Endoscopic Anatomy of the Tensor Fold and Anterior Attic

Objectives The objectives of the study were to (1) study the anatomical variations of the tensor fold and its anatomic relation with transverse crest, supratubal recess, and anterior epitympanic space and (2) explore the most appropriate endoscopic surgical approach to each type of the tensor fold variants. Study Design Cadaver dissection study. Setting Temporal bone dissection laboratory. Subjects and Methods Twenty-eight human temporal bones (26 preserved and 2 fresh) were dissected through an endoscopic transcanal approach between September 2016 and June 2017. The anatomical variations of the tensor fold, transverse crest, supratubal recess, and anterior epitympanic space were studied before and after removing ossicles. Results Three different tensor fold orientations were observed: vertical (type A, 11/28, 39.3%) with attachment to the transverse crest, oblique (type B, 13/28, 46.4%) with attachment to the anterior tegmen tympani, and horizontal (type C, 4/28, 14.3%) with attachment to the tensor tympani canal. The tensor fold was a complete membrane in 20 of 28 (71.4%) specimens, preventing direct ventilation between the supratubal recess and anterior epitympanic space. We identified 3 surgical endoscopic approaches, which allowed visualization of the tensor fold without removing the ossicles. Conclusions The orientation of the tensor fold is the determining structure that dictates the conformation and limits of the epitympanic space. We propose a classification of the tensor fold based on 3 anatomical variants. We also describe 3 different minimally invasive endoscopic approaches to identify the orientation of the tensor fold while maintaining ossicular chain continuity.

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Classification of small type B/C follicles as primordial follicles in mature rats

Reproduction ◽

10.1530/reprod/119.1.43 ◽

2000 ◽

pp. 43-48 ◽

Cited By ~ 30

Author(s):

S Meredith ◽

G Dudenhoeffer ◽

K Jackson

Keyword(s):

Dna Synthesis ◽

Granulosa Cells ◽

Single Layer ◽

Reliable Indicator ◽

Type B ◽

Primordial Follicles ◽

Type C

In the present study, follicles were classified according to the morphology of their granulosa cells. Type B follicles contained only flattened granulosa cells; type B/C follicles had a mixture of flattened and cuboidal granulosa cells in a single layer, and type C follicles had a single layer of cuboidal granulosa cells. The primary objectives of the study were to determine whether 5-bromo-2-deoxyuridine incorporation into type B/C follicles was a marker for initiation of growth and how long type B/C follicles could remain at the same stage before transformation to type C follicles. Female Holtzman rats received bromo-deoxyuridine for 7 days. After the infusion (day minipumps were removed = day 0), rats were ovariectomized on days 0 (n = 9), 30 (n = 8), 90 (n = 8) and 150 (n = 9). The numbers of type B, B/C and C follicles within one ovary were determined using modified fractionator counting. Analysis over all times demonstrated that there were more (P < 0.0001) type B/C (941 +/- 61 per ovary) than type C (140 +/- 18 per ovary) or type B (159 +/- 19 per ovary) follicles. The numbers of type B and type C follicles did not differ from each other at any time. Only one of 34 rats evaluated had bromo-deoxyuridine-labelled type B follicles. On day 150, 57% of the bromo-deoxyuridine-labelled type B/C follicles remained from day 0. It is concluded that (1) DNA synthesis in granulosa cells of type B/C follicles is not a reliable indicator of impending growth; and (2) type B and type B/C follicles are both components of the pool of primordial follicles.

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Possible factors for ankle fractures

Vojnosanitetski pregled ◽

10.2298/vsp1003225t ◽

2010 ◽

Vol 67 (3) ◽

pp. 225-228 ◽

Cited By ~ 2

Author(s):

Dejan Tabakovic ◽

Radovan Manojlovic ◽

Marko Kadija ◽

Mihailo Ille ◽

Goran Turkovic ◽

...

Keyword(s):

Body Weight ◽

Significant Risk ◽

Ankle Fractures ◽

Type B ◽

Physical Exercises ◽

Appropriate Treatment ◽

Fracture Body ◽

Type C ◽

Fracture Types

Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI), height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p < 0.001) with a significantly higher age (59.9 years, SD ? 14.2) in relation to males (45.1 years, SD ? 12.8) (p < 0.0001). Type A fracture was most frequent in the younger patients (34.2 years, SD ? 8.6), and those with increased physical exercises (p = 0.020). In type B fracture, the risk factor was osteoporosis (p = 0.0180), while in type C fracture, body weight (p = 0.017) and osteoporosis (p = 0.004) were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.

