Articles de revues : « Humps (Anatomy) »

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Drumheller, Glenn W. "The Cottle Push down Operation." American Journal of Cosmetic Surgery 12, no. 3 (1995): 255–61. http://dx.doi.org/10.1177/074880689501200307.

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The “push down” operation was developed by Maurice H. Cottle, M.D., of Chicago. This operation was developed as a more physiologic approach to the management of hump noses. This operation grew out of Dr. Cottle's observation of nasal trauma and his expertise with the handling of nasal septum deformities. He realized that there was a particular degree of support to the nasal dorsum given by the cartilaginous septum. Traditional hump removal, which involves amputation of the roof of the nasal dorsum, has serious physiologic and anatomical sequelae that are avoided using the push down operation. The push down operation not only lowers the dorsum of the nose, but also eliminates prominent bony humps. This effect is due to the flexibility of the chondro-osseous joint between the nasal bones and the cartilaginous vault. This area is known as the “K” area or keystone area. This is where the septum, upper lateral cartilages, and nasal bones join. This junction provides a hinge-like action, allowing for straightening of the dorsum and hump reduction. When performing the push down operation, the operating surgeon must have a thorough knowledge of septum, pyramid, and tip anatomy. The key to the push down operation is the septum, and thorough knowledge of its normal and abnormal anatomy is imperative.

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Kumar, Rajesh, Monica Gulati, Sachin Kumar Singh, Deepika Sharma, and Omji Porwal. "Road From Nose to Brain for Treatment of Alzheimer: The Bumps and Humps." CNS & Neurological Disorders - Drug Targets 19, no. 9 (2020): 663–75. http://dx.doi.org/10.2174/1871527319666200708124726.

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: Vulnerability of the brain milieu to even the subtle changes in its normal physiology is guarded by a highly efficient blood brain barrier. A number of factors i.e. molecular weight of the drug, its route of administration, lipophilic character etc. play a significant role in its sojourn through the blood brain barrier (BBB) and limit the movement of drug into brain tissue through BBB. To overcome these problems, alternative routes of drug administration have been explored to target the drugs to brain tissue. Nasal route has been widely reported for the administration of drugs for treatment of Alzheimer. In this innovative approach, the challenge of BBB is bypassed. Through this route, both the larger as well as polar molecules can be made to reach the brain tissues. Generally, these systems are either pH dependent or temperature dependent. Results: The present review highlights the anatomy of nose, mechanisms of drug delivery from nose to brain, critical factors in the formulation of nasal drug delivery system, nasal formulations of various drugs that have been tried for their nasal delivery for treatment of Alzheimer. Conclusion: It also dives deep to understand the factors that contribute to the success of such formulations to carve out a direction for this niche area to be explored further.

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Pattnaik, Sandeep Abhijit, Suvradeep Mitra, Tushar Subhadarshan Mishra, Suvendu Purkait, Pankaj Kumar, and Suprava Naik. "A Vasculitis-Associated Neuromuscular and Vascular Hamartoma Presenting as a Fatal Form of Abdominal Cocoon." International Journal of Surgical Pathology 27, no. 1 (2018): 108–15. http://dx.doi.org/10.1177/1066896918786582.

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Neuromuscular and vascular hamartoma (NMVH), also known as neuromesenchymal hamartoma, is a rare hamartomatous condition of the intestine. It usually presents with submucosal humps protruding in the intestinal lumen causing obstructive features. The other clinical manifestations are hematochezia or melena and protein-losing enteropathy. The etiopathogenesis of these lesions is not well known, although an association with small bowel Cröhn’s disease and diaphragm disease had been postulated, the latter related to chronic nonsteroidal anti-inflammatory drug intake. Only 24 cases of NMVH are reported in the English literature and all of them could be adequately cured by resection of the affected part of the bowel. Moreover, none of these cases presented with abdominal cocoon or showed any evidence of vasculitis. We describe a peculiar case of NMVH in a 45-year-old male who presented with abdominal cocoon with symptomatic recurrence and fatal outcome within a month of surgery. Histopathology revealed classical histomorphology of NMVH with evidence of vasculitis. This appears to be the first case of a fatal form of NMVH, presenting with abdominal cocoon and associated with vasculitis.

