Normal Anatomy Research Articles

Formation of professional competence in anesthesiology interns (sociological research data)

Background. A sociological study has been conducted among anesthesiology interns of the second year of study whose results make it possible to interpret the formation of a body of knowledge, abilities and skills in them, which are gained in the process of training on the specialty “Anesthesiology and intensive care”. Among the tasks in postgraduate medical education, those stand out that involve the training of competent specialists capable of quickly solving practical tasks in health care with the introduction of innovative technologies. The aim of the study: to establish trends in the formation of professional competence among anesthesiology interns through their sociological survey. Materials and methods. At the end of 2022, a sociological survey was conducted among anesthesiology interns (a total of 63 doctors of both sexes, average age was 24.2 years). Results. When choosing the future profession of an anesthesiologist, 49.20 % of respondents indicated that it was their own choice; 23.80 % of interns noted the influence of parents on the choice of future specialty, 15.87 % indicated their friends or acquaintances or other factors. The interns noted the presence of personal experience of working in health care institutions — 88.88 % answered positively (at the same time, 14.28 % of respondents mentioned previous experience of working in an intensive care unit as a nurse) and 11.12 % denied such experience. Most respondents said what attracts them to anesthesiology as a specialty: the possibility of obtaining a quick positive result of their activity — 85.71 % and the satisfaction of saving a human life — 57.14 %. A significant part of the interviewees noted such a factor as prestige (38.09 %) and a small number of interns noted “other” (6.34 %). Among the subjects and disciplines during training at a higher educational institution, the most important for anesthesiologists, according to the interns, are physiology and pathophysio­logy — 93.65 %, pharmacology — 80.95 %, normal or pathological anatomy — 46.03 %, physics — 28.57 %, chemistry — 25.39 %; 1.58 % of the respondents answered that all subjects are important at the same time or clinical pharmacology. When choosing a future specialty, interns chose from such medical specialties as surgery (39.6 %), neurology (9.52 %), emergency medicine (19.04 %), and others. Among the directions in anesthesiology, interns consider obstetric anesthesiology (47.62 % of respondents), cardiac anesthesiology (66.66 %), neuroanesthesiology (53.96 %), trauma anesthesia (68.25 %), pediatric anesthesiology (46.03 %), anesthesia in abdominal surgery (46.03 %), intensive care (3.17 %), and 4.76 % of respondents answered that all directions in anesthesiology are important. Intern doctors noted the following necessary personality traits and human values for successful work as an anesthesiologist: determination (74.60 %), leadership qualities (44.44 %), excellent health (33.33 %), the ability to quickly make the right decisions (90.47 %), other (11.11 %). The interns indicated which directions in anesthesiology they would like to thoroughly study during the face-to-face training at the department, namely: cardiopulmonary resuscitation (92.06 % of respondents), intensive care in emergency situations (85.71 %), ultrasound diagnosis in anesthesiology (71.42 %), acute poisonings (68.25 %), prevention and treatment of pain syndromes (80.95 %), features of providing assistance to the victims (39.68 %) and others: emergency medical care and mana­gement of patients with combat trauma in the intensive care unit (4.76 %), features of anesthesia in various pathological conditions, regional anesthesia, pharmacotherapy of emergencies, intensive care for acute pathologies (1.58 % of respondents). Conclusions. The conducted sociological research among anesthesiology interns of the second year of study allowed to detect the following trends in the formation of professional competence of anesthesiology interns: a significant amount of information and high professional requirements for anesthesiologists imply constant improvement of their knowledge and skills that is impossible without a sufficiently high level of motivation. The presence of previous work experien­ce of intern doctors in health care institutions emphasizes the meaning­fulness of the choice of future specialty, social and professional understanding of the essence of practical medicine, ensures communication skills with colleagues. Among the subjects and disciplines taught in higher education institutions, in the opinion of anesthesiology interns, the most important are: physiology and pathophysiology, pharmacology, normal or pathological anatomy, physics and chemistry. When choosing the future specialty “Anesthesiology and intensive care”, interns most often chose from such medical specialties as surgery, neurology, and emergency medicine. For successful work as an anesthesiologist, according to anesthesiology interns, the most relevant are: determination, leadership qualities, excellent health, the ability to quickly make the right decisions, etc. Among the directions in anesthesiology, interns of the second year of study expressed their desire to thoroughly study: cardiopulmonary resuscitation, intensive care in emergency situations, ultrasound diagnosis in anesthesiology, acute poisonings, prevention and treatment of pain syndromes, features of providing assistance to the victims, and others.

