Anatomical variations of the recurrent laryngeal nerve according to the inferior thyroid artery and their clinical impact in patients undergoing thyroidectomy.

BACKGROUND: Recurrent laryngeal nerve identification is the 'gold standard' in thyroidectomy, to determine nerve function security and prevent severe complications. This study assessed the topographical relationship between the recurrent laryngeal nerve and the inferior thyroid artery in patients undergoing total thyroidectomy, and determined its clinical impact. METHODS: A retrospective study was performed of patients undergoing total thyroidectomy in a single tertiary centre over a six-month period. RESULTS: Sixty-four patients were included. Among the 128 recurrent laryngeal nerve dissections, the nerve was identified traversing the inferior thyroid artery anteriorly in 27.3 per cent, with equal distribution between the two sides. No significant sex association was reported. One patient had transient vocal fold palsy, and hypocalcaemia was observed in 21.9 per cent, yet there was no statistical association with the topographical variation of the recurrent laryngeal nerve. CONCLUSION: Almost one-third of patients had an anatomical variation in which the recurrent laryngeal nerve ran superiorly to the inferior thyroid artery. Recurrent laryngeal nerve variation had no clinical impact on local complications or hypocalcaemia.

Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anaesthesia.

BACKGROUND: Caudal epidural block (CEB) failure or complications are not unheard even among experienced anaesthesiologists and are usually due to sacral hiatus (SH) anatomy variations. The aim of the present study is to observe, record and analyse important anatomical features of SH and correlate them with potential CEB limitations. MATERIALS AND METHODS: The SH of 155 complete and undamaged Greek adult dry sacra of known sex were included in the study. Three non-metric (shape of SH and location of hiatal apex and base in relation to level of sacral/coccygeal vertebra) and five metric parameters (height of the SH, transverse width of the SH at the base, anteroposterior diameter of the SH at the level of its apex and the distance from the sacral apex and base to the upper border of S2 foramina) were evaluated. RESULTS: Inverted U (34.83%) and inverted V (26.45%) were the commonest shapes. Hiatal apex and base were most commonly related to the level of S4 (78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual distance were 19.05 ± 8.65 mm, 5.39 ± 1.84 mm and 12.41 ± 3.16 mm, respectively, whereas mean distance between the upper border of S2 foramen and the apex and base of the SH were 46.34 mm and 63.48 mm, respectively. Anatomical variations of SH that might be responsible for CEB failure, such as elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and narrowing (< 3 mm) at the apex of SH were found in 17.43% of sacra (male 10.94% and female 25.22%). CONCLUSIONS: This study suggests a potential risk of failure of CEB in Greek patients, especially in females, which should be kept in mind while giving caudal epidural anaesthesia.

An aperture in the sagittal plane of the dorsal wall of the sacrum.

The dorsal wall of the sacrum presents various anatomical variations, while the dorsal bony wall of the sacral canal suffers more. We report a case of a sacrum with a series of variants in the midline due to abnormal ossification and a bizarre aperture on the sagittal plane between the 1st and the 2nd sacral spinous processes. A failure of the ossification patter during embryological life, or an ossification of the supraspinous ligament may result in such an aperture. Sacrum variety is of great importance for the daily proper medical practice.

Anatomy and clinical significance of sacral variations: a systematic review.

The sacrum is a large trilateral bone located at the base of the vertebral column serving to transfer the body weight from the trunk to the pelvis and lower extremities. Over the years, an abundance of sacral anatomical divergences has been reported, including numerical and/or morphological variations of sacral entities. The majority of these anatomical alternations has been incidentally identified during radiological investigations, surgical procedures or discovered in anatomical, anthropological and forensic research studies. Throughout international literature, however, there is a scarcity of an integrative recording of all known anatomical variations of the sacrum in a single study. This constitutes the objective of the present paper: to provide an exhaustive systematic review of the relevant literature, as well as to thoroughly describe all the recognized deviations of the sacrum structure, while highlighting the aspects of their clinical significance.

Greenish-blue gastric content: Literature review and case report on acute copper sulphate poisoning.

A literature review of cases of acute poisoning by copper sulfate was conducted, emphasizing therapeutic interventions, and a new fatality case is reported. Specifically, the relevant literature was reviewed for incidence rates, sociodemographic variables, pathophysiology, diagnosis, prognosis, and therapeutic outcome of copper sulfate poisoning. Results conclude that copper sulfate poisoning incidence varies in different regions. It is rare in western countries, while it is very common in South Asian countries. The majority of patients belong to rural populations and are males in the third decade of their lives. The lethal dose of ingested copper is considered to be 10-20 g; 14-36% of the patients pass away within a few hours of ingestion, while the average hospitalization time is more than 20 days. The clinical features of copper sulfate poisoning include erosive gastropathy, intravascular hemolysis, methemoglobinemia, hepatitis, and acute kidney injury. The therapeutic management focuses on absorption reduction, close observation for complications, supportive therapy, and chelation therapy.

