A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

A Human Case of Lumbosacral Canal Sparganosis in China

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People’s Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1-S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1-S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study.

Developing a Method to Precisely Locate the Keypoint During Craniotomy Using the Retrosigmoid Keyhole Approach: Surgical Anatomy and Technical Nuances

Objective: To explore the precise location of the keypoint during craniotomy using the retrosigmoid keyhole approach.Methods: This study included 20 dry skulls and 10 wet cadaveric specimens. On the inner surface of dry skulls, the junction between the inferior margin of the transverse sinus (ITS) and the posterior margin of the sigmoid sinus (TSJ) was marked. The keypoint (D) was identified as the TSJ's corresponding point on the external surface of the temporal mastoid process (MP). The distance from the keypoint to the top point of the digastric groove, mastoidale, and asterion were noted (AD, BD, CD, respectively). A method to accurately locate the keypoint was developed based on these relationships. The developed method was used on the wet cadaveric specimens to evaluate its accuracy, safety, rapidity, and minimal invasion.Results: No significant difference was found between the AD, BD, and CD of the left and right sides. The drilling point was oriented on a straight line 12 mm above the top point of digastric groove, perpendicular to the Frankfort horizontal plane (FHP). In the cadaveric specimens, the operative area was clearly exposed. No venous sinus rupture occurred. The average craniotomy time was 28.74 ± 3.89 min.Conclusions: A potentially safe, accurate, and rapid craniotomy procedure was developed with the added advantage of preserving the visibility of the operating field and preventing venous sinus injury.

Posture-based Morphological Deformation of the Parotid Gland and its Clinical Implications for Minimally Invasive Procedures

Anatomical studies of the parotid gland are important for mid- and lower face filler, botulinum toxin, and thread lifting procedures. The purpose of this study was to observe the topographic anatomy of the parotid gland using cadaveric dissections. The superficial lobe of the parotid gland was studied in 30 hemisected heads. Reference lines were made on the lateral aspect of the face. A reference line (the line connecting the mandibular angle to the upper margin of the zygomatic arch, along the posterior margin of the ramus) was divided into four sections (P1, P2, P3, and P4). The superior, inferior, anterior, and posterior borders of the parotid gland were measured using the reference lines and sections. Using these measurements, we categorized the superficial lobe of the parotid gland into two types: type Ia, pistol-shaped; Ib, pistol-shaped with an accessory lobe; and type II, oval-shaped. The superior border of the parotid gland started just below the inferior margin of the zygomatic arch. The parotid gland covered the posterior part of the masseter muscle near P1 and P2, but at P3 and below P3, the tail of the parotid gland was located posterior to the ramus and covered the anterior part of the sternocleidomastoid muscle. The topographic anatomy of the parotid gland serves as a reliable reference for esthetic procedures in the lower face and neck region.

A Comprehensive Study on Supratrochlear Foramen of Human Humerus and its Clinical Significance - A Review.

The lower end of humerus has numerous fossae which play a significant role during extreme movements. Coronoid fossa and olecranon fossa are separated by a delicate supratrochlear septum; occasionally septum has perforation and form an aperture, named as Supratrochlear foramen (STF). The knowledge of this foramen will be beneficial for anatomists, anthropologists, orthopedic surgeons, and radiologists. The aim of the present study was to establish the prevalence and morphometry of STF of the humerus in South Indian population and to correlate with the previous studies. The present prospective study was carried out with 274 (146 left sided + 127 right sided) dried humeri of unknown sex and age. The distal humeri were examined for the presence of STF, morphometry such as diverse shapes, vertical and horizontal diameters, and distance from STF to medial, lateral epicondyle and also to the inferior margin of trochlea using digital vernier caliper. In the present study, out of 274 dried humeri, 69 showed presence of STF, 163 were translucent and 42 were opaque. The prevalence of STF was 25.18%. After keen observation, shapes of the STF were categorized accordingly. The oval (42%) showed higher percentage whereas the other shapes showed as follows: - irregular (12%), round (19%), rectangular (12%), reniform (9.7%), sieve (7.3%) and triangular (2%). The mean vertical and transverse diameters of STF on the right side were 3.12 ± 1.09 and 5.5 ± 1.83mm and on the left side, it was 3.47± 1.32 and 4.9± 1.5mm respectively. The mean distance from STF to medial and lateral epicondyle on the right side was 25.12± 3.1 and 28.09± 2.3mm and for the left side 24.97± 2.9mm and 27.16± 2.4mm respectively. The anatomical knowledge regarding the supratrochlear foramen is much promising for the orthopaedic surgeons during intramedullary nailing for supracondylar fracture of humerus. STF appears as a radiolucent area in radiographs, which may pose a difficulty for the radiologist in differentiating it from an osteolytic or cystic lesion. In addition, STF is predominantly found in the primates, it may act an evolutionary link between the humans and lower animals.

