Clinical anatomy of the orbitomeningeal foramina: variational anatomy of the canals connecting the orbit with the cranial cavity

Purpose

In addition to the optic canal and the superior orbital fissure, orbits are connected with the cranial cavity via inconstant canals including the orbitomeningeal foramen. This study has been carried out in order to define many anatomical and radiological details of the orbitomeningeal foramen that are relevant in the clinical practice.

Methods

Almost 1000 skulls and 50 computerized tomographies were examined to determine incidence, number, length, and caliber of the orbitomeningeal foramen as well as the topography of their orbital and cranial openings. A retrospective study of angiographies carried out on more than 100 children was performed to look for arteries candidate to run through the orbitomeningeal foramen.

Results

Orbitomeningeal foramina were detected in 59.46 % of skulls and in 54 % of individuals by computerized tomography. Orbits with two to five foramina were found. Canals were classified as M-subtype or A-subtype depending on their cranial opening. Large foramina, with the caliber ranging between 1 and 3 mm, were found in 12.17 % of orbitomeningeal foramen-bearing orbits. By computed tomography the average caliber measured 1.2 ± 0.3 and 1.5 ± 0.5 mm (p < 0.005) at the orbital and cranial openings, respectively (p < 0.005). Angiographies showed meningo-lacrimal and meningo-ophthalmic arteries, meningeal branches of the lacrimal and supraorbital arteries, and some unidentified arteries that could pass through the orbitomeningeal foramina.

Conclusions

Orbitomeningeal foramina are a common occurrence. When large they may house important arteries that can be the source of severe bleedings during deep dissection of the lateral wall of the orbit. Orbital surgeons should be aware of their existence.

     

Anatomical study of pterygoid canal (PC) and palatovaginal canal (PVC) in endoscopic trans-sphenoidal approach

Purpose

The primary purpose of our work was to make anatomical measurements of pterygoid canal (PC) and palatovaginal canal (PVC). The secondary goal was to locate the two structures based on the landmarks in the trans-sphenoidal surgery and draw a safe corridor of fenestration in the bottom of sphenoid sinus during surgical procedure to sphenopalatine region.

Materials and methods

Computed tomographic angiography (CTA) images of PC, PVC and sphenoid sinus in 200 adults were reviewed. Multiplanar reconstruction of the CT images was performed, and the anatomical features of the PC and PVC were studied in the coronal, sagittal, and axial planes. The length, diameter and direction of PC and PVC were measured in the plane through or perpendicular to them. The anterior and posterior opening of PC and PVC were identified by the surgical landmarks such as the middle lowest point of sellar floor, the sagittal midline and the bottom of the sphenoid sinus.

Result

Both PC and PVC can be found and identified easily on CTA image, the shape and size of the PC and PVC were in agreement with those retrieved from previous literatures, the position of them can be located by the anatomical landmarks in sphenoid sinus.

Conclusion

Knowing the anatomical features of PC and PVC and their location based on the anatomical landmarks are helpful to the endoscopic trans-sphenoidal surgery. These data in our study will provide surgeons a better understanding of PC and PVC and their relationship to sphenoid sinus. Notably, it will not help the surgeons to avoid injuring neurovascular structures as well as provided supportive information for the choice of the appropriate endoscopic equipment.

     

How does wrist position affect the length of the distal radioulnar ligament: a three-dimensional image study in vivo?

Purpose

This study was designed to investigate the length changes of the distal radioulnar ligament at different wrist positions and to determine the effect of hyperextension on the distal radioulnar ligament and to find out the most vulnerable position where the distal radioulnar ligament rupture and foveal avulsion.

Methods

We obtained computed tomography scans of the wrists for 12 volunteers including two groups: hyperextension group and hyperextension with maximal rotation group. The images were reconstructed to the three-dimensional bone structures with customized software. The four portions of the distal radioulnar ligament were measured and analyzed statistically.