Internal laryngopyocele as a cause of acute airway obstruction: an extremely rare case and review of the literature.

The laryngocele is an abnormal cystic dilatation of the saccule or appendix of the laryngeal ventricle, filled with air and communicating with the lumen of the larynx. When the neck of the laryngocele is obstructed, it becomes filled with mucus of the glandular secretion and is changed to a laryngomucocele. When this lesion becomes infected, a laryngopyocele is formed. The laryngocele is fairly rare and laryngopyocele occurs even more rarely. Overall, 39 cases of laryngopyocele have been reported in the world literature. Only in 4 cases was a laryngopyocele reported to have caused acute airway obstruction and only one case of internal laryngopyocele causing acute airway obstruction has been reported until now. This is the first case reported in the literature of an internal laryngopyocele in a female patient in a septic condition, which caused almost 100% obstruction of the airway. An emergency tracheotomy was performed in order to secure the airway. Computed tomography of neck was performed which revealed a cystic 29 mm hypodense mass extending from the right false vocal cord to the level of the epiglottis, narrowing the laryngeal cavity and causing an almost 100% airway obstruction. Laryngopyoceles may present with a rapid and alarming obstruction of the airway and, therefore, an urgent tracheotomy may be inevitable. It is an emergency case, in the field of otolaryngology, and should be included in the differential diagnosis of acute airway obstruction, especially when hoarseness, stridor and fever are present. Diagnosis requires a high index of suspicion for these lesions and scrupulous clinical and radiological evaluation. A computed tomography scan is critical in determining the nature and site of the lesion. The recommended treatment of laryngopyocele is immediate endoscopic drainage. Definitive management of laryngopyoceles is surgical excision which can be performed immediately after endoscopic drainage or some time thereafter.

Evaluation of improvement in quality of life and physical activity after total knee arthroplasty in greek elderly women.

BACKGROUND: The aim of this study was to evaluate the changes in quality of life of patients after total knee arthroplasty and to assess the changes in physical activity by using a self-reported questionnaire and by counting the number of steps 3-6 months after post-operatively. METHODS: Included were fifty two elderly women (age 72.6±65.9 years, mean±SD) with knee osteoarthritis undergoing primary knee arthroplasty. Health-related quality of life, physical activity, pain and function and the number of steps were assessed before, 3 and 6 months post-operatively. We used the Medical Outcomes Study Short Form (SF-36), the Physical Activity Scale for the Elderly (PASE) and the pedometer SW200 Digiwalker of Yamax. RESULTS: Patients showed a significant improvement (p< 0.01, η2 =0.22) in health-related quality of life, particularly in physical function, (p<0 .001) body pain (p< 0.001) and vitality scale (p< 0.001) of SF-36 at 3 and 6 months after the procedure. Physical activity (PASE score) increased at 3 and 6 months after arthroplasty (p< 0.001, η2 =0.74), and the number of steps increased 6 months after, compared to the assessment that took place 3 months after operation (p< 0.001). CONCLUSIONS: Our results suggest that total knee arthroplasty leads to a gradual improvement in quality of life of elderly patients over the first 6 post-operative months.

Uterine cancer through the works of the eccentric Auguste Joseph Lutaud (1847- 1925), famous gynaecologist, publisher and intellectual of the 19th century.

Auguste Lutaud was standing for almost half century in front of the French and International stage for his controversy and eccentric personality, his undisputed authority in gynecology, his writings and his publishing success. Thanks to his writings, he is considered as the main propagator of the prevailing ideas on uterine cancer diagnosis and treatment.

Anomalies of the inferior vena cava: a report of two cases and a short review of the literature.

The inferior vena cava, also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart. Congenital anomalies of the inferior vena cava result from the persistence of the embryonic venous system. The majority of cases are clinically silent and are diagnosed in routine dissection studies, in retroperitoneal surgeries, or through imaging for other reasons. Although these anomalies are rare, they are of great importance during operations in the abdominal area or in the treatment of thromboembolic diseases. We report two cases of double vena cava and left vena cava, respectively, and a short review of the relevant literature.

A giant aneurysm of the internal carotid artery, which caused dysphagia: case study and short review of literature.

