Relationship of tissue dimensions and three captive bolt placements on cadaver heads from mature swine (Sus scrofa domesticus) > 200 kg body weight

Three penetrating captive bolt (PCB) placements were tested on cadaver heads from swine with estimated body weight (BW) >200 kg (sows = 232.9 ± 4.1 kg; boars = 229.3 ± 2.6 kg). The objectives were to determine tissue depth, cross-sectional brain area, visible brain damage (BD), regions of BD, and bolt-brain contact; and determine relationships between external head dimensions and tissue depth at each placement. A Jarvis PAS – Type P 0.25R PCB with a Long Stunning Rod Nosepiece Assembly and 3.5 gr power loads was used at the following placements on heads from 111 sows and 46 boars after storage at 2-4° C for approximately 62 h before treatment: FRONTAL (F) – 3.5 cm superior to the optic orbits at midline, TEMPORAL (T) – at the depression posterior to the lateral canthus of the eye within the plane between the lateral canthus and the base of the ear, or BEHIND EAR (BE) – directly caudal to the pinna of the ear on the same plane as the eyes and targeting the middle of the opposite eye. For sows, the bolt path was in the plane of the brain for 42/42 (100%, 95% CI: 91.6-100.0%) F heads, 39/40 (97.5%, 95% CI: 86.8-99.9%) T heads, and 34/39 (87.5%, 95% CI: 72.6-95.7%) BE heads; for the heads that could reliably be assessed for BD damage was detected in 25/26 (96.2%, 95% CI: 80.4-99.9%) F heads, 24/35 (68.6%, 95% CI: 50.7-83.2%) T heads, and 5/40 (12.5%, 95% CI: 4.2-26.8%) BE heads. For boars, the bolt path was in the plane of the brain for 17/17 (100.0%, 95% CI: 80.5-100.0%) F heads, 18/18 (100.0%, 95% CI: 81.5-100.0%) T heads, and 14/14 (100.0%, 95% CI: 76.8-100.0%) BE heads; damage was detected in 11/12 (91.7%, 95% CI: 61.5-99.8%) F heads, 2/15 (13.3%, 95% CI: 1.7-40.5%) T heads, and 7/14 (50.0%, 95% CI: 23.0-77.0%) BE heads. Tissue depth was reported as mean ± standard error followed by 95% one-sided upper reference limit (URL). For sows, total tissue thickness was different (P < 0.05) between placements (F: 52.7 ± 1.0 mm, URL: 64.1 mm; T: 69.8 ± 1.4 mm, URL: 83.9 mm; BE: 89.3 ± 1.5 mm, URL: 103.4 mm). In boars, total tissue thickness was different (P < 0.05) between placements (F: 41.2 ± 2.1 mm, URL: 56.3 mm; T: 73.2 ± 1.5 mm, URL: 83.4 mm; BE: 90.9 ± 3.5 mm, URL: 113.5 mm). For swine > 200 kg BW, F placement may be more effective than T or BE due to less soft tissue thickness, which may reduce concussive force. The brain was within the plane of bolt travel for 100% of F heads with brain damage for 96.2% and 91.7% of F sow and boar heads, respectively.

ANATOMICAL CHARACTERISTICS OF THE TEMPOROFACIAL NERVE BRANCH WITHIN THE PAROTID GLAND IN VIETNAMESE ADULTS

Objectives: Describe anatomical characteristics of the temporal branch of the facial nerve within the parotid gland in Vietnamese adults. Study population: The study was conducted in 12 hemifaces (right: 7; left: 5) of Vietnamese adult cadavers (5 cadavers with both hemifaces and 2 cadavers with only hemiface). Gender: 4 male (57.1%) and 3 female (42.9%). The average age was 73.0 ± 13.39 years (52-88 years). Method: Descriptive cross-sectional with analysis. Result and Conclusion: Most of the temporofacial trunks were located within the parotid gland (81.8%); 18.2% were located behind the parotid gland. The length of the facial nerve within the parotid gland was 8.88 ± 3.55 mm (4.62 - 16.96mm). The distance from the division point of the temporofacial trunk into the temporofrontal branch and the orbital nerve branch to the line (d) [crossing through the lateral canthus (A) and the point that root of the helix intersecting with the face] and (d2) [crossing the lateral canthus and the upper point of the tragus, just above the upper edge of external auditory canal] was 36.06 ± 7.50mm (19.26- 45.34 mm) và 21.94 ± 6.28 mm (11.52- 37.20 mm).

