Estudio morfológico de pontículus pósticus en telerradiografías laterales / Morphological study of pontículus pósticus in lateral teleradiographies

OBJETIVO establecer la prevalencia de Pontículus Pósticus (PP) en pacientes atendidos en el Servicio de Imagenología de la Universidad Finis Terrae en el periodo 2015-2020. METODOLOGÍA estudio de tipo transversal descriptivo, donde se analizaron 334 telerradiografías laterales (TL) obtenidas del Servicio de Imagenología de la Universidad Finis Terrae entre los años 2015 y 2019 adquiridas mediante el equipo marca SIRONA modelo Orthophos XG, seleccionándolas según criterios de inclusión y exclusión. Se analizó la primera vértebra cervical buscando la presencia de PP consignando: sexo, edad y tipo de osificación según clasificación de Cederberg y Stubbs, asignándoles valores numéricos para posteriormente realizar el análisis estadístico de tipo descriptivo uni y bivariado. RESULTADOS se seleccionaron 320 TL. La prevalencia de PP fue del 31,9% de las TL incluidas, de los cuales el 68,1% correspondió al tipo 1 de la clasificación de Cederberg y Stubbs, el 14,1% al tipo 2, 10,3% al tipo 4 y el 7,5% al tipo 3. La edad media en pacientes con PP presente correspondió a 30,63 años +/­ 15,888 D.E con un mínimo de 12 años y un máximo de 78. En cuanto a la presencia de PP y la variable sexo, el 53,9% correspondió al sexo femenino y el 46,1% al sexo masculino, en donde no se encontró una predilección estadísticamente significativa (p = 0,08). CONCLUSIONES el PP es una variante anatómica de prevalencia variada, siendo levemente mayor en esta población chilena en comparación con otros países. Además, su evidencia es escasa y no existe un consenso sobre su prevalencia y diversas variables como el género y la edad, difiriendo en varios estudios. Es importante conocer e investigar más sobre la epidemiología de esta anomalía y su relación con distintos desórdenes neurológicos

OBJETIVE to establish the prevalence of Ponticulus Posticus (PP) in patients attended in Radiology Service of Finis Terrae University between the years 2015 and 2020. METHODOLOGY descriptive cross-sectional study, 334 lateral cephalograms were analyzed obtained from the Radiology Service of Finis Terrae University between the years 2015 and 2020 acquired from SIRONA system model Orthophos XG, selecting them following the inclusion and exclusion criteria. The first cervical vertebrae were analyzed searching for the presence of PP, consigning: Type of ossification by Cederberg and Stubbs classification, Age and Sex, assigning them numerical values to subsequently perform the descriptive statistical analysis uni and bivariate. RESULTS the prevalence of PP found was 31,9% of the 320 included TL, of which 68,1% corresponded to Type 0 of Cederberg and Stubbs classification, 14,1% to Type 1, 10,3% to Type 3 and the 7,5% al Type 2. The average age of present PP patient's was 30,63 years +­ 15,888 S.D with a minimum of 12 years and a maximum de 78. As for the presence of PP and sex variable, 53,9% corresponded to female sex and 46,1% to males, where no statistically significant predilection was found (p = 0,08). CONCLUSIONS PP is an anatomical variant with varied prevalence worldwide, being slightly higher in Chile, compared to other countries. In addition, their evidence is scarce and there is no consensus on its prevalence and various variables such as gender and age, differing in several studies. It is important to know and research more about the epidemiology of this anomaly and its relationship with different neurological disorder

Arcuate Foramen: An Anatomical Variation in the Atlas Vertebrae

Background: Arcuate foramen is a variation in the posterior arch of atlas vertebrae. It is commonly called as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incomplete ossification of the posterior atlantooccipital membrane over the vertebral artery groove resulting in the formation of arcuate foramen containing the vertebral artery and the posterior branch of the first cervical spinal nerve. Aims: The aim of the present study was to identify the percentage of incidence of arcuate foramen in the atlas and its clinical important. Materials and Methods: The study was conducted in the Department of Anatomy, Katihar Medical College, Katihar, India with 32 adult dried atlas vertebrae. Results: We found four (12.5%) atlas with arcuate foramen. One atlas having complete arcuate foramen and three having partial complete arcuate foramen. Conclusion: Awareness of this type of variation is very important for neurosurgeons and radiologist during their clinical practice. The presence of the arcuate foramen would also complicate screw placement during surgery. Clinical prescreening for signs of vertebrobasilar insufficiency is important for chiropractic and manual therapies.

