Anatomical Procedures Research Articles

Comparison of thyroid surgery techniques: a retrospective cohort study and meta-analysis of traditional electric knife vs. straight bipolar electrocoagulation forceps.

In recent years, advancements in surgical techniques for thyroidectomy have led to varying outcomes and efficiencies. Understanding these differences is crucial to optimize patient care and surgical success. This study compared intra- and postoperative parameters of thyroid surgery for thyroidectomy or thyroid cancer. One approach involved the traditional electric knife, employing traditional clamp-ligation skills and an electric knife. The other approach utilized straight bipolar electrocoagulation forceps for micro-hemostasis and micro-cutting. Data were analyzed retrospectively for 228 patients who underwent thyroidectomy at the Third Affiliated Hospital of Kunming Medical University from January 2014 to November 2018. Surgery was performed either as traditional open surgery (n=150) or as a meticulous anatomical procedure involving bipolar electrocoagulation (n=78). In addition, data from published studies comparing the two surgical procedures were meta-analyzed. The bipolar electrocoagulation procedure was associated with significantly shorter total operation time, lower intraoperative blood loss and lower rate of hypocalcemia. The two procedures were associated with similar rates of hoarseness. Meta-analysis of eight studies involving 2,080 patients showed that bipolar electrocoagulation was associated with significantly shorter total operation time than the traditional approach (mean difference =-21.29 min, 95% CI: -26.32 to -16.27) and with less intraoperative bleeding (mean difference =-12.87 min, 95% CI: -23.81 to -1.93). Straight bipolar electrocoagulation forceps can be used to perform fine dissection during thyroid surgery. Performing "micro-hemostasis" and "micro-cutting" manipulations with these straight bipolar forceps can smoothly dissect nerves and parathyroid glands and may reduce intraoperative bleeding, operation time and rates of postoperative complications, might accelerate recovery after surgery.

Acromioclavicular Joint Reconstruction with Modified Weaver–Dunn Operation Versus Hamstring Tendon Autograft Comparative Study

Abstract Background: The dislocation of the acromioclavicular joint (ACJ) is recognized as one of the most frequently occurring injuries most often after either direct or indirect force is applied to the affected shoulder. The best method of AC reconstruction is still controversial. Modified Weaver–Dunn operation (WD) is one of the popular operations. Recent ACJ reconstruction methods include the usage of the gracilis, semitendinosus auto grafts, synthetic grafts, end buttons, nonabsorbable sutures, suture anchors, and tight-rope system. Aim and Objectives: Clinical and radiological results of hamstring autograft versus modified WD operation for reconsrtuction of coracoclavicular and acromioclavicular ligaments. Patients and Methods: This prospective study was carried out at the orthopedic department of Benha University Hospital carried out on 30 cases with chronic ACJ dislocation. They divided into two groups. The modified WD technique was employed on 15 patients, whereas an autogenous semitendinosus tendon graft was used on the other 15. There was a comparison of radiographs taken before and after surgery. Results: Mean surgical time and coracoclavicular (CC) distance differed statistically between groups. Neither demographic data nor postoperative information (pain, range of motion, and postop) showed a difference of statistical significance between the groups. Constant score and post operative American Shoulder and Elbow Surgeons Score (ASES) and post operative complications show no statistically significant difference. Conclusion: Both AC and CC reconstruction by hamstring tendon autograft showed good-to-excellent outcomes with no implant-related complications as some other treatment methods, also more anatomical procedure more than WD operation with better biomechanical vertical and horizontal stability.

Anatomy and Histochemistry of Alliaceae and Iridaceae Species: Quality Control of Traditional Medicine Raw Materials

Alliaceae (Allium cepa and Allium ascalonicum) and Iridaceae (Eleutherine bulbosa) are widely used as spices, condiments, and traditional medicine. These three species are vulnerable to adulteration because they are morphologically similar in shape and colour. This study aims to identify and authenticate the three samples through anatomical and histochemical approaches. Anatomical and histochemical analyses were performed on fresh sections of the bulbs samples according to standard anatomical procedures with a razor blade and identification of the main compound groups using specific reagents. Anatomically, the three samples had similar patterns and cell organelles (cell nucleus, cytoplasm, and cell wall). Histochemical techniques identified the presence of alkaloids, phenolics, lipophilics, and terpenoids groups. Histochemical techniques can be applied in identifying the compound groups of the three samples and can be used as an alternative in testing the quality control of traditional medicine raw materials.