The Role of Serum IL-1β in Combination with Fractional Exhaled Nitric Oxide in the Diagnosis of Adult Bronchial Asthma

Background: Asthma is a chronic airway disorder, in which cytokines are probably contributing in the inflammation and in the pathophysiology of the disease. This study aimed to determine the benefit of measurement of FENO and IL-1β in the diagnosis of asthma. Method: The study was conducted in Merjan Medical City and Spiro private clinic in Babylon province in the period from March to June 2019, 127 asthmatic patients were compared with 60 healthy subjects as control group. The age ranged from 10 to 60 years old, fractional exhaled nitric oxide (FENO) test was performed to assess asthma by using (Medisoft® company, Belgium). Body mass index (BMI) was subtracted as weight (kg)/height (m2). Waist circumference/cm (WC) was calculated between the inferior margin of thoracic ribs and midline of the iliac-crest. Hip circumference/cm (HC) was calculated from the broadest hip eminent before the waist/hip ratio (W/H) computed. The FENO measures had classified into low (<25 ppb) or intermediate-high (⩾25 ppb) according to the ‘’American Thoracic Society recommendations’’. Iterleukine-1 beta (IL-1β) was measured in the sera by ELISA technique using Human IL-1β (Interleukin 1-Beta) ELISA Kit from Elabscience®. Results: there was no significant correlation between the levels of FENO and IL-1β with body weight as measured by the way of BMI and waist/hip ratio. There was no correlation between duration of asthma with the levels of FENO and IL-1β. ROC curve analysis of FENO test in BA patients showed significant (p-0.001) high sensitivity (92%) and specificity (90%). However, ROC curve analysis of IL-1β in BA patients revealed non-significant (p-0.53), lower accuracy (56.4%), sensitivity 962%) and specificity (57%) to distinguish BA patients). Conclusion: No relation between obesity and eosinophilic airways inflammation. The measurement of FENO level is more important in assessment of asthma inflammation than IL-1β.

Intra-diploic epidermoid cyst: An iceberg lesion

Introduction: Intraosseous epithelial inclusion cysts of the skull, presenting as lytic defects, constitute a very small percentage of the primary intracranial tumours. The case is presented by virtue of not only the rarity of the variant but also to highlight the importance of timely intervention by a neurosurgeon after adequate investigation and in a tertiary care setting. Case Report: A 45 year old female patient presented to the local Primary Healthcare Centre(PHC) with a small scalp swelling in the occipital region. . Intraoperative identification of intracranial extension was made by the surgeon as inferior margin of the swelling couldn’t be reached and also by palpation of the huge bone defect following which the procedure was abandoned midway and patient was referred to our centre for further management. Imaging: Contrast Enhanced Computerised Tomograhy(CECT) revealed a well defined, mixed density lesion with hypodense and an isodense component in right occipital region. Lesion was measuring 4.2(Cranio caudal) x 3.3(Antero posterior) x 3.6( transverse) cm. A sharp marginated bone defect was noted involving both the outer and inner tables of the occipital bone. Operative management: Lesion was approached through a right occipital craniotomy wherein the margins of bone defect were nibbled away to gain a wide access to the lesion. Pearly white, flaky contents of the lesion along with capsule were identified and excised completely. Discussuion: Intradiploic epidermoid cysts are very rare, accounting for <3% of all intracranial epidermoid cysts.(5) These cysts grow very slowly and usually present as painless bony swelling under the scalp. Conclusion: Cranial epidermoid is a fairly common entity and intradiploic variant of the same isnot uncommonly seen in neurosurgical practise. These lesions may present as a small scalp lesion which should not be judged based on its apparent size as these lesions are not infrequently known to have a bigger intracranial extension

