Superolateral Quadrant Research Articles

Postmortem Analysis of Optic Nerve Head Vascularization in an Individual With Glaucoma.

Reduced ocular perfusion likely contributes to glaucomatous damage at the optic nerve head (ONH). In recent decades, investigators have focused heavily on ocular perfusion pressure and other factors affecting blood flow to the eye. Comparatively, far less attention has been focused on the blood vessels themselves. Here, we asked whether glaucomatous individuals exhibit anatomical deficiencies (i.e., fewer blood vessels) in their ONH blood supply. To answer this question, we performed a systematic literature review to (1) determine how many studies have reported measuring blood vessels in the ONH and (2) whether these studies reported differences in blood vessel quantity. Additionally, we report a method for quantifying blood vessels in ex vivo human ONH preparations, including an ONH from an individual with glaucoma. Our results show that only two studies in the past 50 years have published data concerning blood vessel density in glaucomatous ONHs. Interestingly, both studies reported decreased blood vessel density in glaucoma. Consistent with this finding, we also report reduced blood vessel numbers in the superolateral quadrant of a glaucomatous individual's ONH. Vascularity in the three remaining quadrants was similar to control. Together, our findings raise the interesting possibility that individuals with a relatively sparse ONH blood supply are more likely to develop glaucoma. Future studies with larger sample sizes and more thorough quantification are necessary to determine the link more accurately between glaucoma and the blood supply to the ONH.

Variability of anterolateral thigh flap perforator locations - clinical implications.

<b><br>Introduction:</b> The anterolateral thigh flap is an example of a free flap widely applied for reconstruction of tissues within various areas of the body.</br> <b><br>Aim:</b> The aim of the study was to determine the most common locations of the ALT flap perforators in men and women as well as to clarify any potential differences in the location of the vessel in male vs. female subjects.</br> <b><br>Material and method:</b> In years 2021-2022, a study was conducted at the Plastic, Reconstructive, and Aesthetic Surgery Clinic in a group of 90 volunteers (45 women and 45 men, a total of 180 lower extremities) to determine the location of the anterolateral thigh flap perforator against the flap surface using a portable Doppler probe.</br> <b><br>Results:</b> Variable locations were revealed for the anterolateral thigh flap perforator within the study. In women, the perforator is located more distally from the anterior superior iliac spine, most frequently within the inferolateral quadrant, while being located closer to the anterior superior iliac spine, and most frequently within the superolateral quadrant, in men. No perforator was found in 3.3% of the examined limbs. No statistically significant differences were observed between the course of the perforators within the left and right lower limbs in individual patients.</br> <b><br>Conclusions:</b> The location of the ALT flap perforator is subject to sexual dimorphism, which facilitates the investigation area being narrowed down to the well-defined locations of its most frequent occurrence when planning anterolateral thigh flap reconstructive procedures.</br&gt.

Evaluation of nerve innervation distribution of orbicularis oculi muscle for botulinum neurotoxin application using Sihler's method

BackgroundBlepharospasm is the involuntary and forced closure of the eyelids due to spasm-like contraction of the orbicularis oculi muscle around the eye. The study aimed to reveal the nerve innervation of the orbicularis oculi muscle for Botulinum neurotoxin (BoNT) treatment of blepharospasm by Sihler’s staining technique. MethodsThis study used six cephalus (12 orbicularis oculi muscles) with an average age of 69,6 (62−88) years. Then, the orbicularis oculi muscles were removed by dissection, and Sihler's staining technique was applied to the muscles. The limit for dissection of the muscle is the orbital opening level, where the nerves enter the muscle, and the muscle attaches to the bone. ResultsIn the region above the palpebral fissure, the nerves entering the muscle were densely located in the superolateral quadrant between 9 and 12 o′clock in the right eye and between 12 and 3 o′clock in the left eye. In the region under the palpebral fissure, the nerves’ density in the orbicularis oculi muscle was higher between 4 and 7 o′clock in the right eye and between 5 and 8 o′clock in the left eye. ConclusionThis study unveiled the nerve branches associated with the orbicularis oculi muscle. It pinpointed precise crossing points of these nerve branches, which can be targeted for applying BoNT in treating blepharospasm. Consequently, by utilizing minimal BoNT, it is anticipated that the quantity of toxin administered will decrease, leading to more efficient outcomes and reduced expenses. Furthermore, this approach can aid in averting potential undesired complications during BoNT administration.