Bariatric surgery is as safe as other common operations: an analysis of the ACS-NSQIP

BackgroundMetabolic and Bariatric Surgery (MBS) is the most effective management for patients with obesity and weight-related medical conditions. Nonetheless, some primary care physicians (PCPs) and surgeons from other specialties are reluctant to refer patients for MBS due to safety concerns. ObjectivesTo compare the outcomes of patients who underwent MBS with those who underwent other common operations. SettingAmerican College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). MethodsPatients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), classified as MBS, were compared to nine frequently performed procedures including hip arthroplasty and laparoscopic cholecystectomy, appendectomy, colectomy, hysterectomy, and hernia repairs, among others. A multivariable logistic regression was constructed to compare outcomes including readmission, reoperation, extended length of stay (ELOS) (>75th percentile or ≥3 days) and mortality. ResultsA total of 1.6 million patients were included, with 11.1% undergoing MBS. The odds of readmission were marginally lower in the cholecystectomy (adjusted odds ratio [aOR] = .88, 95% confidence interval (CI) [.85, .90]) and appendectomy (aOR = .88, 95% CI [.85, .90]) cohorts. Similarly, odds of ELOS were among the lowest, surpassed only by same-day procedures such as cholecystectomies and appendectomies. The MBS group had significantly low odds of mortality, comparable to safe anatomical procedures such as hernia repairs. Infectious and thrombotic complications were exceedingly rare and amongst the lowest after MBS. ConclusionsMBS demonstrates a remarkably promising safety profile and compares favorably to other common procedures in the short-term. PCPs and surgeons from other specialties can confidently refer patients for these low-risk, lifesaving operations.

Correlating habitat dynamism with foliar anatomical modulations: A study with <i>Phymatosorus scolopendria </i>(Burm. F.) ching

There is a dearth in ecological details on Cryptogamia when compared to available literature on higher plants. Hence, we investigated the extent of variation in altitude, light intensity and sunlight duration existing in four contrasting habitats dominated by Phymatosorus scolopendria in relation to fern foliar anatomical dynamics using standard anatomical procedures and ecological protocol. The species consistently possessed diacytic and anisocytic stomata across the habitats whereas anomocytic stomata were also found in the shrub epiphytes. Similarly, unicellular trichomes were consistently present in epiphytic plant forms while oil droplets were consistent throughout except in the tree epiphytes. Also, the stomatal index and number of stomata differed significantly (P<0.05) and were highest in the epiphytes growing on the tree barks (17.337±3.00; 14.33±1.154) but least in the erect forms (12.875±1.10; 8.67±0.577) respectively. The lithophytes recorded highest number of epidermal cells (76.67±15.280) whereas the erect forms recorded the least (46.33±4.041). Altitude varied between 8.23 to 10.36 m; light intensity ranged between 1045 to 13088 lux while sunlight duration ranged from 2 to 8 hours/day. Correlation analysis revealed significant (P<0.05 and P<0.01) coefficients. Specifically, altitude indicated strong positive association with light intensity (r= 0.987* ) and sunlight duration (r= 0.990**) while light intensity correlated strongly with sunlight duration (r= 0.958). The stomatal types were strongly associated with altitude (r=0.679), light intensity (r= 0.769) and sunlight duration (0.570) while stomatal index correlated inversely with altitude (r= - 0.505) and sunlight duration (r= - 0.553). Implicitly, shady habitats with short durations of low light intensity induced higher stomatal development and density while prolonged sunlight duration and increasing light intensity retained low stomatal density in this plant. This pattern indicates a close association between species anatomical progression in relation to prevailing environmental conditions. This information reveals aspects of plant survival mechanism in different environmental scenarios and may aid future conservation efforts.

Patellar Dislocation: Workup and Decision-Making.

