Internal carotid artery anatomy – not always straightforward

Objectives To present a rare variant of internal carotid artery anatomy. Methods Case report presenting CT angiography finding of internal carotid anatomy variant. Results We present the case of an unusual origin of the occipital artery from cervical portion of the internal carotid artery as an incidental finding during CT angiography of the carotid arteries. In discussion, we discuss the possible embryological basis, incidence and prevalence of such finding and its possible clinical implications. Conclusion One of the specific aspects of carotid arteries is their straightforward anatomy – the cervical portion of internal carotid artery, unlike the external carotid, does not give origin to any branches – this aspect is even used as a highlight for orientation, e.g. during ultrasound examination. However, although rare, variants exist, and sometimes can have clinical importance – in the endovascular access or surgical treatment.

MINERALIZATION OF TEETH ENAMEL AFTER ERUPTION

The aim: The paper was aimed at the study of the processes of mineralization of the enamel of the permanent tooth after its eruption. Materials and methods: To study the structure of the enamel of permanent teeth has been carried out using light and electron microscopy. The study of the process of the development of the primordia of the permanent teeth involved 10 culled puppies of 30-40 days of age. Microscopic, electron microscopic, immunohistochemical methods of research have been used to study the processes of histogenesis. Results: The studies show that in the postnatal period, the formation of the crown, externally covered with cuticular epithelium, marks the formation of the primordium of the permanent tooth at the follicle stage. After eruption of a tooth, different parts of its crown have three individual structural and functional barriers to enamel biomineralization. The first one is provided by the cuticular epithelium of the pitted areas of the crown, which ensures filtering of the salivary fluid from the protein deposit in the form of a pellicle. The second barrier is defined on the lateral and cuspidate surfaces of the enamel, where the cuticle is erased or poorly expressed. The third structural and functional barrier of enamel biomineralization is located in the cervical portion of teeth of different classes. Conclusions: Different areas of the enamel in the tooth crown have specific filtration barriers, which can be distinguished as follows: pit-and-fissure-and-groove, cuspidateand-approximal, and cervical barriers. The cuticle is poorly expressed or totally absent on the cusps of the tooth crowns in contrast to pitted areas.

A Phylogenetic and Ontogenetic Perspective of the Unique Accumulation of Arterial Variations in One Human Anatomic Specimen

Background and objectives: Anatomical dissection is an indispensable means of acquiring knowledge about the variability of the human body. We detected the co-existence of several arterial variations within one female anatomic specimen during routine anatomical dissection. The aim of this study was to evaluate if this status is a regular pattern in any of other vertebrates. Materials and Methods: Besides of a meticulous anatomic dissection, we performed a literature review concerning the frequency, the phylogenesis, and ontogenesis of all of these variations. Results: Exceptionally, the middle colic artery arose from an extraordinarily divided celiac trunk. The kidneys received three polar arteries. On the left side, a corona mortis replaced the obturator artery. The aortic arch gave rise to a bicarotid trunk, and the right subclavian artery originated and coursed as a typical lusorial artery leading to a non-recurrent laryngeal nerve on the right side. Furthermore, variations of the branches of the thyrocervical trunk were found to be present. Extraordinarily, in their cervical portion both internal carotid arteries gave rise to two arteries each. All of these variations developed within two to three weeks, around the sixth week of gestation. It was not possible to ascribe all or even one of the variations to a singular species of vertebrates. Conclusion: Apparently, arterial variations are frequently a result of random development. Medical professionals must always be aware of anatomical variations; the absence of such awareness would create major difficulties during surgery. The present case confirms the relevance of anatomical dissection, particularly for medical students.

