Anatomical Characteristics, Relations, and Clinical Considerations of the Facial Index and Cephalic Index in Young Chileans Aged Between 18 and 21 Years / Características Anatómicas, Relaciones y Consideraciones Clínicas del Índice Facial e Índice Cefálico en Jóvenes Chilenos entre 18 y 21 Años

SUMMARY: Humans throughout history have shown similarities between both their cephalic and facial complexion, among certain ethnic groups, due to genetic and demographic factors. Several studies have demonstrated the different constitutions of specific groups of people in order to generate data of a certain population or group. The present research aims to preliminarily study the existence of possible relations between Cephalic Index and Facial Index among categories of individuals in an odontology student population from a private university in Santiago, Chile. Empirical, descriptive, and cross-sectional study. In this study, 129 students with age range 18-21 were taken as subjects in a non-probabilistic way. Regarding Cephalic Index (CI), the Retzius classification was used, and the Facial Index (FI) was measured considering the maximum height of the face, from nasion to gnathion (Na-Gn), and the maximum width, from right zygion to left zygion (Zr-Zl). In this study, 129 people were taken as sample, 82 females and 47 males. Among women, the most predominant cephalic biotype was brachycephalic (59.8 %), followed by mesocephalic (37.8 %), and dolichocephalic (2.4 %). On the other hand, men's most common biotype was mesocephalic (57.5 %), followed by brachycephalic (36.2 %), and dolichocephalic (6.4 %). Regarding facial biotype, both in female and male subjects the following pattern was shown: euryprosopic (F: 59.7 %, M: 59.6 %), mesoprosopic (F: 26.8 %, M: 29.8 %), and leptoprosopic (F: 13.4 %, M: 10.6 %). Facial parameters of the subjects (odontology students from a Chilean university) tend to be mostly euryprosopic, followed by mesoprosopic and leptoprosopic. Additionally, mesocephalic biotypes tend to be similar to other studies conducted in Chile.

Los seres humanos a lo largo de la historia han mostrado similitudes tanto entre su complexión cefálica como facial, entre ciertos grupos étnicos, debido a factores genéticos y demográficos. Varios estudios han demostrado las diferentes constituciones de grupos específicos de personas para poder generar datos de una determinada población o grupo. La presente investigación tiene como objetivo estudiar preliminarmente la existencia de posibles relaciones entre el Índice Cefálico y el Índice Facial entre categorías de individuos en una población de estudiantes de odontología de una universidad privada de Santiago, Chile, en un estudio empírico, descriptivo y transversal. En este estudio, se tomó como sujetos de forma no probabilística a 129 estudiantes con edades comprendidas entre 18 y 21 años. Respecto al Índice Cefálico (IC), se utilizó la clasificación de Retzius, y el Índice Facial (FI) se midió considerando la altura máxima de la cara, desde nasión hasta gnatión (Na-Gn), y el ancho máximo, desde cigio derecho a izquierdo. cigio (Zr-Zl). En este estudio se tomó como muestra 129 personas, 82 mujeres y 47 hombres. Entre las mujeres, el biotipo cefálico más predominante fue el braquicéfalo (59,8 %), seguido del mesocefálico (37,8 %) y el dolicocéfalo (2,4 %). Por otro lado, el biotipo más común en los hombres fue el mesocefálico (57,5 %), seguido del braquicéfalo (36,2 %) y el dolicocéfalo (6,4 %). Respecto al biotipo facial, tanto en sujetos femeninos como masculinos se mostró el siguiente patrón: euriprosópico (F: 59,7 %, M: 59,6 %), mesoprosópico (F: 26,8 %, M: 29,8 %) y leptoprosópico (F: 13,4 %, M: 10,6 %). Los parámetros faciales de los sujetos (estudiantes de odontología de una universidad chilena) tienden a ser en su mayoría euriprosópicos, seguidos de mesoprosópicos y leptoprosópicos. Además, los biotipos mesocefálicos tienden a ser similares a otros estudios realizados en Chile.

Variación Morfológica en la Musculatura Cefálica de Diplobatis ommata y Narcine vermiculatus (Chondrychthyes: Narcinidae) / Morphological Variation in the Cephalic Musculature of Diplobatis ommata and Narcine vermiculatus (Chondrychthyes: Narcinidae)

Los trabajos realizados sobre batoideos han demostrado que existen grandes variaciones en la musculatura de la región cefálica ventral, estos cambios están asociados a los diferentes estilos de vida de los organismos y por tanto, a los mecanismos de alimentación. El objetivo de este trabajo fue llevar a cabo un estudio comparativo de la morfología de la musculatura cefálica dorsal y ventral de dos especies de la familia Narcinidae: Narcine vermiculatus y Diplobatis ommata. Se observó que ambas especies comparten un patrón morfológico común. Los músculos que mostraron mayores variaciones en la región dorsal fueron el depresor rostral, el preorbital lateral y el elevador rostral. La diferencia más importante en esta región, entre ambas especies, fue la ausencia del músculo cucularis en D. ommata. En la región ventral las principales diferencias se observaron en los músculos depresor mandibular, preorbital medial, interbranquial y depresor hiomandibular. Este último músculo está formado por dos paquetes en D. ommata, en tanto que en N. vermiculatus por uno. Se puede concluir que la morfología de la musculatura cefálica es constante; sin embargo, se observan diferencias importantes en el grado de desarrollo de los músculos tanto en la región dorsal como en la ventral.