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McKinney, Peter, Peter Johnson, and Jamie Walloch. "Anatomy of the Nasal Hump." Plastic and Reconstructive Surgery 77, no. 3 (1986): 404–5. http://dx.doi.org/10.1097/00006534-198603000-00010.

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Xiang, Hao, Jason Han, William E. Ridley, and Lloyd J. Ridley. "Dromedary hump: Anatomic variant." Journal of Medical Imaging and Radiation Oncology 62 (October 2018): 72. http://dx.doi.org/10.1111/1754-9485.20_12784.

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Susuki, Kenta, Masatoshi Ban, Masaki Ichimura, and Hideaki Kudo. "Comparative anatomy of the dorsal hump in mature Pacific salmon." Journal of Morphology 278, no. 7 (2017): 948–59. http://dx.doi.org/10.1002/jmor.20687.

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Gerecci, Deniz, and Stephen W. Perkins. "The Use of Spreader Grafts or Spreader Flaps—or Not—in Hump Reduction Rhinoplasty." Facial Plastic Surgery 35, no. 05 (2019): 467–75. http://dx.doi.org/10.1055/s-0039-1695727.

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AbstractHump reduction is one of the most common reasons patients seek cosmetic rhinoplasty. Spreader grafts or spreader flaps have become a key maneuver in supporting and reconstructing the nasal midvault after reductive profileplasty to prevent long-term functional and cosmetic sequelae. This article reviews the pertinent anatomy, describes indications for spreader graft or spreader flap placement, discusses surgical techniques and approaches for spreader graft placement, and describes complications of spreader graft use after hump reduction.

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Khmara, T. "FETAL ANATOMY OF THE STRUCTURES OF THE BUTTLE REGION IN THE HUMAN FETUS." Clinical anatomy and operative surgery 19, no. 4 (2020): 20–24. http://dx.doi.org/10.24061/1727-0847.19.4.2020.46.

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In the scientific literature, there are reports on the compression of the nerves of the sacral plexus of the pelvic area or above the gluteal fold in different age periods of a person's life. However, not enough attention is paid by morphologists to the options for the exit of the pudendal, superior and inferior gluteal neurovascular bundles and the sciatic nerve from the pelvic cavity in the perinatal period of human ontogenesis. To perform therapeutic and diagnostic manipulations, as well as surgical interventions in the gluteal region, accurate information is required about the projection-syntopic relationships of the pudendal, superior and lower gluteal neurovascular bundles and the sciatic nerve in human fetuses of different age groups. The study was carried out on 34 preparations of human fetuses, 186.0-310.0 mm parietococcygeal length. The material was fixed in a 7% formalin solution for two weeks, after which the topographic anatomical features of the muscles, blood vessels and nerves of the gluteal region in fetuses of 6-8 months were studied by fine dissection under the control of a binocular loupe. Human fetal preparations were received after artificial termination of pregnancy, which were carried out for social and medical reasons on the basis of district and city maternity hospitals. In 63.24% of the examined fetuses of 6-8 months, the projection of the superior gluteal vessels corresponds to the point located on the border between the upper and middle third osteocetabular line, less often (33.82% of observations) - downward (by 1.5-4, 3 mm) and medially (2.0-4.5 mm) from the specified point, and as an exception (only 3%) - 5.0-5.5 mm laterally from this point. The superior sciatic nerve is located 1.0-3.8 mm lateral to the vessels of the same name. In 75.01% of cases, the lower gluteal vessels leave the pelvis medially (by 2.0-4.7 mm) and down (by 1.5-4.2 mm) from the middle of the osteo-hump line. In 17.64% of observations, the projection of the lower gluteal vessels corresponds to the middle of the osteo-hump line, and in 7.35% of the fetuses, the projection of these vessels is determined 2.5-3.4 mm outward from the point located in the middle of the osteo-hump line. The sciatic nerve leaves the pelvis mainly (75% of observations) medially (2.0-5.4 mm) from the middle of the hump-acetabular line, and in 25% of cases the projection of the sciatic nerve corresponds to the middle of this line.

