المؤلفون: Byrne, Robert A, Fremes, Stephen, Capodanno, Davide, Czerny, Martin, Doenst, Torsten, Emberson, Jonathan R, Falk, Volkmar, Gaudino, Mario, McMurray, John J V, Mehran, Roxana, Milojevic, Milan, Uva, Miguel Sousa

المصدر: European Heart Journal; 11/1/2023, Vol. 44 Issue 41, p4310-4320, 11p

مصطلحات موضوعية: DRUG-eluting stents, CORONARY artery disease, CORONARY artery bypass, SURGICAL & topographical anatomy, MYOCARDIAL revascularization, PERCUTANEOUS coronary intervention, MYOCARDIAL infarction

الشركة/الكيان: EUROPEAN Society of Cardiology

مستخلص: In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0–32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality. [ABSTRACT FROM AUTHOR]

: Copyright of European Heart Journal is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Gelezhe, Pavel, Frank, Konstantin, Casabona, Gabriela, Kaye, Kai O., Kassirer, Samuel, Moelhoff, Nicholas, Freytag, David L., Gotkin, Robert H., Alfertshofer, Michael, Cotofana, Sebastian

المصدر: Journal of Cosmetic Dermatology; Nov2023, Vol. 22 Issue 11, p2957-2963, 7p

مصطلحات موضوعية: SUBMANDIBULAR gland, PAROTID glands, SURGICAL & topographical anatomy, CAROTID artery, ULTRASONIC imaging

الشركة/الكيان: UNITED States. Food & Drug Administration

مستخلص: Background: Neuromodulators have predominantly been used for the treatment of upper facial lines, but their use has expanded to include lower face and neck treatments. However, the injection sites for these treatments are based on skin surface landmarks, which may pose risks to nearby structures and result in undesired outcomes. Objective: To investigate the spatial relationship between the FDA‐approved skin surface landmarks for neuromodulator injections in the parotid and submandibular glands and the topographical anatomy of critical facial structures such as the facial artery, facial vein, external carotid artery, and retromandibular vein. Materials and methods: A cross‐sectional retrospective analysis was conducted on contrast‐enhanced cranial CT scans. The scans were analyzed for the morphology and location of the parotid and submandibular glands. Measurements were taken for gland volume, craniocaudal extent, anterior–posterior extent, and distances between the skin surface and gland capsule or nearby structures such as arteries. Results: The study sample consisted of 53 subjects, including 7 males and 46 females, with a mean age of 36.91 years and a mean BMI of 23.28 kg/m2. The mean volume of the parotid gland was 31.9 ± 3.0 cc in males and 28.5 ± 3.6 cc in females with p < 0.001, while the mean volume of the submandibular gland was 18.2 ± 2.0 cc in males and 14.5 ± 3.4 cc in females with p < 0.001. The mean distances between skin surface and the gland capsule were 5.98 ± 2.2 and 8.84 ± 4.0 mm for the parotid and submandibular gland, respectively. This distance increased with higher age and higher BMI values in a statistically significant manner with p < 0.001. Conclusion: The distances between FDA‐approved skin surface landmarks and the parotid and submandibular glands varied significantly depending on gender, age, and BMI. Optimal injection depth and location for neuromodulator treatments cannot be generalized based on these landmarks alone, emphasizing the need for real‐time ultrasound imaging guidance. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Cosmetic Dermatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

العنوان البديل: Medicina u doba Hipokrata i posle Hipokrata.

المؤلفون: Lazarević, Tatjana¹, Kovačević, Zoran¹, Petrović, Mirjana A. Janićijević¹, Ljujić, Biljana¹, Glišić, Miloš¹, Janićijević, Katarina¹ kaja.andreja@yahoo.com

المصدر: Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia. Oct2022, Vol. 79 Issue 10, p1048-1054. 7p.

