Possible association between successful intubation via the right nostril and anatomical variations of the nasopharynx during nasotracheal intubation: a multiplanar imaging study

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

Anaesthesia and Intensive Care ◽

10.1177/0310057x7500300306 ◽

1975 ◽

Vol 3 (3) ◽

pp. 209-217 ◽

Cited By ~ 7

Author(s):

G. C. Fisk ◽

W. de C. Baker

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Squamous Metaplasia ◽

Nasotracheal Intubation ◽

Newborn Infants ◽

Respiratory Epithelium ◽

Lower Trachea ◽

Nasotracheal Tube ◽

Mucosal Changes ◽

The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

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The Role of the Right Prefrontal Cortex in Self-evaluation of the Face: A Functional Magnetic Resonance Imaging Study

Journal of Cognitive Neuroscience ◽

10.1162/jocn.2008.20024 ◽

2008 ◽

Vol 20 (2) ◽

pp. 342-355 ◽

Cited By ~ 69

Author(s):

Tomoyo Morita ◽

Shoji Itakura ◽

Daisuke N. Saito ◽

Satoshi Nakashita ◽

Tokiko Harada ◽

...

Keyword(s):

Prefrontal Cortex ◽

Face Recognition ◽

Inferior Frontal Gyrus ◽

Video Recording ◽

Imaging Study ◽

The Self ◽

Anterior Cingulate ◽

Precentral Gyrus ◽

Self Evaluation ◽

The Right

Individuals can experience negative emotions (e.g., embarrassment) accompanying self-evaluation immediately after recognizing their own facial image, especially if it deviates strongly from their mental representation of ideals or standards. The aim of this study was to identify the cortical regions involved in self-recognition and self-evaluation along with self-conscious emotions. To increase the range of emotions accompanying self-evaluation, we used facial feedback images chosen from a video recording, some of which deviated significantly from normal images. In total, 19 participants were asked to rate images of their own face (SELF) and those of others (OTHERS) according to how photogenic they appeared to be. After scanning the images, the participants rated how embarrassed they felt upon viewing each face. As the photogenic scores decreased, the embarrassment ratings dramatically increased for the participant's own face compared with those of others. The SELF versus OTHERS contrast significantly increased the activation of the right prefrontal cortex, bilateral insular cortex, anterior cingulate cortex, and bilateral occipital cortex. Within the right prefrontal cortex, activity in the right precentral gyrus reflected the trait of awareness of observable aspects of the self; this provided strong evidence that the right precentral gyrus is specifically involved in self-face recognition. By contrast, activity in the anterior region, which is located in the right middle inferior frontal gyrus, was modulated by the extent of embarrassment. This finding suggests that the right middle inferior frontal gyrus is engaged in self-evaluation preceded by self-face recognition based on the relevance to a standard self.

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Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

Anatomy Research International ◽

10.1155/2012/838179 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Theodoros Mariolis-Sapsakos ◽

Vasileios Kalles ◽

Konstantinos Papatheodorou ◽

Nikolaos Goutas ◽

Ioannis Papapanagiotou ◽

...

Keyword(s):

Bile Ducts ◽

Hepatic Duct ◽

Anatomical Variations ◽

Common Hepatic Duct ◽

Drainage Pattern ◽

Left Hepatic Duct ◽

Surgical Interventions ◽

Drainage Patterns ◽

The Common ◽

The Right

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

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Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck

Diagnostics ◽

10.3390/diagnostics10090670 ◽

2020 ◽

Vol 10 (9) ◽

pp. 670

Author(s):

Alison M. Thomas ◽

Daniel K. Fahim ◽

Jickssa M. Gemechu

Keyword(s):

