Morphometric Analysis of the Sella Turcica and Sphenoid Sinus: A Retrospective Cross-Sectional Study / Análisis Morfométrico de la Silla Turca y Seno Esfenoidal: Un Estudio Transversal Retrospectivo

SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

Evaluation of the normal craniocervical junction craniometry in 137 asymptomatic patients / Evaluación de la craneometría de la unión craneocervical normal en 137 pacientes asintomáticos

SUMMARY: To our best knowledge, most of the craniometric studies on the normal craniocervical junction (CCJ), are still poorly studied and based on measurements taken from plain radiographs. In this study, the authors conducted a craniometric evaluation of the CCJ in a population without known CCJ abnormalities. The purpose of the study was to assess the normal CCJ craniometry based on measures obtained from CT scans. The authors examined 137 consecutive CCJ CT scans obtained in patients evaluated at their hospital for treatment of non-CCJ conditions between 2018 and 2019. Twelve craniometrical dimensions were conducted, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, and the clivus-canal angle (CCA).

Hasta donde sabemos, aun son escasos y pocos los estudios craneométricos respecto a la unión craneocervical normal (UCCN) y estos se basan en mediciones tomadas de radiografías simples. En este estudio, realizamos una evaluación craneométrica de la UCCN en una población sin anomalías conocidas. El propósito del estudio fue evaluar la craneometría UCCN normal en función de las medidas obtenidas de las tomografías computarizadas. Los autores examinaron 137 tomografías computarizadas UCCN consecutivas obtenidas en pacientes evaluados en su hospital para el tratamiento de condiciones no UCCN entre los años 2018 y 2019. Se realizaron doce dimensiones craneométricas, incluida la relación del proceso odontoides con la base del cráneo, el intervalo atlantodental (ADI), la longitud del clivus y el ángulo clivus-canal (CCA).

Knee Pain and Limping as Presenting Symptoms of Metastatic Thyroid Cancer.

BACKGROUND Most thyroid nodules are fortunately benign; however, up to 15% of thyroid nodules turn out to be malignant. Follicular thyroid cancer is the second most common type of thyroid malignancy, originating from the follicular cells lined by cuboidal epithelium, with a peak incidence between the ages of 40 and 60 years. The feature that differentiates follicular carcinoma from adenoma is the presence of capsular invasion. While distant metastases occur in 10% to 15% of patients with follicular thyroid cancer, only 2% to 13% of patients with thyroid cancer develop bone metastases. Metastasis to the knee in thyroid cancer is extremely rare. This report describes a rare case of limping and knee pain as presenting symptoms of metastasis of follicular thyroid cancer to the knee joint observed during clinical practice and addresses its implications. CASE REPORT A 60-year-old woman presented with right knee swelling, disabling pain, and difficulty with walking in the last 3 months. Magnetic resonance imaging showed a large mass, and a computed tomography scan-guided biopsy confirmed it to be a distant metastasis of follicular thyroid cancer. The patient underwent total knee replacement and thyroidectomy and was postoperatively treated with radioactive iodine therapy. She was in good condition at her 1-year follow-up, with no recurring pathology. CONCLUSIONS This case reports on the metastasis of follicular thyroid cancer to the knee, which is exceedingly rare. However, it should be considered in the differential diagnoses of lytic bone lesions, as early diagnosis and management yield a more favorable prognosis for patients.

Spontaneous cervical epidural hematoma presenting as quadriparesis: A case report in compliance with the SCARE guidelines.

Spinal epidural hematoma (SEH) is a rare disease. Several pathologies have been described as a cause, including trauma, arteriovenous malformations, coagulopathies, and iatrogenic causes. Spontaneous spinal epidural hematomas (SSEH) are blood in the spinal extradural space without a known cause. The incidence of SSEH has been estimated as 0.1 per 100,000 per year. Herein, we report a case of spontaneous spinal epidural hematoma in the cervical spine. We report a 57-year-old male patient who presented with sudden axial neck pain associated with upper and lower extremities weakness. Symptoms were precipitated by coughing. MRI of the cervical spine revealed an extradural lesion compressing the dorsal aspect of the spinal cord from C4 - C7. He underwent urgent decompressive laminectomy and evacuation of the hematoma.