Validation of Eye Temperature Assessed Using Infrared Thermography as an Indicator of Welfare in Horses

This study aimed to validate eye temperature (ET) assessed using infrared thermography (IRT) as an indicator of welfare in horses. Moreover, this study aimed to determine the most accurate position for ET measured using IRT and to validate this approach as a gold-standard measurement method. As the quantitative data obtained by IRT have strongly influenced the ET results depending on the specific location of the measurement area, an accurate definition of the regions of interest (ROI) was established. A total of 176 horses (Thoroughbred, Warmblood, and Halla horses) were used at the racing course of the Korea Racing Authority and public horse-riding clubs in South Korea. The present study also compared temperatures among three ROIs of the eye—lacrimal sac, medial canthus, and lateral canthus—at rest. Correlations between ET, rectal temperature (RT), heart rate (HR), and respiratory rate (RR) were assessed. There were no significant correlations between HR, RR or RT; however, among the three ROIs, the temperature of the medial canthus was positively correlated with RT (p < 0.05). Furthermore, the size of ROI was negatively correlated with accuracy of temperature measurement. These results indicate that the most suitable area for ET measurement using IRT in horses is the medial canthus, and it is recommended to use the average temperature of the smallest ROIs (2 × 2 pixels) for temperature analysis. Therefore, this study offers a validated protocol in which ET measured using IRT in the horses is useful as an indicator of welfare.

Collision Cutaneous Neoplasms Consisting of Melanoma and Basal Cell Carcinoma

Collision tumors are defined as two histologically different tumor types that arise at the same anatomical location. According to the literature review performed, there are reports of 27 cases of collision tumors involving lentigo maligna melanoma (LMM) in-situ and basal cell carcinoma (BCC). In the absence of melanocytic extension beyond the lamina propria of the BCC compartment, mixed tumors are considered as melanoma in-situ colonizing the BCC, rather than invasive melanomas. We report an uncommon case of collision of BCC with LMM, two primary skin tumors that are seen in patients with significant sunlight exposure. In our case, the patient is a 91-year-old male presented with a translucent plaque with areas of brown pigmentation on his left lateral canthus. He had a history of multiple BCCs, squamous cell carcinomas and an invasive melanoma of right cheek. Given the clinical impression of BCC, the lesion was curetted. Histological examination demonstrated melanoma in-situ heavily infiltrating the dermal nodules of BCC. Deposits of melanin pigment were scattered throughout the tumor. The BCC contained about 50% atypical melanocytes. Further immunohistochemical evaluation with melanocytic and epithelial markers (melanin A, SOX-10, pan-cytokeratin and p63) confirmed the diagnosis. An unequivocal independent invasive melanoma component was not identified in this material. The collision of BCC and LMM is very rare. However, given the sun-damaged changes promote both tumors, their development at the same site, although unexpected, can be explained. Since the prognosis of the two entities is independent, wider excision to exclude invasive malignant melanoma is indicated.