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Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study

Journal of Neurosurgery ◽

10.3171/2018.1.jns172858 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1468-1477 ◽

Cited By ~ 6

Author(s):

David Hasan ◽

Mario Zanaty ◽

Robert M. Starke ◽

Elias Atallah ◽

Nohra Chalouhi ◽

...

Keyword(s):

Blood Pressure ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Type B ◽

Type D ◽

Type C ◽

Radiographic Classification

OBJECTIVEThe overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%–7% per year despite receiving the best available medical therapy. Here, authors propose a radiographic classification of COICA that can be used as a guide to determine the technical success and safety of endovascular recanalization for symptomatic COICA and to assess the changes in systemic blood pressure following successful revascularization.METHODSThe radiographic images of 100 consecutive subjects with COICA were analyzed. A new classification of COICA was proposed based on the morphology, location of occlusion, and presence or absence of reconstitution of the distal ICA. The classification was used to predict successful revascularization in 32 symptomatic COICAs in 31 patients, five of whom were female (5/31 [16.13%]). Patients were included in the study if they had a COICA with ischemic symptoms refractory to medical therapy. Carotid artery occlusion was defined as 100% cross-sectional occlusion of the vessel lumen as documented on CTA or MRA and confirmed by digital subtraction angiography.RESULTSFour types (A–D) of radiographic COICA were identified. Types A and B were more amenable to safe revascularization than types C and D. Recanalization was successful at a rate of 68.75% (22/32 COICAs; type A: 8/8; type B: 8/8; type C: 4/8; type D: 2/8). The perioperative complication rate was 18.75% (6/32; type A: 0/8 [0%]; type B: 1/8 [12.50%]; type C: 3/8 [37.50%], type D: 2/8 [25.00%]). None of these complications led to permanent morbidity or death. Twenty (64.52%) of 31 subjects had improvement in their symptoms at the 2–6 months’ follow-up. A statistically significant decrease in systolic blood pressure (SBP) was noted in 17/21 (80.95%) patients who had successful revascularization, which persisted on follow-up (p = 0.0001). The remaining 10 subjects in whom revascularization failed had no significant changes in SBP (p = 0.73).CONCLUSIONSThe pilot study suggested that our proposed classification of COICA may be useful as an adjunctive guide to determine the technical feasibility and safety of revascularization for symptomatic COICA using endovascular techniques. Additionally, successful revascularization may lead to a significant decrease in SBP postprocedure. A Phase 2b trial in larger cohorts to assess the efficacy of endovascular revascularization using our COICA classification is warranted.

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A New Classification of Cochleovestibular Malformations and Implications for Predicting Speech Perception Ability after Cochlear Implantation

Audiology and Neurotology ◽

10.1159/000365584 ◽

2015 ◽

Vol 20 (2) ◽

pp. 90-101 ◽

Cited By ~ 12

Author(s):

Sung-Wook Jeong ◽

Lee-Suk Kim

Keyword(s):

Speech Perception ◽

Cochlear Implantation ◽

Test Scores ◽

Type A ◽

Cochlear Nerve ◽

Type B ◽

New Classification ◽

Type D ◽

Type C

Objectives: The aims of this study were to introduce a new classification of cochleovestibular malformation (CVM) and to investigate how well this classification can predict speech perception ability after cochlear implantation in children with CVM. Methods: Fifty-nine children with CVM who had used a cochlear implant for more than 3 years were included. CVM was classified into 4 subtypes based on the morphology of the cochlea and the modiolus on temporal bone computed tomography (TBCT): normal cochlea and normal modiolus (type A, n = 16), malformed cochlea and partial modiolus (type B, n = 31), malformed cochlea and no modiolus (type C, n = 6), and no cochlea and no modiolus (type D, n = 6). Speech perception test scores were compared between the subtypes of CVM using analysis of covariance with post hoc Bonferroni test. Univariate and multivariate regression analyses were used to identify the significant predictors of the speech perception test scores. Results: The speech perception test scores after implantation were significantly better in children with CVM type A or type B than in children with CVM type C or type D. The test scores did not differ significantly between the implanted children with CVM type A or type B and those without CVM. In univariate regression analysis, the type of CVM was a significant predictor of the speech perception test scores in implanted children with CVM. Multivariate regression analysis revealed that the age at cochlear implantation, cochlear nerve size and preimplantation speech perception test scores were significant predictors of the postimplantation speech perception test scores. The chance of cochlear nerve deficiency increased progressively from CVM type A to type D. Conclusion: The new classification of CVM based on the morphology of the cochlea and the modiolus is simple and easy to use, and correlated well with postimplantation speech perception ability and cochlear nerve status. This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of children with CVM.

