Clinical and surgical implications of the pulmonary azygos lobe: a systematic review / Implicaciones clínicas y quirúrgicas del lóbulo ácigos pulmonar: una revisión sistemática

SUMMARY: Azygos lobe is one of the most common pulmonary variations. Although numerous studies discuss to the clinical and surgical implications of anatomical variations, there are few investigations about this topic. The aim of this study was to discuss the anatomy of the pulmonary azygos lobe and its possible clinical and surgical correlations. In this systematic review, a total of 48 results were found between 1968 and 2020. After application of eligibility criteria, 16 articles were included to analysis. Our results showed there were no reports of surgery complications in azygos lobe presence. In all articles that described the anatomical variation, the pulmonary azygos lobe received tertiary segmental branches. Among the surgical implications in the presence of the azygos lobe, complications are of low complexity. It is necessary to teach about this anatomical variation in medical schools in cadavers. Emphasizing the obvious morphological modifications in the superior mediastinum.

RESUMEN: El lóbulo ácigos es una de las variaciones pulmonares más comunes. Aunque numerosos estudios discuten las implicaciones clínicas y quirúrgicas de las variaciones anatómicas, existen pocas investigaciones sobre este tema. El objetivo de este estudio fue discutir la anatomía del lóbulo ácigos pulmonar y sus posibles correlaciones clínicas y quirúrgicas. En esta revisión sistemática se encontraron un total de 48 resultados entre los años 1968 y 2020. Después de la aplicación de los criterios de elegibilidad, 16 artículos fueron incluidos para análisis. Nuestros resultados mostraron que no hubo informes de complicaciones quirúrgicas en presencia del lóbulo ácigos. En todos los artículos que describieron la variación anatómica, el lóbulo ácigos pulmonar recibió ramas segmentarias terciarias. Dentro de las implicaciones quirúrgicas en presencia del lóbulo ácigos, las complicaciones son de baja complejidad. En las escuelas de medicina es necesaria la enseñanza en cadáveres de esta variación anatómica, destacando las evidentes modificaciones morfológicas en el mediastino superior.

Food–Drug Interaction And Their Clinical Implications: Selected Investigations

Food-drug interactions occur as a result of pharmacokinetic or pharmacodynamics mechanisms. Pharmacokinetic mechanisms include what the body does to a drug while Pharmacodynamics mechanisms involve what drugs do to the body. Many types of food have been shown to influence metabolism and the absorption of drugs. Large numbers of drugs are produced and introduced yearly. The interaction between Food and drug may cause negative effects in the nutritional status of the patient as well as safety and efficacy of drug therapy. Due to the possibility of unexpected or poor outcomes, generally, food-drug interactions, in this case, should be avoided. As the good clinical practice, drugs taken by mouth must be absorbed either through the lining of the stomach or the small intestine. Reduction in the absorbance of a drug might be influenced by the presence of food in the digestive tract. The avoidance of such interactions could be possible if the drug is taken 1 hour before or 2 h after eating the food. The effects of several types of food such as milk or milk products, grapefruit and grapefruit juice, bananas, oranges, legumes, fermented meats and pickled fish and some nutrient elements such as calcium, potassium, magnesium, iron, zinc, and vitamin K are highlighted in this paper including their clinical implications.

A Study On Variations Of Nutrient Foramen Of Humerus With Its Clinical Implications

Background: Nutrient foramen is an opening into shaft of humerus which gives passage to the blood vessels ofmedullary cavity. The knowledge of nutrient foramen is important in surgical procedures like bone grafting andmore recently in microsurgical vascularized bone transplantation. Lack of an adequate vascular supply cansignificantly delay or prevent fracture healing. Nutrient artery is the major source of blood supply to the longbone and hence plays an important role in fracture healing.Objective: The nutrient foramens obey the rule of ossification, that is directed away from the growing end of thebone or not.Materials and Methods: The present study consisted of 68 (34 right and 34 left) dried humeurus excluding anyfracture or pathological abnormalities. Number and direction of nutrient foramen was observed in each humerus.Location of nutrient foramen in relation with surfaces and zones of humeurus was determined.Result: It has been observed that 94.12% of the humerus had a single nutrient foramen, 6.39% double foramen,all humerus have nutrient foramina. It was concluded that the majority (73.61%) of the nutrient foramina werepresent on the antero-medial surface, 8.33% on the anterolateral surface and 8.33% on the posterior surface ofthe shaft of humerus and 8.33% of nutrient foramina present on anterior border. It was also concluded that most(86.11%) of the foramina present in the zone II followed by zone I (8.33%) then by zone III (5.56%). All foraminawere directed toward the lower end of humerus.Conclusion: By knowing the number and location of the nutrient foramina in humerus would be useful in preventingintra-operative injury of nutrient artery during orthopedic, plastic and reconstructive surgery and will also berelevant in medico legal practice.

