Upper Pole Research Articles

Mastopexie nach massivem Gewichtsverlust – Erweiterte Ribeiro-Technik und Einsatz der lateralen Interkostalarterien-Perforatorlappenplastik (LICAP-Flap) zur Autoaugmentation

Mastopexy in massive weight loss patients is challenging. The breast mound is often unstable and deflated, with a loose inelastic skin envelope. It has become apparent that mammaplasty techniques in these cases should rely more on glandular recontouring rather than on the skin envelope for shaping. Published methods include plication, suspension and autoaugmentation. The residual local tissue (glandular breast tissue, fat tissue, dermoglandular fat flap) is utilised to its full extent in order to reshape a form-stable breast with full upper pole projection. The evolution of a technique is presented. In this study we retrospectively analysed 68 massive weight loss patients who underwent an extended Ribeiro technique with a superomedial pedicle mastopexy and suspension by an inferior dermoglandular flap. The current procedure involves incorporating the lateral intercostal artery perforator flap (LICAP flap) and medial breast pillar additionally to the inferior dermoglandular Ribeiro flap. This essentially autoaugments the upper pole by creating an "autoprosthesis", narrows the widened breast, and redefines the inframammary fold. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensibility and surgical revision rate were obtained. From 01/2011 to 12/2016, we performed 136 autoaugmentation mastopexies. The average age was 41.2 years, average body mass index (BMI) was 27,1 kg/m2, average weight loss was 54.3 kg, average sternal notch-NAC distance was 32.3 cm, average operation time was 109 minutes. In 12 breasts, a free-nipple graft was necessary. The complication rate was 5.1 %, surgical revision rate was 17.6 %. 95 % of the patients were "very satisfied" or "satisfied" with the aesthetic result. Nipple sensibility was rated as "very good" or "good" by 85 % of patients. Modification of the Ribeiro technique by using the medial and lateral breast pillar (LICAP flap) allows autoaugmentation of the upper pole. Parenchymal shaping through plication and suspension of the breast mound should improve breast shape over time, with the aim of reducing the incidence of recurrent ptosis. The presented technique is a reproducible and reliable method with a low complication rate.

Die Ribeiro-Technik bei Gigantomastie – Review von 294 Reduktionsplastiken in 8 Jahren

Reduction mammaplasty in patients with gigantomastia is challenging even to very experienced plastic surgeons. Extremely elongated pedicles impair the vascular supply of the nipple-areola complex. Breast shaping and effective reduction are difficult due to the severely stretched skin envelope. The Ribeiro technique is the standard technique for reduction mammaplasty in our clinic. The aim of this study is to review our approach in patients with gigantomastia in comparison to the current literature. From 01/2009 to 12/2016, we performed 1247 reduction mammaplasties in 760 patients. In 294 reduction mammoplasties (23.6 %), resection weight was more than 1000 g per breast corresponding to the definition of gigantomastia. The Ribeiro technique with a superomedial pedicle and inferior dermoglandular flap for autologous augmentation of the upper pole was implemented as standard procedure. In cases with a sternal notch-nipple distance > 40 cm, free nipple grafting was performed. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and surgical revision rate were obtained and retrospectively analysed. In 174 patients, 294 reduction mammaplasties were performed with a resection weight of more than 1000 g per breast. Average resection weight was 1389.6 g (range, 1000-4580 g). Average age was 43.5 years (range, 18-76 years), average body mass index (BMI) was 29.2 kg/m2 (range, 19-40 kg/m2), average sternal notch-nipple distance was 34.8 cm (range, 27-52 cm), average operation time was 117 minutes (range, 72-213 minutes). A free nipple graft was necessary in 30 breasts. Overall complication rate was 7.8 %; secondary surgical revision rate was 16 %. 93 % of the patients were "very satisfied" and "satisfied" with the aesthetic result. Nipple sensitivity was rated "very good" and "good" in 88 %. The Ribeiro technique is a well established, versatile standard technique for reduction mammaplasty, which helps to create high-quality reproducible results with longterm formstable shape. In gigantomastia, this procedure is also very effective to achieve volume reduction and aesthetically pleasing results with a low complication rate.

