One-stage oblique lateral corridor antibiotic-cement reconstruction for Candida spondylodiscitis in patients with major comorbidities: Preliminary experience

Fungal spondylodiscitis is rare (0.5%–1.6% of spondylodiscitis) and mainly caused by Candida albicans. Surgical intervention in spondylodiscitis patients is indicated for compression of neural elements, spinal instability, severe kyphosis, failure of conservative management and intractable pain. However, there is no evidence-based optimal surgical approach for spondylodiscitis. There have been only case reports of surgical treatment for Candida spondylodiscitis. We evaluated the preliminary results of the efficacy and safety of one-stage debridement via oblique lateral corridor with interbody fusion (OLIF) using stand-alone cement reconstruction after debridement for the treatment of Candida spondylodiscitis in patients with major co-morbidities. Five patients (4 males, 1 female, mean age: 64.2 years) suffering from Candida albicans lumbar spondylodiscitis who underwent this procedure were studied. Their predominant symptoms were unremitting back and leg pain and all had pre and postoperative anti-fungal therapy under microbiologist supervision. The operative time ranged from 137 minutes to 260 minutes (mean: 213.4 minutes). The mean blood loss was 160 mL (range: 100–200 mL). There were no perioperative complications. At follow-up all showed major improvement in pain and ambulatory status. CT scan showed radiological stability for all patients at 6–12 months. Our preliminary results showed stand-alone anterior debridement and spinal re-construction with cement through mini-open OLIF approach might be a safe and effective option for patients with spinal fungal infection and major comorbidities.     

Anatomical Variations in the Pseudosylvian Fissure Morphology of Brachy‐, Dolicho‐, and Mesaticephalic Dogs

The purpose of the study is the following: (1) to anatomically characterize the right and the left pseudosylvian fissure (Psf) morphology; (2) to determine Psf variations between both hemispheres and between the three considered groups; and (3) to understand how these variations may influence brain surgery for dogs. Also we sought to determine whether there are any potential differences between brachy‐ (B), dolicho‐ (D), and mesaticephalic (M) dogs. The present study considered 138 brain hemispheres (N = 138) from 69 adult dog cadavers and used bregma craniometric point (b‐ the junction of coronal and sagittal cranial vault sutures) to characterize the Psf location on the superolateral brain surface. For statistical analysis, P values <0.05 were considered significant. The Psf was easily identified in all specimens at both hemispheres. Statistically significant differences for Psf width were registered between the groups, presenting M as the narrowest Psf regions. Fissure body length can be sorted in ascending order as D < M < B in both hemispheres, with the left Psf bigger than the right for all considered skulls. The greatest difference was registered in the B group with the left Psf 25.0% bigger than the right. Bregma has proved to be useful to appoint Psf location as more superior or inferior in the encephalic lateral surface, exhibiting in all groups the left Psf a superior position. For the groups the most inferior location was registered in M and the most superior in D. Understanding the Psf morphology and anatomical variations may provide important information to ensure safer intracranial procedures. Anat Rec, 298:1255–1260, 2015. © 2015 Wiley Periodicals, Inc.     

3D statistical modeling techniques to investigate the anatomy of the sacrum,its bone mass distribution,and the trans‐sacral corridors

The complex anatomy of the sacrum makes surgical fracture fixation challenging. We developed statistical models to investigate sacral anatomy with special regard to trans‐sacral implant fixation. We used computed tomographies of 20 intact adult pelves to establish 3D statistical models: a surface model of the sacrum and the trans‐sacral corridor S1, including principal component analysis (PCA), and an averaged gray value model of the sacrum given in Hounsfield Units. PCA demonstrated large variability in sacral anatomy markedly affecting the diameters of the trans‐sacral corridors. The configuration of the sacral alae and the vertical position of the auricular surfaces were important determinants of the trans‐sacral corridor dimension on level S1. The statistical model of trans‐sacral corridor S1 including the adjacent parts of the iliac bones showed main variation in length; however, the diameter was the main criterion for the surgically available corridor. The averaged gray value model revealed a distinct pattern of bone mass distribution with lower density particularly in the sacral alae. These advanced 3D statistical models provide a thorough anatomical understanding demonstrating the impact of sacral anatomy on positioning trans‐sacral implants. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1543–1548, 2014.     

