Science.gov

Sample records for mysterium ligamentum alare

  1. Alar

    Integrated Risk Information System (IRIS)

    Alar ; CASRN 1596 - 84 - 5 Human health assessment information on a chemical substance is included in the IRIS database only after a comprehensive review of toxicity data , as outlined in the IRIS assessment development process . Sections I ( Health Hazard Assessments for Noncarcinogenic Effects ) a

  2. "mysterium Cosmographicum", for Orchestra, Narrator/actor, and Computer Music on Tape. (with Original Composition)

    NASA Astrophysics Data System (ADS)

    Keefe, Robert Michael

    Mysterium Cosmographicum is a musical chronicle of an astronomy treatise by the German astronomer Johannes Kepler (1571-1630). Kepler's Mysterium Cosmographicum (Tubingen, 1596), or "Secret of the Universe," was a means by which he justified the existence of the six planets discovered during his lifetime. Kepler, through flawless a priori reasoning, goes to great lengths to explain that the reason there are six and only six planets (Mercury, Venus, Earth, Mars, Jupiter, and Saturn) is because God had placed one of the five regular solids (tetrahedron, cube, octa-, dodeca-, and icosahedron) around each orbiting body. Needless to say, the publication was not very successful, nor did it gain much comment from Kepler's peers, Galileo Galilei (1564-1642) and Tycho Brahe (1546-1601). But hidden within the Mysterium Cosmographicum, almost like a new planet waiting to be discovered, is one of Kepler's three laws of planetary motion, a law that held true for planets discovered long after Kepler's lifetime. Mysterium Cosmographicum is a monologue with music in three parts for orchestra, narrator/actor, and computer music on tape. All musical data structures are generated via an interactive Pascal computer program that computes latitudinal and longitudinal coordinates for each of the nine planets as seen from a fixed point on Earth for any given time frame. These coordinates are then mapped onto selected musical parameters as determined by the composer. Whenever Kepler reads from his treatise or from a lecture or correspondence, the monologue is supported by orchestral planetary data generated from the exact place, date, and time of the treatise, lecture, or correspondence. To the best of my knowledge, Mysterium Cosmographicum is the first composition ever written that employs planetary data as a supporting chronology to action and monologue.

  3. Ligamentum flavum hematoma in the lumbar spine.

    PubMed

    Yamaguchi, Satoshi; Hida, Kazutoshi; Akino, Minoru; Seki, Toshitaka; Yano, Shunsuke; Iwasaki, Yoshinobu

    2005-05-01

    A 62-year-old male presented with a rare case of ligamentum flavum hematoma manifesting as low back pain and gait difficulty beginning 1 month before consulting our institute. He had no history of lumbar spine surgery or lumbar puncture. However, he might have suffered forgotten back injury while practicing martial arts. Magnetic resonance imaging showed a heterogeneous intensity mass lesion with a cystic component at the L3-4 levels. The lesion was totally removed through a hemilaminectomy. Intraoperative and histological findings confirmed the diagnosis of old hematoma with granulomatous change in the ligamentum flavum. Postoperatively, his low back pain and gait difficulty resolved within a few days. PMID:15914970

  4. The Articulated Alar Rim Graft: Reengineering the Conventional Alar Rim Graft for Improved Contour and Support.

    PubMed

    Ballin, Annelyse C; Kim, Haena; Chance, Elizabeth; Davis, Richard E

    2016-08-01

    Surgical refinement of the wide nasal tip is challenging. Achieving an attractive, slender, and functional tip complex without destabilizing the lower nasal sidewall or deforming the contracture-prone alar rim is a formidable task. Excisional refinement techniques that rely upon incremental weakening of wide lower lateral cartilages (LLC) often destabilize the tip complex and distort tip contour. Initial destabilization of the LLC is usually further exacerbated by "shrink-wrap" contracture, which often leads to progressive cephalic retraction of the alar margin. The result is a misshapen tip complex accentuated by a conspicuous and highly objectionable nostril deformity that is often very difficult to treat. The "articulated" alar rim graft (AARG) is a modification of the conventional rim graft that improves treatment of secondary alar rim deformities, including postsurgical alar retraction (PSAR). Unlike the conventional alar rim graft, the AARG is sutured to the underlying tip complex to provide direct stationary support to the alar margin, thereby enhancing graft efficacy. When used in conjunction with a well-designed septal extension graft (SEG) to stabilize the central tip complex, lateral crural tensioning (LCT) to tighten the lower nasal sidewalls and minimize soft-tissue laxity, and lysis of scar adhesions to unfurl the retracted and scarred nasal lining, the AARG can eliminate PSAR in a majority of patients. The AARG is also highly effective for prophylaxis against alar retraction and in the treatment of most other contour abnormalities involving the alar margin. Moreover, the AARG requires comparatively little graft material, and complications are rare. We present a retrospective series of 47 consecutive patients treated with the triad of AARG, SEG, and LCT for prophylaxis and/or treatment of alar rim deformities. Outcomes were favorable in nearly all patients, and no complications were observed. We conclude the AARG is a simple and effective method for

  5. The ligamentum teres—its increasing importance

    PubMed Central

    O'Donnell, John M.; Pritchard, Michael; Salas, Antonio Porthos; Singh, Parminder J.

    2014-01-01

    The ligamentum teres (LT) has attracted much greater interest over recent years due to the increased use of hip arthroscopy. There have been advancements in our understanding of the LT’s biomechanical function and its role in hip and groin pain. Our ability to suspect LT tears by clinical examination and imaging has improved. Publications by many authors concerning LT tear treatment and outcomes continue to increase. This manuscript is a review of the function, mechanism of injury, clinical assessment, imaging, arthroscopic assessment, treatment, outcomes, reconstruction, and unusual conditions of the LT. PMID:27011796

  6. Microsurgical excision of hematoma of the lumbar ligamentum flavum.

    PubMed

    Takeno, Kenichi; Kobayashi, Shigeru; Miyazaki, Tsuyoshi; Yayama, Takafumi; Baba, Hisatoshi

    2010-07-01

    Hematoma of the lumbar ligamentum flavum is a very rare cause of sciatica. A 72-year-old man presented with left-sided sciatica and paresthesia of the lateral aspect of his left foot. From CT and MRI findings, he was diagnosed as having a hematoma embedded in the ligamentum flavum, which compressed the dura mater at the L5/S1 disc level. After an adequate surgical field was obtained with a microscope and a Casper retractor, the hematoma of the ligamentum flavum could be excised via a unilateral approach and satisfactory decompression of the cauda equina and nerve roots were obtained. PMID:20537575

  7. Isolated unilateral rupture of the alar ligament.

    PubMed

    Wong, Sui-To; Ernest, Kimberly; Fan, Grace; Zovickian, John; Pang, Dachling

    2014-05-01

    Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment. PMID:24679079

  8. Alar base reduction: the boomerang-shaped excision.

    PubMed

    Foda, Hossam M T

    2011-04-01

    A boomerang-shaped alar base excision is described to narrow the nasal base and correct the excessive alar flare. The boomerang excision combined the external alar wedge resection with an internal vestibular floor excision. The internal excision was inclined 30 to 45 degrees laterally to form the inner limb of the boomerang. The study included 46 patients presenting with wide nasal base and excessive alar flaring. All cases were followed for a mean period of 18 months (range, 8 to 36 months). The laterally oriented vestibular floor excision allowed for maximum preservation of the natural curvature of the alar rim where it meets the nostril floor and upon its closure resulted in a considerable medialization of alar lobule, which significantly reduced the amount of alar flare and the amount of external alar excision needed. This external alar excision measured, on average, 3.8 mm (range, 2 to 8 mm), which is significantly less than that needed when a standard vertical internal excision was used ( P < 0.0001). Such conservative external excisions eliminated the risk of obliterating the natural alar-facial crease, which did not occur in any of our cases. No cases of postoperative bleeding, infection, or vestibular stenosis were encountered. Keloid or hypertrophic scar formation was not encountered; however, dermabrasion of the scars was needed in three (6.5%) cases to eliminate apparent suture track marks. The boomerang alar base excision proved to be a safe and effective technique for narrowing the nasal base and elimination of the excessive flaring and resulted in a natural, well-proportioned nasal base with no obvious scarring. PMID:21404164

  9. Alar and Apples: Newspaper Coverage of a Major Risk Issue.

    ERIC Educational Resources Information Center

    Friedman, Sharon M.; And Others

    A study reviewed coverage in 13 newspapers during 1989 of the issue of spraying the pesticide Alar on apples. Using VU/TEXT, a newspaper database, 297 articles in 13 newspapers that included the specified code words "Alar" with or without "apple" or "apples" were retrieved and analyzed using a 33-question coding instrument which recorded general…

  10. The Seesaw Technique for Correction of Vertical Alar Discrepancy.

    PubMed

    Hyun, Sang Min; Medikeri, Gaurav Shankar; Jung, Dong-Hak

    2015-09-01

    Alar vertical discrepancy including alar base has been viewed as one of the most challenging reconstructive problems in rhinoplasty. The authors have created a simple technique that consistently gives aesthetically acceptable results. The authors have designed the seesaw technique to correct alar discrepancy (type 1 to 3). Type 1 has been used in 14 patients, type 2 has been used in three patients, and type 3 has been used in seven patients. Alar discrepancy was corrected satisfactorily in all cases, with good cosmetic outcome. One case required scar revision and another case required revision for overcorrection; satisfactory results were ultimately achieved in both cases. This new technique is quite easy to design and is effective in the correction of alar discrepancy. It yields good postoperative results along with satisfactory aesthetic outcomes. PMID:26313821

  11. Structural Properties of the Native Ligamentum Teres

    PubMed Central

    Philippon, Marc J.; Rasmussen, Matthew T.; Turnbull, Travis Lee; Trindade, Christiano A.C.; Hamming, Mark G.; Ellman, Michael B.; Harris, Matthew; LaPrade, Robert F.; Wijdicks, Coen A.

    2014-01-01

    Background: A majority of studies investigating the role of the ligamentum teres (LT) have focused primarily on anatomical and histological descriptions. To date, however, the structural properties of the LT have yet to be fully elucidated. Purpose: To investigate the structural properties of the native LT in a human cadaveric model. Study Design: Descriptive laboratory study. Methods: A total of 12 human cadaveric hemipelvises (mean age, 53.6 years; range, 34-63 years) were dissected free of all extra-articular soft tissues to isolate the LT and its acetabular and femoral attachments. A dynamic tensile testing machine distracted each femur in line with the fibers of the LT at a displacement-controlled rate of 0.5 mm/s. The anatomic dimensions, structural properties, and modes of failure were recorded. Results: The LT achieved a mean yield load of 75 N and ultimate failure load of 204 N. The LT had mean lengths of 38.0 and 53.0 mm at its yield and failure points, respectively. The most common (75% of specimens) mechanism of failure was tearing at the fovea capitis. On average, the LT had a linear stiffness of 16 N/mm and elastic modulus of 9.24 MPa. The mean initial length and cross-sectional area were 32 mm and 59 mm2, respectively. Conclusion: The human LT had a mean ultimate failure load of 204 N. Therefore, the results of this investigation, combined with recent biomechanical and outcomes studies, suggest that special consideration should be given to preserving the structural and corresponding biomechanical integrity of the LT during surgical intervention. Clinical Relevance: The LT may be more important as a static stabilizer of the hip joint than previously recognized. Further studies are recommended to investigate the appropriate indications to perform surgical repair or reconstruction of the LT for preservation of hip stability and function. PMID:26535290

  12. Ossified Ligamentum Longitudinale Anterius in Adult Human Dry Vertebrae

    PubMed Central

    Venumadhav, Nelluri; KS, Siddaraju

    2014-01-01

    Background: The ligamentum longitudinale anterius is a broad and strong band of fibrous tissue that runs along the anterior surfaces of the bodies of the vertebrae. Aim: The study was undertaken to evaluate the incidence of ossified ligamentum longitudinale anterius in adult dry human vertebra. Materials and Methods: This study was carried out on 95 sets of dry human vertebral columns irrespective of age and sex at Mayo Institute of Medical Sciences- Barabanki,-UP, Melaka Manipal Medical College-Manipal University and Department of Anatomy, KMCT Medical College, Manassery- Calicut, India. All the sets of vertebral columns were macroscopically inspected for the ossified ligamentum longitudinale anterius. Results: It was observed that out of 95 sets of vertebral columns, 27 (28.42%) vertebral columns showed ossification. Out of 27 vertebral columns, 17 (17.89%) vertebral columns showed segmental type of ossification, 2 (2.11%) vertebral columns showed continuous type of ossification and 8 (8.42%) vertebral columns showed mixed type of ossification at different vertebral level. Conclusion: Such type of ossification will affect the biomechanics of the spine and may result in stiff neck, low back pain, dysphagia, odynophagia, compression of the brachial plexus, aphonia, immobility or mucosal thickening of larynx. Hence, knowledge of such abnormalities should be kept in mind to minimise serious complications in any surgical intervention or investigative procedures in the region. PMID:25302180

  13. Spontaneous haematoma of ligamentum flavum. Case report and literature review.

    PubMed

    Albanese, A; Braconi, A; Anile, C; Mannino, S; Sabatino, G; Mangiola, A

    2006-06-01

    Spontaneous infarction of the ligamentum flavum is a very rare cause of mielo-radicular compression. In the literature only four cases are reported, all characterized by a clinical history of slowly progressive mielo-radiculopathy and good outcome after surgical treatment. A 70 year-old female patient presented with a four months clinical history of spontaneous, sub-continuous, progressive lumbar pain with bilateral irradiation to the L4-L5 dermatomers, right leg monoparesis and hypoaesthesia affecting tactile, thermal and pain sensivity, urinary incontinence and constipation. CT scan and MRI evidenced an extradural ovalar lesion in correspondence of the L1-L2 levels, that exerted compression over the dural sac, dislocating it anteriorly. The patient underwent a L1-L2 laminectomy and the lesion was totally resected. Rapid improvement of the patient's symptomatology has been noticed in the postoperative period, with complete recovery during the following month. Histologic examinations demonstrated that the mass was a haematoma of the ligamentum flavum. It's our opinion, that a picture of ligamentum flavum haematoma should be taken into account in differential diagnosis of posterior mielo-radicular compression. The progressive growth of the haematoma may explain the long clinical history of these patients and surgical treatment, even if delayed, permits an excel-lent clinical outcome. PMID:16841030

  14. Correction of Alar Retraction Based on Frontal Classification.

    PubMed

    Kim, Jae Hoon; Song, Jin Woo; Park, Sung Wan; Bartlett, Erica; Nguyen, Anh H

    2015-11-01

    Among the various types of alar deformations in Asians, alar retraction not only has the highest occurrence rate, but is also very complicated to treat because the ala is supported only by cartilage and its soft tissue envelope cannot be easily stretched. As patients' knowledge of aesthetic procedures is becoming more extensive due to increased information dissemination through various media, doctors must give more accurate, logical explanations of the procedures to be performed and their anticipated results, with an emphasis on relevant anatomical features, accurate diagnoses, detailed classifications, and various appropriate methods of surgery. PMID:26648808

  15. Acute traumatic cord injury associated with ossified ligamentum flavum.

    PubMed

    Kow, Chien Yew; Chan, Patrick; Etherington, Greg; Rosenfeld, Jeffrey V

    2016-08-01

    Ossification of the ligamentum flavum (OLF) is an uncommon condition, which usually occurs amongst people of Asian descent, and most commonly in the thoracic spine region. Whilst often asymptomatic, OLF can cause spinal canal stenosis, with patients presenting with back pain, posterior cord syndrome or myelopathy. We present a rare case of acute spinal cord injury associated with OLF after a kite surfing accident, with the resulting paraplegia partially improved after decompression was performed. The prevalence, presentation and management of OLF are also discussed. PMID:27052256

  16. Progressive relapse of ligamentum flavum ossification following decompressive surgery.

    PubMed

    Ando, Kei; Imagama, Shiro; Ito, Zenya; Kobayashi, Kazuyoshi; Ukai, Junichi; Muramoto, Akio; Shinjo, Ryuichi; Matsumoto, Tomohiro; Nakashima, Hiroaki; Ishiguro, Naoki

    2014-12-01

    Thoracic ossification of the ligamentum flavum (T-OLF) is a relatively rare spinal disorder that generally requires surgical intervention, due to its progressive nature and the poor response to conservative therapy. The prevalence of OLF has been reported at 3.8%-26%, which is similar to that of cervical ossification of the posterior longitudinal ligament (OPLL). The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up. However, there have been no reports on the progression of OLF following surgery. We report a case of thoracic myelopathy secondary to the progressive relapse of OLF following laminectomy. PMID:25558329

  17. Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement

    PubMed Central

    Ghent, Finn; Davidson, Trent; Mobbs, Ralph Jasper

    2014-01-01

    Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent uncomplicated microscope assisted decompression with excellent results. The demographics, presentation, aetiology, and management of juxtafacet cysts are discussed. PMID:25580330

  18. Ligamentum Flavum Hypertrophy in Asymptomatic and Chronic Low Back Pain Subjects

    PubMed Central

    2015-01-01

    Purpose To examine ligamentum flavum thickness using magnetic resonance (MR) images to evaluate its association with low back pain symptoms, age, gender, lumbar level, and disc characteristics. Materials and Methods Sixty-three individuals were part of this IRB-approved study: twenty-seven with chronic low back pain, and thirty-six as asymptomatic. All patients underwent MR imaging and computed tomography (CT) of the lumbar spine. The MR images at the mid-disc level were captured and enlarged 800% using a bilinear interpolation size conversion algorithm that allowed for enhanced image quality. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Disc height at each level was measured by the least-distance measurement method in three-dimensional models created by CT images taken of the same subject. Analysis of variance and t-tests were carried out to evaluate the relationship between ligamentum flavum thickness and patient variables. Results Ligamentum flavum thickness was found to significantly increase with older age, lower lumbar level, and chronic low back pain (p < 0.03). No difference in ligamentum flavum thickness was observed between right and left sided measurements, or between male and female subjects. Disc height and both ligamentum flavum thickness measurements showed low to moderate correlations that reached significance (p < 0.01). Additionally, a moderate and significant correlation between disc degeneration grade and ligamentum flavum thickness does exist (p <0.001). Conclusion By measuring ligamentum flavum thickness on MR images at two different sites and comparing degrees of disc degeneration, we found that ligamentum flavum thickness may be closely related to the pathogenesis of pain processes in the spine. PMID:26010138

  19. Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report.

    PubMed

    Gazzeri, Roberto; Galarza, Marcelo; Gorgoglione, Leonardo; Bisceglia, Michele; D'Angelo, Vincenzo

    2005-10-01

    A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient's myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation. PMID:15981000

  20. Dose-dependent regulation of cell proliferation and collagen degradation by estradiol on ligamentum flavum

    PubMed Central

    2014-01-01

    Background Estradiol plays an important role in the regulation of collagen metabolism. Deficiency of estradiol has been reported to be associated with the degeneration of many connective tissues. However, the association of estradiol and hypertrophy of the ligamentum flavum was seldom explored. Therefore, we studied the effects of estradiol on cultured cells from the ligamentum flavum. Methods Primary cultures of human ligamentum flavum cells obtained from surgical specimens of 14 patients undergoing spinal surgery were used to investigate the effect of estradiol on cell proliferation and the expression of collagen, elastin, and matrix metalloproteinases. Downstream pathways of estrogen receptor underlying the regulation of metalloproteinases were also investigated. Results In our study, we revealed the existence of estrogen receptors on both female and male ligamentum flavum cells with a gender difference. 17β-estradiol increased early (24 hours) proliferation of ligamentum flavum cells in a dose dependent manner and the effect could not be seen when the cell density increased. Estradiol with a concentration of 10-9 M decreased collagen levels and increased the expression of MMP-13. Adding an antagonist of PI3K downstream pathway could reverse the expression of MMP-13 caused by estradiol. Conclusions The results implied estradiol regulated the expression of MMP-13 via PI3K pathway and contributed to the homeostasis of extracellular matrix in the ligamentum flavum. PMID:25022571

  1. Tissue transglutaminase is involved in mechanical load-induced osteogenic differentiation of human ligamentum flavum cells.

    PubMed

    Chao, Yuan-Hung; Huang, Shih-Yung; Yang, Ruei-Cheng; Sun, Jui-Sheng

    2016-07-01

    Mechanical load-induced osteogenic differentiation might be the key cellular event in the calcification and ossification of ligamentum flavum. The aim of this study was to investigate the influence of tissue transglutaminase (TGM2) on mechanical load-induced osteogenesis of ligamentum flavum cells. Human ligamentum flavum cells were obtained from 12 patients undergoing lumbar spine surgery. Osteogenic phenotypes of ligamentum flavum cells, such as alkaline phosphatase (ALP), Alizarin red-S stain, and gene expression of osteogenic makers were evaluated following the administration of mechanical load and BMP-2 treatment. The expression of TGM2 was evaluated by real-time PCR, Western blotting, and enzyme-linked immunosorbent assay (ELISA) analysis. Our results showed that mechanical load in combination with BMP-2 enhanced calcium deposition and ALP activity. Mechanical load significantly increased ALP and OC gene expression on day 3, whereas BMP-2 significantly increased ALP, OPN, and Runx2 on day 7. Mechanical load significantly induced TGM2 gene expression and enzyme activity in human ligamentum flavum cells. Exogenous TGM2 increased ALP and OC gene expression; while, inhibited TG activity significantly attenuated mechanical load-induced and TGM2-induced ALP activity. In summary, mechanical load-induced TGM2 expression and enzyme activity is involved in the progression of the calcification of ligamentum flavum. PMID:27115725

  2. Relationship between Hyperactivity of Depressor Septi Nasi Muscle and Changes of Alar Base and Flaring during Smile

    PubMed Central

    Beiraghi-Toosi, Arash; Rezaei, Ezatollah; Zanjani, Elham

    2016-01-01

    BACKGROUND Hyperactivity of depressor septi nasi muscle leads to smiling deformity and nasal tip depression. Lateral fascicles of this muscle help in widening the nostrils. The purpose of this study was to evaluate the relationship between the nasal length changes and the alar base and the alar flaring changes during smile. METHODS Standard photographs are performed in the face and lateral views with forward gaze in the repose and maximum smile. Nasal length, alar base, and alar flaring were measured on the prints of the photographs. To decrease possible errors in the size of the printed photographs, middle face height from glabella to ANS was measured in the lateral view and the interpupil distance in the face view to standardize the measurements. RESULTS Fifty cases were enrolled in this study. In 39 cases (78%), the nasal length was increased during smile. Forty-six cases (92%) had an increase in alar base diameter during smile. Alar flaring during smile increased in 48 cases (96%). Nasal length and alar base changes during smiling were not significantly correlated. Nasal length and alar flaring changes during smiling were not significantly related too. On the other hand, alar base and alar flaring changes during smile showed correlation. Alar base and alar flaring changes during smile were not significantly different in hyperactive and non-hyperactive cases. CONCLUSION Nasal length change during smiling and hypertrophy of the medial fascicles of depressor septi nasi were not related to alar base or alar flaring change during smile. PMID:27308240

  3. Focal Ligamentum Flavum Hypertrophy with Ochronotic Deposits: An Unusual Cause for Neurogenic Claudication in Alkaptonuria

    PubMed Central

    Vijayasaradhi, Mudumba; Biswal, Debabrat

    2012-01-01

    Neurogenic claudication resulting from focal hypertrophy of the ligamentum flavum in the lumbar spine due to ochronotic deposits has not been reported till date. The authors discuss one such case highlighting the pathogenesis, histological and radiological features. Salient features of management are also emphasized upon. PMID:22708021

  4. Tissue engineering and the future of hip cartilage, labrum and ligamentum teres

    PubMed Central

    Stubbs, Allston J.; Howse, Elizabeth A.; Mannava, Sandeep

    2016-01-01

    As the field of hip arthroscopy continues to evolve, the biological understanding of orthopaedic tissues, namely articular cartilage, labral fibro-cartilage and the ligamentum teres continues to expand. Similarly, the need for biological solutions for the pre-arthritic and early arthritic hip continues to be a challenge for the sports medicine surgeon and hip arthroscopist. This article outlines existing biological and tissue-engineering technologies, some being used in clinical practice and other technologies being developed, and how these biological and tissue-engineering principals may one day influence the practice of hip arthroscopy. This review of hip literature is specific to emerging biological technologies for the treatment of chondral defects, labral tears and ligamentum teres deficiency. Of note, not all of the technologies described in this article have been approved by the United States Food and Drug Administration and some of the described uses of the approved technologies should be considered ‘off-label’ uses. PMID:27026815

  5. Postlaminectomy synovial cyst formation: a possible consequence of ligamentum flavum excision.

    PubMed

    Walcott, Brian P; Coumans, Jean-Valery

    2012-02-01

    Ligamentum flavum is generally resected with impunity when a laminectomy is performed; it is a strong ligament and its removal may not be inconsequential. We sought to examine the consequence of resection of ligamentum flavum as it pertains to the formation of synovial cysts. Following IRB approval, we retrospectively reviewed the charts of consecutive patients who underwent a laminectomy for any diagnosis during the years 2009-2010. Exclusions were made for patients undergoing resection of a synovial cyst, laminectomy done as part of a fusion, and microdiscectomy. A total of 201 laminectomies were performed. 10 instances of post-laminectomy synovial cyst occurred in only the lumbar spine. Synovial cysts occurred exclusively after surgery for stenosis (n=10). Laminectomy and resection of the ligament flavum is a risk factor for the subsequent formation of a synovial cyst. Secondary synovial cyst formation should be suspected in individuals who develop radiculopathy after laminectomy for stenosis. PMID:22051031

  6. Tissue engineering and the future of hip cartilage, labrum and ligamentum teres.

    PubMed

    Stubbs, Allston J; Howse, Elizabeth A; Mannava, Sandeep

    2016-04-01

    As the field of hip arthroscopy continues to evolve, the biological understanding of orthopaedic tissues, namely articular cartilage, labral fibro-cartilage and the ligamentum teres continues to expand. Similarly, the need for biological solutions for the pre-arthritic and early arthritic hip continues to be a challenge for the sports medicine surgeon and hip arthroscopist. This article outlines existing biological and tissue-engineering technologies, some being used in clinical practice and other technologies being developed, and how these biological and tissue-engineering principals may one day influence the practice of hip arthroscopy. This review of hip literature is specific to emerging biological technologies for the treatment of chondral defects, labral tears and ligamentum teres deficiency. Of note, not all of the technologies described in this article have been approved by the United States Food and Drug Administration and some of the described uses of the approved technologies should be considered 'off-label' uses. PMID:27026815

  7. Ligamentum flavum cyst in the lumbar spine: a case report and review of the literature.

    PubMed

    Taha, H; Bareksei, Y; Albanna, W; Schirmer, M

    2010-06-01

    Degenerative changes in the lumbar spine can be followed by cystic changes. Most reported intraspinal cysts are ganglion or synovial cysts. Ligamentum flavum pseudocyst, as a cystic lesion in the lumbar spine, is a rare and unusual cause of neurologic signs and symptoms and is usually seen in elderly persons (due to degenerative changes). They are preferentially located in the lower lumbar region, while cervical localization is rare. Complete removal of the cyst leads to excellent results and seems to preclude recurrence. We report the case of a right-sided ligamentum flavum cyst occurring at L3-L4 level in a 70-year-old woman, which was surgically removed with excellent postoperative results and complete resolution of symptoms. In addition, we discuss and review reports in the literature. PMID:20582448

  8. A potential mechanism of dural ossification in ossification of ligamentum flavum.

    PubMed

    Li, Bo; Guo, Shigong; Qiu, Guixing; Li, Wenjing; Liu, Yongsheng; Zhao, Yu

    2016-07-01

    Ossification of the ligamentum flavum (OLF) mostly occurs in the thoracic spine, leading to thoracic spinal stenosis. Surgical treatment is considered as the best option for OLF patients. When the dura mater ossifies, the difficulty of surgery and the risk of complications significantly increase. The cause of dural ossification (DO) is still unknown. Based on the existing research and clinical studies, we propose a potential mechanism of DO in OLF. Firstly, with the progression of OLF, it will compress the dura mater and even the spinal cord. Then, with flexion and extension of spine, relative movement (friction) between the ossified ligamentum flavum and compressed dura mater will lead to local inflammation, subsequently causing dural adhesion. Finally, the adhesion tissue can serve as a pathway for the transportation of osteogenic cytokines (BMP for example) from the ossified ligamentum flavum to the compressed dura mater. Dura will ossify under exposure of these osteogenic cytokines. If this hypothesis is confirmed, it will contribute to the prevention and management of DO. For progressive OLF patients, early surgical treatment before DO should be recommended. PMID:27241243

  9. Decreased elastic fibers and increased proteoglycans in the ligamentum flavum of patients with lumbar spinal canal stenosis.

    PubMed

    Yabe, Yutaka; Hagiwara, Yoshihiro; Tsuchiya, Masahiro; Honda, Masahito; Hatori, Kouki; Sonofuchi, Kazuaki; Kanazawa, Kenji; Koide, Masashi; Sekiguchi, Takuya; Itaya, Nobuyuki; Itoi, Eiji

    2016-07-01

    Elastic fibers and proteoglycans are major components of the extracellular matrix and their changes have been reported in some pathological conditions. Further, recent studies have indicated that some glycosaminoglycans and proteoglycans inhibit elastic fiber assembly. The purpose of this study was to investigate changes of the elastic fibers and proteoglycans in the ligamentum flavum and analyze their relationships to thickening of the ligamentum flavum from lumbar spinal canal stenosis (LSCS). Ligamentum flavum samples were collected from 20 patients with LSCS (thickened flavum group) and 10 patients with lumbar disc herniation (non-thickened flavum group) as a control. Elastica-Masson staining and alcian blue staining were used to compare the relationship between the changes in the elastic fibers and proteoglycans. Gene and protein expressions of the elastic fibers and proteoglycans were analyzed by quantitative reverse transcription polymerase chain reaction and immunohistochemistry. Histological changes indicated that proteoglycans mainly increased on the dorsal side of the ligamentum flavum in accordance with the decreased elastic fibers in the thickened flavum group. The gene and protein expressions of fibrillin-2 and DANCE were significantly lower and decorin, lumican, osteoglycin, and versican were significantly higher in the thickened flavum group. Our study shows that elastic fibers decrease and proteoglycans increase in the thickened ligamentum flavum. Decreased gene expression of elastogenesis and disrupted elastic fiber assembly caused by increased proteoglycans may lead to a loss of elasticity in the thickened ligamentum flavum. Decreased elasticity may cause buckling of the tissue, which leads to thickening of the ligamentum flavum. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1241-1247, 2016. PMID:26679090

  10. Spontaneous Ligamentum Flavum Hematoma in the Rigid Thoracic Spine : A Case Report and Review of the Literature

    PubMed Central

    Lee, Hyun-Woo; Song, Joon-Ho; Chang, In-Bok

    2008-01-01

    Ligamentum flavum hematoma is a rare condition. Twenty cases including present case have been reported in English-language literature. Among them, only one case reported in pure thoracic spine. A 72-year-old man presented with thoracic myelopathy without precedent cause. Magnetic resonance images revealed a posterior semicircular mass which was located in T7 and T8 level compressing the spinal cord dorsally. T7-8 total laminectomy and extirpation of the mass was performed. One month later following surgery, the patient fully recovered to normal state. Pathologic result was confirmed as ligamentum flavum hematoma. Ligamentum flavum hematoma of rigid thoracic spine is a very rare disease entity. Most reported cases were confined to mobile cervical and lumbar spine. Surgeons should be aware that there seems to be another different pathogenesis other than previously reported cases of mobile cervical and lumbar spine. PMID:19096657

  11. Reconstruction of Congenital Isolated Alar Defect Using Mutaf Triangular Closure Technique in Pediatric Patients.

    PubMed

    Temel, Metin; Gunal, Ertan; Kahraman, Serif Samil

    2016-06-01

    Congenital isolated alar defects are extremely rare, occurring in approximately 1 in 20,000 to 40,000 live births. The patients are presented here of 2 pediatric patients operated on for congenital isolated alar defect. The reconstruction of congenital isolated alar defects was made in a 3-layered fashion. The skin defects were covered using the Mutaf triangular closure technique in which 2 cutaneous local flaps are designed in an unequal Z-plasty manner. Conchal cartilage graft was used between the skin and mucosal closure to replace the missing part of the lower lateral cartilage in these patients. The early results were promising in Patient 1, but sufficient improvement was detected in the alar cartilage postoperative follow-up period in Patient 2. Hence, this patient required revision 1 to 2 years postoperatively. This technique provides excellent aesthetic and functional results, except for this problem in Tessier 2 cleft patients. The use of the Stair step flap technique with Mutaf triangle closure technique achieved cosmetically and functionally excellent results in the reconstruction and repair of a large, irregular, narrow cleft, in the inadequate rotation of the lateral part of the lower lateral cartilage. However, because of this problem, evaluation of the long-term follow-up of patients is necessary. PMID:27192642

  12. Role of ligamentum flavum in the symptomatology of prolapsed lumbar intervertebral discs.

    PubMed Central

    Ramani, P S; Perry, R H; Tomlinson, B E

    1975-01-01

    Hypertrophy of the ligamentum flavum has been reported to occur in the prolapsed intervertebral disc syndrome. The ligaments from 28 patients were compared with a necropsy control group (18). Only minor histological anomalies were noted in two patients and the ligament was not thickened in cases of disc prolapse. In addition, there was no evidence to suggest previous trauma to the ligaments associated with disc protrusion or that the elastic fibres in the ligament degenerate with age, although some degeneration of the collagen fibres had apparently occurred in the two oldest control cases. Images PMID:1151422

  13. Smooth dissection of ligamentum flavum for lumbar microdiscectomy. Preliminary report of this personal technique.

    PubMed

    Nicoletti, Giovanni F; Platania, Nunzio; Albanese, Vincenzo

    2005-09-01

    A newly designed technique for preservation of the ligamentum flavum (LF) during the lumbar discectomy is presented. This technique allows the evacuation of the lumbar herniated disk, without removal or laminar disinsertion of the LF. This ligament is smoothly dissected longitudinally in its more lateral portion, obtaining, after discectomy, the contact of the 2 margins with restoration of its functional integrity. Forty-five patients were operated on with this technique. We feel that this technique could offer advantages in reduction of epidural fibrosis and of decreased risk of dural injury, and is helpful to the surgeon in the case of recurrence of discal herniation. PMID:16099252

  14. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres

    PubMed Central

    van Arkel, R. J.; Amis, A. A.; Cobb, J. P.; Jeffers, J. R. T.

    2015-01-01

    In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty. Cite this article: Bone Joint J 2015; 97-B:484–91. PMID:25820886

  15. Alar-spanning suture for tip contouring in closed approach rhinoplasty for African-Caucasian noses.

    PubMed

    Cedin, Antonio Carlos

    2013-06-01

    The alar-spanning suture is one of the easiest techniques for correcting the width of the alar complex that reduces the bulbous tip of African-Caucasian patients. This conservative technique does not weaken the lateral crura and yields long- term predictable results. Rhinoplastic surgeons should keep in mind this useful and reliable tool in their options for refinement of these challenging wide tips and not create so dramatic a change that the appearance is not consonant with the patient's ethnic heritage. Despite cosmetic surgeons usually performing it through an external columellar incision approach, it is possible, in many cases, to do it in a closed access, and thus avoid the risk of hyperpigmentation or hypertrophic scarring. PMID:23761120

  16. Management of the droopy tip: a comparison of three alar cartilage-modifying techniques.

    PubMed

    Foda, Hossam M T

    2003-10-01

    The droopy tip is a common nasal deformity in which the tip is inferiorly rotated. Five hundred consecutive rhinoplasty cases were studied to assess the incidence and causes of the droopy tip deformity and to evaluate the role of three alar cartilage-modifying techniques--lateral crural steal, lateral crural overlay, and tongue in groove--in correcting such a deformity. The external rhinoplasty approach was used in all cases. Only one of the three alar cartilage-modifying techniques was used in each case, and the degree of tip rotation and projection was measured both preoperatively and postoperatively. The incidence of droopy tip was 72 percent, and the use of an alar cartilage-modifying technique was required in 85 percent of these cases to achieve the desired degree of rotation. The main causes of droopy tip included inferiorly oriented alar cartilages (85 percent), overdeveloped scrolls of upper lateral cartilages (73 percent), high anterior septal angle (65 percent), and thick skin of the nasal lobule (56 percent). The lateral crural steal technique increased nasal tip rotation and projection, the lateral crural overlay technique increased tip rotation and decreased tip projection, and the tongue-in-groove technique increased tip rotation without significantly changing the amount of projection. The lateral crural overlay technique resulted in the highest degrees of rotation, followed by the lateral crural steal and finally the tongue-in-groove technique. According to these results, the lateral crural steal technique is best indicated in cases with droopy underprojected nasal tip, the lateral crural overlay technique in cases of droopy overprojected nasal tip, and the tongue-in-groove technique in cases where the droopy nasal tip is associated with an adequate amount of projection. PMID:14504527

  17. Primary rhinocheiloplasty: Comparison of open and closed methods of alar cartilage reposition

    PubMed Central

    Yasonov, S. A.; Lopatin, A. V.; Kugushev, A. Yu.