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Dandekar, Usha, Kundankumar Dandekar, and Sushama Chavan. "Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance." Anatomy Research International 2015 (December 16, 2015): 1–6. http://dx.doi.org/10.1155/2015/412595.

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The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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Lezhnev, D. A., D. V. Davydov, M. O. Dutova, and V. V. Petrovskaya. "ANATOMICAL VARIANTS OF PYRIFORM APERTURES AND NASAL BONES IN PATIENTS WITH NORMAL CONFIGURATION AND DIFFERENT AESTHETIC DEFORMITIES OF EXTERNAL NOSE USING MULTISLICE COMPUTED TOMOGRAPHY." Journal of radiology and nuclear medicine 99, no. 5 (2018): 237–43. http://dx.doi.org/10.20862/0042-4676-2018-99-5-237-243.

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Objective. To identify the anatomical variants of nasal bones and pyriform apertures in view of normal configuration of external nose and different types of aesthetic nasal deformities, to estimate its possible relations.Material and methods. We performed a retrospective analysis of multi-slice computed tomography (MSCT) data of 2737 patients with the image processing (multiplanar and 3D-volume rendering). The sample comprised 121 patients with aesthetic nasal deformities (rhinokyphosis – nasal hump, long nose, combined deformity like a hidden hump, short nose, wide nose) and 37 individuals with normal European nasal configuration.Results. The most frequent variants of pyriform apertures are drop, heart and pear types. The most common variants of nasal bones in all groups were II, V, VI types according to Lang and Baumeister. Every kind of deformities was described with their characteristic features of pyriform apertures and nasal bones.Conclusion. Statistically proved correlation between the facts of deformities and variants of pyriform apertures and nasal bones was obtained. The preoperative study of variable anatomy must be always performed for improving functional and aesthetic results of rhinoplasty.

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Das, S., and IP Tuli. "Anomalous Facial Nerve: An Unusual Cause of Obstruction of Middle Ear Ventilation." Kathmandu University Medical Journal 13, no. 1 (2015): 74–76. http://dx.doi.org/10.3126/kumj.v13i1.13758.

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Numerous anomalies and variations of facial nerve anatomy leading to iatrogenic injury are described. However, there are no reports of facial nerve dehiscence near its second genu causing a hump and obstructing middle ear ventilation pathway, as found in our case.This particular anomaly of facial nerve is being reported to highlight its uniqueness and that a dehiscent facial nerve may be a rare but dangerous cause of obstruction of the attic ventilation. One has to be aware of this unusual anomaly to prevent inadvertent damage to the facial nerve while clearing aditus block in persistent otitis media.Kathmandu University Medical Journal Vol.13(1) 2015; 74-76

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Shadfar, Scott. "Reductive Nasal Profileplasty." Facial Plastic Surgery 35, no. 05 (2019): 446–57. http://dx.doi.org/10.1055/s-0039-1696653.

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AbstractReductive nasal profileplasty is often the pillar of aesthetic nasal surgery. The surgeon must be knowledgable in the key tenants of preoperative analysis and examination to better approach the core elements for hump takedown. Photo imaging or morphing is a practical and technically easy means to open the discussion with the patients to determine their specific goals and ensure that these goals align with their needs functionally. Various approaches can be taken dependent upon the demands from the patient's anatomy and surgical goals planned preoperatively. The component resection technique is described in detail, as well as discussions regarding the need to predict and prophylactically treat the possible long- and short-term sequelae that can occur with reductive nasal profileplasty. Complementary procedures should also be considered to achieve the most balanced nasal and facial aesthetic.