The retropharyngeal space is a virtual space behind the pharynx, which extends from the scull base to the level of the fourth thoracic vertebra. Many retropharyngeal masses can cause dysphagia or airway obstruction. We report the case of a 69 year-old woman with a much enlarged aneurysm in the extracranial portion of the left internal carotid, causing dysphagia, and a short review of the relevant literature.

Hypovolemic shock due to giant uterus leiomyoma detachment.

Uterine leiomyoma (UL) is the most common benign gynecologic tumor of the reproductive age females. It is symptomatic only in 25% of the patients causing dysmenorrhea, menorrhagia or anemia. In some patients it occurs just as a palpable abdominal mass. In this study, we report a 50-year-old woman with a giant mass, attached to the uterus, which was detached and therefore led to shock due to major hemorrhage. Surgical removal of both the mass and the uterus confirmed the diagnosis of a pedunculated uterine leiomyoma.

Stability of long term facilitation and expression of zif268 and Arc in the spinal cord dorsal horn is modulated by conditioning stimulation within the physiological frequency range of primary afferent fibers.

Long term facilitation (LTF) of C-fiber-evoked firing of wide dynamic range neurons in the spinal dorsal horn in response to conditioning stimulation (CS) of afferent fibers is a widely studied cellular model of spinal nociceptive sensitization. Although 100 Hz CS of primary afferent fibers is commonly used to induce spinal cord LTF, this frequency exceeds the physiological firing range. Here, we examined the effects of electrical stimulation of the sciatic nerve within the physiological frequency range on the magnitude and stability of the C-fiber-evoked responses of wide dynamic range neurons and the expression of immediate early genes (c-fos, zif268, and Arc) in anesthetized rats. Stimulation frequencies of 3, 30 and 100 Hz all induced facilitation of similar magnitude as recorded at 1 h post-CS. Strikingly, however, 3 Hz-induced potentiation of the C-fiber responses was decremental, whereas both 30 and 100 Hz stimulation resulted in stable, non-decremental facilitation over 3 h of recording. The number of dorsal horn neurons expressing c-fos, but not zif268 or Arc, was significantly elevated after 3 Hz CS and increased proportionally with stimulation rate. In contrast, a stable LTF of C-fiber responses was obtained at 30 and 100 Hz CS, and at these frequencies there was a sharp increase in zif268 expression and appearance of Arc-positive neurons. The results show that response facilitation can be induced by stimulation frequencies in the physiological range (3 and 30 Hz). Three hertz stimulation induced the early phase of LTF, but the responses were decremental. Arc and zif268, two genes previously coupled to LTP of synaptic transmission in the adult brain, are upregulated at the same frequencies that give stable LTF (30 and 100 Hz). This frequency-dependence is important for understanding how the afferent firing pattern affects neuronal plasticity and nociception in the spinal dorsal horn.

A clinical case report of a Schwannoma on the tip of the tongue.

OBJECTIVES: Schwannomas (neurilemmomas) are benign solitary tumours which arise from the Schwann cells of the neural sheath, most often from the VIII cranial nerve. Extracranially, 25% of all schwannomas are located in the head and neck. Intra-oral development is uncommon and a location in the tongue has been reported in individual cases. METHODOLOGY: We present a young patient with a schwannoma in the distal right side of the tongue. RESULTS: The tumour had grown slowly producing no symptoms. The diagnosis was made on histological examination. Surgical enucleation of the mass was uncomplicated and there was no recurrence. CONCLUSIONS: We report a further case of a schwannoma of the tongue, highlighting the need for this to be considered in the differential diagnosis.

Recording of long-term potentiation in single dorsal horn neurons in vivo in the rat.

We have published several reports on long-term potentiation (LTP) in single spinal wide dynamic range (WDR) neurons (responding to both innocuous and noxious stimuli) in urethane-anaesthetised rats. The protocol presented here, with single unit recordings of dorsal horn neurons before and after a nociceptive conditioning stimulation, may be useful in many electrophysiological studies of plastic changes in the spinal cord, such as LTP. We invite others to use this protocol for the study of spinal plasticity. Findings using this technique may be relevant for the understanding of changes in nociceptive transmission, induction of central sensitisation and maybe even in mechanisms of pathological pain and chronic pain states. We describe modified and alternative protocols for the study of LTP mechanisms under different conditions in intact and in spinalised animals, and after natural noxious stimuli. We present a novel method minimising peripheral influence of afferent input induced by antidromic neurogenic inflammation or inflammatory changes following a natural noxious stimulation. This is made possible by dissection of the sciatic nerve at two separate locations and local anaesthetic block distal to the stimulation site.