    2016-01-01

    Aims: To establish which rhinoplasty method for primary repairing of unilateral cleft lip (UCL) is better. Settings and Design: Two patient groups with cleft lip were compared. Each group was operated on either by McComb's technique as closed rhinoplasty method or by Vissarionov–Kosin technique as an open method. Subjects and Methods: First group included 29 patients and the second consisted of 31. All patients were operated on by single surgeon over 10 years. Randomization was based on wishes and intention of surgeon to use one of two methods. Evaluation of results was based on impartial data, and subjective information collected from respondents with different levels of knowledge about UCL. The objective scale was based on the evaluation of five noticeable residual deformations of nose that usually appear after primary lip-nose surgery: Alar flattening, low position of alar, widening or narrowing of nostril, and deformation of the upper part of nostril rim. Subjective evaluation was based on the opinion of respondents who were ranged every case depending on own judgment. Statistical Analysis: Was performed using Fisher method and Chi-square by Statistica 10.0, StatSoft Inc. Results: Approach with general analysis indicated no difference between two methods. Despite of absence of clear differences between two groups we consider the closed rhinoplasty more favorable due to less damage to alar cartilages and no scars inside nostrils. Conclusions: We think that mentioned scarring may complicate secondary rhinoplasty, which is often needed to correct nose deformation. PMID:27563601

  18. Ossification of ligamentum flavum, a rare cause of myelopathy: First case report of a Lebanese patient.

    PubMed

    El Helou, Antonios; Alaywan, Moussa; Tarabay, Antonio; Nachanakian, Antoine

    2016-01-01

    Ossification of ligamentum flavum (OLF) is a well-known pathology causing myelopathy, although it is a rare disease. The most commonly affected population is from the Far East and mainly Japanese. However, few reports and studies have shown the prevalence of the disease all over the world. We report the case of a 33-year-old man presenting with signs of progressive myelopathy. Magnetic resonance imaging (MRI) showed Th2-Th11 OLF with severe narrowing and intramedullary hypersignal at the level Th2-Th3. This is the first Lebanese case reported in the literature. A decompressive laminectomy with flavectomy was done. This case adds to the previous reported cases on the occurrence of the disease in different populations. PMID:27057241

  19. Editorial Commentary: Ligamentum Teres Tears and Femoroacetabular Impingement: Complex Coexistence of Impingement and Instability.

    PubMed

    Larson, Christopher M

    2016-07-01

    In a large Level IV case series of 2,213 hip arthroscopies with the diagnosis of femoroacetabular impingement, the intraoperative status of the ligamentum teres (LT) was recorded as normal in 11%, frayed and/or partially torn in 88%, and completely torn in 1.5% of hips. Although specific physical examination maneuvers for detecting LT tears were not available early in the study period, thus limiting a detailed assessment of such tests, the authors identified that female gender, a lower lateral center edge angle, a higher Tonnis angle, and capsular laxity were all associated with complete LT tears. This study further supports the complex coexistence of impingement and instability. PMID:27373179

  20. S-1 and S-2-alar-iliac screw fixation via intraoperative navigation.

    PubMed

    Pham, Martin H; Jakoi, Andre M; Hsieh, Patrick C

    2016-07-01

    Adult deformity patients often require fixation to the sacrum and pelvis for construct stability and improved fusion rates. Although certain sacropelvic fixation techniques can be challenging, the availability of intraoperative navigation has made many of these techniques more feasible. In this video case presentation, the authors demonstrate the techniques of S-1 bicortical screw and S-2-alar-iliac screw fixation under intraoperative navigation in a 67-year-old female. This instrumentation placement was part of an overall T-10-pelvis construct for the correction of adult spinal deformity. The video can be found here: https://youtu.be/3HZo-80jQr8 . PMID:27364427

  1. Rhinoplasty. The difficult nasal tip: total resection of the alar cartilages.

    PubMed

    Rodriguez-Camps, Salvador

    2009-01-01

    There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices. PMID:18797961

  2. Ligamentum teres injuries - an observational study of a proposed new arthroscopic classification.

    PubMed

    Porthos Salas, Antonio; O'Donnell, John M

    2015-10-01

    Ligamentum teres (LT) Injuries or tears have been said to be a common cause of groin discomfort and pain, and they have been identified in 8-51% of patients undergoing hip arthroscopy. Currently, in the literature there exist three arthroscopic classifications for LT injuries and tears: the first classification was established by Gray and Villar, Botser and Domb proposed the second one which they called a descriptive classification according to the degree of partial thickness LT tears and more recently the last classification by Cerezal et al. (RadioGraphics 2010; 30:1637-51), where they take into account the one by Gray and Villar but adding an avulsion fracture and absence of the LT. We propose a new classification, which also takes into account, observed LT pathologies, as well as the possible pathological mechanism of LT tears, and offer a guide to treatment. This classification is based on direct arthroscopic observation and dynamic rotational maneuvers of the hip under distraction. This classification incorporates those pathologies, which have been observed as a result of this more focused examination of the LT. PMID:27011847

  3. Is Early Nasal Shaping With a Limited Alar Base Incision Possible in the Repair of Cleft Lips?

    PubMed

    Kapi, Emin; Bozkurt, Mehmet; Ozer, Torun; Celik, Mehmet Yusuf

    2016-05-01

    The repair of cleft lips has an important place in plastic and reconstructive surgery. In the treatment of these deformities, the aim was to restore the normal lip morphology in the cleft area as well as repairing any coexisting nasal deformities. Various methods are in use for this purpose. One of the most commonly employed surgical methods is Millard repair. However, this method may lead to additional scarring in the alar base on the cleft side subsequent to the incision. In this study, the results obtained from a group who have been applied alar base incisions during the modified Millard repair are compared to a group who have undergone intranasal wide dissections.The patients enrolled in the study were randomized into 2 groups. The first group were applied the modified Millard repair. In the second group, the rotation, advancement, and C-flaps were prepared according to Millard surgical repair technique; however, instead of an alar base and nasofacial groove incision on the cleft side, a nasal and maxillary supraperiosteal wide dissection was made through the incision in the mucosa of the nostril.The intranasal dissection performed during the study was observed to provide the targeted outcome and a more satisfactory cosmetic result through the modified Millard repair. In conclusion, the authors are of the opinion that the limited alar base incision and the wide supraperiosteal dissection performed in patients with cleft lips is an alternative method that can be employed in a wide range of patients. PMID:27092908

  4. Toward less misleading comparisons of uncertain risks: the example of aflatoxin and alar.

    PubMed Central

    Finkel, A M

    1995-01-01

    Critics of comparative risk assessment (CRA), the increasingly common practice of juxtaposing disparate risks for the purpose of declaring which one is the "larger" or the "more important," have long focused their concern on the difficulties in accommodating the qualitative differences among risks. To be sure, people may disagree vehemently about whether "larger" necessarily implies "more serious," but the attention to this aspect of CRA presupposes that science can in fact discern which of two risks has the larger statistical magnitude. This assumption, encouraged by the indiscriminate calculation of risk ratios using arbitrary point estimates, is often incorrect: the fact that environmental and health risks differ in unknown quantitative respects is at least as important a caution to CRA as the fact that risks differ in known qualitative ways. To show how misleading CRA can be when uncertainty is ignored, this article revisits the claim that aflatoxin contamination of peanut butter was "18 times worse" than Alar contamination of apple juice. Using Monte Carlo simulation, the number 18 is shown to lie within a distribution of plausible risk ratios that ranges from nearly 400:1 in favor of aflatoxin to nearly 40:1 in the opposite direction. The analysis also shows that the "best estimates" of the relative risk of aflatoxin to Alar are much closer to 1:1 than to 18:1. The implications of these findings for risk communication and individual and societal decision-making are discussed, with an eye toward improving the general practice of CRA while acknowledging that its outputs are uncertain, rather than abandoning it for the wrong reasons. Images Figure 1. Figure 2. PMID:7607139

  5. Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine.

    PubMed

    Zhong, Zhao-Ming; Wu, Qian; Meng, Ting-Ting; Zhu, Yong-Jian; Qu, Dong-Bin; Wang, Ji-Xing; Jiang, Jian-Ming; Lu, Kai-Wu; Zheng, Shuai; Zhu, Si-Yuan; Chen, Jian-Ting

    2016-06-01

    Ossification of the ligamentum flavum (OLF) is a rare disease that causes acquired thoracic spinal canal stenosis and thoracic myelopathy. The aim of this study was to investigate clinical outcomes of symptomatic thoracic OLF treated using posterior decompressive laminectomy. We retrospectively analyzed the medical records of 22 patients who underwent posterior decompressive laminectomy for symptomatic thoracic OLF. The surgical results were evaluated using the modified Japanese Orthopaedic Association (JOA) scoring system and Hirabayashi recovery rate. The intensity of pain was evaluated using a visual analog scale (VAS). The mean duration of follow-up was 35.6months. The mean JOA score was significantly improved at final follow-up (9.18±standard deviation of 1.53 points [range, 6-11 points]) compared with before surgery (5.64±2.04 points [range, 3-9 points]) (P<0.001). The mean Hirabayashi recovery rate was 65.49% (range, 20-100%). Recovery outcomes were excellent in nine patients, good in eight patients, fair in four patients and unchanged in one patient. No patient was classified as deteriorated. The VAS scores were 2.82±3.08 before surgery and 0.59±1.05 at final follow-up (P=0.001). Surgical complications, which resolved after appropriate and prompt treatment, included dural tear in five patients, cerebrospinal fluid leakage in one patient, immediate postoperative neurologic deterioration in one patient, epidural hematoma in one patient, and wound infection in one patient. Our findings suggest that posterior decompressive laminectomy is an effective treatment for symptomatic thoracic OLF and provides satisfactory clinical improvement, but surgery for thoracic OLF is associated with a relatively high incidence of complications. PMID:26898582

  6. A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry

    PubMed Central

    Choe, Yun Seon; Kim, Min-Woo

    2015-01-01

    In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim. PMID:26719646

  7. The Evaluation and Observation of “Hidden” Hypertrophy of Cervical Ligamentum Flavum, Cervical Canal, and Related Factors Using Kinetic Magnetic Resonance Imaging

    PubMed Central

    Zeng, Cheng; Xiong, Jian; Wang, Jeffrey C.; Inoue, Hirokazu; Tan, Yanlin; Tian, Haijun; Aghdasi, Bayan

    2015-01-01

    Study Design Retrospective cohort study. Objective The objective was to measure the change of flavum ligament diameter during positional changes of the cervical spine using kinetic magnetic resonance imaging (MRI) and to examine the correlational diameter changes of the flavum ligament, disk bulging, and the spinal canal from extension to flexion positions. Methods One hundred eight-nine patients underwent kinetic MRI in neutral, extension, and flexion positions. The diameters of cervical ligamentum flavum, disk bulging, and cervical spinal canal and the disk degeneration grade and Cobb angles were measured from C2–C3 to C7–T1. Results In all, 1,134 cervical spinal segments from 189 patients were included. There was a 0.26 ± 0.85-mm average increase in the diameter of the ligamentum flavum from flexion to extension, and 62.70% of the segments had increased ligamentum flavum diameter from flexion to extension. For all segments of the 189 patients, the cervical spinal canal diameters had an average decrease at the disk level of 0.56 ± 1.21 mm from flexion to extension. For all segments with cervical spinal canal narrowing ≥1 mm from flexion to extension view, the ligamentum flavum diameters at C3–C4 to C5–C6 had significant increases compared with patients with spinal canal narrowing < 1 mm (p < 0.05). For patients with ligamentum flavum hypertrophy of ≥1 mm from the flexion to extension view, the cervical spinal canal diameters at C2–C3, C4–C5, and C5–C6 had significant decreases compared with patients with ligamentum flavum hypertrophy of <1 mm (p < 0.05). Conclusion The “hidden” hypertrophy of ligamentum flavum was significant at C4–C5 and C5–C6 and significantly contributes to the stenosis of cervical spinal canal in the extension position. PMID:26933617

  8. The Evaluation and Observation of "Hidden" Hypertrophy of Cervical Ligamentum Flavum, Cervical Canal, and Related Factors Using Kinetic Magnetic Resonance Imaging.

    PubMed

    Zeng, Cheng; Xiong, Jian; Wang, Jeffrey C; Inoue, Hirokazu; Tan, Yanlin; Tian, Haijun; Aghdasi, Bayan

    2016-03-01

    Study Design Retrospective cohort study. Objective The objective was to measure the change of flavum ligament diameter during positional changes of the cervical spine using kinetic magnetic resonance imaging (MRI) and to examine the correlational diameter changes of the flavum ligament, disk bulging, and the spinal canal from extension to flexion positions. Methods One hundred eight-nine patients underwent kinetic MRI in neutral, extension, and flexion positions. The diameters of cervical ligamentum flavum, disk bulging, and cervical spinal canal and the disk degeneration grade and Cobb angles were measured from C2-C3 to C7-T1. Results In all, 1,134 cervical spinal segments from 189 patients were included. There was a 0.26 ± 0.85-mm average increase in the diameter of the ligamentum flavum from flexion to extension, and 62.70% of the segments had increased ligamentum flavum diameter from flexion to extension. For all segments of the 189 patients, the cervical spinal canal diameters had an average decrease at the disk level of 0.56 ± 1.21 mm from flexion to extension. For all segments with cervical spinal canal narrowing ≥1 mm from flexion to extension view, the ligamentum flavum diameters at C3-C4 to C5-C6 had significant increases compared with patients with spinal canal narrowing < 1 mm (p < 0.05). For patients with ligamentum flavum hypertrophy of ≥1 mm from the flexion to extension view, the cervical spinal canal diameters at C2-C3, C4-C5, and C5-C6 had significant decreases compared with patients with ligamentum flavum hypertrophy of <1 mm (p < 0.05). Conclusion The "hidden" hypertrophy of ligamentum flavum was significant at C4-C5 and C5-C6 and significantly contributes to the stenosis of cervical spinal canal in the extension position. PMID:26933617

  9. A novel approach to navigated implantation of S-2 alar iliac screws using inertial measurement units.

    PubMed

    Jost, Gregory F; Walti, Jonas; Mariani, Luigi; Cattin, Philippe

    2016-03-01

    OBJECT The authors report on a novel method of intraoperative navigation with inertial measurement units (IMUs) for implantation of S-2 alar iliac (S2AI) screws in sacropelvic fixation of the human spine and its application in cadaveric specimens. METHODS Screw trajectories were planned on a multiplanar reconstruction of the preoperative CT scan. The pedicle finder and screwdriver were equipped with IMUs to guide the axial and sagittal tilt angles of the planned trajectory, and navigation software was developed. The entry points were chosen according to anatomical landmarks on the exposed spine. After referencing, the sagittal and axial orientation of the pedicle finder and screwdriver were wirelessly monitored on a computer screen and aligned with the preoperatively planned tilt angles to implant the S2AI screws. The technique was performed without any intraoperative imaging. Screw positions were analyzed on postoperative CT scans. RESULTS Seventeen of 18 screws showed a good S2AI screw trajectory. Compared with the postoperatively measured tilt angles of the S2AI screws, the IMU readings on the screwdriver were within an axial plane deviation of 0° to 5° in 15 (83%) and 6° to 10° in 2 (11%) of the screws and within a sagittal plane deviation of 0° to 5° in 15 (83%) and 6° to 10° in 3 (17%) of the screws. CONCLUSIONS IMU-based intraoperative navigation may facilitate accurate placement of S2AI screws. PMID:26565762

  10. Laminoplasty and Laminectomy Hybrid Decompression for the Treatment of Cervical Spondylotic Myelopathy with Hypertrophic Ligamentum Flavum: A Retrospective Study

    PubMed Central

    Ding, Huairong; Xue, Yuan; Tang, Yanming; He, Dong; Li, Zhiyang; Zhao, Ying; Zong, Yaqi; Wang, Yi; Wang, Pei

    2014-01-01

    Objective To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF). Background Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum. Methods This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale. Results No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3±15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit. Conclusion Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF. PMID:24740151

  11. Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

    PubMed Central

    Yoon, Sang Hoon; Kim, Wook Ha; Chung, Sang-Bong; Jin, Yong Jun; Park, Kun Woo; Lee, Joon Woo; Chung, Sang-Ki; Yeom, Jin S.; Jahng, Tae-Ahn; Chung, Chun Kee; Kang, Heung Sik; Kim, Hyun-Jib

    2010-01-01

    The aim of this study was to analyze the clinical characteristics of thoracic ossified ligamentum flavum (OLF) and to elucidate prognostic factors as well as effective surgical treatment modality. The authors analyzed 106 thoracic OLF cases retrospectively from January 1999 to December 2008. The operative (n = 40) and the non-operative group (n = 66) were diagnosed by magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging. We excluded cases exhibiting ventral compressive lesions causing subarachnoid space effacement in thoracic vertebrae as well as those with a coexisting cervical compressive myelopathy. Those in the operative group were treated with decompressive laminectomy as well as resection of OLF. The preoperative neurologic status and postoperative outcomes of patients, as indicated by their modified Japanese Orthopedic Association (mJOA) scores and recovery rate (RR), Modic changes, the axial (fused or non-fused) and sagittal (omega or beak) configurations of OLF, and the ratios of the cross-sectional area (CSA) and anteroposterior diameter (APD) of the most compressed level were studied. The most commonly affected segment was the T10–11 vertebral body level (n = 49, 27.1%) and the least affected segment was the T7–8 level (n = 1, 0.6%). The ratios of the CSA in non-fused and fused types were 77.3 and 59.3% (p < 0.001). When Modic changes were present with OLF, initial mJOA score was found to be significantly lower than those without Modic change (7.62 vs. 9.09, p = 0.033). Neurological status improved after decompressive laminectomy without fusion (preoperative vs. last mJOA; 7.1 ± 2.01 vs. 8.57 ± 1.91, p < 0.001). However, one patient exhibited transient deterioration of her neurological status after surgery. In the axial configuration, fused-type OLF revealed a significant risk for a decreased postoperative mJOA score (0–7, severe and moderate) (Odds ratio: 5.54, χ2 = 4.41, p = 0.036, 95% CI: 1.014–30

  12. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

    PubMed Central

    2010-01-01

    Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI) have been found in patients with whiplash-associated disorders (WAD) but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4%) patients completed the Neck Disability Index (NDI) and an 11-point numeric rating scale (NRS-11) on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women), 38 (34.2%) had grades 2-3 alar ligament changes and 25 (22.5%) had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1%) reported disability (NDI > 8) and 23 (20.7%) neck pain (NRS-11 > 4). Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007) and so did low expectations of recovery (odds ratio 4.66, p = 0.005). Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients without previous

  13. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var)

    PubMed Central

    2013-01-01

    Background Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Results Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. Conclusions The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage. PMID:23557095

  14. Evaluating Osteogenic Potential of Ligamentum Flavum Cells Cultivated in Photoresponsive Hydrogel that Incorporates Bone Morphogenetic Protein-2 for Spinal Fusion

    PubMed Central

    Chiang, Chih-Wei; Chen, Wei-Chuan; Liu, Hsia-Wei; Wang, I-Chun; Chen, Chih-Hwa

    2015-01-01

    Regenerative medicine is increasingly important in clinical practice. Ligamentum flava (LF) are typically removed during spine-related surgeries. LF may be a source of cells for spinal fusion that is conducted using tissue engineering techniques. In this investigation, LF cells of rabbits were isolated and then characterized by flow cytometry, morphological observation, and immunofluorescence staining. The LF cells were also cultivated in polyethylene (glycol) diacrylate (PEGDA) hydrogels that incorporated bone morphogenetic protein-2 (BMP-2) growth factor, to evaluate their proliferation and secretion of ECM and differentiation in vitro. The experimental results thus obtained that the proliferation, ECM secretion, and differentiation of the PEGDA-BMP-2 group exceeded those of the PEGDA group during the period of cultivation. The mineralization and histological staining results differed similarly. A nude mice model was utilized to prove that LF cells on hydrogels could undergo osteogenic differentiation in vivo. These experimental results also revealed that the PEGDA-BMP-2 group had better osteogenic effects than the PEGDA group following a 12 weeks after transplantation. According to all of these experimental results, LF cells are a source of cells for spinal fusion and PEGDA-BMP-2 hydrogel is a candidate biomaterial for spinal fusion by tissue engineering. PMID:26426006

  15. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity

    PubMed Central

    Zhang, JingTao; Wang, LinFeng; Li, Jie; Yang, Peng; Shen, Yong

    2016-01-01

    The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery. PMID:26960572

  16. Hypertrophy of Ligamentum Flavum in Lumbar Spine Stenosis Is Associated with Increased miR-155 Level

    PubMed Central

    Chen, Jianwei; Liu, Zude; Zhong, Guibin; Qian, Lie; Li, Zhanchun; Qiao, Zhiguang; Chen, Bin; Wang, Hantao

    2014-01-01

    Hypertrophy of ligamentum flavum (LF) contributes to lumbar spinal stenosis (LSS) and is caused mainly by fibrosis. Recent data indicate that miR-155 plays a crucial role in the pathogenesis of different fibrotic diseases. This study aimed to test the hypothesis that miR-155 exerts effects on LF thickness by regulating collagen expression. We found that LF thickness and the expression of collagen I and, collagen III were higher in LF from LSS patients than in LF from lumbar disc herniation (LDH) patients (P < 0.01). The expression of miR-155 was significantly higher in LF from LSS group than in LF from LDH group (P < 0.01). miR-155 level was positively correlated with LF thickness (r = 0.958, P < 0.01), type I collagen level (r = 0.825, P < 0.01), and type III collagen level (r = 0.827, P < 0.01). miR-155 mimic increased mRNA and protein expression of collagen I and collagen III in fibroblasts isolated from LF, while miR-155 sponge decreased mRNA and protein expression of collagen I and III in fibroblasts. In conclusions, miR-155 is a fibrosis-associated miRNA and may play important role in the pathogenesis of LF hypertrophy. PMID:24963214

  17. Technique and nuances of an S-2 alar iliac screw for lumbosacral fixation in patients with transitional and normal anatomy.

    PubMed

    Ohya, Junichi; Vogel, Todd D; Dhall, Sanjay S; Berven, Sigurd; Mummaneni, Praveen V

    2016-07-01

    S-2 alar iliac (S2AI) screw fixation has recently been recognized as a useful technique for pelvic fixation. The authors demonstrate two cases where S2AI fixation was indicated: one case was a sacral insufficiency fracture following a long-segment fusion in a patient with a transitional S-1 vertebra; the other case involved pseudarthrosis following lumbosacral fixation. S2AI screws offer rigid fixation, low profile, and allow easy connection to the lumbosacral rod. The authors describe and demonstrate the surgical technique and nuances for the S2AI screw in a case with transitional S-1 anatomy and in a case with normal S-1 anatomy. The video can be found here: https://youtu.be/Sj21lk13_aw . PMID:27364429

  18. Human Lumbar Ligamentum Flavum Anatomy for Epidural Anesthesia: Reviewing a 3D MR-Based Interactive Model and Postmortem Samples.

    PubMed

    Reina, Miguel A; Lirk, Philipp; Puigdellívol-Sánchez, Anna; Mavar, Marija; Prats-Galino, Alberto

    2016-03-01

    The ligamentum flavum (LF) forms the anatomic basis for the loss-of-resistance technique essential to the performance of epidural anesthesia. However, the LF presents considerable interindividual variability, including the possibility of midline gaps, which may influence the performance of epidural anesthesia. We devise a method to reconstruct the anatomy of the digitally LF based on magnetic resonance images to clarify the exact limits and edges of LF and its different thickness, depending on the area examined, while avoiding destructive methods, as well as the dissection processes. Anatomic cadaveric cross sections enabled us to visually check the definition of the edges along the entire LF and compare them using 3D image reconstruction methods. Reconstruction was performed in images obtained from 7 patients. Images from 1 patient were used as a basis for the 3D spinal anatomy tool. In parallel, axial cuts, 2 to 3 cm thick, were performed in lumbar spines of 4 frozen cadavers. This technique allowed us to identify the entire ligament and its exact limits, while avoiding alterations resulting from cutting processes or from preparation methods. The LF extended between the laminas of adjacent vertebrae at all vertebral levels of the patients examined, but midline gaps are regularly encountered. These anatomical variants were reproduced in a 3D portable document format. The major anatomical features of the LF were reproduced in the 3D model. Details of its structure and variations of thickness in successive sagittal and axial slides could be visualized. Gaps within LF previously studied in cadavers have been identified in our interactive 3D model, which may help to understand their nature, as well as possible implications for epidural techniques. PMID:26891398

  19. Thickness of the Ligamentum Flavum: Correlation with Age and Its Asymmetry-An Magnetic Resonance Imaging Study

    PubMed Central

    Khambatta, Seema; Ambiye, Medha Vijay

    2015-01-01

    Study Design A retrospective radiological study of the ligamentum flavum (LF). Purpose This study is an attempt to measure and compare the thickening of the LF on both the sides with the use of magnetic resonance imaging, to investigate if there is a predominant tendency to thicken a specific side and also to determine if a correlation between the thickening of the LF and increasing age exists. Overview of Literature Even though many studies measured the thickness of the LF, very few have compared it on each side, or determined its correlation with age. Methods The thickness of LF was measured at the L3-4, L4-5, L5-S1 levels on both sides using the magnetic resonance images of 200 patients (n=1,200). The sample population was divided into three groups: 21-40 years, 41-60 years, and 61-80 years. The data was analyzed statistically, comparing the thickness of LF on both sides and in various age-groups. Results The thickness of the LF was found to increase with age; however, there were several younger instances with thicknesses >4 mm. The mean thickness of the right LF at different spinal levels was measured (L3-L4=3.38±0.94 mm, L4-L5=3.70±1.16 mm, and L5-S1=3.65±1.16 mm) while the mean thickness of the left LF was higher (L3-L4=3.52±0.99 mm, L4-L5=3.84±1.12 mm, and L5-S1=3.78±1.24 mm). Conclusions The LF thickness does not appear to have any side dominance; however, it tends to thicken with increasing age. PMID:25901237

  20. Analysis of the Relationship between Hypertrophy of the Ligamentum Flavum and Lumbar Segmental Motion with Aging Process

    PubMed Central

    Yoshiiwa, Toyomi; Kawano, Masanori; Ikeda, Shinichi; Tsumura, Hiroshi

    2016-01-01

    Study Design Retrospective cross-sectional study. Purpose To investigate the relationship between ligamentum flavum (LF) hypertrophy and lumbar segmental motion. Overview of Literature The pathogenesis of LF thickening is unclear and whether the thickening results from tissue hypertrophy or buckling remains controversial. Methods 296 consecutive patients underwent assessment of the lumbar spine by radiographic and magnetic resonance imaging (MRI). Of these patients, 39 with normal L4–L5 disc height were selected to exclude LF buckling as one component of LF hypertrophy. The study group included 27 men and 12 women, with an average age of 61.2 years (range, 23–81 years). Disc degeneration and LF thickness were quantified on MRI. Lumbar segmental spine instability and presence of a vacuum phenomenon were identified on radiographic images. Results The distribution of disc degeneration and LF thickness included grade II degeneration in 4 patients, with a mean LF thickness of 2.43±0.20 mm; grade III in 10 patients, 3.01±0.41 mm; and grade IV in 25 patients, 4.16±1.12 mm. LF thickness significantly increased with grade of disc degeneration and was significantly correlated with age (r=0.55, p<0.01). Logistic regression analysis identified predictive effects of segmental angulation (odds ratio [OR]=1.55, p=0.014) and age (OR=1.16, p=0.008). Conclusions Age-related increases in disc degeneration, combined with continuous lumbar segmental flexion-extension motion, leads to the development of LF hypertrophy. PMID:27340534

  1. Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report

    PubMed Central

    Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersegun; Gucer, Hasan; Yolas, Coskun

    2016-01-01

    Hematoma of the ligamentum flavum (LF) is a rare cause of neural compression and sciatica. Currently, the etiology and epidemiological characteristics of ligamentum flavum hematoma (LFH) are unknown and epidemiological investigations using rewieving of reported cases have not been performed. We report the case of a 63-year-old man with a LFH compressing the spinal canal at the left L2–L3 level, rewieved relevant literature. In Medline research, wefound a total of 50 reported cases with LFHs, and the interesting point of these cases were analyzed. Many of cases were old males. Interestingly, 39 of the 50 cases were reported from Asian countries. The ages of 42 patients could be verified. The youngest age was 45 years, oldest age was 81 years, and mean age was 66.07 years. Thirty-three out of these 42 patients (78.53%) were older than 60 years. An important aspect of the present review is to bring attention for occurrence in older Asian males. With an increasing number of elderly people in the general population, there is a need to investigate risk factors such as sexual gender, age, and geographic location for LFH. PMID:27041879

  2. MiR-132-3p Regulates the Osteogenic Differentiation of Thoracic Ligamentum Flavum Cells by Inhibiting Multiple Osteogenesis-Related Genes

    PubMed Central

    Qu, Xiaochen; Chen, Zhongqiang; Fan, Dongwei; Sun, Chuiguo; Zeng, Yan

    2016-01-01

    Ossification of the ligamentum flavum (OLF) is a disorder of heterotopic ossification of spinal ligaments and is the main cause of thoracic spinal canal stenosis. Previous studies suggested that miR-132-3p negatively regulates osteoblast differentiation. However, whether miR-132-3p is involved in the process of OLF has not been investigated. In this study, we investigated the effect of miR-132-3p and its target genes forkhead box O1 (FOXO1), growth differentiation factor 5 (GDF5) and SRY-box 6 (SOX6) on the osteogenic differentiation of ligamentum flavum (LF) cells. We demonstrated that miR-132-3p was down-regulated during the osteogenic differentiation of LF cells and negatively regulated the osteoblast differentiation. Further, miR-132-3p targeted FOXO1, GDF5 and SOX6 and down-regulated the protein expression of these genes. Meanwhile, FOXO1, GDF5 and SOX6 were up-regulated after osteogenic differentiation and the down-regulation of endogenous FOXO1, GDF5 or SOX6 suppressed the osteogenic differentiation of LF cells. In addition, we also found FOXO1, GDF5 and SOX6 expression in the ossification front of OLF samples. Overall, these results suggest that miR-132-3p inhibits the osteogenic differentiation of LF cells by targeting FOXO1, GDF5 and SOX6. PMID:27556448

  3. Supra-thyroid alar cartilage approach for the complete resection of laryngeal submucosal tumors and postoperative voice quality.

    PubMed

    Ueha, Rumi; Nito, Takaharu; Sakamoto, Takashi; Fujimaki, Yoko; Yamauchi, Akihito; Yamasoba, Tatsuya

    2015-10-01

    Various surgical approaches for the treatment of laryngeal submucosal tumors have been reported. Endoscopic excision is indicated for small lesions, while external approaches are recommended for larger tumors. This report introduces a supra-thyroid alar cartilage approach (STACA), which has strong advantages for the preservation of the laryngeal framework and voice recovery after surgery. Case series with chart review. Four patients with laryngeal submucosal tumors in the paraglottic space underwent complete tumor removal through STACA. Medical charts were reviewed to evaluate patient background, major complaints, tumor type, tumor size, the time period from operation to tracheostomy closure, tumor recurrence, and the difference between pre- and postoperative voice quality. Voice quality was assessed using the GRBAS score, maximum phonation time (MPT) and Voice Handicap Index-10 (VHI-10) 6 months after surgery. All patients were females between 43 and 67 years of age. Two patients had schwannoma, one laryngocele, and one lipoma. Mean tumor size was 3.4 cm. The main complaints were hoarseness in all patients, and dyspnea in one. The periods of time from surgery to oral intake and tracheostomy closure were 3.5 and 7 days, respectively. No patient developed recurrence during a minimum follow-up period of 2 years. The postoperative GRBAS scores, MPT and VHI-10 improved in all patients. STACA has advantages including minimal trauma, no deformity to the laryngeal framework, and good voice qualities after the resection of laryngeal submucosal tumors. PMID:26048355

  4. Nostril and alar reshaping.

    PubMed

    Planas, J; Planas, J

    1993-01-01

    The authors recommend, when necessary, the use of external excisions for correcting variations in the shape of the nostrils and alae in the cleft lip-nose deformity, in primary rhinoplasties, and in secondary rhinoplasties. Their experience in the use of external incisions was originally stimulated by Millard's paper of 1960 which recommended different types of remodeling external excisions in his analysis of how to handle variations in the shape of the nostrils and alae. PMID:8517221

  5. Ossification of the cervical ligamentum flavum and osseous brown tumor: late manifestations of primary hyperparathyroidism misdiagnosed in a case of parathyroid carcinoma

    PubMed Central

    Sampanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Vasileiou, Sotirios

    2016-01-01

    Summary Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations. Herein we aimed at presenting an unique case of a young patient with late manifestations of parathyroid cancer and reviewing the relevant literature. A 45-year-old male patient presented in the Outpatient Clinic with an episode of nephrolithiasis. His personal medical history includes: recurrent episodes of nephrolithiasis, laminectomy in the cervical spine due to ossification of the cervical ligamentum flavum and surgical resection of a giant cell tumor of the brain. Laboratory testing revealed findings of primary hyperparathyroidism (serum calcium 16,0 mmol/l phosphorus 1,46 mg/dl and parathyroid hormone/PTH 8560 pg/ml). Neck ultrasound and technetium-99 m sestamibi scan were performed showing a parathyroid tumor. Due to the persistently high serum calcium and PTH levels, the high alkaline phosphatase levels (440 IU/L) and the late manifestations of HPT, surgical excision of the tumor was performed. The tumor was identified as parathyroid carcinoma. Immediately after surgery serum calcium and phosphorus levels were normalized. The patient is on a regular follow-up program with no signs of recurrence or metastasis one year after the excision. We describe the coexistence of rare late manifestations of HPT, which had not been adequately investigated at their onset in this young patient. Therefore, increased awareness is needed in order to recognize and further investigate signs or symptoms of HPT. PMID:27252748

  6. Ossification of the cervical ligamentum flavum and osseous brown tumor: late manifestations of primary hyperparathyroidism misdiagnosed in a case of parathyroid carcinoma.

    PubMed

    Sampanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Vasileiou, Sotirios

    2016-01-01

    Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations. Herein we aimed at presenting an unique case of a young patient with late manifestations of parathyroid cancer and reviewing the relevant literature. A 45-year-old male patient presented in the Outpatient Clinic with an episode of nephrolithiasis. His personal medical history includes: recurrent episodes of nephrolithiasis, laminectomy in the cervical spine due to ossification of the cervical ligamentum flavum and surgical resection of a giant cell tumor of the brain. Laboratory testing revealed findings of primary hyperparathyroidism (serum calcium 16,0 mmol/l phosphorus 1,46 mg/dl and parathyroid hormone/PTH 8560 pg/ml). Neck ultrasound and technetium-99 m sestamibi scan were performed showing a parathyroid tumor. Due to the persistently high serum calcium and PTH levels, the high alkaline phosphatase levels (440 IU/L) and the late manifestations of HPT, surgical excision of the tumor was performed. The tumor was identified as parathyroid carcinoma. Immediately after surgery serum calcium and phosphorus levels were normalized. The patient is on a regular follow-up program with no signs of recurrence or metastasis one year after the excision. We describe the coexistence of rare late manifestations of HPT, which had not been adequately investigated at their onset in this young patient. Therefore, increased awareness is needed in order to recognize and further investigate signs or symptoms of HPT. PMID:27252748

  7. TGF-β1, in association with the increased expression of connective tissue growth factor, induce the hypertrophy of the ligamentum flavum through the p38 MAPK pathway.