Late coronary ischemıc syndromes assocıated wıth transcatheter aortıc valve ımplantatıon: A revıew of mechanıstıc and clınıcal aspects

In the past years, transcatheter aortic valve implantation (TAVI) has emerged as a promising option for the treatment of aortic valve pathologies particularly in the the presence of surgically high-risk situations. Importantly, a variety of specific procedural complications including acute coronary osteal occlusion, though very rare, has been reported in major clinical studies. However, little is known about the late impact of TAVI on coronary system at the macro and microvascular levels. On the other hand, clinical studies as well as real life experiences have shown variable rates of acute coronary syndrome (ACS) readmissions among TAVI recipients in the short and long terms. Within this context, it may be suggested that even though late coronary ischemic events arising after TAVI, to some extent, appears to be spontaneous or attributable to certain stressors, TAVI may also have the potential to directly account for, accelerate or contribute to the evolution of these ischemic events on follow-up. Accordingly, the present review primarily focuses on potential association of TAVI with late coronary ischemic syndromes along with a particular emphasis on its mechanistic basis and clinical implications among TAVI recipients.

A Study On Variations Of Nutrient Foramen Of Ulna In Saurashtra Region With Its Clinical Relevance

Background: Nutrient foramen is an opening into shaft of Ulna which gives passage to the blood vessels ofmedullary cavity. The knowledge of nutrient foramen is important in surgical procedures like bone grafting andmore recently in microsurgical vascularized bone transplantation.Objective: To determine the number, location and direction of nutrient foramen and whether the nutrient foramensobey the rule of ossification, that is directed away from the growing end of the bone or not.Method: The present study consisted of 150 (75 right and 75 left) dried ulna bones excluding any fracture orpathological abnormalities Number and direction of nutrient foramen was observed in each ulna. Location ofnutrient foramen in relation with surfaces and zones of ulna was determined.Result: It has been observed that 96.67% of the ulna had a single nutrient foramen, 1.33% double foramen and 2%had no nutrient foramen. It was concluded that 90% of the nutrient foramina were present on the anteriorsurface, 5.33% on anterior border and 4.67% on interosseous border It was also concluded that most (62.67%)of the foramina present in the zone II followed by zone I (23.33%) then by zone III (14%). All foramina weredirected toward the upper end of ulna.Conclusion: By knowing the number and location of the nutrient foramina in ulna would be useful in preventingintra-operative injury of nutrient artery during orthopedic, plastic and reconstructive surgery and will also berelevant in medico legal practice.

Perioperative Coagulopathy and the Clinical Implications.

Perioperative bleeding as conceived in this review refers to the clinical scenario whereby there is impairment of blood coagulation leading to prolonged or excessive bleeding, accompanying trauma or surgical exposure. Aetiology of bleeding disorders could be classified under the following subheadings: vascular disorders, Thrombocytopenia, Platelet function defects, Coagulation factors disorder(s). Primary haemostasis is initiated or triggered by the release of tissue factor at the site of injury leading to generation of small quantity thrombin, sufficient to activate platelets leading to the formation of prothrombin complex. The ability of FXa to activate FVII creates a link between the extrinsic and intrinsic coagulation pathways; leading to the generation of sufficient thrombin to convert fibrinogen to fibrin which organizes platelet plug to indissoluble clots (Secondary haemostasis) or thrombus formation. A balance is required between haemostasis, thrombosis and fibrinolysis to prevent perioperative coagulopathy. Whenever positive findings in the history and physical examination suggests an increased risk of significant bleeding, then it is more cost effective to carry out routine screening tests of coagulation. Specific coagulation tests used routinely has longer turnaround times and is not appropriate in the perioperative setting. Current recommendations for the prevention of massive bleeding in the perioperative setting; requires communication of appropriate treatment plans in a multidisciplinary setting, intraoperative monitoring, the treatment of underlying disorder, and replacement therapy with blood products. As point-of-care diagnostics becomes available in emergency areas, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products.

Thyroid Stem Cells: Concept and Clinical Implications

Thyroid pathology is the commonest endocrine surgical problem encountered. However, the study of thyroid stem cells is relatively new in the field of stem cell research. Since the identification of thyroid stem cells in 1992, research interest in this area has been increasing mainly based on furthering our knowledge of the biology of these important cells that are thought to be responsible for tumourigenesis and propagation of cancers. This article reviews the current science and biology of thyroid stem cells and summarizes their potential role in the general management of thyroid disorders.

A Cadaveric Study of Normal and Variant Levels of Division of Sciatic Nerve and Coupled Anomalies with Clinical Application in Surgical Interventions.

Background: Sciatic nerve, the thickest and the largest nerve of the body, is formed in the pelvis. After passing through the greater sciatic foramen, it enters the gluteal region, and subsequently the nerve passes on the back of thigh to reach the superior angle of popliteal fossa where it bifurcates into tibial and common fibular nerves. It usually divides into its terminal branches outside the pelvis; however it may rarely divide within the pelvis. In such cases, the tibial nerve and the common fibular nerve may leave the pelvis through different routes. The knowledge of different routes of exits of the sciatic nerve is of utmost importance for the surgeons and the interventionists dealing with this region as this is the site of innumerable surgical manipulations as well as nerve injuries during deep intramuscular injections in gluteal region, failed sciatic nerve block in anaesthesia and injury during posterior hip surgeries. These variations may result in non-discogenic sciatica because of the nerve compressions under other adjacent anatomic structures. Purpose of the study: This study is an attempt to analyse the course, distribution and levels of the division of sciatic nerve into tibial nerve and common fibular nerve and their clinical implications. Results: Out of the total 120 lower limbs studied, deviation from the usual described pattern was observed in four limbs. One cadaver showed bilateral variation while other two described unilateral disparity from the standard prototype. Conclusion: This knowledge of variant anatomy of division and course of sciatic nerve and its terminal branches will not only assist surgeons to take care during interventions, but also facilitate to plan accordingly during various surgical procedures and management.