Optimization strategy of anaesthesia for laparoscopic gynecological surgery: anterior quadratus lumborum block at supra-arcuate ligament combined with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.

Effect of ultrasound-guided quadratus lumborum block at the lateral supra arcuate ligament for open liver surgery / 中国医师杂志

Objective:To investigate the analgesic effect of ultrasound-guided quadratus lumborum block at the lateral supra arcuate ligament (LSQLB) and subcostal transversus abdominis plane block (TAPB) for open liver surgery.Methods:Forty-two patients who underwent elective open liver surgery in Lishui Central Hospital from February 2021 to October 2021 were randomly divided into two groups: LSQLB group (L group, n=21) and TAPB group (T group, n=21). Both groups underwent preoperative ultrasound-guided nerve block, and then LSQLB in group L and subcostal TAPB under the right costal margin in group T. The surgery was subsequently completed under general anesthesia. Patient controlled intravenous analgesia (PCIA) was performed in both groups. The mean arterial pressure (MAP) and heart rate (HR) before skin cutting (T 0), immediately after skin cutting (T 1), at the time of liver exploration (T 2), and at the time of suturing (T 3) were compared between the two groups; the intraoperative sufentanil and remifentanil consumption was recorded; the visual analogue score (VAS) of pain at 2, 8, 16, 24, and 48 h postoperatively and the number of analgesic pump presses and remedial analgesia at 48 h postoperatively were recorded. The incidence of adverse effects such as postoperative hypotonia (lower limb muscle strength ≤grade 4 on the blocked side), hypotension, nausea and vomiting were recorded. Results:The MAP and HR at T 1, T 2 and T 3, the dosage of sufentanil and remifentanil during operation of group L were lower than those of group T(all P<0.05); the VAS score at 2, 8, 16 and 24 hours after operation in group L were lower than those of group T (all P<0.05). The number of analgesic pump presses and remedial analgesia at 48 hours postoperatively in group L were less than those in group T after operation (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions such as postoperative hypokinesia, hypotension, nausea and vomiting in the two groups (all P>0.05). Conclusions:LSQLB for open liver surgery is more hemodynamically stable and has a more definite analgesic effect.

Middle Cranial Fossa Approach: The Incudomalleolar Joint as a Reliable Landmark

Abstract Introduction The middle cranial fossa approach is performed by fewer neurotologists owing to a reduced number of indications. Consistent landmarks are mandatory to guide the surgeon in a narrow field. Objectives We have evaluated the incus and malleus head and the incudomalleal joint (IMJ) as a key landmark for identifying the superior semicircular canal (SSC) and to get oriented along the floor of the middle cranial fossa. Methods A combination of 20 temporal bone dissections and CT imaging were utilized to test and describe these landmarks. Results The blue line of the SSC is consistently identified along the prolongation of a virtual line through the IMJ and the angulation toward the root of zygoma. The mean distance from the zygoma toward the IMJ ranged from 1.60 to 1.90cm. Once the IMJ was identified, the blue line of the SSC was consistently found along the virtual line through the IMJ within 5 to 9mm. Conclusions The IMJ is a safe and consistent anatomical marker in the surgical approach to the middle cranial fossa floor. Opening the tegmen 1.5 to 2cm medial to the root of the zygoma and identifying the joint allows to trace a virtual line toward the SSC within 5 to 9mm. Knowledge of the close relationship between the direction of the IMJ and the superior canal can be used in all transtemporal approaches, thus orienting the surgeon in a rather narrow field with limited retraction of the dura and brain.