SUMMARY: Works conducted on batoids have revealed large variations in the musculature of the ventral cephalic region, associated to the different lifestyles of these organisms and, therefore, to their feeding mechanisms. This work aimed to conduct a comparative study of the dorsal and ventral cephalic muscular morphology of two species of the family Narcinidae: Narcine vermiculatus and Diplobatis ommata. It was observed that both species share a common morphological pattern. Muscles with larger variations in the dorsal region were the rostral depressor, the lateral preorbital and the rostral elevator. The most relevant difference in this region between both species was the absence of the cucularis muscle in D. ommata. In the ventral region, the main differences were observed in the mandibular depressor, medial preorbital, interbranchial and hyomandibular depressor muscles. In D. ommata, the latter is formed by two packages, and by one in N. vermiculatus. It can be concluded that the cephalic musculature is constant; however, significant differences are observed in the muscle development degree in both the dorsal and the ventral regions.

Morbilidad y mortalidad de la duodenopancreatectomía cefálica convencional en pacientes con enfermedad del confluente biliopancreático

Introducción: La duodenopancreatectomía cefálica es una operación cada vez más frecuente en pacientes seleccionados. Objetivo: Identificar la morbilidad y la mortalidad concerniente a la duodenopancreatectomía cefálica convencional. Métodos: Se realizó un estudio observacional, descriptivo de una serie de 15 casos operados de duodenopancreatectomía cefálica. Se investigaron las variables: estadificación según clasificación tumor, linfonódulo, metástasis (TNM), diagnóstico anatomopatológico, complicaciones, tiempo quirúrgico y estado al egreso. Se utilizaron el número absoluto y el porcentaje como medidas de resumen para las variables estadificación y diagnóstico; la media, la mediana y el rango para el tiempo quirúrgico y el intervalo de confianza para el estado al egreso. Resultados: El diagnóstico anatomopatológico principal fue adenocarcinoma de páncreas con 9 pacientes (60,1 %) y de duodeno con 2 (13,3 %). El estadio posoperatorio IIA fue el que prevaleció con 5 (45,5 %). El retraso del vaciamiento gástrico fue la complicación quirúrgica que prevaleció, con 7 (46,7 %) enfermos, seguida de la fístula biliar con 3 (20,0 %). La fístula pancreática, la lesión de la vena mesentérica superior y la hemorragia posoperatoria se presentaron una sola vez (6,7 %), respectivamente. Estas 2 últimas, provocaron la muerte del enfermo en las primeras 48 horas del posoperatorio. Fallecieron 4 (26,7 %) pacientes de la serie. Conclusiones: Las complicaciones posquirúrgicas se observan principalmente a expensas del retardo del vaciamiento gástrico, la fístula biliar y pancreática. La mortalidad puede estar relacionada con la prolongación del tiempo quirúrgico igual o mayor de 5 horas, con el consiguiente aumento de las pérdidas hemáticas.

Introduction: Cephalic duodenopancreatectomy is an increasingly frequent operation in selected patients. Objective: To identify the morbidity and mortality related to conventional cephalic duodenopancreatectomy. Methods: An observational, descriptive study of a series of 15 cases operated on cephalic duodenopancreatectomy. The variables were investigated: staging according to the Tumor, Linphonod, Metastasis (TNM) classification, pathological diagnosis, complications, surgical time and discharge status. Absolute number and percentage were used as summary measures for the variables staging and diagnosis; mean, median and range for surgical time and confidence interval for discharge status. Results: The main pathological diagnosis was adenocarcinoma of the pancreas with 9 patients (60.1%) and of the duodenum with 2 (13.3%). Postoperative stage IIA was the one that prevailed with 5 (45.5%) patients. Delayed gastric emptying was the prevailing surgical complication, with 7 (46.7%) patients, followed by biliary fistula with 3 (20.0%). Pancreatic fistula, superior mesenteric vein injury, and postoperative hemorrhage occurred only once (6.7%), respectively. These last 2, caused the death of the patient in the first 48 hours of the postoperative period. Four (26.7%) patients in the series died. Conclusions: Postoperative complications are mainly observed at the expense of delayed gastric emptying and biliary and pancreatic fistula. Mortality may be related to the prolongation of surgical time equal to or greater than 5 hours with the consequent increase of blood loss.

Caracterización clinicoepidemiológica de pacientes operados de duodenopancreatectomía cefálica con enfermedad del confluente biliopancreático / Clinical epidemiological characterization of patients operated on cephalic pancreaticoduodenectomy with disease of the biliopancreatic confluent

