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Surgical Pathology Clinics Jun 2009Because of the singular anatomic structure of the nipple, some breast lesions only occur at this site. The overlying skin includes normal Toker cells near the duct... (Review)
Review
Because of the singular anatomic structure of the nipple, some breast lesions only occur at this site. The overlying skin includes normal Toker cells near the duct orifices. These cells are occasionally so numerous as to be called Toker cell hyperplasia. Ductal carcinoma in situ (DCIS) may involve nipple skin by direct extension from the underlying ducts (Paget disease of the nipple). The numerous skin appendages (eg, sebaceous, apocrine, and eccrine glands(1)) in the nipple and areola are the likely origin of syringomatous adenomas. At the duct orifices, the normal squamous epithelium dips into the breast for a short distance and abruptly transitions to glandular luminal and myoepithelial cells. When keratin-producing cells extend deeper into the ducts, the condition of squamous metaplasia of lactiferous ducts (SMOLD) results. With age, the lactiferous sinuses are subject to weakened duct walls, inspissated secretions, and rupture, which result in the inflammatory masses or nipple discharge associated with duct ectasia. Superficial epithelial proliferations within the large lactiferous sinuses form nipple adenomas, and deeper proliferations often result in large-duct papillomas. Below the areola is a supporting smooth muscle layer that can give rise to leiomyomas, although these tumors are extraordinarily rare. The proximity of these lesions to the skin results in the majority of them presenting as palpable masses, skin changes, or nipple discharge. Biopsy specimens from these lesions may be small, superficial, or fragmented because of concern about maintaining the cosmetic appearance of the nipple and areola. Knowledge of the location of the biopsy, and the clinical presentation, is often essential in making the correct diagnosis.
PubMed: 26838328
DOI: 10.1016/j.path.2009.02.010 -
Surgical Endoscopy Aug 2020Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroidectomy approach using an anatomical study and to evaluate the efficacy of this approach on clinical application.
METHODS
Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler's method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy approach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroidectomy approach.
RESULTS
In phase 1, numerous inferior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the medial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001).
CONCLUSIONS
Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.
Topics: Adult; Aged; Cadaver; Cicatrix; Female; Gases; Humans; Male; Mandibular Nerve; Middle Aged; Mouth; Natural Orifice Endoscopic Surgery; Neck Dissection; Operative Time; Postoperative Complications; Prospective Studies; Thyroidectomy; Treatment Outcome
PubMed: 31531736
DOI: 10.1007/s00464-019-07117-x -
Journal of Neurosurgical Sciences Jun 2018Endoscopic endonasal access to the jugular foramen and occipital condyle - the transcondylar-transtubercular approach - is anatomically complex and requires detailed... (Review)
Review
Endoscopic endonasal access to the jugular foramen and occipital condyle - the transcondylar-transtubercular approach - is anatomically complex and requires detailed knowledge of the relative position of critical neurovascular structures, in order to avoid inadvertent injury and resultant complications. However, access to this region can be confusing as the orientation and relationships of osseous, vascular, and neural structures are very much different from traditional dorsal approaches. This review aims at providing an organizational construct for a more understandable framework in accessing the transcondylar-transtubercular window. The region can be conceptualized using a three-vector coordinate system: vector 1 represents a dorsal or ventral corridor, vector 2 represents the outer and inner circumferential anatomical limits; in an "onion-skin" fashion, key osseous, vascular, and neural landmarks are organized based on a 360-degree skull base model, and vector 3 represents the final core or target of the surgical corridor. The creation of an organized "global-positioning system" may better guide the surgeon in accessing the far-medial transcondylar-transtubercular region, and related pathologies, and help understand the surgical limits to the occipital condyle and jugular foramen - the ventral posterolateral corridor - via the endoscopic endonasal approach.
Topics: Humans; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Skull Base
PubMed: 29527888
DOI: 10.23736/S0390-5616.18.04356-4 -
American Journal of Otolaryngology 2018
Topics: Chronic Disease; Eustachian Tube; Humans; Otitis Media; Otitis Media with Effusion
PubMed: 29395282
DOI: 10.1016/j.amjoto.2018.01.012 -
Clinical Anatomy (New York, N.Y.) 2000The various studies of J.E. McNeal (1968ndash;1977) established with precision the different sites of predilection for prostatic carcinomas, benign prostatic hypertrophy... (Review)
Review
The various studies of J.E. McNeal (1968ndash;1977) established with precision the different sites of predilection for prostatic carcinomas, benign prostatic hypertrophy (BPH), and inflammation, making the division of the prostate into right, left, and middle lobes and isthmus inadequate for their description. Unfortunately, his positional terms for the sites (peripheral, central, transition, and preprostatic) are not based on the usual parameters and cannot be directly related to those of other workers. Nevertheless, the International Federation of Associations of Anatomists' Federative Committee on Anatomical Terminology has made recommendations in Terminologia Anatomica, based on his findings but modified to take some account of those of Tisell and Salander (1975 Scand J Urol Nephrol 1975 9:185-191). The use of the term lobe is confined to the right and left lobes and the variable middle lobe. The term lobule is used for the subdivisions, which are named from the anatomical position. Thus each side has a superomedial, an anteromedial, an inferoposterior, and an inferolateral lobule. Also necessary to describe a site of predilection is a peri-urethral gland zone. In ultrasound diagnosis, the trapezoid area is important: its upper limit is the rectoperinealis, its anterior limit is the intermediate part of the urethra, its lower limit is the anoperinealis, and its posterior limit is the anorectal junction. Confusion at the bladder neck is resolved by recognizing that the position of the internal urethral orifice varies with functional state of the bladder: while it is filling the orifice lies above the base of the prostate; when voiding begins, the orifice descends to the base of the prostate; between the filling internal orifice and the emptying internal orifice is the bladder neck part of the urethra.