Single-incision laparoscopic repair for an arcuate line hernia: a case report

Background The arcuate line is the inferior margin of the posterior layer of rectus abdominis sheath. An arcuate line hernia is a parietal interstitial hernia consisting of ascending protrusion of intraperitoneal contents above the arcuate line. Arcuate line hernias are rare, and fewer than 20 cases undergoing surgical repair have been reported. Various surgical approaches were used in previous cases, and there is no consensus regarding the ideal repair method. We report the first case of an arcuate line hernia repaired using single-incision laparoscopic surgery. Case presentation The patient was a 78-year-old man who presented with a history of intermittent lower abdominal quadrant pain of more than 2 month’s duration. He had not previously undergone abdominal surgery, but had a history of mycobacterial lung disease and asthma. His vital signs were normal on presentation, and he experienced no vomiting or nausea. On palpation, his abdomen was flat and soft, and no mass was palpable. However, there was slight tenderness in the right lower quadrant. Blood laboratory test results were within normal ranges. Computed tomography revealed small bowel protrusion between the rectus abdominis and the posterior rectus sheath, and an arcuate line hernia was suspected and subsequently confirmed intraoperatively. The patient underwent single-incision laparoscopic repair with the intraperitoneal onlay mesh technique with tacks and with care to avoid the inferior epigastric vessels. The operation time was 30 min, and no intra- or post-operative complications occurred. Surgery relieved his symptoms, with no recurrence within 1 year postoperatively. Conclusions Single-incision laparoscopic surgery was performed easily and successfully in this rare patient with arcuate line hernia. Arcuate line hernia should be considered in patients presenting with abdominal symptoms, and single-incision laparoscopic repair should be considered for repair.

Morphological Classification of Arch of Frohse and Its Implication in Compression of Deep Branch of Radial Nerve

BACKGROUND Arcade of Frohse (AF) is a tendinous superior margin of superficial layer of supinator muscle which was first described by Frohse and Frankel in 1908. Since then it has been studied by many authors and held accountable as one of the essential components for compression of deep branch of radial nerve (DBRN) which leads to radial tunnel syndrome. Considering AF as an important element of compression, we made an attempt to classify it on the basis of its shape and to find out if any particular shape has a predominant role in compression of the nerve. We also observed the structure of superior and inferior margin of the supinator muscle. METHODS This study was conducted among 80 (70 males and 10 females) formalin fixed upper limbs present in the Department of Anatomy. The limbs were maintained in supine with slightly flexed position and dissection was performed to expose the supinator muscle. The proximal and distal borders of supinator muscles were examined meticulously with the help of magnified lens. The morphometric measurements were taken with the help of a digital caliper. RESULTS The FA is classified into four categories as loop, high arc, low arch and linear shaped. The most frequent shape observed was arch shaped (high and low arch) about 66%, followed by loop shaped (30%) and least was linear shaped (2.5%). On the basis of structure, the proximal and distal margin of supinator muscle was reported to be tendinous in majority of the cases. The distance of the AF from the fixed reproducible anatomical landmark like inter epicondylar line (IEL) was measured and the average distance found was 3.36 cm. CONCLUSIONS Knowledge of different shapes would aid surgeons and radiologists for better approach towards diagnosis and management of supinator syndrome. The morphometric finding can be useful for surgeons to locate the superior margin of supinator (AF) in surgical procedures for decompression of DBRN in supinator syndrome. KEY WORDS Arcade of Frohse, Inter Epicondylar Line, Supinator Muscle, Deep Branch of Radial Nerve and Radial Tunnel Syndrome

Sparganum in the Lumbosacral Canal: a Case Report

Background: Sparganosis is a rare parasitic infection caused by invasion of the larvae of tapeworms Spirometra mansoni called sparganum. It often lodges in human eyes, subcutaneous body of limbs, oral and maxillofacial regions. However, lumbosacral spinal canal invasion is extremely rare and the diagnosis is very difficult. We herein report a case of spinal sparganosis.Case presentation: A 56-year-old man presented at the hospital after having experienced perianal pain for a week. MRI of the lumbosacral spine with gadolinium contrast study revealed an enhancing mass at the S1-S2 level that was clinically suggestive of a tumor. The patient underwent laminectomy from S1 to S2. We detected a live worm in inferior margin of L5 and spinal sparganosis was diagnosed by histological examination. He had a history of ingesting undercooked frog meat in his youth. Both in CSF and serum samples, we detected anti-sparganum antibodies. A dose of praziquantel, albendazole and dexamethasone was administered to the patient because we did not remove the parasitic mass completely.Conclusions: Sparganosis of the central nervous system is extremely rare, especially spinal sparganosis. The mainly treatments spinal sparganosis are surgical removal of the larva and administration of high-dose praziquantel, albendazole and dexamethasone.