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Surgical Endoscopy Feb 2010Chronic pain and hernia recurrence are the most frequent long-term complications of treating inguinal hernia. One reason may be postsurgical changes in the anatomy of...
BACKGROUND
Chronic pain and hernia recurrence are the most frequent long-term complications of treating inguinal hernia. One reason may be postsurgical changes in the anatomy of the groin.
METHODS
In a retrospective investigation from 1994 to 2008, 1,194 patients undergoing 1,421 laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphies were studied. Anatomical structures in the groin, seen in 1,214 primary and 207 recurrent hernias, were charted by means of video analysis. Hernia orifices, myopectineal orifice (MPO), and Hesselbach's and Hessert's triangles were measured in their respective vertical and horizontal diameters in order to calculate the surface area. Other anatomical changes were also recorded.
RESULTS
The mean surface area of hernial orifices was 3.00 +/- 2.01 cm(2) in primary hernias and 3.60 +/- 3.81 cm(2) in recurrent hernias. The mean surface area of Hesselbach's triangle was 4.23 +/- 2.21 cm(2) in the former group and 2.09 +/- 2.10 cm(2) in the latter (p < 0.0001). The mean surface area of Hessert's triangle in primary hernias (9.03 +/- 6.17 cm(2)) was significantly larger than that in recurrent hernias (3.11 +/- 3.67 cm(2); p < 0.0001). Further anatomical changes in suture-treated recurrent hernias included a dislocated spermatic cord, a raised inguinal ligament, and asymmetry in the region.
CONCLUSION
The treatment of inguinal hernia by the suture technique is followed by significant anatomical changes such as reduction of the surface area and a subsequent increase of tension in the inguinal region. This could be one of the main reasons for chronic pain and hernia recurrence.
Topics: Abdominal Muscles; Anthropometry; Chronic Disease; Female; Groin; Hernia, Femoral; Hernia, Inguinal; Humans; Ligaments; Male; Muscle Contraction; Pain, Postoperative; Postoperative Complications; Recurrence; Reoperation; Retrospective Studies; Stress, Mechanical; Surgical Mesh; Suture Techniques; Video Recording
PubMed: 19551430
DOI: 10.1007/s00464-009-0595-z -
Pediatric and Developmental Pathology :... May 2024Ebstein anomaly (EA) is a rare congenital heart defect characterized by abnormal development of the tricuspid valve (TV) and right ventricular myocardium. This study...
Ebstein anomaly (EA) is a rare congenital heart defect characterized by abnormal development of the tricuspid valve (TV) and right ventricular myocardium. This study documents 2 dramatic cases of fetal EA characterized by hydrops and cardiomegaly, leading to intrauterine or early neonatal death. These clinical outcomes were associated with morphological abnormalities including severe tricuspid regurgitation, unguarded TV orifice, pulmonary atresia, and flattened right ventricular myocardium. This study highlights that these adverse anatomical features may result in unfavorable clinical outcomes in fetal EA. While timely identification of such features by prenatal ultrasound is crucial for providing accurate prognostic stratification and guiding treatment decisions, fetopsy may be necessary to discern EA among the spectrum of right-heart anomalies.
PubMed: 38762771
DOI: 10.1177/10935266241250235 -
BMC Oral Health Jul 2021To evaluate the root anatomy, root canal morphology and the anatomical relationship between the roots and maxillary sinus of maxillary second premolars by CBCT in a...
BACKGROUND
To evaluate the root anatomy, root canal morphology and the anatomical relationship between the roots and maxillary sinus of maxillary second premolars by CBCT in a western Chinese population.
METHODS
A total of 1118 CBCT scans of the maxillary second premolars were collected from West China Hospital of Stomatology, Sichuan University. Information below were measured on axial, coronal and sagittal sections, recorded and evaluated properly: the number of roots and canals, the morphology of canal system classified by Vertucci standard, the inter-orifice distance of canal orifices, the curvature of each canal and the distance from root tip to maxillary sinus floor.
