Surgical Exposure of the Lesser Trochanter and the Medial Proximal Part of the Femur

Abstract Objectives Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies. Design This study presents anatomical dissection and quantitative analysis. Setting Cadaveric heads were used for dissection. EEAs were performed using the medial petrosectomy (MP), the inferior petrosectomy (IP), and the inferomedial petrosectomy (IMP) techniques. Participants Six cadaver heads (12 sides, total) were dissected; each technique was performed on four sides. Main Outcomes and Measures Outcomes included the area of exposure, visible distances, angles of attack, and bone resection volume. Results The IMP technique provided a greater area of exposure (p < 0.01) and bone resection volume (p < 0.01) when compared with the MP and IP techniques. The IMP technique had a longer working length of the abducens nerve (cranial nerve [CN] VI) than the MP technique (p < 0.01). The IMP technique demonstrated higher angles of attack to specific neurovascular structures when compared with the MP (midpons [p = 0.04], anterior inferior cerebellar artery [p < 0.01], proximal part of the cisternal CN VI segment [p = 0.02]) and IP (flocculus [p = 0.02] and the proximal [p = 0.02] and distal parts [p = 0.02] of the CN VII/VIII complex) techniques. Conclusion Each of these approaches offers varying degrees of access to the petroclival region, and the surgical approach should be appropriately tailored to the pathology. Overall, the IMP technique provides greater EEA surgical exposure to vital neurovascular structures than the MP and the IP techniques.

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Proximal Part of the Lumen of the Centriole

10.32388/gyansj ◽

2020 ◽

Author(s):

Keyword(s):

Proximal Part

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Possibility of simultaneous transposition of segments of the pectoralis major muscle to restore flexion in the shoulder and elbow joints (clinical observation)

MedAlliance ◽

10.36422/23076348-2020-8-1-61-68 ◽

2020 ◽

Vol 8 (1) ◽

pp. 61-68

Keyword(s):

Anterior Part ◽

Pectoralis Major Muscle ◽

Elbow Flexion ◽

Functional Results ◽

Proximal Part ◽

Deltoid Muscle ◽

Pectoralis Major ◽

Orthopedic Surgeons ◽

Active Function ◽

Head Neck

The pectoralis major is a widely used muscle in reconstruction surgery for replacement soft tissue defects of a head, neck, thorax, upper limbs and restoration of muscle active function. The peculiarities of anatomy of the pectoralis major makes it possible to divide the muscle into several segments with their own innervations and supply and use them independently from each other. This article describes the anatomy of the pectoralis major and the opportunity for clinical applications of different segments of this muscle. The authors demonstrate the result of the restoration of shoulder and elbow flexion in a patient with arthrogryposis due to simultaneous transfer of the proximal part of pectoralis major to the anterior part of the deltoid muscle and the distal part of pectoralis major to the biceps with good functional results. The article will be useful for plastic surgeons, orthopedic surgeons and physiotherapists.

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Hip geometry in hip fracture patients in Greenland occurring over a 7.7-year period

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02482-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Inuuteq Fleischer ◽

Mogens Laursen ◽

Stig Andersen

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Fracture Risk ◽

Cortical Thickness ◽

Geometric Analysis ◽

Osteoporotic Fractures ◽

Premature Death ◽

Neck Length ◽

Hip Geometry ◽

Lesser Trochanter

Abstract Background Hip geometry influences hip fracture risk. Hip fractures are common, and they are associated with pain, disability, premature death and marked costs on society. Osteoporotic fractures are frequent in Arctic populations and increase with advancing age in this society with a steep rise in life expectancy. Greenland Inuit is a distinct ethnic group, and data on hip geometry is missing. We thus aimed to describe hip geometry in 7.7 years of consecutive hip fracture patients in Greenland. Methods We evaluated collodiaphysial angle, femoral neck length, the outer and inner diameter of the femur at 2 and 5 centimetres below the centre of the lesser trochanter and the cortical thickness from pelvic and hip radiographs in all patients operated in Greenland over 7.7 years. We included all 84 patients with one non-fractured hip visible for geometric analysis. Analyses were conducted in duplicate. Results We found a collodiaphysial angle of 134.8/132.6o in men/women (p = 0.06) and a femoral neck length of 38.0/33.9 mm in men/women (p = 0.001). Cortical thickness was affected by sex in the adjusted analysis (p < 0.001). Cortical thickness index at 5 cm below the centre of the lesser trochanter decreased with age (p = 0.026) and may be influenced by height (2 cm below the centre of the lesser trochanter, p = 0.053). Conclusion Our findings differed from European data and suggest a delicate balance in hip geometry in Arctic populations. Ethnic peculiarities influence the structure of the hip and may influence fracture risk. A focus on hip geometry and risk factors for osteoporotic fractures in Arctic populations is warranted.