Lateral sliding flap for one-step reconstruction of medium-sized eyelid defects

Background/purpose: To report the results of our clinical study on the efficacy of a ‘Lateral Sliding Flap’: A one-step technique for lower or upper eyelid reconstruction. Methods: Retrospective analysis of a consecutive case series of patients treated with a ‘Lateral Sliding Flap’ following tumour removal by horizontal block excision. In this technique a (medium-sized) defect of up to 50% of the eyelid was reconstructed by disinsertion of the lateral canthus, medial advancement of the lateral (remaining) (full-thickness) eyelid and a laterally-based horizontal skin-muscle advancement flap, followed by canthal fixation. We recorded the operating time and evaluated the postoperative eyelid apposition, lid contour, complications and frequency and type of re-operation. The outcome was scored (according to four grades (excellent/good/fair/ poor) of lid apposition and contour. Results: Seven consecutive patients, all treated by one oculoplastic surgeon in one year, were included. Six were female, one was male. Five had lower eyelid defects, two had upper eyelid defects of 40-50% of the horizontal width. The average age was 67,9 years, ranging from 52 to 85 years. The mean postoperative follow-up time was 31 months, ranging from 21-43 months. The average duration of the reconstruction was 31 minutes (ranging from 25 to 38 minutes). The outcome was excellent in 3 patients, good in 3 patients and fair in one patient. (Some) lash loss may be encountered. No complications such as flap ischemia of necrosis were noted. No re-operation was required. Conclusion: The ‘Lateral Sliding Flap’ is an efficaceous, one-step technique for reconstruction of defects of up to 50% of the lower or upper eyelid. With the technique a normal eyelid margin is created at the level of the cornea for optimal visual function and comfort. Compared to Tenzel’s semicircular rotation flap, the ‘lateral sliding flap’ results in a shorter vertical scar and “Hidden” horizontal scars in the relaxed skin tension lines.

Interstitial HDR Brachytherapy in the Treatment of Non-Melanocytic Skin Cancers around the Eye

Background: Eyelid tumors are rare skin cancers, the most common of which is basal cell carcinoma characterized primarily by local growth. In addition to surgery, radiotherapy is among the basic methods of treatment. External beam radiotherapy is associated with the risk of complications within ocular structures, especially the lens. In the case of interstitial brachytherapy, it is possible to administer a high dose to the clinical target volume (CTV), while reducing it in the most sensitive structures. Methods: This paper presents the results of an analysis of 28 patients treated with interstitial high dose rate (HDR) brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral canthus; and the cheek, nose and temples with the infiltration of ocular structures. The patients were treated according to two irradiation schedules: 49 Gy in 14 fractions of 3.5 Gy twice a day for 7 days of treatment, and 45 Gy in 5 Gy fractions twice a day for 5 days. The mean follow-up was 22 months (3–49 months). Results: two patients (6%) had a relapse: a local recurrence within the irradiated area in one of them, and metastases to lymph nodes in the other. The most common early complication was conjunctivitis (74%), and the most common late complication was dry eye syndrome (59%). Conclusions: Interstitial HDR brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral cants; and the cheek, nose and temples with infiltration of ocular structures is a highly effective, short and relatively low burden type of treatment.

A COMPREHENSIVE REVIEW ON APANGA MARMA

The concept of marma is one of the unique principles mentioned in ancient Ayurvedic texts. Marma are the vital sites in the body where there is confluence of mamsa, sira, snayu, asthi and sandhi where prana resides. These generate the symptoms from excruciating pain to fatal effect when exposed to trauma. Ancient ayurvedic seers have mentioned 107 such vital areas in the body. Apanga marma is one among them, present in the head region, at the area outer to lateral canthus and below the tail end of eyebrow within half angula dimension. It is a vaikalyakara marma and results in blindness or visual impairment on injury. Knowledge of marma is very important in clinical field in preventing the complications during the surgical and parasurgical procedures. Details are collected from ayurvedic texts and published papers aiming to provide a comprehensive overview on Apanga marma.

