thoracodorsal nerve bundles and to develop a system for their coding.Materials and methods. After fixation in a 2% solution of acetic acid using the MBS-10 stereomicroscope, we performed macro- and microscopic intra-trunk dissection of thoracodorsal nerve bundles in 121 specimens obtained from 105 corpses of males and females who died at the age of 40–97 years. Using the obtained findings, we compiled a database in the MS Excel 12.0 software and determined the number of anatomical variations in absolute and relative (% from 121 specimens) units.Results. The study revealed that the thoracodorsal nerve is a mixed nerve, which consists of 1 motor and 1– 3 sensory bundles that variously pass through the spinal nerves, trunks, and the axillary nerve with the formation of 20 intra-trunk pathways. In 77% of cases, sensory bundles arising from the thoracodorsal nerve pass through the posterior bundle, the posterior division, the middle trunk, and the C7 spinal nerve or the inferior trunk and the C8 spinal nerve. In 22% of cases, the thoracodorsal nerve has one or, rarely, two duplicate sensory pathways besides the main one. In 93% of cases, the motor bundle to the thoracodorsal nerve passes through the C7 spinal nerve and the middle trunk, the posterior division, and the posterior bundle. Coding the anatomical variations of the intra-trunk pathways in the direction of sensory bundle «posterior bundle → posterior division → trunk → spinal nerve; motor bundle ← posterior bundle ← posterior division ← trunk ← spinal nerve allows to briefly yet clearly and fully display the morphological diversity of the nerve anatomy.Conclusion. The identified anatomical variations of the intra-trunk pathways can be useful in the diagnosis of injuries and diseases. They expand indications for the use of spinal nerves, trunks of the brachial plexus, and the thoracodorsal nerve in reconstructive surgery.

Interventional reperfusion for acute embolism of the middle cerebral artery trunk with contralateral internal carotid artery congenital absence.

Internal carotid artery congenital absence with acute embolism of the middle cerebral artery trunk is very rare. A 65-year-old female with a history of hypertension and atrial fibrillation was admitted to the neurology department of our hospital. Computed tomography of the head and neck showed no carotid canal of the petrous portion of the temporal bone; digital subtraction angiography (DSA) showed no left internal carotid artery and the right middle cerebral artery trunk occlusion. These results suggested acute embolism of the middle cerebral artery trunk with contralateral internal carotid artery congenital absence. Mechanical thrombectomy was performed, which had a good outcome. This case showed the vascular anatomy features of ICA congenital absence with contralateral large vessel acute occlusion, and it is essential to promptly identify the vascular variation during the interventional procedure.

Vasculogenic Myoclonus of Peripheral Origin after Whiplash Injury: A Case Report

Based on the neuroanatomical origin of the electrical discharge, myoclonus could be classified in terms of its etiology as cortical, subcortical, spinal, or peripheral. A 29-year-old female patient experienced a continuous involuntary rhythmic twitching movement of the right elbow for 6 months. This myoclonus occurred immediately after a whiplash injury caused by a rear-end car accident. The patient had no radiological, clinical, or electrophysiological evidence for central nervous system origin. Concentric needle electromyography recordings of the right biceps, brachioradialis, and triceps muscles presented bursts of spontaneous rhythmic activity synchronous to the clinical myoclonus. Doppler ultrasound on the right arm revealed that the biceps and triceps contraction coincided with the vascular pulsation of the brachial artery and vein. This result suggested that myoclonus was caused by vascular stimulation, similar to the pathophysiology of hemifacial spasms. A whiplash injury around the neck or arm may have affected the vascular structures in the upper and middle trunks, resulting in vasculogenic myoclonus. Electromyography can be used to determine the classification and distribution of myoclonic jerks.

