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2.
Am Surg ; 86(2): 146-151, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106908

RESUMO

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4-10 cm). D2: 4.9 ± 0.8 cm (3.5-7 cm). D3: 6.8 ± 0.9 cm (5-9 cm). D4: 6.1 ± 1 cm (4.8-8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Endoscopia/métodos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Músculos Abdominais/anatomia & histologia , Dissecação/métodos , Artérias Epigástricas/anatomia & histologia , Humanos , Masculino , Estudos Prospectivos , Sínfise Pubiana/anatomia & histologia , Telas Cirúrgicas , Artérias Umbilicais/anatomia & histologia , Ducto Deferente/anatomia & histologia
5.
Br J Anaesth ; 124(3): 308-313, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31973825

RESUMO

BACKGROUND: Incomplete peripheral nerve blocks distal to the popliteal region are commonly considered a sciatic and femoral/saphenous nerve block failure. The existence of a much more distal innervation area of the posterior femoral cutaneous nerve (PFCN) as described has not been assumed yet. We therefore investigated the distal termination of the PFCN in the lower leg. METHODS: In 83 human lower extremities embalmed with Theil's method, the course of the PFCN was investigated from the sub-gluteal fold to the most distal macroscopically dissectible branch. The topographic connection to other landmarks, such as the small saphenous vein or small arteries, was investigated. RESULTS: Popliteal ending of the PFCN was found in 9.7% of cases. The PFCN terminated at the proximal or distal lower leg in 45.7% and 44.6% of cases, respectively. The PFCN had a close connection to the Achilles tendon in 13.2% of cases and was found distally to the medial malleolus in one case. The small saphenous vein was close to the PFCN in 90.3% of cases and can therefore be used as a landmark to identify the nerve. In 40.9% of cases, the PFCN was accompanied by a small descending branch of the inferior gluteal artery. In two cases, an innervation of the fibula or calcaneus periosteum was found. CONCLUSIONS: The PFCN has a much more distal termination in the lower leg than previously demonstrated. To ensure complete anaesthesia of the lower leg and foot, the PFCN must be included in combined peripheral nerve block procedures.


Assuntos
Nervo Femoral/anatomia & histologia , Extremidade Inferior/inervação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Sensação , Pele/inervação , Coxa da Perna/inervação
6.
Khirurgiia (Mosk) ; (1): 94-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994507

RESUMO

Nowadays, the issue of splenic flexure mobilization (SFM) in anterior and low anterior rectal resection for rectal cancer is still debatable. This stage is important because dissection results tension-free anastomosis and excision of specimen of enough length with adequate number of harvested lymph nodes. However, literature review confirmed the absence of agreement regarding reduced incidence of colorectal anastomotic leakage and improved long-term oncologic outcomes after SFM. Opinion about selective approach to this procedure is becoming more common. Therefore, randomized trials are necessary to determine a need for routine SFM or indications for selective approach to SFM in anterior rectal resection for rectal cancer.


Assuntos
Colo Transverso/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Colectomia/métodos , Dissecação/métodos , Humanos , Laparoscopia
7.
Eur. j. anat ; 24(1): 37-48, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186063

RESUMO

Paralysis of the facial nerve is a common complication during the surgical removal of parotid gland tumors (parotidectomies). This may be due to the close relationship of the tumor and the facial nerve (along its extracranial course). This study aimed to explore the extracranial course of the facial nerve in terms of branching patterns, bony anatomical landmarks and variations. The sample comprised of 40 facial nerve specimens. The parameters identified and recorded were facial nerve trunk division, branching patterns and variations in terms of connections, course and branching. The parameters were classified and compared according to sex and laterality. Bifurcation of the facial nerve trunk occurred in 90% of cases, whilst trifurcation occurred in only 10%. The cases of trifurcation displayed variations. The frequency of each type of branching pattern was: Type I = 7.5%, Type II = 12.5%, Type III = 25%, Type IV = 15%, Type V = 27.5% and Type VI =12.5%. The six types were further categorized into three subtypes based on the origin of the buccal branch. The distance fromthe facial nerve trunk to bony anatomical landmarks was measured viz. mastoid process, angle of the mandible and external auditory canal. Only the distance to the angle of the mandible displayed significant differences according to sex (p-value < 0.001) and laterality (p- value = 0.002). All three landmarks displayed good-excellent reliability (ICC values ranged from 0.82 to 0.95) with regard to bony anatomical landmarks for the localization of the facial nerve trunk. The present study proposes the use of the three subtypes in conjunction with the classification system. Anatomical knowledge of the extracranial course of the facial nerve and its relation to bony anatomical landmarks are of im-portance to surgeons during procedures such as parotidectomies


