Is low carotid bifurcation determined by vertebral level always convenient for surgical approach?

Although high-level carotid bifurcation (HCB) could lead to notable surgical difficulty, the definitive reference point for HCB is unclear. HCB is typically characterized as carotid bifurcation (CB) located higher than the level of the third cervical vertebra (C), however, a major obstacle regarding carotid artery surgical exposure is angle of the mandible (AM). The objective of this study was to investigate CB level, define HCB in relation to AM and vertebral levels, and measure the vertical distance from HCB to ipsilateral AM. Moreover, the percentage of surgically challenged CBs, misclassified as low CBs (LCB) based on vertebral level, was investigated. Patients who underwent neck computed tomography angiography were retrospectively studied. HCBs were classified into two categories: CBs above the C3 and either at or above the ipsilateral AM. Of 172 CBs (86 patients; 57 men, 29 women), CB was mostly found at C3 (44.19%), whereas AM was commonly located at C2 (51.16%). Based on vertebral level and AM, HCBs were detected in 10.47% and 20.35% of CBs, respectively. The association of HCBs determined by either C3 or AM between both sides in each individual was nonsignificant (p>0.05), but HCBs determined by C3 level were predominant in women (OR = 3.58, 95%CI = 1.31-9.80). Considering both C3 and AM, there was 8.72% of HCBs. The remaining 91.28% was classified as LCBs, including 11.63% of CBs located at both C3 and AM which were actually classified as HCBs if determined by AM. In cases of CBs above AM level, the mean vertical distance was as high as 6.56 ±2.41mm.

An analysis of pain intensity, injury incidence, and their associations with socio-demographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic.

This cross-sectional study explored the relationship between pain intensity, injury incidence, and sociodemographic factors in 120 high school athletes (mean age 16.78±0.91) participating in various sports. The aims of this study are to examine the correlation between factors and Verbal Rating Scale (VRS) for pain intensity, to investigate the correlation between sport types and injured region, and to explore the correlation between injured regions and VRS during training and game competition. Using VRS, we found 64 (53.3%) participants experienced pain during training, with varying degrees of intensity. Chi-square analysis revealed a significant association between VRS scores and school grade (p = 0.044) and cool-down practices (p = 0.037). However, no significant associations were found with gender, age, or sport type. In game competition, 29 (24.2%) participants reported experiencing pain. Here, there was no significant association between VRS and any considered variables. Lower limb injuries were predominant (n = 64), particularly to the knee (n = 23) and ankle/foot (n = 18). Certain sports, like Athletics, Karate-Do, Football, and Western Boxing, demonstrated multiple injury sites, whereas Thai boxing was associated primarily with ankle and foot injuries. Pain intensity varied by injury location, with the highest 'worst pain' reported for elbow injuries during training and knee injuries during competition. Significant associations were found between injured region and pain intensity level during both training and competition (p<0.001). Our findings highlight the need for injury prevention strategies and pain management among high school athletes, emphasizing proper cool-down activities. Further research is warranted to confirm these findings and explore underlying mechanisms.

Predetermining glenoid dimensions using the scapular dimensions.

BACKGROUND: Variations of morphology of the glenoid cavity have been previously reported. These influence the surgical reconstruction or arthroplasty of the shoulder. This study aims to study the variation of the shape of suprascapular notch, shape of glenoid cavity, dimensions of both the scapular and the glenoid cavity, and predict the glenoid dimensions from the scapular dimension parameters. MATERIALS AND METHODS: Adult-dried scapulae were collected. The shapes of each suprascapular notch and glenoid cavity were evaluated. The scapular height, scapular width, glenoid superoinferior distance, and glenoid anteroposterior distance were measured using a digital vernier caliper, and statistical analysis was conducted on the data that were obtained. RESULTS: There were 264 scapulae included in this study (166 male and 98 female). Most of the glenoid cavities were pear shaped (69.7%). The two most common types of suprascapular notches were small depression notches (31.8%) and the absence of notches (25.8%). The mean ± SD of scapular height, scapular width, glenoid superoinferior distance, and glenoid anteroposterior distance were 148.2 ± 10.0, 108.1 ± 6.4, 37.1 ± 2.2, and 27.4 ± 2.1 mm, respectively, in the male samples and 133.0 ± 7.0, 97.0 ± 5.2, 33.2 ± 1.9, and 23.7 ± 1.7 mm, respectively, in the female samples. The male scapulae were significantly larger than the female scapulae (p value < 0.05). However, there were no differences between the male and female scapulae in terms of scapular index or glenoid index (p value > 0.05). Scapular height and width were significantly associated with both the glenoid superoinferior distance (p = 0.0001) and glenoid anteroposterior distance (p value = 0.0001). CONCLUSION: Scapular height and width can predict the dimensions of the glenoid. In cases of glenoid bone loss or shoulder arthroplasty, the native normal glenoid dimensions can be determined from the scapular dimensions as visualized using a true scapular anteroposterior radiograph. The surgeon can use these preoperative parameters when performing glenoid reconstruction or shoulder arthroplasty.