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Locketz, Garrett D., Kirkland N. Lozada, and Daniel G. Becker. "Osteotomies—When, Why, and How?" Facial Plastic Surgery 36, no. 01 (2020): 057–65. http://dx.doi.org/10.1055/s-0040-1701478.

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AbstractAn ideal nasal osteotomy should deliver precise, predictable, and reproducible cosmetic and functional results while minimizing soft-tissue trauma and postoperative complications. In addition to closing an open roof deformity after hump reduction, other common indications for osteotomies include the crooked nose and a wide bony vault. The literature has reported numerous and diverse osteotomy techniques as well as differences in timing of osteotomies. Each has its own merits and indications, and its proponents. In this article, we review the anatomy and nomenclature relating to osteotomies. We review the locations and paths of the osteotomies—lateral, intermediate, medial, and superior/transverse. We consider the percutaneous and endonasal approaches, as well as timing of osteotomies and other considerations. We also discuss technical considerations in the selection of instrumentation for osteotomies.

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Kavitha Kamath, B. "An anatomical study of Moynihan's hump of right hepatic artery and its surgical importance." Journal of the Anatomical Society of India 65 (August 2016): S65—S67. http://dx.doi.org/10.1016/j.jasi.2016.04.004.

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Chaves, Andréa, Elvira Maria Régis Pedrosa, Rejane Magalhães de Mendonça Pimentel, Rildo Sartori Barbosa Coelho, Lílian Margarete Paes Guimarães, and Sandra Roberta Vaz Lira Maranhão. "Resistance induction for Meloidogyne incognita in sugarcane through mineral organic fertilizers." Brazilian Archives of Biology and Technology 52, no. 6 (2009): 1393–400. http://dx.doi.org/10.1590/s1516-89132009000600011.

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The effects of Coda Radimax (CR), Coda Humus-PK (CH) and Coda Vit (CV) on the induction of resistance for Meloidogyne incognita in sugarcane (Saccharum sp.) varieties (RB92579, RB863129, RB867515) through nematode reproduction, plant development and root anatomy analysis, emphasizing the differences of the lignin deposition, and cortex-vascular cylinder proportions were investigated. In 90 days after inoculation with eggs of M. incognita, CR reduced the number of eggs per root system in all the sugarcane varieties; CH and CV reduced eggs density in RB867515; CR increased stalk number in RB92579 and fresh weight of shoots in RB863129 and RB92579; CH increased plant height in RB92579 and fresh weight of shoots in RB92579 and RB867515, CV affected fresh weigh of shoots and roots of RB863129. All the tested compounds did not affect stalk diameter, number and dry weight of shoots. Cross-sections of roots showed no anatomical changes in the M. incognita inoculated tissues.

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AKSOY, Selda, Mehmet Ali GÜNER, İnanç GÜVENÇ, Sedat BİLGE, and Onur TEZEL. "Radioanatomical examination of the dorsal tubercle and surrounding regions for intraosseous infusions." Anatomy 14, no. 3 (2020): 165–70. http://dx.doi.org/10.2399/ana.20.807055.