Features of median arcuate ligament syndrome in computed tomography angiography / 中华消化外科杂志

Objective:To investigate the features of median arcuate ligament syndrome (MALS) in computed tomography angiography (CTA).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 56 patients with MALS who were admitted to Ruijin Hospital, Shanghai JiaoTong University School of Medicine from November 2019 to October 2020 were collected. There were 30 males and 26 females, aged from 19 to 78 years, with a median age of 54 years. All 56 patients underwent CTA. Observation indicators: (1) CTA examination; (2) correlation analysis; (3) surgical situations. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages. Spearman correlation analysis with test level of 0.05 was used to analyze the correlation between celiac trunk stenosis and the distance between the original location of celiac trunk and original location of superior mesenteric artery and the minimum distance of celiac trunk and superior mesenteric artery. Results:(1) CTA examination. ① Celiac trunk stenosis: results of cross sectional examina-tion of CTA showed that of 56 patients, there were 2 cases of celiac trunk occlusion, 10 cases of severe stenosis, 9 cases of moderate stenosis and 35 cases of mild stenosis. Results of sagittal examination of CTA showed that of 56 patients, there were 2 cases of celiac trunk occlusion, 21 cases of severe stenosis, 15 cases of moderate stenosis and 18 cases of mild stenosis. ② Examination of patients with different degree of vascular stenosis: according to the results of sagittal examination of CTA, the 2 cases with celiac trunk occlusion were negative for aneurysms, aortic dissection or vascular variations but positive for compensated varix of the anterior and posterior pancreatico-duodenal arches. Of the 21 cases with celiac trunk severe stenosis, 2 cases were positive for aneurysms, 1 case was positive for aortic dissection, 7 cases were positive for compensated varix of the anterior and posterior pancreaticoduodenal arches, 8 cases were positive for collateral circula-tions of anterior and posterior pancreaticoduodenal archs and 8 cases were positive for vascular variation. Of the 15 cases with celiac trunk moderate stenosis, 2 cases were positive for aneurysms, 3 cases were positive for aortic dissection, 2 cases were positive for compensated varix of the anterior and posterior pancreaticoduodenal arches, 4 cases were positive for collateral circulations of anterior and posterior pancreaticoduodenal archs and 7 cases were positive for vascular variation. Of the 18 cases with celiac trunk mild stenosis, 1 case was positive for aneurysms, 2 cases were positive for aortic dissection, 7 cases were positive for collateral circulations of the anterior and posterior pancreaticoduodenal arches, 6 cases were positive for vascular variation. All 56 patients were negative for ischemia of liver, spleen and stomach. ③ Original location of celiac trunk: of 56 patients, there were 43 cases had celiac trunk originated horizontally from the lower edge of T12 vertebral body, 2 cases had celiac trunk originated from the middle of T12 vertebral body, 1 case had celiac trunk originated from the upper part of T12 vertebral body, 7 cases had celiac trunk originated from the upper part of L1 vertebral body, 1 case had celiac trunk originated from the middle of L1 vertebral body and 2 cases had occluding celiac trunk. (2) Correlation analysis: results of sagittal observation on CTA examination showed the distance between the original location of celiac trunk and original location of superior mesenteric artery of the 56 patients was (6.0±4.0) mm. The distance between the original location of celiac trunk and original location of superior mesenteric artery of patients with celiac trunk mild, moderate or severe stenosis were (6.2±2.8)mm, (8.1±4.4)mm and (5.3±3.2)mm respectively. There were 23 cases of the 56 patients had the distance between the original location of celiac trunk and original location of superior mesenteric artery <5 mm. Results of correlation analysis showed that the degree of celiac trunk stenosis was not related to the distance between the original location of celiac trunk and original location of superior mesenteric artery ( r=?0.205, P>0.05). Results of sagittal observation on CTA examination showed the shortest distance between celiac trunk and superior mesenteric artery of the 56 patients was (3.8±2.4)mm. The shortest distance between celiac trunk and superior mesenteric artery of patients with celiac trunk mild, moderate or severe stenosis were (4.2±2.0)mm, (4.4±3.3)mm and (3.0±1.9)mm, respectively. There were 45 cases of the 56 patients had the shortest distance between celiac trunk and superior mesenteric artery <5 mm. Results of correlation analysis showed that the degree of celiac trunk stenosis was not related to the shortest distance between celiac trunk and superior mesenteric artery ( r=?0.249, P>0.05). (3) Surgical situations: of 56 patients, 2 cases were positive for clinical symptoms of abdominal pain, 54 cases were negative for clinical symptoms, 4 cases under-went surgical treatment and 52 cases not underwent surgical treatment. Of the 4 cases undergoing surgical treatment, 2 cases with abdominal pain were diagnosed as MALS by upper abdominal CTA. Celiac trunk of the 2 cases were severe stenosis and stents implantation under celiac arteriography were performed. Results of postoperative CTA showed celiac trunk was negative for obvious stenosis. The other 2 cases who were negative for clinical symptoms of MALS were planed to pancreaticoduo-denectomy for pancreatic head tumor. Results of preoperative CTA showed severe stenosis of celiac trunk and arterial bypass grafting was performed for the 2 cases during pancreaticoduodenectomy to alleviate liver ischemia caused by gastroduodenal artery ligation which would avoid the incidence of postoperative MALS associated complications. Result of postoperative CTA three-dimensional reconstruction showed the bypass vessel was unobstructed. Conclusion:Based on sagittal result of CTA examination, the stenosis of celiac trunk, the anatomical relationship between celiac trunk and arcuate ligament and the original location of celiac trunk of MALS patients can be evaluated.