Unilateral renal cystic disease in a 15-year-old female: A left huge kidney associated with significant morbidity

Unilateral renal cystic disease (URCD) is a rare nonfamilial, nonprogressive disorder of one kidney and is not related with autosomal dominant polycystic kidney disease. The present case is a report of a 15-year-old female who had a huge multicystic mass involving the lower and middle part of the left kidney with normal minimal residual renal parenchyma at the upper pole. All the laboratory tests were within normal limits. The right kidney was entirely normal. Left nephrectomy was performed because of a significant morbidity. Here, the clinic, radiologic and pathologic findings are described and their differential diagnosis is discussed.

Curative resection by splenectomy for solitary splenic metastasis from early gastric cancer: a case report and literature review

BackgroundSolitary metastasis of a malignancy to the spleen is rare, particularly for gastric cancer. Only a few case reports have documented isolated splenic metastasis from early gastric cancer. We describe a case of splenic metastasis from early gastric cancer.Case presentationA 60-year-old man underwent a distal gastrectomy for early gastric cancer. It infiltrated the submucosa with pathological nodal involvement (pT1bN2M0, stage IIB). One year after the gastrectomy, an abdominal computed tomography scan showed a low-density lesion, 17 mm in diameter, at the upper pole of the spleen. Positron emission tomography/computed tomography showed focal accumulation of fluorine-18 fluorodeoxyglucose in the spleen without extrasplenic tumor dissemination or metastasis. We diagnosed splenic metastasis of gastric cancer, and performed a splenectomy. Histological examination confirmed moderately differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma (solid type) that was consistent with the features of the primary gastric cancer. The splenic tumor was pathologically and immunohistochemically diagnosed as a metastasis from the gastric carcinoma. More than 18 months after the splenectomy, the patient has had no evidence of recurrent gastric cancer.ConclusionWhen solitary metastasis to the spleen is suspected during the postoperative follow-up of a patient with gastric cancer, a splenectomy is a potentially effective treatment.

Néphrectomie partielle pour tumeur de Wilms unilatérale chez l’enfant : est-ce pertinent ?

Wilms tumors (WTs) are the most frequent renal tumors in children. Radical nephrectomy (RN) remains the gold-standard surgical treatment for this type of cancer. Excellent results in overall survival (>90%) make it possible to consider nephronic preservation. The objective of this systematic review is to evaluate the relevance of nephron-sparing surgery (NSS) for the treatment of nonsyndromic unilateral Wilms tumor (UWT) in children. Articles in English related to "unilateral Wilms tumor, unilateral nephroblastoma, partial nephrectomy, nephron-sparing surgery, renal function" identified in the Medline library were screened and data were extracted to perform a qualitative systematic review. We identified 377articles, 14 of which were integrated into the analysis. Data on 4288children were included, 3994 (93.1%) underwent RN, whereas 294 (6.8%) underwent NSS. StageI anatomopathology resulted in 55.1% RN and 79% NSS. Overall survival and event-free survival were similar: respectively 95.7% and 92.8% after RN and 96 and 90.5% after NSS. Positive margin status was higher after NSS (8.5% vs 0.5%), but tumor rupture and local tumor recurrences were similar. The rate of mild to moderate renal function was higher after RN (42% vs 10% after NSS). NSS is regularly performed for WT in case of bilateral or syndromic tumors, but the literature considering UWT does not show consensus. The superiority of NSS for renal outcomes has now been fully evaluated, but the main problem of this surgery in case of UWT is to ensure oncologic outcomes as good as outcomes after RN. WTs are usually massive tumors for which partial nephrectomy is contraindicated, but studies showed that chemotherapy before surgery could reduce tumor volume and make NSS possible. This review shows that NSS results seem to be as good as RN results and that preoperative chemotherapy should be highlighted for its participation in the reduction of the positive margin status. Although radiotherapy is used with caution because of its side effects, some studies showed that it gave excellent results for oncologic salvage after local recurrence. Constant progress in medical imaging and detection systems has led to the emergence of a new type of assistance for surgeons such as image reconstruction and vessel or urinary tract system segmentation. Virtual simulation of the operation based on a real case should help evaluate the feasibility of complex procedures in the near future. NSS for UWT seems to be a credible therapeutic alternative. New technologies such as 3Dreconstruction should help surgeons define the best parameters to select ideal tumors for this surgery in the near future. For the moment, small tumors (<4cm), distant from the renal hilum (ideally on the upper pole) that respect at least 50% of the renal parenchyma (ideally superficial with exophytic development) seem to be the perfect indication for NSS.