No disponible


Assuntos
Humanos , Masculino , Feminino , Nervo Facial/anatomia & histologia , Glândula Parótida/anatomia & histologia , Glândula Parótida/cirurgia , Pontos de Referência Anatômicos/inervação , Cadáver , Processo Mastoide/anatomia & histologia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Dissecação/métodos , Mandíbula/anatomia & histologia
8.
Eur. j. anat ; 24(1): 63-68, ene. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-186066

RESUMO

During a routine female cadaveric dissection, we found an unusual bilateral pelvic branching pattern of the internal and external iliac arteries. The vaginal and middle rectal arteries had a common origin from the right internal pudendal artery. An aberrant obturator artery arises from both external iliac arteries. A right aberrant obturator artery gives a small branch to the back of the pubic bone. The left inferior epigastric artery arises from the common trunk of the external iliac artery with the aberrant obturator artery. Knowledge of arterial variations helps to reduce the internal hemorrhage during abdominal and pelvic surgeries


No disponible


Assuntos
Humanos , Feminino , Artéria Ilíaca/anatomia & histologia , Cadáver , Dissecação/métodos , Variação Anatômica , Artérias/anatomia & histologia , Músculos Psoas/anatomia & histologia , Linfonodos/anatomia & histologia , Nervo Pudendo/anatomia & histologia , Hemorragia
10.
J Surg Oncol ; 121(1): 144-152, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31638275

RESUMO

BACKGROUND AND OBJECTIVES: Development of vascularized submental lymph node (VSLN) flap has encountered dilemmas; (a) whether to include skin paddle, (b) how to reduce the harvest area while gaining most lymph nodes. To answer, these structures were studied; submental perforator, lymph nodes in neck-level I and anterior belly of digastric muscle (ABDM). METHODS: Forty VSLN flaps were harvested from 23 cadavers. The lymph nodes and arterial supply were studied macro- and microscopically. The nodes were classified by arterial supplies, location along the longitudinal axis and relationship with ABDM. RESULTS: VSLN flap had 4.4 lymph nodes by average (range 1-8) predominantly located in the posterior three-quarter of the flap. Half of the submental perforators were originated deep to ABDM. they circumvent the muscle, supplied much of the nodes in neck sublevel Ia before reaching the skin. While sublevel Ib located the most surgically accessible submental nodes. Most of their arterial supply was branched from submental perforator lateral to ABDM, not directly from the submental artery. CONCLUSION: The flap could be reduced to the posterior three-quarter of the original area. Skin paddle should be included to serve as an indirect lymph node monitor. If Ia lymph nodes are to be included, ABDM should be sacrified.


Assuntos
Linfonodos/anatomia & histologia , Linfonodos/irrigação sanguínea , Músculos do Pescoço/anatomia & histologia , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Idoso , Artérias/anatomia & histologia , Cadáver , Dissecação , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/irrigação sanguínea
11.
Urology ; 136: 263-265, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31704457

RESUMO

OBJECTIVE: To find a method of safely inserting a suprapubic catheter (SPC) under local anesthetic and under ultrasound guidance in patients who may not be fit for a general anesthetic but also are seen to have bowel overlying the anterior bladder wall which obscures a safe route to the bladder. MATERIALS AND METHODS: We used ultrasonography to visualize the bladder which was initially filled via the indwelling urethral catheter. A 22-gauge needle attached to a syringe filled with 30 mL of fluid (made up of 10 mL of 1% lidocaine plus 20 mL sterile water) was inserted transabdominally under ultrasound guidance into a space between the pubic symphysis and bowel. The fluid was then injected into the space to hydrodissect the bowel away from the bladder. Once the space had been created, an 18-guage needle was passed into the bladder and a SPC was inserted via the Seldinger technique. RESULTS: Successful SPC insertion was confirmed on ultrasound guidance with no associated bowel or other injury. Telephone follow-up with the patient 6 months later revealed that the patient had no complications and no infections. CONCLUSION: Hydrodissection can be considered when inserting SPC under local anesthetic under ultrasound guidance when there is bowel obscuring any safe route to the bladder. This may be particularly useful in patients who may not be fit for a general an aesthetic.


Assuntos
Cateteres de Demora , Ultrassonografia de Intervenção , Cateterismo Urinário/métodos , Idoso , Dissecação/métodos , Humanos , Masculino , Água/administração & dosagem
12.
Ann Otol Rhinol Laryngol ; 129(2): 101-109, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31522512

RESUMO

OBJECTIVE: To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. METHOD: A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. RESULT: Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. CONCLUSION: Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses.