The Effect of COVID 19 on Liver Parenchyma Detected and measured by CT scan Hounsfield Units.

Background: COVID 19 may affect organs other than lungs, including liver, leading to parenchymal changes. These changes are best assessed by unenhanced computed tomography (CT). We aim to investigate the effect of COVID 19 on liver parenchyma by measuring the attenuation in CT scan Hounsfield unit (HU). Materials and Methods: A cohort of patients, who tested COVID 19 polymerase chain reaction positive, were enrolled and divided into two groups: fatty liver (FL) group (HU ≤ 40) and nonfatty liver (NFL) group (HU > 40) according to liver parenchyma attenuation measurements by high resolution noncontrast CT scan. The CT scan was performed on admission and on follow up (10-14 days later). Liver enzyme tests were submitted on admission and follow up. Results: Three hundred and two patients were enrolled. Liver HU increased significantly from 48.9 on admission to 53.4 on follow up CT scan (P<0.001) in all patients. This increase was more significant in the FL group (increased from 31.9 to 42.9 [P =0.018]) Liver enzymes were abnormal in 22.6% of the full cohort. However, there was no significant change in liver enzymes between the admission and follow up in both groups. Conclusion: The use of unenhanced CT scan for assessment of liver parenchymal represents an objective and noninvasive method. The significant changes in parenchymal HU are not always accompanied by significant changes in liver enzymes. Increased HU values caused by COVID 19 may be due to either a decrease in the fat or an increase in the fibrosis in the liver.

Kikuchi-Fujimoto disease in the Eastern Mediterranean zone.

Kikuchi-Fujimoto disease (KFD) is a rare benign and self-limiting syndrome. We aim to review cases of KFD at our institution as a rare illness in the Arab ethnic descent and to analyse reports from most countries in the East Mediterranean zone. This is a retrospective study in which the histopathology database was searched for the diagnosis of KFD. A full review of KFD patients' medical records was done. Data regarding demographic features, clinical presentation, laboratory findings, comorbidities, and management protocols were obtained. Published KFD cases from east Mediterranean countries were discussed and compared to other parts of the world. Out of 1968 lymph node biopsies studied, 11 (0.6%) cases of KFD were identified. The mean age of patients with KFD was 32 years (4-59). 73% (8/11) were females. The disease was self-limiting in 5 patients (45%); corticosteroid therapy was needed in 4 patients (34%). One patient was treated with methotrexate and one with antibiotics. One patient died as a consequence of lymphoma. Jordanians and Mediterranean populations, especially those of Arab ethnic background, seem to have low rates of KFD. The genetic susceptibility theory may help to explain the significantly higher disease prevalence among East Asians. Early diagnosis of KFD-although challenging-is essential to reduce the morbidity related to this illness.

Comparison of safety and efficacy of intragastric botulinum toxin-A versus gastric balloon.

Background: A prospective case-matched study was conducted to compare the safety and efficacy of endoscopic intragastric botulinum toxin-A (EIBT) versus endoscopically planned gastric balloon (EPGB), as a treatment for obesity. Methods: A total of 176 patients (matched for age and sex) were equally divided to undergo EIBT (n = 88) or EPGB (n = 88). Patients who received EIBT were restricted to a body mass index (BMI) of 25 to 35 kg/m2, whereas a BMI >25 kg/m2 was allowed in the EPGB group. The main measured outcomes were weight loss, procedure duration, complications, early satiety, and quality of life (QoL). Results: The patients were followed up for a mean of 6 months. The mean weight loss was greater in the EPGB group than in the EIBT group (15.6 kg vs. 9.3 kg, P < 0.001). However, the percentage excess weight loss and the satiety score were greater in the EIBT group (59.1% vs. 42.2%, P < 0.001; and 3.5 vs. 2.3, P < 0.001) respectively. The procedure duration was shorter for EIBT patients (10 min vs. 15 min, P < 0.001). The postoperative complication rate recorded in the EPGB group was significantly higher (30% vs. 9%, P = 0.001). Adverse symptoms lasted longer in EPGB (5.2 days vs. 0.7 days, P < 0.001). Both groups enjoyed similar improvements in QoL. Conclusion: EIBT is a safe and effective treatment for mild obesity. Although the weight loss was greater in the EPGB group, the percentage excess weight loss, procedure duration, postoperative complications, and symptom duration were significantly better in the EIBT group. QoL improvement was comparable between the two groups.