Results

No significant differences were noted in the lengths of the each portion of the distal radioulnar ligament among neutral position, wrist hyperextension, and hyper-radial extension. From neutral position to hyperextension with maximal pronation, the lengths of the palmar superficial radioulnar ligament (psRU) and dorsal deep radioulnar ligament (ddRU) decreased significantly, whereas the dorsal superficial radioulnar ligaments (dsRU) and palmar deep radioulnar ligament (pdRU) increased significantly. From neutral position to hyperextension with maximal supination, the lengths of the pdRU and dsRU ligaments decreased significantly, and the lengths of psRU and ddRU ligaments changed little.

Conclusions

The factor of hyperextension has little effect on the length of the distal radioulnar ligament and the distal radioulnar ligament may be under great tension at the position of hyperextension with maximal pronation. These findings can provide more information to understand the pathomechanics of the triangular fibrocartilage complex injury caused by a fall on the outstretched hand and can provide information relevant to the distal radioulnar ligament restoration.

     

Correlation of ultrasound appearance,gross anatomy,and histology of the femoral nerve at the femoral triangle

Purpose

Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography.

Materials and methods

Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis.

Results

On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection.

Conclusion

The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

     

Spatial anatomy of the round ligament,gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver

Purpose

To analyze the vascular structure of the liver in patients with a right-sided round ligament.

Methods

We reviewed 16 patients with a right-sided round ligament and 3 polysplenia and situs inversus patients with a left-sided round ligament who underwent multidetector row CT with contrast media. The patient population consisted of 13 men and 6 women (mean 62 years). We analyzed the axial and volume-rendered images for the location of the round ligament, gallbladder, portal veins, hepatic veins, and hepatic artery. The following imaging findings for the patients with polysplenia and situs inversus were horizontally reversed.

Results

The prevalence of a right-sided round ligament with and without polysplenia was 75 and 0.11 %, respectively. The gallbladder was located to the right, below, and left of the round ligament in 27.7, 38.8 and 33.3 %, respectively. Independent branching of the right posterior portal vein was noted in 57.8 %. PV4 was difficult to identify in 36.8 %. The middle hepatic vein was located to the left of the round ligament. Two branching patterns for the lateral and medial branches of the right anterior hepatic artery were noted: the common (44.4 %) and separated types (55.5 %). Both of the right anterior hepatic artery and portal vein ramified into two segments; the lateral segment with many branches and the medial segment with a few branches.

Conclusions

The right-sided round ligament divided the right anterior section into the lateral and medial segments based on the portal vein and hepatic artery anatomy.

     

The classification of frontal sinus pneumatization patterns by CT-based volumetry

Purpose

We aimed to define the classification of frontal sinus pneumatization patterns according to three-dimensional volume measurements.

Methods

Datasets of 148 sides of 74 dry skulls were generated by the computerized tomography-based volumetry to measure frontal sinus volumes. The cutoff points for frontal sinus hypoplasia and hyperplasia were tested by ROC curve analysis and the validity of the diagnostic points was measured.

Results

The overall frequencies were 4.1, 14.2, 37.2 and 44.5 % for frontal sinus aplasia, hypoplasia, medium size and hyperplasia, respectively. The aplasia was bilateral in all three skulls. Hypoplasia was seen 76 % at the right side and hyperplasia was seen 56 % at the left side. The cutoff points for diagnosing frontal sinus hypoplasia and hyperplasia were ‘1131.25 mm³’ (95.2 % sensitivity and 100 % specificity) and ‘3328.50 mm³’ (88 % sensitivity and 86 % specificity), respectively.

Conclusions

The findings provided in the present study, which define frontal sinus pneumatization patterns by CT-based volumetry, proved that two opposite sides of the frontal sinuses are asymmetric and three-dimensional classification should be developed by CT-based volumetry, because two-dimensional evaluations lack depth measurement.

     

Micronized palmitoylethanolamide reduces joint pain and glial cell activation

Objective and design

Temporomandibular disorder (TMD) is a common painful condition in the temporomandibular joint (TMJ). Joint inflammation is believed to be a chief cause of pain in patients with TMD, through the release of pro-inflammatory cytokines that induce peripheral sensitization of nerve terminals followed by microglial stimulation.