Recurrent Laryngeal Nerve ◽

Surgical Procedures ◽

Anatomical Variations ◽

Laryngeal Nerve ◽

Inferior Thyroid Artery ◽

Branching Pattern ◽

The Right ◽

Relationship Of ◽

Intrinsic Laryngeal Muscles ◽

Formalin Fixed

Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally. Our findings indicate that extra-laryngeal branches coming off the RLN on both the right and left side innervate the esophagus, trachea, and mainly intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2–5 extra-laryngeal branches. On the left, 74.6% of the cadavers demonstrated 2–3 extra-laryngeal branches. In relation to the inferior thyroid artery (ITA), 67.9% of right RLNs were located anteriorly, while 32.1% were located posteriorly. On the other hand, 32.1% of left RLNs were anterior to the ITA, while 67.9% were related posteriorly. On both sides, 3–5% of RLN crossed in between the branches of the ITA. Anatomical consideration of the variations in the course, branching pattern, and relationship of the RLNs is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy and anterior cervical discectomy and fusion (ACDF) surgery. The information gained in this study emphasizes the need to preferentially utilize left-sided approaches for ACDF surgery whenever possible.

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Bilateral anatomical variations of the hand extensors

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i2.19481 ◽

2016 ◽

Vol 15 (2) ◽

pp. 278-282

Author(s):

Humberto Ferreira Arquez

Keyword(s):

Anatomical Variation ◽

Medical Science ◽

Ring Finger ◽

Anatomical Variations ◽

Extensor Digitorum ◽

Left Hand ◽

Extensor Tendons ◽

Right Hand ◽

The Right ◽

Little Finger

Background: The purpose of this paper is to describe an anatomical variation of the hand extensor on the little finger of the right hand which receives four tendons, condition unknown, as it is the first case reported so far in the literature. The human extensor tendons of hand often display an array of variations. Awareness of the anatomy and variations of the extensor tendons on the dorsum of the hand is necessary not only for the anatomist but also for surgeons when considering tendons for hand surgery, tendon rerouting or transplants. Materials and Methods: Bilateral anatomical variation in the upper limb was found during routine dissection in a 75-year-old male cadaver in the Morphology Laboratory at the University of Pamplona. The variations were recorded and photographed. Result: In the left hand the extensor digitorum there was a single tendon to the index, double tendon to the middle, triple tendon to the ring finger, a single tendon to the little finger or digiti minimi. The extensor digiti minimi has double tendon. In the right hand the extensor digitorum there was a single tendon to the index, triple tendon to the middle finger, triple tendons to the ring finger, a double tendon to the little finger. The extensor digiti minimi has double tendon. The little finger receives four tendons, 2 of extensor digitorum and 2 of extensor digiti minimi. The dorsum of the left hand and right showed juncturae tendinum type 2, between the extensors tendons in the 3rd intermetacarpal space; type 3, between the extensors tendons in the 4th inter metacarpal space. Conclusion: The presence of multiple tendons may alter the kinematics around the site of attachment to the phalanx. Knowledge of anatomical variations and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.278-282

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Aberrant Frontostriatal Connectivity in Negative Symptoms of Schizophrenia

Schizophrenia Bulletin ◽

10.1093/schbul/sby165 ◽

2018 ◽

Vol 45 (5) ◽

pp. 1051-1059 ◽

Cited By ~ 10

Author(s):

Dinesh K Shukla ◽

Joshua John Chiappelli ◽

Hemalatha Sampath ◽

Peter Kochunov ◽

Stephanie M Hare ◽

...

Keyword(s):

Functional Connectivity ◽

Negative Symptom ◽

Negative Symptoms ◽

Imaging Study ◽

Anterior Cingulate ◽

Functional Magnetic Resonance ◽

Resting State Functional Connectivity ◽

Symptom Scale ◽

Distinct Component ◽

The Right

AbstractNegative symptoms represent a distinct component of psychopathology in schizophrenia (SCZ) and are a stable construct over time. Although impaired frontostriatal connectivity has been frequently described in SCZ, its link with negative symptoms has not been carefully studied. We tested the hypothesis that frontostriatal connectivity at rest may be associated with the severity of negative symptoms in SCZ. Resting state functional connectivity (rsFC) data from 95 mostly medicated patients with SCZ and 139 healthy controls (HCs) were acquired. Negative symptoms were assessed using the Brief Negative Symptom Scale. The study analyzed voxel-wise rsFC between 9 frontal “seed regions” and the entire striatum, with the intention to reduce potential biases introduced by predefining any single frontal or striatal region. SCZ showed significantly reduced rsFC between the striatum and the right medial and lateral orbitofrontal cortex (OFC), lateral prefrontal cortex, and rostral anterior cingulate cortex compared with HCs. Further, rsFC between the striatum and the right medial OFC was significantly associated with negative symptom severity. The involved striatal regions were primarily at the ventral putamen. Our results support reduced frontostriatal functional connectivity in SCZ and implicate striatal connectivity with the right medial OFC in negative symptoms. This task-independent resting functional magnetic resonance imaging study showed that medial OFC–striatum functional connectivity is reduced in SCZ and associated with severity of negative symptoms. This finding supports a significant association between frontostriatal connectivity and negative symptoms and thus may provide a potential circuitry-level biomarker to study the neurobiological mechanisms of negative symptoms.