Latest Progresses in Surgical Treatment of Median Arcuate Ligament Syndrome / 中国医学科学院学报

Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.

Mechanism of KNDy neurons in arcuate nucleus of hypothalamus involved in the occurrence of perimenopausal hot flashes / 解剖学报

Hot flashes are the most common specific symptom of perimenopausal women, which seriously endangers their physical and mental health and quality of life. Because the pathogenesis of hot flashes is not yet clear, and existing estrogen replacement therapy has many limitations and contraindications, it is particularly urgent and important to explore the pathogenesis of hot flashes and find new therapeutic targets. Recent studies suggest that abnormalities of KNDy neurons in the arcuate nucleus of hypothalamus when estrogen decreases during perimenopause are the key factors that trigger hot flashes. Some scholars believe that KNDy neurons in the arcuate nucleus are involved in the occurrence of hot flashes by regulating the pulse release of gonadotropin-releasing hormone and its downstream luteinizing hormone, while some other scholars believe that KNDy neurons in the arcuate nucleus play a key role in the process of hot flashes by regulating the median preoptic nucleus of the hypothalamic preoptic area. Therefore, this review intends to summarize the above two types of current relationship between the KNDy neurons in the arcuate nucleus and the occurrence of hot flashes and the possible mechanisms by which KNDy neurons participate in hot flashes, and lay a theoretical foundation for the exploring of new targets and method for the treatment of perimenopausal hot flashes.

A dangerous surgical masquerade - medial arcuate ligament syndrome as acute coronary syndrome: a case report

Median arcuate ligament syndrome is an uncommon cause for abdominal pain and weight loss, caused by median arcuate ligament compressing the celiac plexus or artery. Median arcuate ligament is the continuation of the posterior diaphragm which passes superior to celiac artery and surrounds the aorta. In this case report, A 67 year old male presented with complaints of sudden onset chest pain and loss of weight for the past 6 months. CECT thorax and abdomen it showed features of focal stenosis of coeliac axis and post stenotic dilation of the coeliac trunk suggesting median arcuate ligament syndrome. Laparoscopic median arcuate ligament release was done to relieve the patient from symptoms. Diagnosis of median arcuate ligament syndrome should be considered in a patient presenting with chest pain and weight loss with normal cardiac status and unexplained etiology.

Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach / Tratamento da síndrome do ligamento arqueado mediano: resultado da abordagem laparoscópica

ABSTRACT Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.

