Management of Suprachoroidal Hemorrhage in a Patient With Boston Type I Keratoprosthesis

Purpose: Suprachoroidal hemorrhage (SCH) is a rare but vision-threatening complication in patients with keratoprosthesis devices (KPro), particularly in the setting of concurrent glaucoma tube shunts. Although there are many approaches to draining an SCH, surgery can be especially challenging in these patients because a crowded anterior chamber, and frequent anterior extension of the SCH. Methods: A case report is discussed. Results: We describe a novel approach to surgical drainage of SCH in a 64-year-old monocular patient with a Type I Boston KPro, an Ahmed valve, and aphakia. Conclusion: Successful repair of appositional SCH in the context of KPro can be safely and effectively achieved by injecting viscoelastic through the backplate holes of the KPro, thereby providing internal tamponade within the vitreous compartment while liquefied hemorrhage is drained by sclerotomy.

Diagnosing necrotizing external otitis on CT and MRI: assessment of pattern of extension

Background and purpose Necrotizing external otitis (NEO) is a serious complication of external otitis. NEO can be classified according to—anterior, medial, posterior, intracranial, and contralateral—extension patterns. Currently there is no consensus on the optimal imaging modality for the identification of disease extension. This study compares NEO extension patterns on MR and CT to evaluate diagnostic comparability. Methods Patients who received a CT and MR within a 3-month interval were retrospectively examined. Involvement of subsites and subsequent spreading patterns were assessed on both modalities by a radiologist in training and by a senior head and neck radiologist. The prevalence of extension patterns on CT and MR were calculated and compared. Results All 21 included NEO cases showed an anterior extension pattern on CT and MR. Contrary to MR, medial extension was not recognized on CT in two out of six patients, and intracranial extension in five out of eight patients. The posterior extension pattern was not recognized on MR. Overall, single anterior extension pattern (62%) is more prevalent than multiple extension patterns (38%). Conclusion All anterior NEO extension pattern were identified on CT as well as MR. However, the medial and intracranial spreading patterns as seen on MR could only be identified on CT in a small number of patients. The posterior spreading pattern can be overlooked on MR. Thus, CT and MR are complimentary for the initial diagnosis and work-up of NEO as to correctly delineate disease extent through the skull base.

The tetrapod fauna of the upper Permian Naobaogou Formation of China: 6. Turfanodon jiufengensis sp. nov. (Dicynodontia)

The dicynodont fossils from the Naobaogou Formation of Nei Mongol, China are abundant and diverse but poorly studied. In this article, one nearly complete skeleton and four cranial specimens from the Naobaogou Formation are referred to the dicynodontoid genus Turfanodon as a new species, T. jiufengensis. Previously, Turfanodon was known only from upper Permian sites in Xinjiang and Gansu. The new specimens are referred to Turfanodon based on the following characters: snout tall with steeply sloping profile, anterior tip of the snout squared off, facial region heavily pitted, nasal bosses present as paired swellings near the posterodorsal margin of the external nares, preparietal depressed, intertemporal bar long and narrow, premaxilla contacting frontal, palatal surface of premaxilla exposed in lateral view, and anterior pterygoid keel restricted to the anterior tip of the anterior ramus of the pterygoid. Turfanodon jiufengensis is differentiated from the type species, T. bogdaensis, by a contact of the lacrimal with the septomaxilla, discrete, raised nasal bosses, the dorsal edge of the erupted portion of the canine tusk slightly posterior to the anterior orbital margin, an anterior extension of the lacrimal distinctly shorter than that of the prefrontal, and a premaxillary dorsal surface with a median ridge. The holotype skeleton of T. jiufengensis includes a complete axial column with 50 vertebrae (six cervical, 23 dorsal, six sacral, and 15 caudal). Turfanodon represents the first confirmed tetrapod genus shared by the late Permian faunas of the Junggar and Ordos basins, and appears to be the first dicynodont genus distributed across both tropical and temperate zones (based on paleoclimate reconstructions). Based on tetrapod fossil content, the Naobaogou Formation can be roughly correlated to the Daptocephalus Assemblage Zone of South Africa (255–252 Ma in age).