Surgical removal of an orbital liposarcoma in a dog using the cavitron ultrasonic surgical aspirator

AbstractA 9‐year‐old boxer presented with unilateral exophthalmos, reduced globe retropulsion and central exposure keratitis in the right eye. On the superolateral orbital quadrant, a firm, well‐limited mass in close proximity to the globe was detected. Ultrasonic and computed tomography examinations confirmed a retrobulbar mass. The biopsy examination revealed the presence of a tumour of adipocytes, consistent with hibernoma. The retrobulbar mass was surgically removed using dorsal orbitotomy with a cavitron ultrasonic surgical aspirator. Complete retrobulbar mass removal was achieved with minimal and transient postoperative complications. The histopathological examination of the mass fragment obtained during surgery showed liposarcoma. Controlled computed tomography performed 4 months after surgery did not reveal signs of recurrence or metastasis. Ophthalmic examination was within normal limits during 1 year of follow‐up. The cavitation ultrasonic surgical aspirator allows precise mass excision with preservation of delicate orbital structures and is particularly useful in cases with challenging anatomical access.

Distributions of Breast Cancer Primary Tumor Locations in Indonesian Patients

<p><strong>Introduction:</strong> Overseas studies have shown various distributions of breast cancer primary tumor locations based on stages and histopathologic types. Based on them, breast cancer was consistently reported to be found on theleft breast more than the right. Breast cancer laterality was estimated to be one of the determinant factors in prognosis. In Indonesia, there are only a few studies on the laterality of breast cancer, as well as the characteristics that accompany it. The aim of this study is to know the distributions of primary breast cancer tumor locations in Indonesian patients.</p><p><strong>Material and Methods:</strong> A cross-sectional design study was done and the data was collected from Siloam Hospital Lippo Village radiology and pathology anatomy department within the 2014-2018 period. The results were presented using descriptive statistics.</p><p><strong>Results:</strong> A total of 74 breast cancer patients from various ages and stages were enrolled in this study. Based on the histopathological types, 84.2% patients left breast tumors and 72.2% patients with right breast tumors had invasive ductal carcinoma of no special type. Based on quadrants, 50% tumors on the left breast are in the superolateral quadrant, followed by 31.6% in superomedial, 13.2% in inferomedial, and the rest in inferolateral. Conclusion: Most tumors are located in the superolateral quadrant and the most histopathological types are non-specific invasive carcinomas.</p>

Subconjunctival Fat Prolapse

Subconjunctival fat prolapse is an extremely rare condition. Confirmation of the fatty nature of this lesion and demonstration of the focal tenon capsule defect makes Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of orbit the investigations of choice. This manuscript report a 69-year-old female who presented with complaints of swelling in lateral aspect of both orbit, since two years. On clinical examination, there was yellowish colored swelling in the superolateral quadrant of bilateral orbit. CT scan show herniation of intraconal fat content through the defect at the tenon capsule, intermuscular septum and thus confirmed the nature of lesion and the diagnosis. The patient was not willing for surgical correction and preferred regular follow-ups.

P26 A case of B-cell lymphoma affecting the eye in a patient with rheumatoid arthritis following a reduction in the frequency of rituximab therapy

P26 A case of B-cell lymphoma affecting the eye in a patient with rheumatoid arthritis following a reduction in the frequency of rituximab therapy

Quantitative assessment of the vascularity of the skeletally immature patella: a cadaveric study using MRI.

