Myocardial infarct size and sex-related angiographic differences in myocardial infarction in nonobstructive coronary artery disease.

BACKGROUND: Myocardial infarction in nonobstructive coronary artery disease (MINOCA) is a recently described infarct subtype. There are few studies that examine coronary artery disease (CAD) extent, MI size and type, and treatment differences at hospital discharge compared to myocardial infarction in obstructive coronary artery disease (MICAD), or that explore sex-specific MINOCA attributes of coronary anatomy and infarct size. METHODS: Our study population consisted of a single tertiary-center of consecutive patients that had coronary angiography for acute MI between 2005 and 2015. The MI type at presentation, MI size and ejection fraction (post-MI), and gender differences between MINOCA patients were examined. RESULT: Among 1698 cases with acute MI, 95 had MINOCA (5.6%). MINOCA patients were younger, more often had NSTEMI, lower peak cardiac troponin (cTn) values, and greater ejection fraction than MICAD patients (all P-values <0.005). At hospital discharge, 30-day re-admission rates were similar. MINOCA patients less frequently received optimal medical therapy. When women were analyzed, the 45 women with MINOCA had smaller MIs (P < 0.001) and greater ejection fraction (P = 0.002) than the 358 women with MICAD. Sex comparisons of the 95 MINOCA patients revealed women were older than men (P < 0.001), had lower mean peak cTn values (P < 0.001), greater ejection fraction (P = 0.02), and more single-vessel disease involvement than men (P < 0.0001). CONCLUSION: The average MI size is smaller in MINOCA than MICAD patients, and there are sex-related differences in clinical presentation, coronary artery disease extent, and MI size. Re-admission rates are similar and MINOCA patients are less likely to receive guideline recommended medical therapy at discharge.

Transient global amnesia: Minor inconvenience or early warning sign?

Transient global amnesia (TGA) is a clinical diagnosis and is often a diagnosis of exclusion. However, despite the benign nature of this condition, it has been associated with underlying life-threatening medical conditions (e.g., myocardial infarction, dissecting aortic aneurysm, arrhythmias). Our case report highlights the importance of early recognition of those with cardiovascular risk factors who present with acute onset altered mental status to look for underlying medical comorbidities.

The superior petrosal sinus: a review of anatomy, embryology, pathology, and neurosurgical relevance.

The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement.

Gerbode defect: A comprehensive review of its history, anatomy, embryology, pathophysiology, diagnosis, and treatment.

The purpose of this paper is to survey the literature on Gerbode defect and provide an overview of its history, anatomy, development, pathophysiology, diagnosis, and treatment options. The available literature on this topic, including case reports, was thoroughly reviewed. Gerbode defect is defined as abnormal shunting between the left ventricle and right atrium resulting from either a congenital defect or prior cardiac insults. The pathophysiology underlying the development of Gerbode defect is a disease process that injures the atrioventricular septum and leads to the abnormal shunting of blood. Although the most prevalent cause of Gerbode defect has historically been congenital, an increasing trend towards acquired cases has recently been reported owing to improved diagnostic capabilities and a greater number of invasive cardiac procedures. In conclusion, Gerbode defect is an increasingly recognized condition that warrants further study.

Update on the Notochord Including its Embryology, Molecular Development, and Pathology: A Primer for the Clinician.

The notochord is a rod-like embryological structure, which plays a vital role in the development of the vertebrate. Though embryological, remnants of this structure have been observed in the nucleus pulposus of the intervertebral discs of normal adults. Pathologically, these remnants can give rise to slow-growing and recurrent notochord-derived tumors called chordomas. Using standard search engines, the literature was reviewed regarding the anatomy, embryology, molecular development, and pathology of the human notochord. Clinicians who interpret imaging or treat patients with pathologies linked to the notochord should have a good working knowledge of its development and pathology.

Usher Parsons (1788-1868) and His 19th-Century Understanding and Surgical Treatment of Spinal Curvatures.

Usher Parsons was a prominent surgeon in the 19th century. However, his contributions to the understanding and treatment of spinal curvatures have been largely forgotten. Herein, we review Parsons' theories, understanding, and treatment strategies for treating abnormal spinal curvatures. This glimpse into history offers insight into the thought processes and surgical strategies that were available in the early 19th century. It is pioneers in this field, such as Usher Parsons, on which our current understanding of spinal curvatures and its treatment is built.

The filum terminale internum and externum: A comprehensive review.

INTRODUCTION: The filum terminale has oven been overlooked in the literature probably due to its small size and historical lack of research on its true morphology. However, this structure's roll in the tethered cord syndrome has become more apparent. Therefore, the current comprehensive review seemed timely. METHODS: Using standard search engines, the history, embryology, anatomy, pathology and surgery of the filum terminale were reviewed. CONCLUSIONS: It is only recently that the true anatomy and pathological involvement of the filum terminale in the tethered cord syndrome have been elucidated.