RESULTS
Among the 1118 teeth, 94.2% (1053) are single-rooted and 55.1% (616) have one canal. Type I (55.1%) is the commonest root canal morphology followed by Type II (31.9%). The mean inter-orifice distance (IOD) for multi-canal teeth ranging from 2.72 ± 0.32 to 3.41 ± 0.11 mm. Of 1622 canals, 38.8% (630) curvature are mesiodistal and 30.9% (501) are straight canals. The distance from root tip to maxillary sinus floor increased with age and the mean distance of single-rooted ones is 2.47 ± 3.45 mm.
CONCLUSIONS
All kinds of canal morphology category can be detected in maxillary second premolars. The IOD might be a predictable factor for root canal morphology. Roots of maxillary second premolars are related to maxillary sinus which should be treated carefully.
Topics: Bicuspid; China; Cone-Beam Computed Tomography; Dental Pulp Cavity; Humans; Maxilla; Maxillary Sinus; Sinus Floor Augmentation; Spiral Cone-Beam Computed Tomography; Tooth Root
PubMed: 34284763
DOI: 10.1186/s12903-021-01714-w -
Circulation Journal : Official Journal... 2015The aim of this study was to identify anatomical variations in coronary artery orifices among high-risk patients with a small aortic root undergoing bioprosthetic aortic... (Clinical Trial)
Clinical Trial
BACKGROUND
The aim of this study was to identify anatomical variations in coronary artery orifices among high-risk patients with a small aortic root undergoing bioprosthetic aortic valve replacement (BAVR) and transcatheter aortic valve replacement (TAVR) in order to prevent coronary orifice obstruction perioperatively.
METHODS AND RESULTS
Coronary orifice and root structure were identified in 400 patients using aortic multidetector-row computed tomography (MDCT). We measured the aortic root diameter; intercommissural distances; and distance from coronary orifice to valve annulus, commissure, and sinotubular junction. We examined positional relationships between the coronary orifice and stent post, or sewing cuff of the bioprosthetic valve and leaflet of the transcatheter aortic valve. Most left coronary artery orifices were distributed near the center of the non-left and left-right commissures; right ones were relatively distributed on the non-right commissural side. Thirty-four patients (8.5%) with BAVR (coronary orifice near the commissure: 31, 7.8%; low takeoff: 5, 1.3%; and both: 2) and 39 (9.8%) with TAVR were at risk for coronary orifice obstruction. During BAVR, one-stitch rotation of the stent and one-stitch rotation with intra-annular implantation were used in near-commissure and low takeoff cases, respectively. During TAVR, percutaneous coronary intervention may be required in the height of the coronary orifice was ≤10 mm from the base of the ventricle aortic junction.
CONCLUSIONS
Potential coronary complications during BAVR and TAVR in high-risk patients for coronary obstruction were identified using preoperative aortic MDCT. Choice of appropriate surgical technique or valve is essential.
Topics: Adult; Aged; Aged, 80 and over; Aortic Valve; Bioprosthesis; Coronary Angiography; Coronary Occlusion; Coronary Vessels; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Transcatheter Aortic Valve Replacement
PubMed: 26227280
DOI: 10.1253/circj.CJ-15-0415 -
British Heart Journal Apr 1977The results are reported of a study of 83 necropsied hearts with atresia of the right atrioventricular orifice. It is emphasised that right atrial or atrioventricular...