Acute patellar dislocation (PD) is usually a problem of adolescents and young adults. In most cases, it is a sports-related injury. It is the result of an indirect force on the knee joint, which leads to valgus and external rotation of the tibia relative to the femur. PD is unlikely to occur on a knee with normal patellofemoral joint (PFJ) anatomy. Acute PD consists of an acute injury of the ligamentous medial patellar stabilizers in the background of factors predisposing to patellar instability. These factors are classified into three groups. The first group refers to the integrity of the ligamentous medial patellar restraints, particularly, the medial patellofemoral ligament (MPFL). The second group refers to an abnormal PFJ anatomy, which renders the patella inherently unstable inside the trochlea. The third group refers to the overall axial and torsional profile of the lower limb and to systemic factors, such as ligament laxity and neuromuscular coordination of movement. PD at a younger age is associated with an increased number and severity of patellar instability predisposing factors and lower stress to dislocate the patella. Acute primary PD is usually treated conservatively, while surgical treatment is reserved for recurrent PD. The aim of treatment is to restore the stability and function of the PFJ and to reduce the risk of patellar redislocation. Surgical procedures to treat patellar instability are classified into non-anatomic and anatomic procedures. Non-anatomic procedures are extensor mechanism realignment techniques that aim to center the patella into the trochlear groove. Anatomic procedures aim to restore the PFJ anatomy (ruptured ligaments, osteochondral fractures), which has been severed after the first incident of PD. Anatomic procedures, especially MPFL reconstruction, are more effective in preventing recurrent PD, compared with non-anatomic techniques. Theoretically, all factors that affect PFJ stability should be evaluated and, if possible, addressed. This is practically impossible. Considering that the MPFL ruptures in almost all PDs, MPFL reconstruction is the primary procedure, which is currently selected by most surgeons as a first-line treatment for patients with recurrent PD. Restoration of the axial and torsional alignment of the lower limbs is also increasingly implemented by surgeons. Non-anatomic surgical techniques, such as tibial-tuberosity osteotomy, are used as an adjunct to anatomic procedures. In the presence of multiple PFJ instability factors, acute MPFL reconstruction may be the treatment of choice for acute primary PD as well. Skeletal immaturity of the patient precludes osseous procedures to avoid premature physis closure and subsequent limb deformity. Unfortunately, restoration of the patient's previous activity level or participation in more strenuous sports is questionable and not easy to predict. In the case of competitive athletes, PD may prevent participation in elite levels of sports.

Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction With Pedicular Hamstrings Tendon Graft, Single-Strand Gracilis for ALL and Single Blind Femoral Tunnel

Combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALL r) is a common procedure to treat rotational instability and to prevent ACL graft failure. Recent studies have described numerous combined reconstruction techniques to obtain the most anatomical procedure with the least graft donor site morbidity and the best clinical results.Hamstring (HG) grafts are the most popular graft in literature. Leaving pedicle HG can preserve enough blood supply to improve tendon-bone healing with additional mechanical fixation of the graft on the tibial side. A single femoral tunnel reduces bone loss and prevents convergence of 2 femoral tunnels. We describe an original ACL and ALL reconstruction technique that preserves hamstring tibial insertion with a single blind femoral tunnel.

Accuracy of radiographic techniques in detection of the calcaneofibular ligament calcaneal insertion for lateral ankle ligament complex surgery.

Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery. To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically. MRIs of 25 ankles were utilized to identify the "true" insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs. X and Y coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula. X and Y distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test. The Best and Taser techniques were found to be closest to the true CFL insertion when combining X and Y distances. For distance in the X direction, there was no significant difference between techniques (P = 0.264). For distance in the Y direction, there was a significant difference between techniques (P = 0.015). For distance in the combined XY direction, there was a significant difference between techniques (P = 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the Y (P = 0.042) and XY (P = 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the XY direction (P = 0.017). There was no significant difference between the Best and Taser methods. If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.

Diversity of Trichomes in Calliandra haematocephala Hassk. (Caesalpinioideae DC., Fabaceae Lindl.)

