The prevalence and distribution of the flexor carpi radialis brevis muscle in the Turkish population

The flexor carpi radialis brevis (FCRB) is a very rare anomalous muscle that is usually asymptomatic but may cause various pathologies, such as radial-sided wrist pain. The aim of this study was to determine the prevalence of FCRB in the Turkish population, its location, and sex differences. Forearm, wrist, and hand magnetic resonance images of 849 individuals aged 18–65 years were retrospectively evaluated in this study. The survey found an FCRB prevalence of 4%, with a prevalence of 3.6% among women and of 4.7% among men. However, the difference between the sexes was not statistically significant (p = 0.629). The origin of all 34 FCRBs identified was the distal third of the anterior aspect of the radius; the insertion site of 28 was the second metacarpal bone, whereas that of the remaining 6 was the os trapezium. In conclusion, the data of this study report the prevalence of FCRB for the first time in the Turkish population, which will contribute to radiological and surgical evaluations in the region and help in early and accurate diagnosis of various pathological conditions that may be caused by FCRB.

Classification and Morphometric Features of Pterion in Thai Population with Potential Sex Prediction

Background and Objectives: The landmark for neurosurgical approaches to access brain lesion is the pterion. The aim of the present study is to classify and examine the prevalence of all types of pterion variations and perform morphometric measurements from previously defined anthropological landmarks. Materials and methods: One-hundred and twenty-four Thai dried skulls were investigated. Classification and morphometric measurement of the pterion was performed. Machine learning models were also used to interpret the morphometric findings with respect to sex and age estimation. Results: Spheno-parietal type was the most common type (62.1%), followed by epipteric (11.7%), fronto-temporal (5.2%) and stellate (1.2%). Complete synostosis of the pterion suture was present in 18.5% and was only present in males. While most morphometric measurements were similar between males and females, the distances from the pterion center to the mastoid process and to the external occipital protuberance were longer in males. Random forest algorithm could predict sex with 80.7% accuracy (root mean square error = 0.38) when the pterion morphometric data were provided. Correlational analysis indicated that the distances from the pterion center to the anterior aspect of the frontozygomatic suture and to the zygomatic angle were positively correlated with age, which may serve as basis for age estimation in the future. Conclusions: Further studies are needed to explore the use of machine learning in anatomical studies and morphometry-based sex and age estimation. Thorough understanding of the anatomy of the pterion is clinically useful when planning pterional craniotomy, particularly when the position of the pterion may change with age.

Physical, Biochemical, Cytological, Bacteriological Screening of Carpal hygroma Fluid vis-a-vis Surgical Management of Carpal hygroma in Cattle and Buffaloes- A report of 15 Cases

Fifteen animals affected with unilateral 9 and bilateral 6 carpal hygroma were presented with the history of swelling on the anterior aspect of the carpus since 3-18 month. Hygroma fluid samples from all the cases were aseptically collected for physical, biochemical, cytological and bacteriological investigations. The colour of hygroma fluid was pale yellow with slight deposits. Glucose, chloride and total protein levels were 43±4.08 mmol/dL, 107±6.50 mmol/dL and 3.20 g/dL, respectively. Cytological examination revealed cell count of 150 cells/µL, 20% neutrophils and 80% lymphocytes. Moreover, mild (+) cellular degeneration changes were also seen. The hygroma fluid samples from all animals were screened for brucellosis. Two cows were found positive for Brucella in tube agglutination test with antibody titres of 160 and 320 IU, respectively. Whereas, the hygroma fluid samples from other animals showed no growth on culture. Surgical excision of carpal hygroma in all cases was done under xylazine sedation (@ 0.02mg/kg body wt) and intravenous regional anaesthesia (IVRA). In brucella infected cows (n=2), hygroma sacs were excised en mass. Skin sutures were applied and the limb was put in fiber-glass cast for 10 days. In bilateral cases, the hygroma of one limb was treated at first instant followed by counter limb after 15 days. In all cases, the wound healing occurred by first intention without any complication. It was concluded that brucella organism may be present in hygroma fluid and due precaution are required while collecting fluid samples. The presence of hygroma may be considered as evidence of brucellosis in the herd. The owners should be advised not to breed such animals in future.

Simon’s sign: Case report and review of the literature

Hanging is a common method of suicide and multiple autopsy findings can be observed at the postmortem examination. Simon's sign is a haemorrhage into the anterior aspect of the intervertebral discs of the lumbar region that can be observed in hangings and other traumatic causes of death. This finding is considered evidence of vitality. Several mechanisms have been proposed regarding bleeding development. In this paper, we present a case of hanging in which Simon's sign was observed at the autopsy. A review of the literature regarding Simon's bleeding has been performed, and a discussion of the potential mechanism is reported. Although Simon's sign may be observed in hangings, a careful evaluation of all the available data, including investigation, autopsy findings, and toxicology, is mandatory to avoid misinterpretation of death's cause and manner.