A never before reported variant of the sacrum.

INTRODUCTION: Several important steps occur in order for the sacrum to develop properly. Embryological derailment can result in several different anatomical variants. CASE REPORT: Herein, we report, to our knowledge, the first case of a duplicated sacrum in the sagittal plane. CONCLUSIONS: Clinicians and radiologists should be aware of such a finding if found during imaging. We would hypothesize that such a variant occurred near the 29th day of development and probably arose from an error in the HOX gene. To our knowledge, this represents the first reported case.

Historical Perspective of Split Cord Malformations: A Tale of Two Cords.

INTRODUCTION: Our appreciation and understanding of what is now known as the split cord malformation (SCM) have a long history. The oldest known example of SCM is from roughly AD 100. Other isolated examples can be found in the large body of work of the pathologists of the 1800s, where the SCMs were found incidentally during autopsies. CONCLUSIONS: SCM has a rich history and has intrigued physicians for over 200 years. Many well-known figures from the past such as Chiari and von Recklinghausen, both pathologists, made early postmortem descriptions of SCM. With the advent of MRI, these pathological embryological derailments can now often be detected and appreciated early and during life. Our understanding and ability to treat these congenital malformations as well as the terminology used to describe them have changed over the last several decades.

Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine.

Few studies have examined the costovertebral joint and its ligaments in detail. Therefore, the following review was performed to better elucidate their anatomy, function and involvement in pathology. Standard search engines were used to find studies concerning the costovertebral joints and ligaments. These often-overlooked ligaments of the body serve important functions in maintaining appropriate alignment between the ribs and spine. With an increasing interest in minimally invasive approaches to the thoracic spine and an improved understanding of the function and innervation of these ligaments, surgeons and clinicians should have a good working knowledge of these structures.

The intriguing history of vertebral fusion anomalies: the Klippel-Feil syndrome.

INTRODUCTION: Our knowledge and understanding of vertebral fusion, defined and eponymously known as Klippel-Feil syndrome in the early 1900s, have a long history. This uncommon finding has been identified as early as 500 B.C. in an Egyptian mummy. Many more examples of spinal vertebra fusion have been described by Greek historians and recovered by archeologists demonstrating this entity's rich history. CONCLUSIONS: Klippel-Feil syndrome is a rare skeletal anomaly characterized by abnormal fusion of two or more vertebrae. With the advent of newer molecular technology and genetic discoveries, we now have a better understanding of the etiology and possible pathogenesis of this disease.

The Forgotten Lumbocostal Ligament: Anatomical Study with Application to Thoracolumbar Surgery.

INTRODUCTION: Most ligaments of the human body have been well studied. However, the lumbocostal ligament has received little attention in the extant medical literature and, to our knowledge, has not undergone anatomical study. Therefore, the present study was performed to better characterize this structure's anatomy and relationships. METHODS: In the prone position, 10 adult cadavers underwent dissection of their lumbocostal ligaments. All specimens were unembalmed and had no history of surgery to the spine. The lumbocostal ligament was dissected and measurements made using calipers and a ruler. This ligament's attachments were determined as well as its relationships to surrounding fasciae, muscle, and nerves. RESULTS: A lumbocostal ligament was identified on all sides. The ligament was posterior to the quadratus lumborum muscle on all sides. The mean length of the ligament was 3 cm. The overall shape of the ligaments ranged from short bands to large rhomboidal sheets. Inferiorly, the lumbocostal ligament blended with the middle layer of the thoracolumbar fascia on all sides. The ligament attached to the transverse processes of L1 on 25% of sides and onto the transverse processes of L1 and L2 on 75% of sides. The ligament became taut with rib elevation and was lax with rib depression. CONCLUSIONS: The lumbocostal ligament is a constant structure of the thoracolumbar junction. Appreciation of this ligament can help localize the transverse processes of L1 and L2 and adjacent nerves, such as the regional dorsal rami as they exit near its attachment onto the lumbar transverse processes.

The Human Central Canal of the Spinal Cord: A Comprehensive Review of its Anatomy, Embryology, Molecular Development, Variants, and Pathology.

The human central canal of the spinal cord is often overlooked. However, with advancements in imaging quality, this structure can be visualized in more detail than ever before. Therefore, a timely review of this part of the cord seemed warranted. Using standard search engines, a literature review was performed for the development, anatomy, and pathology involving the central canal. Clinicians who treat patients with issues near the spine or interpret imaging of the spinal cord should be familiar with the morphology and variants of the central canal.