Correlation between COVID-19 severity, body mass index and radiological hepatic morphology / Correlación entre la gravedad de COVID-19, el índice de masa corporal y la morfología hepática radiológica

SUMMARY: Obesity and fatty liver steatosis are already considered metabolic risk factors which may aggravate the severity of COVID-19. This study aims to investigate the correlation between COVID-19 severity, obesity, and liver steatosis and fibrosis. 230 consecutive patients with laboratory-confirmed COVID-19 aged between 15 and 84? years, admitted to a hospital devoted to COVID-19 patients, were enrolled in the study. COVID-19 severity was classified as severe versus non-severe based on admission to ICU. Obesity was assessed by Body Mass Index (BMI). CT-scan was used to check for the liver steatosis. Fibrosis-4 score was calculated. The study was conducted in March-May 2020. Obesity strongly and positively correlated with severe COVID-19 illness r: 0.760 (P<0.001). Hepatic steatosis had rather less of a correlation with COVID-19 severity r: 0.365 (P<0.001). Multivariable-adjusted association between hepatic steatosis or obesity, or both (as exposure) and COVID-19 severity (as the outcome) revealed increased risk of severe COVID-19 illness with obesity (Adjusted model I OR: 465.3, 95 % CI: 21.9-9873.3, P<0.001), with hepatic steatosis (Adjusted model I OR: 5.1, 95 % CI: 1.2-21.0, P<0.025), and with hepatic steatosis among obese patients (Adjusted model I OR: 132, 95 % CI: 10.3-1691.8, P<0.001). Obesity remained the most noticeable factor that strongly correlated with COVID-19 severity, more than liver steatosis. However, the risk to COVID-19 severity was greater in those with both factors: obesity and liver steatosis.

RESUMEN: La obesidad y la esteatosis del hígado graso ya se consideran factores de riesgo metabólico que pueden empeorar la gravedad de la COVID-19. Este estudio tiene como objetivo investigar la correlación entre la gravedad de COVID- 19, la obesidad y la esteatosis y fibrosis hepática. El estudio se realizó en 230 pacientes consecutivos entre 15 y 84 años con COVID-19 confirmado por laboratorio, ingresados en un hospital dedicado a pacientes con COVID-19. La gravedad de COVID-19 se clasificó como grave, versus no grave según el ingreso a la UCI. La obesidad se evaluó mediante el índice de masa corporal (IMC). Se utilizó una tomografía computarizada para verificar la esteatosis hepática. Se calculó la puntuación de Fibrosis-4. El estudio se realizó entre marzo-mayo de 2020. La obesidad se correlacionó fuerte y positivamente con la enfermedad grave de COVID-19 r: 0,760 (P <0,001). La esteatosis hepática tuvo una correlación bastante menor con la gravedad de COVID-19 r: 0.365 (P <0.001). La asociación ajustada multivariable entre la esteatosis hepática u obesidad, o ambas (como exposición) y la gravedad de COVID-19 (como resul- tado) reveló un mayor riesgo de enfermedad grave por COVID- 19 con obesidad (OR del modelo ajustado I: 465,3, IC del 95%: 21,9 -9873,3, P <0,001), con esteatosis hepática (OR del modelo I ajustado: 5,1, IC del 95 %: 1,2-21,0, P <0,025) y con esteatosis hepática entre los pacientes obesos (OR del modelo I ajustado: 132, IC del 95 % : 10,3-1691,8, P <0,001). La obesidad siguió siendo el factor más notable que se correlacionó significativamente con la gravedad de COVID-19, más que la esteatosis hepática. Sin embargo, el riesgo de gravedad de COVID-19 fue mayor en aquellos con ambos factores: la obesidad y esteatosis hepática.

Intractable Biliary Candidiasis in Patients with Obstructive Jaundice and Regional Malignancy: A Retrospective Case Series.