Ultrasound of the eye – Part 1: Normal anatomy, technical parameters and scanning technique

AbstractA request for an ultrasound of the eye can be a relatively infrequent occurrence for a sonographer, but ultrasound can play a pivotal role in the detection of vision threatening conditions. In those instances where sonographers are required to perform the occasional ocular ultrasound, a sound knowledge of normal anatomy, scanning techniques, technical parameters and pitfalls is pertinent to ensure pathology is not overlooked. Ultrasound of the eye is commonly performed following trauma or visual disturbance. As such it is a useful diagnostic tool when fundoscopic examination of the eye is limited. The fact that it lacks the use of ionizing radiation, is non‐invasive and readily accessible are just some of its many advantages. However, the greatest advantage is its ability to provide a dynamic assessment of the eye. Ocular structures have a higher sensitivity to ultrasound exposure, which necessitates the correct use of technical parameters so as to not induce any vision affecting biological effects. The purpose of this article is to introduce sonographers to normal ocular anatomy, optimal scanning techniques for enhanced pathology detection, and most importantly the safe use of physical parameters to minimize damage to sensitive ocular structures.

P-522 Embryo transfer procedural parameters do not predict IVF cycle outcome

Abstract Study question Do embryo transfer (ET) procedural parameters affect the clinical outcome, in terms of positive human chorionic gonadotropin (hCG), clinical pregnancy and live-birth? Summary answer Observation of ET procedural parameters, either as single parameters or combined in a model, does not seem to have a predictive value on cycle outcome. What is known already It has been reported that several ET procedural parameters of technical nature may influence IVF outcome. Observational studies on variables during and post ET from mucus presence to catheter reload, have been published and data hitherto is conflicting leaving practitioners confounded. It is essential to evaluate the effect of the reported ET performance parameters, clarifying the degree of effect on a singular or combinatorial level. This will assist practitioners in recording and analysing strictly factors that hold high-significance predictive value, instead of redundantly recording moot parameters that may be unfit to serve as key performance indicators post ET. Study design, size, duration A prospective observational study was performed between 3/2018 and 9/2022 in a single IVF center. ET procedures for a total of 1417 women were assessed. The performance parameters studied and associated with clinical outcomes were the following: time of ET, presence of cervical mucus in the catheter, presence of blood, catheter reload, employment of tenaculum and stylet, resistance during transfer, ease of transfer according to the practitioner and discomfort as experienced by the patient. Participants/materials, setting, methods Only women of normal endometrial and uterine anatomy and function were included. Genetic and endocrine abnormalities, azoospermia and PGT cycles were excluded. Embryo grading was performed according to Veeck’s and Gardner’s system depending on developmental stage. All ETs were performed employing the same type of soft catheter. The clinical outcomes evaluated were positive hCG, clinical pregnancy, and live-birth. Associations were evaluated on a singular or combinatorial level between the ET performance parameters and clinical outcomes. Main results and the role of chance A univariate logistic regression was employed to evaluate the possible effect of each of the ET procedural parameters. None of the ET parameters presented with statistical significance. The employment of ultrasound, the number, and the quality of transferred embryos, maternal age as well as the physician and embryologist performing the transfer were evaluated as covariates in a univariate regression model. Number (p = 0.01) and quality of transferred embryos (p = 0.003), as well as maternal age (p = 0.004) presented with statistical significance. The multivariate approach yielded similar results. To evaluate the possibility that interactions between the ET procedural parameters could affect cycle outcome a model was created evaluating all possible interactions and combination of the ET parameters. To adjust for possible multiple comparison bias, the Bonferroni correction was employed. Only the presence of mucus along with significant resistance seemed to present with statistical significance (p < 0.0001). However, when adjusting for the covariates the combination of cervical mucus and significant resistance did not provide a statistically significant effect on clinical outcomes and thus cannot be considered as an independent predictor. When subgrouping only for women below the age of 35 with at least one top quality embryo, no statistically significant association was observed. Limitations, reasons for caution The sample size could be a reason for caution when interpreting the results of the present study as a larger number of women presenting with each combination may be required to reach the threshold of statistical significance. The single-center nature of the study may present as another limitation. Wider implications of the findings Data indicates that ET procedural parameters hold no predictive value singularly or combinatorially. The only robust predictive factors are embryo quality, number, and maternal age. While further studies are required to cement this finding, it may be the case that the time-consuming recording and analysis of such parameters is redundant. Trial registration number Not applicable

Prevalence of two-rooted and one-rooted mandibular canines with two root canals in Poland, assessed using CBCT: A preliminary study.