Percutaneous Management of Stone Containing Calyceal Diverticula: Associated Factors and Outcomes

We evaluated the outcomes of percutaneous treatment and metabolic evaluation of calyceal diverticula with associated stones. We retrospectively identified 51 patients with a calyceal diverticulum in our prospectively maintained percutaneous nephrolithotomy database. Patients with complete data were separated into 14 with stones isolated to the diverticulum and 15 with renal stones in and outside the diverticulum. A total of 571 patients with renal stones but no diverticulum were used for comparison. Statistical differences were assessed using the chi-square test and the t-test. Patients with stones isolated to the diverticulum were younger (44 vs 54 years, p = 0.024), had a lower body mass index (23.2 vs 27 kg/m2, p = 0.032) and were more often female (71% vs 44%, p = 0.046) compared to patients with renal stones but no diverticulum. Calyceal diverticula were anterior in 19 of 29 cases and in the upper pole in 15. Average diverticular size was 2.5 cm with a 1.5 cm stone burden. Percutaneous treatment was successful in 96% of patients with a 4% complication rate. The diverticular neck was dilated in 22 of 51 patients (43%). During 5-year followup in the 51 patients there was 1 stone recurrence, which was managed by ureteroscopy, while 46 and 5 patients showed complete absence and reduction of the diverticulum, respectively. Of the calyceal diverticular stones 82% contained calcium phosphate compared to only 33% in patients with renal stones but no diverticulum. All patients with a diverticulum had at least 1 metabolic derangement. Percutaneous treatment of calyceal diverticula is safe and effective regardless of size or location, including anterior diverticula. Infundibular neck dilation does not appear to be necessary. There are metabolic abnormalities in a significant proportion of patients with a calyceal diverticulum.

Respectively right upper pole then left upper pole are retracted by using a moderate amount of tension

Respectively right upper pole then left upper pole are retracted by using a moderate amount of tension

MP50-09 ROBOTIC FLEXIBLE URETEROSCOPIC TREATMENT OF RENAL AND URETERAL CALCULI: FIRST-IN-MAN EXPERIENCE WITH A NOVEL ROBOTIC SYSTEM

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2017MP50-09 ROBOTIC FLEXIBLE URETEROSCOPIC TREATMENT OF RENAL AND URETERAL CALCULI: FIRST-IN-MAN EXPERIENCE WITH A NOVEL ROBOTIC SYSTEM Mihir Desai, Shashikant Mishra, Abhishek Singh, Ravindra Sabnis, Arvind Ganpule, and Mahesh Desai Mihir DesaiMihir Desai More articles by this author , Shashikant MishraShashikant Mishra More articles by this author , Abhishek SinghAbhishek Singh More articles by this author , Ravindra SabnisRavindra Sabnis More articles by this author , Arvind GanpuleArvind Ganpule More articles by this author , and Mahesh DesaiMahesh Desai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1597AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present the first in man experience with the Robotic Endoscopy System (RES) for the treatment of renal and ureteral calculi. METHODS The RES is a novel system comprised of a remote-driven robotic flexible ureteroscope and robotic access sheath. The robotic ureteroscope incorporates digital optics and the system has the ability to control the laser fiber and irrigation inflow-outflow remotely. The system has a stroke length to navigate the collecting system from the urethra to the kidney. The primary performance endpoint was completion of the intended procedure; the primary safety endpoint was incidence of perioperative complication. The RES performance was graded on a visual analog scale of 1 (worst) to 10 (best) for stability, ease of locating stones, ability to fragment, control and visualization. P values were calculated using the Mann-Whitney U test or Fisher's exact test. RESULTS Of 18 screened adult patients, 16 underwent flexible robotic ureteroscopy (11 with 1; 4 with 2 and 1 with 3 stones). Two patients were excluded intraoperatively due to ureteral strictures. The twenty-two treated stones were distributed throughout the collecting system (n = 7 lower pole, n = 5 renal pelvis, n = 5 interpolar, n = 3 upper ureter, n = 1 upper pole and n = 1 distal ureter). Median stone size was 10 (6 to 20) mm. All procedures were completed successfully using robotic control. One patient experienced fever (101°F) that resolved without intervention. Overall, median total procedure time (TPT) was 73.5 (range = 21 to 131) minutes; median total robot time (TRT) was 42 (6 to 99) minutes. In patients with a single stone only, median TPT decreased from 98 (50 to 131) minutes (first 5 cases) to 40 (21 to 77) minutes (last 6 cases), P = 0.036; median TRT also decreased from 44 (20 to 89) minutes (first 5 cases) to 19.5 (6 to 43) minutes (last 6 cases), P = 0.055. In 5 patients with lower pole stones, median TPT was 50 (21 to 131) minutes; median TRT was 20 (16 to 76) minutes. Stability, ease of locating stone and control, as evaluated by number of scores greater than 9, improved significantly in the last 6 cases(P = 0.035). CONCLUSIONS The robotic ureteroscopy with calculi lithotripsy is safe and feasible using the RES. Future comparative studies to manual ureteroscopy are warranted. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e687 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mihir Desai More articles by this author Shashikant Mishra More articles by this author Abhishek Singh More articles by this author Ravindra Sabnis More articles by this author Arvind Ganpule More articles by this author Mahesh Desai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Do renal stones that fail lithotripsy require treatment?