Topics: Diagnosis, Differential; Endosonography; Humans; Male; Prostate; Prostatic Diseases; Rectum; Terminology as Topic; Urethra
PubMed: 10797629
DOI: 10.1002/(SICI)1098-2353(2000)13:3<207::AID-CA9>3.0.CO;2-9 -
British Journal of Neurosurgery Aug 2014The jugular tubercle (JT) is an important part of the craniovertebral junction. The removal of the JT in the far-lateral approach provides a significant increase in the...
BACKGROUND
The jugular tubercle (JT) is an important part of the craniovertebral junction. The removal of the JT in the far-lateral approach provides a significant increase in the operative space. The purpose of this morphometrical study was to define the anatomical variations of the JT.
METHODS
Thirty-eight dry skulls were included in this study. Seven anatomical parameters were defined and analyzed. The JT, hypoglossal canal (HC), jugular bulb, condylar fossa, occipital condyle (OC), internal jugular foramen, and condylar canal were selected as landmarks. The measurements were made separately for the right and the left sides.
RESULTS
Significant morphological variations in the JT were noted. A protuberance was apparent on the JT and classified according to its shape, size, and number. Morphological differences of protuberance of JT were described and classified into seven different types as follows: flat (Type I), sharp (Type II), circular (Type III), pin-point (Type IV), large (Type V), double (Type VI), and unclassified (Type VII). The HC was observed in all specimens. To define the relationship between the JT and the intracranial orifice of the HC, four localizations were identified. To define the relationship between the JT and the intracranial orifice of the HC.
CONCLUSIONS
Variations of the JT and the relationship of the JT to the neighboring bone and neural structures are important for modifications of the far-lateral approach. This study presents a detailed anatomical analysis of the shape, size, and orientation of the JT with a new description of protuberance of JT classified into seven types.
Topics: Cadaver; Humans; Hypoglossal Nerve; Imaging, Three-Dimensional; Neurosurgical Procedures; Occipital Bone
PubMed: 24635526
DOI: 10.3109/02688697.2014.889656 -
Seminars in Thoracic and Cardiovascular... 2013Despite a wide anatomic diversity, the complete repair of all conotruncal anomalies includes two surgical steps. 1) An intracardiac tunnel is created to connect the left... (Review)
Review
Despite a wide anatomic diversity, the complete repair of all conotruncal anomalies includes two surgical steps. 1) An intracardiac tunnel is created to connect the left ventricle to one of the arterial orifices (usually the aortic, sometimes the pulmonary), through the conoventricular ventricular septal defect. Any conal septum should be resected to create a short, large, and straight tunnel. Abnormal insertions of the atrioventricular valves (tricuspid and mitral) on the conal septum should be preserved. "Intramural" residual ventricular septal defects must be avoided by anchoring the intracardiac patch directly to the arterial annulus. 2) To connect the right ventricle to the pulmonary artery, either an intracardiac or an extracardiac reconstruction is carried out, according to the distance between the tricuspid valve and the pulmonary orifice. When extracardiac reconstruction is indicated, it is usually performed without prosthetic conduit (with or without French maneuver, eventually using the left atrial appendage). In most patients, complete repair can be performed as a primary operation during infancy.
Topics: Abnormalities, Multiple; Anastomosis, Surgical; Cardiac Surgical Procedures; Double Outlet Right Ventricle; Female; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Male; Postoperative Complications; Pulmonary Artery; Plastic Surgery Procedures; Risk Assessment; Survival Rate; Transposition of Great Vessels; Treatment Outcome; Tricuspid Valve; Ventricular Outflow Obstruction
PubMed: 23561812
DOI: 10.1053/j.pcsu.2013.02.001 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2023Measuring the important anatomic parameters related to vidian neurectomy to locate the vidian nerve accurately and prevent the surgical complications. High resolution...