Materials and subject

TMJ was induced in rats with the injection of complete Freund’s adjuvant (CFA) emulsion into the left TMJ capsule.

Treatment

The present study would assess the effects of micronized palmitoylethanolamide (m-PEA) on glial activation and trigeminal hypersensitivity.

Methods

Ten mg/kg m-PEA or corresponding vehicle was administered 1 h after CFA and mechanical allodynia and edema were evaluated at 24 and 72 h after CFA injection.

Results

CFA-injected animals showed TMJ edema and ipsilateral mechanical allodynia accompanied by a robust growth in GFAP protein-positive satellite glial cells and activation of resident macrophages in the TG. Moreover, m-PEA administration significantly reduced the degree of TMJ damage and pain, macrophage activation in TG and up-regulation of Iba1.

Conclusions

The results confirm that m-PEA could represent a novel approach for monitoring pain during trigeminal nerve sensitization.

     

Changes of empathy in medical college and medical school students: 1-year follow up study

Background

This study aims to determine the correlation between medical education systems, medical college (MC) and medical school (MS), and empathy by investigating the changes in empathy among students with each additional year of medical education.

Methods

The subjects were MC and MS students who had participated in the same study the previous year. All participants completed the same self-report instruments: a questionnaire on sociodemographic characteristics, and the Korean edition of the Student Version of the Jefferson Scale of Empathy (JSE-S-K), Among 334 students, the final analysis was conducted on the data provided by 113 MC and 120 MS students, excluding 101 with incomplete data.

Results

The age and sex did not affect the changes in empathy. Though the JSE-S-K score of MS was significantly higher than that of MC in initial investigation, this study found no difference of empathy between MC and MS.

Conclusion

Empathy increased significantly after one year of medical education. The difference between two education systems, MC and MS, did not affect the changes in empathy.

     

<Emphasis Type="Italic">Helicobacter bilis</Emphasis>-Associated Suppurative Cholangitis in a Patient with X-Linked Agammaglobulinemia

?

Helicobacter bilis is a commensal bacterium causing chronic hepatitis and colitis in mice. In humans, enterohepatic Helicobacter spp. are associated with chronic hepatobiliary diseases.

Purpose

We aimed at understanding the microbial etiology in a patient with X-linked agammaglobulinemia presenting with suppurative cholangitis.

Methods

16S rDNA PCR directly performed on a liver biopsy retrieved DNA of H. bilis.

Results

Clinical outcome resulted in the normalization of clinical and biological parameters under antibiotic treatment by a combination of ceftriaxone, metronidazole, and doxycyclin followed by a 2-week treatment with moxifloxacin and a 2-month treatment with azithromycin.

Conclusion

In conclusion, these data suggest a specific clinical and microbiological approach in patients with humoral deficiency in order to detect H. bilis hepatobiliary diseases.

     

Evaluation of morphology of the nasopalatine canal using cone-beam computed tomography in a subgroup of Turkish adult population

Purpose

The aim of the study was to evaluate the anatomy and morphology of the nasopalatine canal (NPC) using cone-beam computed tomography (CBCT) and to determine variations of the NPC in relation to age, gender, and status of edentulism of anterior maxilla.

Methods

Patients scheduled for CBCT imaging for further radiographic evaluation of the maxilla with various reasons were consecutively enrolled in this study. Reformatted sagittal and coronal slices were analyzed with regard to dimensions and anatomic characteristics of the NPC. The correlation of age, gender, and status of edentulism of anterior maxilla with all the variables were evaluated.

Results

The study comprised 157 subjects with a mean age of 49.64 years. The analysis of the diameter of the incisive foramen revealed a mean of 4.48 mm whereas the diameter of the palatine foramen revealed a mean of 2.88 mm. The mean length of NPC was 10.87 mm and found significantly longer in males and patients with anterior teeth. In terms of incisive foramen and palatine foramen diameter, there was not any significant difference between males and females and between patients with and without anterior teeth (p > 0.05).