Observational outcome in surgery for Chiari malformation patients

Chiari malformation is the commonest anomaly of the craniovertebral junction involving both the skeletal as well as the neural structures. It is congenital anomaly of the hindbrain characterised by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Most common presenting symptoms was pain in the nape of neck with sub-occipital headache and weakness. If not intervened early in these cases they may progress to quadriparesis and respiratory failure. This study includes authors experience of 30 surgical corrections of Chiari malformation performed at civil hospital Ahmedabad from 2017 to 2019. The age and sex of the patient, the presence of syrinx, the type of surgical procedure and the clinical outcome were determined post-operatively and on follow up. Cerebro spinal fluid leak and collection were observed in patient who undergone duroplasty only with no leakage in patient undergone syringo-subarachnoid shunt. Overall, tingling/numbness had best improvement showed improvement in 13 out of 16 patients. Power showed improvement in 20 out of 27 patients and pain showed improvement in 18 patients. Wasting, clawing and cerebellar signs and bony deformity showed no improvement in any of the above procedures. Authors can conclude for Chiari malformation decompression with or without duroplasty with additional procedure with post-operative physiotherapy and analgesia is the suitable treatment.

THE EFFECT OF ERGOTHERAPY ON FUNCTIONAL RECOVERY OF UPPER EXTREMITIES IN PATIENTS WITH TRAUMATIC DISEASE OF THE CERVICAL SPINAL CORD IN THE LATE REHABILITATION PERIOD

Aim. The purpose of the article is to study the effect of physical rehabilitation on the correction of motor disorders in individuals with traumatic disease (TD) of the cervical portion (C6-C7) of the spine in the late rehabilitation period and experimentally substantiate the features of reco­very in the upper extremities. Materials and methods. The experiment involved 30 patients with TD of the cervical portion (C6-C7) of the spine in the late rehabilitation period (2 to 12 months after injury). To assess motor functions in the examined patients, manual muscle testing and dynamometry were performed for measuring muscle strength. The study of the function of the hand was carried out using an adapted modified test. The Barthel scale and the daily activity questionnaire were used to study the formation of self-service skills. The obtained data were processed with the Statistica 10.0 and Microsoft Excel Professional software. Results. The modified method of physical rehabilitation for people with TD of the cervical portion (C6-C7) of the spine in the interim period is a set of practically tested technologies. These technologies include a comprehensive set of activities and the following methods of kinesitherapy: PNF (proprioceptive neuromuscular facilitation), Bobath-therapy, Trankviletati method, Feldenkrais method, as well as mechanotherapy with specialized simulators (Dikul). Ergotherapy is a separate element, which is included in rehabilitation of patients with TD of the cervical portion of the spine together with exercise therapy, daily exercises. Conclusion. As a result of the use of a modified method of physical rehabilitation, in patients of the experimental group, the amplitude and muscle strength of the upper extremities significantly increased, the dynamics of the manipulative function of the hand and self-care skills improved in relation to initial values and the control group.

Can the Macrogeometry of Dental Implants Influence Guided Bone Regeneration in Buccal Bone Defects? Histomorphometric and Biomechanical Analysis in Beagle Dogs

The aim of this experimental animal study was to assess guided bone regeneration (GBR) and implant stability (ISQ) around two dental implants with different macrogeometries. Forty eight dental implants were placed within six Beagle dogs. The implants were divided into two groups (n = 24 per group): G1 group implants presented semi-conical macrogeometry, a low apical self-tapping portion, and an external hexagonal connection (whereby the cervical portion was bigger than the implant body). G2 group implants presented parallel walls macrogeometry, a strong apical self-tapping portion, and an external hexagonal connection (with the cervical portion parallel to the implant body). Buccal (mouth-related) defects of 2 mm (c2 condition) and 5 mm (c3 condition) were created. For the control condition with no defect (c1), implants were installed at crestal bone level. Eight implants in each group were installed under each condition. The implant stability quotient (ISQ) was measured immediately after implant placement, and on the day of sacrifice (3 months after the implant placement). Histological and histomorphometric procedures and analysis were performed to assess all samples, measuring crestal bone loss (CBL) and bone-to-implant contact (BIC). The data obtained were compared with statistical significance set at p < 0.05. The ISQ results showed a similar evolution between the groups at the two evaluation times, although higher values were found in the G1 group under all conditions. Within the limitations of this animal study, it may be concluded that implant macrogeometry is an important factor influencing guided bone regeneration in buccal defects. Group G1 showed better buccal bone regeneration (CBL) and BIC % at 3 months follow up, also parallel collar design can stimulate bone regeneration more than divergent collar design implants. The apical portion of the implant, with a stronger self-tapping feature, may provide better initial stability, even in the presence of a bone defect in the buccal area.