مصطلحات موضوعية: *PHYSICIANS, *SURGICAL & topographical anatomy, *HUMAN dissection, *MEDICAL ethics, *DRUGS, *SPINAL cord diseases, *PHACOEMULSIFICATION

المؤلفون: Co, Michael¹ (AUTHOR), Cheung, Kwong Yee Chloe¹ (AUTHOR), Cheung, Wan Suen¹ (AUTHOR), Fok, Ho Man¹ (AUTHOR), Fong, Ka Hey¹ (AUTHOR), Kwok, Oi Yan¹ (AUTHOR), Leung, Tsz Wai Kelvin¹ (AUTHOR), Ma, Hei Chun Justin¹ (AUTHOR), Ngai, Pui Ting Isabelle¹ (AUTHOR), Tsang, Man Kit¹ (AUTHOR), Wong, Cheuk Yin Matthew¹ (AUTHOR), Chu, Kent-Man¹ (AUTHOR) chukm@hku.hk

المصدر: Surgeon (Elsevier Science). Oct2022, Vol. 20 Issue 5, pe195-e205. 11p.

مصطلحات موضوعية: *SURGICAL & topographical anatomy, *ANATOMY education, *DISTANCE education, *ONLINE education, *SURGICAL education, *DISTANCE education students

مستخلص: Rapid development of COVID-19 has resulted in a massive shift from traditional to online teaching. This review aims to evaluate the effectiveness of distance learning on anatomy and surgical training. This systematic review was conducted in line with the PRISMA statement and current methodological literature. The databases CINAHL, Cochrane, EMBASE and Pubmed were searched using the search terms "Distant learning" OR "Distance learning" AND "Anatomy OR Surgery". 182 non-duplicate studies were identified. 20 studies were included for qualitative analysis. 10 studies evaluated students' performance with distance learning. 3 studies suggested that students' learning motivation improved with distance learning pedagogy. 5 studies found improved student performance with distance learning (performance or task completion time) when compared to conventional physical method. While 2 other studies found non-inferior student performance. 10 studies evaluated students' feedback on distance learning. Most feedbacks were positive, with flexibility, efficiency, increased motivation and better viewing angles as the most-liked features of distance teaching. 4 studies pointed out some limitations of distance learning, including the lack of personal contact with tutor, poor network and reduced student concentration. 7 studies evaluated tutors' feedback on distance learning. Tutors generally liked online platforms for the ease of tracking silent students, monitoring performance and updating fast-changing knowledge. Yet the lack of hands-on experience for students, technical issues and high costs are the main concerns for tutors. In conclusion, distance learning is a feasible alternative for anatomy and surgical teaching. [ABSTRACT FROM AUTHOR]

المؤلفون: Kockro, Ralf A.^1,2 (AUTHOR), Schwandt, Eike¹ (AUTHOR), Ringel, Florian¹ (AUTHOR), Eisenring, Christian Valentin^2,3 (AUTHOR) ralf.kockro@hirslanden.ch, Nowinski, Wieslaw Lucjan⁴ (AUTHOR)

المصدر: Journal of Neurological Surgery. Part B. Skull Base. 2022, Vol. 83 Issue 5, pe298-e305. 8p.

مصطلحات موضوعية: *SKULL base, *SURGICAL & topographical anatomy, *GRAPHICAL user interfaces, *ANATOMY, *MAGNETIC resonance imaging, *MEDICAL students

مصطلحات جغرافية: MAINZ (Germany : Landkreis), ZURICH (Switzerland)

