Cardiac ventricular false tendons: A meta-analysis.

Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.

Advancing Preoperative Strategies for Thyroidectomy in Graves' Disease: A Narrative Review.

Graves' disease is an autoimmune disorder characterized by thyroid-stimulating antibodies that can potentially lead to thyrotoxicosis, goiter, skin disease, and eye disease. Available treatment options for Graves' disease include management with antithyroid drugs (ATDs), thyroid ablation with radioactive iodine (RAI), and surgical thyroid gland removal. For individuals unable to reach a normal thyroid hormone level, promptly considering a thyroidectomy is essential. Preoperative strategies to achieve a euthyroid state prevent thyroid storms and minimize postoperative complications and are therefore crucial. While variations in professional guidance exist, this review focuses on standard medical interventions as well as compares respective guidelines set forth by the American Thyroid Association, the European Thyroid Association, the American Association of Clinical Endocrinology, and the American Association of Endocrine Surgeons. There is consensus among these organizations underscoring the importance of rendering patients euthyroid prior to surgery and the use of ATDs. Most guidelines recommend screening for vitamin D deficiency as well as endorse thyroidectomy as the preferred treatment option for hyperthyroidism with skilled surgeons. Nevertheless, discrepancies do become apparent in aspects such as potassium iodide (SSKI) course duration and preoperative dexamethasone administration. By understanding these differing approaches, healthcare professionals can more effectively manage Graves' disease prior to surgery, resulting in improved patient outcomes and enhanced surgical success.

Musculus pterygoideus proprius: A meta-analysis.

The pterygoideus proprius muscle can be found incidentally in the infratemporal fossa, where it is spatially associated with the muscles of mastication, the maxillary artery, and the trigeminal nerve and its branches. Anatomists have described the muscle in various ways over the past 160 years, chiefly as a musculotendinous structure that originates from the infratemporal crest of the sphenoid bone and inserts into the lateral pterygoid plate and the lateral pterygoid muscle. It is present in non-human primates, albeit rarely, with similar anatomical findings. Embryologically, the pterygoideus proprius is thought to have developed from the first pharyngeal arch mesenchyme along with other muscles of mastication. Its close association with the maxillary artery and trigeminal nerve suggests possible clinical significance in trigeminal neuralgia and temporomandibular joint disorders. The literature was reviewed systematically to detail the historical background of research on the pterygoideus proprius muscle and explain its morphology, prevalence, embryology, and potential clinical significance. Despite its rarity, we propose that it is important to recognize its presence when the infratemporal fossa is approached.

Postoperative scores for robot-assisted and conventional total knee arthroplasty: A meta-analysis.

Background: Knee osteoarthritis is the most common joint disease globally. As obesity and age rates continue to rise in the U.S., the demand for total knee arthroplasty (TKA) is expected to grow significantly by 2030. Advanced techniques such as robotic-assisted (RA-TKA) aim to address this growing concern and improve patient quality-of-life. Since utilization of RA-TKA increased from 2010 to 2018, it is important to compare RA-TKA to conventional TKA (C-TKA) performance. This study compares RA-TKA to C-TKA in patient-reported WOMAC scores and objective range of motion (ROM) scores in eligible short-term (one-year or less) and long-term (one-year to fifteen-years) postoperative follow-up studies. Methods: A systematic review using the PubMed database was performed to identify articles including RA-TKA, CA-TKA, C-TKA, WOMAC scores, and ROM scores. Results: Between RA-TKA and C-TKA, weighted analysis found significant effects in short-term (15.45, 95% CI: 4.96-25.94) and long-term (2.62, 95% CI: 0.62-4.61) WOMAC scores. Conclusion: As approximately 7-20% of C-TKA surgeries result in poor subjective outcomes, and with revision rates and the demand for TKA set to rise, our analysis suggests that patient quality-of-life and cost effectiveness may be significantly improved by RA-TKA over C-TKA.

The Evolution of Corpus Callosotomy for Epilepsy Management.

Corpus callosotomy, first used in the management of epilepsy by William P. van Wagenen in 1940, was for years a contentious procedure. Two decades later, Nobel Laureate Roger W. Sperry's split-brain studies inspired surgeons to reexamine the role of corpus callosotomy in the control of epileptic seizures. In 1962, Joseph Bogen and Philip Vogel performed complete corpus callosotomies in patients with a history of generalized seizures. The identification of a set of postsurgical disconnection symptoms and other neurologic deficits begged the improvement of the surgical technique. Modifications to the operation, including anterior callosotomy, posterior callosotomy, partial callosotomy, staged callosotomy, microsurgical techniques, and radiosurgical techniques, continue to refine the procedure.

Recurrent Laryngeal Nerve Reinnervation in Rats Posttransection: Neurotrophic Factor Expression over Time.

OBJECTIVE: Recurrent laryngeal nerve (RLN) injury causes vocal fold paralysis from which functional recovery is typically absent due to nonselective reinnervation. This study investigates expression of axon guidance cues and their modulators relative to the chronology of reinnervation by examining the expression of glial-derived neurotrophic factor (GDNF), netrin 1, and laminin 111 (LAMA1) in nonpooled laryngeal muscles. This study is the first to describe the post-RLN injury expression pattern of LAMA1, a target of particular interest as it has been shown to switch netrin 1-mediated growth cone attraction to repulsion. STUDY DESIGN: Animal experiment (rat model). SETTING: Basic science laboratory. METHODS: The right RLNs of 64 female Sprague-Dawley rats were transected, with sacrifice at 1, 3, 7, 21, 28, and 56 days postinjury (DPI). Single-animal messenger RNA was isolated from the ipsilateral posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA) for quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis. Immunostaining for LAMA1 expression was performed in the same muscles. RESULTS: LAMA1 was elevated in the PCA at 3 to 56 DPI, LTA at 7 DPI, and MTA at 14 and 28 DPI. This correlates with the chronology of laryngeal reinnervation. Using a new protocol, single-animal muscle qRT-PCR possible and expression results for GDNF and netrin 1 were similar to previous pooled investigations. CONCLUSION: Reliable qRT-PCR is possible with single rat laryngeal muscles. The expression of netrin 1 and LAMA1 is chronologically coordinated with muscle innervation in the LTA and MTA. This suggests that LAMA1 may influence netrin 1 to repel axons and delay LTA and MTA reinnervation.