Objective: High structural diversity of trichomes in the members of family Fabaceae Lindl. has been a subject of study from decades. The present study was aimed to study structural diversity of trichomes in Power Puff Tree (Calliandra haematocephala,Caesalpinioideae, Fabaceae) a pan-tropical ornamental tree.
 Methods: Plant specimens were collected from the campus of Govind Ballabh Pant University of Agriculture and Technology Pantnagar (India) during the year 2020. Plant species was identified with the help of relevant Floras. Fresh plant material was used for vestiture and trichome study under light microscope using standard anatomical procedures. Illustrations of trichomes were drawn by using prism type camera lucida and photographs were taken at different magnifications. Standard terminology of trichome types given by payne 1978 was adopted to describe different structural types of trichomes.
 Results: Nine different types of glandular and non-glandular trichomes were recorded in Calliandra haematocephala Hassk. Four different vestiture types were recorded on the surfaces of studied parts. Trichomes were found present in all vegetative parts and some reproductive parts viz; peduncle, bracts, bracteole, petals while other reproductive parts like sepals, filaments, anther, ovary, style and stigma were found completely glabrous. Present study suggests that trichome morphology and distribution on different plant parts can be used to identify plant species. Calliandra haematocephala Hassk. can be identified in its vegetative phase of life when floral parts are lacking or fragmentary.

Between anatomy and pathology : The dissection reports of Galen of Pergamum

The autopsy protocols in the work of the Greco-Roman physician Galen of Pergamum have so far primarily been examined from a literary and socio-historic point of view. An analysis focused on the medical aspects is still incomplete. Which pathologic-anatomic competence do the Galenic section reports convey? The approximately 400 Galenic case histories were examined for anatomic and pathologic statements obtained during dissections of animals and men. In 29 reports, anatomy and pathology issues are addressed. Most section reports can be found in the work On anatomical procedures (De anatomicis administrationibus). The texts do not follow afixed structure. Galen is always the leading actor, observer, and analyst. Many interventions were performed in front of an audience. Monkeys were by far the most commonly dissected animals. Galen stayed away from little animals, because in his opinion their anatomy was not sufficiently similar to that of men. The post-mortem examination of human corpses with scientific intent was limited to victims of epidemics, armed conflicts, and accidents. The dissection reports cover only part of Galen's pathologic expertise. The attractive public opening of animals earned him alarge part of his reputation as ascientifically oriented physician. The dissection reports are an essential part of the collection of Galen's case histories and provide important detailed information on the history of anatomy and pathology in late antiquity.

An Anatomical Dissection Method for Observation of Fibrous Facial Structures.

In recent years, structures including the superficial musculoaponeurotic system and retaining ligaments that support the facial soft tissue have been clarified. However, these structures are very difficult to observe in their entirety by the standard gross anatomical procedure (ie, dissection from superficial to deep layers). Furthermore, accurate descriptions of these structures are rare in both anatomical and plastic surgery textbooks. The aim of this study was to clarify the facial fibrous structures in a gross anatomical view. The authors' novel method used soft facial tissue and bone. The tissue was fixed in gelatin and sectioned at a thickness of 5 to 10 mm. Each section was placed on a wooden board; the bone was then pinned, and the skin was pulled outward with sutures to hyperextend the soft tissue. Subsequently, the loose connective tissue was torn and fat tissue was removed under a surgical microscope. After the removal of fat tissue, the fibrous facial structures (eg, the superficial musculoaponeurotic system and retaining ligaments) could be observed clearly. The thickness of the sections allowed three-dimensional observation, such that a structure located deep within a section could be clearly observed. The expansion of soft tissue facilitated observation of the facial layer and fibrous structures, and the locations of nerves and vessels. Therefore, the facial layer structure was readily discerned. This method is likely to be very useful in the field of plastic surgery because it enabled intuitive identification of facial layers and their characteristics. The dissection method developed by the authors reveals the connected morphology of each tissue of the face, thus providing basic data for analyzing soft tissue changes due to aging and gravity. This will be useful for the development of anti-aging medicine.

Extrafloral nectary development, characterization and secretion in Chamaecrista debilis and Chamaecrista desvauxii var. langsdorfii (Leguminosae, Caesalpinioideae)

Although the petiole glands in Chamaecrista are usually termed extrafloral nectaries (EFNs), additional studies on the morphoanatomy and chemical nature of the exudates are necessary to properly classify a plant secretory structure. The correct classification of such structures is also important in taxonomic and phylogenetic studies. Based on standard anatomical procedures for light microscopy our study aims to broaden our current understanding of the EFNs in Chamaecrista. We describe and compare the ontogenesis and the morphoanatomy of the petiole EFNs in C. debilis and C. desvauxii var. langsdorfii, species that belong to two distinct sections in Chamaecrista. The morphoanatomy along with the presence of sugars in exudates supports the classification of the petiole glands in both species as EFNs. The EFN development is rapid, and their secretory activity starts before the young leaves complete their expansion. The major difference among the EFNs of both species is their outer morphology which is useful on the taxonomy. Both EFNs are anatomically similar and composed of a secretory epidermis, a nectariferous parenchyma and vascular tissue more abundant in phloem in comparison to xylem.