The results are reported of a study of 83 necropsied hearts with atresia of the right atrioventricular orifice. It is emphasised that right atrial or atrioventricular orificial atresia is a better term to describe this anomaly than "tricuspid atresia". Use of the latter term can be confusing when the morphologically tricuspid valve is located beneath the left atrium. It is accepted that the definition employed may include cases in which the mitral valve may be atretic, blocking normal exit from the right atrium, but it is argued that such cases would present clinically as "tricuspid atresia" and therefore are correctly designated as right atrial orificial atresia. The results show that the majority of hearts with right atrial orificial atresia have the ventricular morphology of primitive ventricle, most with, but a few without an outlet chamber. However, in a minority of hearts an imperforate membrane interposes between the right atrium and a formed but hypoplastic right ventricle. In two of the hearts, the imperforate membrane showed features of Ebstein's malformation. The hearts could be further subdivided according to the ventriculoarterial connection. Most had normally connected arteries (66 of 83), and all but 2 also had normal relations between the arteries; in these 2 hearts there was "anatomically corrected malposition". Twelve hearts showed transposition, one had double-outlet outlet chamber, and another persistent truncus arteriosus. The remaining 3 hearts, all without outlet chamber, had by definition a double outlet connection. A segmental approach provides the best way of classifying this anomaly, and an embryological explanation is offered for the variations in anatomy observed.
Topics: Aortic Valve Stenosis; Coronary Vessel Anomalies; Coronary Vessels; Ebstein Anomaly; Heart Atria; Heart Defects, Congenital; Heart Ventricles; Humans; Pulmonary Valve Stenosis; Tricuspid Valve
PubMed: 869977
DOI: 10.1136/hrt.39.4.414 -
Journal of Clinical Neuroscience :... Jun 2021Endoscopic endonasal approach to paramedian cranial base implies sacrifice of the nasal structures.
BACKGROUND
Endoscopic endonasal approach to paramedian cranial base implies sacrifice of the nasal structures.
OBJECTIVE
The present study aimed to illustrate the anatomy and provide critical anatomical landmarks for the endoscopic prelacrimal recess approach (PLRA) to the paramedian middle cranial base.
METHODS
Anatomical dissections were performed in 10 cadaveric specimens.
RESULTS
Successful access to the paramedian middle cranial base was achieved in all dissections via the PLRA with the removal of the pterygoid process. For the dissection of the infratemporal fossa and pterygopalatine fossa, the buccal nerve and infraorbital neurovascular bundle can serve as important anatomic landmarks to identify the detailed structures. In the upper parapharyngeal space, the stylopharyngeal aponeurosis can present as anatomical barriers to protect the parapharyngeal segment of the internal carotid artery (PPICA); while the levator veli palatini muscle can be considered as a landmark to locate the PPICA. For the dissection of the Eustachian tube (ET), the isthmus of the ET and ET sulcus can serve as useful landmarks to identify the posterior genu of the ICA and horizontal segment of the petrous ICA respectively.
CONCLUSION
The PLRA to the paramedian middle cranial base is anatomically feasible and can facilitate preservation of the integrity of nasal structures. The buccal nerve, infraorbital neurovascular bundle, levator veli palatini muscle, stylopharyngeal aponeurosis, the isthmus of the ET, and ET sulcus can serve as critical anatomic landmarks in their respective region and may facilitate the application of this approach.
Topics: Cadaver; Humans; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Skull Base
PubMed: 33992193
DOI: 10.1016/j.jocn.2021.03.024 -
Journal of Cardiovascular Development... Mar 2023Quantification of chronic mitral regurgitation (MR) is essential to guide patients' clinical management and define the need and appropriate timing for mitral valve... (Review)
Review
Quantification of chronic mitral regurgitation (MR) is essential to guide patients' clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality.