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Effect of Changes in Mass on Middle Ear Function

Otolaryngology ◽

10.1177/019459989310900520 ◽

1993 ◽

Vol 109 (5) ◽

pp. 899-910 ◽

Cited By ~ 58

Author(s):

Shinsei Nishihara ◽

Hiroshi Aritomo ◽

Richard L. Goode

Keyword(s):

Middle Ear ◽

Hearing Threshold ◽

Laser Doppler Vibrometer ◽

Ossicular Chain ◽

High Frequencies ◽

Before And After ◽

Ventilation Tubes ◽

Temporal Bones ◽

Middle Ear Transfer Function ◽

Vibrating Systems

Vibrating systems such as the middle ear are affected by changes in mass. After disease or ear surgery, significant changes in mass may contribute positively or negatively to the postoperative hearing threshold. This article describes experiments in 15 human temporal bones of the addition or reduction of mass on the middle ear transfer function. Measurement of stapes and umbo vibration was performed using a Laser Doppler Vibrometer before and after the addition of different masses at several sites on the tympanic membrane (TM) and ossicular chain. The input was 61 pure tones swept from 147 to 19433 Hz at 80 dB SPL. The addition of mass onto the TM produced varying detrimental effects on sound transmission, depending on the location and amount of mass. The insertion of ventilation tubes, weighing 12 to 17 mg each, produced losses at 1.5 to 5.0 kHz compared with tympanotomy alone. Addition of mass to the umbo and malleus head produced a loss at mid and high frequencies, whereas addition of mass on the incus long process and stapes also produced a high-frequency decrease in stapes displacement. Reduction of TM mass by removal of the epithelium produced an increase, especially at 2.0 to 4.0 kHz.

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Endoscopic Anatomy of Hypotympanum Surgical Implications

Annals of Otology and Neurotology ◽

10.1055/s-0038-1676952 ◽

2018 ◽

Vol 01 (02) ◽

pp. 058-067

Author(s):

Rajesh Boddepalli ◽

Sreerama Boddepalli

Keyword(s):

Temporal Bone ◽

Local Anesthesia ◽

Type A ◽

Jugular Foramen ◽

Type B ◽

Cadaveric Dissection ◽

Endoscopic Anatomy ◽

Type C ◽

Four Levels ◽

Temporal Bones

Abstract Objective To assess the endomeatal endoscopic morphological anatomy of hypotympanum under local anesthesia and further cadaveric dissection of temporal bone to know complete anatomical details of hypotympanum. Materials and Methods Two hundred six cases of live operations were studied, these included 160 cases of simple dry perforations for myringoplasty and 46 cases of stapedectomy operations. All operations were performed under local anesthesia using a 0-degree, 4-mm endoscope. The hypotympanum was visualized. Twenty wet temporal bones were dissected endoscopically and complete hypotympanic details were studied. Results Out of 206 cases, 94 cases (45%) were found to be type A; 51 cases (25%) were type B and 60 cases (30%) were type C hypotympanum. Wet cadaveric bones were dissected to visualize the transmeatal endoscopic jugular foramen in four levels (levels 1, 2, 3, and 4).

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A BIOLOGICAL CLASSIFICATION OF ENCAPSULATUS PNEUMONIÆ (FRIEDLÄNDER'S BACILLUS)

Journal of Experimental Medicine ◽

10.1084/jem.44.1.113 ◽

1926 ◽

Vol 44 (1) ◽

pp. 113-128 ◽

Cited By ~ 46

Author(s):

Louis A. Julianelle

Keyword(s):

Serological Test ◽

Type A ◽

Heterogeneous Group ◽

Type B ◽

Biological Classification ◽

Type C ◽

Working Out

A biological classification has been made of thirty strains of Friedländer's bacillus. This study reveals that there exist among these strains three sharply defined and specific types and one heterogeneous group. The three types are Type A, fifteen strains; Type B, six strains; Type C, three strains; and Group X, six strains. The agglutination, agglutinin adsorption, protection, thread, and precipitin reactions have been employed in the working out of this classification, and the types have been proved highly specific by means of each serological test.