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Objectives: The aim of the study was to determine the soft tissue thickness overlying the dorsal tubercle and the relationship with adjacent anatomical structures in the distal radius for using this area as an alternative intraosseous route. Methods: Contrast-enhanced MR images of 56 adult patients (28 females, 28 males) without any wrist pathology were evaluated. The shape of dorsal tubercle and its relations with neighboring tendons and vessels with a diameter larger than 2 mm was identified on the axial T1-weighted sections. The soft tissue thickness above the most protruding point of the dorsal tubercle, the distance of the dorsal tubercle to closest tendon on the radial and ulnar sides, as well as its distance to the bone edges on the ulnar and radial sides, and the cortical bone thickness of the radius was evaluated. Results: The dorsal tubercle had sharp edges in 40 cases (71.4%), blunt in 12 cases (21.4%), and hump in 4 (%7.1) cases. Branches of dorsal venous plexus were found on its surface in 11 cases, extensor pollicis longus tendon only was found superficial to the dorsal tubercle in 7 cases while both extensor pollicis longus and dorsal venous branches were found in 2 cases. Conclusion: Dorsal tubercle of the distal radius can be considered as an important alternative route for IO infusions since it can be easily accessed without having a risk of injury to important structures, and can provide effective flow.

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Rodrigues Dias, David, Luis Cardoso, Mariline Santos, Sandra Sousa e Castro, Cecília Almeida e Sousa, and Miguel Gonçalves Ferreira. "The Caucasian Hump: Radiologic Study of the Osteocartilaginous Vault versus Surface Anatomy. Clinical Implications in Structured and Preservation Rhinoplasty." Plastic & Reconstructive Surgery 148, no. 3 (2021): 523–31. http://dx.doi.org/10.1097/prs.0000000000008213.

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Alghamdi, Hanan M., Afnan F. Almuhanna, Bander F. Aldhafery, Raed M. AlSulaiman, Ahmed Almarhabi, and Abdulaziz AlQurain. "The Prevalence of Hjortsjo Crook Sign of Right Posterior Sectional Bile Duct and Bile Duct Anatomy in ERCP." Canadian Journal of Gastroenterology and Hepatology 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/2532610.

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Aim. The frequency of the Right Posterior Sectional Bile Duct (RPSBD) hump sign in cholangiogram when it crosses over the right portal vein known as Hjortsjo Crook Sign and the bile duct anatomy are studied. Knowledge of the implication of positive sign can facilitate safe resection for both bile duct and portal vein. Methods. Prospectively, we included 237 patients with indicated ERCP during a period from March 2010 to January 2015. Results. The mean age (±SD) and male to female ratio were 38.8 (±19.20) and 1 : 1.28, respectively. All patients are Arab from Middle Eastern origin, had biliary stone disease, and underwent diagnostic and therapeutic ERCP. Positive Hjortsjo Crook Sign was found in 17.7% (42) of patients. The sign was found to be equally more frequent in Nakamura’s RPSBD anatomical variant types I, II, and IV in 8.4% (20), 6.8% (16), and 2.1% (5), respectively, while rare anatomical variant type III showed no positive sign. Conclusion. Hjortsjo Crook Sign frequently presents in RPSBD variation types I, II, and IV in our patients.

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Plön, Stephanie, Guilherme Frainer, Andrew Wedderburn‐Maxwell, Geremy Cliff, and Stefan Huggenberger. "Dorsal fin and hump vascular anatomy in the Indo‐Pacific humpback dolphin ( Sousa plumbea ) and the Indo‐Pacific bottlenose dolphin ( Tursiops aduncus )." Marine Mammal Science 35, no. 2 (2018): 684–95. http://dx.doi.org/10.1111/mms.12570.

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Pastorek, Norman, and Patrick Cleveland. "Improving Projection of the Nasal Tip in Primary Endonasal Rhinoplasty." Facial Plastic Surgery 38, no. 01 (2021): 046–56. http://dx.doi.org/10.1055/s-0041-1736391.

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AbstractGaining, improving, and maintaining nasal tip projection is one of the most essential elements of successful endonasal rhinoplasty. For years the hallmark of inadequate nasal tip projection following rhinoplasty has been the Polly beak deformity. Early rhinoplasty technique consisted of intracartilaginous excision of the cephalic margin of the lower lateral cartilages, cartilage and bony hump reduction, and osteotomies. Some of these simple rhinoplasties still look good decades later, however, many are conspicuous in their lack of nasal tip projection. The reason for this inconsistency in rhinoplasty results was the surgeon's inattention to the structural integrity and anatomical position of the LLC. The senior author uses a combination of suture, strut, and cartilage grafting techniques to achieve ideal projection in a manor tailored to each patient's unique anatomic needs.