Influence of body lesion severity on oxidative status and gut microbiota of weaned pigs

Body lesions in pigs are a common welfare concern, particularly during the weaning period. These lesions can lead to pain, infection, and impaired mobility, resulting in reduced growth performance and increased mortality. Moreover, weaning stress can affect gut microbiota, immune response and increase the oxidative stress of piglets during this transition period. It has been hypothesised that social stress and body lesions could contribute to affect the gut microbiota, physiological and immune response of piglets. The study aims to evaluate the impact of the body lesions due to social stress on microbial profile, immune response, and oxidative status of weaned piglets. Lesion score (LS) on skin, tail, ear, neck, middle trunk, and hind quarters was measured 1 week (28 days of age, T1) and 7 weeks postweaning (T2) on 45 tail-docked pigs according to the method suggested from the Walfer Quality® (2009) on a scale from 0 to 2. Based on the LS, at T1, piglets were classified as High LS (n = 16), when LS was >1 in at least two of the areas considered, or Low LS (n = 29). At T2, based on the same scoring system and to the LS observed at T1, piglets were divided into four groups: High to Low LS (H-L, n = 11), High to High LS (H-H, n = 5), Low to Low LS (L-L, n = 21) and Low to High LS (L-H, n = 8). Blood and faecal samples were collected at T1 and T2. At T1, pigs with a high LS had a lower biological antioxidant potential compared with the L group (P < 0.02). At T2, the L-H group had a lower Reactive Oxygen Metabolites concentration compared with the H-H group (P = 0.03) while the L-L group had a lower concentration of Immunoglobulin A compared with H-H and L-H groups (P = 0.02 and P = 0.04, respectively). At T1, piglets with high LS had a different microbiota compared to piglets with low LS (R2 = 0.04, P < 0.01). Low LS pigs were characterised by a higher abundance of Firmicutes, Blautia, Eubacterium coprostanoligenes, Faecalibacterium, Megasphaera, Subdoligranulum (P.adj < 0.05), while pigs with high LS were characterised by higher abundance of Bacteroidota, Rikenellaceae RC9, Prevotellaceae UCG-003, uncultured-Lachnospiraceae and uncultured-Oscillospiraceae (P.adj < 0.05). At T2, the H-H group were characterised by Oscillospirales-UCG-010, H-L by Agatobachter and L-L by Alloprevotella (P.adj < 0.05). Overall, this study provides valuable insights into the relationship between body lesions, oxidative stress, and gut microbiota in weaned pigs.

Ophiostomatální houby v porostech borovice lesní (Pinus sylvestris L.) postižených dlouhodobým suchem

In this study, presence of ophiostomatiod fungi (absence, presence) on wood cross-section samples (total 72) from freshly cut Scots pine (Pinus sylvestris L.) trees (total 24) at four sites (Valtice, Příšťpo, Brodce, Vrbová Lhota) affected by long-term drought was evaluated in relation to: sampling period (spring, summer, autumn), tree age (30–40, 50–90 years), wood sample origin (bottom trunk, middle trunk, twigs), tree defoliation (&gt;25–60%, &gt;60–99%), and presence of other taxa. Ophiostomatoid fungi were present on 33% wood cross-section samples from 50% trees. Presence of ophiostomatoid fungi was significantly different in relation to sampling period (i.e. the highest in autumn, the lowest in spring), and was directly proportional to both presence of mites and Nematocera larvae; it was insignificantly different in relation to site, tree age, wood sample origin, defoliation, and presence of other taxa. These results show: (1) frequent presence of ophiostomatoid fungi in wood tissues of Scots pine trees, (2) insignificant effect of ophiostomatoid fungi on health status of the trees, (3) relationship of presence of ophiostomatoid fungi with both presence of mites and Nematocera larvae.

Three-dimensional evaluation of the association between face and back asymmetry among pre-pubertal subjects.

The aim was to compare the degree of back symmetry in two groups of subjects with and without pathologic facial asymmetry and to assess any possible associations between face and back asymmetry evaluated on three-dimensional surface face and back scans. The study design consisted of allocation of 70 subjects (35 females, 35 males) aged 6.4±0.5 years, according to the percentage of whole face symmetry assessed on three-dimensional (3D) facial scans into a 'symmetric' (symG; symmetry ≥70%) and 'asymmetric'(asymG; symmetry <70%). The 3D face and back scans were analysed using colour deviation maps and percentages of symmetry of the whole face and back surfaces as well as their three separate areas: forehead, maxillary and mandibular areas for the face and neck, upper and middle trunk areas for the back, were calculated. Non-parametric statistical tests were used for between-group comparisons (Mann-Whitney U test). Within each group, differences between each face or back area were tested with the Friedman test. Correlations between face and back symmetry were assessed with the Spearman rho coefficient. The symG exhibited a significantly higher symmetry in each facial area than the asymG. The mandibular area was the least symmetric area of the face within each group, with significantly smaller values than the maxillary area in the symG and significantly smaller values than the forehead and maxillary area in the asymG. The percentage of whole back symmetry did not significantly differ (p>0.05) between the symG ( 82.00% [67.4;88.00]) and asymG (74.3% [66.1;79.6]). The only significant between-group difference was observed for the symmetry of the upper trunk area (p=0.021), with lower symmetry values in the asymG. No significant associations were detected between face and back parameters. The percentages of symmetry in each facial area were significantly higher among subjects without pathologic facial asymmetry. The most asymmetric area of the face, regardless of the degree of whole face symmetry, was its mandibular area. No significant differences were detected within different back areas; however, subjects with asymmetric faces showed significantly smaller symmetry of their upper trunk area.