Measuring the important anatomic parameters related to vidian neurectomy to locate the vidian nerve accurately and prevent the surgical complications. High resolution CT(HRCT) was used to measure the distance parameters between the important anatomic landmarks in 50 patients (100 sides) with chronic rhinosinusitis, sinus cyst or allergic rhinitis et al. The distance from the posterior opening of the palatovaginal canal to the upper edge of the sphenoidal process of palatine bone, the upper edge of the sphenoidal process of palatine bone to the external opening of the vidian canal, the external opening of the vidian canal to the greater palatine canal, and the external opening of the vidian canal to the foramen rotundus were measured. The posterior opening of the palatovaginal canal, the upper edge of the sphenoidal process of palatine bone, the external opening of the vidian canal, the greater palatine canal, and the foramen rotundum are of great value in locating vidain nerve and preventing surgical complications. The distance from the posterior opening of the palatovaginal canal to the upper edge of the sphenoidal process of palatine bone, the upper edge of the sphenoidal process of palatine bone to the external opening of the vidian canal, the external opening of the vidian canal to the greater palatine canal, and the external opening of the vidian canal to the foramen rotundus were(12.46±1.19) mm, (3.23±0.36) mm, (6.09±0.75) mm and(7.6±1.16) mm respectively. HRCT can be used as a powerful tool for preoperative localization of the external pterygoid nerve orifice and its related important anatomical landmarks, and the preoperative distance parameters obtained are valuable for intraoperative localization of the pterygoid nerve to prevent the occurrence of complications.
Topics: Humans; Sphenoid Sinus; Sphenoid Bone; Tomography, X-Ray Computed; Denervation; Geniculate Ganglion
PubMed: 36756831
DOI: 10.13201/j.issn.2096-7993.2023.02.013 -
Revista Espanola de Enfermedades... May 2023We report the endoscopic finding of a double papilla of Vater in a patient presenting choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography...
We report the endoscopic finding of a double papilla of Vater in a patient presenting choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP). The images showed the presence of two perfectly delimited papillary orifices, 1cm apart from each other. After cannulation of each orifice, we observed the Wirsung and the common bile duct (CBD) as completely independent ducts. Given the diagnostic challenge posed by this entity and the importance of differentiating it from a bilioenteric fistula, we believe it is worth knowing about it in order to manage it properly and to minimize secondary risks during the exploration.
Topics: Humans; Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Catheterization; Common Bile Duct; Choledocholithiasis
PubMed: 36148671
DOI: 10.17235/reed.2022.9184/2022 -
Zhonghua Yi Xue Za Zhi Dec 2021To analysis the anatomical features of normal vestibular nerve canal based on 10 μm otology CT. Sixty-seven patients (103 ears) underwent 10 μm otology CT...
To analysis the anatomical features of normal vestibular nerve canal based on 10 μm otology CT. Sixty-seven patients (103 ears) underwent 10 μm otology CT examinations in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from September 2020 to March 2021 were retrospectively recruited. There were 24 males and 43 females, aged from 18 to 70 (40±17) years. According to the morphology of the inferior vestibular nerve canal, it can be divided into four types as follows: uniform straight type, curved type, ampullary type and direct connection. The anatomical variables of the superior vestibular nerve canal (external orifice, isthmus and internal orifice widths, canal length, angle with labyrinthine segment of the facial nerve) and inferior vestibular nerve canal (widths of the externaland internal orifice, canal length, angles with long axis of the vestibule and the modiolus) between the different sides, genders and canal morphologies were analyzed and compared, respectively. 100% superior vestibular nerve canals and 75.7% (78/103) inferior vestibular nerve canals are clearly depicted by otology CT. The left-side ear presented with larger internal orifice diameter of the superior vestibular neve canal [(1.46±0.47) mm vs (1.31±0.41) mm], and a smaller angle between the inferior vestibular neve canal and the modiolus [(41.6±16.9)° vs (51.6±21.0)°] than the right-side ear (all <0.05, respectively), respectively. Compared to females, males demonstrated larger internal orifice of the superior vestibular nerve canal [(1.55±0.37) mm vs (1.28±0.36) mm, <0.05]. The uniform straight type of the inferior vestibular nerve canal was the most common type (62.1%, 64/103), followed by the direct connection (19.4%, 20/103), and the ampullary type was the least common type (4.9%, 5/103). There were significant differences in external diameter and angles with the long axis of the vestibule and the modiolus between the four morphologies of the superior vestibular nerve canal (all <0.05, respectively). Ten μm otology CT is capable of depicting normal vestibular nerve canal clearly. Quantitative measurement of the normal vestibular nerve canal can provide references for the imaging diagnosis and preoperative evaluation of lesions in this area.
Topics: Female; Humans; Male; Otolaryngology; Retrospective Studies; Tomography, X-Ray Computed; Vestibular Nerve; Vestibule, Labyrinth
PubMed: 34905885
DOI: 10.3760/cma.j.cn112137-20210816-01839