Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

Pituitary - To evaluate the impact of using consistent complication-avoidance protocols in patients undergoing endoscopic pituitary adenoma surgery including techniques for avoiding anosmia,...     

Safe Zone for Superolateral Entry Pin Into the Distal Humerus in Children: An MRI Analysis

Background

The radial nerve is at risk for iatrogenic injury during placement of pins, screws, or wires around the distal humerus. Unlike adults, detailed anatomic information about the relationship of the nerve to the distal humerus is lacking in children.

Question/purposes

This study evaluates the relationship of the radial nerve to the distal humerus in a pediatric population on conventional MRI and proposes an anatomic safe zone using easily identifiable bony landmarks on an AP elbow radiograph.

Methods

To determine the course of the radial nerve at the lateral distal humerus, we reviewed 23 elbow radiographs and MRIs of 22 children (mean age, 9 ± 4 years; range, 3–12 years) obtained as part of their workup for various elbow conditions. We described a technique using distance ratios calculated as a percentage of the patient’s own transepicondylar distance, defined as the distance measured between the apices of the medial and lateral epicondyles, on the AP elbow radiograph and the midcoronal MR image. The cross-reference tool on a Picture Archiving and Communication System was then used to identify axial MR image at the level where the transepicondylar distance was measured. On this axial image, a line was drawn connecting the medial and lateral epicondyles (the transepicondylar axis) and its midpoint was determined. The radial nerve angle was measured by a line from the radial nerve to the midpoint of the transepicondylar axis and a line along the lateral half of the transepicondylar axis. On this axial slice, the closest distance from the nerve to the underlying cortex of the distal humerus was measured. To further localize the nerve along the distal humerus, predetermined percentages of the transepicondylar distance were projected proximally from the level of the transepicondylar axis along the longitudinal axis of the humerus on the midcoronal MR image. At these designated heights, the corresponding axial MR image was identified using the cross-reference tool and the nerve was mapped in a similar fashion. We then proposed a simpler method using a best-fit line drawn along the lateral supracondylar ridge on the AP radiograph to define the safe zone for lateral pin entry.

Results

On axial MR images, the radial nerve was located in the anterolateral quadrant with a mean radial nerve angle of 54° (range, 35°–87) at 0% transepicondylar distance (23 MRIs), 41° (range, 24°–63°) at 50% transepicondylar distance (23 MRIs), and ≥ 10° at 75% transepicondylar distance (on the 13 MRIs that extended this far cephalad). The mean closest distance between the radial nerve and the underlying humeral cortex was 10 mm (range, 3–26 mm) at 0% transepicondylar distance and 7 mm (3–16 mm) at 50% transepicondylar distance. On the AP elbow radiograph, the height of the lateral supracondylar ridge, determined by a best-fit line drawn along the lateral cortex of the ridge, diverged from the most proximal extent of the ridge at a point located at 60% transepicondylar distance (range, 51%–76%). At the corresponding location on the axial MR image, the nerve was located anterolaterally with a mean radial nerve angle of 39° (range, 15°–61°) and a mean distance of 6 mm (range, 2–10 mm) from the underlying humerus.

Conclusions

Our data suggest that percutaneous direct lateral entry Kirschner wires and half-pins can be safely inserted in the distal humerus in children along the transepicondylar axis, either at or slightly posterior to the lateral supracondylar ridge, when placed caudal to the point located where the lateral supracondylar ridge line diverges from the proximal extent of the supracondylar ridge on AP elbow radiograph.     

Pangolin Indexing System: implications in forensic surveillance of large seizures

International Journal of Legal Medicine - Demand for pangolin scales in East Asia has increased dramatically in the past two decades, raising concern to the pangolin survival and bringing them to...     

Primary Malignant Melanoma of Maxillary Gingiva

Malignant melanoma of maxillary gingiva is a rare clinical entity. Mucosal melanoma is more aggressive than cutaneous form and carries comparatively poorer prognosis. High index of suspicion is required for diagnosing malignant melanoma of oral cavity. Any pigmented lesion in the oral cavity should be taken seriously by the clinician.     

Targeting VPAC1 Receptors for Imaging Glioblastoma

Molecular Imaging and Biology - Scintigraphic imaging of malignant glioblastoma (MG) continues to be challenging. We hypothesized that VPAC1 cell surface receptors can be targeted for positron...     

Onychocryptosis – decrypting the controversies

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.     

淋巴细胞和Ⅲ型前胶原氨基端肽与肺气肿合并肺纤维化的关系

目的:观察肺气肿合并肺纤维化(CPFE)淋巴细胞亚型的分布和III型前胶原氨基端肽(PIIINP)水平及纤维化程度,探讨其炎症反应、免疫状态与肺纤维化(PF)的关系。方法:对2005-03/2007-03西安交通大学第一附属医院收治的21例CPFE、25例特发性肺纤维化(IPF)19例对照进行如下检测:光镜下观察肺活检标本的病理改变;对支气管肺泡灌洗液(BALF)进行炎细胞计数和分类;流式细胞术(FCM)检测BALF中T淋巴细胞亚型;放射免疫法检测BALF和血清PⅢNP水平。结果:活检病理结果发现,IPF组纤维化率高于CPFE组(P0.01),但两组纤维化率与是否吸烟均不相关(P0.05);BALF炎细胞分类结果显示CPFE组细胞总数和淋巴细胞比例均高于IPF组和对照组(P0.05,P0.01);FCM检测BALF发现CPFE组CD8+T淋巴细胞百分比高于IPF组和对照组(P0.05);CPFE组和IPF组CD4+/CD8+比值均明显低于对照组(P0.01);三组之间CD4+的百分率无统计学差异;CPFE组与IPF组血清PIIINP检测值均高于对照组(P0.01),其中CPFE组血清PIIINP检测值显著低于IPF组(P0.01)。BALF与血清PIIINP水平呈正相关(γ=0.82)。结论:CPFE的PF病变具有自身特点和发展规律,香烟烟雾刺激可能并非其直接或主要致纤维化因素;CPFE肺组织局部具有较IPF和对照明显且以CD8+T淋巴细胞增高为主的炎性反应,抗淋巴细胞炎症和免疫调节治疗可能有助于改善病情;血清PⅢNP可用作早期发现CPFE和监测PF治疗的指标。