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The article provides a review on the diagnosis and management of instability and degenerative arthritis of the sternoclavicular joint. A database search from PubMed search engine using terms like sternoclavicular instability and arthritis was done in August 2012. A figure-of-8 graft reconstruction is suggested as method based on biomechanical data and clinical series. Indications for surgical management include failed closed reduction or chronic recurrence of posterior dislocations.

Objectives: Mandibular tori have been identified as a contributing factor in difficult exposure during intubation. However, no investigation has measured the effect of mandibular tori on glottic exposure during suspension microlaryngoscopy (SML). The objective of this study was to measure how the size and location of mandibular tori affect glottic exposure during simulated SML at different thyromental distances. Methods: Suspension microlaryngoscopy was modeled on an anatomically accurate skull and larynx with thyromental distances between 6 and 12 cm. Mandibular tori were simulated by protruding screws 5 to 15 mm from the lingual aspect of the mandible. The tori were positioned either 15 mm (anterior) or 25 mm (posterior) from the midline of the symphysis. The glottic exposure for the various-size tori in each location was measured by recording the displacement of the glottiscope tip relative to the most anterior exposure achievable without tori. The glottiscope angle relative to the horizontal plane was measured for each condition. Results: Mandibular tori of more than 10 mm had a significant impact on glottic exposure. Displacement of the glottiscope tip ranged from 2 to 9 mm for anteriorly placed tori and from 7 to 29 mm for posteriorly placed tori, with larger tori causing greater displacement. Increasing the thyromental distance increased the posterior glottiscope tip displacement regardless of torus size or location. The glottiscope angle increased with larger tori (12° to 28°), but this angle did not change with increasing thyromental distance. Conclusions: Larger size and more-posterior location of mandibular tori more significantly reduce glottic exposure during SML. The inner table of the mandible is the most relevant anatomic constraint on glottic exposure, which varies with the presence or absence of mandibular tori independent of thyromental distance. [ABSTRACT FROM AUTHOR]

The alimentary system may be thought of as an open-ended tube within a tube that begins at the oral cavity and ends at the anus. Gastrointestinal lumens are potential spaces that accommodate ingested substances and are lined by polarized epithelium that is smooth and shiny (with the exception of the rumen) when healthy and intact. Because xenobiotics most frequently enter the body via ingestion, the gastrointestinal system and its ancillary glands are the first line of defense against foreign materials and pathogens of all types. The anatomic, biochemical, physical, secretory, and endocrinologic properties of the epithelium, resident, and blood-borne effector cells, microbiota, genetic polymorphisms, and gut-associated lymphoid tissue (which comprises one-quarter of the body’s total) must be physically or functionally altered for diarrhea to occur. The average person ingests 700 tons of antigens in their lifetime. That enteritis does not occur more often than it does is testimony to the efficacy of gastrointestinal protective systems. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates the incidence of roof impingement by the native anterior cruciate ligament (ACL) in hyperextensible knees. The study examines the risk of roof impingement by anatomic placement of the ACL graft in hyperextensible knees. It urges surgeons to consider roof impingement after anatomic double-bundle ACLreconstruction in patients with a hyperextensible knee.

The article presents a study that determines the primary biomechanical function of the isolated posteromedial bundle, anterolateral bundle, and the intact posterior cruciate ligament (PCL) between 0° and 120°of knee flexion. The study explores the role of PCL's functional bundles through the full range of knee flexion. It suggests a codominant relationship between the two bundles based on their ability to resist posterior tibial translation.