RESUMO Racional: A síndrome do ligamento arqueado mediano (SLAM) é condição rara que pode causar manifestações clínicas significativas, incluindo dor abdominal e perda de peso. Seu diagnóstico pode ser difícil e muitas vezes estabelecido tardiamente. A abordagem laparoscópica tornou-se o tratamento padrão para ela. Objetivo: Avaliar o resultado do tratamento laparoscópico em pacientes com SLAM. Método: Os dados de seis pacientes com SLAM submetidos a ressecção laparoscópica do ligamento arqueado mediano foram revisados ​​retrospectivamente. Os seguintes dados avaliados foram: idade, gênero, resultados dosexames clínicos e complementares, escore ASA, achados e complicações operatórias, complicações e mortalidade pós-operatórias, tempo de internação e readmissão hospitalar. O diagnóstico de SLAM foi estabelecido por angiotomografia e/ou angiorressonância. Resultados: Havia quatro (66,7%) mulheres e dois (33,3%) homens com idades entre 32 e 60 anos. Os principais sintomas foram dor epigástrica (100%) e perda de peso (66,7%). Os achados de estenose de alto grau do tronco celíaco proximal e dilatação pós-estenótica observados na angiografia confirmaram o diagnóstico em todos os pacientes. O procedimento cirúrgico transcorreu sem intercorrências em todos os pacientes. A única complicação pós-operatória foi retenção urinária, que ocorreu em um homem. No seguimento de três meses, todos os pacientes estavam assintomáticos. Conclusão: O tratamento laparoscópico da SLAM é seguro e eficaz no alívio das manifestações clínicas dos pacientes.

Effect of Xiaoyaosan on Changes of JAK/STAT Pathway in Hypothalamic Arcuate Nuclei of Rats With Chronic Mild Unpredictable Stress / 中国实验方剂学杂志

Objective:To observe the changes of leptin receptor-tyrosine kinase Janus2 （JAK2）/signal transducer and activator of transcription 3 （STAT3） pathway and the regulatory effect of Xiaoyaosan on the hypothalamic arcuate nuclei of rats with chronic mild unpredictable stress model （CUMS）. Method:Sixty male sprague-dawley rats were randomly divided into normal group， model group， Xiaoyaosan group， and fluoxetine group. After one-week adaptive feeding， the rats in model group， Xiaoyaosan group and fluoxetine group were uesd to replicate the chronic psychological stress rat model through mild unpredictable stimulation. Meanwhile ， they were simultaneously administered the corresponding drugs， Xiaoyaosan 19.27 g·kg-1·d-1， Fluoxetine 2 mg·kg-1·d-1 （based on the average adult body weight of 60 kg）， the rats in the normal group and the model group were given the same volume of normal saline for 6 weeks. The body weight， food intake， sucrose consumption ratios， and the experimental behavior in the open field test （OFT） of the groups were observed. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were used to detect the expressions of ob-R， JAK2， and STAT3 in the arcuate nucleus of rat hypothalamus. Result:Compared with the normal group， the body weight and food intake of the model group were significantly decreased （P<0.05， P<0.01）， the sucrose consumption ratios ， the total behavioral distance of the experimental field and the total distance of the central area were significantly reduced， the protein and mRNA expressions of ob-R， JAK2， STAT3 in the arcuate nucleus of hypothalamus in rats increased significantly （P<0.05， P<0.01）. Compared with the model group， the body weight of Xiaoyaosan group increased significantly on the 7th， 14th， 21st and 28th days （P<0.05， P<0.01）， the food intake of rats increased significantly on the 21st and 35th days of the experiment （P<0.05）， and the sucrose consumption ratios， the total distance of the experimental behavior in the open field test （OFT） and the total distance of the central area were significantly improved. Xiaoyaosan had a corresponding regulatory effect on the protein and mRNA expressions of ob-R， JAK2， STAT3 in the arcuate nucleus of hypothalamus in model rats （P<0.05， P<0.01）. Conclusion:Xiaoyaosan regulates the body weight， appetite， and energy metabolism of chronically mild and unpredictable stress rats， which may be related to the ob-R-JAK2/STAT3 pathway in the hypothalamic arcuate nucleus.