Conclusion

There was relationship between the gender of the patients and the length of the NPC, with significantly lower mean values in females. This result suggests that careful analysis of anatomical structures by taking into consideration some variables would aid the clinician in performing a safer surgical intervention and prevent possible complications. CNCT scanning prior to implant surgery specifically in edentulous patients with severely atrophic maxillae might be a good diagnostic tool to guide the clinician for a safer and predictable procedure.

     

Glücklich als Paar – glücklicher Schlaf?

Background

Millions of people share a bed with their partner. Sleep und relationship could possibly influence each other.

Objectives

To identify and discuss connections between relationship and sleep quality.

Methods

Review of the literature in electronic databases.

Results

Conflict and violence in relationships lead to decreases in both partners’ sleep quality. Constructive approaches to resolving conflicts is necessary for good sleep, and vice versa. Women prefer partners with sleep-wake rhythms matching their own and report higher relationship satisfactions when the couple’s chronotypes are compatible.

Conclusions

Sleep and circadian rhythms play important roles in relationships. When treating insomnia, the relationship and the partner’s sleep should be taken into account.

     

Ethical Assessment of Human Embryonic Stem Cell Research According to Turkish Muslim Scholars: First Critical Analysis and Some Reflections

Background

Turkey, with a Muslim population of officially over 99 %, is one of the few secular states in the Muslim world. Although state institutions are not based on Islamic juridical and ethical norms, the latter play a significant role in defining people’s attitudes towards controversial issues in the modern world, especially when backed by opinions of Muslim scholars living in Turkey. Accordingly, opinions of Muslim scholars undoubtedly have an important effect on bioethical decisions made by institutions and individuals.

Objective(s)

To explore the ethical positions of Muslim scholars living in Turkey and their arguments used in the ethical assessment of embryonic stem cell research; to discuss the biological-moral tensions arising in medical research on human embryos.

Design

Qualitative study.

Setting

Muslim scholars located in different parts of Turkey.

Methods

Qualitative method, involving the collection of opinions of various scholars, by means of 15 individual semi-structured interviews, evaluated using thematic qualitative analysis.

Results

Positions regarding embryonic stem cell research differ among Muslim scholars in Turkey. On the other hand, even where positions are similar, they are often supported by different arguments.

Conclusion

Despite the heterogeneity of the arguments presented, the dominant position considers embryonic stem cell research as morally acceptable.

     

Prevalence of ponticulus posticus in a Northern Italian orthodontic population: a lateral cephalometric study

Purpose

The term “ponticulus posticus” refers to a partial or complete bony arch over the vertebral artery as it crosses the superolateral surface of the posterior arch of the atlas. This anatomical modification is linked to different symptoms, ranging from neckache to headache and migraine. This bony arch may also be incorrectly assessed during orthopaedic surgery for fixation of C1–C2, with consequent risk of damaging the vertebral artery. Its frequency in the general population has been widely analysed by literature in different geographic contexts, but an analysis of the prevalence of such feature in the Italian population is still missing.

Methods

A Northern Italian orthodontic sample was analysed to assess the prevalence of ponticulus posticus. Lateral teleradiographies of 221 patients were examined. All the patients underwent lateral cephalometry for odontoiatric purposes and none of them was affected by congenital diseases or skeletal deformities.

Results

In the analysed sample, ponticulus posticus had a prevalence of 7.7 % for the complete form, and 9.0 % for the incomplete form. Complete and partial forms were observed, respectively, in 8.8 and 11.0 % of males, and in 6.9 and 7.7 % of females, without statistically significant differences.

Conclusions

The current investigation provided the first data concerning the frequency of ponticulus posticus in Italy: further studies are needed to widen the sample, verify possible regional variations and improve the analysis by more advanced radiological examinations such as CT and cone beam CT scans.

     

Ontological analysis of SNOMED CT

Background

SNOMED CT is the most comprehensive medical terminology. However, its use for intelligent services based on formal reasoning is questionable.

Methods

The analysis of the structure of SNOMED CT is based on the formal top-level ontology DOLCE.

Results

The analysis revealed several ontological and knowledge-engineering errors, the most important are errors in the hierarchy (mostly from an ontological point of view, but also regarding medical aspects) and the mixing of subsumption relations with other types (mostly 'part of').