Osteoarthritis of the acromioclavicular (AC) joint is a common condition causing anterior or superior shoulder pain, especially with overhead and cross-body activities. This most commonly occurs in middle-aged individuals because of degeneration to the fibrocartilaginous disk that cushions the articulations. Diagnosis relies on history, physical examination, imaging, and diagnostic local anesthetic injection. Diagnosis can be challenging given the lack of specificity with positive physical examination findings and the variable nature of AC joint pain. Of note, symptomatic AC osteoarthritis must be differentiated from instability and subtle instability, which may have similar symptoms. Although plain radiographs can reveal degeneration, diagnosis cannot be based on this alone because similar radiographic findings can be seen in asymptomatic individuals. Nonoperative therapy can provide symptomatic relief, whereas patients with persistent symptoms can be considered for resection arthroplasty by open or arthroscopic technique. Both techniques have proven to provide predictable pain relief; however, each has its own unique set of potential complications that may be minimized with an improved understanding of the anatomical and biomechanical characteristics of the joint along with meticulous surgical technique. [ABSTRACT FROM PUBLISHER]

Background: Morphological alterations of the hip joint are important contributors to the development of osteoarthritis. Whileplane-specific variations in the shape of the proximal femur have been described, there are no defined reference standardsfor measurements in adolescent patients.Purpose: To evaluate hips in asymptomatic adolescent patients using radially reformatted multidetector computed tomography(MDCT) to define the morphological characteristics of the femoral head-neck (FHN) junction with respect to patient sex and physealstatus, and to establish reference values for a angle, FHN offset, and epiphyseal extension (EE).Study Design: Cross-sectional study; Level of evidence, 3.Methods: A total of 132 pelvic MDCT scans in adolescent patients with abdominal pain were reformatted into radially orientedplanes along the femoral necks. The diameter of the femoral head, a angle, EE, and FHN offset were measured. Reference valuesfor a angle, EE, and FHN offset were determined, and the α angle, EE, and FHN offset were compared between open versusclosed physeal status for each sex.Results: The α angle measurements in male patients were higher than in female patients in anterior (A), anterosuperior (AS), andsuperior (S) planes (P < .001). The median α angle was highest for all patients in the AS plane (male, 52°; female, 49°). Openphyses correlated with higher α angles compared with closed physes in all imaging planes except the AS plane. The FHN offsetwas lowest in the AS plane for all patients and was increased in female patients with closed physes compared with open physesin the A plane and in the A, S, posterosuperior, and posterior planes in male patients (P<.05). There were subtle plane-specificvariations in EE.Conclusion: The a angle is higher and FHN offset is lower in the AS plane in patients with closed versus open physes, whereasthe opposite is true in all other planes. The a angles in male patients were higher than in female patients, although there were nosignificant sex-based differences in the FHN offset. The a angles were highest and FHN offset was lowest in the AS plane. Therewere subtle variations in EE across all planes, and the EE was higher in patients with closed versus open physes.Clinical Relevance: Plane- and sex-specific reference values for a angle, FHN offset, and EE in asymptomatic adolescent patientswill assist orthopaedic surgeons and radiologists in appropriately suggesting femoroacetabular impingement based onthe imaging evaluation of patients with hip pain, whose measurements lie at the periphery of or outside the reference intervalsin the appropriate clinical context. [ABSTRACT FROM AUTHOR]

Background: There has been no study using magnetic resonance arthrography (MRA) to compare clinical features and structuralintegrity after arthroscopic repair of bursal and articular side partial-thickness rotator cuff tears (PTRCTs).Hypothesis: The 2 groups studied, which consisted of patients who underwent arthroscopic repair for either the articular side orthe bursal side, would show significant improvement in overall outcomes after surgery, even though clinical outcomes and structuralintegrity would not be significantly different. It was thought that the incidence of preoperative positive impingement signs andprotruded spurs on the acromion undersurface would be higher in patients with a bursal side tear.Study Design: Case-control study; Level of evidence, 3.Methods: The current study consisted of 83 patients who underwent arthroscopic repair for either articular side (group A; n = 29)or bursal side (group B; n = 54) PTRCT and who were available at the 2-year follow-up. Clinical outcomes were compared by useof the Neer impingement sign, visual analog scale for pain, Simple Shoulder Test, University of California Los Angeles score, andAmerican Shoulder and Elbow Surgeons score. At 6 months after surgery, MRA was used to assess structural integrity.Results: At 2-year follow-up, both groups showed significant improvement in pain and shoulder function scores, even thoughthere was no significant difference between groups. The retear rate on follow-up MRA was not significantly different betweengroup A (8%) and B (11%). Patients in group B, compared with group A, showed a higher incidence of the preoperative impingementsign (89% vs 52%, respectively; P = .004), protruded spur on the acromion undersurface (69% vs 0%, respectively; P<.001), and concomitant acromioplasty (93% vs 24%, respectively; P<.001).Conclusion: Both articular and bursal side PTRCTs showed significant functional improvements after arthroscopic repair. Thebursal side tears had a higher incidence of impingement sign at preoperative examination and more often had a protrudedspur on the acromion undersurface. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional study which was carried out to use quantitative magnetic resonance imaging (MRI) to examine the patellar cartilage in patients with patellofemoral pain. It mentions that 20 patients in the age group of 18 to 45 years with anterior knee pain and no evidence of osteoarthrities were employed for the study. It concludes that lateral facets of patients with patellofemoral pain (PFP) and patellar tilt were not seen in control patients.