BACKGROUND: Candida species are infrequently grown in bile cultures. An association between biliary candidiasis and regional malignancy may exist. The role of fungus membranes in frequent biliary stent occlusion is also presented in this case series. METHODS: We retrospectively identified patients who underwent percutaneous trans-hepatic cholangiogram (PTC) for obstructive jaundice between January 2014 and January 2019. The results of bile cultures - obtained by PTC - for all patients were analyzed, and patients with fungus growth were determined; their medical records were reviewed. RESULTS: A total of 71 patients with obstructive jaundice underwent PTC between January 2015 and January 2019. Five patients (all male; mean age 55.8 years) had candida species growth in bile cultures. Two patients were diagnosed with cholangiocarcinoma, one with adenocarcinoma of the head of the pancreas, one with gallbladder cancer, and one with locally advanced gastric adenocarcinoma. Formation of fungal balls predisposed to frequent PTC drain clogging. Eradication of Candida was achieved in 4 patients after 10 days to 3 weeks of antifungal therapy. CONCLUSION: We present a case series of biliary candidiasis in patients with obstructive jaundice and regional malignancy. We suggest that patients with obstructive jaundice and regional malignancy should be screened for biliary candidiasis. Persistent cholestasis may be caused by the recurrent formation of fungal membranes (balls).

Migrated Inferior Vena Cava (IVC) Filter Strut: A Rare Cause of Chronic Distal Pancreatitis with Likely Malignant Transformation.

BACKGROUND Inferior vena cava (IVC) filters are indicated for patients with recurrent venous thrombosis despite proper anticoagulation or whenever anticoagulation is contraindicated. IVC filter deployment is an invasive procedure with various complications. One example is IVC filter limb fracture and migration, which is associated with significant morbidity and/or mortality. Extravascular migration toward pancreas may induce pancreatitis. Patients with chronic pancreatitis are known to have an increased risk of pancreatic malignancy. CASE REPORT We report an extremely rare case of IVC filter fractured limb in 44-year-old woman, which had migrated into the pancreatic tail and manifested as chronic distal pancreatitis. A pancreatic adenocarcinoma was found by biopsy at the pancreas tail. It is likely that a foreign body promoted this metaplasia and neoplastic transformation. CONCLUSIONS Early detection and retrieval of a displaced foreign body in organs, such as the pancreas, seem to be essential to reduce risk of subsequent complications, including chronic inflammation and possibly neoplasia.

A snapshot of Ischemic stroke risk factors, sub-types, and its epidemiology: Cohort study.

The burden of stroke can be substantially studied by establishing the functional consequences of stroke and its predictors on the population, economy and to guide rehabilitation efforts. This study aims to determine the subtypes, risk factors, and epidemiology of stroke in Jordan. Methods: A retrospective cohort study design was carried out to determine the risk factors and subtypes of stroke during 2017-2018. The study sample included 176 ischemic stroke patients of the King Abdullah University Hospital. Data was collected through medical records, which was then statistically analysed through frequencies and percentages. Results: Total 176 cases were identified out of which 101 (57.38%) were males and 75 (42.61%) were females and male to female ratio was 1.9:1. Hypertension was the commonest risk factor identified (50.56%), followed by diabetes mellitus (19.88%), hyperlipidaemia (15.34%), coronary artery disease (6.25%), atrial fibrillation (4.54%), and past history of stroke (1.13%). Risk factors such as hypertension (p = 0.007), diabetes (p = 0.000), coronary artery disease (p = 0.000) were significantly associated with subtypes of ischemic strokes. Conclusion: The study concludes that mean age of men was higher as compared to women in small vessel occlusion. The risk of ischemic stroke in patients with dyslipidaemia, diabetes mellitus, and hypertension was higher in middle-aged and old patients.

Endovascular Management of Superficial Femoral Artery Occlusion Secondary to Embolization of Celt ACD® Vascular Closure Device.