Conclusion

The found errors impede formal reasoning. The paper presents a possible way to correct these problems.

     

Deficiencies in elements involved in TLR4-receptor signalling in RBL-2H3 cells

Objective

RBL-2H3 cells express Toll-like receptors, including TLR4. This study aims to assess various aspects of the TLR4 pathway.

Methods

RBL-2H3 cells were indirectly stained for cell surface TLR4, 25 CD14 and intracellular MyD88 proteins and analysed through flow cytometry for single-colour staining.

Results

While TLR4-receptors are expressed in RBL-2H3 cells, associated elements involved in the signaling pathway, CD14 and MyD88, are not.

Conclusion

Care should be taken if RBL-2H3 cells are used to study aspects of the innate immune system in mast cells.

     

The Pain of Ambivalence over Emotional Expression

Purpose

Ambivalence over emotional expression (AEE) is defined as the desire to express emotion but failing to do so. Recent studies have revealed that AEE is associated with more pain. Pain is common among cancer survivors. This cross-sectional study investigated the association between AEE and pain, its underlying mechanism, and cultural relevance among cancer survivors.

Methods

Ninety-six Chinese American breast cancer survivors completed a questionnaire package assessing AEE and pain.

Results

AEE was positively associated with pain severity and pain interference. The association between AEE and pain interference was mediated by intrusive thoughts.

Conclusion

Cancer survivors who are ambivalent over emotional expression may experience high levels of intrusive thoughts, which results in high levels of symptom reports in their pain. The study confirmed the association between AEE and pain and its underlying mechanism among a group whose culture generally encourages emotional suppression. Findings suggest interventions focusing on reducing intrusive thoughts may be effective at reducing pain.

     

Histamine intolerance: a metabolic disease?

Objective

To evaluate the evidence regarding the disease concept of histamine intolerance as a state of inadequate histamine inactivation.

Methods

Keyword-based systematic screening of the scientific literature and of public websites focusing on diagnostic and therapeutic procedures.

Results

Histamine intolerance is commonly diagnosed based solely on subjective reporting of symptoms instead of following systematic diagnostic procedures based on objective laboratory and physical parameters. The only effective long-term therapy is avoidance of histamine-containing food.

Conclusions

The concept of histamine intolerance as a metabolic disease is in need of more experimental and clinical evidence and affected patients will benefit from a clear, evidence-based diagnostic and therapeutic regime.

     

Picture perfect—how seeking perfection influences sleep and romantic relationships

Background

Studies have shown that sleep quality is negatively affected by perfectionism. Moreover, partner- or relationship-oriented perfectionism negatively influences relationship quality.

Objective

This paper aims to investigate the association of general perfectionism with sleep quality and relationship quality.

Materials and methods

A study assessing perfectionism, sleep quality, and relationship quality was performed via analyzing online questionnaires completed by 489 German adults from the general population.

Results

Participants with impaired sleep showed a higher level of maladaptive perfectionism (concern over mistakes and doubts, parental expectations, and criticism) than participants with good sleep, whereby the severity of sleep problems was not determining. Relationship quality is affected by perfectionism. However, this association is mediated by sleep quality.

Conclusion

Perfectionism is associated with worse sleep quality but not with worse relationship quality when sleep quality is integrated into the model as a mediator.

     

A Family Day program enhances knowledge about medical school culture and necessary supports

Background

A Family Day program was implemented at Indiana University School of Medicine to educate the families and friends of in-coming medical students about the rigors of medical school and the factors that contribute to stress.

Methods

Surveys that assessed knowledge, beliefs, and attitudes about medical school were administered to participants before and after the program.

Results

After the program, participants showed a significant improvement in their understanding of medical school culture and the importance of support systems for medical students. Post-test scores improved by an average of 29% (P < 0.001) in each of the two years this program was administered.

Conclusions

The inclusion of family members and other loved ones in pre-matriculation educational programs may serve to mitigate the stress associated with medical school by enhancing the students' social support systems.