骨性Ⅱ类错（牙合）拔牙矫治与牙弓形态 颊廊及侧貌变化的相关性研究

目的探讨恒牙列骨性Ⅱ类错[牙合]拔牙矫治后牙弓形态、颊廊及侧貌的变化情况及其相关性,为骨性Ⅱ类错[牙合]拔牙矫治提供参考。方法选取2013-01~2017-12在广西壮族自治区人民医院口腔正畸科接受拔牙矫治的恒牙列骨性Ⅱ类错[牙合]患者15例,应用X线头影测量技术分析矫治前后患者牙颌颅面结构变化,游标卡尺测量矫治前后上颌模型牙弓长度、宽度的变化,Adobe Photoshop CS6软件测量分析矫治前后患者正面微笑像变化。分析矫治前后颅颌牙面软硬组织,牙弓宽度、长度以及正面微笑像颊廊相关指标的变化情况及相关性。结果矫治后,患者SNA角、ANB角、U1-NA角、UL-E和LL-E较治疗前降低,NLA角较治疗前增加,差异有统计学意义(P<0.05);上颌牙弓中段宽度(UPP)、上颌牙弓后段长度(UPD)、上颌牙弓后段宽度(UMM)和上牙弓全段长度(UAD+UPD)指标均减小,与治疗前比较差异有统计学意义(P<0.05)。与治疗前比较,矫治后正面微笑像口角宽度(Ch to Ch)、正面微笑像颊廊宽度之和(BC)及正面微笑像双侧颊廊比率(BCR)水平增加,正面微笑像上颌可见牙列宽度(Va to Va)水平降低,但治疗前后比较差异均无统计学意义(P>0.05)。Pearson相关分析结果显示,UPP变化与BC和BCR变化呈负相关(P<0.05);UAD+UPD变化与UL-E变化呈正相关(P<0.05);Ch to Ch变化与U1-NA和UL-E变化呈负相关(P<0.05);BC变化与SNB角呈正相关(P<0.05)。结论骨性Ⅱ类错[牙合]拔牙矫治后牙弓长度变化与侧貌凸度改善密切相关,牙弓中段宽度减少可能会引起正面微笑时颊廊增加。     

登岛作战海上伤病员后送通道建立研究

本文针对未来登岛作战的特点,提出海上伤病员后送通道的设想,界定后送通道的概念,推导其理论模型,定量分析通道的时空结构,在此基础上构建通道系统仿真模型,并论证通道运作方案,力求形成完整而系统的后送通道理论,为制定登岛作战卫勤保障计划提供科学依据,为陆(岛)上及海域救治阶梯的有效衔接提供必要手段。     

Avoiding iatrogenic vascular injury in tibial external fixation with half pins. An in-vivo study based on CT angiography

BackgroundExternal fixation is an important tool in the management of variety of tibial fractures. Appropriate half pin insertion is important, to provide stable fixation without compromising the surgical field for definitive surgical procedures, and avoiding further damage to the important structures of the traumatized limb. There is paucity of literature about the optimal trajectories and safe corridors for half pins insertion based on in vivo studies. The available studies are based on anatomic atlases, cadaveric studies or half pin related complications.The aim of the current study is to present the findings of CT angiograms, in patients with external fixation of tibia, to enhance our understanding of optimal trajectories in safe corridors for half pins insertion.Material and methodsWe performed a retrospective study of patients with external fixators on the tibia, who had undergone CT angiogram as part of pre-operative planning for orthoplastic reconstructive procedures. The relationship between the tips of the fixator half pins and named vessels of the leg were analyzed, pins within 5 mm of a named vessel were considered to be a risk of causing iatrogenic injury.ResultsA total 51 patients, with in situ temporizing external fixators, with 134 half pins in different segments of the tibia were analyzed. More than 5 mm of penetration beyond the far cortex was noted in 47%, while in another 16% of pins penetration was more than 10 mm beyond the cortex. A tip to vessel distance (TVD) of 5 mm or less was noted in 28/134 (21%) of the pins, which highlights potential risk to the neurovascular bundles of the leg.ConclusionRisk of iatrogenic injury to neurovascular structures from half pin insertion can be reduced by meticulous use of fluoroscopy, by avoiding penetration beyond the far cortex, and avoiding exiting with half pins on the lateral surface in the distal 1/3rd of segment II of tibia. Moreover observing optimal trajectories and safe corridors for pin insertion, and selection of appropriate type of half pin can mitigate the risk to these structures.     

拔牙和非拔牙矫治对颊廊影响的研究

目的 研究拔牙和非拔牙矫治对颊廊的影响.方法 随机选取安氏Ⅰ类错(牙合)拔牙矫治患者和不拔牙矫治患者各25例,在其矫治前后的牙(牙合)模型上,分别对上下尖牙区和磨牙区唇颊面最突出的位置进行牙弓宽度的测量,同时在其矫治前后面部正位像上,测量笑容宽度和上颌可见牙列宽度,计算颊廊系数.所有数据均经统计学分析.结果 非拔牙组矫治前后牙弓宽度变化无统计学意义.拔牙组矫治后上、下颌尖牙间宽度分别增加了2.87 mm和1.30 mm(P＜0.05),但上下颌磨牙间宽度的变化无统计学意义.两组治疗前后颊廊系数变化均无统计学意义.结论 对于安氏Ⅰ类错(牙合)患者,拔牙和不拔牙矫治对颊廊均无明显的影响.     

A morphometric study of the structures bordering the infra-cochlear corridor – Relevant for endoscopic/microscopic ear surgery

Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts (molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery (PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein (ICV)/cochlear aqueduct (CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein (JV) meet close to the jugular foramen, were measured to be around 1.3?mm, 6?mm and 8?mm respectively, thus constituting an approximate 6?×?8 mm² infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.     

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??Aesthetics has got increasingly attention in the practice of today′ s dentistry. The smile is one of the most important facial expressions. A number of characteristic features were described to formulate a standard smile??including smile type??gingival contour??buccal corridor??etc. These parameters vary from study to study and have changed a lot in the recent decades. The present review aims to address the factors associated in the smile aesthetics.