Introducción: La duodenopancreatectomía cefálica continúa siendo una intervención quirúrgica compleja. Objetivo: Caracterizar a los pacientes operados de duodenopancreatectomía cefálica según variables epidemiológicas, clínicas e histológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de una serie de 15 casos operados de duodenopancreatectomía cefálica en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante el quinquenio 2016-2020. Las variables analizadas fueron edad, sexo, comorbilidades, hábitos tóxicos, síntomas y signos, así como tipo histológico de las lesiones. Resultados: Predominaron los pacientes del sexo masculino (80,0 %) y el grupo de 50 a 55 años de edad (40,0 %). Las comorbilidades más frecuentes fueron la hipertensión arterial en 80,0 % de la casuística, seguida de la diabetes mellitus en 53,3 %. Prevalecieron el tabaquismo (66,7 %) y el alcoholismo (60,0 %), así como los signos de obstrucción biliar (73,3 %). El diagnóstico histológico principal fue adenocarcinoma de páncreas en 60,1 % de los afectados. Conclusiones: La duodenopancreatectomía cefálica se realiza predominantemente en pacientes con adenocarcinomas de páncreas y, en menor medida, con adenocarcinomas de duodeno y otras afecciones benignas; en afectados del sexo masculino, con edades intermedias y avanzadas de la vida, hipertensión arterial y diabetes mellitus, así como tiempo prolongado de ser fumadores y consumidores de alcohol. Los signos de obstrucción biliar son de importancia capital en el diagnóstico clínico.

Introduction: The cephalic pancreaticoduodenectomy continues being a complex surgical intervention. Objective: To characterize patients operated on cephalic duodenopancreatectomy according to selected epidemiological, clinical and histologic variables. Methods: An observational, descriptive and retrospective study of a series of 15 cases operated on cephalic pancreaticoduodenectomy was carried out in the General Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, during the five year period 2016-2020. The analyzed variables were age, sex, comorbidities, toxic habits, symptoms and signs, as well as histologic type of the lesions. Results: There was a prevalence of the male sex patients (80.0 %) and the 50 to 55 age group (40.0 %). The most frequent comorbidities were hypertension in 80.0 % of the case material, followed by the diabetes mellitus in 53.3 %. Nicotine addiction (66.7 %) and alcoholism (60.0 %) prevailed, as well as the signs of biliary obstruction (73.3 %). The main histologic diagnosis was pancreas adenocarcinoma in 60.1 % of those affected. Conclusions: The cephalic pancreaticoduodenectomy is carried out predominantly in patients with pancreas adenocarcinomas and, to a lesser extent, in patients with duodenum adenocarcinomas and other benign affections; in those affected of the male sex, with intermediate and advanced ages of life, hypertension and diabetes mellitus, as well as long time of being smokers and alcohol consumers. The signs of biliary obstruction are of capital importance in the clinical diagnosis.

Learning curve for ultrasound-guided external cephalic version without anesthesia in full-term and near-term pregnancies / 中华围产医学杂志

Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.

Cephalofacial differences between males 18 years of age and 20-30 years of age / Diferencias cefalofaciales entre hombres de 18 años y de 20-30 años

SUMMARY: The human skull is comprised of many flat and irregular bones, divided into two groups: cranial and facial bones. The size, shape and growth of the human skull are the product of many interrelated internal and external factor interactions. The purpose of the present study was to explore the systematic differences in cephalofacial size and shape classification between two measured groups of different ages and different period of done measurements. Five cephalofacial variables and four cephalofacial indexes were measured on 795 entities of the Kosovo Albanian population in two different timelines; 401 male entities aged 20-30 years old were measured during the timeline 1997-1999, while 394 male entities aged 18 years old were measured during the timeline 2016-2018. The gained data were analyzed in terms of basic descriptive statistical parameters and the percentage of distribution of results. The most pronounced differences between the age groups of 18 year-olds and the age group of 20-30 year-olds, are mainly emphasized in the morphological height of the face, total facial index and transverse cephalic index. While in other dimensions, the distribution of results is very similar. Differences between groups can be justified by the age at which the growth of the cephalofacial bones ends and the influence of external factors such as nutritional and socio-economic factors.

RESUMEN: El cráneo humano está compuesto por huesos planos e irregulares, divididos en dos grupos: huesos craneales y faciales. El tamaño, la forma y el crecimiento del cráneo humano son el producto de muchas interacciones de factores internos y externos interrelacionados. El propósito del presente estudio fue explorar las diferencias sistemáticas en la clasificación de tamaño y forma cefalofacial entre dos grupos de diferentes edades y en diferentes períodos de mediciones. Se midieron cinco variables cefalofaciales y cuatro índices cefalofaciales en 795 entidades de la población albanesa de Kosovo en dos líneas de tiempo diferentes. Se midieron 401 entidades masculinas de 20 a 30 años. Durante el periodo 1997-1999 se medieron 401 entidades masculinas de 20 a 30 años, mientras que 394 entidades masculinas de 18 años se se midieron durante el periodo 2016-2018. Los datos obtenidos se analizaron en términos de parámetros estadísticos descriptivos básicos y el porcentaje de distribución de los resultados. Las diferencias más pronunciadas entre los grupos de edad de 18 años y el grupo de 20-30 años, se enfatizan principalmente en la altura morfológica de la cara, índice facial total e índice cefálico transversal. Mientras que en otras dimensiones, la distribución de resultados es muy similar. Las diferencias entre grupos pueden estar asociadas a la edad en la que finaliza el crecimiento de los huesos cefalofaciales y la influencia de factores externos, tal como aspectos nutricionales y socioeconómicos.