Anatomical change of SMV branches after the Cattell Braasch maneuver facilitates safe resection around the uncinated process in pancreatoduodenectomy

Background The aims of the present study were to demonstrate the anatomical change of superior mesenteric vein (SMV) branches and to show how the Cattell Braasch maneuver facilitates a safer ligation of these venous branches during a pancreatoduodenectomy (PD). Methods Between January 2010 and December 2019, 97 patients with peripancreatic tumors underwent pancreatectomy. We retrospectively reviewed preoperative triple-phase enhanced computed tomography (CT) images and analyzed variations in SMV branches. Anatomical changes in SMV branches after the Cattell Braasch technique were observed using our operation video and illustrations. Results The first jejunal vein (J1v) in 75% of patients ran posterior to the superior mesenteric artery (SMA), while the remainder (25%) ran anterior to it. The inferior pancreatoduodenal vein (IPDV) was preoperatively detected in 91% of patients. The IPDV drained into the J1v in 74% of patients and into the SMV in 37%. After the Cattell Braasch maneuver, the J1v which ran posterior to the SMA now was found to lie to the right anterolateral side the SMA and the visualization of both the J1v and the IPDV were much more clearly visualized. Conclusions The most frequent venous variation was the IPDV draining into the J1v posterior to the SMA. After the Cattell Braasch maneuver, the IPDV was now located to the right anterolateral anterior aspect of the SMA which facilitates its visualization and should allow a safer ligation.

334 Localisation of Sentinel Node for Cutaneous Melanoma of Trunk

Aim Our aim was to review localisation of sentinel node for cutaneous melanoma of trunk based on position. This was to investigate whether we can predict sentinel node position and therefore avoid scintigram. Method We have collected 50 patients with cutaneous melanoma of the trunk who underwent sentinel node biopsy. We have reviewed and recorded position of the melanoma and most likely position of sentinel biopsy. This has been on the day of surgery compared to scintigram. Results Majority of the melanomas have drained into the predicted location. Midline melanomas had tendency to drain bilaterally. The most difficult to predict were melanomas on the anterior aspect of trunk. Conclusions In majority of cases surgeons were able to predict position of sentinel node biopsy and therefore scintigram might not be necessary. If such approach is adapted, the need for radiologist involvement on the day of surgery may decrease.

Ectomesenchymal Chondromyxoid Tumor: A Rare Association With an Asymmetrical Soft Palate Cleft

Ectomesenchymal chondromyxoid tumor (ECT) is a rare oral lesion first described by Smith et al. in 1995 . These tumors are typically painless, slow growing and benign masses occurring predominantly on the anterior tongue dorsum. Prior to this seminal report, many ECTs may have been misdiagnosed due to the histological similarities with other lesions. Immunohistochemical stains aid in definitive diagnosis of an ECT. A total of 39 papers since published have reported 96 patients with ECT. Most lesions involve the anterior aspect of the tongue, with only 6 occurring in the posterior tongue and 2 involving the hard palate. ECTs are considered to develop from ectomesenchymal cells of neural crest cells that have migrated to the tongue during embryological development. This paper is of a rare case of ECT of the posterolateral tongue occurring in association with an unusual asymmetrical soft palate cleft. It is postulated that since the tongue develops before the formation of the soft palate, an ECT lesion occurring on the posterior aspect may have a causal contribution to the development of the soft palate cleft.

Intra-articular fibrous bands at the tibiotalar joint: diagnosis and outcomes of arthroscopic removal in 4 ankles

The authors retrieved the records of 4 patients that exhibited unusual structural anomalies or pathologies, notably the presence of a fibrous band at the anterior aspect of the tibiotalar joint, observed during arthroscopic exploration or treatment between January and December 2019. Only 1 patient had surgical antecedents on the ipsilateral ankle (extra-articular tenodesis 10 years earlier). The remaining 3 patients had no surgical antecedents on the ipsilateral ankle. The fibrous band was removed in all patients during arthroscopic Brostöm procedure or exploration. For the first 3 patients, the intra-articular fibrous band was not observed prior to arthroscopy by either the senior surgeon or radiologist on any of the images (2 MRIs and 1 CTA), but retrospective inspection confirmed that the intra-articular fibrous band was present but had been overlooked.At a follow-up of 22.3 ± 5.0 months (range, 15–26), all patients reported a decrease in pVAS (− 5.0 ± 2.6, range, 2–8), and an improvement in AOFAS (51.0 ± 17.7, range, 26–65), EFAS (14.5 ± 8.7, range, 6–23) and EFAS sport (8.0 ± 5.3, range, 2–10).This case report corroborates the findings of an earlier discovery of an intra-articular fibrous band in 4 ankles, with more detailed information for clinical and radiologic diagnosis, as well as outcomes of arthroscopic removal. Clinicians should beware of such foreign bodies in the ankle, particularly in patients with history of sprains, and consider arthroscopic removal in cases with persistent pain and/or functional impairment.

Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.

Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns

Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) ( P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.