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Non-recurrent inferior laryngeal nerve: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20204159 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3469

Author(s):

Shah Urvin Manish ◽

Boopathi Subbarayan ◽

Saravanakumar Subbaraj ◽

Tirou Aroul Tirougnanassambandamourty ◽

S. Robinson Smile

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nodular Goiter ◽

Anatomical Variations ◽

Laryngeal Nerve ◽

Anatomical Landmarks ◽

Inferior Laryngeal Nerve ◽

Nonrecurrent Inferior Laryngeal Nerve ◽

Aged Woman ◽

Middle Aged Woman ◽

The Right

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

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The role of the basolateral amygdala in the perception of faces in natural contexts

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2015.0376 ◽

2016 ◽

Vol 371 (1693) ◽

pp. 20150376 ◽

Cited By ~ 12

Author(s):

Ruud Hortensius ◽

David Terburg ◽

Barak Morgan ◽

Dan J. Stein ◽

Jack van Honk ◽

...

Keyword(s):

Basolateral Amygdala ◽

Complex Structure ◽

Dorsal Stream ◽

Imaging Study ◽

Control Group ◽

Precentral Gyrus ◽

Functional Magnetic Resonance ◽

Context Processing ◽

The Right

The amygdala is a complex structure that plays its role in perception and threat-related behaviour by activity of its specific nuclei and their separate networks. In the present functional magnetic resonance imaging study, we investigated the role of the basolateral amygdala in face and context processing. Five individuals with focal basolateral amygdala damage and 12 matched controls viewed fearful or neutral faces in a threatening or neutral context. We tested the hypothesis that basolateral amygdala damage modifies the relation between face and threatening context, triggering threat-related activation in the dorsal stream. The findings supported this hypothesis. First, activation was increased in the right precentral gyrus for threatening versus neutral scenes in the basolateral amygdala damage group compared with the control group. Second, activity in the bilateral middle frontal gyrus, and left anterior inferior parietal lobule was enhanced for neutral faces presented in a threatening versus neutral scene in the group with basolateral amygdala damage compared with controls. These findings provide the first evidence for the neural consequences of basolateral amygdala damage during the processing of complex emotional situations.

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VARIATION IN THE STRUCTURE OF LEVATOR GLANDULAE THYROIDEA – A CASE REPORT

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703872 ◽

2015 ◽

Vol 05 (01) ◽

pp. 086-087

Author(s):

Raghavendra A Y. ◽

Vishal Kumar ◽

Vinay Kumar V. ◽

Harsha C R.

Keyword(s):

Thyroid Gland ◽

Hyoid Bone ◽

Anatomical Variations ◽

Treatment Modalities ◽

Endocrine Gland ◽

Anterior Aspect ◽

Pyramidal Lobe ◽

Inferior Border ◽

The Right ◽

First Time

AbstractThe thyroid gland is an important and easily approachable endocrine gland, situated in the lower part of anterior aspect of neck. The Levator glandulae thyroidea (LGT) is a fibro-musculo-glandular band. It is usually present on the left side connecting the pyramidal lobe of thyroid gland to the hyoid bone. During the routine dissection of neck it was observed that the LGT was present on the right side of midline of neck extending from pyramidal lobe of the right side of isthmus of thyroid gland to the inferior border of hyoid bone. It was muscular throughout with 6.5cm in length, 1.5cm breadth and 1.75mm in its thickness. This is a rare variation in the morphology and situation of LGT observed for the first time. The presence of LGT and its anatomical variations gain importance in the pathologies related to thyroid gland and their treatment modalities.

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