EVALUATION OF VARIATIONS IN SPHENOID SINUS PNEUMATIZATION USING MULTIDETECTOR COMPUTED TOMOGRAPHY IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL, VISAKHAPATNAM

BACKGROUND: The purpose of our study was to assess the prevalence of different patterns of pneumatization in the sphenoid sinuses as detected on the computed tomography (CT) images of paranasal sinuses of the patients presenting with various pathologies. This is a retrospective radiological study of CT im MATERIALS AND METHODS: ages of paranasal sinuses, done at Radio diagnosis department of a Tertiary care hospital. The study comprised CT images of 500 patients in the age range of 18-75years who were referred for CT scan of paranasal sinuses for various pathologies between the period of July 2018 and July 2019. All images of paranasal sinuses had been acquired following a standardized protocol in axial plane. Their reconstructed images in axial, coronal and sagittal planes were evaluated, using Osirix software, for the extent and different patterns of sphenoid sinus pneumatization. The Images of sphenoid sinuses were assessed for the posterior, lateral and anterior extension of their pneumatization The sphenoid sinuses pneumatization patterns in the RESULTS: descending order of prevalence were complete sellar (75.0%), incomplete sellar (22.6%), presellar (2.4%) and conchal (0%). The clival extensions was seen in 75% of patients and lateral extension sides in 49.1% patients. Lateral recesses as assessed on coronal images was seen in 49.1 % of cases with the prevalence in descending order being extension into pterygoid process 59.8 %, greater wing of sphenoid 9.2 %, full lateral 41% and lesser wing (anterior clinoid process) 19.3%. The pure forms were relatively less common and combined forms being more common. A preoperative review of the sphenoid anatomy should allow for safer endo

The frontal longitudinal system as revealed through the fiber microdissection technique: structural evidence underpinning the direct connectivity of the prefrontal-premotor circuitry

OBJECTIVEThe purpose of this study was to investigate the morphology, connectivity, and correlative anatomy of the longitudinal group of fibers residing in the frontal area, which resemble the anterior extension of the superior longitudinal fasciculus (SLF) and were previously described as the frontal longitudinal system (FLS).METHODSFifteen normal adult formalin-fixed cerebral hemispheres collected from cadavers were studied using the Klingler microdissection technique. Lateral to medial dissections were performed in a stepwise fashion starting from the frontal area and extending to the temporoparietal regions.RESULTSThe FLS was consistently identified as a fiber pathway residing just under the superficial U-fibers of the middle frontal gyrus or middle frontal sulcus (when present) and extending as far as the frontal pole. The authors were able to record two different configurations: one consisting of two distinct, parallel, longitudinal fiber chains (13% of cases), and the other consisting of a single stem of fibers (87% of cases). The fiber chains’ cortical terminations in the frontal and prefrontal area were also traced. More specifically, the FLS was always recorded to terminate in Brodmann areas 6, 46, 45, and 10 (premotor cortex, dorsolateral prefrontal cortex, pars triangularis, and frontal pole, respectively), whereas terminations in Brodmann areas 4 (primary motor cortex), 47 (pars orbitalis), and 9 were also encountered in some specimens. In relation to the SLF system, the FLS represented its anterior continuation in the majority of the hemispheres, whereas in a few cases it was recorded as a completely distinct tract. Interestingly, the FLS comprised shorter fibers that were recorded to interconnect exclusively frontal areas, thus exhibiting different fiber architecture when compared to the long fibers forming the SLF.CONCLUSIONSThe current study provides consistent, focused, and robust evidence on the morphology, architecture, and correlative anatomy of the FLS. This fiber system participates in the axonal connectivity of the prefrontal-premotor cortices and allegedly subserves cognitive-motor functions. Based in the SLF hypersegmentation concept that has been advocated by previous authors, the FLS should be approached as a distinct frontal segment within the superior longitudinal system.

Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins

Background A clear understanding of the anatomical characteristics of the pulmonary veins (PVs) is essential for the successful performance of segmentectomy and important to avoid intraoperative pulmonary vessels injury. However, there is no report showing the relations between the branching patterns of PVs and pulmonary arteries (PAs). Moreover, internationally accepted symbols for describing PVs remain unavailable. For anatomically assessing the branches and courses of the subsegmental veins in the left upper lobe (LUL), the diverse branching patterns of blood vessels and bronchi should be investigated. Methods The branching patterns and intersegmental courses of PVs were assessed by performing three-dimensional image analysis of the bronchi, and PAs and PVs in the LUL in 103 patients who were scheduled to receive segmentectomy in LUL from January 2008 through August 2012. Results Branching types of the bronchi and pulmonary vessels failed to be independent each other. Although the combinations of anterior extension type of bronchus with the inter-lobar type (IL-type) of arterial branching pattern were often observed, but those with the mediastinal type (M-type) were rarely observed. The combinations of apical vein dominant type with the IL-type of arteries, and intermediate and central vein types with the M-type were often observed. Since LUL was adjoined by various subsegments, and the intersegmental pulmonary veins showed diverse patterns. Conclusions This study found the relationship among PA, PV, and bronchus patterns, in the subsegment where the branching patterns were fixed in 103 cases. This study discovered PVs that was difficult to be named by the conventional naming systems because of the diversity of the locations in the subsegment.

Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins

Background : Although a clear understanding of the anatomical characteristics of the pulmonary veins (PVs) is essential for the successful performance of segmentectomy and is important to avoid intraoperative pulmonary vessels injury, there is no report showing the relations between the branching patterns of PVs and pulmonary arteries (PAs). Moreover, internationally accepted symbols for describing the PVs remain unavailable. For anatomically assessing the branches and courses of the subsegmental veins in the left upper lobe (LUL), the diverse branching patterns of blood vessels and bronchi should be investigated. Methods : The branching patterns and intersegmental courses of PVs were assessed by performing three-dimensional image analysis of the bronchi, and PAs and PVs in the LUL in 103 patients who were scheduled to receive segmentectomy in LUL from January 2008 through August 2012. Results : Branching types of the bronchus and pulmonary vessels failed to be independent each other. Combinations of anterior extension type of bronchi with the inter-lobar type (IL-type) of arterial branching pattern were often observed, but those with the mediastinal type (M-type) were rarely observed. The combinations of apical vein dominant type with the IL-type of arteries, and intermediate and central vein type with the M-type were often observed. LUL was adjoined by various subsegments, and the intersegmental pulmonary veins showed diverse patterns. Conclusions : This study found the relationship among PA, PV, and bronchus patterns, and in the subsegment where the branching patters were fixed in 103 cases. This study discovered PVs that was difficult to be named by the conventional naming systems because of the diversity of the locations in the subsegment.

Anatomical Analysis of the Left Upper Lobe of Lung on Three-Dimensional Images with Focusing the Branching Pattern of the Subsegmental Veins

Background: Although a clear understanding of the anatomical characteristics of the pulmonary veins (PVs) is essential for the successful performance of segmentectomy and is important to avoid intraoperative pulmonary vessels injury, there is no report showing the relations between the branching patterns of PVs and pulmonary arteries (PAs). Moreover, internationally accepted symbols for describing the PVs remain unavailable. For anatomically assessing the branches and courses of the subsegmental veins in the left upper lobe (LUL), the diverse branching patterns of blood vessels and bronchi should be investigated. Methods: The branching patterns and intersegmental courses of PVs were assessed by performing three-dimensional image analysis of the bronchi, and PAs and PVs in the LUL in 103 patients who were scheduled to receive segmentectomy in LUL from January 2008 through August 2012. Results: Branching types of the bronchus and pulmonary vessels failed to be independent each other. Combinations of anterior extension type of bronchi with the inter-lobar type (IL-type) of arterial branching pattern were often observed, but those with the mediastinal type (M-type) were rarely observed. The combinations of apical vein dominant type with the IL-type of arteries, and intermediate and central vein type with the M-type were often observed. LUL was adjoined by various subsegments, and the intersegmental pulmonary veins showed diverse patterns. Conclusions: This study found the relationship among PA, PV, and bronchus patterns, and in the subsegment where the branching patters were fixed in 103 cases. This study discovered PVs that was difficult to be named by the conventional naming systems because of the diversity of the locations in the subsegment.

Post-traumatic arachnoid cyst without neurological sequels

An eight-year-old male patient was admitted to the hospital with a history of left median paramedian frontal craniectomy due to car trauma at six months of age. Axial computed tomography of the skull with reconstruction in three dimensions revealed an arachnoid cyst with slight herniation of the brain in the frontal lobe, leading to protrusion against the skullcap, causing dilation of the ex-vacuum of the anterior extension of the homolateral lateral ventricle. He presented asymmetrical lateral ventricles, a reduced base cistern, and a slightly ectatic IV centred ventricle. After the physical examination, no neurological deficit was found, despite the changes identified in the images. It is believed that such conditions may progressively worsen with the development and maturation of nervous tissue over the age of the assessed child. To confirm this, specialized monitoring is of fundamental importance.