    PubMed

    Cao, Yan-Lin; Duan, Yang; Zhu, Li-Xin; Zhan, Ye-Nan; Min, Shao-Xiong; Jin, An-Min

    2016-08-01

    Hypertrophy of the ligamentum flavum (LF) is one of the key pathomechanisms of lumbar spinal stenosis (LSS). Transforming growth factor (TGF)-β1 is abundantly expressed in hypertrophied degenerative LF tissues from LSS. However, the molecular mechanisms underling the association between TGF-β1 and LF hypertrophy have not yet been fully elucidated. In this study, we investigated the important role of the mitogen-activated protein kinase (MAPK) pathway in the pathogenesis of LSS by analyzing the expression of connective tissue growth factor (CTGF) and extracellular matrix (ECM) components (collagen I and collagen III) in TGF-β1-treated LF cells. Cell growth assay revealed that TGF-β1, in association with CTGF, enhanced the the proliferation of LF cells, and we found that TGF-β1 also elevated CTGF expression and subsequently enhanced the mRNA expression of collagen I and collagen III. The increased mRNA expression levels of CTGF, collagen I and collagen III were abolished by p38 inhibitors. Both immunofluorescence imaging and western blot analysis of p38 and p-p38 revealed the increased expression and phosphorylation of p38. Silencing the expression of p38 by siRNA in LF cells decreased the protein expression of p38, p-p38 and CTGF, as well as the mRNA expression of CTGF, collagen I and collagen III. Taken together, our findings indicate that TGF-β1, in association with the increased expression of CTGF, contribute to the homeostasis of the ECM and to the hypertrophy of LF through the p38 MAPK pathway. PMID:27279555

  8. TGF-β1, in association with the increased expression of connective tissue growth factor, induce the hypertrophy of the ligamentum flavum through the p38 MAPK pathway

    PubMed Central

    Cao, Yan-Lin; Duan, Yang; Zhu, Li-Xin; Zhan, Ye-Nan; Min, Shao-Xiong; Jin, An-Min

    2016-01-01

    Hypertrophy of the ligamentum flavum (LF) is one of the key pathomechanisms of lumbar spinal stenosis (LSS). Transforming growth factor (TGF)-β1 is abundantly expressed in hypertrophied degenerative LF tissues from LSS. However, the molecular mechanisms underling the association between TGF-β1 and LF hypertrophy have not yet been fully elucidated. In this study, we investigated the important role of the mitogen-activated protein kinase (MAPK) pathway in the pathogenesis of LSS by analyzing the expression of connective tissue growth factor (CTGF) and extracellular matrix (ECM) components (collagen I and collagen III) in TGF-β1-treated LF cells. Cell growth assay revealed that TGF-β1, in association with CTGF, enhanced the the proliferation of LF cells, and we found that TGF-β1 also elevated CTGF expression and subsequently enhanced the mRNA expression of collagen I and collagen III. The increased mRNA expression levels of CTGF, collagen I and collagen III were abolished by p38 inhibitors. Both immunofluorescence imaging and western blot analysis of p38 and p-p38 revealed the increased expression and phosphorylation of p38. Silencing the expression of p38 by siRNA in LF cells decreased the protein expression of p38, p-p38 and CTGF, as well as the mRNA expression of CTGF, collagen I and collagen III. Taken together, our findings indicate that TGF-β1, in association with the increased expression of CTGF, contribute to the homeostasis of the ECM and to the hypertrophy of LF through the p38 MAPK pathway. PMID:27279555

  9. An aid to tailoring the alar cartilages in tip rhinoplasty.

    PubMed

    Cucin, R L

    1980-06-01

    An aid to achieving a more precisely symmetric and individualized result in tip rhinoplasty is presented as an aid to both neophytes and experienced surgeons. It is thought to be particularly helpful in teaching variations of tip rhinoplasty and anticipating the results of proper resection. PMID:7384286

  10. [Stress on the ligamentum transversum acetabuli in physiological stress on the hip joint].

    PubMed

    Löhe, F; Eckstein, F; Putz, R

    1994-09-01

    We investigated the strain on the transverse acetabular ligament (TAL) and the labrum close to the anterior and posterior horn of the lunate surface using Omega strain gauges [5] while increasing loads were applied to the hip joint. Two fresh hip joint specimens and four specimens fixed in 3.7% formalin were examined. The two components of the joint were disarticulated and soaked in physiological saline and then placed in a material-testing machine (Zwick) in the neutral position of the joint. The strain on the TAL and the labrum was measured at loads of 10 N, 350 N, 700 N, 1050 N, 1400 N, 2100 N and 2800 N. Finally, the contact areas were measured at a load of 350 N using a polyether casting method. Depending on load, the length of the TAL increased by up to about 3.2% at a load of 2800 N, but the length of the labrum increased by only 0.5% at the same load. Following rotation of the femoral head to positions corresponding to 15 degrees extension and 15 degrees and 30 degrees flexion, only slight differences of about 0.2% for the TAL and even less for the labrum were measured. The contact areas are all located in the anterior and posterior horn of the lunate surface. The measured changes in strain on the TAL confirm the widening of the acetabular notch and a subsequent stretching of the TAL as the load on the hip joint increases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7973747

  11. [Features of the receptors of the alar system of locusts which have lost their ability to fly].

    PubMed

    Kniazeva, N I

    1986-02-01

    Using two species of locusts, Romalia microptera Beavy and Podisma pedestris L., receptors of the wing apparatus are described: campaniform sensillas of the wing, hair receptors of the tegula, chordotonal organ and thorax stretch receptor. A comparative analysis of the receptors mentioned with the homologous sensitive organs, participating in the control of wing movements, is performed in well flying species (Locusta migratoria migratorioides and Schistocerca gregaria). Loss of ability to fly is accompanied with a sharp decrease in the wing campaniform sensillas and in the tegula proprioceptive hairs. Simultaneously, there is loss of connection between the thorax receptors and the wing elements that are present in good flyers. The thorax stretch receptor begins to innervate the longitudinal dorsal muscle, as it is observed in the abdominal segments. The data obtained make it possible to speak about homology of the tergal chordotonal organs and the thorax and abdomen stretch receptors and about the pathways of their evolution, when the insects obtain and loose their ability to fly. PMID:3707362

  12. Kepler's Use of Archetypes in his defence against Aristotelian Scepticism

    NASA Astrophysics Data System (ADS)

    Martens, Rhonda M.

    In 1621, looking back over an impresive career, Johannes Kepler commented that "almost every book on astronomy which I have published since that time could be referred to one or another of the important chapters set out in this little book (the Mysterium Cosmographicum) and would contain either an illustration or a completion of it". Kepler viewed the Mysterium, his first book, as the genesis of hist later works; Here the author is focusing on the conceptual foundations it provided for his approach to physical astronomy and the Aristotelian dominant during his time. It turns out that despite Kepler's arowedly Platonic and Pythagorean sympathies, his physical astronomy comports with Aristotle's directives in the Posterior Analytics. Perhaps paradoxically, his arhetypal cosmology as expressed in the Mysterium enabled the merging Platonic and Aristotelian intuitions in his construction of the new astronomy.

  13. Effects of Conducting Plane on Band and Choral Musicians' Perceptions of Conductor and Ensemble Expressivity

    ERIC Educational Resources Information Center

    Silvey, Brian A.; Fisher, Ryan A.

    2015-01-01

    The purpose of this study was to examine whether one aspect of conducting technique, the conducting plane, would affect band and/or choral musicians' perceptions of conductor and ensemble expressivity. A band and a choral conductor were each videotaped conducting 1-min excerpts from Morten Lauridsen's "O Magnum Mysterium" while using a…

  14. After liber novus.

    PubMed

    Shamdasani, Sonu

    2012-06-01

    This paper reflects on the conference question concerning the clinical and theoretical significance of Jung's Liber Novus, two years after its initial publication, and looks at how Jung himself reflected upon it and how it informed his turn to alchemy, with particular attention to the theme of opposites and their reconciliation in Liber Novus, later taken up in Mysterium Coniunctionis. PMID:22724599

  15. Mästlin, Michael (1550-1631)

    NASA Astrophysics Data System (ADS)

    Murdin, P.

    2000-11-01

    Born in Göppingen, Germany, taught by, and an assistant to, PETER APIAN, became professor of astronomy at Tubingen, where he taught the Copernican as well as the Ptolemaic system. He taught KEPLER, and helped him to publish his first work, Mysterium Cosmographicum (1596). He made his own astronomical instruments. He was one of the first three or four astronomers to see in Cassiopeia what is now ...

  16. Vascular ring

    MedlinePlus

    ... with aberrant subclavian and left ligamentum ateriosus; Congenital heart defect - vascular ring; Birth defect heart - vascular ring ... accounts for less than 1% of all congenital heart problems. The condition occurs as often in males ...

  17. Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note.

    PubMed

    Hussain, Namath S; Perez-Cruet, Mick

    2016-01-01

    Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group's operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results.  Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times.  Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies. PMID:27433407

  18. Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note

    PubMed Central

    Perez-Cruet, Mick

    2016-01-01

    Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group’s operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results.  Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times.  Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies. PMID:27433407

  19. Johannes Kepler and David Fabricius: Their Discussion on the Nova of 1604

    NASA Astrophysics Data System (ADS)

    Granada, Miguel A.

    David Fabricius (1564-1617) was one of the most important astronomers in the period between 1596, the year of publication of Kepler's Mysterium cosmographicum, and 1609, the year of publication of the Astronomia nova.1 Kepler praised Fabricius as the most accurate observational astronomer after Tycho Brahe's death in 1601.2 Fabricius was a Reformed pastor in Ostfriesland (East Frisia), his remote natal region, and a vocational astronomer. He published nothing in the field of astronomy except for the short treatises between 1604 and 1606 concerning the nova that appeared in October 1604 in Serpentarius.

  20. Nasal Tip Deficiency.

    PubMed

    Cerkes, Nazim

    2016-01-01

    Nasal tip deficiency can be congenital or secondary to previous nasal surgeries. Underdeveloped medial crura usually present with underprojected tip and lack of tip definition. Weakness or malposition of lateral crura causes alar rim retraction and lateral nasal wall weakness. Structural grafting of alar cartilages strengthens the tip framework, reinforces the disrupted support mechanisms, and controls the position of the nasal tip. In secondary cases, anatomic reconstruction of the weakened or interrupted alar cartilages and reconstitution of a stable nasal tip tripod must be the goal for a predictable outcome. PMID:26616702

  1. Yes You Can! Personal Experience of Writing for "School Science Review"

    ERIC Educational Resources Information Center

    Thompson, Alaric; Auty, Geoff

    2013-01-01

    Alaric Thompson describes his experience of writing for "School Science Review" for the first time in the hope that his experience will encourage others. Geoff Auty introduces his piece and explains how it came about.

  2. Optical fiber guided needle insertion to localize epidural space in porcine

    NASA Astrophysics Data System (ADS)

    Chang, Yin; Ting, Chien Kun; Tsou, Mei-Yung; Chen, Pin-Tarng; Chan, Kwok-Hon

    2010-02-01

    A novel optical method of guiding epidural catheter insertion is introduced due to high failure rate of traditional technique for epidural blocks. Experiments of ex-vivo and in-vivo in porcine were performed. In the ex-vivo study the optically reflective spectra of identified porcine tissues were obtained. By which wavelengths of 650 nm and 532 nm were selected to differentiate epidural space and ligamentum flavum. Then the typical stylet of an insertion needle set was replaced by a specially designed hollow stylet which contained optical fibers served for tissue illumination and receiving reflected light from tissue in the in-vivo experiment in pigs. The data was promising with mean magnitudes for 650 nm and 532 nm and their ratio at epidural space and ligamentum flavum were 3.565+/-0.194, 2.542+/-0.145, 0.958+/-0.172 and 3.842+/-0.191, 2.563+/-0.131, 1.228+/-0.244 respectively. Paired t test showed that significant differences occurred between epidural spaces and ligamentum flavum in both 650nm (p<0.001), 532nm (p=0.014) and their ratio (p <0.001). Two-way ANOVA for reflective lights of 650 and 532 nm indicates no significant difference at the different puncture sites for ligamentum flavum and epidural space (all p>0.05).

  3. Anatomical study of the intrahepatic biliary ducts. Parameters that guide the surgical approach in transplanting the left lobe of the liver

    PubMed Central

    FARIAS, F.; BIGOLIN, A. VICENTE; CAVAZZOLA, L. TOTTI; DA COSTA FILHO, O. PEREIRA; DA COSTA, R. GONÇALVES; KALIL, A. NOCCHI

    2013-01-01

    Summary Introduction The techniques of split liver transplantation and transplanting organs from living donors require a thorough anatomical knowledge of biliary drainage, and this is an important factor in preventing complications. Methods forty-five human livers were used to perform this study. Measurements were made between the confluence of the right hepatic duct (RHD) and the left hepatic duct (LHD) and among the following structures: the venous ligament, the vertex of the confluence of the duct of segment II (DSll) and the duct of segment III (DSIII), the insertion of the duct of the segment I (DSI) and the duct of segment IV (DSIV). Then the distance between the vertex of the confluence of DSII and DSIII and the ligamentum venosum was checked. Results The LHD had less anatomical variation than the RHD. Four drainage patterns were established for the left lobe, and pattern l, in which the confluence of DSll and DSIII is to the left of the ligamentum venosum, is considered to be the most constant one. A single duct of the confluence of DSll and DSIII was found 1, 2 and 2.5 cm to the right of the ligamentum venosum in 65%, 80%, and 95% of the cases, respectively. Conclusion It was possible to show evidence of four drainage patterns of the left anatomical lobe of the liver. Furthermore, it was possible to establish the ligamentum venosum as an anatomical reference for locating the confluences of the ducts of the left liver segments. PMID:24091176

  4. Jung's quest for the Aurora consurgens.

    PubMed

    Haaning, Aksel

    2014-02-01

    The paper focuses on the year 1929 when Jung published 'A European commentary' to Richard Wilhelm's German translation of the Taoist text The Secret of the Golden Flower. This shows that Jung had already started on the track of European alchemy by following up Conrad Waldkirch's preface in Artis Auriferae (1593); and it raises the question of whether this could be the possible missing link to Jung's subsequent research in Alchemy and Hermetic Philosophy in the years to come. It is argued that here was the beginning of Jung's quest for the Aurora consurgens, the publication of which concludes the Mysterium Conuinctionis more than twenty years later. It is further maintained that this choice of the Aurora is a profound expression of Jung's ambition to revitalize the past from within the individual, and helps explain Jung's deep concern with the welfare and future of modern society. PMID:24467350

  5. Cosmological Theories at the time of Tycho Brahe

    NASA Astrophysics Data System (ADS)

    Hadravova, Alena; Hadrava, Petr

    The basic task of astronomy till the epoch of Kepler was to create a model of the Solar system which would agree with observations and simultaneously be self -consistent. From the observational point of view the geocentric and heliocentric theories were equivalent and for a suitable choice of free parameters represented by the system of epicicles they could agree with Kepler's laws to any accuracy. The main advantage of Copernicus'system was its deeper consistency manifesting itself by smaller number of free parameters. This was achieved on behalf of intuitively accepted physical ideas. The comromising system of Tycho was able to save an essential part of these ideas and, moreover, to overcome the disageement of Copernicus's system with observational limits on stellar parallaxes. On the other hand, the Kepler's model from Mysterium cosmographicum was an attempt to derive all free parameters from very basic geometric symmetries. Such an idea provides deep motivation even for today's cosmology.

  6. A Journal of travel of an astrophysicist

    NASA Astrophysics Data System (ADS)

    Gaina, Alex B.

    2015-06-01

    The authors is descibing personal impressions from a number of scientific conferences took between 1993 and 1998 in Trieste (ICTP,with the participation of 2 Nobel Laureats Winners: Professor Abdus Salam (1926-1996) and Professor Gert t'Hooft), Catania astrophysical Observatory and University (1995-JENAM 1995), Athens Observatory and University (1996-Wide Field Spectroscopy), Prague Technicke Museum (1996- Symposium "Mysterium Cosmographicum"),Prague technical University (1998 -JENAM 1998),which in fact contained also a trip to Nicolaus Copernicus Astronomical Center in Torun (Poland). Besides,some details on trips through Ukraine, Poland, Serbia, where a kind meeting with astronomers from Belgrade took place in 1995, former Yugoslav Countries: Monetnegro, Slovenija and Croatia, Bulgaria, where another meeting with physicists from the Academy of Sciences of Bulgaria took place has been given also.

  7. Kepler's winding Path to true Heliocentrism

    NASA Astrophysics Data System (ADS)

    Bialas, Volker

    The paper concerns the evolution of concepts by Johannes Kepler from Aristotelian conception of the Universe to Heliocentrism. Already as young Magister in Tubingen Kepler has taken an active part in Physical disputations of the candidates and has defended the doctrines of Copernik (1). In the Mysterium Cosmographicum he refers the planetary distances no longer to the center of the earth's orbit, but to the center of the true sun. But just by working out his Astronomia Nova Kepler succeeds in creating a strictly heliocentric astronomy as his handwriting Manuscripts give detailed information (2). Notes: 1) fragmentum orations de motu terrae. In Keppler Gesammelte werke Vol. 20.1, Munich 1988, p. 147-149 2) Commentaria in Theoriam Martis. Edition in: Kepler Gessamelete Werke Vol. 20.2 (in preparation)

  8. From Cosmos to Confession: Kepler and the Connection Between Astronomical and Religious Truth

    NASA Astrophysics Data System (ADS)

    Rothman, Aviva

    In October of 1595, Johannes Kepler joyfully conveyed to Tübingen the news that he had completed his first book, the Mysterium cosmographicum. "I truly desire," he wrote to Michael Maestlin, his former professor of mathematics, "that these things are published as quickly as possible for the glory of God, who wants to be known from the Book of Nature […]. I wanted to be a theologian; for a long time I was distressed: behold God is now celebrated too in my astronomical work."1 Unable to devote himself to the Book of Scripture directly,2 Kepler had turned his focus to God's other book - the Book of Nature - which, he believed, also revealed God's providential plan.

  9. Kepler's Cosmos And The Lathe Of Heaven

    NASA Astrophysics Data System (ADS)

    Brecher, Kenneth

    2011-01-01

    Johannes Kepler's Mysterium Cosmographicum, published in 1596, presented his vision of the geometrical structure of the solar system. Kepler sought to account for the number of planets, thought to be six, as well as their orbital radii. He assigned orbits to the planets in three-dimensional space. Kepler proposed that the planets move on six spheres inscribed within and circumscribed around the five platonic solids. How did he arrive at his model? By his own account reported in the book, the central idea occurred to him while giving a lecture about planetary conjunctions. But was this revelation the origin of the model? In this presentation, we discuss the artistic, scientific and mathematical environment in which Kepler was immersed in late 16th century Europe. Examples will be shown of some of the readily available inscribed polyhedra that he may have seen - printed in widely circulated books, included in well-known paintings and engravings, and displayed as three dimensional ornamentally turned sculptures. It is highly likely that he saw such physical models five years later while in the employ of Rudolf II who was an avid ornamental turner. Layered polyhedral ivory turnings were made by the nobility with what were then fairly common lathes. Kepler himself wanted to have his own celestial model made into a punch bowl! Therefore, it seems plausible that Kepler had seen models of inscribed platonic solids well before 1596. Later in life Kepler reprinted the Mysterium Cosmographicum with very little fundamental change in its outlook, even after having found what we now call Kepler's three laws of planetary motion. His interest in nested polyhedra may well have preceded any astronomical evidence or geometrical reasoning, arising from artistic and aesthetic encounters that occurred early in his life. Project LITE is supported by the NSF through DUE Grant # 0715975.

  10. “Don Juan-Fracture” as a Hint to Aortic Isthmus Rupture

    PubMed Central

    Suksompong, Sirilak; von Bormann, Benno

    2014-01-01

    We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called “Don-Juan fracture,” and aortic rupture at the site of ligamentum arteriosum are discussed. PMID:25478249

  11. Prevention of nerve root adhesions after laminectomy.

    PubMed

    Yong-Hing, K; Reilly, J; de Korompay, V; Kirkaldy-Willis, W H

    1980-01-01

    In repeat lumbar surgery for failure of the original operation to provide lasting relief, well-organized fibrous tissue is often noted binding together the dura, nerve roots, and erector spinae muscles. Lumbar laminectomy was carried out in 46 dogs and seven groups of animals studied. Gelfoam failed to prevent fibrosis. Free fat grafts prevented fibrosis whether the graft was placed at the laminectomy site or around the nerve roots. Vascularization of the grafts was demonstrated by injection of India ink before sacrifice. Ligamentum nuchae, which is similar to ligamentum flavum in its high elastic content, was also effective in preventing scar formation. The operative biopsy findings at reexploration in four patients who had free fat grafts following laminectomy are presented. PMID:7361199

  12. Thoracoscopic correction of a congenital persistent right aortic arch in a young cat

    PubMed Central

    Plesman, Rhea; Johnson, Matthew; Rurak, Sarah; Ambrose, Barbara; Shmon, Cindy

    2011-01-01

    A 9-week-old kitten was diagnosed with a congenital vascular ring anomaly by means of an esophageal contrast study. At 6 mo of age, a non-selective vascular study was used to diagnose a persistent right aortic arch (PRAA). Left-sided thoracoscopic surgery was performed, using a Liga-Sure vessel sealant device to seal and transect the ligamentum arteriosum. PMID:22467970

  13. Adaptive spatial compounding for improving ultrasound images of the epidural space on human subjects

    NASA Astrophysics Data System (ADS)

    Tran, Denis; Hor, King-Wei; Kamani, Allaudin; Lessoway, Vickie; Rohling, Robert N.

    2008-03-01

    Administering epidural anesthesia can be a difficult procedure, especially for inexperienced physicians. The use of ultrasound imaging can help by showing the location of the key surrounding structures: the ligamentum flavum and the lamina of the vertebrae. The anatomical depiction of the interface between ligamentum flavum and epidural space is currently limited by speckle and anisotropic reflection. Previous work on phantoms showed that adaptive spatial compounding with non-rigid registration can improve the depiction of these features. This paper describes the development of an updated compounding algorithm and results from a clinical study. Average-based compounding may obscure anisotropic reflectors that only appear at certain beam angles, so a new median-based compounding technique is developed. In order to reduce the computational cost of the registration process, a linear prediction algorithm is used to reduce the search space for registration. The algorithms are tested on 20 human subjects. Comparisons are made among the reference image plus combinations of different compounding methods, warping and linear prediction. The gradient of the bone surfaces, the Laplacian of the ligamentum flavum, and the SNR and CNR are used to quantitatively assess the visibility of the features in the processed images. The results show a significant improvement in quality when median-based compounding with warping is used to align the set of beam-steered images and combine them. The improvement of the features makes detection of the epidural space easier.

  14. The distribution of nociceptive innervation in the painful hip: a histological investigation.

    PubMed

    Haversath, M; Hanke, J; Landgraeber, S; Herten, M; Zilkens, C; Krauspe, R; Jäger, M

    2013-06-01

    Our understanding of the origin of hip pain in degenerative disorders of the hip, including primary osteoarthritis, avascular necrosis and femoroacetabular impingement (FAI), is limited. We undertook a histological investigation of the nociceptive innervation of the acetabular labrum, ligamentum teres and capsule of the hip, in order to prove pain- and proprioceptive-associated marker expression. These structures were isolated from 57 patients who had undergone elective hip surgery (44 labral samples, 33 ligamentum teres specimens, 34 capsular samples; in 19 patients all three structures were harvested). A total of 15,000 histological sections were prepared that were investigated immunohistochemically for the presence of protein S-100, 68 kDa neurofilament, neuropeptide Y, nociceptin and substance P. The tissues were evaluated in six representative areas. Within the labrum, pain-associated free nerve ending expression was located predominantly at its base, decreasing in the periphery. In contrast, the distribution within the ligamentum teres showed a high local concentration in the centre. The hip capsule had an almost homogeneous marker expression in all investigated areas. This study showed characteristic distribution profiles of nociceptive and pain-related nerve fibres, which may help in understanding the origin of hip pain. PMID:23723270

  15. The Learning Conference: Knowledge Creation through Participation and Publication

    ERIC Educational Resources Information Center

    Louw, Ina; Zuber-Skerritt, Ortrun

    2011-01-01

    Purpose: The aim of this paper is to identify the principles and characteristics of a learning conference which uses action learning and action research (ALAR) processes to create: optimal learning for all participants through a collaborative, inclusive conference culture; further knowledge creation in publishing conference papers post-conference…

  16. Descending Mediastinitis in Epstein-Barr Virus Infection

    PubMed Central

    van Driel, E. M.; Janssen, M. J. F. M.

    2015-01-01

    Our case report describes a previously healthy 34-year-old male who develops a descending mediastinitis as a complication of an Epstein-Barr virus (EBV) infection. The mediastinitis was suspected to have developed by a breakthrough of a peritonsillar abscess through the space between the alar and prevertebral space. PMID:25740774

  17. Conditional cell ablation via diphtheria toxin reveals distinct requirements for the basal plate in the regional identity of diencephalic subpopulations.

    PubMed

    Lee, Bumwhee; Lam, Duc Tri; Baek, Kwanghee; Yoon, Jaeseung; Jeong, Yongsu

    2015-06-01

    The mammalian diencephalon is the caudal derivative of the embryonic forebrain. Early events in diencephalic regionalization include its subdivision along the dorsoventral and anteroposterior axes. The prosomeric model by Puelles and Rubenstein (1993) suggests that the alar plate of the posterior diencephalon is partitioned into three different prosomeres (designated p1-p3), which develop into the pretectum, thalamus, and prethalamus, respectively. Here, we report the developmental consequences of genetic ablation of cell populations from the diencephalic basal plate. The strategy for conditionally regulated cell ablation is based on the targeted expression of the diphtheria toxin gene (DTA) to the diencephalic basal plate via tamoxifen- induced, Cre-mediated recombination of the ROSA(DTA) allele. We show that activation of DTA leads to specific cell loss in the basal plate of the posterior diencephalon, and disrupted early regionalization of distinct alar territories. In the basal plate-deficient embryos, the p1 alar plate exhibited reduced expression of subtype-specific markers in the pretectum, whereas p2 alar plate failed to further subdivide into two discrete thalamic subpopulations. We also show that these defects lead to abnormal nuclear organization at later developmental stages. Our data have implications for increased understanding of the interactive roles between discrete diencephalic compartments. PMID:25950659

  18. Subcutaneous Nasolabial Flap for Eliminating Depressed Nasal Floor in Adult Cleft Rhinoplasty: Technical Note.

    PubMed

    Rahpeyma, Amin; Khajehahmadi, Saeedeh; Torabizadeh Siraji, Arman

    2015-06-01

    Depressed nasal floor extension into the nostril in cleft patients is difficult to solve. Suggested ways for solving this problem need skin incisions other than routine open rhinoplasty incisions. Nasolabia subcutaneous flap makes the infrastructure in depressed nasal floor in cleft patients. Alar advancement and medial nasal floor triangular flap cover it. PMID:26180711

  19. Reflecting on a Leadership Development Programme: A Case Study in South African Higher Education

    ERIC Educational Resources Information Center

    Louw, Ina; Zuber-Skeritt, Ortrun

    2009-01-01

    Leadership development in higher education is of vital importance to South Africa's future. We present a case study that focuses on a leadership development programme (LDP) through action learning and action research (ALAR) for women academics in South Africa during 2000 and 2001. It identifies the effects of the LDP on participants five years…

  20. Repair of "coup de sabre," a linear form of scleroderma.

    PubMed

    Sengezer, M; Deveci, M; Selmanpakoglu, N

    1996-10-01

    A case of coup de sabre, a linear form of scleroderma, is presented. Treatment consisted of soft-tissue expansion and autologous bone grafting to the forehead, a composite graft for alar reconstruction, and a scalp graft for eyebrow reconstruction. None of the linear scleroderma cases reported in the literature consisted of bony reconstruction. PMID:8905054

  1. Urea Unfolding Study of E. coli Alanyl-tRNA Synthetase and Its Monomeric Variants Proves the Role of C-Terminal Domain in Stability

    PubMed Central

    Banerjee, Baisakhi; Banerjee, Rajat

    2015-01-01

    E. coli alanyl-tRNA exists as a dimer in its native form and the C-terminal coiled-coil part plays an important role in the dimerization process. The truncated N-terminal containing the first 700 amino acids (1–700) forms a monomeric variant possessing similar aminoacylation activity like wild type. A point mutation in the C-terminal domain (G674D) also produces a monomeric variant with a fivefold reduced aminoacylation activity compared to the wild type enzyme. Urea induced denaturation of these monomeric mutants along with another alaRS variant (N461 alaRS) was studied together with the full-length enzyme using various spectroscopic techniques such as intrinsic tryptophan fluorescence, 1-anilino-8-naphthalene-sulfonic acid binding, near- and far-UV circular dichroism, and analytical ultracentrifugation. Aminoacylation activity assay after refolding from denatured state revealed that the monomeric mutants studied here were unable to regain their activity, whereas the dimeric full-length alaRS gets back similar activity as the native enzyme. This study indicates that dimerization is one of the key regulatory factors that is important in the proper folding and stability of E. coli alaRS. PMID:26617997

  2. Malignant perivascular epithelioid cell tumor of the gallbladder: a case report and review of literature.

    PubMed

    Zhao, Liena; Anders, Karl H

    2014-09-01

    Perivascular epithelioid cell tumors are rare mesenchymal neoplasms composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. The perivascular epithelioid cell tumor family includes angiomyolipoma, clear cell sugar tumor of the lung, lymphangioleiomyomatosis, clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres, and rare clear cell tumors of other anatomic sites. Perivascular epithelioid cell tumors have been reported previously in various sites, but to our knowledge not in the gallbladder. We report here, for the first time, a malignant perivascular epithelioid cell tumor arising in the gallbladder. PMID:25171708

  3. A Novel Technique for Managing Pancreaticojejunal Anastomotic Leak after Pancreaticoduodenectomy

    PubMed Central

    Unek, Tarkan; Ozbilgin, Mucahit; Goztok, Mustafa; Astarcıoglu, Ibrahim

    2016-01-01

    Pancreaticoduodenectomy (Whipple's procedure) remains the only definitive treatment option for tumors of the periampullary region. The most common and life-threatening complications following the procedure are pancreatic anastomotic leakage and subsequent fistula formation. When these complications occur, treatment strategy depends on the severity of anastomotic leakage, with patients with severe leakages requiring reoperation. The optimal surgical method used for reoperation is selected from among different options such as wide drainage, definitive demolition of the pancreaticojejunal anastomosis and performing a new one, or completion pancreatectomy. Here we present a novel, simple technique to manage severe pancreatic leakage via ligamentum teres hepatis patch. PMID:27403368

  4. Neck ligament strength is decreased following whiplash trauma

    PubMed Central

    Tominaga, Yasuhiro; Ndu, Anthony B; Coe, Marcus P; Valenson, Arnold J; Ivancic, Paul C; Ito, Shigeki; Rubin, Wolfgang; Panjabi, Manohar M

    2006-01-01

    Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the

  5. Typical asthmatic presentation of congenital vascular ring can masquerade a general physician.

    PubMed

    Swami, Naveen; Koshy, Georgey; Jamal, Maan; Abdulla, Thair S; Alkhulaifi, Abdulaziz

    2013-01-01

    A 24-year-old woman was referred to pulmonologist with worsening breathlessness and wheeze. During childhood, she was diagnosed with asthma and subsequent exacerbations were treated with bronchodilators for many years. The chest X-ray and a spirometry testing raised a doubt of extrinsic tracheal compression and a subsequent enhanced chest CT (computerized tomogram) scan confirmed a right-sided aortic arch and a vascular ring anomaly compressing the trachea. Standard surgical division of ligamentum arteriosum was able to relieve the trachea and so the symptoms. PMID:23476884

  6. Typical Asthmatic Presentation of Congenital Vascular Ring Can Masquerade a General Physician

    PubMed Central

    Swami, Naveen; Koshy, Georgey; Jamal, Maan; Abdulla, Thair S.; Alkhulaifi, Abdulaziz

    2013-01-01

    A 24-year-old woman was referred to pulmonologist with worsening breathlessness and wheeze. During childhood, she was diagnosed with asthma and subsequent exacerbations were treated with bronchodilators for many years. The chest X-ray and a spirometry testing raised a doubt of extrinsic tracheal compression and a subsequent enhanced chest CT (computerized tomogram) scan confirmed a right-sided aortic arch and a vascular ring anomaly compressing the trachea. Standard surgical division of ligamentum arteriosum was able to relieve the trachea and so the symptoms. PMID:23476884

  7. Kepler, Galilei, the telescope and the consequences. (German Title: Kepler, Galilei, das Fernrohr und die Folgen)

    NASA Astrophysics Data System (ADS)

    Gaulke, Karsten; Hamel, Jürgen

    The papers of this volume are dedicated to Johannes Kepler, the astronomy of his time, and the consequences of his researches. They deal with the reception on the Copernican system of the world at the court of landgrave William IV in Kassel and the use of astronomy at a princely court in the 16th century, exemplified by the Kassel residence. Two contributions discuss a text fragment in Kepler's Astronomia Nova and the dimensions of the geo- and heliocentric systems of the world in Kepler's Mysterium Cosmographicum. Other contributions deal with mathematical aspects un Kepler's exchange of letters, the biography of Kepler's discussion partner Ph. Feselius, as well as the early reception of the Tabulae Rudolphinae in the calendar literature, telescopes in Kepler's time, Chr. Scheiner's optical theory of the eye, and finally in the continuation of the heliocentric world system by Otto von Guericke's natural philosophy and science. In conclusion, the documents of the planned call of Kepler to Rostock university, as well as the first publication of a recently found, hitherto unknown letter by Kepler.

  8. World species of the genus Platyscelio Kieffer (Hymenoptera: Platygastridae)

    PubMed Central

    Taekul, Charuwat; Johnson, Norman F.; Masner, Lubomír; Polaszek, Andrew; Rajmohana K.

    2010-01-01

    Abstract The genus Platyscelio Kieffer (Hymenoptera: Platygastridae, Scelioninae) is a widespread group in the Old World, found from West Africa to northern Queensland, Australia. The species concepts are revised and a key to world species is presented. The genus is comprised of 6 species, including 2 known species which are redescribed: Platyscelio africanus Risbec (Benin, Cameroon, Central African Republic, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Mozambique, Nigeria, Sierra Leone, South Africa, Tanzania, Togo, Uganda, Yemen, Zimbabwe); and Platyscelio pulchricornis Kieffer (Australia, Bangladesh, China, India, Indonesia, Japan, Malaysia, Papua New Guinea, Philippines, Solomon Islands, Taiwan, Thailand, Vanuatu, Vietnam). Five species-group names are considered to be junior synonyms of Platyscelio pulchricornis: Platyscelio abnormis Crawford syn. n., Platyscelio dunensis Mukerjee syn. n., Platyscelio mirabilis Dodd syn. n., Platyscelio punctatus Kieffer syn. n., and Platyscelio wilcoxi Fullaway. The following species are hypothesized and described as new taxa: Platyscelio arcuatus Taekul & Johnson, sp. n. (Western Australia); Platyscelio mysterium Taekul & Johnson, sp. n. (Zimbabwe, Botswana, South Africa); Platyscelio mzantsi Taekul & Johnson, sp. n. (South Africa); and Platyscelio striga Taekul & Johnson, sp. n. (Western Australia). PMID:21594118

  9. Technique in Cleft Rhinoplasty: The Foundation Graft.

    PubMed

    Gassner, Holger G; Schwan, Franziska; Haubner, Frank; Suárez, Gustavo A; Vielsmeier, Veronika

    2016-04-01

    Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side. This foundation graft is suture fixated to the piriform crest after complete release of all soft tissue attachments to the alar base. The foundation graft is articulated with a long alar strut graft, which allows for powerful projection of the cleft-sided nasal tip. An advancement flap of vestibular skin is described to correct the vestibular stenosis. A transplant of diced cartilage in fascia is added to augment maxillary soft tissue volume. Subjective and objective measures of form and function are presented in a retrospective series of five cases, illustrating the efficacy of the techniques described. PMID:27097143

  10. Sentinel node in ovarian cancer: study protocol for a phase 1 study

    PubMed Central

    2013-01-01

    Background The concept of sentinel lymph node surgery is to determine whether the cancer has spread to the very first lymph node or sentinel node. If the sentinel node does not contain cancer, then there is a high likelihood that the cancer has not spread to other lymph nodes. The sentinel node technique has been proven to be effective in different types of cancer. In this study we want to determine whether a sentinel node procedure in patients with ovarian cancer is feasible when the tracers are injected into the ovarian ligaments. Methods/Design Patients with a high likelihood of having an ovarian malignancy in whom a median laparotomy and a frozen section analysis is planned and patients with endometrial cancer in whom a staging laparotomy is planned will be included. Before starting the surgical staging procedure, blue dye and radioactive colloid will be injected into the ligamentum ovarii proprium and the ligamentum infundibulo-pelvicum. In the analysis we calculate the percentage of patients in whom it is feasible to identify sentinel nodes. Other study parameters are the anatomical localization of the sentinel node(s) and the incidence of false negative lymph nodes. Trial registration Approval number: NL40323.068.12 Name: Medical Ethical Committee Maastricht University Hospital, University of Maastricht Affiliation: Maastricht University Hospital Board Chair Name: Medisch Ethische Commissie azM/UM PMID:23414057

  11. Inflammatory changes after extradural anaesthesia may affect the spread of local anaesthetic within the extradural space.