BACKGROUND This report describes the endovascular management of a Celt ACD® vascular closure device (VCD) lodged in the superficial femoral artery (SFA), 1 year after its deployment. There is a paucity of evidence in the existing literature regarding the management of complications related to embolized VCD discovered months or years after its deployment. CASE REPORT A 70-year-old male patient, who was a heavy smoker, presented with right lower-limb intermittent claudication of 2 months' duration. He underwent a successful left retrograde iliac artery and left SFA angioplasty 1 year ago. The right femoral pulse was normal, whereas the right popliteal pulse was absent. The right ankle-brachial index was 0.64. Doppler ultrasound showed evidence of mid-right SFA occlusion. Angiogram showed an embolized Celt ACD VCD in the right SFA causing segmental occlusion. An endovascular attempt to retrieve the embolized VCD via a snare failed, as the VCD got deeply embedded in the vessel wall. After successful balloon angioplasty, a stent was placed into the SFA with excellent angiographic and clinical outcomes. CONCLUSIONS This case demonstrates the risk of dislodgement of the VCD and its distal embolization with a risk of late ischemia. Endovascular retrieval may be unsuccessful for chronically embolized VCD. Therefore, stent angioplasty is an acceptable option.

Variation in the vertebral levels of the origins of the abdominal aorta branches: a retrospective imaging study.

Our aim was to investigate the variation in the vertebral levels of the origins of the celiac artery, superior and inferior mesenteric arteries, paired renal arteries, and common iliac arteries. We conducted a retrospective imaging study in a large public secondary hospital on a nonrandom sample of 227 participants. We consecutively included adult patients who had undergone computed tomography angiography of the abdomen and excluded patients with a history of any vertebral abnormality or whose images revealed evidence of a vertebral abnormality or a congenital anomaly of any of the branches of the abdominal aorta. The primary outcome was the frequency distribution of the vertebral levels of the landmarks. The secondary outcomes were the intercorrelations of the vertebral levels of the landmarks and their relationships with age, sex, weight, height, and body mass index. The celiac artery originated at T11/T12-L1/L2, followed by the superior mesenteric artery at T12-L2, the paired renal arteries at T12/L1-L2/L3, the inferior mesenteric artery at L2-L4, and the common iliac arteries at L3-L5. The vertebral levels of the landmarks were positively intercorrelated and stronger between proximate pairs. In addition, the vertebral levels of the landmarks were related to age, but not sex, weight, height, or body mass index. The intercorrelations suggest that a considerable proportion of the variation is accounted for by 'trickle-down' variation; variation in the vertebral level of a proximal landmark results in variation in the vertebral level of the immediate distal landmark. The overarching parameter remains unidentified.

Splenic artery tortuosity index on abdominal CT Scan: correlation with age, sex, BMI and abdominal cavity diameters / Índice de tortuosidad de la arteria esplénica en TC abdominal: correlación con la edad, el sexo, el IMC y los diámetros de la cavidad abdominal

Thorough knowledge of splenic artery course and morphology may help clinician to provide better practice. This Study aims at finding out if there was a relationship between splenic artery tortuosity index and age, sex, Body Mass Index (BMI) and abdominal cavity diameters. Routine abdominal Computerized Tomography (CT) scan images were retrospectively analyzed for 219 patients. Splenic artery tortuosity index was calculated. Abdominal cavity diameters were measured. Age, sex, and BMI were recorded. Splenic artery straight length (x) mean was 9.41 cm (SD 1.33). Splenic artery tortuous length mean was 15.15 cm (SD 3.31). Splenic artery tortuosity index mean was 1.63 (SD 0.36). Pearson correlation coefficient for Splenic artery tortuosity index vs. age was: 0.02 (P value 0.80). Splenic artery tortuosity index for females vs. males were 1.70 vs. 1.57 (P value 0.01). Pearson correlation coefficient for Splenic artery tortuosity index vs. BMI was 0.02 (P value 0.75). Pearson correlation coefficient for Splenic artery tortuosity index vs. abdominal cavity diameters were: Anterior-Posterior (AP) diameter -0.01 (P value 0.88) and transverse diameter 0.00 (P value 0.98). There may be a relationship between splenic artery tortuosity and female sex, but not with age, BMI and abdominal cavity diameters (AP and Transverse).

