Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers

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.

Novel Data About Unusual Location of Toxoplasma Gondii Within Active Microbial Community in the Anterior Chamber of the Eye of Egyptian Rural Children

In Egypt, many cases of granulomatous anterior uveitis consisting of single or multiple gelatinous nodules were detected in children living in rural areas. These lesions are believed to be waterborne and were previously attributed to flatworms ‘stage, showing some improvement after antiparasitic treatment. In a trial to explore the nature of these ocular lesions among rural Egyptian children, twenty surgically excised ocular lesions were subjected to transmission electron microscopy (TEM) examination. TEM results were combined with previous results of the metagenomic analysis performed for four cases out of the twenty samples, revealing the presence of Toxoplasma gondii (T. gondii), besides, a wide range of microbial communities, including variable species of fungi, bacteria, and archaea. The excised lesions ranged from 1 to 5 mm in size and demonstrated an extensive inflammatory cellular infiltrate. Using TEM, five out of twenty samples revealed active eukaryotic organisms with intact energetic cellular organelles, besides, numerous nuclei encircled within a syncytial layer and enclosed by a hyaline layer rich in mitochondria. Six samples showed inactivity in the cellular and the covering portions, while just inflammatory reaction was seen in the remaining nine samples. Toxoplasma gondii was found free within the distal part of the syncytium while, the proximal part showed the active synthesis of possibly extra polymeric substance, perhaps secreted by the microbial community. In a conclusion, Toxoplasma gondii has been detected among a microbial community in an atypical lesion in the eye. Further studies need to be sustained on genotype characterization, proteomic analysis, besides, the aquatic transmission of these mixed microbial species to the ocular tissues to clarify the reason behind such ocular illness.

Bleb-Independent Glaucoma Surgery to Activate the Uveolymphatic Route of Non-Trabecular Aqueous Humor Outflow: Short-Term Clinical and OCT Results

The deep sclerectomy technique was modified to enhance aqueous humor (AH) outflow via the non-trabecular pathway. A pilot study was carried out to assess its safety and effectiveness. Thirty-eight patients were under observation. After superficial scleral flap (4 × 4 mm), deep scleral layers were divided into three parts by three parallel-to-limbus incisions. Deep sclerectomy without creating a window in the Descemetes’ membrane was carried out in the distal part. A collagen implant was placed under the sclera of the remaining two parts with one end in the intrascleral pool. The third proximal part was excised to expose the uvea and implant. A Nd:YAG laser trabeculotomy at the surgery site was made on postoperative days 7–10. Outcome measures were IOP change, use of hypotensive medication(s), complications, and the need for a second surgery. At six months, the mean IOP decreased from 29.1 ± 9.2 mm Hg to 14.0 ± 4.3 mm Hg (p = 1.4 × 10−9); hypotensive medication use reduced from 2.9 ± 0.9 to 0.6 ± 1.0 (p = 1.3 × 10−10); complete success was achieved in 68.4% of cases and partial success was achieved in 31.6% of cases. Intraoperative and postoperative complications were rare and manageable. The OCT of the surgery site revealed the absence of bleb in all cases. Lymphatic vessels with characteristic bicuspid valves in their lumen were detected in conjunctiva near the operation site and over it in 32 patients. IOP decrease in the proposed technique was achieved by activation of the uveolymphatic route of AH outflow.

Lithofacies Analysis of the Tista River Deposits, Rangpur, Bangladesh

Eight (8) distinct lithofacies within the fluviatile reach of the Tista River have been recognized by the detailed study of the sediments as exposed along the river bank and river bars. Genetically, the matrix-supported conglomerate (Gms), massive sand (Sm), Trough cross stratified sand (St), planar cross stratified sand (Sp), ripple laminated sand (Sr) comprise the channel deposits whereas, the ripple laminated sand (Sr), parallel laminated sand (Sh), clay with silt (Fl) and massive Clay (Fm) represent overbank fine deposits. The channel deposits were laid down under relatively high energy conditions compared to the sediments of overbank fines. The stratigraphic succession is indicative of fining upward sequence. The dominance of coarser-grained sediments at the base of the lithostratigraphic unit, especially the matrix supported conglomerate (Gms) suggests that the deposition took place in the proximal part of the Tista Fan, which might be of glacial origin. Massive clay (Fm) is the final stage of vertical aggradations in the overbanks, possibly in the floodplains, flood basins, and back swamps when the velocity of the transporting medium was virtually lean that promotes the deposition of clay materials from suspension. The growth of cracks in the sedimentary succession is resulting from the compaction of the sediments and/or instant change in the paleoslope direction. The unimodal distribution of paleocurrent data with high mode value indicates mainly unidirectional sediment transport. The study of the lithofacies manifests that the deposits are produced by the braided river and debris flows. The modification of the depositional pattern from debris flow to overbank fines discloses the change of climatic condition in the Quaternary period.

