The coronal suture,a useful bony landmark in neurosurgery?

Summary In the present study the variation of the localisation and the course of the coronal suture (CS) was examined on the lateral skull X-ray. The study shows a variation of the localisation and course of the CS from the average position within +/–4 mm in 65–77% and extreme differences between minimum and maximum values between 16 and 21 mm. The CS has also a considerable variation in its localisation relative to the precentral gyrus. Additionally the craniocerebral relationships and the localisation of the precentral gyrus and pyramidal tract are altered by the lesion or the space occupying process itself.A more exact localisation of the precentral gyrus, respectively the pyramidal tract can be obtained with CT and intraoperative cortical stimulation of the motor strip^{2, 4, 5}.     

Rouviere沟引导下腹腔镜胆囊切除术40例

目的 总结利用Rouviere沟引导定位胆囊管在腹腔镜胆囊切除术（LC）中的经验和体会。方法 回顾性分析芜湖市第五人民医院普外科2018年1月至2019年12月行LC的40例患者临床资料。术者均利用Rouviere沟及其延长线作为解剖标志在术中定位胆囊管的位置。结果 均在Rouviere沟延长线上顺利定位胆囊管,完成LC。无中转开腹、胆管损伤、胆漏、术后出血,手术时间（54.4±13.5）min,出血量4（3～5.5）mL,术后住院时间（2.8±0.7）d。结论 Rouviere沟出现率高,能够快速、准确定位胆囊管位置,可有效避免LC产生的医源性胆管损伤。     

The flat spot of the proximal ulna: a useful anatomic landmark in total elbow arthroplasty

The relationship between the flat subcutaneous dorsal surface (flat spot) of the ulna and the anatomic flexion axis of the elbow was investigated in 68 cadaveric ulnae. The flat spot and the guiding ridge of the greater sigmoid notch were digitized with an electromagnetic tracking device. The area of the flat spot, as well as its angle with the plane of the greater sigmoid notch, was calculated. The size of the flat spot was variable but was found to be nearly perpendicular to the plane of the greater sigmoid notch (mean, 89.8 degrees +/- 6.5 degrees ). This indicates that the subcutaneous dorsal surface of the proximal ulna is a useful landmark to assist the surgeon intraoperatively to orient the ulnar component axially in total elbow arthroplasty.     

Misdiagnoses: a timely reminder.

This case report of an occult infection masquerading as palindromic arthritis was misdiagnosed for almost 2 years. The episodic bouts of erysipelas were not obvious, and it was even suggested that the silicone implanted 7 years previously could possibly be inciting an autoimmune disease. Approximately 2 years after the onset of the recurrent episodes of fever, myalgias, and arthralgias, coagulase-negative staphylococci were found residing in the valve stems of bilumen breast implants, which were removed. The symptom complex disappeared and has not recurred.     

Rouviere沟引导下精准胆囊三角解剖技术在腹腔镜胆囊切除术中的应用

目的 探讨Rouviere沟引导下精准胆囊三角区解剖技术在腹腔镜胆囊切除术（LC）中的应用效果。方法 回顾性分析2020年1月至2020年12月安徽医科大学附属滁州医院接受LC术的89例患者临床资料,按照胆囊三角的解剖方式分为研究组（Rouviere沟引导下的精准解剖,n=48）和对照组（传统钝性解剖,n=41）。比较两组在手术时间、术中出血量、腹腔引流管放置等方面的差异;比较两组术后第1天活动能力（Barthel指数）、术后住院时间和总治疗费用差异,以及医源性胆管损伤和术后出血发生率的差异。结果 研究组的手术时间、术中出血量、腹腔引流管放置率均低于对照组,具有统计学差异（P＜0.05）。研究组术后第1天活动能力评分（Barthel指数）明显高于对照组（Z=-7.040,P＜0.05）。研究组术后住院时间和总治疗费用均低于对照组,具有统计学差异（P＜0.05）。而且研究组医源性胆管损伤的发生率明显低于对照组（χ2 =4.807,P＜0.05）。结论 和传统钝性解剖胆囊三角相比,Rouviere沟引导下精准胆囊三角解剖技术在LC中的应用具有明显优势。Rouviere沟作为肝脏表面重要的解剖定位标志,有助于临床医师精准、安全地显露胆囊三角,减少术中并发症特别是医源性胆管损伤的发生。     

腹腔镜胆囊切除术中利用Rouviere沟协助定位胆囊管的临床应用

目的:探讨腹腔镜胆囊切除术中利用Rouviere沟(右肝管右后支进入肝脏的表面标志)协助定位胆囊管的优势。方法:收集2014年7月至2015年8月203例行LC患者的临床资料,其中实验组采用Rouviere沟协助定位胆囊管,传统组采用经Calot三角直接解剖胆囊管。对比两组手术时间、出血量、胆管损伤情况。结果:两组手术时间[(37.5±6.6)min vs.(42.7±11.3)min]、术中出血量[(39.6±11.1)ml vs.(58.4±28.2)ml]差异有统计学意义(P0.05)。传统组1例(0.99%)发生胆道损伤,1例(0.99%)腹腔内出血。结论:利用Rouviere沟协助定位胆囊管较传统方法在缩短手术时间、减少出血量方面具有优势。同时Rouviere沟的可见性较高,且利用其进行定位的方法较容易掌握,值得临床推广。     

Bilateral re-expansion pulmonary edema in a child: a reminder

Re-expansion pulmonary edema (RPE) is an uncommon complication of sudden reinflation of a lung collapsed by pneumothorax or pleural effusion. We present a case of bilateral pulmonary edema following unilateral drainage of a pleural effusion in a young child with non-Hodgkin's lymphoma.     