Importancia del sitio de terminación de la vena cefálica del antebrazo / Importance of the cephalic antebrachial vein termination site

RESUMEN: Las venas superficiales de la fosa cubital se han estudiado con varios fines, venopunciones, cateterismos, fístulas, entre otros. Se han descrito varios patrones venosos en esta región en diferentes poblaciones. En uno de estos la vena cefálica termina en la vena basílica a nivel del antebrazo generando posibles riesgos de lesiones durante la canalización. En el presente estudio se evaluaron 200 miembros superiores de 100 personas colombianas, 50 mujeres y 50 hombres, 70 de ellas nacidas en la ciudad de Bucaramanga y 30 en la ciudad de Villavicencio. Se registró el número de venas cefálicas y su sitio de terminación, en el brazo o antebrazo. El patrón venoso que predominó en ambos miembros superiores fue el tipo I. El patrón IV en el cual la vena cefálica termina en la vena basílica se presentó en 12 casos (6 %) en el miembro superior derecho y en 17 casos (8,5 %) en el miembro superior izquierdo. Se encontró dos venas cefálicas entre el 13 % y 13,5 % dependiendo del lado y tres venas cefálicas entre el 1 % y 2 %. Conocer esta particularidad de los patrones venosos podría disminuir el riesgo de complicaciones durante la venopunción.

SUMMARY: The superficial veins of the ulnar fossa have been studied for various purposes, venipuncture, catheterization, fistulae, among others. Various venous patterns have been described in this region in different populations. In one of these, the cephalic vein ends in the basilic vein at the level of the forearm, generating possible risks of injury during cannulation. In the present study, 200 upper limbs of 100 Colombians, 50 women and 50 men, were evaluated, 70 of them born in the city of Bucaramanga and 30 in the city of Villavicencio. The number of cephalic veins and their termination site, on the arm or forearm, were recorded. The venous pattern that predominated in both upper limbs was type I. Pattern IV in which the cephalic vein ends in the basilic vein occurred in 12 cases (6 %) in the right upper limb and in 17 cases (8.5 %) in the left upper limb. Two cephalic veins were found between 13 % and 13.5 % depending on the side and three cephalic veins between 1 % and 2 %. Knowing this particularity of venous patterns could reduce the risk of complications during venipuncture.

Estudio cadavérico del arco de la vena cefálica / Cadaveric study of the cephalic vein arch

RESUMEN: Dentro de las disfunciones de los angioaccesos, la estenosis del arco de la vena cefálica (AVC) juega un papel significativo. Existen características anatómicas del AVC que explican, en parte, este fenómeno. Todo esto obliga a un conocimiento profundo del AVC y sus principales variantes. Se disecaron 43 (n=43) axilas de cadáveres adultos fijados en solución en base a formol. Se registró: longitud del AVC (LAC), angulación del AVC respecto a la vena cefálica (AAC), tipo de terminación (simple o múltiple), presencia de afluentes y su número. LAC promedio 31,6 mm (rango 17-46 mm); AAC promedio 128,95° (rango 65-165°). En cuanto al tipo de terminación 41 (95,3 %) fueron simples, mientras que 2 casos (4,7 %) fueron de forma múltiple. Respecto a los afluentes, se encontraron en 42 de los casos (90,5 %). Se encontraron válvulas en 27 (62,8 %) de los casos. La longitud promedio del AVC fue de 31,6 mm, se dispuso en la mayoría de los casos en ángulo obtuso, presentando en la mayoría de los casos terminación de tipo simple. Además, en el 90,5 % se encontró afluentes que se agotaban en el AVC y en más de la mitad de los casos se encontraron válvulas. Se discuten las implicancias de estos hallazgos en la génesis de la disfunción de angioaccesos.

SUMMARY: Within the angio access dysfunctions, the stenosis of the cephalic vein arch (AC) has a significant role. There are anatomical characteristics of AVC that partially explain this phenomenon. This requires a deep understanding of AVC and its main variants. 43 axillary regions of formalin-fixed adult cadavers were dissected. For this study, the following were registered: length of the AVC (LAC), angulation of the AVC with respect to the cephalic vein (AAC), type of termination (single or multiple), presence and number of tributaries. LAC average 31.6 mm (range 17-46 mm); AAC average 128,95° (range 65-165°). Regarding the type of termination, 41 (95.3 %) were simple, while 2 cases (4.7 %) were multiple. Tributaries were found in 42 of the cases (90.5 %). Valves were found in 27 (62.8 %) of the cases. The average length of the AVC was 31.6mm. Most cases presented an obtuse angle, and simple termination. In addition, in 90.5 % tributaries were found and in more than half of the cases valves were found. Implications of these findings in the genesis of angioaccess dysfunction are discussed.

Pregnancy outcome of external cephalic version in singleton pregnancy with breech presentation at term

Background: Breech delivery is associated with poor perinatal outcomes irrespective of the route of delivery. External cephalic version can be a useful tool in management of breech presentation at term by converting it to a cephalic presentation. A study was conducted to evaluate maternal and neonatal outcome of external cephalic version in singleton pregnancies with breech presentation in third trimester.Methods: A prospective observational study was carried out at a tertiary care hospital over a period of 2 years. This study included a total of 65 uncomplicated cases of breech presentation who fulfilled the inclusion criteria. External cephalic version was carried out after 36 weeks of period of gestation in primigravida and after 37 weeks in multigravida women. These patients were followed up till delivery and data was collected and analysed regarding the mode of delivery, maternal and fetal outcome.Results: External cephalic version was successful in 41 patients with a success rate of 63%. Out of them, vaginal delivery could be achieved in 31 cases (75.6%) and LSCS was done for rest of the 10 cases. The success rate was higher in multigravida ladies compared to primigravida ladies. No major procedure related adverse event was noticed in our study.Conclusions: External cephalic version is a very safe and easy procedure which can reduce the rate of cesarean delivery in singleton pregnancies with breech presentation. The results of this study are in favor of wider practice of this procedure in selected cases.