On the Taxonomic Status of the Red Icefish Channichthys rugosus (Notothenioidei: Channichthyidae) from the Kerguelen Islands (South Ocean)

The presented work is the final part of the taxonomic revision of the Antarctic icefishes of the genus Channichthys Richardson, 1844 (Notothenioidei: Channichthyidae) from the Kerguelen Islands, the species composition of which was discussed until recently. Based on the morphological study of all available specimens from the ZIN and BMNH collections (including the holotype), a comprehensive redescription of the Red icefish Channichthys rugosus Regan, 1913 from the waters of the Kerguelen islands (South Ocean) was carried out, including external morphology, seismosensory system, gill apparatus, and axial skeleton. As a result, new diagnostic features of Red icefish were discovered and previously known ones were clarified, which made it possible to confirm the species validity. Comparison with other valid species icefishes was done. Channichthys rugosus differs from Ch. rhinoceratus Richardson, 1844 by a high anterior dorsal fin, the fin membrane of which reaches the apexes of its longest rays (does not reach in Ch. rhinoceratus), as well as a narrow and concave interorbital space (compared to the wider and flat one), by stronger granulation and a uniform reddish body color (dark spotted-marble in Ch. rhinoceratus). Channichthys rugosus differs from Ch. velifer Meissner, 1972 by the number of rays in the first dorsal fin (7–9 versus 9–12) and pectoral fin (18–20 versus 20–21), the presence of bone plaques in the proximal part of the medial lateral line (absent in Ch. velifer), and monochromatic reddish body coloration (spotted in Ch. velifer). Channichthys rugosus differs from Ch. panticapaei Shandikov, 1995 by the presence of only 1 row of gill rakers on the first gill arch (2 rows in Ch. panticapaei) and by light coloration (brownish-black in Ch. panticapaei).

Retrospective analysis of the appendiceal neoplasms: sampling technique may influence neoplasm detection

Background and aimsAppendiceal neoplasms are uncommon entities that are usually determined incidentally during the histopathological examination. Different techniques used for the macroscopic sampling of appendectomy material may affect the determinating neoplasms.Materials and methodsH&E-stained slides of 1280 cases who underwent appendectomy between 2013 and 2018 were reviewed retrospectively for histopathological features.ResultsNeoplasms were determined in 28 cases (3.09%); 1 lesion was observed in the proximal part of the appendix, 1 covering the entire length from proximal to distal and 26 in the distal part. In the 26 cases that observed in the distal part, the lesion was seen on both sides of the longitudinal section of the distal appendix in 20 cases, while it was seen on only one distal longitudinal section in the remaining 6 cases.ConclusionThe vast majority of appendiceal neoplasms are seen in the distal part of the appendix, and, in some cases, neoplasms might be seen on only one side of the distal section. Sampling only one-half of the distal part of the appendix, where tumours are most often observed, could result in some neoplasms being missed. Therefore, sampling the whole distal part would be more beneficial to determine small diameter tumours that do not create macroscopic findings.