The rates of extracorporeal shock wave lithotripsy (SWL) appear stable in the UK. However, there is little evidence on the natural history of these calculi if SWL fails. We set to look at the effectiveness of SWL in patients with a single, previously untreated renal stone and the natural history of those stones that failed treatment. We retrospectively reviewed all data from our prospectively collected database of patients undergoing a first treatment for a single renal stone between October 2010 and November 2013. Outcomes after SWL were categorised as success, subsequent intervention needed or conservative management. The medical records of patients managed conservatively were reviewed to determine whether further intervention was required and why. We further sought to define, in those patients where SWL failed, whether subsequent active intervention was needed. For the remainder, we examined whether conservative management was a reasonable management option. 313 patients fitted the inclusion criteria. Of these, 144 were treated successfully. Of the 170 patients with a residual stone, 51 went on to flexible ureteroscopy directly at their next clinical review mainly due to persistent symptoms. 79 patients were managed conservatively, and for 39 follow-up data were unavailable as their follow-up was at a different hospital. 63 patients (80%) were successfully managed conservatively with no recurrence of symptoms over the follow-up period (mean 2years 4months). 16 (20%) patients that were initially managed conservatively required subsequent intervention. Of these, 87% had a stone in an upper pole calyx. Conservative management of renal stones after failed SWL is a suitable option for asymptomatic patients with stones not located in the upper pole. For patients with upper pole stones, early intervention is warranted due to the high risk of requiring intervention.

Nephron-sparing surgery in multiple renal cancer: a case report

BACKGROUND: In the last decade, nephron-sparing surgery has largely supplanted the radical approach for the treatment of small renal masses. More recently, ablative technologies have been discussed as alternative in patients that are not eligible for surgical approach.CASE SUMMARY: A 54-year-old Caucasian man was referred to our Urology Clinic for multiple renal masses. A computed tomography (CT) scan revealed three contrast-enhanced lesions located in the upper pole, middle renal, and in the lower pole of the left kidney 20 mm, 25 mm, and 45 mm long, respectively. The patient underwent laparoscopic tumorectomy of two lesions and cryoablation of the left renal mass by the transperitoneal approach, performed without clamping the renal vessels. At the end of the procedure the operator posed a reno-ureteral ipsilateral stent to tutor the urinary tract. Tumor enucleation and cryoablation were chosen to preserve renal function.CONCLUSION: This case report shows that in young patients with multiple renal tumors, cryoablation treatment is feasible and outcomes are promising as well. However, risk of complications should be considered and discussed with patients.

Muscle Strength Endurance Testing Development Based Photo Transistor with Motion Sensor Ultrasonic

The endurance of upper-body muscles is one of the most important physical fitness components. As technology develops, the process of test and assessment is now getting digital; for instance, there are a sensor stuck to the shoe (Foot Pod, Polar, and Sunto), Global Positioning System (GPS) and Differential Global Positioning System (DGPS), radar, photo finish, kinematic analysis, and photocells. Those devices aim to analyze the performances and fitness of athletes particularly the endurance of arm, chest, and shoulder muscles. In relation to that, this study attempt to create a software and a hardware for pull-ups through phototransistor with ultrasonic motion sensor. Components needed to develop this device consist of microcontroller MCS-51, photo transistor, light emitting diode, buzzer, ultrasonic sensor, and infrared sensor. The infrared sensor is put under the buffer while the ultrasonic sensor is stuck on the upper pole. The components are integrated with an LED or a laptop made using Visual Basic 12 software. The results show that pull-ups test using digital device (mean; 9.4 rep) is lower than using manual calculation (mean; 11.3 rep). This is due to the fact that digital test requires the test-takers to do pull-ups perfectly.