Morphological and Morphometrical Studies on the Skull of Binturong (Arctictis binturong)

The binturong or bearcat is the largest species of the family Viverridae. It is uncommon in much of its range and has been assessed as vulnerable on the IUCN red list. The size of the head was small, narrow and light in proportion to the body. The skull of the binturong was dolichocephalic as per the cephalic index (56.25). There was no prominent internasal suture and the orbits were incomplete with optic foramen present near the ventral surface. The mean skull length, skull width, skull base length, cranial length, cranial width, cranial height, were 14.95±0.10 cm, 8.47±0.10 cm, 15.07±0.02 cm, 11.16±0.09 cm, 6.56±0.11 cm, 3.16±0.08 cm, respectively. The mean facial length, facial width, maxilla length, maxilla height, distance between infraorbital foramen, diameter of infraorbital foramina, nasal length, nasal width were 4.95±0.08 cm, 6.14±0.12 cm, 4.46±0.01 cm, 3.83±0.02 cm, 4.68±0.10 cm, 0.49±0.07 cm, 2.94±0.03 cm, 1.97±0.11 cm, respectively. Scanty literature available on morphological and morphometrical studies of the skull of binturong. Therefore this present study was aimed to establish a morphometric database that will eventually guide the use of these measurements for diagnosis and treating different disorders

Los tipos craneométricos caninos aparecen bien expresados a nivel de conformación del arco cigomático / Craneometric canine types are well expressed at the level of the zygomatic arch conformation

Dentro del espectro de conformación del cráneo, se reconocen generalmente tres amplias categorías que se corresponden con el concepto de biotipo cefálico, determinado por el Índice Cefálico. El Estos tres biotipos cefálicos son: el braquiocefálico, mesaticefálico y dolicocefálico, pero están basados en medidas lineales. A fin de revisar esta clasificación en base a su geometría, se estudiaron 53 cráneos de perros adultos, correspondientes a los tres grupos craneométricos descritos: 16 braquicéfalos, 20 mesaticéfalos y 17 dolicocéfalos. Para ello se obtuvieron fotografías en el plano ventral, en las que posteriormente se ubicaron 17 hitos anatómicos que se analizaron mediante técnicas de morfometría geométrica. De estos hitos, 5 correspondían a la zona neurocraneal y el resto al esplacnocráneo. Los tres grupos craneométricos mostraron diferencias estadísticamente significativas entre ellos tanto por el tamaño como por la forma. Las variables que contribuyeron más a explicar la diferenciación fueron las ubicadas en el margen más lateral de los arcos cigomáticos y en la base de este mismo arco. Las variables esplacnocraneales presentaban una alometría mucho más marcada que las neurocráneos. Puesto que el arco cigomático debe ser considerado como parte del esplacnocráneo, sugerimos que es tan importante el índice cefálico (que tiene en cuenta la máxima anchura de la cabeza) como el facial (que tiene en cuenta la máxima anchura de la cara). La conformación neurocraneal sería mucho más conservativa y por ende el índice craneal, de mucho menor poder discriminatorio entre grupos. El cambio entre tipos se debería a los músculos masetero y temporal, que tienen su inserción en el arco.

Within the wide conformation of skull spectrum, there are generally three recognized broad categories that correspond to the concept of cephalic biotype, determined by the cephalic index. The three cephalic biotypes are: brachiocephalic, mesaticephalic and dolichocephalic, which are based on linear measures. In order to revise this classification based on its geometry, we studied 53 skulls of adult dogs, corresponding to the three craneometric groups previously described: 16 brachycephalic, 20 mesaticephalic and 17 dolichocephalic. Images on ventral plane were obtained and 17 anatomical landmarks were subsequently located and analyzed by means of geometric morphometric techniques. Five of those landmarks corresponded to the neurocraneal area and the rest of the splanchnocranium. The three craneometric groups showed statistically significant differences between them for both size and shape. The variables that contributed to the differentiation between them were located along the edge of the zygomatic arches and on the basis of this arch. Splanchnocranial variables also presented a much more marked allometry than the neurocraneal variables. Since the zygomatic arch should be considered as part of the splanchnocranium, we suggest that the cephalic index (which takes into account the maximum width of the head) is as important as the facial index (which takes into account the maximum width of the face). The neurocraneal index would be much more conservative, and therefore less discriminatory between the groups.