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Stratigraphic revision and reconstruction of the deep-sea fan of the Voirons Flysch (Voirons Nappe, Chablais Prealps)

Swiss Journal of Geosciences ◽

10.1186/s00015-020-00383-1 ◽

2021 ◽

Vol 114 (1) ◽

Author(s):

Jérémy Ragusa ◽

Lina Maria Ospina-Ostios ◽

Pascal Kindler ◽

Mario Sartori

Keyword(s):

Deep Sea ◽

Distal Part ◽

Accretionary Prism ◽

Proximal Part ◽

Late Eocene ◽

Lithostratigraphic Units ◽

Stratigraphic Record ◽

Sea Fan ◽

Stratigraphic Evolution ◽

Depositional Setting

AbstractThe Voirons Flysch (Caron in Eclogae Geologicae Helvetiae 69:297–308, 1976), is a flysch sequence aggregated into the sedimentary accretionary prism of the Chablais and Swiss Prealps. Its palaeogeographic location is still debated (South Piemont or Valais realm). We herein present a stratigraphic revision of the westernmost unit of the former Gurnigel Nappe sensu Caron (Eclogae Geologicae Helvetiae 69:297–308, 1976): the Voirons Flysch. This flysch is subdivided into three lithostratigraphic units at the formation level (the Voirons Sandstone, the Vouan Conglomerate, the Boëge Marl), with an additional unit (Bruant Sandstone) of uncertain attribution, ranging from the early Eocene to probably the late Eocene. We further propose a new model of the depositional setting of the deep-sea of the Voirons Flysch based on palaeocurrent directions, the overall geometry and sedimentary features. This model depicts an eastward deflected deep-sea fan. The stratigraphic record of the proximal part of this fan is fairly complete in the Voirons area, whereas its most distal part is only represented by one small exposure of thinly bedded sandstones in the Fenalet quarry. The stratigraphic evolution of the Voirons Flysch shows two major disruptions of the detrital sedimentation at the transition between Voirons Sandstone—Vouan Conglomerate and Vouan Conglomerate—Boëge Marl. The cause of these disturbances has to be constrained in the framework of the palaeogeographic location of the Voirons Flysch.

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A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0041-1728760 ◽

2021 ◽

Author(s):

Andrew G. Yun ◽

Marilena Qutami ◽

Kory B. Dylan Pasko

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Radiation Exposure ◽

Hip Arthroplasty ◽

Fluoroscopy Time ◽

Lesser Trochanter ◽

Total Hip ◽

Preoperative Templating ◽

The Mean ◽

Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

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Frozen elephant trunk infection: to defrost or to debranch?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa466 ◽

2020 ◽

Author(s):

Joseph Nader ◽

Yuthiline Chabry ◽

Houda Nazih ◽

Thierry Caus

Keyword(s):

Proximal Part ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Hybrid Prosthesis

Abstract Infections of frozen elephant trunk hybrid prosthesis (HP) are not well documented in the literature and their management is not standardized yet. We report herein the case of a 59-year-old patient who benefited from a Thoraflex™ HP aortic arch replacement for an acute type A aortic dissection. He presented a year later with a Staphylococcus aureus infection of the proximal part of this prosthesis. We performed a replacement of the proximal compound of the HP accompanied by a complete debranching of the 3 supra-aortic vessels with an inter-carotidal retro-oesophageal bypass. As we left in situ the endovascular graft within the descending aorta, a life-long antibiotic therapy was introduced. The postoperative follow-up was uneventful, and the patient discharged home 2 weeks after his surgery. As an alternative to a more radical redo surgery with major risk, a hybrid medical and surgical treatment of infected frozen elephant trunk could be considered.

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Focused Genetic Recombination of Bacteriophage T4 Initiated by Double-Strand Breaks

Genetics ◽

10.1093/genetics/162.2.543 ◽

2002 ◽

Vol 162 (2) ◽

pp. 543-556

Author(s):

Victor Shcherbakov ◽

Igor Granovsky ◽

Lidiya Plugina ◽

Tamara Shcherbakova ◽

Svetlana Sizova ◽

...

Keyword(s):

Genetic Recombination ◽

Bacteriophage T4 ◽

Proximal Part ◽

Coupling Model ◽

Strand Break ◽

Double Strand Breaks ◽

Strand Breaks ◽

The Right ◽

Frequency Distance

Abstract A model system for studying double-strand-break (DSB)-induced genetic recombination in vivo based on the ets1 segCΔ strain of bacteriophage T4 was developed. The ets1, a 66-bp DNA fragment of phage T2L containing the cleavage site for the T4 SegC site-specific endonuclease, was inserted into the proximal part of the T4 rIIB gene. Under segC+ conditions, the ets1 behaves as a recombination hotspot. Crosses of the ets1 against rII markers located to the left and to the right of ets1 gave similar results, thus demonstrating the equal and symmetrical initiation of recombination by either part of the broken chromosome. Frequency/distance relationships were studied in a series of two- and three-factor crosses with other rIIB and rIIA mutants (all segC+) separated from ets1 by 12-2100 bp. The observed relationships were readily interpretable in terms of the modified splice/patch coupling model. The advantages of this localized or focused recombination over that distributed along the chromosome, as a model for studying the recombination-replication pathway in T4 in vivo, are discussed.