Classification and incidence of pterion patterns of Thai skulls / Clasificación e incidencia de los patrones de pterion en cráneos de Tailandia

SUMMARY: The pterion, a landmark for neurosurgery, is the weakest part of the skull owing to relatively thin bone. Variant patterns of pterion can confuse the clinicians during diagnosis of the lateral skull fractures in emergency situations. Thedifferent pterion types of many races have been reported but not of Thais. In this study; therefore, we investigated the incidence of sutural pterion patterns on of Thai skulls. The infratemporal fossa of 110 sides from 55 dried skulls identified as Thais were observed and classified for individual pterion types. The results showed that the pterion patterns can be classified into 4 types; spheno-parietal (87.27 %), fronto-temporal (4.55 %), uni-epipteric (6.36 %), and multi-epipteric (1.82 %) types. It was found that the spheno-parietal type was dominant in males (61.81 %) than in females (25.45 %). The majority of the skulls showed bilateral symmetry (85.45 %) in all types and the unilateral ones were far less (14.55 %). In bilateral pterion incidence, the spheno-parietal type was approximately 93.61 % while the uni-epipteric type was not found. Moreover, the bilateral multi-epipteric type was found only in one female skull (2.13 %). These findings will be useful for the radiologists and the neurosurgeons concerning lateral skull fractures in emergency diagnosis.

RESUMEN: El pterion es un punto de referencia para la neurocirugía, y es la parte más débil del cráneo debido a estar conformado por hueso relativamente delgado. Los diversos patrones de pterion pueden confundir a los clínicos durante el diagnóstico de fracturas laterales de cráneo en situaciones de emergencia. Con excepción de los tailandeses, diferentes tipos de pterion se han reportado en muchas razas. hemos investigado la incidencia de diversos patrones de pterion en cráneos de Tailandia. Analizamos 110 fosas infratemporales, correspondientes a 55 cráneos secos del Noreste de Tailandia y se clasificaron de acuerdo al tipo de pterion. Los resultados mostraron que el pterion puede clasificarse en 4 tipos: esfeno-parietal (87,27 %), fronto-temporal (4,55 %), epiptérico (3,63 %) y multi-epiptérico (1,81 %). Se encontró que el tipo esfeno-parietal tuvo mayor incidencia en hombres (61,81 %) que en mujeres (25,45 %). Además, la incidencia de simetría bilateral (85,45 %) fue mayor que la unilateral (14,55 %). A nivel bilateral, el tipo esfeno-parietal fue de 93,61 %, mientras que el tipo epiptérico no se observó. Por otra parte, el tipo multiepiptérico fue encontrado bilateralmente en un solo cráneo femenino (2,13 %). Esta incidencia puede ser utilizada como un conocimiento básico para los radiólogos tailandeses sobre las fracturas laterales del cráneo en un diagnóstico de emergencia.

Classification of portal vein tributaries in Thai cadavers including a new type V.

PURPOSE: To compare portal vein tributaries in Thai with Thompson classification. METHODS: In 211 Thai cadavers, abdominal regions were dissected to identify the portal veins and their tributaries. The subjects were classified into types based on modes of drainage of the left gastric and inferior mesenteric veins. Percentages of all types of venous drainage were counted. RESULTS: There are four types of portal tributaries as defined by Thompson, type I_47.87 %, type II_13.27 %, type III_7.58 %, and type IV_29.86 %. There were 1.42 % of whose inferior mesenteric veins entered the joining angle of the superior mesenteric and splenic veins, and were classified as type V. The left gastric vein mostly drained into the portal vein in 79.15 %, while the inferior mesenteric vein emptied into the splenic vein mainly in 55.45 %. CONCLUSIONS: A new variance of portal tributaries in Thai cadavers is reported. The variations of portal vein formations are critical for liver surgery and interventional radiological procedures.