Shear wave elastography of the testes inahealthy study collective - Differences instandard values between ARFI andVTIQtechniques.

Shear wave elastography (SWE) is a recent technique in the assessment of tissue elasticity. Different elastography techniques have been described over the years.Acoustic Radiation Force Impulse Imaging (ARFI) uses mechanical excitation of tissue to create detectable shear waves, a higher shear wave velocity being associated with an increased tissue stiffness.The Virtual Touch Tissue Imaging Quantification (VTIQ) method uses a mechanical push pulse as well, additionally creating a colour-coded map, in which tissue stiffness can be measured within a stored map on the ultrasound device after measurement.ARFI has been used in determining standard values in testes of a healthy study collective, VTIQ has already been used in the evaluation of unclear scrotal masses.Both techniques allow an operator-independent examination without application of mechanical pressure. The aim of this study was to determine whether there is a statistically significant difference between shear wave velocity values of both techniques in a healthy collective. Twenty patients without known testicular pathology underwent standard B-mode sonography and additional shear wave elastography in the ARFI mode as well as the VTIQ technique of both testes using the Siemens Acuson S2000™ and S3000™ ultrasound devices (Siemens HealthCare, Erlangen, Germany).Measurements of shear wave velocity were performed in the upper pole, the central portion and the lower pole separately for each testis. Values were described in m/s.Statistical evaluation was performed using paired t-test analysis. We measured a mean shear wave velocity of 0.81 m/s using ARFI and 1.07 m/s with VTIQ.Shear wave velocities determined by VTIQ were all significantly higher than values gained in the ARFI mode. (p < 0.001 to p = 0.007). Values were between 0.22 and 0.29 m/s higher, when the examination was performed using VTIQ. ARFI and VTIQ elastography modes both proved to be feasible techniques in the assessment of testicular tissue elasticity. Consideration of higher values for VTIQ is important, when different elastography measurement results are compared, especially for the application of devices in a clinical setting, e.g. in the work-up of scrotal masses.A calculable factor for a comparison between both devices is desirable, but to be further assessed in largerstudies.

Differences of standard values of Supersonic shear imaging and ARFI technique - in vivo study of testicular tissue.

To investigate the difference of standard values of Supersonic shear imaging (SSI) and Acoustic Radiation Force Impulse (ARFI) technique in the evaluation of testicular tissue stiffness in vivo. 58 healthy male testes were examined using B-mode sonography and ARFI and SSI. B-mode sonography was performed in order to scan the testis for pathologies followed by performance of real-time elastography in three predefined areas (upper pole, central portion and lower pole) using the SuperSonic® Aixplorer ultrasound device (SuperSonic Imagine, Aix-en-Provence, France). Afterwards a second assessment of the same testicular regions by elastography followed using the ARFI technique of the Siemens Acuson 2000™ ultrasound device (Siemens Health Care, Germany). Values of shear wave velocity were described in m/s. Parameters of elastography techniques were compared using paired sample t-test. The values of SSI were all significantly higher in all measured areas compared to ARFI (p < 0.001 to p = 0.015). Quantitatively there was a higher mean SSI wave velocity value of 1,1 compared to 0.8 m/s measured by ARFI. SSI values are significantly higher than ARFI values when measuring the stiffness of testicular tissue and should only be compared with caution.

A new method of subtotal thyroidectomy for Graves' disease leaving a unilateral remnant based on the upper pole.

Background:The aim of this prospective randomized study was to evaluate the feasibility of subtotal thyroidectomy with leaving a unilateral remnant based on the upper pole.Methods:Patients who underwent the subtotal thyroidectomy and isthmusectomy leaving either a unilateral remnant based on the upper pole (Group I, 79 patients) or the bilateral dorsal thyroid tissue remained (Group II, 89 patients) were compared in operation time, blood loss, recurrence, and postoperative complications.Results:Among 168 patients analyzed, the operation time remained similar, but the blood loss, the reoperation time, and recurrence in Group I were much less than Group II. In addition, no postoperative hemorrhage occurred in Group I. Two patients (2.28%) in Group II underwent recurrent laryngeal nerve damages. Four patients (5.06%) in Group I and 3 patients (3.37%) in Group II experienced transient hypocalcemia. Recurrence only occurred in Group II.Conclusion:In terms of blood loss, reoperation time, postoperative complication, and the recurrence, subtotal thyroidectomy with recurrent laryngeal nerves identification and the unilateral superior pole remnant of the gland provides a better outcome than subtotal thyroidectomy with bilateral dorsal thyroid tissue remnant.