    PubMed

    Igarashi, T; Hirabayashi, Y; Shimizu, R; Mitsuhata, H; Saitoh, K; Fukuda, H; Konishi, A; Asahara, H

    1996-09-01

    We have assessed cephalad spread of analgesia in 491 patients undergoing extradural anaesthesia at the L2-3 or L3-4 interspace. Patients were classified into one of three groups based on the number of previous lumbar extradural anaesthesia procedures: none (group I, n = 339), one (group II, n = 82), and two or more (group III, n = 70). Cephalad spread of analgesia was greater in group I than in groups II and III, regardless of the puncture site. In addition, we examined the extradural space using a flexible extraduroscope in 32 patients who were excluded from the analysis of spread. Extraduroscopy showed the extradural space to be patent in patients with no history of prior lumbar extradural anesthesia, but it was not clearly identified in patients who had received extradural anaesthesia one or more times because of aseptic inflammatory changes, including proliferation of connective tissue, adhesions between the dura mater and the ligamentum flavum, granulation and changes in the ligamentum flavum. Extradural anaesthesia may cause aseptic inflammatory changes in the extradural space which may reduce the spread of analgesia. PMID:8949808

  12. Obtuse-angled Laminotomy as a Modification of Multilevel Laminectomy for Spinal Cord Decompression.

    PubMed

    Jhas, Sumit; Pirouzmand, Farhad

    2016-03-01

    The purpose of this note is to describe an obtuse-angled laminotomy of C7 during cervical decompression that aims to preserve cervicothoracic junction stability and potentially reduce pain. Cervical spondylotic myelopathy can result from degenerative cervical spinal disease including, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multilevel myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Multilevel laminectomy is traditionally used when degenerative changes affect 3 or more levels and when there is primarily dorsal compressive disease. Traditional laminectomy can result in instability and kyphosis. The C7 lamina can be particularly vulnerable given the location at cervicothoracic junction. We describe an obtuse-angled laminotomy for the most caudal lamina in a planned decompression. This lamina is left attached to ligamentum nuchea, adjacent fascia, and paravertebral muscles. Only the base of spinous process and ventral portion of lamina's cortical and cancellous bone are removed in an obtuse angle through the opening. This variation is aimed to preserve as much of the cervical stability while still achieving the goal of decompression. PMID:26889986

  13. New theory of uterovaginal embryogenesis

    PubMed Central

    Makiyan, Zograb

    2016-01-01

    ABSTRACT Background: The explanation of uterine and vaginal embryogenesis in humans still poses many controversies, because it is difficult to assess early stages of an embryo. The literature review revealed many disagreements in Mullerian theory, inciting some authors to propose new embryological hypotheses. In the original Mullerian theory: the paramesonephral ducts form the Fallopian tubes, uterus and vagina; the mesonephral ducts regress in female embryos. Aims: The aim of this article is to investigate the development of Mullerian ducts in humans, using comparative analysis of fundamental embryological theory and various utero-vaginal anomalies. Material and methods: Between 1998 and 2015, 434 patients with various uterovaginal malformations had been operated on at the Scientific Centre of Obstetrics Gynaecology and Perynatology in Moscow. The anatomies of the uterovaginal malformations in these patients were diagnosed with ultrasound and MRI and then verified during surgical correction by laparoscopy. Results: A systematic comparison of uterovaginal malformations to those in the literature has allowed us to formulate a new theory of embryonic morphogenesis. The new theory is significantly different: ovary, ovarian ligamentum proprium, and ligamentum teres uteri derive from gonadal ridges; Fallopian tubes and vagina completely develop from mesonephral ducts. The uterus develops in the area of intersection between the mesonephral ducts with gonadal ridges by the fusion of the two. Conclusions: The new theory may to induce future embryological studies. The hypothetic possibility that the ovary and endometrium derive from the gonadal ridges could be the key to understanding the enigmatic aetiologies of extragenital and ovarian endometriosis. PMID:26900909

  14. Clinical and radiographical results of labral reconstruction

    PubMed Central

    Camenzind, Roland S.; Steurer-Dober, Isabelle; Beck, Martin

    2015-01-01

    Treatment of femoroacetabular impingement (FAI) includes correction of underlying bony deformities. Labrum preservation is recommended whenever possible. In hips, where the labrum is missing or damaged beyond preservation, labral reconstruction is an option to restore labral seal. Between 2008 and 2011, 84 hips underwent treatment for FAI by means of a surgical hip dislocation. In 13 of these hips (11 patients), the severely damaged or missing labrum was reconstructed with ligamentum capitis femoris. Pre- and postoperative radiographic and clinical data were analysed with a mean follow-up of 38 months (range: 19–65 months). Clinical outcome was determined with Oxford hip score (OHS) and overall satisfaction, rest and load pain with a visual analogue scale (VAS; 0–100). Clinical outcome was compared with a control group where labral refixation was performed. Mean OHS improved significantly (P ≤ 0.001) from 29 (SD 8) to 44 (SD 4). Overall satisfaction with the hip increased significantly (P = 0.002) from 44 (SD 35) to 87 (SD 15). Mean VAS for rest pain decreased significantly (P = 0.0004) from 45 (SD 35) to 5 (SD 7) as well as for load pain (P = 0.0007) from 59 (SD 26) to 16 (SD 19). There were no significant differences between the two groups. Reconstruction of the acetabular labrum with ligamentum capitis femoris yields good clinical results. Technical superiority of open labral reconstruction may explain the unexpected, excellent outcome. PMID:27011865

  15. Posterior epidural fibrotic mass associated with Baastrup’s disease

    PubMed Central

    Jang, Eui-Chan; Lee, Han-Jun; Kim, Jae Yoon; Yang, Jae Jun

    2010-01-01

    A few reports have demonstrated rare cases of Baastrup’s disease that involve epidural cysts that cause dural compression. However, there have been no reports of a midline epidural fibrotic mass being associated with Baastrup’s disease. A 60-year-old man presented with neurogenic claudication that had lasted for 5 years. Radiography showed anterolisthesis at the L4–L5 level, magnetic resonance imaging demonstrated severe stenosis due to a posterior noncystic mass, and the linear fluid signal tracked into the posterior epidural space at the L4–L5 level. A cleft in the ligamentum flavum was identified by probe at surgery, and this enabled the probe to be inserted into the epidural space without excising ligamentum flavum. Histological analysis showed that the fibrotic mass consisted of a collagen matrix that had a cystic component and exhibited a peripheral inflammatory reaction. This report shows that it is possible for an extended epidural cystic mass that occurs in Baastrup’s disease to change over time through peripheral inflammation into a cyst-containing fibrotic mass. PMID:20063020

  16. Depicting the inner and outer nose: the representation of the nose and the nasal mucosa on the human primary somatosensory cortex (SI).

    PubMed

    Gastl, Mareike; Brünner, Yvonne F; Wiesmann, Martin; Freiherr, Jessica

    2014-09-01

    The nose is important not only for breathing, filtering air, and perceiving olfactory stimuli. Although the face and hands have been mapped, the representation of the internal and external surface of the nose on the primary somatosensory cortex (SI) is still poorly understood. To fill this gap functional magnetic resonance imaging (fMRI) was used to localize the nose and the nasal mucosa in the Brodman areas (BAs) 3b, 1, and 2 of the human postcentral gyrus (PG). Tactile stimulation during fMRI was applied via a customized pneumatically driven device to six stimulation sites: the alar wing of the nose, the lateral nasal mucosa, and the hand (serving as a reference area) on the left and right side of the body. Individual representations could be discriminated for the left and right hand, for the left nasal mucosa and left alar wing of the nose in BA 3b and BA 1 by comparing mean activation maxima and Euclidean distances. Right-sided nasal conditions and conditions in BA 2 could further be separated by different Euclidean distances. Regarding the alar wing of the nose, the results concurred with the classic sensory homunculus proposed by Penfield and colleagues. The nasal mucosa was not only determined an individual and bilateral representation, its position on the somatosensory cortex is also situated closer to the caudal end of the PG compared to that of the alar wing of the nose and the hand. As SI is commonly activated during the perception of odors, these findings underscore the importance of the knowledge of the representation of the nasal mucosa on the primary somatosensory cortex, especially for interpretation of results of functional imaging studies about the sense of smell. PMID:24659451

  17. Further characterization of Escherichia coli alanyl-tRNA synthetase.

    PubMed

    Sood, S M; Slattery, C W; Filley, S J; Wu, M X; Hill, K A

    1996-04-15

    Selected physical and thermodynamic parameters for Escherichia coli alanyl-tRNA synthetase (AlaRS) have been determined primarily to assess the quaternary structure of this enzyme. The extinction coefficient (epsilon) at 280 nm was determined experimentally to be 0.71 ml mg-1 cm-1, and the partial specific volume (nu) was calculated from the amino acid composition to be 0.73 ml g-1. From viscosity experiments the intrinsic viscosity (eta) of AlaRS was extrapolated to be 3.4 ml g-1 and the degree of hydration (delta 1) estimated to be 0.67 gH2O g(-1)(AlaRS). Laser light-scattering studies indicated some heterogeneity; a radius of 6.3 nm was calculated for the major fraction with a diffusion coefficient (D20,W) of 3.89 x 10(-7) cm2 s-1. In 50 mM Hepes, pH 7.5, 20 mM KCl, 2 mM 2-mercaptoethanol and at a protein concentration of 4.2 mg ml-1 the sedimentation coefficient (S20,W) was 6.36 S; this value increased slightly when the protein concentration was decreased. The combination of S20,W and D20,W under these conditions yielded a molecular weight of approximately 186,000 Da, corresponding to a dimer. The S20,W was virtually independent of temperature in the range of 10-37 degrees C, while an Arrhenius plot of aminoacylation activity was biphasic. The isoelectric point was determined experimentally to be 4.9. Sedimentation equilibrium data were best fit to a decamer association complex in which dimeric AlaRS is the predominant species at 25 degrees C. PMID:8645007

  18. Regional expression of Pax7 in the brain of Xenopus laevis during embryonic and larval development

    PubMed Central

    Bandín, Sandra; Morona, Ruth; Moreno, Nerea; González, Agustín

    2013-01-01

    Pax7 is a member of the highly conserved Pax gene family that is expressed in restricted zones of the central nervous system (CNS) during development, being involved in early brain regionalization and the maintenance of the regional identity. Using sensitive immunohistochemical techniques we have analyzed the spatiotemporal pattern of Pax7 expression in the brain of the anuran amphibian Xenopus laevis, during development. Pax7 expression was first detected in early embryos in the basal plate of prosomere 3, roof and alar plates of prosomere 1 and mesencephalon, and the alar plate of rhombomere 1. As development proceeded, Pax7 cells were observed in the hypothalamus close to the catecholaminergic population of the mammillary region. In the diencephalon, Pax7 was intensely expressed in a portion of the basal plate of prosomere 3, in the roof plate and in scattered cells of the thalamus in prosomere 2, throughout the roof of prosomere 1, and in the commissural and juxtacommissural domains of the pretectum. In the mesencephalon, Pax7 cells were localized in the optic tectum and, to a lesser extent, in the torus semicircularis. The rostral portion of the alar part of rhombomere 1, including the ventricular layer of the cerebellum, expressed Pax7 and, gradually, some of these dorsal cells were observed to populate ventrally the interpeduncular nucleus and the isthmus (rhombomere 0). Additionally, Pax7 positive cells were found in the ventricular zone of the ventral part of the alar plate along the rhombencephalon and the spinal cord. The findings show that the strongly conserved features of Pax7 expression through development shared by amniote vertebrates are also present in the anamniote amphibians as a common characteristic of the brain organization of tetrapods. PMID:24399938

  19. Internal Nasal Valve Incompetence Is Effectively Treated Using Batten Graft Functional Rhinoplasty

    PubMed Central

    Bewick, J. C.; Buchanan, M. A.; Frosh, A. C.

    2013-01-01

    Introduction. Internal nasal valve incompetence (INVI) has been treated with various surgical methods. Large, single surgeon case series are lacking, meaning that the evidence supporting a particular technique has been deficient. We present a case series using alar batten grafts to reconstruct the internal nasal valve, all performed by the senior author. Methods. Over a 7-year period, 107 patients with nasal obstruction caused by INVI underwent alar batten grafting. Preoperative assessment included the use of nasal strips to evaluate symptom improvement. Visual analogue scale (VAS) assessment of nasal blockage (NB) and quality of life (QOL) both pre- and postoperatively were performed and analysed with the Wilcoxon signed rank test. Results. Sixty-seven patients responded to both pre- and postoperative questionnaires. Ninety-one percent reported an improvement in NB and 88% an improvement in QOL. The greatest improvement was seen at 6 months (median VAS 15 mm and 88 mm resp., with a P value of <0.05 for both). Nasal strips were used preoperatively and are a useful tool in predicting patient operative success in both NB and QOL (odds ratio 2.15 and 2.58, resp.). Conclusions. Alar batten graft insertion as a single technique is a valid technique in treating INVI and produces good outcomes. PMID:23653651

  20. Molecular Regionalization of the Diencephalon

    PubMed Central

    Martinez-Ferre, Almudena; Martinez, Salvador

    2012-01-01

    The anatomic complexity of the diencephalon depends on precise molecular and cellular regulative mechanisms orchestrated by regional morphogenetic organizers at the neural tube stage. In the diencephalon, like in other neural tube regions, dorsal and ventral signals codify positional information to specify ventro-dorsal regionalization. Retinoic acid, Fgf8, BMPs, and Wnts signals are the molecular factors acting upon the diencephalic epithelium to specify dorsal structures, while Shh is the main ventralizing signal. A central diencephalic organizer, the zona limitans intrathalamica (ZLI), appears after neurulation in the central diencephalic alar plate, establishing additional antero-posterior positional information inside diencephalic alar plate. Based on Shh expression, the ZLI acts as a morphogenetic center, which cooperates with other signals in thalamic specification and pattering in the alar plate of diencephalon. Indeed, Shh is expressed first in the basal plate extending dorsally through the ZLI epithelium as the development proceeds. Despite the importance of ZLI in diencephalic morphogenesis the mechanisms that regulate its development remain incompletely understood. Actually, controversial interpretations in different experimental models have been proposed. That is, experimental results have suggested that (i) the juxtaposition of the molecularly heterogeneous neuroepithelial areas, (ii) cell reorganization in the epithelium, and/or (iii) planar and vertical inductions in the neural epithelium, are required for ZLI specification and development. We will review some experimental data to approach the study of the molecular regulation of diencephalic regionalization, with special interest in the cellular mechanisms underlying planar inductions. PMID:22654731

  1. Mesencephalic basolateral domain specification is dependent on Sonic Hedgehog.

    PubMed

    Martinez-Lopez, Jesus E; Moreno-Bravo, Juan A; Madrigal, M Pilar; Martinez, Salvador; Puelles, Eduardo

    2015-01-01

    In the study of central nervous system morphogenesis, the identification of new molecular markers allows us to identify domains along the antero-posterior and dorso-ventral (DV) axes. In the past years, the alar and basal plates of the midbrain have been divided into different domains. The precise location of the alar-basal boundary is still under discussion. We have identified Barhl1, Nhlh1 and Six3 as appropriate molecular markers to the adjacent domains of this transition. The description of their expression patterns and the contribution to the different mesencephalic populations corroborated their role in the specification of these domains. We studied the influence of Sonic Hedgehog on these markers and therefore on the specification of these territories. The lack of this morphogen produced severe alterations in the expression pattern of Barhl1 and Nhlh1 with consequent misspecification of the basolateral (BL) domain. Six3 expression was apparently unaffected, however its distribution changed leading to altered basal domains. In this study we confirmed the localization of the alar-basal boundary dorsal to the BL domain and demonstrated that the development of the BL domain highly depends on Shh. PMID:25741244

  2. Mesencephalic basolateral domain specification is dependent on Sonic Hedgehog

    PubMed Central

    Martinez-Lopez, Jesus E.; Moreno-Bravo, Juan A.; Madrigal, M. Pilar; Martinez, Salvador; Puelles, Eduardo

    2015-01-01

    In the study of central nervous system morphogenesis, the identification of new molecular markers allows us to identify domains along the antero-posterior and dorso-ventral (DV) axes. In the past years, the alar and basal plates of the midbrain have been divided into different domains. The precise location of the alar-basal boundary is still under discussion. We have identified Barhl1, Nhlh1 and Six3 as appropriate molecular markers to the adjacent domains of this transition. The description of their expression patterns and the contribution to the different mesencephalic populations corroborated their role in the specification of these domains. We studied the influence of Sonic Hedgehog on these markers and therefore on the specification of these territories. The lack of this morphogen produced severe alterations in the expression pattern of Barhl1 and Nhlh1 with consequent misspecification of the basolateral (BL) domain. Six3 expression was apparently unaffected, however its distribution changed leading to altered basal domains. In this study we confirmed the localization of the alar-basal boundary dorsal to the BL domain and demonstrated that the development of the BL domain highly depends on Shh. PMID:25741244

  3. Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

    PubMed

    Fice, Jason B; Cronin, Duane S

    2012-04-01

    Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. PMID:22284991

  4. Dynamic Mechanical Properties of Intact Human Cervical Spine Ligaments

    PubMed Central

    Ivancic, Paul C.; Coe, Marcus P.; Ndu, Anthony B.; Tominaga, Yasuhiro; Carlson, Erik J.; Rubin, Wolfgang; (FH), Dipl-Ing; Panjabi, Manohar M.

    2009-01-01

    BACKGROUND CONTEXT Most previous studies have investigated ligaments mechanical properties at slow elongation rates of less than 25 mm/s. PURPOSE To determine the tensile mechanical properties, at a fast elongation rate, of intact human cervical anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. STUDY DESIGN/SETTING In vitro biomechanical study. METHODS A total of 97 intact bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines (average age: 80.6 years, range, 71 to 92 years) and were elongated to complete rupture at an average (SD) peak rate of 723 (106) mm/s using a custom-built apparatus. Non-linear force vs. elongation curves were plotted and peak force, peak elongation, peak energy, and stiffness were statistically compared (P<0.05) among ligament. A mathematical model was developed to determine the quasi-static physiological ligament elongation. RESULTS Highest average peak force, up to 244.4 and 220.0 N in the ligamentum flavum and capsular ligament, respectively, were significantly greater than in the anterior longitudinal ligament and middle-third disc. Highest peak elongation reached 5.9 mm in the intraspinous and supraspinous ligaments, significantly greater than in the middle-third disc. Highest peak energy of 0.57 J was attained in the capsular ligament, significantly greater than in the anterior longitudinal ligament and middle-third disc. Average stiffness was generally greatest in the ligamentum flavum and least in the intraspinous and supraspinous ligaments. For all ligaments, peak elongation was greater than average physiological elongation computed using the mathematical model. CONCLUSIONS Comparison of the present results with previously reported data indicated that high speed elongation may cause cervical ligaments to fail at a higher peak force and smaller peak elongation and may be stiffer and absorb less energy, as compared to a

  5. Assessment of MRI as a Modality for Evaluation of Soft Tissue Injuries of the Spine as Compared to Intraoperative Assessment

    PubMed Central

    Vasu, Chembumkara; Kanthila, Mahesha; Ravichandra, Gopalakrishna; Acharya, Koteshwar Devadasa; Hussain, Mohamed Musheer

    2016-01-01

    Introduction Traumatic injuries of the spine and spinal cord are potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that directly compare MR imaging findings to surgical findings. Aim Hence, this study was undertaken to assess the sensitivity of MRI in identifying injuries to the soft tissue structures of the spine. Materials and Methods MRI scans were performed on 31 cases of acute spinal injuries that presented within 72 hours of the trauma and underwent surgical fixation by either an anterior or posterior approach. The non-osseous structures namely; Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament (ISP) and the Spinal Cord were evaluated. They were classified as ‘True Positive’ if an injury was found to correlate with intraoperative findings and as ‘False Negative’ when diagnosed falsely as normal. The statistical sensitivity of MRI in diagnosing injuries to the non-osseous structures of the spine were thus calculated. Results Of the 31 patients, in 51.6% of patients the site of injury was to the cervical spine (n=16), thoracic spine was the next highest in occurrence of 39% (n=12) and lumbar spine accounted for the least. In correlating the imaging findings to the intraoperative findings, MRI was highly sensitive in detecting injuries to the Posterior Longitudinal Ligament (94.4%) and the Spinal cord (93%) and fairly high in detecting injuries to the Intervertebral disc. However coming to the ligamentum flavum and interspinous ligaments, the sensitivity of the MRI dropped to 62.5% and 63.6% respectively. Conclusion MRI was found to be highly sensitive in detecting injuries to the spinal cord and the posterior longitudinal ligament and

  6. 400 years astronomical observatory in Jena

    NASA Astrophysics Data System (ADS)

    Schielicke, Reinhard E.

    ``Nam cum aliquod observatorium mihi comparaverim, ... '': ``As I have equiped my observatory now'', Georg Limnaeus, professor of mathematics in Jena from 1588 to 1611, wrote on 24 April 1598, ``I have decided to make friends with some experts by letter; I know from your Prodromus that you are one of them''. The letter was addressed to Johannes Kepler and was related to his first work about the ``Mysterium cosmographicum''. Kepler sent some copies of his paper to Galileo Galilei, Tycho Brahe, Reimar Ursus and also to Limnaeus in Jena from the Frankfurt Book Fair in 1597. Limnaeus gave him - apart from the words expressing praise but which actually were meaningless concerning Kepler's ideas - the information about Brahe Kepler had asked for and which may have promoted his move to Prague. The above mentioned observatory is considered to be the first one in Jena. Astronomy had already been established as a subject since the establishment of the ``Hohe Schule'' in 1548 and since the foundation of the university ten years later. Nothing is known about the instruments and the location of the observatory. Limnaeus did not belong to the taxpaying house-owners of which there exists an index; he obviously rented a flat. To all appearances the correspondence announced was not continued either. For the following centuries the professors Heinrich Hoffmann, Erhard Weigel, Georg Albrecht and Georg Erhard Hamberger are named in the literature running the observatory in Jena. The ``Herzogliche Sternwarte'' fitted out under Goethe's overall supervision in 1813 eventually developed into the university institute of today.

  7. Dysplasia of the caudal vertebral articular facets in four dogs: results of radiographic, myelographic and magnetic resonance imaging investigations.

    PubMed

    Penderis, J; Schwarz, T; McConnell, J F; Garosi, L S; Thomson, C E; Dennis, R

    2005-05-01

    Congenital anomalies of the vertebral column associated with aberrations of one of the primary vertebral ossification centres have been frequently described in the veterinary literature, but clinically significant abnormalities of secondary vertebral ossification centres, particularly involving the caudal articular processes, are much less frequently reported. This paper describes three dogs with aplasia and one dog with hypoplasia of the caudal vertebral articular processes. Thoracolumbar spinal cord compression and ataxia was evident in the three dogs with aplasia but no clinical signs were evident in the dog with hypoplasia. The radiographic appearance was similar in all four cases, with aplasia or hypoplasia of the caudal articular facets at one or more intervertebral joints in the thoracolumbar region. Bone proliferation was evident secondary to an associated degenerative joint disease. Compensatory hyperplasia of the adjacent cranial articular facets and ligamentum flavum protruded into the vertebral canal, resulting in a compressive myelopathy observed by myelography and magnetic resonance imaging. PMID:15879540

  8. Postoperative paralysis following posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament.

    PubMed

    Yamazaki, Masashi; Okawa, Akihiko; Mannoji, Chikato; Fujiyoshi, Takayuki; Furuya, Takeo; Koda, Masao

    2011-02-01

    A 60-year-old man presented with thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). His spinal cord was severely impinged anteriorly by a beak-type OPLL and posteriorly by ossification of the ligamentum flavum at T4/5. He underwent surgical posterior decompression with instrumented fusion (PDF). Immediately after surgery, he developed a Brown-Séquard-type paralysis, which spontaneously resolved without requiring the addition of OPLL extirpation. This example highlights that the risk of postoperative neurological deterioration cannot be eliminated even when PDF is selected as the surgical procedure for thoracic OPLL, especially in instances in which the spinal cord is severely compressed. PMID:21030260

  9. Vascular ring diagnosis following respiratory arrest

    PubMed Central

    Robson, Evie Alexandra; Scott, Alison; Chetcuti, Philip; Crabbe, David

    2014-01-01

    Vascular rings can present with non-specific respiratory and/or oesophageal symptoms. Early diagnosis requires a high index of suspicion. This case report describes an uncommon acute presentation of a vascular ring. We report a thriving 14-month-old child with a long history of recurrent wheeze and ‘noisy breathing’. He presented acutely with food bolus impaction in the oesophagus which led to a respiratory arrest. Oesophagoscopy and bronchoscopy suggested vascular ring anomaly. A contrast-enhanced CT scan demonstrated a right-sided aortic arch with left ligamentum arteriosum encircling the oesophagus and airway. The ligament was ligated and divided. At follow-up 6 months later, the infant had mild persistent stridor but was otherwise well. PMID:24895385

  10. Lumbar epidural varices: An unusual cause of lumbar claudication.

    PubMed

    Subbiah, Meenakshisundaram; Yegumuthu, Krishnan

    2016-01-01

    Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP). However as the magnetic resonance imaging (MRI) in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings. PMID:27512228

  11. Lumbar epidural varices: An unusual cause of lumbar claudication

    PubMed Central

    Subbiah, Meenakshisundaram; Yegumuthu, Krishnan

    2016-01-01

    Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP). However as the magnetic resonance imaging (MRI) in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings. PMID:27512228

  12. Hip arthroscopy☆

    PubMed Central

    de Amorim Cabrita, Henrique Antônio Berwanger; de Castro Trindade, Christiano Augusto; de Campos Gurgel, Henrique Melo; Leal, Rafael Demura; de Souza Marques, Ricardo da Fonseca

    2014-01-01

    Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve. PMID:26229924

  13. Ossification of thoracic ligamenta flava

    SciTech Connect

    Kudo, S.; Minoru, O.; Russell, W.J.

    1983-07-01

    Although ligamentum flavum ossification (LFO) often occurs in normal persons, there are no reports of its detection on lateral chest radiographs made during screening examinations. Review of 1,744 consecutive lateral chest radiographs identified LFO in 6.2% of males and 4.8% of females. LFO occurred mainly at the intervertebral segments from T9-T10 through T12-L1. Most prevalent was the hook-shaped LFO, protruding inferoirly from the inferior facets into the projections of the intervertabral foramina. Though LFO can cause severe neurologic symptoms, none of the affected persons in this study reported such symptoms. LFO was first visualized radiographically when the subjects were 20-40 years old, and it may be a physiologic condition. The LFO in these cases existed independent of thoracic posterior longitudinal ligament ossification, diffuse idiopathic skeletal hyperostosis, and degenerative osteoarthritis.

  14. Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

    PubMed Central

    Asamoto, Shunji; Muto, Jun; Jimbo, Hiroyuki

    2016-01-01

    Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF). Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS). A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL), which involves a microsurgical technique, is a safe, complication-free procedure. PMID:27041887

  15. LUMBAR DISC HERNIATION

    PubMed Central

    Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term. PMID:27019834

  16. Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy

    PubMed Central

    Nguyen, Ha Son; Doan, Ninh; Shabani, Saman; Baisden, Jamie; Wolfla, Christopher; Paskoff, Glenn; Shender, Barry; Stemper, Brian

    2016-01-01

    Background: Lumbar back pain and radiculopathy are common diagnoses. Unfortunately, conventional magnetic resonance imaging (MRI) findings and clinical symptoms do not necessarily correlate in the lumbar spine. With upright imaging, disc pathologies or foraminal stenosis may become more salient, leading to improvements in diagnosis. Materials and Methods: Seventeen adults (10 asymptomatic and 7 symptomatic volunteers) provided their informed consent and participated in the study. A 0.6T upright MRI scan was performed on each adult in the seated position. Parameters were obtained from the L2/3 level to the L5/S1 level including those pertaining to the foramen [cross-sectional area (CSA), height, mid-disc width, width, thickness of ligamentum flavum], disc (bulge, height, width), vertebral body (height and width), and alignment (lordosis angle, wedge angle, lumbosacral angle). Each parameter was compared based on the spinal level and volunteer group using two-factor analysis of variance (ANOVA). Bonferroni post hoc analysis was used to assess the differences between individual spinal levels. Results: Mid-disc width accounted for 56% of maximum foramen width in symptomatic volunteers and over 63% in asymptomatic volunteers. Disc bulge was 48% greater in symptomatic volunteers compared to asymptomatic volunteers. CSA was generally smaller in symptomatic volunteers compared to asymptomatic volunteers, particularly at the L4-L5 and L5-S1 spinal levels. Thickness of ligamentum flavum (TLF) generally increased from the cranial to caudal spinal levels where the L4-L5 and L5-S1 spinal levels were significantly thicker than the L1-L2 spinal level. Conclusions: The data implied that upright MRI could be a useful diagnostic option, as it can delineate pertinent differences between symptomatic volunteers and asymptomatic volunteers, especially with respect to foraminal geometry. PMID:27041883

  17. Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy: A Retrospective Analysis of 25 Cases

    PubMed Central

    Zhang, Li; Miao, Hai-xiong; Wang, Yong; Chen, An-fu; Zhang, Tao

    2015-01-01

    Objective Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. Methods Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. Results Twenty-five patients were included. The mean preoperative VAS score was 6.6±1.6 and 4.6±3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32±1.2) and the back (VAS score, 1.75±1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60±6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). Conclusion Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine. PMID:26279816

  18. Nasal tip support: A finite element analysis of the role of the caudal septum during tip depression

    PubMed Central

    Manuel, Cyrus T.; Leary, Ryan; Protsenko, Dmitriy E.; Wong, Brian J.F.

    2014-01-01

    Objective/Hypothesis Although minor and major tip support mechanisms have been described in detail, no quantitative models exist to provide support for the relative contributions of the structural properties of the major alar cartilage, the fibrous attachments to surrounding structures, and the rigid support structures in an objective manner. Study Design The finite element method was used to compute the stress distribution in the nose during simple tip compression, and then identify the specific anatomic structures that resist deformation and thus contribute to “tip support”. Additionally, the impact of caudal septal resection on nasal tip support was examined. Method The computer models consisted of three tissue components with anatomically correct geometries for skin and bone derived from CT data. Septum, upper lateral cartilages, and major alar cartilages were fitted within the model using 3D CAD software. 5mm nasal tip compression was performed on the models with caudal septal resection (3mm and 5 mm) and without resection to simulate palpation, then the resulting spatial distribution of stress and displacement was calculated. Results The von Mises stress in the normal model was primarily concentrated along medial crural angle. As caudal septum length was reduced, stress was redistributed to adjacent soft tissue and bone, resulting in less force acting on the septum. In all models, displacement was greatest near the intermediate crura. Conclusions These models are the first step in the comprehensive mechanical analysis of nasal tip dynamics. Our model supports the concept of the caudal septum and major alar cartilage as providing the majority of critical load-bearing support. Level of Evidence N/A PMID:23878007

  19. NMR studies of protonation and hydrogen bond states of internal aldimines of pyridoxal 5'-phosphate acid-base in alanine racemase, aspartate aminotransferase, and poly-L-lysine.

    PubMed

    Chan-Huot, Monique; Dos, Alexandra; Zander, Reinhard; Sharif, Shasad; Tolstoy, Peter M; Compton, Shara; Fogle, Emily; Toney, Michael D; Shenderovich, Ilya; Denisov, Gleb S; Limbach, Hans-Heinrich

    2013-12-01

    Using (15)N solid-state NMR, we have studied protonation and H-bonded states of the cofactor pyridoxal 5'-phosphate (PLP) linked as an internal aldimine in alanine racemase (AlaR), aspartate aminotransferase (AspAT), and poly-L-lysine. Protonation of the pyridine nitrogen of PLP and the coupled proton transfer from the phenolic oxygen (enolimine form) to the aldimine nitrogen (ketoenamine form) is often considered to be a prerequisite to the initial step (transimination) of the enzyme-catalyzed reaction. Indeed, using (15)N NMR and H-bond correlations in AspAT, we observe a strong aspartate-pyridine nitrogen H-bond with H located on nitrogen. After hydration, this hydrogen bond is maintained. By contrast, in the case of solid lyophilized AlaR, we find that the pyridine nitrogen is neither protonated nor hydrogen bonded to the proximal arginine side chain. However, hydration establishes a weak hydrogen bond to pyridine. To clarify how AlaR is activated, we performed (13)C and (15)N solid-state NMR experiments on isotopically labeled PLP aldimines formed by lyophilization with poly-L-lysine. In the dry solid, only the enolimine tautomer is observed. However, a fast reversible proton transfer involving the ketoenamine tautomer is observed after treatment with either gaseous water or gaseous dry HCl. Hydrolysis requires the action of both water and HCl. The formation of an external aldimine with aspartic acid at pH 9 also produces the ketoenamine form stabilized by interaction with a second aspartic acid, probably via a H-bond to the phenolic oxygen. We postulate that O-protonation is an effectual mechanism for the activation of PLP, as is N-protonation, and that enzymes that are incapable of N-protonation employ this mechanism. PMID:24147985

  20. Topography of Somatostatin Gene Expression Relative to Molecular Progenitor Domains during Ontogeny of the Mouse Hypothalamus

    PubMed Central

    Morales-Delgado, Nicanor; Merchan, Paloma; Bardet, Sylvia M.; Ferrán, José L.; Puelles, Luis; Díaz, Carmen

    2010-01-01

    The hypothalamus comprises alar, basal, and floor plate developmental compartments. Recent molecular data support a rostrocaudal subdivision into rostral (terminal) and caudal (peduncular) halves. In this context, the distribution of neuronal populations expressing somatostatin (Sst) mRNA was analyzed in the developing mouse hypothalamus, comparing with the expression pattern of the genes Orthopedia (Otp), Distal-less 5 (Dlx5), Sonic Hedgehog (Shh), and Nk2 homeobox 1 (Nkx2.1). At embryonic day 10.5 (E10.5), Sst mRNA was first detectable in the anterobasal nucleus, a Nkx2.1-, Shh-, and Otp-positive basal domain. By E13.5, nascent Sst expression was also related to two additional Otp-positive domains within the alar plate and one in the basal plate. In the alar plate, Sst-positive cells were observed in rostral and caudal ventral subdomains of the Otp-positive paraventricular complex. An additional basal Sst-expressing cell group was found within a longitudinal Otp-positive periretromamillary band that separates the retromamillary area from tuberal areas. Apart of subsequent growth of these initial populations, at E13.5 and E15.5 some Sst-positive derivatives migrate tangentially into neighboring regions. A subset of cells produced at the anterobasal nucleus disperses ventralward into the shell of the ventromedial hypothalamic nucleus and the arcuate nucleus. Cells from the rostroventral paraventricular subdomain reach the suboptic nucleus, whereas a caudal contingent migrates radially into lateral paraventricular, perifornical, and entopeduncular nuclei. Our data provide a topologic map of molecularly defined progenitor areas originating a specific neuron type during early hypothalamic development. Identification of four main separate sources helps to understand causally its complex adult organization. PMID:21441981

  1. A Reliable Method to Measure Lip Height Using Photogrammetry in Unilateral Cleft Lip Patients.

    PubMed

    van der Zeeuw, Frederique; Murabit, Amera; Volcano, Johnny; Torensma, Bart; Patel, Brijesh; Hay, Norman; Thorburn, Guy; Morris, Paul; Sommerlad, Brian; Gnarra, Maria; van der Horst, Chantal; Kangesu, Loshan

    2015-09-01

    There is still no reliable tool to determine the outcome of the repaired unilateral cleft lip (UCL). The aim of this study was therefore to develop an accurate, reliable tool to measure vertical lip height from photographs. The authors measured the vertical height of the cutaneous and vermilion parts of the lip in 72 anterior-posterior view photographs of 17 patients with repairs to a UCL. Points on the lip's white roll and vermillion were marked on both the cleft and the noncleft sides on each image. Two new concepts were tested. First, photographs were standardized using the horizontal (medial to lateral) eye fissure width (EFW) for calibration. Second, the authors tested the interpupillary line (IPL) and the alar base line (ABL) for their reliability as horizontal lines of reference. Measurements were taken by 2 independent researchers, at 2 different time points each. Overall 2304 data points were obtained and analyzed. Results showed that the method was very effective in measuring the height of the lip on the cleft side with the noncleft side. When using the IPL, inter- and intra-rater reliability was 0.99 to 1.0, with the ABL it varied from 0.91 to 0.99 with one exception at 0.84. The IPL was easier to define because in some subjects the overhanging nasal tip obscured the alar base and gave more consistent measurements possibly because the reconstructed alar base was sometimes indistinct. However, measurements from the IPL can only give the percentage difference between the left and right sides of the lip, whereas those from the ABL can also give exact measurements. Patient examples were given that show how the measurements correlate with clinical assessment. The authors propose this method of photogrammetry with the innovative use of the IPL as a reliable horizontal plane and use of the EFW for calibration as a useful and reliable tool to assess the outcome of UCL repair. PMID:26147027

  2. Patterns of hypothalamic regionalization in amphibians and reptiles: common traits revealed by a genoarchitectonic approach.