The normal anatomy of mandibular canines presents with 1 root and 1 root canal. Two roots are found in approx. 2% of cases, and a bilateral configuration is even rarer. Canines with 2 root canals are found in around 15% of cases. Cone-beam computed tomography (CBCT) enables the detailed visualization of the teeth. The present study aimed to evaluate the prevalence of two-rooted mandibular canines and one-rooted mandibular canines with 2 root canals in a Polish population by using CBCT. A total of 300 consecutive CBCT scans, taken for different clinical indications, were examined to assess permanent mandibular canine anatomy. The study group included 182 females and 118 males aged 12-86 years (mean age: 31.7 years). Among 600 cases, 27 two-rooted teeth were found (4.5%), and there were only 6 cases of onerooted mandibular canines with 2 root canals (1.0%). Six cases of two-rooted canines had this configuration bilaterally, all in females. Five cases of canines with 2 root canals were found on the left side (83.3%). The predominance of the occurrence of two-rooted canines in females (81.5%) was strongly emphasized. The prevalence of two-rooted mandibular canines in a Polish population, evaluated by means of CBCT, was higher, while the presence of 2 root canals was lower than in recent literature reports. There was no side predilection of two-rooted mandibular canines, although their occurrence was higher in females.

Influence of laminectomy on the lumbosacral cerebrospinal fluid volume: A retrospective magnetic resonance imaging study.

The cerebrospinal fluid volume affects the block height of spinal anaesthesia. Laminectomy of the lumbar spine may result in increased lumbosacral cerebrospinal fluid volume. This study aimed to test the hypothesis that the lumbosacral cerebrospinal fluid volume of patients with a history of lumbar laminectomy would be larger than that of patients with normal lumbar spine anatomy using magnetic resonance imaging. Lumbosacral spine magnetic resonance images of 147 patients who underwent laminectomy at the L2 vertebrae or below (laminectomy group) and 115 patients without a history of spinal surgery (control group) were retrospectively reviewed. The lumbosacral cerebrospinal fluid volumes between the L1-L2 intervertebral disc level and the end of the dural sac were measured and compared between the two groups. The mean (standard deviation) lumbosacral cerebrospinal fluid volume was 22.3 (7.8) ml and 21.1 (7.4) ml in the laminectomy and control groups, respectively (mean difference 1.2 ml; 95% confidence interval -0.7 to 3.0 ml; P = 0.218). In the prespecified subgroup analysis according to the number of laminectomy levels, patients who underwent more than two levels of laminectomy exhibited slightly larger lumbosacral cerebrospinal fluid volume (n = 17, 30.5 (13.5) ml) compared with those who underwent two (n = 40, 20.7 (5.6) ml; P = 0.014) or one level of laminectomy (n = 90, 21.4 (6.2) ml; P = 0.010) and the control group (21.1 (7.4) ml; P = 0.012). In conclusion, the lumbosacral cerebrospinal fluid volume did not differ between patients who underwent lumbar laminectomy and those without a history of laminectomy. However, patients who underwent laminectomy at more than two levels had a slightly larger volume of lumbosacral cerebrospinal fluid than those who underwent less extensive laminectomy and those without a history of lumbar spine surgery. Further studies are warranted to confirm the subgroup analysis findings and elucidate the clinical implications of such differences in the lumbosacral cerebrospinal fluid volume.

A comprehensive review of surgical techniques in unilateral cleft lip repair.

Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures.

Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model.

Knowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches. The computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined. Normal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo. Preoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.

Preliminary Development of an MRI Atlas for Application to Cleft Care: Findings and Future Recommendations.