Assuntos
Dissecação/educação , Internato e Residência/métodos , Laringe/cirurgia , Otolaringologia/educação , Acreditação , Currículo , Humanos , Microcirurgia/educação , Inquéritos e Questionários , Estados Unidos
13.
Braz J Cardiovasc Surg ; 34(6): 667-673, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364343

RESUMO

OBJECTIVE: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). METHODS: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. RESULTS: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. CONCLUSION: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.


Assuntos
Dissecação/métodos , Eletrocoagulação/métodos , Artéria Radial/cirurgia , Coleta de Tecidos e Órgãos/métodos , Procedimentos Cirúrgicos Ultrassônicos/métodos , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Molécula 1 de Adesão Intercelular , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória , Período Pós-Operatório , Artéria Radial/patologia
14.
World Neurosurg ; 135: e562-e566, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863894

RESUMO

BACKGROUND: The need for a better understanding of the subthalamic nucleus (STN)'s vascular anatomy is still evident because revealing its vascular supply may increase insight in the pathogenesis of related disorders, such as STN ischemia. The mechanisms under motor, behavioral, and cognitive changes following deep brain stimulation treatment may also be explained by its pattern of vascularization. The primary goal of this study was to delineate the vascularization of the STN and highlight the predominant perforating arteries supplying its territory. METHODS: Fiber dissections were performed with the modified Klingler technique under 6-40× magnification by preserving all vascular structures. RESULTS: The thalamic and subthalamic regions were dissected from medial to lateral in silicone-injected cadavers. The STN was revealed as a biconvex-shaped structure surrounded by dense inferolateral bundles of myelinated fibers, the zona incerta, bordering the superolateral portion of the red nucleus. The ventral limit of the STN was the substantia nigra, and the internal capsule traversed from its inferior to anterolateral side. The premamillary artery, a large perforator arising from the posterior communicating artery, constantly supplied the STN and was followed proximally along the anterior third ventricular floor toward its origin. The premamillary artery was found to be one of the posterior perforators of the posterior communicating artery in all hemispheres. CONCLUSIONS: The 3-dimensional microsurgical anatomy of the deep-seated STN region is complex, and the additional knowledge on its vascularization should improve our understanding of its surgical anatomy.


Assuntos
Artérias Cerebrais/anatomia & histologia , Núcleo Subtalâmico/irrigação sanguínea , Cadáver , Dissecação/métodos , Humanos , Imagem Tridimensional , Microcirurgia/métodos , Fotografação , Núcleo Subtalâmico/cirurgia
15.
Clin Anat ; 33(1): 128-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606904

RESUMO

Implementing educational activities, such as a wet lab with cadaveric brain dissection, is known to have a direct impact on medical students' motivation. These activities demonstrate the clinical relevance of concepts taught in the classroom setting. The correlation between motivation and academic performance is not clear. First year medical students participated in wet lab activities. The wet lab included cadaveric dissection of the surface and internal anatomy of the brain, as well as discussions facilitated by the neuroscience faculty and clinicians. Discussions were centered around the clinical relevance of the neuroanatomical features dissected during the wet laboratory activities. Following completion of the laboratory activities, students completed a survey, which was used to assess the students' motivation for learning neuroanatomy based on the Attention, Relevance, Confidence, Satisfaction (ARCS) model of motivation. These results were then correlated with performance on a laboratory examination that tested three-dimensional and cross-sectional knowledge of neuroanatomy and practical skills including the use of imaging techniques. The total mean score of motivation was generally high for all categories of ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these results were correlated with students' performance on the lab examination, a positive correlation between students' motivation and lab examination scores was found (R2 = 0.877). Implementation of the neuroanatomy cadaveric dissection lab led to increased student motivation, which was positively correlated with students' academic performance. Clin. Anat. 32:128-135, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Desempenho Acadêmico , Dissecação/educação , Educação de Graduação em Medicina/métodos , Motivação , Neuroanatomia/educação , Encéfalo/anatomia & histologia , Cadáver , Avaliação Educacional , Feminino , Humanos , Masculino , Inquéritos e Questionários
16.
Clin Anat ; 33(1): 146-155, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31625211