The article focuses on a controlled study conducted to understand the impact of bioenhanced anterior constructive ligament (ACL) repair by a bioactive scaffold. The study was conducted on 64 pigs. The results showed that structural properties of tendons after bioenhanced ACL repair were not significantly different from those in bioenhanced ACL reconstruction or conventional ACL but significantly better then untreated ACL transection. The posttraumatic osteoarthritis was also reduced.

The article discusses a cartilage status in relation to return to sports after anterior cruciate ligament (ACL) reconstruction. The article provides various results and high impacts on the qualitatively diminished cartilage that might play a role in the development of osteoarthritis in ACL reconstruction was concluded. The article concludes that high impacts on this qualitatively diminished cartilage might play a role in the development of osteo-arthritis in ACL reconstruction.

The article discusses Magnetic resonance imaging (MRI) which is a noninvasive technology that can quantitatively assess anterior cruciate ligament (ACL) graft size and signal intensity. The study provides various hypothesis and discusses method. It gives various results and volume and grayscale values from high-resolution T2 weighted MRI scans are predictive of structural properties of the healing ligament or graft in a porcine was concluded.

The article discusses the correlation of tibial footprint of the anterior cruciate ligament (ACL) with the intercondylar roof in anatomic ACL reconstructions. It states that there is no statistical relationship between the intercondylar roof angle and the location of the native footprint of the ACL on the tibia. It also discusses various methods and gives relationship of ACL Footprint and Intercondylar Roof Angle.

Renal tubulointerstitium plays an important role in the development and progression of diabetic nephropathy. The aim of this study was to assess serum cystatin C and 2 renal tubular enzymes, neutrophil gelatinase associated lipocalin (NGAL) and N-acetyl-beta-D-glucosaminidase (NAG), as screening markers for early renal dysfunction in patients with type 2 diabetes mellitus (T2DM). ROC curve analysis showed that urinary NAG is the most sensitive marker of microalbuminuria and early renal damage with sensitivity of 83.3%, while serum cystatin C was the most sensitive and specific marker of macroalbuminuria and damage progress with sensitivity of 70.8% and specificity of 83.3% versus 70.6% and 83.3% for uNGAL; and 64.7% and 66.7% for NAG, respectively. Our data indi­cate that urinary NAG is the most sensitive marker for early renal damage in diabetic patients. However, for damage progress, serum cystatin C is the most sensitive and specific marker for follow-up and monitoring renal dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: The functional motor innervation of the larynx is not fully understood because of the complexity of the peripheral neuroanatomy. Since the late 19th century, there has been controversy regarding the role of the superior laryngeal nerve, which may have wider motor projections than are currently acknowledged. The aim of this study was to develop a large animal model to characterize and quantify the functional motor input to the intrinsic laryngeal muscles. Methods: We performed invasive electrophysiology (evoked electromyography) in normal pigs. Results: The thyroarytenoid, lateral cricoarytenoid, and posterior cricoarytenoid muscles receive dual innervation from both the superior and recurrent laryngeal nerves, whereas the cricothyroid muscle is innervated only by the superior laryngeal nerve. Conclusions: The dual innervation pattern from both laryngeal nerves supports the concept of a laryngeal nerve plexus. The motor input through the external branch of the superior laryngeal nerve was surprisingly high. The animal model presented here may be used in future investigations of laryngeal reinnervation following nerve injury. [ABSTRACT FROM AUTHOR]