Equivalent outcomes of ACL revision with over-the-top single and double-bundle reconstruction using hamstring tendon compared to anatomical single and double-bundle reconstruction

PurposeIn revision anterior cruciate ligament reconstruction (ACLR), our procedure of choice is the over-the-top route (OTTR) for cases where it is difficult to use a primary bone tunnel or to create a new bone tunnel due to the enlargement or malposition of the bone tunnel. Depending on the condition of the primary bone tunnel, we choose single (bone tunnel or OTTR) or double (bone tunnel or anteromedial (AM) bundle: OTTR /posterolateral (PL) bundle: bone tunnel) for femoral fixation. This study showed the results of single and double OTTR revision ACLR using the hamstring tendon.MethodsSeventy-eight patients, who underwent revision ACLR using the hamstring tendon and who could be followed up for more than 2 year, were included in this study. The methods of revision ACLR were single in 54 cases (bone tunnel: 24 cases; OTTR method: 30 cases) and double in 24 cases (bone tunnel: 16 cases; OTTR for AM bundle and bone tunnel for PL bundle: eight cases). The cause of re-injury, the meniscus and cartilage injury, the reconstruction method, and the Lysholm score, Lachman test, Pivot-shift test, and the side-to-side difference in the tibial anterior translation were evaluated before and after surgery.ResultsThere was no statistically significant difference in the Lyshom score, Lachman / Pivotshift test and side-to-side difference anterior translation of the tibia between the four groups.ConclusionsThe clinical results of single and double OTTR revision ACLR are equivalent to those of anatomic single and double bone tunnel procedures.

First documented clinical account of brachial plexus palsy from the 12th century.

Although literary depiction of brachial plexus injury can be traced to Homer's Iliad, there is a scientific consensus that the first clinical description of brachial plexus palsy was not documented until the British physician Smellie reported it in the 18th century. However, the authors' recent review of the Syriac Book of Medicines (12th century) has uncovered a much earlier clinical documentation. For this historical vignette, the authors reviewed the historical and anatomical literature regarding earlier descriptions of brachial plexus anatomy and pathology, including a thorough analysis of the Syriac Book of Medicines (attributed to an unknown Syriac physician in the Middle Ages) and Galen's On Anatomical Procedures and On the Usefulness of the Parts of the Body. Building on the galenic tradition with reference to independent dissections, the Syriac physician discussed nervous system anatomy and the clinical localization of neurological injuries. He described a patient who, after initial pulmonary symptoms, developed upper-extremity weakness more pronounced in the proximal muscles. His anatomical correlation placed the injury "where the nerves issue from the first and second muscles between the ribs" (scalene muscles), are "mixed," and "spread through many parts." The patient's presentation and recovery raise the possibility of Parsonage-Turner syndrome. The anatomical description of the brachial plexus is in line with Galen's earlier account and step-by-step surgical exposure, which the authors reviewed. They also examined Ibn Ilyas' drawing of the brachial plexus, which is believed to be a copy of the earliest artistic representation of the plexus. Whereas the Middle Ages were seen as a period of scientific stagnation from a Western perspective, Galen's teachings continued to thrive and develop in the East. Syriac physicians were professional translators, clinicians, and anatomists. There is evidence that brachial plexus palsy was documented in the Syriac Book of Medicines 6 centuries before Smellie.

Intraoperative fractures in shoulder arthroplasty: risk factors and outcomes.