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Weiss, Hans-Rudolf, and Sarah Seibel. "Hemidystrophic Thorax Mimicking Scoliosis." Open Orthopaedics Journal 12, no. 1 (2018): 252–60. http://dx.doi.org/10.2174/1874325001812010252.

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Background: We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and also for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree. Materials and Methods: This case series is a consecutive series of patients where the first author detected a hemidystrophic thorax instead of or in combination with scoliosis. A 3D scan of the trunk was made and adjusted to the coordinates in order to achieve an upright orientation of the upper trunk. The scan was scaled in order to determine certain anatomic landmarks, as performed in preparation for bracing. The scan was cut horizontally at the xiphoid level and the plane at this level was analysed visually in order to detect deformations that were different to the typical scoliotic deformations in the horizontal plane. Results: Seven cases were analysed and described in more detail. Conclusion: The condition of HDT may lead to significant rib humps that mimic scoliosis. According to our case series, mild scoliosis can also be associated with HDT. HDT, according to the cases presented in this study, seems to be a relatively benign deformity. Long-term observations are necessary before a final conclusion can be drawn with respect to prognosis.

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Scime, Natalie V., Kaylee Ramage, and Erin A. Brennand. "Protocol for a prospective multisite cohort study investigating hysterectomy versus uterine preservation for pelvic organ prolapse surgery: the HUPPS study." BMJ Open 11, no. 10 (2021): e053679. http://dx.doi.org/10.1136/bmjopen-2021-053679.

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IntroductionPelvic organ prolapse (POP) is the descent of pelvic organs into the vagina resulting in bulge symptoms and occurs in approximately 50% of women. Almost 20% of women will elect surgical correction of this condition by age 85. Removal of the uterus (hysterectomy) with concomitant vaginal vault suspension is a long-standing practice in POP surgery to address apical (uterine) prolapse. Yet, contemporary evidence on the merits of this approach relative to preservation of the uterus through suspension is needed to better inform surgical decision making by patients and their healthcare providers. The objective of this study is to evaluate POP-specific health outcomes and service utilisation of women electing uterine suspension compared with those electing hysterectomy and vaginal vault suspension for POP surgery up to 1-year postsurgery.Methods and analysisThis is a prospective cohort study planning to enrol 321 adult women with stage ≥2 POP from multiple sites in Alberta, Canada. Following standardised counselling from study surgeons, participants self-select either a hysterectomy based or uterine preservation surgical group. Data are being collected through participant questionnaires, medical records and administrative data linkage at four time points spanning from the presurgical consultation to 1-year postsurgery. The primary outcome is anatomic failure to correct POP, and secondary outcomes include changes in positioning of pelvic structures, retreatment, subjective report of bulge symptoms, pelvic floor distress and impact, sexual function and health service use. Data will be analysed using inverse probability weighting of propensity scores and generalised linear models.Ethics and disseminationThis study is approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-2134). Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, and educational handouts for patients.Trial registration numberNCT04890951.

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Castillo-Martinez, Daniel Benito, Doris Michelle Palacios-Rivera, and Jorge Boy-Serratos. "Anatomic variations of the hepatic arterial irrigation in a Mexican population: contrast enhanced computer tomography evaluation: a cross-sectional study." International Journal of Research in Medical Sciences 10, no. 12 (2022): 2731. http://dx.doi.org/10.18203/2320-6012.ijrms20223073.