Maternal and Neonatal Outcome in Patients with Oligohydramnios

Background: Quantitative estimate of amniotic fluid capacity is asection of daily obstetric scan. Semi quantitate determination ofthe quantity of amniotic fluid is done using amniotic fluid index,that is calculated by addition of the depth in centimeters of largestvertical pocket in four quadrants each. Oligohydramnios withdisapproving maternal and fetal circumstances lead to a worstperinatal result than normal amniotic fluid volume under the sameconditions. In these situations oligohydramnios may indicate amore severe impaired function of placenta and fetal compromise.The present study was conducted to evaluate the maternal andneonatal outcome in pregnant females with Oligohydramnios.Materials and Methods: The present prospective study wasconducted in the Department of Obstetrics and Gynecology for aperiod of 1 year. Estimates of amount of amniotic fluid volume wasestimated using AFI. Color Doppler tests were performed amongstwomen with isolated oligohydramnios. All the information from thefemales was taken on a patient information sheet. Details of infantat birth were recorded. All the data this obtained was arranged ina tabulated form and analyzed using SPSS software. Probabilityvalue of less than 0.05 was considered as significant.Results: A total of 130 subjects were enrolled in the study. Theincidence of oligohydramnios was 2.8%. 37.69% patients hadsevere oligohydramnios, 43.84% patients had moderateoligohydramnios and 18.46% patients had mild oligohydramnios.55% patients were primigravidas. 42.3% patients were preterm,48.5% patients were term and 9.2% patients were post dated.26.9% patients with oligohydramnios showed intrauterine growthrestriction. 15.3% patients had pregnancy induced hypertensionand 6.9% patients had both PIH and IUGR. IUGR was maximallyseen in the group of severe oligohydramnios and foetal distresswas also observed more in this group. 33.8% patients weredelivered vaginally without any instrumentation, 2.3% patientswere delivered with help of vaccum, 63.9% underwent LSCS.There were 10% subjects less than 20 years, 51% were between21-25 years, 25% were between 26-30 years, 9% were between31-35 years. There were 85% (majority) with cephalicpresentation. 13% (n=17) had breech and 2% had transversepresentation.73.27% of babies were low birth weight. 6% babieshad congenital anomalies. 11% babies accounted for perinatalmortality with extreme prematurity as the cause of death inmajority.Conclusion: In our study the most common age group afflictedwas 21-25 years as the incidence of pregnancy is also maximumin this age group. Perinatal morbidity and mortality was maximallyseen in patients with severe oligohydramnios. Isolatedoligohydramnios at more than 36 weeks of gestation does notaffect perinatal outcome. The presence of moderate to severeoligohydramnios should alert the Obstetrician to a high risk fetalcondition and should prompt the obstetrician to initiate an activeintervention in collaboration with the neonatologist. Finally, regularANC checkup, fetal surveillance, treatment of associated maternalmedical conditions help to achieve better perinatal outcome.

Height of elevated fetal buttock for prediction of successful external cephalic version

14 cm, and HOB >7.8 cm were 10.80 (95% confidence interval [CI], 1.57–74.94), 5.26 (95% CI, 1.06–26.19), and 10.50 (95% CI, 1.03–107.12), respectively. Areas under the curve (AUCs) for AFI, HOB, and parity were 0.66 (95% CI, 0.54–0.78), 0.74 (95% CI, 0.64–0.85), and 0.69 (95% CI, 0.62–0.76), respectively. HOB had the largest AUC, but there were no significant differences among the AUCs of other factors. The cut-off value of HOB was 6 cm.CONCLUSION: This study showed that the AUC of HOB was greater than that of parity and AFI, although it was not statistically significant. As HOB is a noninvasive and comprehensive marker to predict successful ECV, consideration of HOB would be helpful before conducting ECV. Further studies are needed.

Benign Cephalic Histiocytosis: A Rare Dermatological Entity in the Paediatric Population

@#Histiocytic proliferation of the skin can be categorised into Langerhan and non-Langerhan types. Benign cephalic histiocytosis (BCH) is a rare cutaneous non-Langerhan histiocytosis typically affecting infants and young children. We report a case of benign cephalic histiocytosis in a boy who, at seven months of age, presented with multiple yellowish papular eruptions on his face. Over the course of 18 months, the lesion spread to his trunk and upper extremities, sparing the mucous membranes, palms and soles. There was no systemic involvement identified. A histopathologic examination of the skin lesion showed diffuse infiltration of histiocytes within the superficial dermis intermingled with scattered eosinophils and small lymphocytes. Immunohistochemical studies showed that the histiocytes were diffusely positive for CD68. Langerhan markers CD1a and S100 were negative. The correct distinction between BCH and other histiocytic proliferations of the skin is important because BCH has a self-limiting clinical course with a tendency of spontaneous remission.

Frecuencia de episiotomías en un hospital de tercer nivel / Frequency of episiotomy in a third-level hospital

OBJETIVO: Determinar la frecuencia y correlación de las episiotomías y desgarros en pacientes con parto eutócico. MATERIALES Y MÉTODOS: Estudio observacional y retrospectivo efectuado en el Hospital General Universitario de Alicante en dos periodos: 1) 2008-2012 y 2) 2013-2018. Se incluyen los partos eutócicos de embarazos únicos, a término, en presentación cefálica. Variables de estudio: episiotomía, desgarro, edad, semanas de embarazo, paridad, inducción del parto, cesárea anterior, analgesia regional, peso y sexo del recién nacido. Los resultados se expresan en porcentaje, coeficiente de correlación y las variables implicadas con razón de momios (RM). RESULTADOS: La tasa de episiotomía entre el periodo 1 vs el 2 disminuyó de manera muy importante: de 42.3 a 32.8%; [p < 0.001; RM: 0.81 (0.78-0.84)]. En cambio, el porcentaje de desgarros aumentó: de 42.7 a 50.8%; (p < 0.001; RM: 1.16[1.13-1.20]). El coeficiente de correlación fue de -0.91. Uno de los factores de riesgo asociados con la episiotomía fue la edad menor de 35 años, con RM de 1.25; IC95%: 1.16-1.35; p < 0.001, pero fue un factor protector de desgarros con RM de 0.76; IC95%: 0.71-0.81; p < 0.001. CONCLUSIONES: La tendencia de la episiotomía es decreciente, mientras que la de desgarro es inversamente proporcional. No se encontraron diferencias en la tasa de desgarro de III y IV grado.