PubMed: 37103029
DOI: 10.3390/jcdd10040150 -
Pacing and Clinical Electrophysiology :... Aug 1998Uniform success for ablation of focal atrial tachycardias has been difficult to achieve using standard catheter mapping and ablation techniques. In addition, our... (Review)
Review
Uniform success for ablation of focal atrial tachycardias has been difficult to achieve using standard catheter mapping and ablation techniques. In addition, our understanding of the complex relationship between atrial anatomy, electrophysiology, and surface ECG P wave morphology remains primitive. The magnetic electroanatomical mapping and display system (CARTO) offers an on-line display of electrical activation and/or signal amplitude related to the anatomical location of the recorded sites in the mapped chamber. A window of electrical interest is established based on signals timed from an electrical reference that usually represents a fixed electrogram recording from the coronary sinus or the atrial appendage. This window of electrical interest is established to include atrial activation prior to the onset of the P wave activity associated with the site of origin of a focal atrial tachycardia. Anatomical and electrical landmarks are defined with limited fluoroscopic imaging support and more detailed global chamber and more focal atrial mapping can be performed with minimal fluoroscopic guidance. A three-dimensional color map representing atrial activation or voltage amplitude at the magnetically defined anatomical sites is displayed with on-line data acquisition. This display can be manipulated to facilitate viewing from any angle. Altering the zoom control, triangle fill threshold, clipping plane, or color range can all enhance the display of a more focal area of interest. We documented the feasibility of using this single mapping catheter technique for localizing and ablating focal atrial tachycardias. In a consecutive series of 8 patients with 9 focal atrial tachycardias, the use of the single catheter CARTO mapping system was associated with ablation success in all but one patient who had a left atrial tachycardia localized to the medial aspect of the orifice of the left atrial appendage. Only low power energy delivery was used in this patient because of the unavailability of temperature monitoring in the early version of the Navistar catheter, the location of the arrhythmia, and the history of arrhythmia control with flecainide. No attempt was made to limit fluoroscopy time in our study population. Nevertheless, despite data acquisition from 120-320 anatomically distinct sites during global and more detailed focal atrial mapping, total fluoroscopy exposure was typically < 30 minutes and was as little as 12 minutes. The detailed display capabilities of the CARTO system appear to offer the potential of enhancing our understanding of atrial anatomy, atrial activation, and their relationship to surface ECG P wave morphology during focal atrial tachycardias.
Topics: Catheter Ablation; Electromagnetic Phenomena; Electrophysiology; Heart; Humans; Image Processing, Computer-Assisted; Tachycardia, Ectopic Atrial
PubMed: 9725163
DOI: 10.1111/j.1540-8159.1998.tb00252.x -
The Journal of Urology Jan 1993The paper reports the anatomy of the ureterovesical junction in pigs without urinary tract disease and the changes that occur with ageing. In comparison with other...
The paper reports the anatomy of the ureterovesical junction in pigs without urinary tract disease and the changes that occur with ageing. In comparison with other mammals the pig has a long intravesical ureter. Its length increases with age, from a mean length of 5 mm. at birth to 36 mm. at maturity. The width of the ureteric orifice also increases with age. The ureteric orifice was horseshoe shaped in 96.5% of cases, the remaining orifices were stadium shaped. The delineation of the anatomy of the porcine UVJ is important in the study of porcine and human pyelonephritis as the pig urinary tract is widely used as a human model.
Topics: Animals; Swine; Ureter; Urinary Bladder
PubMed: 8417200
DOI: 10.1016/s0022-5347(17)36027-5 -
Journal of Cardiovascular Echography 2020Double-orifice mitral valve (DOMV) is a rare congenital anomaly consisting of an accessory bridge of fibrous tissue, which divides the mitral valve (MV) into two...
Double-orifice mitral valve (DOMV) is a rare congenital anomaly consisting of an accessory bridge of fibrous tissue, which divides the mitral valve (MV) into two orifices. The mitral leaflets are essentially normal in most cases, but they can be regurgitant or stenotic. It is most commonly associated with a variety of other cardiac anomalies. Isolated DOMV with normal MV function is very rare. We present here a rare case of congenital DOMV in a 25-year-old female diagnosed by real-time three-dimensional echocardiography (RT3DE). RT3DE enabled complete anatomical and functional assessment of MV apparatus. It added much valuable information over conventional 2DE that helped in establishment of the diagnosis, identification of the anatomical type, and selection of the proper management.
PubMed: 33828944
DOI: 10.4103/jcecho.jcecho_51_19