PurposeWhile predominant blood supply to the adult patella enters inferomedially, little is known about skeletally immature patellar perfusion. Improved knowledge of immature patella vascularity can further understanding of osteochondritis dissecans, dorsal defects of the patella and bipartite patella, and help ensure safe surgical approaches. We hypothesized that the immature patella would exhibit more uniform blood flow. The study purpose was to quantify immature patella regional perfusion in comparison with adults.MethodsTen cadaveric knees were utilized (five immature, five mature). The superficial femoral artery was cannulated proximally. Signal enhancement increases were compared from pre- to post-contrast MRI to assess relative arterial contributions to patella regions (quadrants, anterior/posterior, superior/inferior, medial/lateral, and outer/inner).ResultsQuantitative-MRI analysis revealed similar distribution of enhancement between the immature and mature patella. The inferior pole exhibited significantly higher arterial contribution versus superior pole in both immature and mature groups (p = 0.009; both groups), while the inferomedial quadrant had the highest arterial contribution of all quadrants in both groups. The superolateral quadrant demonstrated the lowest arterial contribution in the immature group and second lowest in the adult group. The patella outer periphery had significantly greater arterial contribution than the inner central region in both immature (p = 0.009) and mature (p = 0.009) groups.ConclusionDistribution of arterial contributions between the immature and mature patella was similar. Our results highlight the importance of inferior and inferomedial blood supply in both immature and mature patellas. These findings have implications for paediatric and adult patients; surgical damage to inferior patellar vessels should be avoided to prevent associated complications.

Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms.

PurposeBipartite patella is a rare developmental variation of the knee cap. We aimed to identify the magnetic resonance imaging (MRI) features of bipartite patella and evaluate the association with clinical symptoms.Material and methodsMRI exams of 61 patients with bipartite variant were evaluated for types of bipartite patella, oedema around the synchondrosis, bipartite fragment height (FH), distance between the fragment and the patella (FPD), and signal characteristics within the synchondrosis. The study was designed with two observers in order to achieve intra- and interobserver compliance. Any other major knee pathologies that can cause pain were also recorded.ResultsOf the 61 participants the average age was 40.1 ± 14.3 years, 44 were males, and 17 were females. Fifty-nine of the bipartite fragments were located at the superolateral quadrant of the patella. There was oedema at the bipartite area in 35 patients. Ten of these patients had no major MRI diagnosis other than oedema, and they were classified as the symptomatic group. The age of the patients in the symptomatic group was statistically lower than in the asymptomatic group (p < 0.05). There was no statistically significant difference between the groups in terms of male and female distributions, signal types across the synchondrosis, and FH or FPD measurements (p > 0.05). High concordance correlation coefficients were observed on measurementsConclusionsMRI of the knee is highly accurate in evaluation of bipartite patella. To our knowledge; a detailed MRI analysis, like in our study, has not previously been performed, and our report is unique in showing that the symptomatic occurrence of bipartite patella is statistically higher in young patients.

Benign and malignant lesions of the breast: clinico-pathological perspective from a government teaching hospital in West Bengal, India

Background: While breast cancer is one of the most commonly diagnosed cancer more than half of the women develop some benign disease of breast in their lifetime. The current study was conducted to describe the clinico-pathological findings associated with breast diseases and study their relationship.Methods: A record-based cross-sectional study was conducted on the samples of breast tissue obtained by fine needle aspiration cytology (FNAC) examination. The clinical variables like age, sex, presenting complaint, involved side (right/left/both) etc. were taken from the clinical notes sent, and nature of the aspirate, histopathological diagnosis, nature of the diagnosed disease (benign/malignant), and axillary metastasis were taken as variables from pathological examination.Results: The mean age of the patients was 33.49 years (±13.24 years) with majority belonging to 20-40 years. Among the 184 specimens examined, 94.57% belonged to female patients. The most frequent presentation was with lump (95.11%). Complaint arising out of right breast (47.83%) were higher compared to left breast (40.76%). Involvement of the supero-lateral quadrant was seen in 75.54%. In 30.44% of the cases the material was bloody or blood-mixed. Majority of the patients (86.41%) were diagnosed with benign disease commonest being fibroadenoma. Ductal carcinoma was the commonest malignant lesion. Younger age group, absence of bloody discharge and absence of peau d’orange were associated with benign lesion in a statistically significant way (p-value &lt;0.001).Conclusions: In consonance with published literature the findings suggest association of older age group with malignant lesions. Blood-mixed aspirate, peau d’orange appear to be danger signs.

Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention.

The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule. Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified. The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level. The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management.

Assessment of Ultrasound / Radio-guided Occult Lesion Localization in Non-palpable Breast Lesions.

Objective(s):Controversy exists about the localization of non-palpable breast lesions. In many countries, the gold standard for the diagnosis of these lesions is needle localization due to its accuracy. This study sought to compare the ultrasound- and radio-guided occult lesion localization (ROLL) as a simple method with the conventional procedures in terms of their diagnostic power.Methods:This study was conducted on 94 patients with non-palpable breast lesions detected by ultrasonography and localized by the combination of ultrasonography and using radiopharmaceuticals. One to ten hours prior to surgery, 0.1-0.2 ml (equivalent to 0.5-1 mCi) of Tc-99m-phytate was injected to the lesion under the guidance of ultrasonography. Then, the lesion was localized using a hand-held gamma probe, and excision of the lesion was performed according to its radioactivity signal. Data analysis was performed using SPSS, version 16.Results:Benign and malignant pathologic results were observed in 77 (81.9%) and 17(18.1%) of the patients, respectively, and the mean volume of the excised tissue was 26.29±27 mm³. 79 patients had a solitary lesion (84%), 55 in the left breast (58.5%) and 39 in superolateral quadrant (41.5%). The mean size of the lesions was 15.7 mm in diameter (ranging from 4 to 34 mm). Additionally, there was a need to secondary surgery in 3 (3.2%) patients and inappropriate localization in 6 (6.4%) patients (subcutaneous or intra-ductal spread of radiodrug).Conclusion:Combination of ultrasound- and radio-guided localization methods for localizing non-palpable breast lesions is a simple and acceptable method for localization with no significant complications. For radio-drug spread and subsequent excessive excised tissue volume, subcutaneous and intra-ductal lesions are not suitable indication for ROLL.

A simple technique to remove well-fixed acetabular components in revision of total hip arthroplasty

Removing well-fixed acetabular components can be a challenge for orthopaedic surgeons in revision of total hip arthroplasty. Acetabular bone loss, fracture, and other complications occurred in extracting implants may result in instability and fail of revision. Thus, instruments are developed to avoid such complications. We report a simple technique by drilling a tunnel on the superolateral quadrant of acetabulum and using an offset staff to remove acetabular components without many matching units. The procedure of removing well-fixed acetabular components is a simple, efficient, inexpensive, bone stock preserving technique.

Valuation of Four-Quadrant Location Method in Diagnosis and Differential Diagnosis of the Orbital Tumor by Comparison Study Combining CT and MRI with Pathology

Valuation of Four-Quadrant Location Method in Diagnosis and Differential Diagnosis of the Orbital Tumor by Comparison Study Combining CT and MRI with Pathology

Complex Orbital Tumors: Can Endoscopy Expand the Indications of Surgery or Improves the Standard Technique?

Introduction: Surgical approaches to orbital lesions represent challenging procedures that often require the combined effort of different specialists. Therefore, the preservation of function is a primary concern. To minimize the risk of injuring important neural and vascular structures in this area, surgical approaches must be available to provide 360 degrees of access to the orbit. In this background, the extended endoscopic endonasal approach (EEA) is reserved for lesions of the inferomedial quadrant of the orbit, the lateral micro-orbitotomy (LO) gives access to the lateral lesions while the supraorbital keyhole (SKA) or transconjunctival (TCJ) approach to the superolateral quadrant of the orbit.