A rare case of multiple neurogenic tumours in the parapharyngeal space

Parapharyngeal space tumours are rare and represent less than 1% of head and neck tumours. Approximately 20% of them are neurogenic tumours, of which the most common are schwannomas and paragangliomas. The authors present the case of a 64-year-old female patient during diagnosis of cervical spine disorders, in whom the presence of a parapharyngeal space tumour reaching the ostium of the internal carotid artery was accidently revealed. After surgical removal of the lesion, two different tumours of different origin, from the vagus nerve and the cervical portion of the sympathetic nervous system, were detected by histopathological examination.

Simplified micrometric surface characterization of different implant surfaces available on the Brazilian market

Aim: This study characterized the implant surfaces available on the Brazilian market in terms of topography, chemical composition, and roughness. Methods: The following brands were selected according to their surfaces: Kopp (Ko), Signo Vinces (Sv), Neodent (Ne), Osseotite (Os) NanoTite (Nt), SIN (Si), Titanium Fix (Tf), conventional Straumann (Str), Active SLA (SLA). The morphological analysis and the alloy impurities and implant surface contaminants were analyzed by SEM-EDS. Surface roughness parameters and 3-D reconstructions were obtained by laser microscopy (20x). Two distinct areas were evaluated: i) the cervical portion (no surface treatment), and ii) the middle third (treated surface). Results: The characterization of the implant surfaces by SEM showed morphological differences between the thread geometries and surface morphology at 800x and 2000x magnification. The EDS elemental analysis showed a predominance of titanium (Ti) for all implants. The SLA surface showed only peaks of Ti while other implants brands showed traces of impurities and contaminants including Al, C, PR, F, Mg, Na, Ni, O, P, and SR. The implant surface roughness in the cervical portion did not exceed Ra 0.5–1.0 μm, constituting a minimally rough surface and obtaining acceptable standards for this region. Only Nt, Str, and SLA presented Ra above 2 μm in the middle third area showing a rough surface favorable for osseointegration. Conclusion: This study concluded that there is no established standard for morphology, chemical composition and implant surface roughness that allows a safe comparison between the available dental implant surfaces. National implant brands generally contain more impurities and surface contaminants than their international counterparts and were consequently more sensitive to the surface treatment techniques.

Intraoperative venoplasty to facilitate placement of tunneled catheters for hemodialysis

Objective With the implementation of the K-DOQI guidelines, more patients are in need of long-term dialysis catheters until maturation of the arteriovenous fistula. However, on occasion, when placing a tunneled cuffed catheter for hemodialysis, we have encountered difficulty with passing the guidewire in spite of demonstration of a patent cervical portion of the internal jugular vein on duplex. Herein, we review our experience with intraoperative venoplasty for placement of Tesio™ catheters (Medcomp Harleysville, PA). Methods Of the 1147 Tesio™ catheters placed since 1997 by our service, 35 venograms were performed due to difficulty encountered with placement of the guidewire. Patent veins were all crossed with the use of angle-guiding catheters, angled glidewires, and a torque vise. If chronically occluded intrathoracic veins were identified, an alternate site was selected for the placement of the Tesio™ catheter. Results Of the 35 cases with difficulty in catheter placement, venogram demonstrated a patent but tortuous vein in 9, chronically occluded intrathoracic veins in 6, and severe stenosis of the intrathoracic veins in 20. In 19 cases with severe stenosis of the intrathoracic veins, balloon angioplasty with an 8-mm balloon was successfully performed, which allowed successful placement of a functional Tesio™ catheter. In the additional one case, the catheter was not able to be placed despite angioplasty. Seven lesions that underwent balloon angioplasty were in the innominate vein, 11 were in the proximal internal jugular vein, and two were in the superior vena cava. Conclusion Venous balloon angioplasty can be used to maintain options for the site of access for tunneled cuffed catheters and may be necessary to assist with placement of long term cuffed dialysis catheters.