    PubMed

    Domínguez, Laura; González, Agustín; Moreno, Nerea

    2015-01-01

    Most studies in mammals and birds have demonstrated common patterns of hypothalamic development highlighted by the combination of developmental regulatory genes (genoarchitecture), supporting the notion of the hypothalamus as a component of the secondary prosencephalon, topologically rostral to the diencephalon. In our comparative analysis we have summarized the data on the expression patterns of different transcription factors and neuroactive substances, used as anatomical markers, in the developing hypothalamus of the amphibian Xenopus laevis and the juvenile turtle Pseudemys scripta. This analysis served to highlight the organization of the hypothalamus in the anamniote/amniotic transition. We have identified supraoptoparaventricular and the suprachiasmatic regions (SCs) in the alar part of the hypothalamus, and tuberal and mammillary regions in the basal hypothalamus. Shared features in the two species are: (1) The supraoptoparaventricular region (SPV) is defined by the expression of Otp and the lack of Nkx2.1/Isl1. It is subdivided into rostral, rich in Otp and Nkx2.2, and caudal, only Otp-positive, portions. (2) The suprachiasmatic area contains catecholaminergic cell groups and lacks Otp, and can be further divided into rostral (rich in Nkx2.1 and Nkx2.2) and a caudal (rich in Isl1 and devoid of Nkx2.1) portions. (3) Expression of Nkx2.1 and Isl1 define the tuberal hypothalamus and only the rostral portion expresses Otp. (4) Its caudal boundary is evident by the lack of Isl1 in the adjacent mammillary region, which expresses Nkx2.1 and Otp. Differences in the anamnio-amniote transition were noted since in the turtle, like in other amniotes, the boundary between the alar hypothalamus and the telencephalic preoptic area shows distinct Nkx2.2 and Otp expressions but not in the amphibian (anamniote), and the alar SPV is defined by the expression of Otp/Pax6, whereas in Xenopus only Otp is expressed. PMID:25691860

  3. Conserved localization of Pax6 and Pax7 transcripts in the brain of representatives of sarcopterygian vertebrates during development supports homologous brain regionalization

    PubMed Central

    Moreno, Nerea; Joven, Alberto; Morona, Ruth; Bandín, Sandra; López, Jesús M.; González, Agustín

    2014-01-01

    Many of the genes involved in brain patterning during development are highly conserved in vertebrates and similarities in their expression patterns help to recognize homologous cell types or brain regions. Among these genes, Pax6 and Pax7 are expressed in regionally restricted patterns in the brain and are essential for its development. In the present immunohistochemical study we analyzed the distribution of Pax6 and Pax7 cells in the brain of six representative species of tetrapods and lungfishes, the closest living relatives of tetrapods, at several developmental stages. The distribution patterns of these transcription factors were largely comparable across species. In all species only Pax6 was expressed in the telencephalon, including the olfactory bulbs, septum, striatum, and amygdaloid complex. In the diencephalon, Pax6 and Pax7 were distinct in the alar and basal parts, mainly in prosomeres 1 and 3. Pax7 specifically labeled cells in the optic tectum (superior colliculus) and Pax6, but not Pax7, cells were found in the tegmentum. Pax6 was found in most granule cells of the cerebellum and Pax7 labeling was detected in cells of the ventricular zone of the rostral alar plate and in migrated cells in the basal plate, including the griseum centrale and the interpeduncular nucleus. Caudally, Pax6 cells formed a column, whereas the ventricular zone of the alar plate expressed Pax7. Since the observed Pax6 and Pax7 expression patterns are largely conserved they can be used to identify subdivisions in the brain across vertebrates that are not clearly discernible with classical techniques. PMID:25147506

  4. Patterns of hypothalamic regionalization in amphibians and reptiles: common traits revealed by a genoarchitectonic approach

    PubMed Central

    Domínguez, Laura; González, Agustín; Moreno, Nerea

    2015-01-01

    Most studies in mammals and birds have demonstrated common patterns of hypothalamic development highlighted by the combination of developmental regulatory genes (genoarchitecture), supporting the notion of the hypothalamus as a component of the secondary prosencephalon, topologically rostral to the diencephalon. In our comparative analysis we have summarized the data on the expression patterns of different transcription factors and neuroactive substances, used as anatomical markers, in the developing hypothalamus of the amphibian Xenopus laevis and the juvenile turtle Pseudemys scripta. This analysis served to highlight the organization of the hypothalamus in the anamniote/amniotic transition. We have identified supraoptoparaventricular and the suprachiasmatic regions (SCs) in the alar part of the hypothalamus, and tuberal and mammillary regions in the basal hypothalamus. Shared features in the two species are: (1) The supraoptoparaventricular region (SPV) is defined by the expression of Otp and the lack of Nkx2.1/Isl1. It is subdivided into rostral, rich in Otp and Nkx2.2, and caudal, only Otp-positive, portions. (2) The suprachiasmatic area contains catecholaminergic cell groups and lacks Otp, and can be further divided into rostral (rich in Nkx2.1 and Nkx2.2) and a caudal (rich in Isl1 and devoid of Nkx2.1) portions. (3) Expression of Nkx2.1 and Isl1 define the tuberal hypothalamus and only the rostral portion expresses Otp. (4) Its caudal boundary is evident by the lack of Isl1 in the adjacent mammillary region, which expresses Nkx2.1 and Otp. Differences in the anamnio-amniote transition were noted since in the turtle, like in other amniotes, the boundary between the alar hypothalamus and the telencephalic preoptic area shows distinct Nkx2.2 and Otp expressions but not in the amphibian (anamniote), and the alar SPV is defined by the expression of Otp/Pax6, whereas in Xenopus only Otp is expressed. PMID:25691860

  5. A Practical Approach to Rhinoplasty.

    PubMed

    Rohrich, Rod J; Ahmad, Jamil

    2016-04-01

    Rhinoplasty continues to be one of the most commonly performed aesthetic surgical procedures. Over the past 25 years, the open approach has increased in popularity and is the focus of this article. The principles for successful rhinoplasty include comprehensive clinical analysis and defining rhinoplasty goals, preoperative consultation and planning, precise operative execution, postoperative management, and critical analysis of one's results. Systematic nasal analysis is critical to establish the goals of surgery. Techniques to address the nasal dorsum, nasal airway, tip complex, alar rims, and bony vault that provide consistent results are discussed. PMID:27018701

  6. Controversies in the Management of Patients with Cleft Lip and Palate.

    PubMed

    Rodman, Regina E; Tatum, Sherard

    2016-08-01

    Cleft lip and palate is one of the most common congenital anomalies. For many years, surgeons have been attempting to reduce the severity of the deformity before the surgical repair to achieve a better outcome. The nasoalveolar molding technique uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into a more normal form and position during the presurgical period. Proponents of nasoalveolar molding claim several benefits, including improved aesthetic outcome, reduced overall costs, and a psychosocial benefit to the family. Research on these outcomes is not conclusive. PMID:27400840

  7. Heminasal agenesis: a reconstructive challenge.

    PubMed

    Fisher, Mark; Zelken, Jonathan; Redett, Richard J

    2014-05-01

    Heminasal agenesis is a rare congenital malformation often associated with deformities of the eyes and lacrimal system, midface, and proboscis lateralis. Reconstruction is especially challenging because of missing lining, cartilage, and skin. We present a case of heminasal agenesis in a 5-year-old girl with concomitant hypertelorism, coloboma of the eyelids, and maxillary hypoplasia. The patient underwent facial bipartition for hypertelorism correction and cantilever bone graft. A forehead flap was designed using an anaplastic model from the patient's twin sister. Cartilage harvested from the conchal bowl and rib provided alar and dorsal support. Reconstructive goals, timing, and options are discussed. PMID:24777004

  8. Calcium hydroxylapatite associated soft tissue necrosis: a case report and treatment guideline.

    PubMed

    Tracy, Lauren; Ridgway, James; Nelson, J Stuart; Lowe, Nelson; Wong, Brian

    2014-04-01

    We present an uncommon case of nasal alar and facial necrosis following calcium hydroxylapatite filler injection performed elsewhere without direct physician supervision. The patient developed severe full-thickness necrosis of cheek and nasal alar skin 24 h after injections into the melolabial folds. Management prior to referral included oral antibiotics, prednisone taper, and referral to a dermatologist (day 3) who prescribed valacyclovir for a presumptive herpes zoster reactivation induced by the injection. Referral to our institution was made on day 11, and after herpetic outbreak was ruled out by a negative Tzanck smear, debridement with aggressive local wound care was initiated. After re-epithelialization and the fashioning of a custom intranasal stent to prevent vestibular stenosis, pulsed dye laser therapy was performed for wound modification. The patient healed with an acceptable cosmetic outcome. This report underscores the importance of facial vasculature anatomy, injection techniques, and identification of adverse events when using fillers. A current treatment paradigm for such events is also presented. PMID:23993752

  9. Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: A 15-year experience

    PubMed Central

    Chuangsuwanich, Apirag; Lohsiriwat, Visnu

    2013-01-01

    Background: Asians have low nasal dorsum, thick skin envelope, low defined alar cartilage, low projection of nasal tip and broad alar base. Augmentation rhinoplasty with silicone prosthesis has been performed with predictable results, but unfavourable results and complications still present. This series show techniques and results from single surgeon experience. Materials and Methods: We retrospectively reviewed 548 patients chart during January 1995 to December 2009. All patients underwent custom-made S-shape implant silicone augmentation rhinoplasty operated by a single surgeon. There were three major operative steps: (1) Intra-operative S-shape implant carving; (2) pocket dissection through bilateral rim incision and (3) tension adjustment before closure. All the patients were recorded for early surgical complications and satisfaction. Results: There were 519 women and 29 men. The mean age is 25.5 years (18-56 years). Mean follow-up period was 6 months (1-60 months). The majority of patient were appointed for esthetic augmentation (86.8%). 515 cases (94.9%) showed well satisfaction following the operation. The total complication rate was 6.5% (4.9% deviation, 0.7% extrusion, 0.5% hematoma and 0.3% infection). All the complications were corrected with uneventful sequelae. Conclusion: Augmentation rhinoplasty with custom-made S-shape silicone implant by closed approach provides high satisfaction with acceptable early complication rate. PMID:24459345

  10. Three-dimensional Nasolabial Morphologic Alterations Following Le Fort I

    PubMed Central

    DeSesa, Christopher R.; Metzler, Philip; Sawh-Martinez, Rajendra

    2016-01-01

    Background: Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional data and have not delineated differences among various Le Fort I subtypes. The purpose of this study is to 3-dimensionally analyze Le Fort I–induced nasal and lip changes comparing advancement alone versus widening alone [surgically assisted maxillary expansion (SAME)] versus advancement and widening. We hypothesize that the combination of maxillary advancement with widening will result in the most profound changes. Methods: A retrospective cohort study was performed. Included Le Fort I patients were grouped as: (1) nonsegmental straight advancement, (2) widening without advancement, and (3) segmental advancement and widening. Pre- and postoperative 3-dimensional photogrammetry (Canfield) were analyzed. Anthropometric landmarks were placed and measured by 2 independent observers. Statistics involved both paired and unpaired t tests (significance = P < 0.05). Results: One hundred eight photogrammetric data sets were analyzed, including 46 single-piece, 26 SAME, and 36 segmental. Significant postoperative nasal changes were observed within each intragroup analysis. The most dramatic changes were seen after segmental Le Fort I with advancement and widening, which included alar base width, alar width, nostril width, and soft triangle angle, all P < 0.05. Conclusions: Le Fort I osteotomy results in significant alteration of the nasolabial morphology. This is the first study to 3-dimensionally analyze nasal changes that occur comparing maxillary advancement alone versus widening alone (SAME) versus advancement with widening. These objective data permit improved patient counseling and surgical planning. PMID:27622116

  11. Contemporary Concepts for the Bilateral Cleft Lip and Nasal Repair

    PubMed Central

    Khosla, Rohit K.; McGregor, Jyoti; Kelley, Patrick K.; Gruss, Joseph S.

    2012-01-01

    The bilateral cleft lip and nasal deformity presents a complex challenge for repair. Surgical techniques continue to evolve and are focused on primary anatomic realignment of the tissues. This can be accomplished in a single-stage or two-stage repair early in infancy to provide a foundation for future growth of the lip and nasal tissue. Most cleft surgeons currently perform a single-stage repair for simplifying patient care. Certain institutions utilize presurgical orthopedics for alignment of the maxillary segments and nasal shaping. Methods for the bilateral cleft lip repair are combined with various open and closed rhinoplasty techniques to achieve improved correction of the primary nasal deformity. There is recent focus on shaping the nose for columellar and tip support, as well as alar contour and alar base position. The authors will present a new technique for closure of the nasal floor to prevent the alveolar cleft fistula. Although the alveolar fistula is closed, alveolar bone grafting is still required at the usual time in dental development to fuse the maxilla. It is paramount to try and minimize the stigmata of secondary deformities that historically have been characteristic of the repaired bilateral cleft lip. A properly planned and executed repair reduces the number of revisions and can spare a child from living with secondary deformities. PMID:24179448

  12. State-of-the-art three-dimensional analysis of soft tissue changes following Le Fort I maxillary advancement.

    PubMed

    Almukhtar, A; Ayoub, A; Khambay, B; McDonald, J; Ju, X

    2016-09-01

    We describe the comprehensive 3-dimensional analysis of facial changes after Le Fort I osteotomy and introduce a new tool for anthropometric analysis of the face. We studied the cone-beam computed tomograms of 33 patients taken one month before and 6-12 months after Le Fort I maxillary advancement with or without posterior vertical impaction. Use of a generic facial mesh for dense correspondence analysis of changes in the soft tissue showed a mean (SD) anteroposterior advancement of the maxilla of 5.9 (1.7) mm, and mean (SD) minimal anterior and posterior vertical maxillary impaction of 0.1 (1.7) mm and 0.6 (1.45) mm, respectively. It also showed distinctive forward and marked lateral expansion around the upper lip and nose, and pronounced upward movement of the alar curvature and columella. The nose was widened and the nostrils advanced. There was minimal forward change at the base of the nose (subnasale and alar base) but a noticeable upward movement at the nasal tip. Changes at the cheeks were minimal. Analysis showed widening of the midface and upper lip which, to our knowledge, has not been reported before. The nostrils were compressed and widened, and the lower lip shortened. Changes at the chin and lower lip were secondary to the limited maxillary impaction. PMID:27325452

  13. Ontogenetic Expression of Sonic Hedgehog in the Chicken Subpallium

    PubMed Central

    Bardet, Sylvia M.; Ferran, José L. E.; Sanchez-Arrones, Luisa; Puelles, Luis

    2010-01-01

    Sonic hedgehog (SHH) is a secreted signaling factor that is implicated in the molecular patterning of the central nervous system (CNS), somites, and limbs in vertebrates. SHH has a crucial role in the generation of ventral cell types along the entire rostrocaudal axis of the neural tube. It is secreted early in development by the axial mesoderm (prechordal plate and notochord) and the overlying ventral neural tube. Recent studies clarified the impact of SHH signaling mechanisms on dorsoventral patterning of the spinal cord, but the corresponding phenomena in the rostral forebrain are slightly different and more complex. This notably involves separate Shh expression in the preoptic part of the forebrain alar plate, as well as in the hypothalamic floor and basal plates. The present work includes a detailed spatiotemporal description of the singular alar Shh expression pattern in the rostral preoptic forebrain of chick embryos, comparing it with FoxG1, Dlx5, Nkx2.1, and Nkx2.2 mRNA expression at diverse stages of development. As a result of this mapping, we report a subdivision of the preoptic region in dorsal and ventral zones; only the dorsal part shows Shh expression. The positive area impinges as well upon a median septocommissural preoptic domain. Our study strongly suggests tangential migration of Shh-positive cells from the preoptic region into other subpallial domains, particularly into the pallidal mantle and the intermediate septum. PMID:20700498

  14. External rhinoplasty: a critical analysis of 500 cases.

    PubMed

    Foda, Hossam M T

    2003-06-01

    The study presents a comprehensive statistical analysis of a series of 500 consecutive rhinoplasties of which 380 (76 per cent) were primary and 120 (24 per cent) were secondary cases. All cases were operated upon using the external rhinoplasty technique; simultaneous septal surgery was performed in 350 (70 per cent) of the cases. Deformities of the upper two-thirds of the nose that occurred significantly more in the secondary cases included; dorsal saddling, dorsal irregularities, valve collapse, open roof and pollybeak deformities. In the lower third of the nose; secondary cases showed significantly higher incidences of depressed tip, tip over-rotation, tip asymmetry, retracted columella, and alar notching. Suturing techniques were used significantly more in primary cases, while in secondary cases grafting techniques were used significantly more. The complications encountered intra-operatively included; septal flap tears (2.8 per cent) and alar cartilage injury (1.8 per cent), while post-operative complications included; nasal trauma (one per cent), epistaxis (two per cent), infection (2.4 per cent), prolonged oedema (17 per cent), and nasal obstruction (0.8 per cent). The overall patient satisfaction rate was 95.6 per cent and the transcolumellar scar was found to be unacceptable in only 0.8 per cent of the patients. PMID:12818057

  15. Differential regulation of the zebrafish orthopedia1 gene during fate determination of diencephalic neurons

    PubMed Central

    Del Giacco, Luca; Sordino, Paolo; Pistocchi, Anna; Andreakis, Nikos; Tarallo, Raffaella; Di Benedetto, Barbara; Cotelli, Franco

    2006-01-01

    Background The homeodomain transcription factor Orthopedia (Otp) is essential in restricting the fate of multiple classes of secreting neurons in the neuroendocrine hypothalamus of vertebrates. However, there is little information on the intercellular factors that regulate Otp expression during development. Results Here, we identified two otp orthologues in zebrafish (otp1 and otp2) and explored otp1 in the context of the morphogenetic pathways that specify neuroectodermal regions. During forebrain development, otp1 is expressed in anterior groups of diencephalic cells, positioned in the preoptic area (PO) (anterior alar plate) and the posterior tuberculum (PT) (posterior basal plate). The latter structure is characterized by Tyrosine Hydroxylase (TH)-positive cells, suggesting a role for otp1 in the lineage restriction of catecholaminergic (CA) neurons. Disruptions of Hedgehog (HH) and Fibroblast Growth Factor (FGF) pathways point to the ability of SHH protein to trigger otp1 expression in PO presumptive neuroblasts, with the attenuating effect of Dzip1 and FGF8. In addition, our data disclose otp1 as a determinant of CA neurons in the PT, where otp1 activity is strictly dependent on Nodal signaling and it is not responsive to SHH and FGF. Conclusion In this study, we pinpoint the evolutionary importance of otp1 transcription factor in cell states of the diencephalon anlage and early neuronal progenitors. Furthermore, our data indicate that morphogenetic mechanisms differentially regulate otp1 expression in alar and basal plates. PMID:17074092

  16. 400th Anniversary of Marius's Book with the First Image of an Astronomical Telescope and of Orbits of Jovian Moons

    NASA Astrophysics Data System (ADS)

    Pasachoff, Jay M.; Leich, Pierre

    2015-01-01

    Simon Mayr's (Marius's) Mundus Iovialis Anno M·DC·IX Detectus Ope Perspicilli Belgici (The World of Jupiter...) was published in Nuremberg in 1614; Marius was the Ansbach court mathematician. The frontispiece includes not only a portrait of Marius (1573-1624) himself but also, in the foreground, a long tube labelled "perspicillum," the first known image of a telescopic device used for astronomy; the name "telescope" came later. A schematic diagram of Jupiter with four moons orbiting appears at upper left; Marius, following a suggestion from Kepler, gave these Galilean satellites the names now still in use: Io, Europa. Ganymede, and Callisto. The title continues Hoc est, Quatuor Joviali cum Planetarum, cum Theoria, tum Tabulae, Propriis Observationibus Maxime Fundate.... A pair of conferences was held in Germany in 2014 to commemorate the 400th anniversary of Marius's book and to discuss Marius's work and its relation to Galileo's work (http://www.simon-marius.net; http://www.simon-marius.net/index.php?lang=en&menu=1 28 languages are available). Marius (Mayr) had independently discovered the four satellites of Jupiter, apparently one day after Galileo, on December 29 O.S., 1609; by the time he published his work four years later (a local-circulation publication had appeared in Nuremberg in 1611 in Prognosticon Astrologicum auf das Jahr 1612), Galileo had gained fame and priority, and Galileo accused Marius of plagiarism in Il Saggiatore (1623). With his Belgian telescope, Marius also noted the tilt of the orbital plane of Jupiter's moons, sunspots (1611), and the Andromeda Nebula (1612). He claimed to have worked out a system of cosmology similar to the Tychonic system in 1596, contemporaneously to Kepler's Mysterium Cosmographicum. A crater, the Marius Hills, and the Rima Marius on the Moon are named for him by the I.A.U., as well as, to celebrate the quadricentennial, a main-belt asteroid, now (7984) Marius. Acknowledgment: JMP thanks Seth Fagen, PRPH Books in

  17. On the size of the ptolemaic system of the world - a study based on two figures by Johannes Kepler. (German Title: Über die Gröszlig;e des ptolemäischen Weltsystems - Eine Studie, veranlasst durch zwei Bilder bei Johannes Kepler)

    NASA Astrophysics Data System (ADS)

    Oberschelp, Arnold

    It is well known that the geocentric system according to Ptolemy is almost twice as large as the heliocentric planetary system of Copernicus. There are, however, two pictures, given by Kepler in his «Mysterium Cosmographicum» of 1596 which - at first glance - seem to contradict this. The first picture of the heliocentric system is drawn to scale. The second picture shows a geocentric system, which seems to be too small. The puzzle about the size is solved rather trivially by the fact - which is not mentioned by Kepler and which may be overlooked - that the geocentric picture is not drawn to scale and that the angles do not correspond to the degrees noted at them. In order to get a geocentric picture drawn to scale - taking Kepler's degrees for granted - it is necessary to discuss some details of the ptolemaic system. The result is, however, a geocentric system which is too big. The solution of this new puzzle is not obvious. It turns out that one of Keplers degrees (for Mars) does not correspond to the parameters of Ptolemy. Actually, in his book of 1596, Kepler's topic is not the ptolemaic system nor the copernican distances, but his heliocentric model with the five regular polyhedra. While it is interesting to note all these facts, Kepler's pictures and degrees, for the size of the ptolemaic system, lead to a dead end. Using the parameters from the «Almagest» and the principle of nested spheres from the «Planetary Hypotheses» a distance scale (Tab. 10) for the geocentric system is derived. This distance scale, however, is somewhat different from the well known ptolemaic distance scale (Tab. 1). This puzzle is not resolved, but due to the fact that different sources («Almagest» and «Planetary Hypotheses») of Ptolemy are involved. The distances of Tab. 10 correspond better to the ptolemaic system, since the relative thickness of the spheres is computed from the rather precise parameters (eccentricities and epicycle radii) of the «Almagest». The

  18. MRI Evaluation of Lumbar Disc Degenerative Disease

    PubMed Central

    Patel, Rupal; Mehta, Chetan; Patel, Narrotam

    2015-01-01

    Introduction: Lower back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 40 y. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. Aims and Objective: To evaluate the characterization, extent, and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: Cross-sectional and observational study. Materials and Methods: A total 109 patients of the lumbar disc degeneration with age group between 17 to 80 y were diagnosed & studied on 1.5 Tesla Magnetic Resonance Imaging machine. MRI findings like lumbar lordosis, Schmorl’s nodes, decreased disc height, disc annular tear, disc herniation, disc bulge, disc protrusion and disc extrusion were observed. Narrowing of the spinal canal, lateral recess and neural foramen with compression of nerve roots observed. Ligamentum flavum thickening and facetal arthropathy was observed. Result: Males were more commonly affected in Degenerative Spinal Disease & most of the patients show loss of lumbar lordosis. Decreased disc height was common at L5-S1 level. More than one disc involvement was seen per person. L4 – L5 disc was the most commonly involved. Annular disc tear, disc herniation, disc extrusion, narrowing of spinal canal, narrowing of lateral recess, compression of neural foramen, ligamentum flavum thickening and facetal arthropathy was common at the L4 –L5 disc level. Disc buldge was common at L3 – L4 & L4 – L5 disc level. Posterior osteophytes are common at L3 - L4 & L5 –S1 disc level. L1- L2 disc involvement and spondylolisthesis are less common. Conclusion: Lumbar disc degeneration is the most common cause of low back pain. Plain radiograph can be helpful in visualizing gross anatomic changes in

  19. Age- and sex-related changes in the normal human external nose.

    PubMed

    Sforza, Chiarella; Grandi, Gaia; De Menezes, Marcio; Tartaglia, Gianluca M; Ferrario, Virgilio F

    2011-01-30

    The objective of this study was to measure: (1) normal sex-related dimensions of external nose (linear distances, ratios, angles, volume and surface area); and (2) growth changes between childhood and old age. The three-dimensional coordinates of several soft-tissue landmarks on the external nose were obtained by a non-invasive, computerized digitizer in 519 male and 340 female healthy subjects aged 4-73 years. The subjects were divided into 11 non-overlapping age groups: for children and preadolescent subjects, 2-year spans were used, while larger intervals were used for adolescent and adult subjects. From the landmarks, nasal volume and external surface area; nasal and alar base widths, nasal height, nasal bridge length, philtrum length, nasal tip protrusion, right and left nostril lengths, superior and inferior nostril widths; nasal tip protrusion-to-nasal height, and nasal width-to-nasal height ratios; nasal convexity, alar slope, and nasal tip angles were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. On average, men had larger nasal external volume and area, linear distances and nasal width-to-height ratio than women (p<0.01); no sex differences were found for the angles and the nasal tip protrusion-to-nasal height ratio. Age significantly influenced all analyzed measurements (p<0.001): nasal volume, area, linear distances increased from childhood to old age, while the nasal tip angle decreased as a function of age. No consistent age related patterns were found for the ratios and the nasal convexity and alar slope angles. Men and women had different age related patterns, with significant sex by age interactions (p<0.001). Overall, in most occasions male increments in nasal dimensions were larger than female ones. Data collected in the present investigation could serve as a database for the quantitative description of human nasal morphology during normal growth, development and aging. Forensic

  20. Humans are born too soon: impact on pediatric otolaryngology.

    PubMed

    Bluestone, Charles D

    2005-01-01

    Humans are born 12 months too early. Gestation should be 21 months. Humans evolved to become the pre-eminent animal in the world, but our big brain, bipedalism, and small female pelvic outlet have caused us to pay the price of being born too soon with all of its disadvantages. Early birth has an impact on diseases and disorders encountered by the otolaryngologist, including otitis media, laryngomalacia, tracheomalacia, congenital vocal cord paralysis, subglottic and tracheal stenosis, gastroesophageal reflux, congenital micrognathia, and congenital nasal alar collapse. Many of these conditions improve or resolve completely in the first year of life as an infant's immune system and anatomy matures. Knowledge of this evolutionary process can help us understand why some infants will grow out of certain diseases and disorders encountered in pediatric otolaryngology, while others will not. PMID:15627440

  1. Laser turbinectomy as an adjunct to rhinoseptoplasty.

    PubMed

    Selkin, S G

    1985-07-01

    One hundred two inferior turbinectomies were done with the carbon dioxide laser as an adjunct to rhinoseptoplasty. Indications for surgery were airway obstruction on one or both sides not relieved by medical means (42 cases), patient inability to tolerate medication (36 cases), and patient unwillingness to continue to receive medication for prolonged periods (24 cases) in patients unhappy with their appearance. Pathologic processes included allergic rhinitis (34 cases), vasomotor rhinitis (28 cases), and rhinitis medicamentosum (40 cases). A newly designed suction speculum provided easy access to the internal nose and protected the alar rim and the face from laser energy. Only a few minutes of extra operating time were required. Relief of obstruction was comparable to that obtained from cryosurgery, submucous resection of the turbinate, and partial turbinectomy. Intraoperative and postoperative bleeding was less with laser turbinectomy than with any other means. PMID:4015497

  2. Cellular Neurothekeoma in a Female with Guillain-Barré Syndrome: A Case Report and Review of the Literature

    PubMed Central

    Sachdev, Divya; Barnhill, Raymond L.; Taylor, Emma; Worswick, Scott

    2014-01-01

    Cellular neurothekeoma is a rare cutaneous tumor that occurs more frequently in women. A 68-year-old female with a history of left nasal alar basal cell carcinoma and Guillain-Barré syndrome presented to the clinic with a 3-mm firm skin-colored papule with scattered telangiectasias. Histopathologic examination with immunochemistry of the lesion was consistent with cellular neurothekeoma. It stained positive for microphthalmia transcription factor and NKI-C3 and negative for HMB-45 and S-100. The lesion was excised with 3-mm margins, and no recurrence was noted within 1 year of follow-up. We present a case of cellular neurothekeoma in a patient with a history of Guillain-Barré syndrome as well as a review of the literature. Our case report is unique in that no prior association has been found in the literature between cellular neurothekeoma and Guillain-Barré syndrome. PMID:27047928

  3. Alveolar bone grafting

    PubMed Central

    Lilja, Jan

    2009-01-01

    In patients with cleft lip and palate, bone grafting in the mixed dentition in the residual alveolar cleft has become a well-established procedure. The main advantages can be summarised as follows: stabilisation of the maxillary arch; facilitation of eruption of the canine and sometimes facilitation of the lateral incisor eruption; providing bony support to the teeth adjacent to the cleft; raising the alar base of the nose; facilitation of closure of an oro-nasal fistula; making it possible to insert a titanium fixture in the grafted site and to obtain favourable periodontal conditions of the teeth within and adjacent to the cleft. The timing of the ABG surgery take into consideration not only eruption of the canine but also that of the lateral incisor, if present. The best time for bone grafting surgery is when a thin shell of bone still covers the soon erupting lateral incisor or canine tooth close to the cleft. PMID:19884665

  4. Parallel Douglas-Kroll energy and gradients in NWChem: Estimating scalar relativistic effects using Douglas-Kroll contracted basis sets

    NASA Astrophysics Data System (ADS)

    de Jong, W. A.; Harrison, R. J.; Dixon, D. A.

    2001-01-01

    A parallel implementation of the spin-free one-electron Douglas-Kroll-Hess (DKH) Hamiltonian in NWChem is discussed. An efficient and accurate method to calculate DKH gradients is introduced. It is shown that the use of a standard (nonrelativistic) contracted basis set can produce erroneous results for elements beyond the first row elements. The generation of DKH contracted cc-pVXZ(X=D,T,Q,5) basis sets for H, He, B-Ne, Al-Ar, and Ga-Br is discussed. The effect of DKH at the Hartree-Fock level on the bond distances, vibrational frequencies, and total dissociation energies for CF4, SiH4, SiF4, and Br2CO is discussed. It is suggested that the predominant effect of the scalar relativistic correction on the total dissociation energy can be calculated at the Hartree-Fock level if an adequate basis set is used.

  5. Intra And Extra Nasal Laser Surgery

    NASA Astrophysics Data System (ADS)

    Selking, Stuart G.

    1988-06-01

    The author describes his experience with 400 intranasal laser surgical procedures done with the carbon dioxide laser and the surgical microscope. Procedures include excision and vaporization of polyps, turbinates, tumors, telangiectasia, synechia, nasal stenosis, intranasal cysts, papillomata, and septal spurs. The author describes a suction speculum and drape of his own design which provide smoke free access to the internal nose, and protection of the alar rim and the face from laser energy. Relief of obstruction is comparable to that obtained from the more traditional means of intranasal surgery. Intraoperative and early and delayed post operative bleeding is less with laser surgery than with any other means. Avoidance of technical problems is emphasized in this manuscript, since intranasal laser surgery is in some respects difficult to perform. Included are practical suggestions about patient positioning, use of protective devices, and patient selection.

  6. Preoperative non-surgical over-correction of cleft lip nasal deformity.

    PubMed

    Matsuo, K; Hirose, T

    1991-01-01

    Alar cartilage, which is elastic like auricular cartilage, is correctable in the early neonatal period. Taking advantage of this correctability, we have performed preoperative non-surgical over-correction for cleft lip nasal deformity of incomplete and complete cleft lips with a Simonart's band. The device for this correction was made by processing a nostril retainer into a nostril over-corrector which utilises a spring of silicone rubber, works like a tissue expander and is supported by the nostril floor. Twenty cases are reviewed whose follow-up lasted more than 19 months. The earlier the non-surgical over-correction began, the more satisfactory were the results that were obtained. PMID:1993238

  7. Restoration of facial symmetry in a patient with bell palsy using a modified maxillary complete denture: a case report.

    PubMed

    Bagchi, Gautam; Nath, Dilip Kumar

    2012-01-01

    Permanent facial paralysis can be devastating for a patient. Modern society's emphasis on appearance and physical beauty contributes to this problem and often leads to isolation of patients embarrassed by their appearance. Lagophthalmos with ocular exposure, loss of oral competence with resultant drooling, alar collapse with nasal airway obstruction, and difficulties with mastication and speech production are all potential consequences of facial paralysis. Affected patients are confronted with both a cosmetic defect and the functional deficits associated with loss of facial nerve function. In this case history report, a modified maxillary complete denture permitted a patient with Bell palsy to carry on daily activities with minimal facial distortion, pain, speech difficulty, and associated emotional trauma. PMID:22545260

  8. Primary Nasal Reconstruction in Self-Inflicted Nasal Injury.

    PubMed

    Kapadia, Abizer; John, Jerry R; Gaba, Sunil; Sharma, Ramesh Kumar

    2015-10-01

    Self-inflicted injury of the nose is extremely rare. It may be associated with severe psychopathology and suicidal ideation. The authors report a case of a 24-year-old man, who presented with soft-tissue loss over both the alae of his nose. He had cut off the alar rims with an ordinary razor blade. He was overtly concerned about his nose being excessively broad and fat. A diagnosis of body dysmorphic disorder with nonsuicidal self-injury was made. Patient was observed during 72 hours in hospital with psychiatric support and local dressings. The authors undertook primary nasal reconstruction with nasolabial flaps on both sides for coverage. In conclusion, self-inflicted nasal injury mandates a judicious balancing of psychiatric support and surgical reconstruction. This can prevent untoward sequelae including further self-harm and suicide. PMID:26468831

  9. Rhinoplasty in the patient of African descent.

    PubMed

    Harris, Monte O

    2010-02-01

    We are in the midst of truly changing times, as patients of African descent actively embrace facial cosmetic surgery. Gaining surgical consistency in patients of African descent has proven to be elusive and unpredictable for many rhinoplasty surgeons. Surgical success relies on the surgeon's ability precisely to identify anatomic variables and reconcile these anatomic realities with the patient's expectations for aesthetic improvement and ethnic identity. An appreciation for underlying heritage provides a link culturally to connect with prospective patients and serves as a tool for establishing realistic aesthetic goals. This article highlights the significance of exploring ancestry in the rhinoplasty consultation; identifies key anatomic variables in the nasal tip, dorsum, and alar base; and reviews surgical logic that has facilitated the achievement of consistent, balanced aesthetic outcomes. PMID:20206100

  10. [Johanson-Blizzard's syndrome: another cause of pancreatic lipomatosis (author's transl)].

    PubMed

    Bresson, J L; Schmitz, J; Saudubray, J M; Lesec, G; Hummel, J A; Rey, J

    1980-01-01

    A new case of Johanson-Blizzard's syndrome is reported. It concerns a boy born to consanguineous parents and who died at the age of 10 months from malnutrition. Anal imperforation, alar agenesia, hair anomalies, mental retardation and external pancreatic failure were associated. Neither deafness nor hypothyroidism appeared to be present. Autopsy revealed lipomatous hypoplasia of the exocrine pancreas, hitherto unobserved in this syndrome, and probably responsible for the external pancreatic failure noted in published cases. The variability within a given family of the Johanson-Blizzard malformative syndrome is illustrated by two other cases reported in the anamnesis, one involving a brother who had died earlier with cutaneous aplasia at the fontanella and lacrimal canal malposition and one involving a second cousin who presented with isolated anal imperforation. PMID:7469679

  11. Nasolabial Cyst Associated with Odontogenic Infection

    PubMed Central

    Martini, Eveline Claudia; Coppla, Fabiana Madalozzo; Campagnoli, Eduardo Bauml; Bortoluzzi, Marcelo Carlos

    2016-01-01

    The nasolabial cyst or Klestadt cyst is a relatively uncommon nonodontogenic cyst that develops in the nasal alar region; it has uncertain pathogenesis. This lesion has slow growth and variable dimensions and is characterized clinically by a floating tumefaction in the nasolabial fold area around the bridge of the nose, causing an elevation of the upper lip and relative facial asymmetry. Diagnosis is primarily made clinically; if necessary, this is complemented by imaging. This paper reports the case of a 39-year-old male patient who complained of pain in the right upper premolar region and poor aesthetics due to a firm tumor in the right wing of the nose. Initially, this was thought to be due to an odontogenic abscess; however, the differential diagnosis was that a nasolabial cyst was communicating with the apex of teeth 14 and 15. Surgical treatment was carried out, followed by histopathological examination and concomitant endodontic treatment of the teeth involved. PMID:26904312

  12. Nasolabial Cyst Associated with Odontogenic Infection.

    PubMed

    Martini, Eveline Claudia; Coppla, Fabiana Madalozzo; Campagnoli, Eduardo Bauml; Bortoluzzi, Marcelo Carlos

    2016-01-01

    The nasolabial cyst or Klestadt cyst is a relatively uncommon nonodontogenic cyst that develops in the nasal alar region; it has uncertain pathogenesis. This lesion has slow growth and variable dimensions and is characterized clinically by a floating tumefaction in the nasolabial fold area around the bridge of the nose, causing an elevation of the upper lip and relative facial asymmetry. Diagnosis is primarily made clinically; if necessary, this is complemented by imaging. This paper reports the case of a 39-year-old male patient who complained of pain in the right upper premolar region and poor aesthetics due to a firm tumor in the right wing of the nose. Initially, this was thought to be due to an odontogenic abscess; however, the differential diagnosis was that a nasolabial cyst was communicating with the apex of teeth 14 and 15. Surgical treatment was carried out, followed by histopathological examination and concomitant endodontic treatment of the teeth involved. PMID:26904312

  13. Perineal striated muscles: Anatomy, spinal motoneurons, and participation on copulatory behavior in male rabbits (Oryctolagus cuniculus).