El conocimiento del curso y la morfología de la arteria esplénica puede ayudar al médico a proporcionar un diagnóstico y tratamiento oportuno al paciente. Este estudio tuvo como objetivo determinar si existe una relación entre el índice de tortuosidad de la arteria esplénica y la edad, el sexo, el índice de masa corporal (IMC) y los diámetros de la cavidad abdominal. Se tomaron imágenes retrospectivas, de rutina, de 219 pacientes de tomografía computarizada (TC) abdominal. Se calculó el índice de tortuosidad de la arteria esplénica. Se midieron los diámetros de la cavidad abdominal y se registró la edad, sexo y el IMC. La media de la longitud recta de la arteria esplénica (x) fue de 9,41 cm (DE 1,33). La longitud tortuosa de la arteria esplénica fue de 15,15 cm (DE 3,31). La media del índice de tortuosidad de la arteria esplénica fue de 1,63 (DE 0,36). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica vs. edad fue: 0,02 (valor de P 0,80). El índice de tortuosidad de la arteria esplénica para las mujeres frente a los hombres fue de 1,70 frente a 1,57 (valor de P 0,01). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica versus el IMC fue de 0,02 (valor de P 0,75). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica frente a los diámetros de la cavidad abdominal fue: diámetro anterior-posterior (AP) -0,01 (valor P 0,88) y diámetro transversal 0,00 (valor P 0,98). Puede existir una relación entre la tortuosidad de la arteria esplénica y el sexo femenino, sin embargo no se encontró relación con la edad, el IMC y los diámetros de la cavidad abdominal (AP y transversal).

Medical students' vs. consultant surgeons' view of anatomy knowledge / Opinión de los estudiantes de medicina vs. cirujanos consultores sobre el conocimiento de la anatomía

Anatomy is considered the core of surgery. Surgeons often complain about deficiencies in their junior doctor's level of knowledge in anatomy. The study aim was to compare opinions of final year medical students and consultant surgeons regarding current methods of teaching anatomy and which methods should be utilized to enhance medical student's anatomy knowledge. Two questionnaires were developed: one for consultant surgeons and the other one was for medical students. These questionnaires surveyed consultant surgeons and senior medical students regarding their views on various aspects of undergraduate anatomy teaching including: increasing time for anatomy teaching, anatomy knowledge level, surgeons participation in teaching, best methods of teaching and examination of anatomy, areas of strength and weakness among students, and adequacy of current teaching to understand radiology images, laparoscopic and endoscopic views. The response rate for consultants and students was 62.6 %. Surgeons who encouraged increasing the time for undergraduate anatomy teaching were 77.1 %. A significant percentage of surgeons and students thought that their junior surgeons / student level of anatomical knowledge was poor (63.4 % and 46.6 % respectively). Additionally, over two thirds of surgeons and students thought that surgeons participation in anatomy teaching in the first 3 years in medical schools may be useful (68.0 % and 69.0 % respectively). Cadaveric teaching was selected as best method of anatomy teaching by 81.0 % surgeons and 79.6 % students. Only 33.1 % surgeons and 35.4 % student thought that our current anatomy teaching was adequate to understand radiologic, laparoscopic and endoscopic views. Surgeons and students were in agreement regarding students' reduced levels of anatomy knowledge. One particular aspect of such deprivation was students' inability to interpret radiological pictures, laparoscopic and endoscopic views. Increasing time dedicated for anatomy teaching, involving surgeons in the process of anatomy teaching and redirecting the focus on cadaveric dissection may be beneficial.

