Operative treatment of athletic pubalgia in competitive athletes: a retrospective study.

BACKGROUND: Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15 year study reports outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. METHODS: All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients' satisfaction were evaluated. RESULTS: A total of 130 patients (115; 88.5% males and 15; 11.5% females) with a mean age of 26.7±7.5 years were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7±1.7. Three days postoperatively, the mean numeric pain scale was 3.4±1.5, showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27±3.02 weeks. Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up (mean 76.58±46.5 months), a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and two (1.5%) not satisfied with the outcome. CONCLUSIONS: Laparoscopic operative treatment in competitive athletes suffering from athletic pubalgia seems to offer rapid recovery, rapid return to sports, as well as very low complications rate and no recurrence.

Andreas Vesalius of Brussels (1514-1564): his contribution to the field of functional neuroanatomy and the criticism to his predecessors.

Until the fifteenth century, the knowledge about anatomy and function of the nervous system had been significantly influenced by theological notions. Andreas Vesalius of Brussels (1514-1564), based on human cadavers' dissections, criticized his predecessors and contributed to the construction of the current knowledge about functional neuroanatomy. Although he did not avoid mistakes, he successfully demonstrated the high value of human cadavers' dissection in anatomical teaching.

The role of augmented reality in Anatomical education: An overview.

BACKGROUND: The outcomes of the implementation of augmented reality (AR) in anatomical education have not been reviewed so far. We performed a narrative review of the literature concerning these outcomes. METHODS: We searched in the databases PubMed, Scopus, Cochrane, ERIC, CINAHL plus and Web of Science for papers with the aim to explore the outcomes of the implementation of AR in anatomical education. From each paper, we extracted the following data: authors, year of publication, type of study (comparative or not), number of participants, level of outcome according to Kirkpatrick hierarchy, acceptability of AR, impact on examinations performance, ability to facilitate understanding of spatial organization of structures and to motivate students to learn anatomy. RESULTS: Seven papers were eligible for analysis. There were five comparative and two non-comparative studies. Three studies evaluated only students' perceptions about AR, while four papers assessed their examinations performance after the application of AR. Generally, AR was proved a highly acceptable and enjoyable anatomy teaching tool. It had remarkable efficacy in terms of helping students understand three-dimensional organization of structures and achieve satisfactory examinations results. CONCLUSIONS: Although the research concerning the implementation of AR in anatomical education is relatively limited, there are promising results regarding the teaching potential of AR. These results could encourage anatomy educators to include this tool in their teaching methods. Randomized controlled studies are needed to prove if AR could effectively replace or supplement other anatomy pedagogy methods.

Outcomes of the use of plastination in anatomy education: current evidence.

PURPOSE: We aimed to evaluate the quantity and quality of current evidence concerning the outcomes of use of plastinated specimens in anatomy education. METHODS: We performed a narrative literature review, searching for papers dealing with the use of plastination in anatomy education. PubMed, Scopus, ERIC, Cochrane, Web of Science and CINAHL complete electronic databases were searched. The following data were extracted: author(s), year of publication, type of study (comparative or not), number of participants, evaluation of statistical significance, educational outcomes and their level according to Kirkpatrick hierarchy. RESULTS: Six studies were eligible for analysis. Five of them evaluated only students' reactions about plastination and one study also assessed their examinations results. There were four non-comparative and two comparative studies. Only a study evaluated statistical significance (p < 0.05) with higher score of perception in 2nd year undergraduate medical students, who were more familiar with plastination in comparison to 1st year students. Although the use of plastination was accompanied by positive outcomes in the majority of studies (five out of six), this method was not proved superior to traditional cadavers dissection. CONCLUSIONS: The existing evidence about the outcomes of the use of plastination in anatomy education is relatively limited and lacks comparative studies with statistical significant results. Positive students' reactions were generally noted, but further research is needed to clarify if plastination could be of benefit to students' attitude and anatomy knowledge.

Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications.

Anatomy of ophthalmic artery has been thoroughly studied and reviewed in many anatomical and surgical textbooks and papers. Issues of interest are its intracranial and extracranial course, its branches, its importance for vision, and its interaction with various intracranial pathologies. Improvement of our understanding about pathophysiology of certain diseases like aneurysm formation, central retinal artery occlusion, and retinoblastoma and also invention of new therapeutic modalities like superselective catheterization, intra-arterial fibrinolysis, and intra-arterial chemotherapy necessitate a reappraisal of its anatomy from a clinical point of view. The aim of this review is to examine clinical anatomy of ophthalmic artery and correlate it with new diagnostic and therapeutic applications.

Use of Lateral Calcaneal Flap for Coverage of Hindfoot Defects: An Anatomical Appraisal.

Lateral calcaneal flap is an established surgical option for coverage of lateral calcaneum and posterior heel defects. Lateral calcaneal flap vascularization and innervations are based on lateral calcaneal artery neurovascular bundle, that is, lateral calcaneal artery, small saphenous vein, and sural nerve. Anatomical research has allowed exploration of its many advantages but can also lead to its various modifications, permitting a wide variety of clinical applications. In this paper the authors report an anatomical and clinical study on lateral calcaneal artery course and lateral calcaneal flap clinical applications. Anatomic part of our study focused on lateral calcaneal artery course and optimization of surgical technique for flap harvesting. Data were used for design of lateral calcaneal flap in 5 patients. Our results were satisfactory in terms of coverage adequacy, perioperative morbidity, and functional and aesthetical outcome.

Primary and Secondary Prevention of Acute Coronary Syndromes: The Role of the Statins.