    PubMed

    Zempoalteca, R; Lucio, R A; Eguibar, J R

    2008-09-01

    Despite the importance of rabbits in reproductive studies, little information is available on the anatomy and participation of the striated-perineal muscles in male copulatory behavior. In our study, we describe the gross anatomy of two striated-perineal muscles: the ischiocavernosus (ICm) and the bulbospongiosus (BSm). Both muscles have their origin at the ischiadic arc, but the ICm is inserted into the penile crura and the BSm onto the ligamentum suspensorium of the penis. The motoneurons of both muscles were identified using retrograde labeling with horseradish peroxidase coupled to wheat-germ agglutinin. Motoneurons were dispersed in the lower-lumbar and upper-sacral spinal-cord segments, instead of being aggregated in the neuronal nucleus as in other species: the rat, mouse, gerbil, cat, and man. Bilateral dennervation of the ICm or BSm or both in sexually experienced male rabbits did not affect copulatory variables measured at 10, 20, and 30 days after surgery. However, muscular dennervation produced extravaginal ejaculations in 42% of copulatory tests and no ejaculation in 7% of tests, although male pelvic thrusting occurred. These results suggest the participation of the ICm and BSm perineal muscles in penile orientation during copulation but not in seminal emission as described in other mammalian species. PMID:18563835

  14. Left-sided gallbladder: Its clinical significance and imaging presentations

    PubMed Central

    Hsu, Sheng-Lung; Chen, Tai-Yi; Huang, Tung-Liang; Sun, Cheuk-Kwan; Concejero, Allan M; Tsang, Leo Leung-Chit; Cheng, Yu-Fan

    2007-01-01

    AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US), CT and angiography. METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US, CT and angiography were also reviewed. RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies, absence of umbilical portion of the portal vein in the left lobe of the liver, club-shaped portal vein in the right lobe of the liver, and difficulty in identifying segment IV. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment IV artery was identified in four of six patients using angiography, although segment IV was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively. CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US, CT and angiography images that demonstrate no definite segment IV, absence of umbilical portion of the portal vein in the left lobe, and club-shaped right anterior portal vein. PMID:18081230

  15. C2 nerve dysfunction associated with C1 lateral mass screw fixation.

    PubMed

    Huang, Da-geng; Hao, Ding-jun; Li, Guang-lin; Guo, Hao; Zhang, Yu-chen; He, Bao-rong

    2014-11-01

    The C1 lateral mass screw technique is widely used for atlantoaxial fixation. However, C2 nerve dysfunction may occur as a complication of this procedure, compromising the quality of life of affected patients. This is a review of the topic of C2 nerve dysfunction associated with C1 lateral mass screw fixation and related research developments. The C2 nerve root is located in the space bordered superiorly by the posterior arch of C1 , inferiorly by the C2 lamina, anteriorly by the lateral atlantoaxial joint capsule, and posteriorly by the anterior edge of the ligamentum flavum. Some surgeons suggest cutting the C2 nerve root during C1 lateral mass screw placement, whereas others prefer to preserve it. The incidence, clinical manifestations, causes, management, and prevention of C2 nerve dysfunction associated with C(1) lateral mass screw fixation are reviewed. Sacrifice of the C2 nerve root carries a high risk of postoperative numbness, whereas postoperative nerve dysfunction can occur when it has been preserved. Many surgeons have been working hard on minimizing the risk of postoperative C2 nerve dysfunction associated with C1 lateral mass screw fixation. PMID:25430709

  16. Current insights and controversies in the pathogenesis and diagnosis of disc-associated cervical spondylomyelopathy in dogs.

    PubMed

    De Decker, S; da Costa, R C; Volk, H A; Van Ham, L M L

    2012-11-24

    Disc-associated cervical spondylomyelopathy (DA-CSM) is the most common cause of cervical spondylomyelopathy in dogs. In this condition, progressive caudal cervical spinal cord compression is typically caused by protrusion of one or more intervertebral discs. This disc-associated compression is sometimes seen in combination with mild vertebral abnormalities and dorsal compression resulting from ligamentum flavum hypertrophy. The intervertebral disc space between the sixth (C6) and seventh (C7) cervical vertebrae is most commonly affected. Although several large breed dogs can be affected, the adult to older dobermann is overrepresented. Clinical signs vary from cervical hyperaesthesia to tetraplegia. Dogs can present with a chronic progressive or an acute onset of clinical signs. Many aspects of this multifactorial neurological syndrome are not completely understood and are the subject of controversy and debate. Although several factors have been proposed, the underlying pathology and aetiology remain unknown. Recently, new insights have been gained in the pathogenesis, diagnosis and treatment of this challenging neurological syndrome. This review outlines current controversies and new developments concerning the pathogenesis and diagnosis of DA-CSM. PMID:23180710

  17. Elastin peptides prepared from piscine and mammalian elastic tissues inhibit collagen-induced platelet aggregation and stimulate migration and proliferation of human skin fibroblasts.

    PubMed

    Shiratsuchi, Eri; Ura, Megumi; Nakaba, Misako; Maeda, Iori; Okamoto, Kouji

    2010-11-01

    We obtained pure elastin peptides from bovine ligamentum nuchae, porcine aorta, and bonito bulbus arteriosus. The inhibitory activity of these elastin peptides on platelet aggregation induced by collagen and the migratory and proliferative responsivenesses of human skin fibroblasts to these elastin peptides were examined. All of bonito, bovine, and porcine elastin peptides found to inhibit platelet aggregation, but bonito elastin peptides showed a higher inhibitory activity than bovine and porcine elastin peptides did. All elastin peptides enhanced the proliferation of fibroblasts 3.5- to 4.5-fold at a concentration of 10 µg/ml. Bovine and porcine elastin peptides stimulated the migration of fibroblasts, with the optimal response occurring at 10(-1) µg/ml, while maximal response was at 10(2) µg/ml for bonito elastin peptides. Furthermore, pretreatment of fibroblasts by lactose depressed their ability to migrate in response to all elastin peptides, suggesting the involvement of elastin receptor in cell response. These results suggest that both mammalian and piscine elastin peptides can be applied as useful biomaterials in which elasticity, antithrombotic property, and the enhancement of cell migration and proliferation are required. PMID:20853312

  18. Vascular rings.

    PubMed

    Backer, Carl L; Mongé, Michael C; Popescu, Andrada R; Eltayeb, Osama M; Rastatter, Jeffrey C; Rigsby, Cynthia K

    2016-06-01

    The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. In the current era, the diagnosis of a vascular ring is best established by CT imaging that can accurately delineate the anatomy of the vascular ring and associated tracheal pathology. For patients with a right aortic arch there recently has been an increased recognition of a structure called a Kommerell diverticulum which may require resection and transfer of the left subclavian artery to the left carotid artery. A very rare vascular ring is the circumflex aorta that is now treated with the aortic uncrossing operation. Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time. PMID:27301603

  19. Cervical ligamentous instability in a canine in vivo model.

    PubMed

    Whitehill, R; Moran, D J; Fechner, R E; Ruch, W W; Drucker, S; Hooper, W E; McCoig, J A

    1987-12-01

    A canine in vivo model of midcervical ligamentous instability was developed by dividing the anterior longitudinal ligament, anulus fibrosus, and all posterior ligamentous structures including the ligamentum flavum. The natural history of healing in the model, the effect on its healing by an adjacent one-level arthrodesis, and the effect of a one-level arthrodesis on normal adjacent ligamentous structures were studied radiographically, mechanically, and histologically. The authors determined that healing takes place primarily by anterior scar formation in their instability model but not to a degree sufficient to recreate normal mechanical stability. After three months, healing in the model was not affected by an adjacent arthrodesis; however, acutely, instability apparently was increased as three animals became quadriplegic between the second and fourth postoperative days. Arthrodesis did not affect adjacent normal ligamentous structures, during this period. Incomplete healing in the authors' model supports those who advocate arthrodesis as the treatment of choice for destabilizing cervical ligamentous injury. The authors previously reported the case of a patient who sustained bilateral facet dislocations adjacent to an arthrodesed segment and questioned whether this resulted from a stress-concentrating effect. This study indicates that this could well have been the case acutely. Thus, inadvertent exclusion of an unstable segment from an arthrodesis has potentially catastrophic results. Finally, the authors also have previously questioned whether arthrodesis of a midcervical segment could lead to instability of adjacent normal segments. This project does not support such a concern, at least for the three postoperative months of study. PMID:3441821

  20. Multifocal PEComa (PEComatosis) of the female genital tract and pelvis: a case report and review of the literature

    PubMed Central

    2012-01-01

    Perivascular epithelioid cells (PECs) are constantly present in a group of tumors called PEComas, including angiomyolipoma (AML), clear-cell "sugar" tumor (CCST) of the lung and extrapulmonary sites, lymphangioleiomyomatosis, clear-cell myomelanocytic tumor of the falciform ligament/ligamentum teres and rare clear-cell tumors of other anatomic sites. PECs have distinctive morphologic, immunohistochemical, ultrastructural and genetic characteristics, including an epithelioid appearance with a clear to granular cytoplasm, a round to oval, centrally located nucleus, and an inconspicuous nucleolus. PECs also express melanocytic and myogenic markers like HMB45 and smooth muscle actin. PEComa is rare in human, and multifocal PEComas (PEComatosis) is extremely rare. Up to now there have been only less than 5 cases described in the literature. Here we report a 46-year old Chinese woman who had PEComatosis arising from the genital tract and pelvis. To our knowledge, this is the first case of PEComatosis ever reported in China. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1293097548652023. PMID:22404894

  1. Ozone solubilizes elastin and increases its susceptibility to elastase

    SciTech Connect

    Winters, R.S.; Johnson, D.A. )

    1991-03-11

    Ozone is a powerful oxidant gas that may contribute to lung diseases such as emphysema. Because the hallmark of emphysema is destruction of the elastin rich alveoli of the lung, ozonization of elastin was studied in vitro to examine the effects of ozone on elastin structure and susceptibility to proteolysis. Samples of bovine ligamentum nuchae elastin were suspended in 15 ml PBS and bubbled with 13.7 ppm ozone in argon at a flow rate of 3.5 ml/min. Ozone treatment resulted in the solubilization of elastin as evidenced by a visual decrease in turbidity and an increase in the 225 nm absorbance of the supernatant fraction after centrifugation to pellet the insoluble elastin. Insoluble elastin recovered from exposed suspensions was examined for proteolytic susceptibility with human neutrophil elastase (HNE), by incubating 600 {mu}g samples in 1 ml of 50 mM Tris-HCl, 200 mM NaCl, pH 8.0 with 3 {mu}g HNE for various times at room temp. Elastin proteolysis was followed by measuring the 225 nm absorbance of solubilized peptides in supernatant fractions. Ozone exposed elastin, which had been previously ozonized to 5% solubility was found to be approximately twice as susceptible to proteolysis as native elastin.

  2. Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads.

    PubMed

    Kumaresan, S; Yoganandan, N; Pintar, F A; Maiman, D J

    1999-12-01

    An anatomically accurate, three-dimensional, nonlinear finite element model of the human cervical spine was developed using computed tomography images and cryomicrotome sections. The detailed model included the cortical bone, cancellous core, endplate, lamina, pedicle, transverse processes and spinous processes of the vertebrae; the annulus fibrosus and nucleus pulposus of the intervertebral discs; the uncovertebral joints; the articular cartilage, the synovial fluid and synovial membrane of the facet joints; and the anterior and posterior longitudinal ligaments, interspinous ligaments, capsular ligaments and ligamentum flavum. The finite element model was validated with experimental results: force-displacement and localized strain responses of the vertebral body and lateral masses under pure compression, and varying eccentric anterior-compression and posterior-compression loading modes. This experimentally validated finite element model was used to study the biomechanics of the cervical spine intervertebral disc by quantifying the internal axial and shear forces resisted by the ventral, middle, and dorsal regions of the disc under the above axial and eccentric loading modes. Results indicated that higher axial forces (compared to shear forces) were transmitted through different regions of the disc under all loading modes. While the ventral region of the disc resisted higher variations in axial force, the dorsal region transmitted higher shear forces under all loading modes. These findings may offer an insight to better understand the biomechanical role of the human cervical spine intervertebral disc. PMID:10717549

  3. Hand and foot remains from the Gran Dolina Early Pleistocene site (Sierra de Atapuerca, Spain).

    PubMed

    Lorenzo, C; Arsuaga, J L; Carretero, J M

    1999-01-01

    We report here the study of the 22 hand and foot remains from the Early Pleistocene level TD6 of the Gran Dolina site at Sierra de Atapuerca (Burgos, Spain) recovered from 1994 to 1996. These remains are paratypes of Homo antecessor. All of the elements are briefly described and compared with other fossil hominids. The capitate has a constricted neck, well developed head, strong attachment for the ligamentum interosseum trapezoid-capitate, a palmarly placed trapezoid facet with a distinctive small dorsal trapezoid facet, a highly curved and oblique orientation of the second metacarpal facet, and a transversally oriented dorsodistal border. A hamate with a moderately projecting and lightly built hamulus; an inferred reduced styloid process on the third metacarpal base; a wide second metacarpal head; and middle phalanges with well marked insertions for the flexor digitorum superficialis muscle and wide heads. The morphology and dimensions of the pedal remains from TD6 are very similar to modern humans; but the base, proximal articular surface and shafts of the proximal hallucal phalanges are more rounded and the midshaft of the proximal toe phalanx is wider. PMID:10496998

  4. Vascular rings: a radiological review of anatomical variations

    PubMed Central

    Ganie, Iqbal Siddi; Amod, Khatija; Reddy, Darshan

    2016-01-01

    Summary Background The imaging modalities used to diagnose vascular rings have evolved over time, from basic radiographic studies to advanced cross-sectional imaging. The goal of preoperative imaging is to provide the surgeon with an accurate representation of the ring configuration so that the surgical approach may be planned. Methods We conducted a review of all patients with vascular rings who underwent surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa from 1 July 2008 to 1 July 2013. Results Eight patients were diagnosed with vascular rings. Seven patients had an abnormal plain chest radiograph (right aortic arch, tracheal narrowing, or abnormal mediastinal silhouette), while in six patients the contrast oesophagogram demonstrated a fixed extrinsic oesophageal indentation. Computed tomography angiography confirmed the pathology in all cases, with six double aortic arches and two right aortic arches with aberrant left subclavian artery and left ligamentum arteriosum. Conclusions We advocate a diagnostic imaging algorithm consisting of plain chest radiography, contrast oesophagogram and computed tomography angiography prior to surgery. Magnetic resonance imaging may provide an alternative axial imaging modality depending on institutional preference. PMID:26523459

  5. Response of individual thoracolumbar spine ligaments under high-rate deformation.

    PubMed

    Iwaskiw, Alexander S; Armiger, Robert S; Ott, Kyle A; Wickwire, Alexis C M; Merkle, Andrew C

    2012-01-01

    Under-Body Blast (UBB) has emerged as the predominant threat to ground vehicles and Warfighter survivability. The force transference from the vehicle structure to the human body has resulted in serious injuries, with the thoracolumbar spine frequently damaged. Computational models of the human body are being generated to model human response and develop injury mitigation strategies. To effectively model the spine mechanics, the thoracolumbar ligaments, which serve varying roles in contributing to spine stability, must be characterized at relevant strains and strain rates. Adaptation of cervical spine testing methods has allowed for testing of isolated spinal ligaments including the Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), and Ligamentum Flavum (LF). A high-rate servo-hydraulic test machine was used to execute a tensile test protocol for 24 complexes with loading rates ranging from 240 - 2800 mm/s and displacements of 25%, 50%, 75%, 100%, and 300% of the measured ligament length. Non-contact strain field measurements were recorded to produce a three dimensional strain field of the ligament surface. In order to provide the ligament data in a form which can be incorporated in the human computational models, analytical methods for modeling the ligament response are being investigated. Ultimately, this model will be optimized to be utilized in computational models of the lumbar spine. PMID:22846283

  6. MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles.

    PubMed

    Rosenbaum, Daniel G; Servaes, Sabah; Bogner, Eric A; Jaramillo, Diego; Mintz, Douglas N

    2016-01-01

    Developmental dysplasia of the hip is a spectrum disorder of hip development that ranges in severity from abnormal acetabular morphology to complete hip dislocation. While treatment with a Pavlik harness is highly effective in infants younger than 6 months, older infants and children and those with orthotic failure often warrant surgical reduction and placement of a spica cast, which limits subsequent imaging evaluation. Magnetic resonance (MR) imaging has been described in the evaluation of the adequacy of hip reduction for more than 2 decades, but the practice is still not widespread and is performed routinely at relatively few centers. MR imaging is a robust tool for outcome assessment after hip reduction and placement of a spica cast, facilitating multiplanar confirmation of concentric reduction independent of an ossific nucleus or orthopedic hardware. Excellent image contrast of soft tissues allows identification of obstacles to concentric reduction, which may be extra-articular or intra-articular. Extra-articular obstacles include tightening of the adductor muscles and tightening of the iliopsoas tendon with constriction of the joint capsule. Intra-articular obstacles include limbus formation, labral inversion, an enlarged pulvinar, and hypertrophy of the ligamentum teres and/or the transverse acetabular ligament. Intravenous contrast material administration may demonstrate altered epiphyseal blood flow and help identify patients at risk for early ischemia. Imaging technique and image interpretation can be optimized to facilitate the performance of postreduction MR imaging studies where they may be of benefit. (©)RSNA, 2016. PMID:27035836

  7. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine.

    PubMed

    Tetreault, Lindsay; Goldstein, Christina L; Arnold, Paul; Harrop, James; Hilibrand, Alan; Nouri, Aria; Fehlings, Michael G

    2015-10-01

    Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes. In this article, we review the range of degenerative spinal disorders resulting in progressive cervical spinal cord compression and propose the adoption of a new term, degenerative cervical myelopathy (DCM). DCM comprises both osteoarthritic changes to the spine, including spondylosis, disk herniation, and facet arthropathy (collectively referred to as cervical spondylotic myelopathy), and ligamentous aberrations such as ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum. This review summarizes current knowledge of the pathophysiology of DCM and describes the cascade of events that occur after compression of the spinal cord, including ischemia, destruction of the blood-spinal cord barrier, demyelination, and neuronal apoptosis. Important features of the diagnosis of DCM are discussed in detail, and relevant clinical and imaging findings are highlighted. Furthermore, this review outlines valuable assessment tools for evaluating functional status and quality of life in these patients and summarizes the advantages and disadvantages of each. Other topics of this review include epidemiology, the prevalence of degenerative changes in the asymptomatic population, the natural history and rates of progression, risk factors of diagnosis (clinical, imaging and genetic), and management strategies. PMID:26378358

  8. Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis.

    PubMed

    Ren, Longxi; Han, Zhengfeng; Zhang, Jianhua; Zhang, Tongtong; Yin, Jian; Liang, Xibin; Guo, Han; Zeng, Yanjun

    2014-05-01

    The objective of this study is to observe the effect of percutaneous laser disc decompression (PLDD) on lumbar spinal stenosis (LSS). Thirty-two LSS patients were treated using pulsed Nd: YAG laser, of which 21 cases (11 males and 10 females with an average age of 64 years old) were followed up for 2 years. All of the 21 patients had intermittent claudication with negative straight leg raising test results. Fifteen patients suffered from anterior central disc herniation which often compressed the cauda equina but seldom compressed the posterior part; six patients suffered from posterior ligamentum flavum hypertrophy which often compressed the cauda equina but seldom compressed the anterior part. The efficacy was evaluated 1, 3, 6, 12 and 24 months after surgery on 21 patients using the performance evaluation criteria of the lumbago treatment by the Japanese Orthopaedic Association (JOA 29 scores). The fineness (i.e. excellent and good treatment outcome) rate 1, 3, 6, 12 and 24 months after the operation were 46.7%, 66.7%, 66.7%, 66.7% and 66.7%, respectively, in patients with severe anterior compression and 16.7%, 33.3%, 33.3%, 33.3% and 33.3%, respectively, in patients with severe posterior compression. PLDD had certain positive efficacy on the treatment of lumbar spinal stenosis, which was more significant on LSS dominated by the anterior compression than that by the posterior compression. PMID:23996073

  9. Differential diagnosis of pain around the hip joint.

    PubMed

    Tibor, Lisa M; Sekiya, Jon K

    2008-12-01

    The differential diagnosis of hip pain is broad and includes intra-articular pathology, extra-articular pathology, and mimickers, including the joints of the pelvic ring. With the current advancements in hip arthroscopy, more patients are being evaluated for hip pain. In recent years, our understanding of the functional anatomy around the hip has improved. In addition, because of advancements in magnetic resonance imaging, the diagnosis of soft tissue causes of hip pain has improved. All of these advances have broadened the differential diagnosis of pain around the hip joint and improved the treatment of these problems. In this review, we discuss the causes of intra-articular hip pain that can be addressed arthroscopically: labral tears, loose bodies, femoroacetabular impingement, capsular laxity, tears of the ligamentum teres, and chondral damage. Extra-articular diagnoses that can be managed arthroscopically are also discussed, including: iliopsoas tendonitis, "internal" snapping hip, "external" snapping hip, iliotibial band and greater trochanteric bursitis, and gluteal tendon injury. Finally, we discuss extra-articular causes of hip pain that are often managed nonoperatively or in an open fashion: femoral neck stress fracture, adductor strain, piriformis syndrome, sacroiliac joint pain, athletic pubalgia, "sports hernia," "Gilmore's groin," and osteitis pubis. PMID:19038713

  10. [Operation of cross-section and extravasal correction of the femoral vein valves in varicose disease using minimal access].

    PubMed

    Tsukanov, Iu T; Tsukanov, A Iu

    2002-02-01

    Taking into account the heightened demands of patients for the quality of life the aesthetics of upper incisions in varicose disease gains significance. The authors adduce the depiction of the procedure and results of application of two original operations: cross-sectomy with application of public approach and extravasal correction of femoral vein valves using proper fascial tunics by inguinal mini-access. Endosurgical manipulations are performed inside operative space, created by hook-elevator with endoillumination, permitting to reduce cutaneous incision and remove it to aesthetically less significant zones. The 2 cm long incision in the hair-bearing part of public region in inside and horizontal direction was applied in cross-sectomy. The transverse cutaneous incision 2-2.5 cm long 6-7 cm down inguinal ligamentum and medially about femoral vessels projection was proposed for valvuloplasty. Cross-sectomy using mini-access was done in 49 patients, valvuloplasty of femoral vein--in 41. Estimation of immediate and late follow-up results witnesses, that elaborated endosurgical procedures of cross-sectomy and valvuloplasty of femoral vein in patients with varicose disease using mini-access corresponds to aesthetical demands of modern phlebology. PMID:12024722

  11. Synovial cysts of the lumbar spine--pathological considerations and surgical strategy.

    PubMed

    Ganau, Mario; Ennas, Franco; Bellisano, Giulia; Ganau, Laura; Ambu, Rossano; Faa, Gavino; Maleci, Alberto

    2013-01-01

    Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts. PMID:23438660

  12. The “Vessel through Strait” Sign is a Signature Radiological Sign for the Diagnosis of Left Hepatic Artery Variation

    PubMed Central

    Rong, Guanghua; Wang, Zhijun; Wang, Ximing; Yu, Qiang; Zhou, Lin; Wang, Huaming; Zhang, Junhua; Dong, Jinghui; Ma, Wei; An, Weimin; Ren, Hui; Zeng, Zhen; Lu, Yinying; Li, Yongwu

    2016-01-01

    An aberrant artery (AA) can frequently be observed coursing through the fissure for the ligamentum venosum (FLV) which was termed the “vessel through strait” sign (VTSS) by us. Fundamental data including the incidence, anatomical composition and clinical significance of VTSS and the AAs composing VTSS are still lacking. We sought to give a systematic demonstration on this issue in the present study. VTSS was respectively analyzed in 2,275 patients and was observed in 357 of them. Interestingly, 319 (89.4%) out of the 357 patients exhibiting VTSS were proved to have left hepatic artery variation (LHAV) (247 with replaced left hepatic artery, 64 with accessory left hepatic artery and 8 with variant common hepatic artery). We therefore hypothesized that VTSS could be a sign that strongly associated with LHAV and could be used for its diagnosis. In the following validating analysis, VTSS gained a sensitivity of 96.3% and a specificity of 98.3% for the diagnosis of LHAV in another bicenter cohort consisted of 1,329 patients. In conclusion, VTSS is a signature radiological sign of LHAV which could be used as an easy and specific method for the diagnosis of LHAV. PMID:27040020

  13. Abnormal veins around the heart with the closure of the coronary sinus ostium.

    PubMed

    Ishizawa, Akimitsu; Suzuki, Ryoji; Zhou, Ming; Abe, Hiroshi

    2016-06-01

    In a cadaveric dissection course at Akita University Graduate School of Medicine in 2014, we observed abnormal veins in a 72-year-old male who died of prostate cancer. The abnormality consisted of the following: closure of the opening of the coronary sinus (closure of the coronary sinus ostium), a persistent left superior vena cava (Lsvc), and a postaortic left brachiocephalic vein (Palbv). The shunt between the coronary sinus and left atrium was not observed. The blood of the coronary sinus flowed into an oblique vein of the left atrium, which was wide and reverse-funnel shaped, penetrated the pericardial sac then continued to the Lsvc. The anastomotic veins between the Lsvc and the (right) superior vena cava were seen to consist of two veins as follows: one was a left brachiocephalic vein, the other a dorsal postaortic left brachiocephalic vein (dorsal Palbv). The dorsal Palbv passed dorsally on the ligamentum arteriosum, and then passed between the ascending aorta and the trachea. The dorsal Palbv was thicker than the left brachiocephalic vein. We discuss the process of formation of these variations. PMID:26329835

  14. Experimental Characterization of the Anatomical Structures of the Lumbar Spine Under Dynamic Sagittal Bending.

    PubMed

    Bradfield, C A; Demetropoulos, C K; Luongo, M E; Pyles, C O; Armiger, R S; Merkle, A C

    2015-01-01

    Underbody blast (UBB) events transmit high-rate vertical loads through the seated occupant’s lumbar spine and have a high probability of inducing severe injury. While previous studies have characterized the lumbar spine under quasi-static loading, additional work should focus on the complex kinetic and kinematic response under high loading rates. To discern the biomechanical influence of the lumbar spine’s anatomical structures during dynamic loading, the axial force, flexion-extension moments and range of motion for lumbar motion segments (n=18) were measured during different states of progressive dissection. Pre-compression was applied using a static mass while dynamic bending was applied using an offset drop mass. Dynamic loading resulted in peak axial loads of 4,224±133 N, while maximum peak extension and flexion moments were 19.6±12.5 and -44.8±8.6 Nm in the pre-dissected state, respectively. Upon dissection, transection of the interspinous ligament, ligamentum flavum and facet capsules resulted in significantly larger flexion angles, while the removal of the posterior elements increased the total peak angular displacement in extension from 3.3±1.5 to 5.0±1.7 degrees (p=0.002). This study provides insight on the contribution of individual anatomical components on overall lumbar response under high-rate loading, as well as validation data for numerical models. PMID:25996712

  15. Growth characteristics of the fetal ligament of the head of femur: significance in congenital hip disease.

    PubMed Central

    Walker, J. M.

    1980-01-01

    Measurement of the length and width of the ligament of the head of femur (ligamentum teres) in 140 normal human fetuses between 12 weeks and term provides limits for growth changes in this structure. These observations provide no morphological evidence of a significant difference between males and females, or between the right and left sides, to explain the female and left hip preponderance reported in congenital hip disease. The ligament is shown to be variable in length, width, and shape, and it is not a distinctly linear structure through linearity may increase with age. Tests of femoral head mobility support the opinion that this ligament must play a role in fetal and neonatal hip joint stability. Weak correlation only was demonstrated between the ligament variables and acetabular depth, which suggests that ligament shape and socket shape are not closely related. Comparison of measurements from normal and 12 dysplastic or subluxated joints provides no evidence to support previous observations that this structure is unusually long in abnormal hip joints which are not frankly dislocated. Images FIG. 1 PMID:7445537

  16. Airborne Observations of Urban-Derived Water Vapor and Potential Impacts on Chemistry and Clouds

    NASA Astrophysics Data System (ADS)

    Salmon, O. E.; Shepson, P. B.; Grundman, R. M., II; Stirm, B. H.; Ren, X.; Dickerson, R. R.; Fuentes, J. D.

    2015-12-01

    Atmospheric conditions typical of wintertime, such as lower boundary layer heights and reduced turbulent mixing, provide a unique environment for anthropogenic pollutants to accumulate and react. Wintertime enhancements in water vapor (H2O) have been observed in urban areas, and are thought to result from fossil fuel combustion and urban heat island-induced evaporation. The contribution of urban-derived water vapor to the atmosphere has the potential to locally influence atmospheric chemistry and weather for the urban area and surrounding region due to interactions between H2O and other chemical species, aerosols, and clouds. Airborne observations of urban-derived H2O, carbon dioxide (CO2), methane, nitrogen dioxide (NO2), ozone, and aerosols were conducted from Purdue University's Airborne Laboratory for Atmospheric Research (ALAR) and the University of Maryland's (UMD) Twin Cessna research aircraft during the winter of 2015. Measurements were conducted as part of the collaborative airborne campaign, Wintertime INvestigation of Transport, Emissions, and Reactivity (WINTER), which investigated seasonal trends in anthropogenic emissions and reactivity in the Northeastern United States. ALAR and the UMD aircraft participated in mass balance experiments around Washington D.C.-Baltimore to determine total city emission rates of H2O and other greenhouse gases. Average enhancements in H2O mixing ratio of 0.048%, and up to 0.13%, were observed downwind of the urban centers on ten research flights. In some cases, downwind H2O concentrations clearly track CO2 and NO2 enhancements, suggesting a strong combustion signal. Analysis of Purdue and UMD data collected during the WINTER campaign shows an average urban-derived H2O contribution of 5.3%, and as much as 13%, to the local boundary layer from ten research flights flown in February and March of 2015. In this paper, we discuss the potential chemical and physical implications of these results.

  17. Biomechanical characterisation of the human nasal cartilages; implications for tissue engineering.

    PubMed

    Griffin, M F; Premakumar, Y; Seifalian, A M; Szarko, M; Butler, P E M

    2016-01-01

    Nasal reconstruction is currently performed using autologous grafts provides but is limited by donor site morbidity, tissue availability and potentially graft failure. Additionally, current alternative alloplastic materials are limited by their high extrusion and infection rates. Matching mechanical properties of synthetic materials to the native tissue they are replacing has shown to be important in the biocompatibility of implants. To date the mechanical properties of the human nasal cartilages has not been studied in depth to be able to create tissue-engineered replacements with similar mechanical properties to native tissue. The young's modulus was characterized in compression on fresh-frozen human cadaveric septal, alar, and lateral cartilage. Due to the functional differences experienced by the various aspects of the septal cartilage, 16 regions were evaluated with an average elastic modulus of 2.72 ± 0.63 MPa. Furthermore, the posterior septum was found to be significantly stiffer than the anterior septum (p < 0.01). The medial and lateral alar cartilages were tested at four points with an elastic modulus ranging from 2.09 ± 0.81 MPa, with no significant difference between the cartilages (p < 0.78). The lateral cartilage was tested once in all cadavers with an average elastic modulus of 0.98 ± 0.29 MPa. In conclusion, this study provides new information on the compressive mechanical properties of the human nasal cartilage, allowing surgeons to have a better understanding of the difference between the mechanical properties of the individual nasal cartilages. This study has provided a reference, by which tissue-engineered should be developed for effective cartilage replacements for nasal reconstruction. PMID:26676857

  18. Aesthetic rhinoplasty: Avoiding unfavourable results.

    PubMed

    Bhangoo, Kulwant S

    2013-05-01

    Rhinoplasty is one of the most challenging surgical procedures in plastic surgery. It is not surprising that a significant number of patients end up with unfavourable outcomes. Many of these unfavourable outcomes could be the result of poor judgment and wrong decision making. Most frequently, the unfavourable outcome is the result of errors in surgical technique. In this paper, unfavourable outcomes resulting from errors in surgical technique are discussed under the heading of each operative step. Poor placement of intra-nasal incision can result in internal valve obstruction. Bad columellar scars can result from errors during open rhinoplasty. Unfavourable results associated with skeletonisation are mentioned. Tip plasty, being the most difficult part of rhinoplasty, can result in lack of tip projection, asymmetry and deformities associated with placement of tip grafts. Over-resection of the lower lateral cartilages during tip plasty can also result in pinched nose, alar collapse causing external valve obstruction and other alar rim deformities. Humpectomy can result in open roof deformity, inverted V deformity and over-resection resulting in saddle nose. The so-called poly beak deformity is also a preventable unfavourable outcome when dealing with a large dorsal hump. Complications resulting from osteotomies include narrowing of nasal airway, open roof deformity, inverted V deformity and asymmetry of the bony wall resulting from incomplete or green stick fractures. Judicious use of grafts can be very rewarding. By the same token, grafts also carry with them the risk of complications. Allografts can result in recurrent infection, atrophy of the overlying skin and extrusion resulting in crippling deformities. Autografts are recommended by the author. Unfavourable results from autografts include displacement of graft, visibility of the graft edges, asymmetry, warping, and resorption. PMID:24501471

  19. Eppur Si Muove: Evidence for an External Granular Layer and Possibly Transit Amplification in the Teleostean Cerebellum

    PubMed Central

    Biechl, Daniela; Dorigo, Alessandro; Köster, Reinhard W.; Grothe, Benedikt; Wullimann, Mario F.

    2016-01-01

    The secreted signaling factor Sonic Hedgehog (Shh) acts in the floor plate of the developing vertebrate CNS to promote motoneuron development. In addition, shh has dorsal expression domains in the amniote alar plate (i.e., in isocortex, superior colliculus, and cerebellum). For example, shh expressing Purkinje cells act in transit amplification of external granular layer (EGL) cells of the developing cerebellum. Our previous studies had indicated the presence of an EGL in anamniote zebrafish, but a possible role of shh in the zebrafish cerebellar plate remained elusive. Therefore, we used an existing zebrafish transgenic line Tg(2.4shha-ABC-GFP)sb15; Shkumatava et al., 2004) to show this gene activity and its cellular localization in the larval zebrafish brain. Clearly, GFP expressing cells occur in larval alar zebrafish brain domains, i.e., optic tectum and cerebellum. Analysis of critical cerebellar cell markers on this transgenic background and a PH3 assay for mitotic cells reveals that Purkinje cells and eurydendroid cells are completely non-overlapping postmitotic cell populations. Furthermore, shh-GFP cells never express Zebrin II or parvalbumin, nor calretinin. They are thus neither Purkinje cells nor calretinin positive migrating rhombic lip derived cells. The shh-GFP cells also never correspond to PH3 positive cells of the ventral cerebellar proliferative zone or the upper rhombic lip-derived EGL. From this marker analysis and the location of shh-GFP cells sandwiched between calretinin positive rhombic lip derived cells and parvalbumin positive Purkinje cells, we conclude that shh-GFP expressing cells qualify as previously reported olig2 positive eurydendroid cells, which are homologous to the amniote deep cerebellar nuclei. We confirm this using double transgenic progeny of shh-GFP and olig2-dsRed zebrafish. Thus, these zebrafish eurydendroid cells may have the same role in transit amplification as Purkinje cells do in amniotes. PMID:27199681

  20. Evo-devo and the primate isocortex: the central organizing role of intrinsic gradients of neurogenesis

    PubMed Central

    Charvet, Christine J.; Finlay, Barbara L.

    2014-01-01

    Spatial gradients in the initiation and termination of basic processes, such as cytogenesis, cell-type specification and dendritic maturation are ubiquitous in developing nervous systems. Such gradients can produce a niche adaptation in a particular species. For example, the high density of photoreceptors and neurons in the “area centralis” of some vertebrate retinas result from the early maturation of its center relative to its periphery. Across species, regularities in allometric scaling of brain regions can derive from conserved spatial gradients: longer neurogenesis in the alar versus the basal plate of the neural tube is associated with relatively greater expansion of alar plate derivatives in larger brains. We describe gradients of neurogenesis within the isocortex and their effects on adult cytoarchitecture within and across species. Longer duration of neurogenesis in the caudal isocortex is associated with increased neuron number and density per column relative to the rostral isocortex. Later-maturing features of single neurons, such as soma size and dendritic spine numbers reflect this gradient. Considering rodents and primates, the longer duration of isocortical neurogenesis in each species, the greater the rostral-to-caudal difference in neuron number and density per column. Extended developmental duration produces substantial, predictable changes in the architecture of the isocortex in larger brains, and presumably, a progressively changed functional organization whose properties we do not yet fully understand. Many features of isocortical architecture previously viewed as species- or niche-specific adaptations can now be integrated as the natural outcomes of spatiotemporal gradients that are deployed in larger brains. PMID:25247448

  1. Model for Estimating the Threshold Mechanical Stability of Structural Cartilage Grafts Used in Rhinoplasty

    PubMed Central

    Zemek, Allison; Garg, Rohit; Wong, Brian J. F.