Clinical Importance and Epidemiology of Quinolone Resistance / 감염과화학요법

The quinolone class of antimicrobial agents is one of most widely used classes of antimicrobial agents in outpatient and inpatient treatment. However, quinolone resistance in gram-positive and gram-negative bacteria has emerged and increased globally. This resistance limits the usefulness of quinolones in clinical practice. The review summarizes mechanisms of quinolone resistance and its epidemiology and implications in the most common clinical settings, urinary tract infections, respiratory tract infections, intraabdominal infections, skin and skin structure infections, and sexually transmitted diseases.

Middle Cerebral Artery Duplication : Classification and Clinical Implications

OBJECTIVE: Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses. METHODS: A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA. RESULTS: Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA (7/2527, 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe. CONCLUSION: The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.

Nasoendoscopy: Clinical implications.

The purpose of this study is to discuss the clinical use of nasoendoscopy examination of the velopharyngeal closure in patients with nasal speech and to describe the clinical implications of this technique. Three difference patients with hypernasal speech, one with cleft palate, one with hearing loss and one mental retardation, were studied velopharyngeal incompetence through direct assessment of the velopharyngeal closure by nasoendoscopy. An Olympus Nasoendoscope model ENFP3 was used and the Siriraj Speech Stimuli Resonation Test (Manochiopinig & Chuangsuwanich 2001) was used as a standard speech sample. After an explanation and informed consent, 10% of xylocaine was sprayed into a nostril for tropical anaesthesia. The first author performed the nasoendoscopy, meanwhile the second author stimulate the speech sample and velopharyngeal function. The same procedure and condition was conducted to each subject in an operation room. Excursion of the soft palate and pharyngeal wall, completeness, asymmetrical, leakage, adequacy, patterns of closure were observed during speech production. Descriptive analysis was used. The results indicate that intelligible speech production depend on a normal velopharyngeal closure mechanism. Abnormal coupling of the oral and nasal cavities of these patients are characterized by hypernasality, nasal emission, imprecise speech production and decrease speech intensity. These typical signs of velopharyngeal insufficiency could be due to either structural defect (cleft palate), physiological dysfunction (hearing loss) or mental status (mental retardation). Nasoendoscopy provides a direct approach to visualize the velopharyngeal closure. This technique helps clinicians to distinguish between those patients with nasal speech who appear to have the physiological potential for satisfactory velopharyngeal closure from those who do not. This distinction is clinically important because of the marked difference in treatment. Furthermore, in patients considered for a pharyngeal flap operation, pre-operative evaluation of the closure is vital. In conclusion, hypernasal speech alone is not a sign of velopharyngeal insufficiency from structural defect. Thus, a diagnosis is suggested to be made by a cranio-maxillo-facial team after complete evaluation. In addition, nasoendoscopy has been valuable in distinguish different groups of patient as well as planning treatment.

Psychiatric Side Effects of Psychotropic Drugs(II): Clinical & Pathophysiological Implications / 대한정신약물학회지

The psychotropic effects of the original psychotropics currently in use, such as chlorpromazine, iproniazide, imipramine, lithium, and clozapine, have been applied to clinical practice through fortuitous discoveries of their psychiatric side effects (PSE). The etiopathophysiology of various psychiatric disorders have been deduced from the action mechanism of original psychotropics, and the designed drugs which selectively act on those neurotransmitters involved in the therapeutic effects of the original drugs are being developed as novel drugs. Psychiatric side effects cannot be considered to necessarily anti-therapeutic, as seen throughout the history of psychopharmacology. The clinical and pathophysiological significance of PSE deduced from their analyses according to the psychiatric symptoms manifested as PSEs are as follows: 1) PSEs are manifested according to the biological characteristics of the patient across diagnosis. This reflects the lack of biological basis in the current diagnostic system. 2) Psychotropics are important as in vivo pharmacological probes or challenges which, upon administration, allow for the biological characterization of the patient brain, i.e. pharmaco-biological typing of the patient may be performed based on the patient responses to the agent (both therapeutic and adverse effects). Such data may be of importance in subsequent prescription of the patient. 3) The hierarchy of a psychiatric disorder may be modified by drug administration, converting the disorder into that of a lower rank and thus into what is more easily treated. 4) A pharmacological approach, rather than a diagnosis-based one, is required. Consequently, more research into the still unknown psychotropic effects of each psychotropic is desired. In the process, clinically significant psychotropic effects currently undefined from the point of diagnosis-based approach may be discovered.