Poor prognosis is strongly associated with Acute Coronary Syndrome (ACS) and, even though a number of treatment strategies are available, the incidence of subsequent serious complications after an acute event is still high. Statins are hypolipidemic factors and recent studies have demonstrated that they have a protective role during the process of atherogenesis and that they reduce mortality caused by cardiovascular diseases. This review tries to reveal the function of the statins as a component of the primary and secondary action of acute coronary syndrome and to describe the lifestyle changes that have the same effect as the use of statins.

The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice.

The postsynaptic fibers of the pterygopalatine or sphenopalatine ganglion (PPG or SPG) supply the lacrimal and nasal glands. The PPG appears to play an important role in various pain syndromes including headaches, trigeminal and sphenopalatine neuralgia, atypical facial pain, muscle pain, vasomotor rhinitis, eye disorders, and herpes infection. Clinical trials have shown that these pain disorders can be managed effectively with sphenopalatine ganglion blockade (SPGB). In addition, regional anesthesia of the distribution area of the SPG sensory fibers for nasal and dental surgery can be provided by SPGB via a transnasal, transoral, or lateral infratemporal approach. To arouse the interest of the modern-day clinicians in the use of the SPGB, the advantages, disadvantages, and modifications of the available methods for blockade are discussed.▪

A comparison of the i-gel and classic LMA insertion in manikins by experienced and novice physicians.

OBJECTIVE: Airway management is of utmost importance in critical patients, for whom endotracheal intubation remains the gold standard. However, it is a difficult skill to acquire and success rates in novices are unacceptably low. Supraglottic devices constitute promising alternatives. The aim of this study was to assess the use of laryngeal mask airway (LMA) classic LMA (cLMA) and a relatively new supraglottic device, the i-gel, in experienced and novice doctors in a manikin setting. METHODS: The study population comprised 116 doctors. After a brief educational session and presentation of cLMA and i-gel, participants were randomly allocated to insert both devices in an adult manikin. Insertions were performed using a size-4 cLMA and a size-4 i-gel. The primary endpoints were the success rate for each device and the duration of the insertion attempt. Secondary endpoint was the perception of ease of use with each device. RESULTS: First attempt success rate was 90.5% for i-gel and 63.8% for cLMA (P<0.001). I-gel use reduced insertion times (13.32±4.99 s vs. 17.99±6.87 s, P<0.001) and was related with significantly higher first attempt success rates than cLMA in novices (90 vs. 48.3%, P<0.001). In addition, i-gel use provided almost equal success rates for experienced and novice doctors (91 vs. 90%, P=not significant), whereas cLMA use resulted in significantly lower success rates for novices (48.3 vs. 80.4%, P<0.001). CONCLUSION: In this manikin setting i-gel significantly improved success rates and insertion time compared with cLMA. Most importantly, i-gel use resulted in high first pass success rates for novice doctors, equal to those achieved by experienced doctors.

Cardiac arrest in Greek primary health care and willingness of general practitioners to use automatic external defibrillator.

AIM: The aim of this study was to calculate the incidence of out-of-hospital cardiac arrest (OHCA) in primary health care in Greece and assess general practitioners' (GPs) willingness towards the use of automatic external defibrillator (AED). METHODS: We conducted a survey in GPs working in both private and public sectors. The survey consisted of 32 questions and was distributed via email in 180 randomly selected GPs. To estimate OHCA incidence, data concerning the number of examined patients and the number of cardiac arrests were used. RESULTS: Based on the population of our study, the incidence of OHCA in primary health care in Greece is 15.3/100,000 population per year. Most of the arrests occur in health centers, while ventricular fibrillation/ventricular tachycardia are the first monitored rhythms. Almost all GPs were willing to use an AED even though some of them did not know how to use it. CONCLUSIONS: The incidence of OHCA in primary health care in Greece is 15.3/100,000 population per year. Greek GPs may have an important role in managing OHCA victims and are willing to use an AED. This is the first study estimating OHCA in primary health care in Greece.

Glidescope(®) videolaryngoscope improves intubation success rate in cardiac arrest scenarios without chest compressions interruption: a randomized cross-over manikin study.

AIM: The aim of this study was to assess the performance of the Glidescope(®) in a manikin cardiopulmonary resuscitation (CPR) scenario. METHODS: Following a brief didactic session, 45 volunteer doctors inexperienced with airway management, attempted to intubate a manikin using a Macintosh laryngoscope and Glidescope(®) with uninterrupted and without chest compressions. Primary endpoints were intubation times and success rate with each device. Dental compression and level of self-confidence in using each device were also assessed. RESULTS: In the scenario without chest compressions the cumulative success rate related to time to intubation was significantly higher with the Macintosh blade than with the Glidescope(®) (p<0.001). On the contrary, in the scenario with continuous chest compressions, the cumulative rate related to time to intubation was significantly higher with the Glidescope(®) (p=0.035). Significantly fewer attempts were required for the first successful intubation with the Macintosh blade in the non-CPR scenario versus the CPR scenario (p=0.007). Moreover, the number of attempts for the first successful intubation was significantly lower for the Glidescope(®) in the non-CPR (p=0.001) and the CPR scenario (p<0.001). Dental compression was significantly lower with the Glidescope(®) in both scenarios (p<0.001). CONCLUSIONS: Using the GlideScope(®) in a manikin CPR scenario provides extremely high intubation success rates in short times with the first attempt, in medical practitioners inexperienced in intubation.

Amyand's hernia: a case report.

The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand's hernia. We report an Amyand's hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety two years.