The Telemark Breast Score: a Valid Method for Evaluation of Outcome after Breast Surgery.

Background:“Telemark Breast Score” (TBS) has been developed at Telemark Hospital in Norway for evaluation of results after breast surgery based on standardized patients’ photographs taken as a part of daily routine. Its reliability has recently been tested and approved. The external validity of the TBS was assessed by matching its data against the internationally recognized Breast-Q (BQ) questionnaire as a further step to study the validity of this new tool.Methods:The ideal distribution of breast volume is 45% of the total volume above and 55% below the nipple, and a 40° slope line at the upper pole. TBS makes the evaluation of these parameters of breast aesthetics more explicit. The method has been tested on photographs from 31 patients operated on for breast cancer with the Deep Inferior Perforator Flap. The evaluation was done by an independent experienced plastic surgeon earlier participating in the test–retests. The external validity of TBS was investigated against domains 1 and 3 of the BQ reconstruction module. The concordance between ratings was analyzed.Results:Concordance between TBS items and BQ domain 1 items regarding patient satisfaction, and between TBS items and BQ domain 3 items regarding how the patient experienced the outcome of breast reconstruction was relatively high except for 6 comparisons where we could not statistically ensure that more pairs were concordant than discordant. A total of 178 comparisons appeared to be concordant. This means that for all other comparisons, there was a preponderance of pairs of concordant observations, which indicates that measurements from the 2 instruments follow each other.Conclusion:The present data indicate that the TBS can be recommended as a valid tool to professionals for assessment of the outcome after breast reconstruction.

Identification of the specific topographic features of the neck vessels for the prevention of bleedings during tonsillectomy

The objective of the present work was to study syntopy of the large neck vessels in relation to the capsule of palatine tonsils with the use of the MRI technology. A total of 109 patients (218 palatine tonsils) presenting with chronic tonsillitis were available for the examination including 64 women and 45 men at the age varying from 15 to 54 years. All of them underwent MRI-guided vascular visualization in the paratonsillar region together with the measurements of the vessels extending to the capsule of the palatine tonsils at the level of the upper and lower poles, and also close to the mid-third of each palatine tonsil. The distance from the external carotid artery to the upper and lower poles of the palatine tonsils was found to be 17.1±1.01 mm and 10.3±0.18 mm respectively and in the mid-third the palatine tonsil 10.7±0.12 mm; the distance from the internal carotid artery to the upper and low poles of the palatine tonsil amounted to 14.5±0.84 mm and 16.8±0.77 mm respectively while that to the mid-third of the palatine tonsil was 15.3±0.07 mm. The branches of the external carotid artery feeding the palatine tonsils are the most frequent sources of bleedings; the following measurements were obtained: the maxillary artery 16.4±0.43 mm (17.4%) - the upper pole 9.6±0.02 mm (46.2%), the mid-third of the palatine tonsil 18.5±0.74 mm (29.5%) - the lower pole; the lingual artery 4.7±0.02 mm (6.8%) - the mid-third of the palatine tonsil, 6.2±0.82 mm (56.8%) - the lower pole; facial artery: 4.2±0.01 mm (0.76%) - the mid-third of the palatine tonsil; the occipital artery 25.6±0.12 mm (19%) - the upper pole; 14.8±0.11 mm (18.9%) - the mid-third of the palatine tonsil 9.56±0.12 mm (3.8%) - the lower pole; the tonsillar artery 1.88±0.01 mm (9.8%) - the upper pole; 2.51±0.01 mm (23%) - the mid-third of the palatine tonsil; 2.12±0.01 mm (11%) - the lower pole. The distance from the internal jugular vein to the capsule of the palatine tonsils in the region of the upper pole of the palatine tonsil was 28.3±1.01 mm, in the lower pole region 26.6±1.54 mm, and in the region of the mid-third of the palatine tonsil 22.7±1.24 mm. It is concluded that the results of the present study may be useful for the planning of the surgical strategy for the treatment of the patients presenting with chronic tonsillitis and for the prevention of hemorrhagic complications of tonsillectomy.