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Background: Knowledge and mastery of the anatomical variability of the hepatic arteries are essential for surgical disciplines and, given their complexity and importance over time, they have been extensively studied and described.Methods: A retrospective, cross-sectional, analytical study was carried out in which contrast-enhanced computer tomography (CT) studies carried out between January 2021 and December 2021 at the North Central PEMEX hospital were analyzed. A total of 207 contrast-enhanced CT scans were analyzed, and Statistical analysis was performed with the statistical software IBM® SPSS© Statistics.Results: Uflacker type I CT was found in 90.8%, the Michel class I hepatic arterial irrigation in 70.5%, and the origin of CA was documented in the right hepatic arteries (RHA) in 90.3%. Multiple cystic artery (Cas) were identified in 1% and Moynihan's hump in 0.5%. The mean length of the common hepatic artery (CHA) was 53 millimeters.Conclusions: The tomographic study of the anatomical variants of hepatic irrigation is an accessible and non-invasive tool. The nomenclature described in the present work allows a precise and straightforward understanding of clinical-surgical utility.

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Saban, Yves, and Sylvie de Salvador. "Guidelines for Dorsum Preservation in Primary Rhinoplasty." Facial Plastic Surgery 37, no. 01 (2021): 053–64. http://dx.doi.org/10.1055/s-0041-1723827.

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AbstractThe multiplication of scientific articles related to the fast-growing interest in preservation rhinoplasty (PR) may lead to confusion in the decision-making process, thus requiring a need for guidelines through a focus on benefit–risk ratio and revisions. This study analyzes a 352 consecutive primary rhinoplasties series during a 3 year (2016 to 2019) period with 1-year follow-up. The evaluation of the most appropriate procedure to the patient's nasal anatomy and expectations requires to correlate (1) a convenient classification of nasal profile lines; (2) a review of the dorsum preservation techniques (DP) classified as: full DP, DP + resurfacing, bony cartilaginous disarticulation, and finally traditional rhinoplasty; (3) the role of septoplasties, subdividing this series in two main groups; (4) analyzing the revisions in the different subgroups and to the literature. Thirty-five revisions (9.94%) were done. Correlations between profile lines, surgical procedures, and revisions show (1) 129 straight noses underwent full DP in 88 cases with 5.68% revisions; however, DP+ hump resurfacing in 32 patients with no revision. (2) Among 71 tension noses, 33 underwent full DP with 6 revisions (18.18%), while 32 patients had bony cap resurfacing, 1 revision (3.13%). (3) Among 109 kyphotic noses, 64 patients underwent DP + resurfacing with 10 revisions (15.63%); 27 patients had cartilage-only DP with two revisions (7.41%). (4) In the 43 difficult noses group, revisions were done equally in DP + resurfacing and cartilage-only subgroups. Septum stability modifies the correlations, introducing Cottle's septorhinoplasty in the paradigm. The revision rate is jumping ×2.50% when a septoplasty is associated with the rhinoplasty. Correlated to the benefit–risk ratio and the revisions, the following guidelines may be suggested in primary rhinoplasty: (1) Straight noses: full DP, (2) tension noses: DP + dorsum resurfacing and/or Cottle's variations, (3) kyphotic noses: cartilage-only DP, and (4) difficult noses: traditional rhinoplasties.

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Urs, Rodica, Ion Anghel, Adriana Oana Rajput Anghel, and Alina Georgiana Anghel. "Risks and complications in rhinoplasty. A comparative study in structural vs preservation rhinoplasty." Romanian Medical Journal 69, no. 2 (2022): 82–86. http://dx.doi.org/10.37897/rmj.2022.2.7.