To introduce a highly innovative imaging method to study the complex velopharyngeal (VP) system and introduce the potential future clinical applications of a VP atlas in cleft care. Four healthy adults participated in a 20-min dynamic magnetic resonance imaging scan that included a high-resolution T2-weighted turbo-spin-echo 3D structural scan and five custom dynamic speech imaging scans. Subjects repeated a variety of phrases when in the scanner as real-time audio was captured. Multisite institution and clinical setting. Four adult subjects with normal anatomy were recruited for this study. Establishment of 4-D atlas constructed from dynamic VP MRI data. Three-dimensional dynamic magnetic resonance imaging was successfully used to obtain high quality dynamic speech scans in an adult population. Scans were able to be re-sliced in various imaging planes. Subject-specific MR data were then reconstructed and time-aligned to create a velopharyngeal atlas representing the averaged physiological movements across the four subjects. The current preliminary study examined the feasibility of developing a VP atlas for potential clinical applications in cleft care. Our results indicate excellent potential for the development and use of a VP atlas for assessing VP physiology during speech.

Anesthesia in patients with Brugada syndrome: two case reports

BackgroundBrugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention.Case presentationWe report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful.ConclusionsBrugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.

Sonographic evaluation of a surgically created pouch.

This manuscript focuses on a review of the normal and abnormal sonographic appearance of the surgically created pouch as part of an article series on the topic. It includes information regarding sonographic technique, normal anatomy, and commonly encounter diseases and complications.

Can we predict urethral length of boys? – An observational study

An additional knowledge about normal anatomy of urethra in boys can improve clinical outcome of any urological interventions. This will also reduce catheter related complications like intra vesical knotting and urethral injuries. At present there is no systematic data available which has studied the urethral length of boys. We have done this study to analyse the length of urethra in boys. The aim of the study is to measure the urethral length in Indian children from the age of 1 year till 15 years and plot a nomogram. Furthermore to analyse the influence of anthropometry on urethral length and derived a formula to predict the urethral length in boys. This is a single institution prospective observational study. After obtaining clearance from the institutional review board, a total of 180 children from the age of 1-15 were recruited for the study. The urethral length was measured during Foley's catheter removal. Other data like age, weight, and height of the patient are collected and the obtained values were analysed with SPSS software. The acquired figures were further used to derive formulae to predict urethral length. A nomogram of urethral length based on age was plotted. With collected figures, five separate formulae were derived to calculate the urethral length based on the age, height and weight. Furthermore for day-to-day use we have deduced a formulas to calculate urethral length which are simplified forms of original formulae. The length of urethra of a new-born male is 5cm, which attains 8cm by three years of age and to 17cm by adulthood. There were attempts to measure the urethral length in adults using cystoscopy, Foley's catheter and different imaging techniques like Magnetic Resonance Imaging and dynamic retrograde urethrography. Simplified formulae which has been derived from this study for clinical use is Urethral length=8.7+Age (in year) × 0.55 CONCLUSION: Our results will complement the current anatomical understanding of the urethra. This evades some rare complications of catheterisation and facilitate reconstructive procedures.

The use of robot-assisted surgery for the unstable traumatic spine: A retrospective cohort study

BackgroundRobotic assistance has been shown to increase instrumentation placement accuracy in open and minimally invasive spinal fusion. These gains have been achieved without increases in operative times, blood loss, or hospitalization duration. However, most work has been done in the degenerative population and little is known of the utility of robotic assistance when applied to spinal trauma. This is largely due to the uncertainty stemming from the disruption of normal anatomy by the traumatic injury. Since the robot depends upon registration for instrumentation guidance according to the fiducials it uses, trauma can introduce unique challenges. The present study sought to evaluate the safety and efficacy of robotic assistance in a consecutive cohort of spine trauma patients. MethodsAll patients with Thoracolumbar Injury Classification and Severity Scale (TLICS) >4 who underwent robot-assisted spinal fusion using the Globus ExcelsiusGPS at a single tertiary care center for trauma between 2020 and 2022 were identified. Demographic, clinical, and surgical data were collected and analyzed; the primary endpoints were operative time, fluoroscopy time, estimated blood loss, postoperative complications, admission time, and 90-day readmission rate. The paired t-test was used to compare differences between mean values when looking at the number of surgical levels. ResultsForty-two patients undergoing robot-assisted spinal surgery were included (mean age 61.3±17.1 year; 47% female. Patients were stratified by the number of operative levels, 2 (n = 10), 3-4 (n = 11), 5 to 6 (n = 13), or >6 (n = 8). There appeared to be a positive correlation between number of levels instrumented and odds of postoperative complications, admission duration, fluoroscopy time, and estimated blood loss. There were no instances of screw malposition or breach. ConclusionsThis initial experience suggests robotic assistance can be safely employed in the spine trauma population. Additional experiences in larger patient populations are necessary to delineate those traumatic pathologies most amenable to robotic assistance.