RESUMO

A paucity of dissection evidence and quantitative data exists to base anatomical descriptions and illustrations of the fibro-adipose structure of the female breast. The aim of this study was to dissect and provide quantitative data of the fibro-adipose structure of the female breast. The fibro-adipose structure of female embalmed breasts were dissected in the coronal (n = 15) and sagittal planes (n = 3). Quantitative data of breast volume, surface area, fibro-adipose pocket number, size and regional variation were collected. Pearson's correlations were used to investigate pocket number and size with breast volume and surface area. Regional variation in pocket number and size were compared using T tests. Throughout the dissection, photographic evidence was collected to support detailed anatomical descriptions. The mean (SD; range) number of pockets located in the superficial region of the breast was 199 ± 53 (108-306) and the mean pocket surface area was 0.88 ± 0.37 cm2 (0.31-1.97). A strong correlation was found between mean pocket number and breast surface area (r2 = 0.8064) and a very weak correlation between mean individual pocket surface area and breast surface area (r2 = -0.1427; P < 0.01). The pockets located anterior to the corpus mamma were significantly larger and less in number (P < 0.05) than those located posterior. The fibro-adipose structure of the female breast is formed by complex scaffolding, consisting of layers of fibrous tissue pockets embedded with adipose tissue which surrounds the corpus mamma and is firmly attached to the perimeter of the breast. Detailed descriptions are supported by quantitative data and photographic evidence. Clin. Anat. 32:146-155, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Tecido Adiposo/anatomia & histologia , Mama/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação , Feminino , Humanos
17.
Bioelectromagnetics ; 41(1): 63-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31856348

RESUMO

Many neurological disorders are associated with abnormal oscillatory dynamics. The suprachiasmatic nucleus (SCN) is responsible for the timing and synchronization of physiological processes. We performed experiments on PERIOD2::LUCIFERASE transgenic "knock-in" mice. In these mice, a gene that is expressed in a circadian pattern is fused to an inserted gene that codes for luciferase, which is a bioluminescent enzyme. A one-time 3 min magnetic stimulation (MS) was applied to excised slices of the SCN. The MS consisted of a 50-mT field that was turned on and off 4,500 times. The rise time and fall time of the field were 75 µs. A photon count that extended over the full 5 days that the slice remained viable, subsequently revealed how the MS affected the circadian cycle. The MS was applied at points in the circadian cycle that correspond to either maximal or minimal bioluminescence. It was found that both the amplitude and period of the endogenous circadian oscillation are affected by MS and that the effects strongly depend on where in the circadian cycle the stimulation was applied. Our MS dose is in the same range as clinically applied doses, and our findings imply that transcranial MS may be instrumental in remedying disorders that originate in circadian rhythm abnormalities. Bioelectromagnetics. 2020;41:63-72 © 2019 Wiley Periodicals, Inc.


Assuntos
Fenômenos Magnéticos , Núcleo Supraquiasmático/efeitos da radiação , Animais , Relógios Biológicos/efeitos da radiação , Encéfalo , Dissecação , Corantes Fluorescentes/metabolismo , Luciferases/metabolismo , Medições Luminescentes , Camundongos Transgênicos , Fatores de Tempo
18.
Surg Technol Int ; 35: 201-213, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31694060

RESUMO

When Jacques and Pierre Curie first researched ultrasonic energy and piezoelectric effects in the 1880s, they likely had no idea of the profound impact it would eventually have on surgical patients. Today in operating rooms around the world, ultrasonic energy is used for tissue manipulation, dissection, cutting, and coagulation. Surgeons including but not limited to the specialties of gynecology, general surgery, colorectal, thoracic, breast, and bariatric have activated ultrasonic energy in thousands of patients. As a mainstay surgical energy device, patients have benefited from the ultrasonic versatility of its cutting and coagulating effects. The ability of ultrasonic energy to be used near vital organs with precision by adjusting for tissue tension, power settings, and activation time has accounted for its safety and clinical outcomes. This overview of the mechanics of ultrasonic energy and the evolution of the HARMONIC® (UltraCision, Providence, Rhode Island, now owned by Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) surgical tools since 1988 provides readers an understanding of this energy platform and its distinct advantages. Clinical implications of key research and clinical studies are explored and discussed with a focus on patient and surgical outcomes. Research in a variety of fields and tissues is presented with a special emphasis on the gynecological patient.


Assuntos
Instrumentos Cirúrgicos , Dissecação , Humanos , Terapia por Ultrassom
20.
Curr Sports Med Rep ; 18(11): 416-420, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702723

RESUMO

Hamstring muscle injuries (HMI) are common among athletes. HMI can take many months to years to resolve. Often, athletes do not report complete resolution with typical conservative therapy. We present several cases of athletes who presented with chronic hamstring injuries that resolved immediately after being treated with an ultrasound-guided fascial hydrodissection procedure. Following the procedure and graded rehabilitation protocol, athletes reported resolution of pain and tightness in addition to increased performance and a quicker return to play.


Assuntos
Traumatismos em Atletas/cirurgia , Dissecação/métodos , Músculos Isquiotibiais/lesões , Traumatismos da Perna/cirurgia , Lesões dos Tecidos Moles/cirurgia , Adolescente , Adulto , Atletas , Feminino , Humanos , Masculino , Ultrassonografia
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