Bone wax causing a middle trunk plexopathy following vertebral artery injury: a neuroradiological pitfall

BackgroundBone wax is a hemostatic agent widely used in surgery. Since it is neither absorbed nor metabolized, its use remains risky and a potential cause of complications. Even though its MRI radiological characteristics are distinguishable, it is generally misinterpreted as postoperative hematoma or trapped air. We report the first case in literature of brachial plexopathy due to the compressive mass effect of bone wax and the main clues that led us to establish this diagnosis prior to its surgical resection.Case presentationA 20-year-old male, victim of stabbing presented with an open wound of the right latero-cervical region with a vascular injury of the V2 segment of the right vertebral artery on CT angiography. He was first admitted for bleeding from the neck uncontrollable with external pressure. The patient underwent an emergency surgical vertebral artery ligation. Forty-eight hours later, he reported a feeling of paresthesia of right arm with right-sided weakness. Neurologic examination revealed a motor deficit of the right triceps and wrist extensor muscles and absence of the triceps reflex. A postoperative compression of the C7 cervical root or the middle trunk of brachial plexus was initially suspected. A cervical MRI demonstrated a T1- and T2-weighted images well-defined right mass located laterally to the spinal cord in the epidural space at the level of C6–C7 vertebrae with a signal-intensity void on both sequences. T2*-weighted images showed no signal attenuation. It did not enhance after contrast administration. An epidural hematoma was less probable since acute hematoma is typically hypointense on T2*-weighted images. Computed tomography helped rule out residual postoperative air trapped in the epidural space based on the density study of the mass compared to air. Finally, a residual surgical foreign material used for packing during the procedure was suspected. The massive use of bone wax was ultimately confirmed by the surgeon and surgically removed with complete immediate postoperative recovery.ConclusionsThis case highlights the importance of a nuanced critical approach of neurosurgeons and neuroradiologists when interpreting postoperative neuroimaging scans of the spine. It is crucial to always consider foreign body-related complications and to review the per-operative procedure in details.

Laparoscopic left hepatectomy in a goat as a training model for laparoscopic anatomic liver resection: results of training courses with a total of 70 goats.

To create a suitable animal model for the training of laparoscopic anatomic liver resection, we performed left hepatectomy using a goat and found its suitability. We have since started using goats for wet-lab training and have gradually standardized the relevant procedures. Herein, we report our standardized training procedures using a goat and discuss its feasibility as a novel training model. The standardized wet-lab training courses of laparoscopic liver resection conducted on 62 tables with a total of 70 goats were reviewed. The training course began by encircling the hepatoduodenal ligament for the Pringle maneuver, which was repeated during the parenchymal dissection. Following partial liver resection of the left lateral section, left hepatectomy was performed by a standardized procedure for humans in which the liver was split, exposing the entire length of the middle hepatic vein trunk from the dorsal side after extrahepatic transection of the left Glissonean pedicle. If a goat deceased before initiating left hepatectomy, the training was restarted with a new goat. The surgical procedures were performed by surgeons of varying skill levels. A total of 184 surgeons including 10 surgical residents participated in the training. Partial liver resection was initiated in 62 tables, with 8 (13%) dying during or after the procedure of partial liver resection. Subsequently, left hepatectomy was initiated in 61 and completed in 59 tables (98%), regardless of whether the goat survived or deceased, and was not completed in 2 tables (3%) due to time limitation. In 14 tables (23%), the goats deceased during the procedure, however, the procedure was completed. The causes of death were multifactorial, including massive bleeding, reperfusion injury after the Pringle maneuver, and carbon dioxide gas embolism. Left hepatectomy in a goat is useful as a training model for laparoscopic anatomic liver resection.