Bennett fracture combined with hamate fracture: carpometacarpal joint ‘diagonal’ fracture and dislocation: a case report

BackgroundMultiple carpometacarpal fractures and dislocations are rare. This case report describes a novel multiple carpometacarpal injury, namely, ‘diagonal’ carpometacarpal joint fracture and dislocation.Case presentationA 39-year-old male general worker sustained a compression injury to his right hand in the dorsiflexion position. Radiography indicated a Bennett fracture, hamate fracture, and fracture at the base of the second metacarpal. Subsequent computed tomography and intraoperative examination confirmed an injury to the first to fourth carpometacarpal joint along a diagonal line. The normal anatomy of the patient’s hand was successfully restored via open reduction combined with Kirschner wire and steel plate fixation.ConclusionOur findings highlight the importance of taking the injury mechanism into account to avoid a missed diagnosis and to choose the best treatment approach. This is the first case of ‘diagonal’ carpometacarpal joint fracture and dislocation to be reported in the literature.

Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations.

Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.

Non-recurrent laryngeal nerve in thyroid and parathyroid surgery

BACKGROUND: the main reason for postoperative vocal folds paresis is the variable anatomy of the recurrent laryngeal nerve. An example of such an “extreme form of embryonal development» is the non-recurrent laryngeal nerve. However, many surgeons consider this structure to be a rare anomaly with prevalence less than 0.5%. This opinion is associated with a six to seven-fold increase in the number of vocal folds paresis when a surgeon encounters with a non-recurrent laryngeal nerve. Meanwhile, in cadaveric studies a significantly higher prevalence of non-recurrent laryngeal nerve was demonstrated — 2.2%. The right aberrant subclavian artery was diagnosed during CT in 3.1% patients.AIM: the aim of the study is to determine the effectiveness of preoperative ultrasound in detecting the right aberrant subclavian artery and non-recurrent laryngeal nerve.MATERIALS AND METHODS: patients underwent thyroid and parathyroid surgery with identification of a right inferior laryngeal nerve. The preoperative neck ultrasound was performed on all patients with visualization of a brachiocephalic trunk (Y-sign) or a right aberrant subclavian artery (AL-sign). CT-angiography was performed in the postoperative period on patients who had a non-recurrent laryngeal nerve.RESULTS: the study included 1476 patients. The Y-sign was determined among 1338 (90.7%) patients. In these cases a typical anatomy of the recurrent laryngeal nerve was observed. In 138 (9.3%) cases, the Y-sign was not detected. In this subgroup of patients, in 20 (1.4%) cases, a non-recurrent laryngeal nerve and a right aberrant subclavian artery were noted. Thus, the sensitivity of the Y-sign in confirming the normal anatomy of the recurrent laryngeal nerve was 100%, specificity — 91.9%, positive prognostic value — 14.5%, negative prognostic value — 100%. On the contrary, AL-sign was notedall 20 (1.4%) patients with non-recurrent laryngeal nerve and right aberrant subclavian artery. False positive and false negative results were not observed. Three variants of the non-recurrent laryngeal nerve were identified: type I (superior type) — located behind the upper third of the thyroid lobe, has a direct descending way and forms an angle to the larynx of 30–50°; type III (inferior type) — has a direct ascending way (simulates the course of the recurrent laryngeal nerve) and forms an angle to trachea in 30–50°; type II (middle type) — all variants of the non-recurrent laryngeal nerve located between types I and III.CONCLUSION: the preoperative ultrasound detection of brachiocephalic trunk (Y-sign) confirms the presence of a recurrent laryngeal nerve (sensitivity 100%), and visualization of the right aberrant subclavian artery (AL-sign) determines a non-recurrent laryngeal nerve (sensitivity and specificity 100%).