A clinicopathologic study of various breast lesions with cytohistological correlation

Context: Most of the females suffer from breast diseases during their life at some time or the other. Confirmation of breast diseases by clinical examination and pathological confirmation by fine needle aspiration cytology (FNAC) and histopathologic examination has been found to be an important part of diagnostic workup in breast diseases. Aims: To establish a clinicopathologic correlation in patients suffering from breast diseases. Settings and Design: We conducted a prospective study from December 2008 to August 2010. One hundred and twenty-one cases were enrolled using simple random sampling methods. Materials and Methods: Data including age, complaints, and clinical examination was collected from patients presenting for FNAC with breast complaints. Results: A total of 128 cases were studied which included 101 benign cases, 21 malignant cases, and 6 inadequate cases. The final 122 cases included 3 (2.5%) cases of acute mastitis, 2 cases (1.6%) of tubercular mastitis, 44 cases (36.1%) of fibroadenoma, 42 cases (34.4%) of benign breast disease with non-specific descriptive diagnosis, 2 cases (1.6%) of fibrocystic disease, 3 cases (2.5%) of galactocele, 1 (0.9%) case of lactational adenoma, 2 cases (1.6%) of cellular fibroadenoma, and 2 cases (1.6%) of phyllodes tumor. Apart from this, there were 21 cases (17.21%) of ductal carcinoma. Majority of benign cases were between 30 and 39 years of age (43.6%). Majority of malignant cases fell between 50 and 59 years of age (47.6%). Majority (61.5%) of lumps (>3 cm) were malignant, whereas 94.8% of lumps (<3 cm) were benign. Left breast was commonly involved (49.18%) than the right breast (44.26%). Superolateral quadrant (63.1%) was the most commonly involved quadrant. Histology was available for 35 benign cases (34.65%) and out of total malignant cases (21), histology was available for 14 cases (66.66%). No discrepancy was noted.

Mammographic artifact leading to false-positive result.

Dear Editor,A female, 75-year-old was referred by another service withprevious screening mammogram demonstrating clustered pleo-morphic microcalcifications in the superolateral quadrant of herleft breast, classified as highly suspicious mammographic find-ings (BI-RADS category 5), to be submitted to mammography-guided needle localization followed by excisional biopsy of thesuspicious lesion.A new mammography demonstrated an apparently benignnodule already present and stable in relation to the findings of theprevious mammogram, besides the presence of clustered pleo-morphic microcalcifications, both findings located in the supero-lateral quadrant of the left breast. The finding of suspicious micro-calcifications drew attention for being a round-shaped cluster(Figures 1A and 1B).A new assessment detected a skin nevus with irregular sur-face presenting with talc residues in the lesion fissures. Once thelesion was marked with a metal clip, a new mammographic im-age revealed that the microcalcifications corresponded to artifactsrelated to the talc residues present on the dermal nevus surface(Figures 1C and 1D). The mammogram was reclassified as be-nign mammographic findings (BI-RADS category 2) and the pa-tient was referred for follow-up at the public basic health network.Except for non-melanoma skin tumors, breast cancer is themost frequent neoplasm with high mortality in women in Bra-zil