مستخلص: Objective  We evaluated the usefulness of a three-dimensional (3D) interactive atlas to illustrate and teach surgical skull base anatomy in a clinical setting. Study Design  A highly detailed atlas of the adult human skull base was created from multiple high-resolution magnetic resonance imaging (MRI) and computed tomography (CT) scans of a healthy Caucasian male. It includes the parcellated and labeled bony skull base, intra- and extracranial vasculature, cranial nerves, cerebrum, cerebellum, and brainstem. We are reporting retrospectively on our experiences with employing the atlas for the simulation and teaching of neurosurgical approaches and concepts in a clinical setting. Setting  The study was conducted at the University Hospital Mainz, Germany, and Hirslanden Hospital, Zürich, Switzerland. Participants  Medical students and neurosurgical residents participated in this study. Results  Handling the layered graphical user interface of the atlas requires some training; however, navigating the detailed 3D content from intraoperative perspectives led to quick comprehension of anatomical relationships that are otherwise difficult to perceive. Students and residents appreciated the collaborative learning effect when working with the atlas on large projected screens and markedly improved their anatomical knowledge after interacting with the software. Conclusion  The skull base atlas provides an effective way to study essential surgical anatomy and to teach operative strategies in this complex region. Interactive 3D computer graphical environments are highly suitable for conveying complex anatomy and to train and review surgical concepts. They remain underutilized in clinical practice. [ABSTRACT FROM AUTHOR]

المؤلفون: Pinheiro-Neto, Carlos D.^1,2 (AUTHOR) PinheiroNeto.Carlos@mayo.edu, Salgado-Lopez, Laura³ (AUTHOR), Leonel, Luciano C.P.C.³ (AUTHOR), Aydin, Serdar O.³ (AUTHOR), Peris-Celda, Maria^3,4 (AUTHOR)

المصدر: Journal of Neurological Surgery. Part B. Skull Base. 2022, Vol. 83 Issue 5, pe374-e379. 6p.

مصطلحات موضوعية: *SURGICAL & topographical anatomy, *ANATOMICAL specimens, *NASOPHARYNX, *CRANIOVERTEBRAL junction, *CEREBROSPINAL fluid leak, *ATLANTO-occipital joint, *RHINORRHEA

مستخلص: Background  Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective  The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods  Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results  In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion  This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate. [ABSTRACT FROM AUTHOR]

المؤلفون: Salgado-Lopez, Laura^1,2 (AUTHOR), Perry, Avital³ (AUTHOR), Graffeo, Christopher S.³ (AUTHOR), Carlstrom, Lucas P.³ (AUTHOR), Leonel, Luciano C.P.C.^1,2 (AUTHOR), Driscoll, Colin L.W.⁴ (AUTHOR), Link, Michael J.^3,4 (AUTHOR), Peris-Celda, Maria^1,2,3,5 (AUTHOR) periscelda.maria@mayo.edu

المصدر: Journal of Neurological Surgery. Part B. Skull Base. 2022, Vol. 83 Issue 5, pe232-e243. 12p.

مصطلحات موضوعية: *SURGICAL & topographical anatomy, *SCALP, *SKULL base, *INTERNAL carotid artery, *PHOTOGRAPHS, *DISSECTION, *THREE-dimensional imaging

مستخلص: Introduction  The middle fossa (MF) approaches encompass a group of versatile surgical accesses to pathologies in the MF, internal auditory canal (IAC), and superomedial aspect of the posterior fossa. Although many descriptions of the MF approaches have been published, a practical surgical guide that allows an easy understanding for Skull Base trainees is needed. Methods  Three formalin-fixed, colored-injected specimens were dissected under microscopic magnification (six sides). A MF craniotomy followed by IAC drilling was performed on three sides, and anterior petrosectomy (AP) was performed in the remaining three sides. The anatomical dissection was documented in stepwise three-dimensional photographic images. Following dissection, representative case applications were reviewed. Results  The MF approach provides direct access to the MF structures and IAC. The AP provides excellent access to the superomedial aspect of the posterior fossa. Key common steps include: positioning and skin incision; scalp and muscle flaps; burr holes; craniotomy flap elevation; dural dissection along the petrous ridge; division of the middle meningeal artery; and exposure of the greater superficial petrosal nerve, tegmen tympani, and V3. Then, to approach the IAC: superior IAC drilling, and longitudinal dura opening. The area drilled in the AP approach forms a pentagon limited by the petrous internal carotid artery, cochlea, IAC, petrous ridge, and lateral border of V3. Conclusion  The MF approaches are challenging. Operatively oriented skull base dissections provide a crucial foundation for learning these techniques. We describe comprehensive step-by-step approaches intended to develop familiarity in the cadaver laboratory and facilitate understanding of their potential for skull base disorders. Basic surgical principles are described to help in the operating room as well as illustrative cases. [ABSTRACT FROM AUTHOR]