    2014-01-01

    Objectives/Hypothesis Characterizing the mechanical properties of structural cartilage grafts used in rhinoplasty is valuable because softer engineered tissues are more time- and cost-efficient to manufacture. The aim of this study is to quantitatively identify the threshold mechanical stability (e.g., Young’s modulus) of columellar, L-strut, and alar cartilage replacement grafts. Study Design Descriptive, focus group survey. Methods Ten mechanical phantoms of identical size (5 × 20 × 2.3 mm) and varying stiffness (0.360 to 0.85 MPa in 0.05 MPa increments) were made from urethane. A focus group of experienced rhinoplasty surgeons (n = 25, 5 to 30 years in practice) were asked to arrange the phantoms in order of increasing stiffness. Then, they were asked to identify the minimum acceptable stiffness that would still result in favorable surgical outcomes for three clinical applications: columellar, L-strut, and lateral crural replacement grafts. Available surgeons were tested again after 1 week to evaluate intra-rater consistency. Results For each surgeon, the threshold stiffness for each clinical application differed from the threshold values derived by logistic regression by no more than 0.05 MPa (accuracy to within 10%). Specific thresholds were 0.56, 0.59, and 0.49 MPa for columellar, L-strut, and alar grafts, respectively. For comparison, human nasal septal cartilage is approximately 0.8 MPa. Conclusions There was little inter- and intra-rater variation of the identified threshold values for adequate graft stiffness. The identified threshold values will be useful for the design of tissue-engineered or semisynthetic cartilage grafts for use in structural nasal surgery. PMID:20513022

  2. Nasal Sculpting: Calculated and Predictable Tip Elevation With Cephalic Trim

    PubMed Central

    Redstone, Jeremiah S.; Nguyen, Jonathan; North, Durham Alan; Hazani, Ron; Drury, Brad; Yoder, Eric M.; Cooperman, Ross D.; Yoder, Virginia; Little, Jarrod A.; Florman, Larry D.; Wilhelmi, Bradon J.

    2015-01-01

    Background: Rhinoplasty techniques to affect nasal tip rotation are well described. Cephalic alar trim is a powerful method for achieving tip elevation. Previous studies and texts provide aesthetic guidelines for nasolabial angles. Often, surgeon experience determines the degree of lower lateral cartilage resection to achieve optimal results. This study analyzes the change in tip elevation with measured resections of the lower lateral cartilages. This can aid the surgeon in accurately predicting the effect of cephalic alar trim on tip elevation. Methods: Ten fresh cadaveric dissections were performed to determine the change in nasolabial angles after cephalic trim of the lower lateral cartilage. Closed rhinoplasty technique was performed using marginal and intercartilaginous incisions to expose the lower lateral cartilage. Caliper measurements of the lower lateral cartilage were recorded. Serial cephalic trim was performed in 25% increments. True lateral photographs were obtained before and after each serial excision. Nasolabial angle measurements were obtained using a digital goniometer for digital photo analysis. Results: Four female and 6 male cadavers were evaluated. The mean initial nasolabial angle was 106° ± 2°. The mean lower lateral cartilage width was 9.45 ± 1.38 mm. Serial 25% reductions in lower lateral cartilage height resulted in a mean total nasolabial angle change of 7.4°, 12.9°, and 19.6°, respectively. The mean incremental change in the nasolabial angle was 6.47° ± 1.25°. Conclusion: The nasolabial angle is an essential aesthetic feature. Cephalic trim is a key maneuver in affecting the nasolabial angle. A 25% lower lateral cartilage cephalic trim correlates with an average change in the nasolabial angle of 6.47°. Knowledge of the cephalic trim to nasolabial angle relationship aids in achieving desired tip elevation. PMID:26171091

  3. Efficient aminoacylation of the tRNA(Ala) acceptor stem: dependence on the 2:71 base pair.

    PubMed Central

    Beuning, Penny J; Nagan, Maria C; Cramer, Christopher J; Musier-Forsyth, Karin; Gelpí, Josep-Lluis; Bashford, Donald

    2002-01-01

    Specific aminoacylation by aminoacyl-tRNA synthetases requires accurate recognition of cognate tRNA substrates. In the case of alanyl-tRNA synthetase (AlaRS), RNA duplexes that mimic the acceptor stem of the tRNA are efficient substrates for aminoacylation in vitro. It was previously shown that recognition by AlaRS is severely affected by a simple base pair transversion of the G2:C71 pair at the second position in the RNA helix. In this study, we determined the aminoacylation efficiencies of 50 variants of the tRNA(Ala) acceptor stem containing substitutions at the 2:71 position. We find that there is not a single functional group of the wild-type G2:C71 base pair that is critical for positive recognition. Rather, we observed that base-pair orientation plays an important role in recognition. In particular, pyrimidine2:purine71 combinations generally resulted in decreased aminoacylation efficiency compared to the corresponding purine:pyrimidine pair. Moreover, the activity of a pyrimidine:purine variant could be partially restored by the presence of a major groove amino group at position 71. In an attempt to understand this result further, dielectric continuum electrostatic calculations were carried out, in some cases with additional inclusion of van der Waals interaction energies, to determine interaction potentials of the wild-type duplexAla and seven 2:71 variants. This analysis revealed a positive correlation between major groove negative electrostatic potential in the vicinity of the 3:70 base pair and measured aminoacylation efficiency. PMID:12022232

  4. Presurgical nasoalveolar moulding in unilateral cleft lip and palate

    PubMed Central

    Zuhaib, Mohammed; Bonanthaya, Krishnamurthy; Parmar, Renu; Shetty, Pritham N.; Sharma, Pradeep

    2016-01-01

    Context: Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. Aims: The study was conducted to evaluate the efficacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. Settings and Design: Prospective study. Subjects and Methods: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Statistical Analysis Used: Student's t-test for paired comparisons. Results: Results of the study showed a promising reduction in the cleft size before the surgery, significant improvement in nasal symmetry, including the columellar length on the cleft side. Conclusions: PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral

  5. Eppur Si Muove: Evidence for an External Granular Layer and Possibly Transit Amplification in the Teleostean Cerebellum.

    PubMed

    Biechl, Daniela; Dorigo, Alessandro; Köster, Reinhard W; Grothe, Benedikt; Wullimann, Mario F

    2016-01-01

    The secreted signaling factor Sonic Hedgehog (Shh) acts in the floor plate of the developing vertebrate CNS to promote motoneuron development. In addition, shh has dorsal expression domains in the amniote alar plate (i.e., in isocortex, superior colliculus, and cerebellum). For example, shh expressing Purkinje cells act in transit amplification of external granular layer (EGL) cells of the developing cerebellum. Our previous studies had indicated the presence of an EGL in anamniote zebrafish, but a possible role of shh in the zebrafish cerebellar plate remained elusive. Therefore, we used an existing zebrafish transgenic line Tg(2.4shha-ABC-GFP)sb15; Shkumatava et al., 2004) to show this gene activity and its cellular localization in the larval zebrafish brain. Clearly, GFP expressing cells occur in larval alar zebrafish brain domains, i.e., optic tectum and cerebellum. Analysis of critical cerebellar cell markers on this transgenic background and a PH3 assay for mitotic cells reveals that Purkinje cells and eurydendroid cells are completely non-overlapping postmitotic cell populations. Furthermore, shh-GFP cells never express Zebrin II or parvalbumin, nor calretinin. They are thus neither Purkinje cells nor calretinin positive migrating rhombic lip derived cells. The shh-GFP cells also never correspond to PH3 positive cells of the ventral cerebellar proliferative zone or the upper rhombic lip-derived EGL. From this marker analysis and the location of shh-GFP cells sandwiched between calretinin positive rhombic lip derived cells and parvalbumin positive Purkinje cells, we conclude that shh-GFP expressing cells qualify as previously reported olig2 positive eurydendroid cells, which are homologous to the amniote deep cerebellar nuclei. We confirm this using double transgenic progeny of shh-GFP and olig2-dsRed zebrafish. Thus, these zebrafish eurydendroid cells may have the same role in transit amplification as Purkinje cells do in amniotes. PMID:27199681

  6. Formation of pseudotachylitic breccias in the central uplifts of very large impact structures: Scaling the melt formation

    NASA Astrophysics Data System (ADS)

    Mohr-Westheide, Tanja; Reimold, Wolf Uwe

    2011-04-01

    The processes leading to formation of sometimes massive occurrences of pseudotachylitic breccia (PTB) in impact structures have been strongly debated for decades. Variably an origin of these pseudotachylite (friction melt)-like breccias by (1) shearing (friction melting); (2) so-called shock compression melting (with or without a shear component) immediately after shock propagation through the target; (3) decompression melting related to rapid uplift of crustal material due to central uplift formation; (4) combinations of these processes; or (5) intrusion of allochthonous impact melt from a coherent melt body has been advocated. Our investigations of these enigmatic breccias involve detailed multidisciplinary analysis of millimeter- to meter-sized occurrences from the type location, the Vredefort Dome. This complex Archean to early Proterozoic terrane constitutes the central uplift of the originally >250 km diameter Vredefort impact structure in South Africa. Previously, results of microstructural and microchemical investigations have indicated that formation of very small veinlets involved local melting, likely during the early shock compression phase. However, for larger veins and networks it was so far not possible to isolate a specific melt-forming mechanism. Macroscopic to microscopic evidence for friction melting is very limited, and so far chemical results have not directly supported PTB generation by intrusion of impact melt. On the other hand, evidence for filling of dilational sites with melt is abundant. Herein, we present a new approach to the mysterium of PTB formation based on volumetric melt breccia calculations. The foundation for this is the detailed analysis of a 1.5 × 3 × 0.04 m polished granite slab from a dimension-stone quarry in the core of the Vredefort Dome. This slab contains a 37.5 dm3 breccia zone. The pure melt volume in 0.1 m3 PTB-bearing granitic target rock outside of the several-decimeter-wide breccia zone in the granite slab was

  7. The Occupancy of the Components in the Cervical Spine and Their Changes with Extension and Flexion

    PubMed Central

    Sayıt, Emrah; Aghdasi, Bayan; Daubs, Michael D.; Wang, Jeffrey C.

    2015-01-01

    Study Design Retrospective case series. Objectives The kinematics of the cervical spine has been investigated by many researchers. However, the occupancy of the disk bulges, spinal cord, ligamentum flavum, and the rest of the canal as well as the changes of these structures with motion have not yet been investigated. The goal of this study is to investigate these dynamic changes. Methods The kinetic magnetic resonance images of 248 patients (124 men and 124 women) were evaluated, and the occupancy of each structure for each cervical level at neutral, flexion, and extension were calculated. Results Whole canal anteroposterior (AP) diameters showed significant differences between neutral-extension and flexion-extension at the C4–C5 and C5–C6 levels (p < 0.05). The mean disk bulges showed significant differences between neutral-flexion and flexion-extension at the C4–C5, C5–C6, C6–C7, and C7–T1 levels (p < 0.01). The mean spinal canal AP diameter showed significant differences between flexion-extension and neutral-extension at the C3–C4, C4–C5, C5–C6, and C6–C7 levels (p < 0.05). There were significant differences between neutral-flexion at the C4–C5, C5–C6, and C6–C7 levels (p < 0.05). The mean thickness of the ligamentum flavum showed significant differences between flexion-extension at the C3–C4, C4–C5, C5–C6, and C6–C7 levels (p < 0.001). There were significant differences between neutral-extension at the C3–C4 and C5–C6 levels (p < 0.05). There were significant differences between neutral-flexion at the C5–C6 and C6–C7 levels (p < 0.05). The mean thickness of the spinal cord showed significant differences between neutral-flexion at the C2–C3 and C3–C4 levels (p < 0.05). There were significant differences between flexion-extension at the C3–C4 and C4–C5 levels (p < 0.01). The rest of the canal showed significant differences between neutral-extension and flexion

  8. The morphology of the cervico-thoracic sympathetic system in donkeys (Equus asinus L.).

    PubMed

    Ozgel, O; Duzler, A; Dursun, N; Beyaz, F

    2009-04-01

    Five adult donkeys of both sexes, used in applied anatomy classes, and perfused with formalin for teaching purposes, constituted the study material. Ganglion cervicale caudale of the examined materials has observed to exhibit individually variable situation as to extend on the left side of the median line, at the alignment of the first and second intercostal spaces and on the right side between the level of the first and third costa. The ganglion extended more caudally on the right side of median line. The lateral surface of the ganglion was determined to be covered with the m. scalenus medius. On the both sides of the median plane, the ganglion cervicale caudale was seen to be situated on the lateral surface of the m. longus colli. On the left side, the ganglion overlapped the oesophagus in two cadavers and on the right side it was situated within a groove between the m. longus colli and trachea in three cadavers. The rami communicantes received by the ganglion cervicale caudale originated from the eighth cervical and first thoracic spinal segments. The ganglion cervicale caudale was formed by the coalescence of the last cervical and first three thoracic sympathetic ganglia. The ganglion cervicale caudale gave off branches that formed the rami communicantes, plexus cardiacus, n. vertebralis and ansa subclavia. One branch extended from the ganglion to the plexus brachialis. in one specimen, two sympathetic-parasympathetic communicating branches were observed to extend from the ansa subclavia and near by the origin of the truncus sympathicus to the n. vagus. In one of the donkeys examined, a branch originating from the ganglion cervicale caudale on the left side of the median plane was determined to end on the ligamentum arteriosum. A microscopic ganglion structure suggesting the existence of the ganglion cervicale medium was determined in a donkey. PMID:19183351

  9. Articular soft tissue anatomy of the archosaur hip joint: Structural homology and functional implications.

    PubMed

    Tsai, Henry P; Holliday, Casey M

    2015-06-01

    Archosaurs evolved a wide diversity of locomotor postures, body sizes, and hip joint morphologies. The two extant archosaurs clades (birds and crocodylians) possess highly divergent hip joint morphologies, and the homologies and functions of their articular soft tissues, such as ligaments, cartilage, and tendons, are poorly understood. Reconstructing joint anatomy and function of extinct vertebrates is critical to understanding their posture, locomotor behavior, ecology, and evolution. However, the lack of soft tissues in fossil taxa makes accurate inferences of joint function difficult. Here, we describe the soft tissue anatomies and their osteological correlates in the hip joint of archosaurs and their sauropsid outgroups, and infer structural homology across the extant taxa. A comparative sample of 35 species of birds, crocodylians, lepidosaurs, and turtles ranging from hatchling to skeletally mature adult were studied using dissection, imaging, and histology. Birds and crocodylians possess topologically and histologically consistent articular soft tissues in their hip joints. Epiphyseal cartilages, fibrocartilages, and ligaments leave consistent osteological correlates. The archosaur acetabulum possesses distinct labrum and antitrochanter structures on the supraacetabulum. The ligamentum capitis femoris consists of distinct pubic- and ischial attachments, and is homologous with the ventral capsular ligament of lepidosaurs. The proximal femur has a hyaline cartilage core attached to the metaphysis via a fibrocartilaginous sleeve. This study provides new insight into soft tissue structures and their osteological correlates (e.g., the antitrochanter, the fovea capitis, and the metaphyseal collar) in the archosaur hip joint. The topological arrangement of fibro- and hyaline cartilage may provide mechanical support for the chondroepiphysis. The osteological correlates identified here will inform systematic and functional analyses of archosaur hindlimb evolution and

  10. Microinstability of the Hip and the Splits Radiograph.

    PubMed

    Harris, Joshua D; Gerrie, Brayden J; Lintner, David M; Varner, Kevin E; McCulloch, Patrick C

    2016-01-01

    A normal hip has a natural tendency toward stability because of both osseous and soft tissue structures. Hip motion is primarily rotational around a center of rotation. When the femoral head and its center of rotation translate, with or without rotation, the inherent stability of the femoroacetabular articulation may be lost. The spectrum of hip instability ranges from subtle microinstability to traumatic dislocation. Microinstability may be the cause or the effect of several other hip pathologies. Soft tissue contributions to stability include the static capsule, dynamic musculotendinous units, and underlying generalized connective tissue (eg, Ehlers-Danlos). Osseous contributions include multiple femoral and acetabular radiographic coverage parameters. Iatrogenic contributions include an unrepaired capsulotomy, overresection of the acetabular rim (iatrogenic dysplasia), overresection of cam osteochondroplasty, iliopsoas tenotomy, labral debridement, and ligamentum teres debridement. Patients with hip microinstability often have deep groin pain, exhibited by a C sign. These patients frequently participate in flexibility sports and activities, such as ballet, gymnastics, figure skating, and martial arts. On physical examination, generalized hypermobility syndromes should be assessed, as should loss of log-roll external rotation recoil, excessive abduction, trochanteric-pelvic impingement, and abductor fatigue. Standard imaging, including plain radiographs, magnetic resonance imaging, and computed tomography, should be analyzed for all causes of hip pain. A new plain radiograph, the splits radiograph is introduced here, consistently showing lateral femoral head translation and creation of a vacuum sign, showing hip microinstability. The splits radiograph is illustrated in a 22-year-old female dancer who presented with bilateral deep anterolateral groin pain. PMID:26730687

  11. A security evaluation of the Rigid-fix crosses pin system used for anterior cruciate ligament reconstruction in tibial fixation site

    PubMed Central

    Fan, Huaqiang; Wang, Jian; Fu, Yangpan; Dong, Huixiang; Wang, Jianxiong; Tang, Cong; Huang, Changming; Shi, Zhanjun

    2014-01-01

    Our study aims to evaluate the safeness and feasibility that Rigid-fix cross pin system was used for hamstring graft anterior cruciate ligament (ACL) reconstruction in the tibial fixation site. In this study, eleven adult conservative cadaver knees were performed using the Rigid-fix Cross Pin device in the tibial fixation site for modeling the ACL reconstruction. The guide rod top was put through the tibial tunnel at the three horizontal positions: equal pace to articular facet (group A), the plane 5 mm below articular facet (group B), and the plane 10 mm below articular facet (group C). We gave four rotation positions to the cross-pin guide: 0°, 30°, 45°, 60° slope, referring to the parallel line of the posterior border of tibial plateau. We recorded the iatrogenic damages incidence, in the four different slope angle in the three groups, and then compare the incidence using Chi-Square test. Our results suggested that the incidence of chondral injury of tibial plateau in group B and group C was significantly lower compared to group A (χ 2 A-B = 27.077, χ 2 A-C 45.517, P = 0.000); However, there was no significant difference for the incidence penetrating the medial condyle of tibial plateau among the three groups (χ 2 = 5.733, P = 0.057); The highest incidence of injuring ligamentum transversum is in group A with 72.7%, especially at the 60° slope angle. In summary, our study suggested that in order to achieve the satisfactory clinical effect for the Rigid-fix system used in the tibia end fixation of ACL reconstruction surgery, the guide rod top should be put at the 5 mm below articular facet with a slope that parallel to the tibial medial plane at 30°-60° slope angle. PMID:25550991

  12. Complex Primary Total Knee Replacement (TKR) Using Prophylactic Gastrocnemius Flap and Rotating-Hinge Knee in Post-traumatic, Infective Arthritis of the Knee – A Case Report

    PubMed Central

    Patnaik, Sanjeev; Nayak, Biswaranjan; Mishra, Laxmikanta; Sahoo, Akshaya Kumar

    2015-01-01

    Introduction: Prophylactic gastrocnemius flap with primary rotating hinge knee is technically demanding in a case of neglected post-traumatic, infective arthritis of the knee, with challenges of compromised skin and soft tissues, articular bone defect, limb mal-alignment, gross instability, retained hardware and a contracted extensor mechanism with the patella fixed in the lateral gutter all in combination, is rarely reported. We report such a complex case in this study. Case Report: We report a 48 year male patient with a history of fracture lateral femoral condyle of right knee due to road traffic accident 10 years back, for which he got operated with open reduction and internal fixation with cancellous screws, which subsequently got infected. Primary procedure undertaken was removal of implants, debridement, placement of antibiotic-cement spacer followed by prophylactic medial gastrocnemius flap and a temporary joint spanning external fixator. Definitive procedure undertaken, after clearance of infection in 12 weeks was conversion to a rotating hinge TKR using a lateral para-patellar arthrotomy & tibial tubercle osteotomy to address the challenges of fixed patella in the lateral gutter and contracted ligamentum patellae. At one year follow up, the knee was painless, stable, with satisfactory range of motion and improved function without any infection or aseptic lysis. Conclusion: Prophylactic Gastrocnemius flap cover along with rotating hinge knee arthroplasty using a lateral para-patellar approach and tibial tubercle osteotomy in a case of neglected post-traumatic, infective arthritis of knee with the complexities of limb mal-alignment, compromised skin and soft tissue, articular bone loss and ligamentous instability is a satisfactory bail out option in such a highly complex joint scenario. PMID:27299096

  13. A new minimally invasive experimental spinal cord injury model in rabbits.

    PubMed

    Baydin, A; Cokluk, C; Aydin, K

    2007-06-01

    The aim of this experimental study was to evaluate the effectivity of epidural microballoon inflation into the unroofed spinal column for the creation of a new experimental spinal cord injury model in rabbits. 10 New Zealand white rabbits were used for this study. Before operation and after anasthesia with 50 mg/kg ketamine and 8 mg/kg xylazine, spinal evoked potentials (SEP) were recorded in all rabbits. A midline skin incision was done on the lomber skin at the level of L1-L4. Paravertebral muscles were dissected bilaterally. A microhemilaminotomy was done in the right L3 lamina close to the midline by using Midas-rex micro-diamond drill instruments. The ligamentum flavum was opened and removed with microscissors. A microballoon was inserted into the spinal column between the bone and dura mater to the level of T12. The microballoon was inflated by using a pressure- and volume-controlled microballoon inflation device. Pre-injury and post-injury SEPs were recorded. The microballoon was deflated 15 minutes later and removed completely from the epidural space. 24 hours later the SEP study was repeated. Following microballoon inflation the SEP waves dropped to the basal level. All rabbits were paraplegic after the operation. In conclusion, this experimental study demonstrated that the microballoon inflation technique is a very successful method for the evaluation of spinal cord injury in rabbits. Unroofing of the spinal column is extremely important because decompression may be an effective treatment in spinal cord injury. Also the traumatic effect of aneurysm clips represents a different type of injury to the spinal cord. This new model may be used in experimental studies of spinal cord injury in rabbits. PMID:17882754

  14. Nitrogen dioxide reaction with proteins: Evidence for peptide bond cleavage at lysine residues

    SciTech Connect

    Hood, D.B.

    1991-01-01

    Nitrogen dioxide (NO{sub 2}), an air pollutant produced by burning fossil fuels and a component of cigarette smoke, is thought to contribute to the pathogenesis of pulmonary diseases, such as emphysema. To gain information on the mechanism by which NO{sub 2} damages the lung, in vitro exposures of {alpha}{sub 1}-proteinase inhibitor ({alpha}{sub 1}-PI), elastin, bovine serum albumin (BSA), human serum albumin (HSA) and synthetic poly-L-lysine were performed. A genetic deficiency of {alpha}{sup 1}-PI predisposes humans to emphysema and NO{sub 2} has been hypothesized to damage {alpha}{sub 1}-PI, which would leave proteases such as human neutrophil elastase, (HNE) free to attack lung structural proteins. The ability of {alpha}{sub 1}-PI to inhibit HNE declined with exposure to 50% of the control value at molar ratios of NO{sub 2}:{alpha}{sub 1}-PI of 400:1 and greater. Exposure of {alpha}{sub 1}-PI to NO{sub 2} resulted in a 50% lose of immunoreactivity with either monoclonal or polyclonal antibodies in an enzyme-linked immunosorbent assay at molar ratios of NO{sub 2}:{alpha}{sub 1}-PI of essentially 100:1 and greater. The mechanisms of these effects were investigated via ultraviolet-visible spectroscopy and amino acid analysis. The remaining target molecules were labeled by reductive methylation of amino groups with {sup 3}H-HCHO prior to treatment with NO{sub 2} in aqueous solutions at physiological pH. Time course exposure of 5 mg {sup 3}H-insoluble bovine ligamentum nuchae elastin suspensions with up to 120 {mu}moles of NO{sub 2} resulted in 90% solubilization of the label. Amino acid analysis of the soluble and insoluble fractions from these exposures confirmed that 80% of the {sup 3}H-dimethyllysine residues were in the soluble fraction.

  15. Vasculature deprivation – induced osteonecrosis of the rat femoral head as a model for therapeutic trials

    PubMed Central

    Bejar, Jacob; Peled, Eli; Boss, Jochanan H

    2005-01-01

    Experimental Osteonecrosis The authors' experience with experimentally produced femoral capital osteonecrosis in rats is reviewed: incising the periosteum at the base of the neck of the femur and cutting the ligamentum teres leads to coagulation necrosis of the epiphysis. The necrotic debris is substituted by fibrous tissue concomitantly with resorption of the dead soft and hard tissues by macrophages and osteoclasts, respectively. Progressively, the formerly necrotic epiphysis is repopulated by hematopoietic-fatty tissue, and replaced by architecturally abnormal and biomechanically weak bone. The femoral heads lose their smooth-surfaced hemispherical shape in the wake of the load transfer through the hip joint such that, together with regressive changes of the joint cartilage and inflammatory-hyperplastic changes of the articular membrane, an osteoarthritis-like disorder ensues. Therapeutic Choices Diverse therapeutic options are studied to satisfy the different opinions concerning the significance of diverse etiological and pathogenic mechanisms: 1. Exposure to hyperbaric oxygen. 2. Exposure to hyperbaric oxygen and non-weight bearing on the operated hip. 3. Medication with enoxaparin. 4. Reduction of intraosseous hypertension, putting to use a procedure aimed at core decompression, namely drilling a channel through the femoral head. 5. Medication with vascular endothelial growth factor with a view to accelerating revascularization. 6. Medication with zoledronic acid to decrease osteoclastic productivity such that the remodeling of the femoral head is slowed. Glucocorticoid-related osteonecrosis appears to be apoptosis-related, thus differing from the vessel-deprivation-induced tissue coagulation found in idiopathic osteonecrosis. The quantities of TNF-α, RANK-ligand and osteoprotegerin are raised in glucocorticoid-treated osteoblasts so that the differentiation of osteoclasts is blocked. Moreover, the osteoblasts and osteocytes of the femoral cortex mostly

  16. Adaptive spatial compounding for improving ultrasound images of the epidural space

    NASA Astrophysics Data System (ADS)

    Tran, Denis; Kamani, Allaudin; Lessoway, Vickie; Rohling, Robert N.

    2007-03-01

    Epidural anesthesia can be a difficult procedure, especially for inexperienced physicians. The use of ultrasound imaging can help by depicting the location of the epidural space to choose the needle trajectory appropriately. Anatomical features in the lower back are not always clearly visible because of speckle poor reflection from structures at certain angles, and shadows from bony surfaces. Spatial compounding has the potential to reduce speckle and emphasize structures by averaging a number of images taken at different isonation angles. However, the beam-steered images are not perfectly aligned due to non-constant speed of sound causing refraction errors. This means compounding can blur features. A non-rigid registration method, called warping, shifts each block of pixels of the beam-steered images in order to find the best alignment to the reference image without beam-steering. By applying warping, the features become sharper after compounding. To emphasize features further, edge detection is also applied to the individual images in order to select the best features for compounding. The warping and edge detection parameters are calculated in real-time for each acquired image. In order to reduce computational complexity, linear prediction of the warping vectors is used. The algorithm is tested on a phantom of the lower back with a linear probe. Qualitative comparisons are made among the original plus combinations of compounding, warping, edge detection and linear prediction. The linear gradient and Laplacian of a Gaussian are used to quantitatively assess the visibility of the bone boundaries and ligamentum flavum on the processed images. The results show a significant improvement in quality.

  17. Posterior dynamic stabilization: The interspinous spacer from treatment to prevention

    PubMed Central

    Nachanakian, Antoine; El Helou, Antonios; Alaywan, Moussa

    2016-01-01

    Introduction: Managements of lumbar stenosis evoluted over the time from decompression to dynamic stabilization preserving the motion segment passing by the rigid fixation. After long years of rigid fusion, adjacent segment disease became more and more frequent and the concept of dynamic stabilization emerged. Materials and Methods: We report our experience with posterior dynamic stabilization using an interspinous distracter (ISD). One hundred and eight patients were operated between September 2008 and January 2012 with different lumbar spine pathologies. The ages of our patients were between 45 years and 70 years, with a mean age of 55 years. With our growing experience, indication of ISD became narrowed and the interspinous spacer became an absolute tool for adjacent segment disease as a treatment as well as prophylactic with rigid stabilization. Results and Discussion: Overall clinical improvement was noted in ISD-treated patients, with considerable satisfaction in 77% of patients on average. The patient at first reported an improvement of their radicular pain with a mean reduction of 3.6/10 on visual analog scale. Post-operative walking distance progressively increased during the next 3 months. Whereas, a radiological evaluation at 3 months showed a mean of 42% improvement of the disc height. On the other hand, all patients operated with posterior dynamic stabilization (PDS) at the time of rigid stabilization showed no adjacent segment disease compared to those operated with posterior arthrodesis (P < 0.05). Conclusion: Interspinous spacer after surgical decompression for spinal stenosis by excision of Ligamentum flavum demonstrates excellent short-term and long-term results for improvement in back pain, neurogenic claudication, and patient satisfaction. It provides restoration of disc height, reduction of vertebral slip and it's a necessary tool in the management and the prevention of adjacent segment disease. PMID:27057211

  18. Composite tissue flap at perforating branches of saphenous artery: a new design for repairing composite tissue defects in anterior knee

    PubMed Central

    Sun, Guangfeng; Nie, Kaiyu; Jin, Wenhu; Wei, Zairong; Qi, Jianping; Wang, Dali

    2015-01-01

    So far it has been difficult to repair and reconstruct the composite tissue defects in knee. Saphenous artery flap has been widely used to repair complex wounds, but the design and clinical application of composite tissue flap at perforating branches of saphenous artery were not reported. In this research, we design a new composite tissue flap by carrying fascial flap in the medial gastrocnemius muscle with perforators flap in saphenous artery to repair and reconstruct the composite tissue defects in knee. By anatomic observation and analysis, we find that there exists blood-supply in netty form among saphenous arteries, medial artery below the knee, intermuscular branch in high-order position of posterior tibial artery and perforating branch in medial artery of calf. We chose saphenous artery as blood-supplying artery; utilized the netty blood-supplying mode in middle-up and medial part of shank; cut the composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle; reconstructed the ligamentum patellae using medial head of gastrocnemius muscle and Achilles’s tendon; and covered the wounds at front side of knee with flap. Composite tissues were survived completely, free from infection at wounds and exosmosis of joint fluid. Motion function of knee-joint proved satisfactory, and ambulatory function was recovered. There was no complication in donor site. Composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle is one of the most ideal solutions for repairing the composite tissue defects at front side of knee joint. PMID:26885090

  19. Epidural insertion simulator of higher insertion resistance & drop rate after puncture.

    PubMed

    Naemura, K; Sakai, A; Hayashi, T; Saito, H

    2008-01-01

    Accidents such as dural puncture remain one of the problems of epidural anesthesia, and unskilled doctors can repeat such accidents. The purpose of the current research was to provide a new simulator for epidural insertion training. No reference data regarding the resistance force used when inserting a needle into patients have been reported. A comparative study was conducted to aid in the development of a new simulator. Pork loin (n=5) were employed as a substitute for patients. Thickness was set at 2 cm so as to improve the reproducibility. The authors took the conventional simulator apart, and picked a block as an analogue of muscle and ligamentum flavum. A new simulator was made of a melamine foam resin block and a latex rubber sheet. An epidural needle fixed on a motorized stage was inserted at the speed of 2 mm per second. The reaction force was measured while the needle was inserted into each specimen. Waveform of the pork loin exhibited two slopes of different inclines up to peaks and then falls after puncture. The conventional simulator showed a simple increase up to peak and a slow fall after puncture. In contrast, the new simulator showed two slopes up to peak and then a sudden fall after puncture. The insertion resistances were 2.5 N/s for the porcine, 0.8 N/s for the conventional and 2.1 N/s for the new simulator. The drop rates were 5 N/s for the porcine, 0.6 N/s for the conventional and 24 N/s for the new simulator. The higher insertion resistance and drop rate for the new simulator than the conventional simulator will be suitable for epidural insertion training. PMID:19163400

  20. Quantifying the Nonlinear, Anisotropic Material Response of Spinal Ligaments

    NASA Astrophysics Data System (ADS)

    Robertson, Daniel J.

    Spinal ligaments may be a significant source of chronic back pain, yet they are often disregarded by the clinical community due to a lack of information with regards to their material response, and innervation characteristics. The purpose of this dissertation was to characterize the material response of spinal ligaments and to review their innervation characteristics. Review of relevant literature revealed that all of the major spinal ligaments are innervated. They cause painful sensations when irritated and provide reflexive control of the deep spinal musculature. As such, including the neurologic implications of iatrogenic ligament damage in the evaluation of surgical procedures aimed at relieving back pain will likely result in more effective long-term solutions. The material response of spinal ligaments has not previously been fully quantified due to limitations associated with standard soft tissue testing techniques. The present work presents and validates a novel testing methodology capable of overcoming these limitations. In particular, the anisotropic, inhomogeneous material constitutive properties of the human supraspinous ligament are quantified and methods for determining the response of the other spinal ligaments are presented. In addition, a method for determining the anisotropic, inhomogeneous pre-strain distribution of the spinal ligaments is presented. The multi-axial pre-strain distributions of the human anterior longitudinal ligament, ligamentum flavum and supraspinous ligament were determined using this methodology. Results from this work clearly demonstrate that spinal ligaments are not uniaxial structures, and that finite element models which account for pre-strain and incorporate ligament's complex material properties may provide increased fidelity to the in vivo condition.

  1. Post-traumatic avascular necrosis of the femoral head predicted by preoperative technetium-99m antimony-colloid scan: an experimental and clinical study. [Rabbits; patients

    SciTech Connect

    Turner, J.H.

    1983-07-01

    Technetium-99m antimony colloid was used to visualize the bone marrow of the head of the femur within twenty-four hours after interruption of the blood supply by subcapital osteotomy and section of the ligamentum teres in thirteen rabbits and within twenty-four hours after a subcapital fracture in thirty patients. Of the rabbits, all showed loss of marrow radioactivity over the affected femoral head. Bone-imaging with technetium-99m methylene diphosphonate, in contrast, failed to demonstrate any abnormality in the avascular head of the femur for as long as forty-eight hours after osteotomy. This difference between the marrow scan and the bone scan was attributed to earlier loss of function in the marrow cells than in the osteocytes. The thirty patients who had a preoperative scan within twenty-four hours after sustaining a subcapital fracture were treated by internal fixation with a Richards screw and plate and were followed for as long as two years, or until the patient died or radiographs showed evidence of avascular necrosis. The preoperative technetium-99m antimony-colloid activity in the head of the fractured femur was normal in sixteen patients and absent in fourteen; two of the fourteen had no activity in either hip, which precluded assessment of the fractured hip in these patients. In fifteen of the sixteen hips, preservation of the uptake in the marrow of the head of the fractured femur preoperatively predicted normal healing. Late segmental collapse developed in the remaining hip. In eleven of the twelve patients who had loss of marrow activity in the femoral head preoperatively, avascular necrosis developed within two years.