La anatomía es considerada la base de la cirugía. Los cirujanos a menudo se quejan de las deficiencias en el nivel de conocimiento anatómico de su médico subalterno. El objetivo del estudio fue comparar las opiniones de los estudiantes de medicina y los cirujanos consultores del último año con respecto a los métodos actuales de enseñanza de anatomía y los métodos que deben utilizarse para mejorar el conocimiento de la disciplina de los estudiantes de medicina. Se desarrollaron dos cuestionarios: uno para cirujanos consultores y otro para estudiantes de medicina. Estos cuestionarios encuestaron a cirujanos consultores y estudiantes de medicina de alto nivel con respecto a sus puntos de vista sobre diversos aspectos de la enseñanza de anatomía de pregrado, que incluyen: aumentar el tiempo para la enseñanza de anatomía, el nivel de conocimiento de anatomía, la participación de los cirujanos en la enseñanza, los mejores métodos de enseñanza y el examen de anatomía, áreas de fortaleza y debilidad entre los estudiantes, y la adecuación de la enseñanza actual para comprender imágenes de radiología, vistas laparoscópicas y endoscópicas. La tasa de respuesta de consultores y estudiantes fue del 62,6 %. Los cirujanos que señalaron aumentar el tiempo para la enseñanza de anatomía de pregrado fue en el 77,1 %. Un porcentaje significativo de cirujanos y estudiantes consideraron que su nivel de conocimiento anatómico entre cirujanos subalternos y estudiantes era bajo (63,4 % y 46,6 %, respectivamente). Además, más de dos tercios de los cirujanos y estudiantes estimaron que la participación de los cirujanos en la enseñanza de anatomía en los primeros 3 años en las escuelas de medicina puede ser útil (68,0 % y 69,0 %, respectivamente). La enseñanza en el cadáver fue seleccionada como el mejor método de enseñanza de anatomía por 81,0 % de cirujanos y 79,6 % de estudiantes. Sólo el 33,1 % de los cirujanos y el 35,4 % de los estudiantes pensaron que nuestra enseñanza actual de anatomía era adecuada para entender las vistas radiológicas, laparoscópicas y endoscópicas. Los cirujanos y los estudiantes estuvieron de acuerdo con respecto a los reducidos niveles de conocimiento anatómico de los estudiantes. Un aspecto particular de tal privación fue la incapacidad de los estudiantes para interpretar imágenes radiológicas, vistas laparoscópicas y endoscópicas. Puede ser beneficioso aumentar el tiempo dedicado a la enseñanza de la anatomía, involucrando a cirujanos en el proceso de enseñanza de la anatomía y redirigiendo el enfoque a la disección del cadáver.

Endovascular Management of May-Thurner Syndrome in a Patient with Left-Sided Superior Vena Cava: A Case Report.

BACKGROUND May-Thurner syndrome (MTS) is a condition characterized by compression of the left common iliac vein (LCFV) between the right common iliac artery (RCIA) and the lumbar vertebrae. This anatomical entrapment typically affects young women and is mostly asymptomatic. High index of suspicion is required in cases of recurrent left-sided deep vein thrombosis (DVT) and severe leg pain. We describe a case of MTS in a young male patient with a left-sided superior vena cava (LSSVC) that was successfully managed by an endovascular approach. To the best of our knowledge, the coexistence of MTS and LSSVC anomaly has not been reported previously. CASE REPORT A 31-year-old man presented with a history of left-sided iliofemoral deep vein thrombosis and disabling venous claudication of 2 years' duration. Duplex ultrasound and computed tomography venogram (CTV) revealed evidence of MTS with chronic subtotal occlusion of the left common iliac vein (LCIV) with extensive venous collaterals. Venogram via the left femoral vein puncture confirmed the aforementioned findings. Retrograde recanalization of the occluded segment was attempted without success. Therefore, an antegrade approach via the right internal jugular vein was performed to facilitate recanalization. Surprisingly, venography revealed an LSSVC. The occluded CIV was successfully stented and the patient had complete resolution of his symptoms at 22-month follow-up. CONCLUSIONS MTS is a potentially treatable and often-overlooked pathology. In the era of expanded endovascular management of MTS, recognition of this coincidence is essential to prevent unwarranted mishaps during endovascular management when the jugular approach is used.

Sonographic assessment of liver and spleen size based on age, height, and weight: evaluation of Jordanian children.

BACKGROUND: The growth of the liver and spleen is a dynamic process in children, and is related to the somatic parameters of the child, and may be affected by many diseases in children. It is of paramount importance to have standard reference values for the size of these organs for diagnostic and prognostic purposes. The aim of our study was to provide practical and reliable normal reference values for the size of the liver and spleen in children and to correlate the values with age, height, and weight. METHODS: Three hundred fifteen children (142 boys and 173 girls) were prospectively examined by ultrasound due to problems unrelated to the liver or spleen. All of the subjects had normal sonographic appearance of their organs. The ages of the subjects ranged from newborns to 14 years. The liver and spleen size was correlated with age, height, and weight. The spleen size was compared with previous internationally published data. RESULTS: There was no statistical significant difference in the size of the liver and spleen between boys and girls (P>0.05). There was steady increase in the size of the liver and spleen, with good correlation with age and all the somatic parameters. The spleen size was in close proximity to those previously reported in the literature. CONCLUSIONS: Standard spleen and liver size reference values were obtained by ultrasound for Jordanian children and were in concordance with international values.