Arcuate keratotomy infiltration following uneventful femtosecond laser assisted cataract surgery

An 84-year-old gentleman underwent uneventful femtolaser-assisted cataract surgery (FLACS) with an arcuate keratotomy (AK) in the left eye. On the 18th post-operative day, a corneal infiltrate developed involving the AK. Staphylococcus epidermidis was the organism isolated on culture. The infiltrate resolved with topical fortified vancomycin and amikacin eyedrops, and the patient regained a visual acuity of 6/6 after 12 weeks. This is the first case from south-east Asia reported in the literature of an infective infiltrate along a femtosecond laser AK. We propose strict peri-operative recommendations to be followed to prevent and treat such infections.

To Evaluate the Efficacy of Bi Pedicled Strip of External Oblique Aponeurosis for Augmentation of Posterior Wall of Inguinal Canal in Inguinal Hernia Repair

Introduction: In Homo sapiens and other mammalianquadrupeds, there is an absence of posterior rectus sheathbelow the arcuate line and insubstantial transversalis fasciain groin. This anatomical arrangement presents no particularfunctional, anatomic difficulty for quadrupeds as their inguinalcanal is directed uphill during ambulation and therefore isnot subjected to significant gravitational stress. Aims andobjectives: To evaluate the efficacy of bipedicled strip ofexternal oblique aponeurosis for augmentation of posteriorwall of inguinal canal in inguinal hernia repair.Material and methods: This study was carried out onfifty consecutive patients of inguinal hernia admitted in theSurgery Department of Guru Nanak Dev Hospital attached toGovernment Medical College, Amritsar.Conclusion: The present study was an attempt to evaluatethe role of bipedicled strip of external oblique aponeurosis inaugmentation of posterior wall of inguinal canal in inguinalhernia repair. Our findings suggest that the bipedicledundetached strip of external oblique aponeurosis is as efficientas a synthetic mesh in inguinal hernia repair. This repair isalso economically more beneficial for poor patients whocannot afford to have mesh repair. Although the present studyis small and follow up period is short but we still recommendthis procedure as a good alternative to Modified Bassini’s,Shouldice repair and mesh based repairs

To Evaluate The Efficacy Of Bipedicled Strip Of External Oblique Aponeurosis For Augmentation Of Posterior Wall Of Inguinal Canal In Inguinal Hernia Repair.

In Homo sapiens and other mammalian quadrupeds, there is an absence of posterior rectus sheath below the arcuate line and insubstantial transversalis fascia in groin. This anatomical arrangement presents no particular functional, anatomic difficulty for quadrupeds as their inguinal canal is directed uphill during ambulation and therefore is not subjected to significant gravitational stress. Aims and objectives: To evaluate the efficacy of bipedicled strip of external oblique aponeurosis for augmentation of posterior wall of inguinal canal in inguinal hernia repair. Material and methods: This study was carried out on fifty consecutive patients of inguinal hernia admitted in the Surgery Department of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar. Conclusion :The present study was an attempt to evaluate the role of bipedicled strip of external oblique aponeurosis in augmentation of posterior wall of inguinal canal in inguinal hernia repair. Our findings suggest that the bipedicled undetached strip of external oblique aponeurosis is as efficient as a synthetic mesh in inguinal hernia repair. This repair is also economically more beneficial for poor patients who cannot afford to have mesh repair. Although the present study is small and follow up period is short but we still recommend this procedure as a good alternative to Modified Bassini's, Shouldice repair and mesh based repairs.

Celiac artery compression: Dunbar syndrome / Síndrome da compressão da artéria celíaca (síndrome de Dunbar)

Celiac artery compression syndrome, also referred to as median arcuate ligament syndrome, celiac axis syndrome or Dunbar syndrome is a rare disorder consequent to extrinsic compression of the celiac trunk by the median arcuate ligament. Doppler ultrasound, multi-slice computed tomography angiography, magnetic resonance angiography, or invasive selective angiography can identify stenosis of the initial segment of the celiac artery and confirm diagnosis. Treatment options include open surgical or videolaparoscopic section of the median arcuate ligament and the fibers of the celiac plexus, or percutaneous transluminal angioplasty via an endovascular approach. We report herein an interesting case of a 38-year-old woman diagnosed with this rare condition and successfully treated with the surgical strategy