Desulfovibrio desulfuricans AY5 Isolated from a Patient with Autism Spectrum Disorder Binds Iron in Low-Soluble Greigite and Pyrite

The sulphate-reducing bacteria (SRB) of genus Desulfovibrio are a group of prokaryotes associated with autism spectrum disorders (ASD). The connection between the elevated numbers of Desulfovibrio in the gut of children with ASD compared with healthy children remains unresolved. A conceivable consequence of SRB overgrowth in the gut is the conversion of bioavailable iron into low-soluble crystalline iron sulphides, causing iron deficiency in the organism. In this study, we report the draft genome sequence and physiological features of the first cultivable isolate from a patient with ASD, Desulfovibrio desulfuricans strain AY5.The capability of the strain to produce crystalline iron sulphides was studied under different pH conditions. The most notable greigite(Fe3S4) and pyrite (FeS2) formation was revealed at pH 6.0, which suggests that the iron loss due to insoluble sulphide formation may occur in the proximal part of the gastrointestinal tract. Strain AY5 was adapted to grow under nitrogen-limiting conditions by N2 fixation. The urease found in the strain’s genome may play a role in resistance to acidic pH.

689 Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: a case series

Aims The rates of cardiac device-related infection have increased substantially over the past years. Transvenous lead extraction is the standard therapy for such cases. In some patients, however, the procedure cannot be completed through the transvenous route alone. A hybrid surgical and transvenous approach may provide the solution in such cases. Methods and results We present three cases who underwent hybird transvenous and surgical extraction for coronary sinus leads due to infection of CRT-D systems. One patient had an Attain Starfix lead implanted in the coronary sinus. The procedures were performed under local anaesthesia with continuous haemodynamic and transthoracic echocardiographic monitoring. We highlight the characteristics of the patients, the features of the devices, the technical difficulties, and the outcomes of the procedures. In all cases, the right atrial and right ventricular leads were extracted through the transvenous route. In one patient, they were extracted using regular stylets and manual traction, while in the other two patients, telescoping dilator sheaths (Cook), Tightrail hand-powered mechanical sheaths (Spectranetics), and/or Glidelight Excimer Laser sheaths (Spectranetics) were used. The coronary sinus lead could not be retrieved due to extensive fibrosis after utilizing locking stylets and mechanical dilator sheaths in all three cases, in addition to rotational mechanical sheaths and laser sheaths in one case, so the patients were referred to surgery. Two patients underwent left mini-thoracotomy and one patient underwent midline sternotomy to extract the remaining CS lead. The target vein was identified and ligated, then the fibrosis around the lead was dissected, this was followed by lead retrieval through the surgical incision. The patient who underwent sternotomy suffered from mediastinitis, which required reoperation and mediastinal lavage. There were no complications in the other two patients. All three patients were reimplanted with a new CRT-D device on the contralateral side after the resolution of infection. Conclusions A hybrid surgical and transvenous approach can be complementary in case the transvenous route alone fails to completely extract the coronary sinus lead. The transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically, preferably though a limited thoracic incision.

Two new mutations in the CEL gene causing diabetes and hereditary pancreatitis: How to correctly identify MODY8 cases

Objective Maturity-onset diabetes of the young, type 8 (MODY8) is associated with mutations in the CEL gene, which encodes the digestive enzyme carboxyl ester lipase. Several diabetes cases and families have in recent years been attributed to mutations in CEL without any functional or clinical evidence provided. To facilitate correct MODY8 diagnostics, we screened two cohorts of diabetes patients and delineated the phenotype. Research design Young, lean Swedish and Finnish patients with a diagnosis of type 2 diabetes (352 cases, 406 controls) were screened for mutations in the CEL gene. We also screened 58 Czech MODY cases who had tested negative for common MODY genes. For CEL mutation-positive subjects, family history was recorded, and clinical investigations and pancreatic imaging performed. Results One Swedish and one Czech case with germline mutation in CEL were identified. Clinical and radiological investigations of these two probands and their families revealed dominantly inherited insulin-dependent diabetes, pancreatic exocrine dysfunction and atrophic pancreas with lipomatosis and cysts. Notably, hereditary pancreatitis was the predominant phenotype in one pedigree. Both families carried single-base pair deletions in the proximal part of the CEL variable number of tandem repeat (VNTR) region in exon 11. The mutations are predicted to lead to aberrant protein tails that make the CEL protein susceptible to aggregation. Conclusions The diagnosis of MODY8 requires a pancreatic exocrine phenotype and a deletion in the CEL VNTR in addition to dominantly inherited diabetes. CEL screening may be warranted also in families with hereditary pancreatitis of unknown genetic etiology.