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Introduction. Rhinoseptoplasty is considered the most challenging operation because many techniques have to be taken into consideration to achieve an optimal aesthetic and functional results. Rhinoseptoplasty techniques have been perfected over time, following two main surgical approaches: structural rhinoplasty (resection/ reconstruction) and conservative (preservation rhinoplasty). Methods. The authors present the risks and complications in a comparative study of 100 cases with patients in primary rhinoseptoplasty performed between 2019-2021: 50 cases in Structural Rhinoplasty and 50 cases in Preservation Rhinoplasty. The study presents two surgical concepts of rhinoplasty regarding the main advantages, disadvantages and indications of each type of rhinoseptoplasty surgery. Results and conclusions. Complications post-rhinoseptoplasty can be considered as perioperative, functional, anatomic (aesthetic) and psyhological. In this study 10 cases (10%) of primary rhinoplasty required revision surgery. The most frequent postoperative deformity is the “pollybeak” when a deep naso-frontal angle, cartilaginous hump and reduced tip projection are present preoperatively. The pollybeak was the indication in 4 cases (40%) of all revision rhinoplasties. Other frequent postoperative deformities are: wide nasal tip, retractions of the columella base and irregularities of the nasal dorsum. These deformities are very often combined and caused by a loss of septal support. Septorhinoplasty is a difficult procedure and the surgeon must have accurate anatomical knowledge and rich clinical experience. The risks for rhinoplasty-complications can be reduced with increasing experience. It is very important to make distinction between complication and mistake.

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Smith, K. L., D. H. Szarowski, J. N. Turner, and J. W. Swann. "Diverse neuronal populations mediate local circuit excitation in area CA3 of developing hippocampus." Journal of Neurophysiology 74, no. 2 (1995): 650–72. http://dx.doi.org/10.1152/jn.1995.74.2.650.

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1. Studies were undertaken to better understand why the developing hippocampus has a marked capacity to generate prolonged synchronized discharges when exposed to gamma-aminobutyric acid-A (GABAA) receptor antagonists. 2. Excitatory synaptic interactions were studied in small microdissected segments of hippocampal area CA3. Slices were obtained from 10- to 16-day-old rats. Application of the GABAA receptor antagonist penicillin produced prolonged synchronized discharges in minislices that were very similar, if not identical, to those recorded in intact slices. The sizes of minislices were systematically varied. Greater than 90% of those that measured 600 microns along the cell body layer produced prolonged synchronized discharges, whereas most minislices measuring 300 microns produced only brief interictal spikes. 3. Action potentials in the majority (75%, 158 of 254) of cells impaled with microelectrodes were able to entrain the entire CA3 population. They were also able to increase (on average 26%) the frequency of spontaneous population discharges. The population discharges were followed by a refractory period that lasted 5–60 s, during which single cells were unable to initiate a population discharge. 4. The majority (87%) of neurons with intrinsic burst properties were found to entrain the CA3 population. The electrophysiological characteristics of these cells were reminiscent of recordings obtained from more mature rats. Action potentials were quite prolonged and demonstrated a secondary shoulder or hump on the down-slope of the spike. 5. When bursting cells were filled with Lucifer yellow and imaged during recording sessions by videomicroscopy and later using confocal microscopy, they showed the anatomic features of CA3 hippocampal pyramidal cells. Confocal microscopy permitted detailed characterization of individual neurons and showed substantial variation in cellular microanatomy. 6. Another class of cells that were found to entrain the CA3 population but did not demonstrate intrinsic bursts were termed regular-firing cells. These cells possessed many of the anatomic and physiological features of bursting cells with the exception of burst firing. They were rarely encountered in intracellular recordings. 7. The third physiological class of cells was termed fast-spiking cells. These had action potentials that were shorter in duration than the other two cell types. They were distinct in the rapid rate of spike repolarization. They demonstrated modest degrees of spike frequency adaptation and fired repeatedly and at relatively high frequencies. Compared with reports on fast-spiking cells in mature hippocampus and neocortex, action potentials appear to be slower and repetitive discharging appeared to be of a lower frequency.(ABSTRACT TRUNCATED AT 400 WORDS)

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Esposito, Ciro, Daniele Alberti, Alessandro Settimi, et al. "Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers." Surgical Endoscopy, July 6, 2021. http://dx.doi.org/10.1007/s00464-021-08596-7.

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Abstract Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation.

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