المؤلفون: Kutlu, B.¹ (AUTHOR), Guner, M. A.¹ (AUTHOR), Akyol, C.¹ (AUTHOR), Gungor, Y.¹ (AUTHOR), Benlice, C.¹ (AUTHOR), Arslan, M. N.¹ (AUTHOR), Açar, H. İ.¹ (AUTHOR), Kuzu, M. A.¹ (AUTHOR) ayhankuzu@gmail.com

المصدر: Techniques in Coloproctology. Aug2022, Vol. 26 Issue 8, p655-664. 10p.

مصطلحات موضوعية: *HUMAN dissection, *SURGICAL & topographical anatomy, *ANATOMY, *ILIAC vein, *ILIAC artery, *SURGICAL complications

مستخلص: Background: Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. Methods: A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. Results: Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97 mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79 mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9 mm on the right and 24.2 mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35 mm and 4.62 mm at 2 cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2 cm below the SHP bifurcation. Conclusions: Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting. [ABSTRACT FROM AUTHOR]

المؤلفون: Xu, Yuanzhi^1,2 (AUTHOR), Nunez, Maximiliano Alberto¹ (AUTHOR), Mohyeldin, Ahmed¹ (AUTHOR), Fernandez-Miranda, Juan C.¹ (AUTHOR), Cohen-Gadol, Aaron A.^3,4,5 (AUTHOR) cohen@nsatlas.com

المصدر: Journal of Neurological Surgery. Part B. Skull Base. Aug2022, Vol. 83 Issue 4, p430-434. 5p.

مصطلحات موضوعية: *NEUROANATOMY, *SURGICAL & topographical anatomy, *MAXILLARY nerve, *SPHENOID bone, *ENDOSCOPIC surgery, *ZYGOMA

مستخلص: Introduction  Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems. Objective  To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach. Methods  The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective. Results  The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF. Conclusion  The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes. [ABSTRACT FROM AUTHOR]

المؤلفون: Hayashi, Katsuhiro¹ (AUTHOR) hysk@med.kanazawa-u.ac.jp, Tsuchiya, Hiroyuki¹ (AUTHOR)

المصدر: International Journal of Clinical Oncology. Aug2022, Vol. 27 Issue 8, p1238-1246. 9p.

مصطلحات موضوعية: *INTRAMEDULLARY rods, *SURGICAL & topographical anatomy, *THYROID cancer, *BONE metastasis, *FRACTURE fixation, *SURGERY, *RENAL cell carcinoma, TUMOR surgery

مستخلص: Surgery for bone metastasis has two primary goals—palliative care to relieve pain, instability and paralysis, and tumor resection for curing the disease. Oncologically en bloc resection, followed by a reconstruction of the bone defect is the treatment of choice in single bone metastasis from renal cell carcinoma or thyroid cancer. Bone metastases may occur in the extremities, pelvis, or spine, and different resection and reconstruction methods depend on the regional anatomy. For instance, multiple options are available for reconstruction of the pelvis, especially for the acetabulum, including anatomical reconstruction using custom-made implants or recycled autologous bone grafting when a long-term prognosis is expected. Recently, for the spine, total en bloc spondylectomy is extensively performed despite the initial limitations of surgical invasiveness, such as blood loss. Principally, palliative surgery aims to maintain lasting bony stability with minimal surgical invasiveness. Intramedullary nails and plate fixation are frequently used in the extremities but the postoperative failure rate is relatively high. Therefore, surgeons should consider the use of long intramedullary nails and long-type stems for endoprosthesis reconstruction along with cement fixation to reduce the failure rate. Although short-term complications, such as dislocation, have been observed with endoprosthesis reconstruction, it is stable in the long-term follow-up. Percutaneous bone cement injection into the spine and pelvis is also effective and less invasive. [ABSTRACT FROM AUTHOR]