Awareness of the median sacral artery during lumbosacral spinal surgery: an anatomic cadaveric study of its relationship to the lumbosacral spine.

PURPOSE: The purpose was to investigate the median sacral artery (MSA) anatomical pathway in terms of its relationship to the lumbosacral spine. METHODS: The posterior wall and lumbosacral spine of 54 adult embalmed cadavers were dissected. The MSA emerging point was identified. The distance from its emerging point to the lateral border of the vertebral body was measured bilaterally. The pathway of the MSA from the emerging point to the sacral promontory was described together with the MSA length. All outcomes were independently measured by two observers. Statistics on obtained data were calculated. RESULTS: Most of the MSA emerging points were at the L5 vertebral body (94.4 %). The emerging point from the right and left lateral border of the L5 vertebral body was 3.31 ± 0.54 cm and 2.39 ± 0.51 cm, respectively. The MSA then lay along the middle one-third of the anterior surface of the lumbosacral junction. The mean length between the emerging point and the sacral promontory was 2.73 ± 0.97 cm. CONCLUSIONS: The MSA anatomy is important for prevention of intra-operative bleeding. For anterior lumbosacral surgery, the MSA should be identified and controlled before proceeding with the spinal surgery. For posterior bicortical sacral screw placement, the screw tip should be fluoroscopically checked to avoid inserting the screw tip into the mid sacral promontory. By first approaching the anterior sacral promontory, the surgeon will find the MSA within the middle one-third zone, and 2.47-2.99 cm cephalad to this, the iliac vessels. Knowledge of the MSA helps the surgeon to operate more safely.

Origin of the dorsal scapular artery and its relation to the brachial plexus in Thais.

We investigated the variations of the origin of the dorsal scapular artery (DSA) and its relation to the brachial plexus in 252 sides of the posterior cervical triangles of Thais. The origin of this artery on each part of the subclavian artery or other arterial branches was examined with special reference to their course in relation to the brachial plexus. The results show that the DSA originated from three sites; most commonly from the transverse cervical artery (69%) followed by the direct branching from the second (2.8%) or the third part (28.2%) of the subclavian artery. When the DSA was branched from the transverse cervical artery, its course was always posterior or above the brachial plexus. When the DSA arose from the second or the third part of the subclavian artery, it always ran in the branches of the brachial plexus in various sites. The most frequent course was to pass between the upper and middle trunks of the brachial plexus (63.2%). Other courses were far less frequent and found to pass between the anterior division of the upper trunk and the middle trunk of brachial plexus or between the roots of C8 and T1 with the frequency of 1.3 and 2.6%, respectively.

The right ovarian artery arising from the right inferior phrenic artery: a case report.

OBJECTIVE: To report a case of the right ovarian artery arising from the right inferior phrenic artery. MATERIAL AND METHOD: The authors carried out the standard dissection survey of 810 embalmed female cadavers between 1983 and 2010. RESULTS: The authors encountered a case of the right ovarian artery arising from the right inferior phrenic artery in a donated cadaver aged 53 years at decease. CONCLUSION: With the advent of intra-abdominal laparoscopic techniques, the anatomy of the ovarian artery has assumed much more importance.

Left sided inferior vena cava: a case report.

OBJECTIVE: To report a case of left sided inferior vena cava (IVC). MATERIAL AND METHOD: The authors carried out the standard dissection survey of939 embalmed cadavers between 1974 and 2008. RESULTS: The authors encountered a case of left sided IVC in a male donated cadaver aged 65 years at decease. The IVC formed behind the left common iliac artery at the L5 vertebra and coursed proximally on the left of the aorta until it reached the left renal vein and then crossed anterior to the abdominal aorta to assume the normal right side. At the point of crossing, it received the left renal vein. The right renal vein emptied into the IVC on the right side. CONCLUSION: In the era of laparoscopic urological surgery, preoperative diagnosis of this uncommon but important entity is essential to prevent unwarranted surgical mishaps.