Eosinophilic Folliculitis in a Dog

Background: Canine eosinophilic folliculitis is a dermatological disease of acute onset with development of erosive to ulcerative papular lesions, especially on the nasal bridge, that may cause severe skin abnormalities leading to discomfort and pain to the patient. The aim of this report was to characterize a case of a canine eosinophilic folliculitis with papular, ulcerative and crusting dermatitis on the nasal bridge, papules on eyelid and pinna, with confirmed diagnosis based on aspiration cytology, history and response to immunosuppressive therapy with glucocorticoid.Case: A 1-year-old intact Daschund was attended showing an acute onset (over 4 h) of generalized urticarial reaction and nonpruriginous lesion at the muzzle with mild serosanguineous exudate, which persisted for 96 h when the dog was evaluated. It was observed a papular and ulcerative dermatitis with serosanguineous exudate and hematic crusts at nasal bridge, papules measuring 2 mm in diameter in the medial and lateral canthus of the left eyelid, ulcerative papule with hematic crust in the border of left ear pinna, multifocal papules on the skin, dyskeratosis and generalized hair loss. The patient was anesthetized for blood sampling (CBC and serum biochemistry), lesions fine-needle aspiration, scraping and imprint for cytological examination, bacterial culture and nasal turbinates radiography. Fragments for histopathological evaluation were also collected. Erythrogram and platelet evaluation were unremarkable. Leukogram revealed leukocytosis (neutrophilia, lymphocytosis, monocytosis and eosinophilia). Serum biochemistry revealed hyperalbuminemia and discrete hyperproteinemia; values of alanine aminotransferase, creatinine and globulins were within normal range. In cytological examination, intense cellularity was observed with predominance of eosinophils (60%), neutrophils (35%), macrophages performing cytophagocytosis (5%) and degenerated cells. There was no bacterial growth within 48 h after incubation of nasal bridge lesion swab. There were no abnormalities identified at radiographic evaluation of nasal turbinates. As the patient was already with antibiotic therapy and steroidal anti-inflammatory, it was opted to maintain it, since interruption between the day of examination and laboratory results could cause more prejudice than benefit, corticosteroid dose, however, was readjusted (prednisone 2 mg/kg/per os/every 24h). After 1 week of treatment the owner reported significant improvement of clinical signs without any further complaint.Discussion: Typically, type I hypersensitivity reactions such as insect bites do not exceed clinical signs of erythema, local edema and pruritus, with spontaneous remission of clinical signs within few hours after exposure to the antigen. Eosinophilic folliculitis, however, may cause more severe clinical alterations, such as pain, apathy and hyporexia. Nasal bridge is the predominant site described to be affected in cases of eosinophilic folliculitis, being auricular pinna, thorax and limbs considered atypical presentations which can delay proper diagnosis, since in endemic regions for diseases such as visceral leishmaniasis, infectious etiology may be listed first. Differential diagnosis also includes superficial pyoderma, juvenile cellulitis, pemphigus foliaceus and pharmacodermia. The case described in this report emphasize the importance of an accurate diagnosis as well as an early and adequate treatment in order to promote satisfactory response. Also, highlights inadequate use of antimicrobials as a direct consequence of lack of laboratorial investigation.Keywords: skin, eosinophilia, furunculosis, dermatitis, insects.

Case of Angular Blepharitis Caused by Demodex folliculorum

Angular blepharitis is inflammation of the eyelid skin at the lateral canthus, most commonly caused by Staphylococcus and Moraxella species. The Demodex mite is an external parasite that often infests the human eyelid margin and has been implicated in both anterior and posterior blepharitis. The authors describe the case of a 43-year-old female who presented for evaluation of a 3-month history of bilateral canthal eyelid irritation, consistent with angular blepharitis. This is a case report and review of relevant literature. Skin biopsy showed evidence of Demodex folliculorum infestation. Multiple D. folliculorum organisms were visualized within the hair follicles and on the surface, along with pockets of acute and chronic nongranulomatous inflammation surrounding hair follicles. The patient was treated with tea tree oil applied to her eyelids and eyelashes twice daily with complete resolution of symptoms. To our knowledge, this is the first report of angular blepharitis with histopathologic confirmation of Demodex infestation. In this discussion, we cover manifestations of the Demodex mite, angular blepharitis, and treatment options. Due to the lack of literature regarding this entity, we feel that it may be an underrecognized periocular and dermatologic condition that can lead to misdiagnosis, visits to multiple practitioners, and significant functional and cosmetic sequelae to the patient. Demodex infestation should be considered on the differential diagnosis for cases of refractory angular blepharitis, particularly when unresponsive to topical steroids. Based on results from treating Demodex anterior and posterior blepharitis and this case, treatment with tea tree oil should be considered.