Abstract OBJECTIVE: To determine the frequency and correlation of episiotomies and tears of patients with eutocic deliveries. MATERIALS AND METHODS: Observational and retrospective study carried out at the Hospital General de Alicante, Spain, in two periods: 1) 2008-2012 and 2) 2013-2018. Eutocic deliveries of single pregnancies, at term, in cephalic presentation are included. Study variables: episiotomies, tear, age, weeks of pregnancy, parity, labor induction, previous caesarean section, regional analgesia, weight and sex of the newborn. The results are expressed as a percentage, correlation coefficient and the variables involved with odds ratio. RESULTS: The episiotomy rate between period 1 vs. 2 decreased very significantly: 42.3% vs 32.8%; [p <0.001; OR: 0.81 (0.78-0.84)]. In contrast, the percentage of index tears: 42.7% vs 50.8%; (p <0.001; OR: 1.16 [1.13-1.20]). The correlation coefficient was -0.91. Regarding risk factors associated with episiotomy, one of them was the age under 35 years with an OR (95% CI): 1.25 (1.16-1.35; p <0.001), but it was a OR protective factor (95% CI): 0.76 (0.71-0.81; p <0.001) for the appearance of tears. CONCLUSIONS: The tendency in the realization of episiotomies is decreasing, while the tendency of the appearance of tears is inversely proportional. No differences were found in the tear rate of III and IV grade.

Efectos de la curva de aprendizaje en los resultados de la duodenopancreatectomía cefálica en un hospital de nivel II / Effects of the learning curve on the results of cephalic pancreaticoduodenectomy in a level II hospital

Resumen Introducción: La duodeno pancreatectomía cefálica es una operación compleja cuyos resultados a corto plazo son multifactoriales. Objetivo: Evaluar el impacto de la curva de aprendizaje en los resultados a corto plazo de la duodenopancreatectomía cefálica en un hospital de nivel II. Materiales y Método: Se analizaron los datos obtenidos a partir de una base de datos mantenida prospectivamente desde 2005. Se definieron dos periodos de tiempo: de 2005 a 2011 y de 2012 a 2017. Se compararon la morbilidad, mortalidad y estancia postoperatoria de ambos períodos. Resultados: Durante el período de tiempo estudiado se hicieron 126 duodenopancreatectomías cefálicas, 61 durante la primera etapa y 65 durante la segunda. La tasa de transfusión intraoperatoria se redujo de 33% a 15% (p = 0,011). La tasa de transfusión postoperatoria se redujo de 39 a 23% (p = 0,021). No hubo diferencias significativas con respecto a la incidencia global de complicaciones postoperatorias (59% y 52,3%). La incidencia de abscesos intraabdominales fue significativamente menor en el segundo período (18% y 4,6%, respectivamente; p = 0,038). La tasa de reintervenciones se redujo significativamente, de 22% a 9% (p = 0,049). También se redujo significativamente la tasa de mortalidad, de 6,56% a 0% (p = 0,032). La estancia media postoperatoria disminuyó significativamente en el segundo período, pasando de 19,6 a 15,8 días (p = 0,001), con una mayor proporción de pacientes dados de alta en los 8 primeros días de postoperatorio (11,5% y 38,5%, respectivamente; p = 0,001). Conclusión: La curva de aprendizaje es un factor que permite mejorar los resultados de la duodenopancreatectomía cefálica, en un hospital de nivel II, hasta alcanzar valores similares a los de un hospital de nivel III.

Introduction: The duodenum pancreatectomy cephalic is a complex operation whose short-term results are multifactorial. Aim: To assess the impact of the learning curve on the short-term outcomes of cephalic duodenopancreatectomy at a level II hospital. Materials Method: We analyze the data obtained from a database maintained prospectively since 2005. Two time periods were defined: from 2005 to 2011 and from 2012 to 2017. The morbidity, mortality and postoperative stay of both periods were compared. Results: 126 cephalic duodenopancreatectomies were performed, 61 during the first period and 65 during the second. The intraoperative transfusion rate was reduced from 33% to 15% (p = 0.011). The postoperative transfusion rate was reduced from 39 to 23% (p = 0.021). There were no significant differences with respect to the overall incidence of postoperative complications (59% and 52.3%, respectively). However, the incidence of intra-abdominal abscesses was significantly lower in the second period (18% and 4.6%, respectively, p = 0.038). The rate of reoperations was significantly reduced, from 22% to 9% (p = 0.049). The mortality rate was also significantly reduced, from 6.56% to 0% (p = 0.032). The mean postoperative stay decreased significantly in the second period, from 19.6 to 15.8 days (p = 0.001), with a higher proportion of patients discharged in the first 8 postoperative days (11.5% and 38.5%, respectively, p = 0.001). Conclusion: The learning curve is a factor allows improving the results of cephalic pancreaticoduodenectomy, in a level II hospital, until reaching values similar to those of a level III hospital.