BackgroundThe incidence of shoulder arthroplasty in the United States continues to increase, and while the risk of intraoperative complications such as fracture remains relatively low, there has been little investigation into whether certain patient-specific risk factors predispose to this complication. This study characterizes the incidence of intraoperative fracture during shoulder arthroplasty and additionally hypothesizes that certain risk factors may exist in addition to potentially leading to worsened near-term outcomes.MethodsAn institutional database of shoulder arthroplasties (N = 1773; 994 anatomic, 779 reverse) was retrospectively reviewed, and the operative reports for each case were examined for documentation of an intraoperative fracture, including during which surgical step the fracture took place. Various preoperative and intraoperative factors were tested for comparative significance (P < .05) using chi-square and Kruskal-Wallis tests as appropriate. Length of stay, 90-day readmission, and discharge to rehabilitation or skilled nursing facility (SNF) were further examined as secondary outcomes.ResultsTwenty-one (1.2%) intraoperative fractures were documented, a majority of which occurred in reverse shoulder arthroplasties compared to anatomic procedures (overall incidence: 2.5% vs. 0.2%, P < .001). These most commonly occurred during either stem broaching (33%) or seating (33%) and were most likely to involve the metaphysis (53%) or greater tuberosity (33%). Five fractures occurred during revision arthroplasty, while 16 fractures occurred during primary procedures (overall incidence: 3.0 vs. 1.0%, P = .03). Patient factors reaching statistical significance included female gender and liver disease, while age and smoking history were notably not associated with intraoperative fracture. The fracture cohort had a significantly longer mean length of stay (2.42 vs. 2.17 days, P < .001). While the rates of 90-day readmission and discharge to SNF/rehab were higher in the fracture cohort, these values did not reach statistical significance.ConclusionIntraoperative fractures are a rare complication (1.2%) in shoulder arthroplasty, with reverse shoulder arthroplasty, revision cases, and female gender associated with an elevated overall risk. While these patients had a longer inpatient hospitalization, the substantially higher rates of 90-day readmission and discharge to SNF/rehab did not reach significance in our limited institutional cohort. The aforementioned incidence and risk factors serve as crucial evidence for use during the preoperative counseling process with patients as part of a shared decision-making model.

Adventitious root primordia formation and development in the stem of Ananas comosus var. bracteatus slip

ABSTRACT There are about 4–6 slips on a fruit, and they are good materials for effective regeneration of Ananas comosus var. bracteatus. Adventitious root (AR) induction is essential for the propagation of Ananas comosus var. bracteatus slips. Growth regulator treatment, and culture medium are imperative factors that affect slip growth and rooting. In order to screen the optimal methods for slips rooting and reveal the anatomic procedure of slip rooting, this study induced slip rooting by different treatment of growth regulator, culture medium, observed the slip stem structure, AR origination and formation procedure through paraffin sections. The results showed that, slip cuttings treated with 100 mg/L of Aminobenzotriazole (ABT) for 6 hrs, cultured in river sand: coconut chaff: garden soil 2:2:1 medium is the optimal method for rooting. The proper supplementary of ABT can enhance the soluble sugar content, soluble protein content, polyphenol oxidase (PPO) activity and peroxidase (POD) enzyme activity, which resulted in the improvement of rooting. The slip stem structure is quite different from other monocots, which consists of epidermis, cortex, and stele with vascular tissues distributed in the cortex and stele. The AR primordia originates from the parenchyma cells located on the borderline between the cortex and stele. The vascular tissues in the AR develop and are connected with vascular tissue of the stem before the AR grew out the stem. The number of primary xylem poles in AR is about 30.

Evaluation of some pharmacognostic parameters of the herbs for a traditional hematinic (Haematol -B) powdered formulation in Ogbomoso, Nigeria

The traditional hematinic oral powdered herbal drug (Haematol-B) from Ogbomoso, Nigeria had been characterized in terms of its botanical constituents, ascorbic acid and mineral elements composition, but there is inadequate information on the pharmacognostic properties of the ten herbal materials for its formulation. Therefore the objective of this study was to evaluatethe bark and wood anatomy (as appropriate) of seven of these herbs with a view to highlighting the diagnostic markers for their authentication. Following the conventional anatomical procedures of transverse sectioning (TS) and tissue maceration (TIM), a total of 21 characters were drawn from the barks (root or stem as appropriate) of the seven woody species studied, while 41 characteristics of the wood in the roots of three of the species were compiled using TS, transverse longitudinal sectioning (TLS), radial longitudinal sectioning (RLS) and TIM techniques. Staining, mounting and microscopic examinations followed, and the observed features were taxonomically described in accordance with the provisions of International Association of Wood Anatomists. Their diagnostic values among the medicinal herbs studied were also explored. The bark anatomical features that can be used to diagnose the species studied were those of the secondary cortex, phloem rays, axial parenchyma, sclereids and resin ducts. The wood anatomical markers included features of the vessels in the TS and variable ray characteristics in the TLS. The two artificial keys constructed from discontinuities in qualitative and quantitative anatomical features of the barks and the wood are useful tools for avoiding misidentification of the herbal materials studied.