Classical Methods of Tissue Studies: The Artifacts and the Impact of Transverse Serial Sections

This work aims to study the mechanism of appearance of the histological alterations inherent in classical methods of tissue study and to give the difficulties related to the incidence of transverse serial sections. 4 lefts and rights testes were taken from two immature rats aged between 11 and 12 days. The testes were taken under anesthesia by ether inhalation. The gonads were fixed in 10% formic aldehyde and dehydrated in alcohol and then included in the paraffin. The ribbon of transverse serial sections of 5 μm were made by a microtome from the upper pole to the lower pole of the testes. The portions of the ribbon were then spread on slides. The smears were stained with hemalun-eosin and then covered with coverslip. The observation of transverse serial sections presented different types of degradation on them caused by technology. This involves deforming the contours of sections characterized by dye deposits, albuginea folds, tearing or destruction of the seminiferous tubes and then the formation of artificial vacuum between the tubes in the testicular parenchyma. It resulted from the stage of section, the loss of the three-dimensional (3D) coherence of the testes, generating the images visualized in a plan in a two-dimensional (2D) plane resulting from the serial histological sections. The results of this study show that the steps of the methods of tissue study are major factors that can condition the success or failure of reading the results of the histological technique. This study invites us to consider artefacts that combine artificial images created by classical methods of tissue study. In addition, images visualized in a plan with two dimensions (2D) do not allow a direct assessment of the spatial configuration. Thus, a better understanding of the structures, a correction of deformities and a three-dimensional reconstitution (3D) could improve compliance.

Lymphangiomatous Polyp Presenting as Tonsillar Mass

A 19-year-old female presented to ENT OPD of Dhulikhel Hospital, Kathmandu University Hospital, with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. There is no history of difficulty swallowing or recurrent throat infection. Physical examination revealed a pedunculated mass arising from upper pole of left tonsil. Bilateral tonsillectomy was done under general anaesthesia. Grossly, 2.5 × 1.5 × 1 cm polypoidal mass, soft in consistency, was found to be attached to left tonsil. Histopathology report was consistent with lymphangiomatous polyp of tonsil. Postoperative period was uneventful and she was normal during her follow-up at 1 month with bilateral healthy tonsillar fossa.

Giant Cavernous Hemangioma of the Adrenal Gland: Case Report and Review of the Literature

Adrenal tumors are nowadays being detected with increasing frequency due to the widespread use of various radiological imaging techniques (CT, MRI, US). Incidentally discovered adrenal masses (incidentalomas) are shown in 1% to 5% of all abdominal CT scans performed. Cavernous hemangiomas of the adrenal gland are extremely rare, benign in nature and most usually non-functioning lesions. We report a case of a 50-year-old female who presented with flank pain and abdominal discomfort. MRI of the abdomen revealed a large, oval, adrenal tumor mass, embedded between the upper pole of the right kidney and inferior surface of the liver. Surgery was performed, and tumor was excised completely. Histopathological examination revealed a cavernous hemangioma of the adrenal gland.

External laryngeal nerve to identify or not during thyroidectomy: a single-institute experience

Background Iatrogenic injury to the external branch of the superior laryngeal nerve (ESLN) may occur during thyroidectomy because of its close proximity to the upper pole of the thyroid gland. Injury to the ESLN results in postoperative voice changes, which may be severe, especially in professional voice users. Although the main principle in neck surgery is proper dissection and identification rather than avoidance of important structures for their preservation, many surgeons do not routinely identify the ESLN during thyroidectomy because the nerve has variable anatomical courses. This encouraged us to conduct this study to evaluate the incidence of ESLN injury during thyroidectomy when superior thyroid vessels were ligated individually close to thyroid capsule without prior identification of the nerve. Patients and methods The present study included 200 patients with goiters who underwent either total or hemithyroidectomy at the Department of Surgery, Medical Research Institute Hospital, Alexandria University. In all patients, superior thyroid vessels were ligated in branches very close to thyroid capsule without prior positive search for the ESLN. Results In the present study, 185 (92.5%) patients underwent total thyroidectomy, whereas the remaining 15 (7.5%) patients underwent hemithyroidectomy. Transient ESLN injury occurred in 3% of patients, whereas 2% suffered from permanent nerve injury. Conclusion Preservation of the ESLN is necessary during thyroidectomy, especially in professional voice users. Ligation of superior thyroid vessels in branches close to thyroid capsule without prior identification of the ESLN is a safe procedure and does not increase the incidence of nerve injury.