MRI study on predicting the collapse of avascular necrosis of the femoral head

Objective TostudytheriskfactorsofMRIforthepredictionofcollapseinpatients withavascularnecrosisofthefemoralhead. Methods Twenty-twopatients (39hips) diagnosed avascularnecrosisoffemoralheadbyMRwereenrolledinourstudy.ThefollowingMRappearances wereevaluated:bonemarrowedema,jointfluids,signalintensityandlocationofthelesion.The volumeandsurfaceareaofthenecrosiszonewerecalculated.Thetimeoffollow-upwas18—84 months (median,25months).LogisticregressionanalysiswasusedtopredicttheriskfactorsbySPSS 13.0.ThemaximumvalueofYoudenindexwasselectedasthecriticalpointtopredictthecollapseof femoralheadandtodefinethesensitivity,specificityandaccuracy. Results Inthe39hipswith femoralheadnecrosis,21hipshadcollapse.Bilateralcollapseoccurredin5cases.In25hipswiththe necrosissurfacelargerthan25%,collapseoccurredin21 (84%) ;In8hipswiththevolumeoffemoral headnecrosislargerthan30%,collapseoccurredinallcases;1n33hipswiththenecrosislocatingat thesuperolateralquadrant,collapseoccurredin21 (63.6%) ;In22hipswithnecroticareasshowing heterogeneoussignalintensity,collapseoccurredin18 (81.8%) ;In25hipswithlargeamountofjoint effusion,collapseoccurredin16 (64%) ;in18hipswithbonemarrowedema,collapseoccurredin13 (65%).Joint fluid,heterogeneous signal intensity and lesions in the superolateral quadrant,volume ratio,and area ratio were the high risk factors,while bone marrow edema was a relatively low risk factor.The area under ROC curves for area ratio of NASA was greater than that for volume ratio (0.987 vs 0.902).When the critical value for area ratio was 26.7%,the true positive rate was 95.2%,true negative rate was 94.4%,and Youden's index was 0.896. Conclusions The collapse of necrosis of femoral head may result from many factors.The femoral head was easy to collapse when it had large enough area of necrosis and mixed signal intensity,a large amount of joint effusion,bone marrow edema,and superolateral quadrant location.The critical value for area ratio to predict the collapse of femoral head was about 26.7%.The area ratio is more accurate than volume ratio in predicting the collapse of necrosis of femoral head. Key words: Femur head necrosis; Magnetic resonance imaging; Structure collapse; Forecasting

Memede Metal Yabancı Cisim: Olgu Sunumu

It has been reported that foreign body in the breast can cause severe complications such as cardiac tamponade and pneumothorax. For this reason urgent surgical management is necessary. Extraction of these bodies with direct exploration is a difficult method and its success is very low. Although the foreign bodies in the breast can be diagnosed by direct radiograph, ultrasonography, mammogram, and computerized tomography their determination about depth of the foreign body before the surgical intervention is usually deficient. In this study, we are presenting a case that is consulted to our clinic because of sticking a sewing needle into left breast. A 44 year-old woman referred to emergency service because of a sewing needle stick into her left breast 13 hours before, as a result of sleeping while she was sewing. In USG and direct graph a sewing needle was determined at supero-lateral quadrant, at clock line 12-1. In this case this metal foreign body (sewing needle) was extracted by using fluoroscopy in a precise localization and depth. To the best of our knowledge, this is the first case in the literature with direct skin sticking and forwarded to the chest wall. Extraction of metal foreign bodies under local anesthesia with a help of fluoroscopy makes the surgery safe and easy. Also this method lowers the surgery time and the number of complications. Key words: Foreign Body In Breast; Fluoroscopy; Sewing Needle.

A Modified Posterior Approach Preserves Femoral Head Oxgenation During Hip Resurfacing

In 11 patients, the oxygenation was measured in the superolateral quadrant of the femoral head during resurfacing with a modified posterior approach, designed to preserve the blood supply, using a gas-sensitive electrode. These were compared with measures from 10 patients in whom the standard posterior approach was used. The modified approach patients maintained a significantly ( P < .005) higher amount of relative oxygenation after the approach, 78% (standard deviation [SD], 45%) vs 38% (SD, 26%), and acetabular component implantation, 74% (SD, 56%) vs 20% (SD, 28%). The modified posterior approach, unlike the standard extended approach, does not significantly compromise the blood supply to the head; and we recommend this approach be considered for hip resurfacing.