A síndrome da compressão da artéria celíaca, também denominada síndrome do ligamento arqueado mediano, síndrome do eixo celíaco ou síndrome de Dunbar, é uma doença rara causada pela compressão extrínseca do tronco celíaco pelo ligamento arqueado mediano. Ultrassonografia Doppler, angiotomografia computadorizada, angiorressonância magnética ou angiografia seletiva invasiva conseguem identificar a estenose do segmento inicial da artéria celíaca e confirmar o diagnóstico. As opções de tratamento incluem secção videolaparoscópica ou laparotômica (a céu aberto) do ligamento arqueado mediano e das fibras do plexo celíaco, assim como angioplastia transluminal percutânea. Relatamos o interessante caso de uma mulher de 38 anos de idade diagnosticada com essa rara condição e adequadamente tratada pela estratégia cirúrgica

Effect of electroacupuncture on expressions of Gas7 and NGF in arcular nucleus of rats with focal cerebral ischemia / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on the expressions of growth arrest-specific protein 7 (Gas7) and nerve growth factor (NGF) in arcuate nucleus (ARC) of rats with focal cerebral ischemia and explore the potential action mechanism of EA in treatment of focal cerebral ischemia.@*METHODS@#A total of 50 SD rats were randomized into 4 groups, named a normal group ( =12), a sham-operation group ( =12), a model group ( =14) and an EA group ( =12). In the model group and the EA group, the thread embolization method was adopted to duplicate the model of the right middle cerebral arterial embolism. In the sham-operation group, the skin of the neck was opened and sutured without any other intervention. In the EA group, EA was applied to "Baihui" (CV 20) and "Zusanli" (ST 36) on the left side, once a day, 30 min each time, consecutively for 21 days, while there was no any intervention in the normal group, the sham-operation group and the model group. Using the immunohistochemistry (IHC) method and Western blot method, the expressions of Gas7 and NFG of ARC on the ischemic side were determined. Using Nissle staining, the morphological changes in ARC neurons were observed.@*RESULTS@#The results of Nissle staining showed that there was no significant change in the morphology of ARC neurons in the normal group and the sham-operation group. In the model group, the volume of neuron cells was atrophied obviously and the cells were arranged irregularly. In the EA group, the morphology of ARC neuron was similar to the normal group. The results of IHC and Western blot indicated that the expressions of immunoreactive neurons and protein of Gas7 and NGF in ARC of the rats in the model group were increased obviously as compared with the normal group and the sham-operation group and the expressions in the EA group were further enhanced as compared with the model group (all <0.05).@*CONCLUSION@#Gas7 and NGF may be participated in the compensatory process of partial protection of the body in the patients with focal cerebral ischemia. EA up-regulates the expressions of Gas7 and NGF in ARC, which may be one of the neuroprotective mechanisms of EA in treatment of cerebral ischemia.

Damage to the dominant arcuate fasciculus degrades auditory comprehension in non-fluent aphasia / 中华物理医学与康复杂志

Objective@#To investigate the correlation between damage to the dominant arcuate fasciculus (AF) and the occurrence of auditory comprehension dysfunction in post-stroke aphasia.@*Methods@#Eighteen stroke survivors with non-fluent aphasia were recruited into the observation group, and nine healthy counterparts were chosen for the control group. All received diffusion tensor imaging (DTI) scans and fractional anisotropy (FA) values were measured. A Chinese aphasia battery was used to evaluate the aphasics′ language functioning, with the listening true or false, listening recognition and oral instruction auditory comprehension sub-scales used as the observation indices.@*Results@#There were significant differences between the two groups in the FA value of the dominant AF. Spearman correlation showed that the FA value of the dominant AF was positively related to the listening recognition results.@*Conclusions@#Damage to the dominant AF may be one of the reasons for auditory comprehension dysfunction in post-stroke aphasia. It is significantly related to listening recognition.