  2. Jaw myology and bite force of the monk parakeet (Aves, Psittaciformes).

    PubMed

    Carril, Julieta; Degrange, Federico J; Tambussi, Claudia P

    2015-07-01

    Psittaciform birds exhibit novelties in jaw bone structure and musculature that are associated with strong bite forces. These features include an ossified arcus suborbitalis and the muscles ethmomandibularis and pseudomasseter. We analyse the jaw musculature of the monk parakeet (Myiopsitta monachus) to enable future studies aimed at understanding craniofacial development, morphology, function and evolution. We estimate bite force based on muscle dissections, physiological cross-sectional area and skull biomechanical modelling. We also compare our results with available data for other birds and traced the evolutionary origin of the three novel diagnostic traits. Our results indicate that, in Myiopsitta, (i) the arcus suborbitalis is absent and the orbit is ventrally closed by an elongate processus orbitalis and a short ligamentum suborbitale; (ii) the ethmomandibularis muscle is a conspicuous muscle with two bellies, with its origin on the anterior portion of the septum interorbitale and insertion on the medial aspect of the mandible; (iii) the pseudomasseter muscle consists of some fibers arising from the m. adductor mandibulae externus superficialis, covering the lateral surface of the arcus jugalis and attaches by an aponeurotic sheet on the processus orbitalis; (iv) a well-developed adductor mandibulae complex is present; (v) the bite force estimation relative to body mass is higher than that calculated for other non-psittaciform species; and (vi) character evolution analysis revealed that the absence of the arcus suborbitalis and the presence of the m. pseudomassseter are the ancestral conditions, and mapping is inconclusive about presence of one or two bellies of the m. ethmomandibularis. PMID:26053435

  3. Odontoid process fractures: the role of the ligaments in maintaining stability. A biomechanical, cadaveric study

    PubMed Central

    Boughton, Oliver Richard; Bernard, Jason; Szarko, Matthew

    2015-01-01

    Aims: We wished to investigate the role of the cervical ligaments in maintaining atlantoaxial stability after fracture of the odontoid process. Methods: We dissected eight fresh-frozen cadaveric cervical spines to prepare the C1 and C2 vertebrae for biomechanical analysis. The C1 and C2 blocks were mounted and biomechanical analysis was performed to test the stability of the C1-C2 complex after cutting the odontoid process to create an Anderson and D’Alonzo type II fracture then successive division of the atlantoaxial ligaments. Biomechanical analysis of stiffness, expressed as Young’s modulus, was performed under right rotation, left rotation and anterior displacement. Results: The mean Young’s modulus in anterior displacement decreased by 37% when the odontoid process was fractured (p = 0.038, 95% confidence interval 0.04–1.07). The mean Young’s modulus in anterior displacement decreased proportionally (compared to the previous dissection) by the following percentages when the structures were divided: facet joint capsules (bilateral) 16%, ligamentum flavum 27%, anterior longitudinal ligament 10%. These differences did not reach statistical significance (p > 0.05). Discussion: We have found that the odontoid process itself may account for up to 37% of the stiffness of the C1-C2 complex and that soft tissue structures account for further resistance to movement. We suggest magnetic resonance imaging (MRI) of the soft tissues in the acute setting of a minimally displaced odontoid process fracture to plan management of the injury. If the MRI determines that there is associated ligament injury it is likely that the fracture is unstable and we would suggest operative management. PMID:27163067

  4. Ligament of the head of femur: A comprehensive review of its anatomy, embryology, and potential function.

    PubMed

    Perumal, Vivek; Woodley, Stephanie J; Nicholson, Helen D

    2016-03-01

    The functional significance of the ligament of the head of femur (LHF), or ligamentum teres has often been debated. Having gained recent attention in clinical practice, it is suggested to partly provide some mechanical stability to the hip joint. However, the anatomy of this ligament is not well studied. This paper systematically reviews the anatomy of the LHF with the aim of exploring our current understanding of this structure and identifying any gaps in knowledge regarding its morphology and function. A systematic search of Medline, Embase, ProQuest, Web of Science, and Scopus databases was undertaken and relevant data extracted, analyzed. A total of 69 references were obtained, that included 53 full text articles, three published abstracts, and 13 textbooks. Many publications related to clinical studies (n = 11) rather than gross anatomy (n = 7), with one report on variation of the LHF. Considerable inconsistency in the naming and description of the LHF morphology was observed. Variable attachment sites were reported except for the acetabular notch, transverse acetabular ligament, and the femoral fovea. Presence and patency of the ligamental arteries supplying the head of the femur and their exact location were variably described and were often incomplete. The LHF is believed to be taught in extreme hip adduction, but there is little evidence to support this. In conclusions, further investigation of the anatomy of the LHF is recommended, particularly to clarify its mechanical role, innervation, and vascular contribution to the developing and adult femur, so to better inform clinical practice. Clin. Anat. 29:247-255, 2016. © 2015 Wiley Periodicals, Inc. PMID:26480296

  5. Palynostratigraphical correlation of the excavated Miocene lignite seams of the Yataǧan basin (Muǧla Province, south-western Turkey)

    NASA Astrophysics Data System (ADS)

    Bouchal, Johannes Martin; Grímsson, Friðgeir; Denk, Thomas

    2016-04-01

    The excavated main lignite seams and overlying lacustrine sediments of the opencast mines Eskihisar, Salihpaşalar, and Tı naz, Muǧla Province, south-western Turkey were investigated using a high taxonomic resolution palynological approach. The Eskihisar section comprises 47m and 56 samples of which 30 were usable for palynological analysis. The Tı naz section comprises 75 m and 29 samples of which 15 were usable for palynological analysis. Finally, the Salihpaşalar section comprises 25 m and 26 samples of which 16 were usable for palynological analysis. The age of the palynological sections is middle to late Miocene based on radiometric dating and vertebrate fossils. In order to investigate dispersed pollen and spores and their botanical affinities a combined light microscopy and scanning electron microscopy approach was used. The rich palynoflora comprises: seven types of algal cysts (Botryococcus, Zygnemataceae), seventeen spore types belonging to Lycopsida (club mosses), Marsileaceae (water-clover), Osmundaceae, Pteridaceae (brake), and Polypodiaceae; 14 types of gymnosperm pollen belonging to Ephedraceae (Mormon tea), Cupressaceae, Pinaceae (Cathaya, cedar, hemlock, pine, spruce); five types of monocotyledone pollen belonging to Poaceae (grasses, common reed), and Typhaceae (bulrush, bur-reed); ca 90 dicotyledone pollen types belonging to Altingiaceae (sweet gum), Amaranthaceae (goosefoot), Anacardiaceae (sumac family), Apiaceae (parsley family), Aquifoliaceae (holly), Asteraceae (sunflower family), Betulaceae (alder, birch, hazel, hophornbeam, hornbeam), Campanulaceae (bellflower family), Cannabaceae (hackberries), Caprifoliaceae (honeysuckle, teasel family), Caryophyllaceae (pink family), Ericaceae (heather family), Eucommiaceae, Euphorbiaceae (spurge family), Fabaceae (bean family), Fagaceae (beech, oak), Geraniaceae (storkbills), Juglandaceae (hickory, walnut, wingnut), Lamiaceae (bagflower), Linaceae (flax), Lythraceae (waterwillow), Malvaceae

  6. Pythiosis in the Nasal Cavity of Horses.

    PubMed

    Souto, E P F; Maia, L A; Olinda, R G; Galiza, G J N; Kommers, G D; Miranda-Neto, E G; Dantas, A F M; Riet-Correa, F

    2016-01-01

    Two cases of nasal pythiosis are reported in horses from the semi-arid region of northeastern Brazil. From January 1986 to December 2015, the Laboratory of Animal Pathology, Federal University of Campina Grande received 830 equine samples, 156 (18.79%) of which were diagnosed with pythiosis. Of these, two horses (1.28%), a male and a female adult cross-breed, had lesions in the nasal cavity. Both horses had access to water reservoirs. Clinically, they had swelling in the rhinofacial region and a serosanguineous nasal discharge. Macroscopically, in case 1, the lesion affected the nasal vestibule, extending to the alar cartilage and nasal septum. In case 2, the lesion extended through the turbinates and the meatuses of the nasal cavity, as well as the ethmoid region. In both cases, the lesions were characterized by having a yellow-grey granular surface with cavitations of different sizes containing coral-like masses of necrotic tissue (kunkers). Histologically, multifocal necrotizing eosinophilic rhinitis associated with hyphae (2-8 μm) similar to Pythium insidiosum were observed. In case 2, the lesions extended to the muscle, cartilage and bone adjacent to the nasal cavity and lungs. The diagnosis was confirmed by immunohistochemistry. It is concluded that nasal pythiosis occurs sporadically in horses in the semi-arid region of northeastern Brazil where cutaneous pythiosis is prevalent. PMID:27406311

  7. Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique

    PubMed Central

    Leibou, Lior

    2016-01-01

    Background: The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen. Objective: The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach. Methods: In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors’ interdomal suturing technique between the years 2011 and 2013. The average age of the patients was 25.3 years. Intercrural sutures (PDS 4.0 straight needle, Cincinnati, Ohio) were placed as mattress-like suture in the tip region, with the knot buried between both alar cartilages. The suture is tightened progressively according to the tip definition and narrowing sought. Results: The patients were followed for 12 months. All of the patients demonstrated a significant reduction in lobule and tip widths. This series had only 1 complication of tip asymmetry that was revised 1 year after the initial operation. There were no cases of infection, allergic reaction, or extrusion of the suture. Conclusions: Despite the lack of a large volume of patients, our study confirms that this technique is indeed an attractive and highly predictable option for achieving adequate tip refinement and definition when using a nondelivery endonasal rhinoplasty. PMID:27622086

  8. Is alveolar cleft reconstruction still controversial? (Review of literature)

    PubMed Central

    Seifeldin, Sameh A.

    2015-01-01

    Cleft lip and palate (CL/P) is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral and complete or incomplete. Alveolar cleft reconstruction remains controversial with regard to timing, graft materials, surgical techniques, and methods of evaluation. Many studies have been conducted addressing these points to develop an acceptable universal protocol for managing CL/P. The primary goal of alveolar cleft reconstruction in CL/P patients is to provide a bony bridge at the cleft site that allows maxillary arch continuity, oronasal fistula repair, eruption of the permanent dentition into the newly formed bone, enhances nasal symmetry through providing alar base support, orthodontic movement and placement of osseointegrated implants when indicated. Other goals include improving speech, improvement of periodontal conditions, establishing better oral hygiene, and limiting growth disturbances. In order to rehabilitate oral function in CL/P patients alveolar bone grafting is necessary. Secondary bone grafting is the most widely accepted method for treating alveolar clefts. Autogenous bone graft is the primary source for reconstructing alveolar cleft defects and is currently the preferred grafting material. PMID:26792963

  9. Differential requirements for Gli2 and Gli3 in the regional specification of the mouse hypothalamus

    PubMed Central

    Haddad-Tóvolli, Roberta; Paul, Fabian A.; Zhang, Yuanfeng; Zhou, Xunlei; Theil, Thomas; Puelles, Luis; Blaess, Sandra; Alvarez-Bolado, Gonzalo

    2015-01-01

    Secreted protein Sonic hedgehog (Shh) ventralizes the neural tube by modulating the crucial balance between activating and repressing functions (GliA, GliR) of transcription factors Gli2 and Gli3. This balance—the Shh-Gli code—is species- and context-dependent and has been elucidated for the mouse spinal cord. The hypothalamus, a forebrain region regulating vital functions like homeostasis and hormone secretion, shows dynamic and intricate Shh expression as well as complex regional differentiation. Here we asked if particular combinations of Gli2 and Gli3 and of GliA and GliR functions contribute to the variety of hypothalamic regions, i.e., we wanted to approach the question of a possible hypothalamic version of the Shh-Gli code. Based on mouse mutant analysis, we show that: (1) hypothalamic regional heterogeneity is based in part on differentially stringent requirements for Gli2 or Gli3; (2) another source of diversity are differential requirements for Shh of neural vs. non-neural origin; (3) the medial progenitor domain known to depend on Gli2 for its development generates several essential hypothalamic nuclei plus the pituitary and median eminence; (4) the suppression of Gli3R by neural and non-neural Shh is essential for hypothalamic specification. Finally, we have mapped our results on a recent model which considers the hypothalamus as a transverse region with alar and basal portions. Our data confirm the model and are explained by it. PMID:25859185

  10. Three-dimensional facial analysis of Chinese children with repaired unilateral cleft lip and palate

    PubMed Central

    Othman, Siti Adibah; Aidil Koay, Noor Airin

    2016-01-01

    We analyzed the facial features of Chinese children with repaired unilateral cleft lip and palate (UCLP) and compared them with a normal control group using a three-dimensional (3D) stereophotogrammetry camera. This cross-sectional study examined 3D measurements of the facial surfaces of 20 Chinese children with repaired UCLP and 40 unaffected Chinese children aged 7 to 12 years old, which were captured using the VECTRA 3D five-pod photosystem and analyzed using Mirror software. Twenty-five variables and two ratios were compared between both groups using independent t-test. Intra- and inter-observer reliability was determined using ten randomly selected images and analyzed using intra-class correlation coefficient test (ICC). The level of significance was set at p < 0.0018. Intra- and inter-observers’ reliability was considered fair to excellent with an ICC value ranging from 0.54 to 0.99. Statistically significant differences (p < 0.0018) were found mainly in the nasolabial region. The cleft group exhibited wider alar base root width, flattened nose and broader nostril floor width on the cleft side. They tended to have shorter upper lip length and thinner upper vermillion thickness. Faces of Chinese children with repaired UCLP displayed meaningful differences when compared to the normal group especially in the nasolabial regions. PMID:27507713

  11. Three-dimensional facial analysis of Chinese children with repaired unilateral cleft lip and palate.

    PubMed

    Othman, Siti Adibah; Aidil Koay, Noor Airin

    2016-01-01

    We analyzed the facial features of Chinese children with repaired unilateral cleft lip and palate (UCLP) and compared them with a normal control group using a three-dimensional (3D) stereophotogrammetry camera. This cross-sectional study examined 3D measurements of the facial surfaces of 20 Chinese children with repaired UCLP and 40 unaffected Chinese children aged 7 to 12 years old, which were captured using the VECTRA 3D five-pod photosystem and analyzed using Mirror software. Twenty-five variables and two ratios were compared between both groups using independent t-test. Intra- and inter-observer reliability was determined using ten randomly selected images and analyzed using intra-class correlation coefficient test (ICC). The level of significance was set at p < 0.0018. Intra- and inter-observers' reliability was considered fair to excellent with an ICC value ranging from 0.54 to 0.99. Statistically significant differences (p < 0.0018) were found mainly in the nasolabial region. The cleft group exhibited wider alar base root width, flattened nose and broader nostril floor width on the cleft side. They tended to have shorter upper lip length and thinner upper vermillion thickness. Faces of Chinese children with repaired UCLP displayed meaningful differences when compared to the normal group especially in the nasolabial regions. PMID:27507713

  12. Assessment of the 18-month permanence of onlay tip cartilage grafts following rhinoplasty.

    PubMed

    Persichetti, Paolo; Simone, Pierfranco; Carusi, Carlo

    2013-09-01

    Augmentation rhinoplasty requires addition of materials of various natures to reshape the nasal pyramid. Onlay tip grafts are single or multilayered grafts placed horizontally over the alar domes. The aim of the present study was to assess the 18-month permanence of onlay septal cartilage grafts. Twenty-eight patients underwent rhinoplasty with onlay tip cartilage graft, between June 2008 and November 2008 at the Campus Bio-Medico University in Rome, Italy. They were reviewed and photographed 6 months and 18 months postoperatively. Comparison of 6-month and 18-month postoperative pictures was performed with Adobe Photoshop CS. Measurements on pictures were taken with AutoCAD. Comparison of photographs showed no visible difference in nasal tip projection. Comparison of the measurements of tip projection showed a mean reduction of 0.06 mm (0.19%). Considerable stability of nasal tip projection after rhinoplasty with onlay tip grafts was observed postoperatively. Comparison of standardised digital photographs is a valid procedure to assess contour alterations of various anatomical structures after plastic surgery. PMID:23547534

  13. Correction of Asian Short Nose with Lower Lateral Cartilage Repositioning and Ear Cartilage Grafting

    PubMed Central

    Kim, Kenneth K.

    2013-01-01

    Background: Asians with short nose lack the cartilage needed to extend the length of the nose. A rhinoplasty technique using lower lateral cartilage (LLC) repositioning and ear cartilage grafting allows for sufficient nasal lengthening and nasal tip mobility in the correction of short nose in Asians. Methods: Short nose was classified into 3 subtypes: type I, II, or III. During LLC repositioning, the LLC was separated from surrounding retaining structures, except at the footplate. The LLC was approximated medially and advanced with a Medpor strut. A silicone dorsal implant was inserted to suit the newly projected nasal tip. An ear cartilage onlay graft or ear cartilage extension graft was applied to further project and enhance the nasal tip and columella. Results: Of the 854 primary rhinoplasty procedures performed on Asian patients between January 2008 and December 2011, 295 were performed on patients with short nose. LLC repositioning and ear cartilage onlay grafting were performed on 228 patients. LLC repositioning and ear cartilage extension grafting with or without ear cartilage onlay grafting were performed on 67 patients. Short nasal tip, alar retraction, and columellar retraction were corrected. Wound dehiscence with marginal necrosis occurred in 7 patients. One patient developed nasal infection. Conclusions: LLC repositioning and ear cartilage grafting aid in the correction of short nose in Asians. With LLC repositioning and ear cartilage grafting, the nasal tip can be positioned in accordance with the patient’s anatomic limits. The entire nasal tip and columella can be lengthened, while the tip maintains its mobility. PMID:25289239

  14. Anatomy of the Facial Nerve at the Condylar Area: Measurement Study and Clinical Implications

    PubMed Central

    Yang, Hun-Mu; Yoo, Young-Bok

    2014-01-01

    The aim of this study was to elucidate the detailed anatomy of the facial nerve (FN) at the condylar area to helping physicians preventing the iatrogenic trauma on the nerve. We dissected 25 specimens of the embalmed Korean cadavers (13 males and 2 females; mean age 76.9 years). The FN course at the condylar was examined, and the location of the FN branches was measured with superficial standards. The trunks of the FN emerged in the condylar area as one trunk, two trunks, and a loop or plexiform in 36%, 12%, and 52% areas, respectively. The zygomatic branch (Zbr) of FN passed over the tragus-alar line 23 mm anterior to the tragus (Tg) in most of the cases. The Zbr passed over the vertical line 2 cm anterior to the Tg through the area about 6 to 20 mm inferior to the Tg. Regardless of careful approach techniques to the condylar area, the FN could be damaged by a careless manipulation. Any reference landmarks could not guarantee the safety during the approach to the condylar area because more than half of the cases present the complicated branching type in the front of the Tg. PMID:25379533

  15. Experimental infection of Didelphis marsupialis with vesicular stomatitis New Jersey virus.

    PubMed

    Trujillo, Carlos M; Rodriguez, Luis; Rodas, Juan D; Arboleda, John Jairo

    2010-01-01

    Although vesicular stomatitis has been present for many years in the Americas, many aspects of its natural history remain undefined. In this study, we challenged five adult Virginia opossums (Didelphis marsupialis) with vesicular stomatitis New Jersey serotype virus (VSNJV). Opossums had no detectable antibodies against VSNJV prior to being inoculated with 10(6.5) median tissue culture infective doses (TCID(50)) of VSNJV by two routes; intraepithelial/subepithelial (IE/SE) inoculation and scarification in the muzzle (SM). Clinical response was monitored daily and animals were tested for viral shedding. All infected animals developed vesicles and ulcers on the tongue and inflammation of the nasal alar folds. Virus was isolated from esophagus-pharynx, nasal, and from ocular swabs and lesions samples. The failure to detect viremia in these animals indicates that a source other than blood may be required for transmission to insect vectors. Our results suggest that D. marsupialis could play a role in the maintenance of VSNJV outside of domestic animal populations and could provide a model to study vesicular stomatitis virus pathogenesis. PMID:20090034

  16. Dynamic expression of tyrosine hydroxylase mRNA and protein in neurons of the striatum and amygdala of mice, and experimental evidence of their multiple embryonic origin.

    PubMed

    Bupesh, Munisamy; Vicario, Alba; Abellán, Antonio; Desfilis, Ester; Medina, Loreta

    2014-05-01

    Emotional and motivational dysfunctions observed in Parkinson's disease, schizophrenia, and drug addiction are associated to an alteration of the mesocortical and mesolimbic dopaminergic pathways, which include axons projecting to the prefrontal cortex, the ventral striatum, and the amygdala. Subpopulations of catecholaminergic neurons have been described in the cortex and striatum of several mammals, but the presence of such cells in the adult amygdala is unclear in murine rodents, and in other rodents appears to show variations depending on the species. Moreover, the embryonic origin of telencephalic tyrosine hydroxylase (TH) cells is unknown, which is essential for trying to understand aspects of their evolution, distribution and function. Herein we investigated the expression of TH mRNA and protein in cells of the striatum and amygdala of developing and adult mice, and analyzed the embryonic origin of such cells using in vitro migration assays. Our results showed the presence of TH mRNA and protein expressing cells in the striatum (including nucleus accumbens), central and medial extended amygdala during development, which are persistent in adulthood although they are less numerous, generally show weak mRNA expression, and some appear to lack the protein. Fate mapping analysis showed that these cells include at least two subpopulations with different embryonic origin in either the commissural preoptic area of the subpallium or the supraopto-paraventricular domain of the alar hypothalamus. These data are important for future studies trying to understand the role of catecholamines in modulation of emotion, motivation, and reward. PMID:23479178

  17. Safer approaches and landings: A multivariate analysis of critical factors

    NASA Astrophysics Data System (ADS)

    Heinrich, Durwood J.

    The approach-and-landing phases of flight represent 27% of mission time while resulting in 61 of the accidents and 39% of the fatalities. The landing phase itself represents only 1% of flight time but claims 45% of the accidents. Inadequate crew situation awareness (SA), crew resource management (CRM), and crew decision-making (DM) have been implicated in 51%, 63%, and 73% respectively of these accidents. The human factors constructs of SA, CRM, and DM were explored; a comprehensive definition of SA was proposed; and a "proactive defense" safety strategy was recommended. Data from a 1997 analysis of worldwide fatal accidents by the Flight Safety Foundation (FSF) Approach-and-Landing Accident Reduction (ALAR) Task Force was used to isolate crew- and weather-related causal factors that lead to approach-and-landing accidents (ALAs). Logistic regression and decision tree analysis were used on samplings of NASA's Aviation Safety Reporting System (ASRS) incident records ("near misses") and the National Transportation Safety Board's (NTSB) accident reports to examine hypotheses regarding factors and factor combinations that can dramatically increase the opportunity for accidents. An effective scale of risk factors was introduced for use by crews to proactively counter safety-related error-chain situations.

  18. Outcomes following V-Y advancement flap reconstruction of large upper lip defects

    PubMed Central

    Griffin, Garrett R.; Weber, Stephen; Baker, Shan R.

    2016-01-01

    Objective To characterize revision surgery following V-Y subcutaneous tissue pedicle advancement flap repair of large upper lip skin defects. Methods Retrospective review of upper lip skin defects ≥3.0 cm2 that were reconstructed with a V-Y subcutaneous tissue pedicle advancement flap at an academic tertiary care center. Depth and area of the defect, as well as involvement of the vermilion and nasal ala, were recorded as independent variables. Revision techniques were analyzed to identify patterns. Results Thirty patients were identified with upper lip skin defects ranging from 3.0 to 14.0 cm2 (mean 7.0 cm2, median 6.25 cm2). The defect involved the nasal ala in four cases and the vermilion in three cases. At least one revision surgery was performed in 14/30 (47%) patients. Alar or vermilion involvement was a significant factor in revision by chi-square analysis (p=0.026). Larger defect size did not predict a need for revision, even among cases where the defect did not involve the ala or vermilion (p=0.68). Conclusion Reconstruction of large upper lip skin defects with a V-Y subcutaneous tissue pedicle advancement flap is associated with a 47% revision rate, and when the defect involves the ala or vermilion, the revision rate is increased. Defect size alone cannot be used to predict the need for revision surgery. Revision techniques are demonstrated. PMID:22801764

  19. Lhx2 and Lhx9 determine neuronal differentiation and compartition in the caudal forebrain by regulating Wnt signaling.

    PubMed

    Peukert, Daniela; Weber, Sabrina; Lumsden, Andrew; Scholpp, Steffen

    2011-12-01

    Initial axial patterning of the neural tube into forebrain, midbrain, and hindbrain primordia occurs during gastrulation. After this patterning phase, further diversification within the brain is thought to proceed largely independently in the different primordia. However, mechanisms that maintain the demarcation of brain subdivisions at later stages are poorly understood. In the alar plate of the caudal forebrain there are two principal units, the thalamus and the pretectum, each of which is a developmental compartment. Here we show that proper neuronal differentiation of the thalamus requires Lhx2 and Lhx9 function. In Lhx2/Lhx9-deficient zebrafish embryos the differentiation process is blocked and the dorsally adjacent Wnt positive epithalamus expands into the thalamus. This leads to an upregulation of Wnt signaling in the caudal forebrain. Lack of Lhx2/Lhx9 function as well as increased Wnt signaling alter the expression of the thalamus specific cell adhesion factor pcdh10b and lead subsequently to a striking anterior-posterior disorganization of the caudal forebrain. We therefore suggest that after initial neural tube patterning, neurogenesis within a brain compartment influences the integrity of the neuronal progenitor pool and border formation of a neuromeric compartment. PMID:22180728

  20. Lhx2 and Lhx9 Determine Neuronal Differentiation and Compartition in the Caudal Forebrain by Regulating Wnt Signaling

    PubMed Central

    Peukert, Daniela; Weber, Sabrina; Lumsden, Andrew; Scholpp, Steffen

    2011-01-01

    Initial axial patterning of the neural tube into forebrain, midbrain, and hindbrain primordia occurs during gastrulation. After this patterning phase, further diversification within the brain is thought to proceed largely independently in the different primordia. However, mechanisms that maintain the demarcation of brain subdivisions at later stages are poorly understood. In the alar plate of the caudal forebrain there are two principal units, the thalamus and the pretectum, each of which is a developmental compartment. Here we show that proper neuronal differentiation of the thalamus requires Lhx2 and Lhx9 function. In Lhx2/Lhx9-deficient zebrafish embryos the differentiation process is blocked and the dorsally adjacent Wnt positive epithalamus expands into the thalamus. This leads to an upregulation of Wnt signaling in the caudal forebrain. Lack of Lhx2/Lhx9 function as well as increased Wnt signaling alter the expression of the thalamus specific cell adhesion factor pcdh10b and lead subsequently to a striking anterior-posterior disorganization of the caudal forebrain. We therefore suggest that after initial neural tube patterning, neurogenesis within a brain compartment influences the integrity of the neuronal progenitor pool and border formation of a neuromeric compartment. PMID:22180728

  1. Facial emphysema after sinus lift.

    PubMed

    Sakakibara, Akiko; Suzuki, Hiroaki; Yamashita, Atsuya; Hasegawa, Takumi; Minamikawa, Tsutomu; Furudoi, Shungo; Komori, Takahide

    2015-01-01

    An 80-year-old man with a history of en bloc resection of squamous cell carcinoma of the hard palate (T4aN0M0) was performed a lateral-window sinus lift of the edentulous area of the left maxillary molar region to facilitate future placement of dental implants.Two hours after the surgery, the patient complained of sudden malar swelling. Marked swelling was present from the left infraorbital region to the buccal region. The swelling was associated with air pockets at the alar base and in the angulus oculi medialis region and subcutaneous malar tissue. Emphysema appeared after the patient blew his nose. Therefore, the mucous membrane of the maxillary sinus might have had a small hole, and air might have entered the subcutaneous tissue via the bone window when the air pressure in the maxillary sinus increased with nose blowing. It is important to advise patients to avoid increasing the intraoral pressure after sinus-lift procedure. PMID:26088054

  2. Facial emphysema after sinus lift

    PubMed Central

    Sakakibara, Akiko; Suzuki, Hiroaki; Yamashita, Atsuya; Hasegawa, Takumi; Minamikawa, Tsutomu; Furudoi, Shungo; Komori, Takahide

    2015-01-01

    An 80-year-old man with a history of en bloc resection of squamous cell carcinoma of the hard palate (T4aN0M0) was performed a lateral-window sinus lift of the edentulous area of the left maxillary molar region to facilitate future placement of dental implants. Two hours after the surgery, the patient complained of sudden malar swelling. Marked swelling was present from the left infraorbital region to the buccal region. The swelling was associated with air pockets at the alar base and in the angulus oculi medialis region and subcutaneous malar tissue. Emphysema appeared after the patient blew his nose. Therefore, the mucous membrane of the maxillary sinus might have had a small hole, and air might have entered the subcutaneous tissue via the bone window when the air pressure in the maxillary sinus increased with nose blowing. It is important to advise patients to avoid increasing the intraoral pressure after sinus-lift procedure. PMID:26088054

  3. A new genus and species of the subtribe Thyreophorina (Diptera, Piophilidae) from Japan.

    PubMed

    Saigusa, Toyohei

    2015-01-01

    A new genus, Diacanthomyia gen. nov. assigned to the subtribe Thyreophorina of the family Piophilidae is described based on a new species, Diacanthomyia okidoi sp. nov. recently found in Honshu and Kyushu, Japan. The new genus is somewhat similar to the European Centrophlebomyia of the subtribe. However, the new genus is distinguished from the known genera of the subtribe by the following combination of characters: body extensively pollinose or pruinose, 2 pairs of strong reclinate fronto-orbital bristles, 1-2 strong subvibrissal bristles in addition to 2 strong vibrissae, prosternum setose, 1 presutural dorsocentral, 1 strong anterior postsutural intra-alar, scutellum with 2 pairs of scutellar bristles without additional setulae, extensively microtrichose wing membrane, a dark round spot at r-m crossvein and a dark stripe covering m-m crossvein, and vein CuA+CuP abruptly terminated distant from wing margin. The type species inhabits evergreen broadleaved and deciduous broadleaved forests and adults appear during the cold season from December to March. Adults are attracted to decaying carcasses of Japanese deer and wild boar and traps baited with decaying pork spareribs and chicken meat with bones. The larvae of this species feed on decaying meat and marrow of deer, take less than 2 months to grow to mature larvae, and enter into diapause in the soil until autumn. PMID:26701565

  4. La Observación Sistemática de Vecindarios: El caso de Chile y sus perspectivas para Trabajo Social

    PubMed Central

    Sanhueza, Guillermo E.; Delva, Jorge; Andrade, Fernando H.; Grogan-Kaylor, Andrew; Bares, Cristina; Castillo, Marcela

    2012-01-01

    El estudio acerca de las características de los vecindarios y sus efectos sobre las personas ha llegado a ser un área de creciente atención por parte de investigadores de diversas disciplinas en países desarrollados. Aunque actualmente existen diversas metodologías para estudiar efectos del vecindario, una de las más utilizadas es la Observación Sistemática de Vecindarios –Systematic Social Observation SSO, en inglés—porque permite recolectar información acerca de diversas características del entorno físico, social, ambiental y económico de los vecindarios donde se aplica. El objetivo de este artículo es (i) dar a conocer sumariamente algunas investigaciones influyentes sobre efectos del vecindario en Estados Unidos, ii) describir cómo se diseñó e implementó la Observación Sistemática de Vecindarios en la ciudad de Santiago de Chile, iii) señalar algunos facilitadores y obstaculizadores de la implementación del proyecto y, finalmente iv) enunciar posibles contribuciones y limitaciones que esta metodología ofrecería al trabajo social en Chile. PMID:24791060

  5. Combination Nasolabial Transposition Flap and Island Pedicle Flap Following Mohs Surgery of Simultaneous Basal Cell Carcinomas Involving Both Nasal Alae

    PubMed Central

    Lee, Chae Young; Lee, Yeong Kyu; Choi, Kyu Won; Lee, Chae Wook; Kim, Ki Ho

    2008-01-01

    The nasal ala is a challenging area for surgical reconstruction, with thick sebaceous skin, the lack of an ample tissue reservoir, and an adjacent free margin. Numerous flaps have been reported for the repair of alae defects. A 71-year-old woman with simultaneous basal cell carcinomas involving both nasal alae was treated by Mohs micrographic surgery. The surgical defects measured 1.5×1.5 cm on the center of the right nasal ala and 1.0×1.0 cm on the left nasal ala, including the alar crease and rim. The right nasal ala was used as a nasolabial transposition flap and the left nasal ala was reconstructed by an island pedicle flap. The final shape and texture were satisfactory. The flaps survived and nasal symmetry was preserved. Combined nasolabial transposition and island pedicle flaps thus offer a superior esthetic and functional result owing to minimized tension. This may be a valuable reconstructive option in the repair of bilateral nasal alae defects.

  6. Infection in the Nasal Tip Caused by Acellular Dermal Matrix.

    PubMed

    Lee, Kun Hee

    2015-12-01

    A 19-year-old female patient visited our clinic for rhinoplasty. She complained about her low take-off point, which was apparent in profile view, and wanted slight tip projection. She refused additional cartilage harvesting from ears or ribs but consented to the use of homologous tissue, including acellular dermal matrix, for her dorsum and tip. Septoturbinoplasty was performed, and only a very small amount of septal cartilage could be harvested. It was used as both the columellar strut and the alar rim graft. Nasal dorsum and tip were augmented with acellular dermal matrix. Three months postoperatively, she experienced a few episodes of edema and redness on her nasal tip, followed by pus exudation from the nasal skin. Six months postoperatively, she underwent revision rhinoplasty for removal of inflamed grafts, and onlay tip graft with homologous rib cartilage was performed. Nasal dorsum or tip grafts are an integral part of Asian rhinoplasty. Autogenous tissue is the gold standard for grafting materials. However, the limited availability of autogenous tissue and the preference of patients and surgeons for artificial surgical implants make Asian rhinoplasty challenging. Unavailability of autogenous cartilage and patient refusal of artificial implants led to the use of acellular dermal matrix (ADM) in the nasal dorsum and tip for this case. This is the first report of postoperative complication because of infection rather than absorption after ADM use. PMID:26894006

  7. Prosomeric organization of the hypothalamus in an elasmobranch, the catshark Scyliorhinus canicula

    PubMed Central

    Santos-Durán, Gabriel N.; Menuet, Arnaud; Lagadec, Ronan; Mayeur, Hélène; Ferreiro-Galve, Susana; Mazan, Sylvie; Rodríguez-Moldes, Isabel; Candal, Eva

    2015-01-01

    The hypothalamus has been a central topic in neuroanatomy because of its important physiological functions, but its mature organization remains elusive. Deciphering its embryonic and adult organization is crucial in an evolutionary approach of the organization of the vertebrate forebrain. Here we studied the molecular organization of the hypothalamus and neighboring telencephalic domains in a cartilaginous fish, the catshark, Scyliorhinus canicula, focusing on ScFoxg1a, ScShh, ScNkx2.1, ScDlx2/5, ScOtp, and ScTbr1 expression profiles and on the identification α-acetylated-tubulin-immunoreactive (ir), TH-ir, 5-HT-ir, and GFAP-ir structures by means of immunohistochemistry. Analysis of the results within the updated prosomeric model framework support the existence of alar and basal histogenetic compartments in the hypothalamus similar to those described in the mouse, suggesting the ancestrality of these subdivisions in jawed vertebrates. These data provide new insights into hypothalamic organization in cartilaginous fishes and highlight the generality of key features of the prosomeric model in jawed vertebrates. PMID:25904850

  8. Systematic review of changes in maxillary incisor exposure and upper lip position with Le Fort I type osteotomies with or without cinch sutures and/or VY closures.

    PubMed

    Khamashta-Ledezma, L; Naini, F B

    2014-01-01

    The aim was to systematically review the maxillary incisor exposure and upper lip position changes with Le Fort I type osteotomies for advancement ± impaction with rigid internal fixation, taking into account the use of cinch sutures and VY closures. Electronic databases (Cochrane Library, Medline, Embase, and Web of Science) were searched using medical subject headings (MeSH), key words, truncations, and Boolean operators. Hand searching was also undertaken. Of 979 articles identified, 15 were included (11 retrospective, two prospective, and two unspecified). Relevant study details and outcomes were recorded on a spreadsheet, along with an assessment of their quality. In total, these studies assessed 419 patients (266 female, 118 male) with a mean age of 26.4 years (range 14-57 years). Soft tissue changes were assessed on lateral cephalometric radiographs. The mean maxillary hard tissue advancement and impaction ranged between 0.94 and 8.77 mm and -0.56 and 4.2 mm, respectively. The ranges of ratios demonstrated that from pronasale (0.24-0.35) to labrale superius (0.36-1.43), the soft tissues followed the underlying horizontal hard tissue movement increasingly more closely. Alar base cinch sutures and VY closures tended to increase these ratios. The soft tissue response was more variable vertically. None of the studies reported on maxillary incisor exposure change. More good quality prospective studies are needed. PMID:24103543

  9. Oculoauriculovertebral spectrum with a full range of severe clinical manifestations--case report.

    PubMed

    Gawrych, Elżbieta; Janiszewska-Olszowska, Joanna; Chojnacka, Hanna

    2014-12-01

    Oculoauriculovertebral spectrum (OAVS) is a rare congenital malformation consisting of epibulbar dermoids, lid colobomas, auricular deformities, hypoplasia of the soft and bony tissues of the face, associated oral deformities and vertebral anomalies. This report presents a child with a choroid of the right eye, coloboma of the upper eyelid, epibulbar dermoid of the left eye, mandibular hypoplasia, facial asymmetry, bilateral complete cleft lip and palate, hypoplasia of the left alar cartilage, appendage of the left nose, butterfly vertebral defects of Th-1, Th-2 and abnormality of rib XI. Widened sulci of frontal and parietal lobes, bilateral white matter density decrease and calcifications of falx cerebelli were noted. Axial hypotony and delayed psycho-motor development were apparent. This rare case presents a range of severe clinical manifestations of oculoauriculovertebral spectrum. Despite a normal cervical vertebral column, tracheostenosis was present. It caused difficulties in tracheal intubation, creating the need for a tracheostomy, and death after a failed attempt at decannulation. This case indicates that in patients with clinical manifestations including cerebral anomalies, a risk of respiratory insufficiency should be always taken under consideration, when planning surgery. PMID:22154733

  10. Introduction to Lumbosacral and Sacropelvic Fixation Strategies.

    PubMed

    Hsieh, Patrick C; Mummaneni, Praveen V

    2016-07-01

    We are pleased to present this Neurosurgical Focus video supplement on lumbosacral and sacropelvic fixation strategies. Despite advancement in surgical techniques and technologies in spine, achieving consistent solid fusion across the lumbosacral junction remains a major challenge. The anatomy of the lumbosacral junction allows for a higher range of motion compared to other areas of the thoracolumbar spine. The L5-S1 interspace is exposed to significant shear forces. As a result, complications such as pseudoarthrosis, screw pull-out, implant fracture, or sacral fractures can occur. Complications are particularly seen in long fusion constructs ending across the lumbosacral junction. To reduce these complications, various lumbosacral and sacropelvic fixation techniques have been developed and utilized. The current supplement is intended to provide instructional videos that illustrate several current techniques for lumbosacral and sacropelvic fixation. The collection includes techniques for anterior L5-S1 interbody fusion, minimally invasive L5-S1 interbody fusions, lumbosacral pedicle screw placement, sacroiliac fusion, and sacro-alar-iliac screw placement. The authors of the videos in the supplement have provided detailed narration and video illustration to describe the nuances of the various open and minimally invasive techniques for lumbosacral and sacral-pelvic fixation. We are pleased to have such a collection of quality video illustration from experts in the field. It's been our privilege to serve as guest editors for this supplement and we believe that you will enjoy the contents of this supplement. PMID:27364425