Connection between traumatic frontal intracerebral hemorrhage and lower urinary tract symptoms.

OBJECTIVE: There have been no previous studies of urinary symptoms in patients with traumatic frontal intracerebral hemorrhage. The purpose of this work was to provide first insights into the potential role of traumatic frontal intracerebral hemorrhage in the development of urinary symptoms. This condition is known to cause compression in and around the prefrontal cortex, and we wanted to examine its effect on the micturition center. PATIENTS AND METHODS: Patients with voiding dysfunction (n = 176) were assessed for lower urinary tract symptoms using the International Prostate Symptom Score (IPSS). Out of 176 patients, 52 symptomatic patients with voiding difficulties underwent urodynamic testing. All patients with traumatic frontal intracerebral hemorrhage were treated at the University Medical Center Tuebingen, Germany, and the Azad University of Medical Sciences in Tehran, Iran, between 2017 and 2020. Lower urinary tract symptoms (LUTS) were documented in patients with compression of the frontal lobe due to local hemorrhage. All patients routinely performed Brain CT scans. Brain magnetic resonance (MRI) images of the patients with suspicion of diffuse axonal injuries were additionally performed. Out of 176 treated patients (median age of 49 years), 52 patients with voiding difficulties were evaluated. RESULTS: Urodynamic testing of 52 symptomatic patients revealed detrusor overactivity in 25 (48%), low-compliance bladder in 4 (7.7%), detrusor-sphincter dyssynergia in 20 (38%), and uninhibited sphincter relaxation in 11 patients (21%). There was no significant correlation between the volume of hemorrhage and urinary symptoms (p=0.203, Spearman q=0.726). Frontal intracerebral hemorrhage compressing the pre-frontal cortex influences the micturition center and is responsible for lower urinary tract symptoms. CONCLUSIONS: Hemorrhage of the right or left frontal lobe does have a direct relationship with incontinence which completely disappeared in 85% of the patients within 9 months.

The connection between frontal lobe brain tumors and lower urinary tract symptoms - Series of 347 patients.

OBJECTIVE: The present study aimed to provide an early insight into the effect of intra-axial frontal lobe tumors on the micturition center and its potential role in producing compression in and around the prefrontal cortex. PATIENTS AND METHODS: A total of 149 symptomatic patients were selected for urodynamic testing. The study sample included all patients with intra-axial frontal lobe tumors treated at two locations: the University Medical Center Tuebingen (Germany), and Azad University of Medical Sciences (Iran) between 2017 and 2020. Lower urinary tract symptoms (LUTS) were recorded in patients with frontal lobe compression due to local tumor growth. The symptomatic patients had brain magnetic resonance (MRI) images taken to examine for possible lesions. RESULTS: The treated patients (149 patients with a median age of 55 years) were evaluated using computer urodynamic investigation and voiding diaries. The results of urodynamic testing of 149 symptomatic patients showed detrusor over-activity in 82 (55%) patients, dyssynergia of detrusor-sphincter in 67 (45%) patients, uninhibited sphincter relaxation in 40 (27%) patients, and low-compliance bladder in 21 (14%) patients. There was no significant correlation found between tumor size and urinary symptoms (p = 0.103, Spearman q = 0.826). CONCLUSIONS: Frontal intra-axial tumors compressing and infiltrating the prefrontal cortex influence the micturition center and produce lower urinary tract symptoms. The tumors of the right frontal lobe were directly associated with incontinence, which was completely disappeared in 70% of the patients within 2 years.

Clinically relevant variations of the superior thyroid cornu.

PURPOSE: The superior thyroid cornu (STC) of the thyroid cartilage is a variable structure that maybe associated with different clinical symptoms. This study evaluates the three-dimensional anatomy of the STC. METHODS: Measurements were conducted on 97 CT scans (45 male and 52 female). The protocol models a vector from the base to the tip of the STC and references the cornu to the midline. From these data, the length (C), the rotation angle (γ), the inclination angle (ß), and the deviation of STC base (X 2) and tip (X 3) from the midline were measured. An additional measure of the medial inclination quotient (Q = X 3/X 2) was calculated. RESULTS: The STC has a mean length of 13.9 ± 3.26 mm. The male STC is more bent inwards (rotation angle (γ) 60.95° vs. 12.15°; p < 0.001), and the female STC is more steep (inclination angle (ß) 75.44° vs. 73.44°; p < 0.001). The mean Q in men was significantly lower (0.85 ± 0.15 vs. 0.97 ± 0.15; p < 0.001). An extreme medial deformation was found in 13.4 % of the patients. This variation is associated with Q ≤ 0.7, most of the time unilateral and more common in men (86.7 vs. 13.3 %). Furthermore, we can describe STC variations with close proximity to the common carotid artery or the cervical spine. CONCLUSIONS: The clinically most relevant variation of the STC seems to be the extreme medial deviation, which may lead to symptoms described with the superior thyroid cornu syndrome. The evaluation of Q in axial CT scans is easily done and may propose a helpful tool for clinical diagnostics.

Surgical prosection in a traditional anatomical curriculum-Tübingens' Sectio chirurgica.

Despite the rapid rise of integrated curricula, the teaching of gross anatomy by traditional dissection remains a central element in most medical programs worldwide. However, modern didactic concepts demand the integration of clinical content in preclinical settings. The implementation of interdisciplinary tools often leads to a reduction in teaching of comprehensive anatomy. 'Tübingen's Sectio chirurgica' (TSC) introduces a concept of a teaching activity in which surgical prosection is performed in addition to the traditional dissection course. TSC is designed to integrate clinical and preclinical content in a traditional medical curriculum without affecting the systematic presentation of anatomical content. In the past 2 years, about 10,000 medical students have participated in the use of telemedical transmissions of 'live surgery' in a total of 25 sessions of TSC. Here we describe the organisational plan of TSC and the results of an evaluation which was performed to monitor the influence of TSC on student motivation for surgical disciplines as well as for the learning of anatomical factual content. We demonstrate that additional surgical prosection is a valuable tool in increasing the coherence between preclinical and clinical parts of medical education programs.