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Pathomorphological study on gastroduodenal ulceration in horses: Localisation of lesions

Acta Veterinaria Hungarica ◽

10.1556/avet.55.2007.2.10 ◽

2007 ◽

Vol 55 (2) ◽

pp. 241-249 ◽

Cited By ~ 11

Author(s):

Barbora Bezdekova ◽

P. Jahn ◽

M. Vyskocil

Keyword(s):

Single Case ◽

Proximal Part ◽

Gastric Ulcers ◽

Squamous Mucosa ◽

Oesophageal Ulceration ◽

Prevalent Disease ◽

Greater Curvature ◽

Gastroduodenal Ulceration ◽

Lesser Curvature ◽

Low Prevalence

Gastroduodenal ulceration is a prevalent disease in foals and adult horses. Decreased performance as well as fatal complications relate to this syndrome. The objective of our study was to determine the prevalence of gastric ulceration in a mixed population of horses by postmortem examination and to evaluate a possible association between equine gastric ulcer syndrome (EGUS) and sex or age of the examined horses, to evaluate the localisation of lesions in the proximal part of the gastrointestinal tract and to determine the occurrence of gastric parasites. Post-mortem examinations were performed on 71 horses over a period of 24 months. Gastric ulcers were found in 52 horses (73.2%). There was no significant association between age or sex and occurrence of gastric ulcers. In all horses the squamous mucosa lesions were localised near the margo plicatus (100% of the cases), whereas in 23 horses the lesions were near the margo plicatus and lesser curvature and in 7 horses at the greater curvature. In 18 horses the mucosa was affected in the whole extent of the margo plicatus and in 1 horse diffuse lesions of the squamous mucosa were noted. Lesions of the glandular mucosa were localised in 11 horses at the fundic area, in 1 horse they occurred in the pylorus, and in 10 horses diffuse lesions of the glandular mucosa were recorded. A low prevalence of Gasterophilus intestinalis infection was detected (1 horse, 1.4%). We have confirmed that gastric ulcers are a common problem in horses and duodenal or oesophageal ulceration is rare (not a single case of the latter was found in this study). Lesions in the glandular mucosa of the stomach are more frequent in suckling foals than in older animals. Lesions of the glandular mucosa are also common in adult horses, and a complete gastroscopic examination including examination of the pylorus is advisable to evaluate this syndrome.

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P2736Hemodynamic and clinical impact in adult patients with anomalous aortic origin of the coronary artery evaluated with quantitative flow reserve

European Heart Journal ◽

10.1093/eurheartj/ehz748.1053 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Adjedj ◽

F Hyafil ◽

F Aminfar ◽

A Farnoud ◽

V Rubimbura ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Clinical Decision Making ◽

Quantitative Coronary Angiography ◽

Proximal Part ◽

Clinical Impact ◽

Adult Patients ◽

Fractional Flow ◽

Flow Reserve ◽

Quantitative Flow

Abstract Background Anomalous origin of the right coronary artery (ARCA) represents the most frequent form of abnormal coronary origin and may potentially increase the risk for sudden cardiac death. Evaluation of ARCA in adult patients referred for invasive coronary angiograms (ICA) is difficult, and clinical impact is unknown. Quantitative flow reserve (QFR) is an available method able to virtually calculate fractional flow reserve using 3-dimensional quantitative coronary angiography (3D-QCA) based on ICA. Objectives To evaluate the feasibility of QFR analysis in patients with ARCA and its clinical impact. Methods Using the registry of proximal anomalous connections of coronary arteries (ANOCOR registry), a multicentric observational registry including 472 adult patients with ANOCOR between 2010 and 2013, we retrospectively performed QFR analysis from ICA and evaluated the rate of death, myocardial infarction, unplanned revascularization and hospitalization in cardiology at 5 years. Results Among 128 patients with ARCA, 41 (32%) could have QFR analysis with median clinical follow-up of 8.3 years. The mean QFR value was 0.90±0.10, and 3D-QCA analysis showed preserved lumen area despite the elliptical shape of the proximal part of the ARCA which in the worst cases appeared on ICA as a significant narrowing. The event rate was 14.6% (n=6), including three deaths (one due to cancer, one due to stroke, and one cause remains unknown), two unplanned revascularizations, and one hospitalization for heart failure at 5 years. No myocardial infarction was reported. Conclusions QFR analysis of ARCA is feasible and non-significant QFR values are associated with good clinical outcome at 5 years. QFR of ARCA could be the evaluation of choice to help in clinical decision-making during ICA, when applicable.

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