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Introduction: Anatomical variations of the levator scapulae are important and therefore clinically relevant. Thelevator scapulae are now believed to be the leading cause of discomfort in patients with chronic tension-typeneck and shoulder pain and a link between anatomical variants of the muscle and increased risk of developingpain has been speculated. The results obtained were compared with previous studies.Materials and methods: The study was conducted on 32 levator scapulae muscle of 16 cadavers over a period of3 years. The dissection of head and neck was done carefully to preserve all minute details, observing themorphological variations of the muscle in the department of Anatomy, Viswabharathi Medical College,Penchikalapadu, and Kurnool.Results: Total 32 levator scapulae muscles were used. All the sample values were measured to 2 decimal places.The average age of the cadavers in the sample was 82.87 years. The oldest cadaver in the sample was 100 yearsold and the youngest 61 years. Measurements of the proximal and distal attachments and the total length of themuscles were taken. Between 3 and 6 muscle slips were reported at the proximal attachment. Differences werealso observed between sides. The first report of a levator scapula muscle with 6 muscle slips at the proximalattachment was described.Conclusion: In our study we report 3 to 6 muscle slips in our study group. In order to improve the reliability of theresults of this study a greater number of specimens should be used, either through further dissection or inclusionof results from imaging techniques. The findings of the study should still be of great interest to cliniciansassociated with this area of the body. By doing this the speculated link between muscle variation and clinicaloutcomes such as myofascial pain syndrome could be investigated further. The potential applications andexpansions of this study are exciting and may begin to uncover the unexplained mechanisms behind myofascialpain syndrome.
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Objective To evaluate the feasibility and effectiveness of four closure techniques ,large incision with plastic distal at‐tachment and clip with suction ,1 .1 cm small incision with plastic distal attachment and clip with suction in natural orifice translu‐minal endoscopic surgery(NOTES) .Methods Forty‐one ex vivo porcine stomachs were involved in this research .According to the size of incision and different methods of incision closure ,all ex vivo porcine stomachs were divided into four groups .Group A in‐volved 8 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closured by a clip closure direct‐ly ;group B involved 10 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closed by plastic end attachment with suction and clip enclosure technique;group C involved 10 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and their incisions were by a clip closure directly ;group D involved 13 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and closured by plastic end attachment with suction and clip enclosure technique .Stomach leaks were evaluated by leaking studies after the procedure .Results In group A ,1 incision was closed successfully ,7 incisions were clo‐sured unsuccessfully ;in group B ,2 incisions were closed successfully ,8 incisions were closed unsuccessfully ;in group C ,2 incisions were closed successfully ,8 incisions were closured unsuccessfully ;in group D ,11 incisions were closed successfully ,2 incisions were Closured unsuccessfully .Fisher′s exact test showed that group D was significantly related to the success of incision closure .The were significant differences between group A and D ,group B and group D(P<0 .05) .Conclusion Small incision(smaller than 1 cm) and plastic end attachment with suction and clip enclosure technique are optimal in NOTES procedure in this ex vivo porcine stomachs study .
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Bezoars are collection of indigestible materials in the gastrointestinal tract. Many endoscopic techniques for removal of bezoars have been reported recently, but these methods need much equipment. We treated a gastric bezoar with a distal attachment device easily available for an endoscope. A 74-year-old man with a history of diabetes mellitus was admitted to hospital with hematemesis. On the second endoscopic examination, a gastric bezoar (6x4x4 cm) was detected in the stomach. Then, using a distal attachment device, we injected Coca-Cola directly into the bezoar by an injector. With tension force, the bezoar was easily broken due to the impulse of the distal attachment device. The endoscopic technique used in our case can be easily performed and has fewer complications compared to those of other techniques. Therefore, we report here on this new treatment modality that uses a distal attachment device.