Morphological and Applied Anatomical Studies on the Head Region of Malayan Sun Bear (Helarctos malayanus)

The Malayan sun bear is the smallest of the eight bear species. The aim of the research was to investigate the morphological and applied anatomical characteristics of the head region of the Malayan sun bear. The size of the head is large, broad and heavy in proportion to the body. The skull of the Malayan sun bear was mesocephalic according to the cephalic index (80.48). The skull length, skull width, cranial length and maximum skull height was 21.47 cm, 17.28 cm, 17.81 cm and 9.40 cm, respectively. The nasal length, nasal perpendicular height, nasal horizontal-transverse width and nasal circumference were 3.59 cm, 3.50 cm, 3.20 cm and 10.52 cm, respectively. The length and height of the mandible were 14.65 cm and 7.09 cm, respectively. There is no literature available on the regional applied anatomy of maxillofacial and mandibular regions of the Malayan sun bear. Therefore, this study was designed to provide information on morphological and applied anatomical studies on the head region of the Malayan sun bear. This is the first detailed study to provide morphological characteristics of the head region of Malayan sun bear and this information will aid the clinicians in the application of regional anaesthesia in Malayan sun bear

Breech presentation at term: outcomes and mode of delivery in a tertiary care teaching hospital In South India

The aim of this study was to study the outcomes of all patients who presented with breech presentation at term (≥37 weeks), to assess what percentage of patients were offered External cephalic version (ECV), the rates of success of the procedure and the rates of vaginal delivery following successful ECV. It was a retrospective study of 669 patients diagnosed with breech at term, their clinical records were retrieved and data like age, BMI, parity, type of breech and scan findings noted. ECV was done in 256 patients and was successful in 35.5% of women with 51.1% being multigravidas and 26.8% in primigravidas. 76.9% of women with successful ECV delivered vaginally.  There was no significant fetal or maternal morbidity documented as a result of ECV in this study.

Prediction of Cephalic Phenotype by Measuring Cephalic Index and to Study the Correlation between Cephalic Phenotype and Cephalic Index

Background: Dimensional relationship between bodysegments and stature has been the focus of scientists for manyyears. Therefore, prediction of stature from cranial remains isvital in establishing the identity of an unknown individual. Thepresent study was conducted to predict cephalic phenotype bymeasuring cephalic index and to study the correlation betweencephalic phenotype ad cephalic index.Materials and Methods: In this prospective observationalstudy 600 patients attending in the Outpatient department ofmedical, dental and other college’s students of age group 21-25 years in various colleges at Jaipur, India were selected forthe study. Data regarding Head length and Head breadth wascollected. A complete physical examination was carried out.The data collected was compiled, tabulated, analyzed andsubjected to statistical tests. Analysis was done using SPSS.Results: In the present study total sample size was 600 inwhich 300 were male and 300 were female. Mean age offemales was found to be 22.82 and mean age of males wasfound to be 22.96. In our study age group selected was 21 to25 years where 21 were the minimum age found in our studyand 25 being the maximum. In present study result showedthat of the Dolicocephalic Male was 7.66%, Mesocephalic Malewas 82 %, Brachycephalic Male was 10.33%. DolicocephalicFemale 25 was 8.33%, Mesocephalic Female was 84 %,Brachycephalic Female was 7.66% ,Dolicocephalic (Male &female) was 8%, Mesocephalic (Male & female) was 83 %,Brachycephalic (Male & female) 54 was. 9% .Significantdifference was observed in cephalic index between males andfemales.Conclusion: Our study concluded that cephalic index showedsignificant difference.

Sutural Bones: A Study On Incidence, Laterality And Co-relation With Cephalic Index In Dry Crania Of East Indian Ethnicity

Background: Sutural bones are supranumary bones occurring along the sutures and completely surrounded bysutures of the skull. Their number, morphology and location in skull vary in skulls. The knowledge of these bonesis imperative in surgery, medicolegal cases involving child abuse or fracture of skulls and for anthropologicidentification of human populations. This study was undertaken to examine incidence and pattern of distributionof sutural bones in dry skulls from Eastern India and compare the findings with similar studies across the world.Materials and Method: 180 dry crania were identified as male or female skulls and studied for the incidence andpattern of distribution of sutural bones. Also the Cephalic Index was measured for finding its correlation withthe number of sutural bones appearing in a skull.Results: 124 skulls were identified as male and 56 as female skulls. Overall incidence of sutural bone occurrencewas found to be 72.28% which was essentially similar across sexes. The most common sites for sutural bones,in descending order of occurrence, were found to be parieto-occipital suture, asterion, pterion and lambda.Bregma was the least common site where no sutural bone was encountered. A highly statistically significantfinding was in regard to laterality of sutural bone occurrence. Sutural bones occurring along coronal, parietotemporal, parieto-mastoid, occipito-mastoid sutures and pterion exhibited more than 80% tendency towardsunilateral occurrence while those occurring at asterion exhibited around 70% tendency towards unilateraloccurrence. All these findings, although displayed variable degree of sexual dimorphism, were statisticallyinsignificant for variation among sexes. No correlation between the number of sutural bones with cephalic indexwas found.Conclusion: The findings of this study are in agreement with the findings of many similar suitably poweredstudies across the world.