Expression of trophic factors receptors during reinnervation after recurrent laryngeal nerve injury.

OBJECTIVE: An injury of the recurrent laryngeal nerve (RLN) triggers axonal regeneration but results in a poor functional recovery. Netrin-1 and glial cell-derived neurotrophic factor (GDNF) expression are up-regulated in laryngeal muscles during RLN regeneration, but the role of their receptors produced in the nucleus ambiguus is unknown. The aim of this work was to determine the timing of the production of Netrin-1 and GDNF receptors during RLN regeneration and correlate this with the previously identified timing of up-regulation of their trophic factors in the laryngeal muscles. STUDY DESIGN: Laboratory experiment with rat model. METHODS: The right RLN was transected and dextran amine tracer applied. At 7, 14, and 21 days postinjury (DPI), brainstems were removed and harvested. Immunostaining was performed for Netrin-1 (deleted in colorectal carcinoma [DCC], UNC5A) and GDNF receptors (rearranged during transfection [Ret], glycosylphosphatidylinositol-linked cell surface receptors [GFRα1, GFRα2, GFRα3]). The timing and type of receptor production relative to injury as well as their position in the nucleus ambiguus was analyzed. RESULTS: Netrin-1 UNC5A receptors were minimal in the nucleus ambiguus during RLN regeneration. DCC, the receptor that plays an attract role, was immunopositive from 7 to 21 DPI. All GDNF receptors, except GFRα2, were clearly positive from 7 to 14 DPI. No differences of production were observed according to the position of the motor neurons in the nucleus ambiguus. CONCLUSION: An injury of the RLN leads to a higher production of Netrin-1 DCC and GDNF receptors in the nucleus ambiguus. The timing of receptor production is similar to up-regulation of their trophic factors in the laryngeal muscles. LEVEL OF EVIDENCE: NA. Laryngoscope, 129:2537-2542, 2019.

Innervation of the blood vessels of the spinal cord: a comprehensive review.

There is growing evidence that the nervous system influences spinal cord vasculature. However, most descriptions of the spinal cord have paid little attention to this important aspect. We reviewed the literature on the innervation of spinal cord vessels with an emphasis on findings that may be applicable to human medicine. Multiple neurotransmitters and competing theories have been implicated in the neural regulation of spinal cord blood vessels. Identifying valid mechanisms of pathogenesis could be beneficial to human patients with spinal cord lesions. We discuss the various findings on the neural mechanisms behind spinal cord blood flow. Further investigation is warranted due to the current emphasis on comparative animal studies without corresponding corroborative human findings.

A new superficial landmark for the odontoid process: a cadaveric study.

When image guidance is not available or when there is a need to confirm the findings of such technology, superficial landmarks can still play a role in providing surgeons with estimations of the position of deeper anatomical structures. To our knowledge, surface landmarks for the position of the odontoid process have not been investigated. We have therefore performed an anatomical study to investigate such a landmark. One-centimeter metallic rods were placed on the philtrum of the upper lip of 20 cadaveric head specimens. To assess the position relative to the odontoid process, we took lateral and anteroposterior radiographs and recorded the measurements. Descriptive findings from radiographic observations indicated a reasonable approximation between the philtrum and the midpoint of the odontoid process. Based on our results, we suggest that the philtrum of the upper lip can serve as a first line estimation of the position of the odontoid process and can assist in verifying this bony structure following the use of image guidance.

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.

Simultaneous Umbilical Hernia Repair with Transumbilical Ventriculoperitoneal Shunt Placement.

INTRODUCTION: Recently, placement of a ventriculoperitoneal shunt via a transumbilical approach has been reported. PATIENTS AND METHODS: Herein, we report the repair of an umbilical hernia via the same incision and introduction of the distal end of a ventricultoperitoneal shunt into the peritoneal cavity in 3 patients. A case illustration is included. RESULTS: Both hernia repair and placement of the distal end of the ventriculoperitoneal shunt were uncomplicated in our small case series. CONCLUSIONS: To our knowledge, simultaneous repair of an umbilical hernia followed by transumbilical shunt placement has not been reported. As umbilical hernias are so common in infants, this finding, based on our experience, should not exclude placement of peritoneal tubing in the same setting.

Pediatric Hangman's Fracture: A Comprehensive Review.

PURPOSE: Over 170 years ago, traumatic spondylolisthesis of the axis or hangman's fracture was described. Most descriptions of this entity have focused on adult presentations. METHODS: We review the literature on pediatric cases of hangman's fracture emphasizing the embryological as well as presentation aspects. RESULTS: The majority of cervical spine fractures in children occur at C1 and C2 vertebrae. A normal anterolisthesis of C2 can be seen in younger children and can mimic the anterolisthesis seen after traumatic spondylolisthesis. CONCLUSIONS: Traumatic spondylolisthesis of the axis in children requires further investigation due to the current emphasis in the literature on adult clinical findings and diagnostic challenges from the developmental immaturity of the pediatric skeleton.