Damage to the dominant arcuate fasciculus degrades auditory comprehension in non-fluent aphasia / 中华物理医学与康复杂志

Objective To investigate the correlation between damage to the dominant arcuate fasciculus ( AF) and the occurrence of auditory comprehension dysfunction in post-stroke aphasia. Methods Eighteen stroke survivors with non-fluent aphasia were recruited into the observation group, and nine healthy counterparts were chosen for the control group. All received diffusion tensor imaging ( DTI) scans and fractional anisotropy ( FA) values were measured. A Chinese aphasia battery was used to evaluate the aphasics' language functioning, with the listening true or false, listening recognition and oral instruction auditory comprehension sub-scales used as the observation indices. Results There were significant differences between the two groups in the FA value of the dominant AF. Spearman correlation showed that the FA value of the dominant AF was positively related to the listening recognition results. Conclusions Damage to the dominant AF may be one of the reasons for auditory comprehension dysfunction in post-stroke aphasia. It is significantly related to listening recognition.

Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To investigate the long-term follow-up results of arcuate keratotomy in femtosecond laser-assisted cataract surgery. METHODS: The medical records of 78 patients (99 eyes) with corneal astigmatism >0.5 diopters (D) who underwent arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery were retrospectively reviewed. Uncorrected and corrected visual acuities and keratometric and higher order aberration outcomes were compared preoperatively and 2 years postoperatively. RESULTS: The mean uncorrected visual acuities and corrected visual acuities changed from 0.55 ± 0.31 D and 0.33 ± 0.26 D, preoperatively to 0.13 ± 0.19 D and 0.07 ± 0.09 D, 2 years postoperatively. The mean preoperative corneal astigmatism was −1.15 ± 0.66 D. This was reduced to −0.79 ± 0.38 D at 1–2 days after surgery (p < 0.001), followed by no significant change for 2 years. The mean target-induced astigmatism was 1.15 ± 0.66 D preoperatively, and the mean surgically-induced astigmatism and difference vector were 0.69 ± 0.43 D and 0.83 ± 0.48 D, 2 years postoperatively. The mean correction index was 0.68 ± 0.45, 2 years postoperatively. There was no significant difference in higher order aberrations except 4 mm and 6 mm total higher order aberrations and 6 mm trefoil between preoperatively and 2 years postoperatively. CONCLUSIONS: Arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery is a safe and effective way to reduce corneal astigmatism which remained stable over 2 years of follow-up with below moderate astigmatism.

An Osteological Study Of Arcuate Foramen In Atlas And Its Clinical Significance

Background: Atlas, first cervical vertebra bears sulcus over posterior arch for third part of vertebral artery.Sometimes an osseous bridge converts the sulcus into a foramen called as Arcuate foramen. It is commonlycalled as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incompleteossification of the posterior atlanto-occipital membrane over the vertebral artery groove resulting in the formationof a foramen (Arcuate foramen) containing the vertebral artery and the posterior branch of the C-1 spinal nerve.This variation has been associated with vertebro-basilar insufficiency symptoms, various types of headaches,and acute hearing loss. The knowledge of this variant prevents complications during lateral mass screw fixation,posterior laminectomy and endovascular surgery.Aims: The aim of the present study was to analyze the percentage of incidence of arcuate foramen and to identifyits clinical significance.Materials and Methods: Hundred dried human atlas bones were used to study the presence of arcuate foramen inthe department of Anatomy at ESIC Medical College and PGIMSR, Rajajinagar, Bangalore.Results: We came across the presence of arcuate foramen in two out of hundred bones. In both the atlas bones,osseous bridge extending from posterior aspect of superior articular facet to the posterior arch of atlas on theleft side, forming arcuate foramen, posterior to foramen transversarium was observed.Conclusion: Arcuate foramen commonly called as Kimmerle’s anomaly where in a groove for vertebral artery isconverted into a foramen by ossification of the ligament. Awareness of osseous bridging is essential in performingcranio-cervical junction surgeries. It also serves as an anthropological data and also identifying the impact ofcomplete arcuate foramen on the signs and symptoms of vertebra-basilar insufficiency.