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Anatomical nuances of the internal carotid artery in relation to the quadrangular space

Journal of Neurosurgery ◽

10.3171/2016.10.jns16381 ◽

2018 ◽

Vol 128 (1) ◽

pp. 174-181 ◽

Cited By ~ 6

Author(s):

Ricardo L. L. Dolci ◽

Leo F. S. Ditzel Filho ◽

Carlos R. Goulart ◽

Smita Upadhyay ◽

Lamia Buohliqah ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Classification System ◽

Internal Carotid ◽

Preoperative Planning ◽

Anatomical Variations ◽

Type B ◽

Essential Parameter ◽

Type C ◽

Different Shapes

OBJECTIVEThe aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results.METHODSA total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted.RESULTSThe space between the paraclival ICAs (i.e., intercarotid space) can be classified as 1 of 3 different shapes (i.e., trapezoid, square, or hourglass) based on the trajectory of the ICAs. The ICA trajectories also directly influence the volumetric area of the QS. Based on its geometry, the QS was classified as one of the following: 1) Type A has the smallest QS area and is associated with a trapezoid intercarotid space, 2) Type B corresponds to the expected QS area (not minimized or enlarged) and is associated with a square intercarotid space, and 3) Type C has the largest QS area and is associated with an hourglass intercarotid space.CONCLUSIONSThe different trajectories of the ICAs can modify the area of the QS and may be an essential parameter to consider for preoperative planning and defining the most appropriate corridor to reach Meckel's cave. In addition, ICA trajectories should be considered prior to surgery to avoid injuring the vessels.

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Composite Anatomical Variations between the Sciatic Nerve and the Piriformis Muscle: A Nepalese Cadaveric Study

Case Reports in Neurological Medicine ◽

10.1155/2020/7165818 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Ameet Kumar Jha ◽

Prakash Baral

Keyword(s):

Sciatic Nerve ◽

Surgical Intervention ◽

Anatomical Variations ◽

Low Back ◽

Type B ◽

Piriformis Muscle ◽

Structural Variations ◽

Unsuccessful Attempt ◽

Type C ◽

Popliteal Block

Piriformis syndrome is a rare syndrome which is one of the main causes of nondiscogenic sciatica causing severe low back pain due to entrapment of sciatic nerve either by the hypertrophy or by inflammation of the piriformis muscle. We have carried out dissection in 20 Nepalese cadavers. Out of 40 dissected gluteal regions, 37 exhibited typical appearance of sciatic nerve, piriformis muscle, and their relations resembling type-a, whereas 3 gluteal regions showed composite structural variations resembling type-b and type-c based on Beaton and Anson’s classification. Knowledge pertaining to such variations will be helpful during a surgical intervention in the gluteal region and in turn reduces the risk of injuring these nerves which are more susceptible to damage. Our study reports such variations in Nepalese population which will be helpful during evaluation of the pain induction in various test positions and also useful for analysis of the range of the neurological deficiency in sciatic nerve neuropathies. The present study also explains the basis of the unsuccessful attempt of the sciatic nerve block during popliteal block anaesthesia.

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A study of periprosthetic fractures following hemi-arthroplasty of hip in elderly population: diagnosis and management

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203483 ◽

2020 ◽

Vol 6 (5) ◽

pp. 902

Author(s):

Gagandeep Mahi ◽

Milind Atmaram Lokhande ◽

Lokesh Kumar Yogi ◽

Ankit Gawri

Keyword(s):

Indian Population ◽

Correct Diagnosis ◽

Anatomical Variations ◽

Special Focus ◽

X Rays ◽

Diagnosis And Management ◽

Appropriate Treatment ◽

Type C ◽

Hemi Arthroplasty

Background: Hemi-arthroplasty of hip for intracapsular fractures of femoral neck is one of the most commonly done surgical procedures in the low mobility older Indian population. Although there are numerous complications associated with the procedure, we want to study the types and management of peri-prosthetic fractures in patients treated with hip hemi-arthroplasty.Methods: A total of 26 patients were included in the study. A retrospective analysis of the radiological cum clinical diagnosis and management of peri-prosthetic fractures was performed. All patients were followed up till 1.5 years post-operatively.Results: According to Vancouver classification of peri-prosthetic fractures, 10 fractures were classified as type A, 7 as type B1, 3 as type B2, 4 as type B3 and 2 as type C. Fractures were managed either by Open Reduction with Internal Fixation (ORIF) or Revision hemi-arthroplasty. Fractures type AG, B1 and C were managed with ORIF and type B2 and B3 fractures were managed with revision hemi-arthroplasty using longer stem.Conclusions: As evident in our study, majority of fractures occurred intra-operatively, a thorough evaluation of pre-operative x-rays of both hips should be done along with special focus on anatomical variations. Correct diagnosis based on radiological and intraoperative findings followed by appropriate treatment are of paramount importance in the management of peri-prosthetic fractures.

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