A snapshot of the 2020 conception of anatomic liver resections and their applicability on minimally invasive liver surgery. A preparatory survey for the Expert Consensus Meeting on Precision Anatomy for Minimally Invasive HBP Surgery.

The main aim of this survey was to analyze how liver surgeons perform liver resections and to define their conception of anatomic procedures within the incorporation of minimally invasive liver surgery (MILS). The survey was distributed among liver surgeons. It mainly focused on personal experience on open and MILS, methods and landmarks, and experience on anatomic resections and Glissonean approach. A total of 445 valid answers from 54 countries was obtained. Surgeons performing MILS mainly have below 10years of experience (81.8% of responders) and one third has never done complex MILS. New techniques, including indocyanine green demarcation are marginally used (<25%). More than 60% of surgeons do not make a full exposure of hepatic veins during MILS, mainly due to the risk of injury or not considering it to be of utility. Although 88% of responders agreed with the concept of anatomic resection as the "resection along the border/watersheds of each order division identified by the portal vein flow", only 55% of surgeons have ever performed MILS Glissonean approaches. Liver anatomy is not a static concept. Anatomic resections need training and precision. Standardization of complex anatomic resections by a minimally invasive approach should be encouraged.

Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary Patellar Dislocations

Medial patellofemoral complex (MPFC) is considered as the primary medial patellar restraint and has a static, as well as dynamic, component. MPFL reconstruction (MPFL-R) restores only the static component of MPFC, is associated with multiple technical concerns, and has a steep learning curve. Need for physeal sparing techniques and relatively high rates of complications including patella fracture are some other concerns with MPFL-R. We propose a simple procedure for advancement of MPFC onto patella, which is indicated in most of the recurrent lateral instabilities (with a positive lateral glide test result and an intact MPFL on magnetic resonance imaging). The procedure is also indicated in selective acute primary dislocations—those with associated chondral lesions and magnetic resonance imaging–documented isolated patellar side avulsion/injury. MPFC advancement is a more anatomical procedure that also restores dynamic medial checkrein of patella and can be performed even by a novice surgeon. MPFC advancement is devoid of the multiple technicalities of MPFL-R, does not require intraoperative imaging or any postoperative immobilization, and renders complications like donor graft-site morbidity and patella fractures irrelevant. It requires no modifications in patients with open physes and can be performed in isolation or with other procedures as per à la carte principle.

Chronic lateral ankle instability: a current concepts review

ABSTRACT Injuries to the lateral ankle ligaments are quite common, with a reported incidence of up to 22% of all sports injuries, and 85% of all ankle sprains. Most of these are effectively managed using nonoperative measures in the acute setting. Approximately 20% of patients will, however, develop chronic lateral ankle instability (CLAI). Although the anatomy and biomechanics are well documented, more recently, the concepts of the lateral talofibular calcaneal ligament (LTFCL) and microinstability have been described. For those who develop CLAI, a full assessment is mandatory to not only search for correctable risk factors (malalignment), but also to differentiate between functional and mechanical instability. Associated injuries need to be excluded, such as osteochondral lesions of the talus. Rotational ankle instability is a new concept that needs to be considered. Patients who present with CLAI are initially managed conservatively in the form of functional rehabilitation. This management is especially effective in patients with functional instability. Surgery is generally indicated after failed conservative management in patients with objective mechanical instability. The elite athlete is a relative indication to performing surgery early. The choice of surgical procedure is made on an individualised basis, although open anatomical procedures remain the gold standard. Non-anatomical procedures are no longer recommended. Newer minimally invasive and endoscopic techniques show promise in experienced hands but there is only limited evidence to support its use at present. The use of a suture tape as an augment is reserved for specific indications and should not be used routinely. Level of evidence: Level 5 Keywords: chronic lateral ankle instability, ATFL, CFL, functional rehabilitation, Broström, surgical procedures for lateral ankle ligaments