Zuckerkandl结节与喉返神经位置关系的临床解剖学研究

目的 探讨Zuckerkandl结节的解剖及其在甲状腺手术中作为喉返神经解剖标志的临床意义.方法 147例患者(良性106例,恶性41例)甲状腺手术中解剖出喉返神经.测量Zuckerkandl结节大小并分级;辨认Zuckerkandl结节与喉返神经的关系并分型;解剖甲状腺下极并辨认喉返神经与甲状腺下动脉的关系.结果 共对233(左107、右126)侧甲状腺进行解剖.左侧成功解剖93.5％,右侧成功解剖96.0％.Zuckerkandl结节分级如下:0级,左16.0％右13.2％;Ⅰ级,左32.0％右27.3％;Ⅱ级,左46.0％右44.6％;Ⅲ级,左6.0％右14.9％.两侧Zuckerkandl结节分级之间无明显差异.Zuckerkandl结节与喉返神经的关系分型如下:A型,左92.9％,右93.3％;B型,左0右0;C型,左7.1％,右6.7％.左右两侧无明显区别.Zuckerkandl结节分级与喉返神经走行之间存在一定相关性:Zuckerkandl结节分级越高,喉返神经从其内后方走行越多;Zuckerkandl结节分级越低,喉返神经自其外侧通过者越多.右侧喉返神经危险型的发生率(19.0％)高于左侧(8.3％);Zuckerkandl结节与喉返神经的关系对评估甲状腺下极喉返神经通过甲状腺下动脉的方式无明显意义.结论 Zuckerkandl结节是甲状腺手术中定位与解剖喉返神经的重要标志,Zuckerkandl结节分级对喉返神经的解剖及术中损伤的预防有指导意义.     

The hepatic artery: a reminder of surgical anatomy

This study was carried out to document the anatomy of the hepatic artery with the purpose of reminding surgeons of the need for this essential knowledge in order to practice safe hepatobiliary surgery. Repeated surgical mistakes on patients referred to our unit prompted the study. One hundred and eighty consecutive livers procured for transplantation was studied, and the anatomy drawn immediately after dissection. The left hepatic artery arose from the left gastric artery in 15%, and either the splenic, gastroduodenal artery or the aorta in 4% of cases. The right hepatic artery arose from the superior mesenteric artery in 15%, the gastroduodenal, right gastric artery or aorta in 10% of cases. There was a major variation of the coeliac axis in 9% of cases studied. Overall, there was an abnormality in 43% of dissections: 48% were multiple and 27% had more than two vascular variations. A constant pattern of abnormalities occurred in the anatomy of the hepatic artery. Realisation of this vascular pattern should make identification of the anatomy easier. When there is one vascular variation, there is a high chance of there being multiple variations.     

FNAC in the diagnosis of symptomatic breast cancer: a reminder

Fine needle aspiration cytology (FNAC) of 138 symptomatic breast cancers achieved complete sensitivity 97.8%, absolute sensitivity 90.6%, and positive predictive value (C5 diagnosis) 99.2%. The efficiency and other advantages of FNAC in the diagnosis of palpable breast lesions should not be forgotten in the current vogue for core needle biopsy.     

Inferior temporal sulcus as a site of corticotomy: magnetic resonance imaging analysis of individual sulcus patterns

OBJECTIVE: Transcortical approaches to the inferior horn often result in quadrant hemianopsia attributable to the injury to the optic radiation. The inferior temporal sulcus (ITS) has received little attention as an entrance point for the transsulcal approach. We used the method of detecting the ITS with magnetic resonance imaging (MRI) scans and investigated the sulcus pattern of ITS, its incidence rate, and the availability of the ITS to the corticotomy for selective amygdalohippocampectomy. METHODS: The sulcus patterns of the ITS of 100 temporal lobes in 50 healthy individuals were classified according to the number of interruptions by gyral bridges, and the localization of the ITS was characterized in relation to the outer surface by means of the surface anatomy scan of MRI. RESULTS: Most of the ITS was interrupted by one to three gyral bridges (0 bridges, 8%; one bridge, 27%: two bridges, 37%; three bridges, 20%; more than four bridges or no apparent ITS, 8%). When the ITS was present, it was located 15 mm above the orbitotragus line at a point 20 mm anterior to the tragus. The number of gyral bridges was significantly larger in the left temporal lobes than in the right temporal lobes, regardless of the sex of the subject. CONCLUSION: The ITS was clearly identified in 72% of the temporal lobes by the oblique sagittal view of MRI scans; thus, in such cases, the ITS was considered to be a candidate for an entrance point of a small temporal corticotomy. The preoperative observation of the ITS in relation to the orbitotragus line by means of MRI may improve the planning of the transsulcal approaches to deeply seated mesial temporal lesions, such as hippocampal sclerosis.