Acetabulum’un Morfolojik ve Morfometrik Olarak Değerlendirilmesi

Objective: The aim of this study is to reveal the morphological and morphometric features of the acetabulum and to compare them with the current literature. Materials and Methods: A total of 57 coxae (29 left, 28 right) were examined. The anterior ridge of the acetabulum was classified as curved, straight, angular, and irregular according to its morphological features and the transverse diameter of the acetabulum (TD), the vertical diameter of the acetabulum (VD), the anteroposterior diameter of the acetabulum (APD), acetabular depth (AD), acetabular notch width (ANW) and os coxae height (CH) were measured. Results: The types of the anterior ridge of the acetabulum were found as 19 (33.3%) straight, 18 (31.6%) curved, 14 (24.6%) angular, and 6 (10.5%) irregular in shape. The mean values of the TD, VD, APD, ANW, AD and CH were 50.67±3.12 mm, 52.21±3.52 mm, 52.66±3.73 mm, 22.64±2.67 mm, 29.75±2.28 mm and 206.33±11.70 mm respectively. No significant difference was found between the right and left coxae in terms of the measured parameters (p>0.05). There was only a difference between the shapes and the depth of the acetabulum (p<0.05). Conclusion: Knowing the normal anatomy of the acetabulum is important in preventing complications during surgical procedures of this area.

MRI of the Velopharynx: Clinical Findings in Patients with Velopharyngeal Insufficiency

Background: MRI is the only imaging modality capable of directly visualizing the levator veli palatini (LVP) muscles – the primary muscles responsible for velopharyngeal closure during speech. While MRI has been used to describe normal anatomy and physiology of the velopharynx in research studies, there is limited experience with use of MRI in the clinical evaluation of patients with velopharyngeal insufficiency (VPI). Methods: MRI was used to evaluate the velopharyngeal mechanism in patients presenting for VPI management. The MRI followed a fully awake, non-sedated protocol with phonation sequences. Quantitative and qualitative measures of the velopharynx were obtained and compared to age- and sex-matched individuals with normal speech resonance. Results: MRI was successfully completed in 113 of 118 patients (96%). Compared to controls, patients with VPI following cleft palate repair had a shorter velum (p<0.001), higher incidence of LVP discontinuity (p<0.001), and shorter effective velar length (p<0.001). Among patients with persistent VPI after pharyngeal flap placement, findings included a pharyngeal flap base located inferior to the palatal plane (11/15, 73%), shorter velum (p<0.001), and higher incidence of LVP discontinuity (p=0.014). Patients presenting with non-cleft VPI had a shorter (p=0.004) and thinner velum (p<0.001) and higher incidence of LVP discontinuity (p=0.014). Conclusions: MRI provides direct evidence of LVP muscle anomalies and quantitative evaluation of both velar length and velopharyngeal gap. This information is currently unavailable with traditional VPI imaging tools, suggesting MRI may be a useful tool for selecting surgical procedures to address patient-specific anatomic differences.

Pharyngeal Arches, Chapter 1: Normal Development and Derivatives.

The pharyngeal arches form the cornerstone of the complex anatomy of the face and neck. These embryologic structures are the foundation of face and neck development, and anomalous growth can result in craniofacial abnormalities. Surgeons who manage head and neck pathology and pathoanatomy will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal and pathological development of these important structures is paramount to accurate diagnosis and treatment. This manuscript is the first of a three-part educational series that addressed the pharyngeal/branchial arch embryology, development, nomenclature, and normal anatomy (Part I), pathologic anomalies of ear and neck derived from abnormal development of the arches (Part II), and different types of orofacial clefts, including Tessier clefts (Part III).

Anatomical variations in the origin of gonadal artery - A computed tomography angiographic study

Introduction: A sound knowledge of variations of gonadal artery is required during operative, diagnostic and endovascular procedures in the abdomen and pelvis especially with the advancement of newer intra-abdominal operative and laparoscopic techniques. The aim of this study was to analyze the normal anatomy of gonadal arteries and their variations by MDCT in the north Indian population. Materials and methods: 500 patients (aged 18 to 70) referred to the department of Radio diagnosis at SubhartiMedical College &amp; Hospital, Meerut, and neighboring imaging centresin the NCR underwent the cross-sectional study (MDCT). From August 2019 to July 2022, MDCT scan images of the abdomen region were examined for the normal anatomy of the gonadal arteries. Results: Variation were found in both sides gonadal arteries in males and females. The frequency of variations of gonadal arteries in terms of their origin was more commonly found in males. Conclusions: Various morphological anomalies of gonadal arteries are reported. The possible embryological basis for this variation as well as its clinical significance, are discussed. The knowledge of this variation will help the radiologists and surgeons in avoiding clinical complications during uro-radiologic interventions and surgical procedures such as renal and gonadal surgeries. Keywords: Gonadal artery, Testicular artery (TA), Ovarian artery (OA), Renal artery (RA).

Motorized spiral enteroscopy: effectiveness when used for new indications.

Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope. Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022. A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade panenteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II). This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events.