Background: Currently, osteochondral allografts (OCA) are typically used after 4°C storage for prolonged durations (15-43 days), which compromises chondrocyte viability, especially at the articular surface. The long-term in vivo performance of these fresh-stored allografts, in association with variable cellularity, is unknown. Purpose: To determine the effect of 4°C storage duration (14, 28 days) versus the best (fresh) and worst (frozen) conditions of chondrocyte viability on structure, composition, and function of cartilage in the goat and the association of retrieved chondrocyte cellularity with those tissue properties. Study Design: Controlled laboratory study. Methods: The effect of allograft storage on in vivo repair outcomes was determined for OCA transplanted into 15 recipient goats and analyzed at 12 months. Repair outcomes were assessed by examining cartilage structure (gross, histopathology), composition (cellularity by depth, matrix fixed charge), and biomechanical function (stiffness). Relationships between cellularity and structural scores, matrix fixed charge, and stiffness were assessed by linear regression. Results: Repair outcomes in 4°C-stored OCA were similar after 14 and 28 days of storage, and both were inferior to fresh OCA and were accompanied by diminished cellularity at the surface, matrix fixed charge, and histopathological structure. Overall, cellularity by depth and matrix fixed charge in cartilage of fresh OCA were similar to nonoperated controls. However, cellularity at the articular surface and matrix fixed charge in 4°C-stored OCA were lower than fresh, by ~55% (95% confidence interval [CI], 32%-76%) and ~20% (CI, 9%-30%), respectively. In frozen OCA, cellularity and matrix fixed charge were lower than 4°C-stored OCA, by ~93% (CI, 88%-99%) and ~22% (CI, 10%-35%), respectively. Cellularity correlated negatively with cartilage health indices, including structural scores, and positively with matrix fixed charge and stiffness. Conclusion: Reduced cellularity at the articular surface, resulting from 4°C storage, was associated with variable long-term outcomes versus consistently good repair by fresh allografts. Cellularity at the articular surface was an important index of biological performance. Clinical Relevance: Normal chondrocyte density in vivo, especially in the superficial region of cartilage, is important for maintaining long-term cartilage function and matrix content. In human cartilage, containing cells at ~3 to 5 times lower density than goat, repair outcomes may be related to absolute minimum number of cells rather than density. [ABSTRACT FROM AUTHOR]

Objective: To compare the gene expression profiles of the aorta specimens between patients with Stanford type B aortic dissection (AD) and controls. Materials and Methods: Samples of descending aorta were collected from patients with type B AD (n = 12) and from multiorgan donors as controls (n = 12). Phalanx whole genome microarray was used to analyze differential gene expression. Results: Of the 6375 probes validated, 623 genes were found to be differentially expressed between patients with type B AD and controls (fold change ≥2). Gene ontology analysis identified significantly enriched gene groups pertaining to cell–cell adhesion, extracellular matrix, cell–matrix adhesion, cytoskeleton, immune and inflammatory response, and apoptosis. Conclusion: Genes encoding components related to integrity and strength of the aortic wall were downregulated, whereas those related to inflammatory response were upregulated in type B AD. The altered patterns of gene expression indicate preexisting structural defects that are probably a consequence of insufficient remodeling of the aortic wall. [ABSTRACT FROM PUBLISHER]

The proximal boundary of the flexor retinaculum is not readily demarcated, and previous reports of three distinct regions of the flexor retinaculum were not consistent with the authors’ experience. This study was undertaken to clarify the proximal boundary and the constituent parts of the flexor retinaculum. A total of 56 cadaveric wrists were used in the study. The proximal boundary of the flexor retinaculum was identified by a change in thickness and colour of the longitudinally sectioned surface of the continuous membranous sheet of the flexor retinaculum and antebrachial fascia. Steel wires were placed on the proximal and distal boundaries, and anteroposterior radiographic images were taken. MRI was carried out before dissection or serial section. The locations of the proximal and distal boundaries of the flexor retinaculum varied. The flexor retinaculum was comprised of two parts, which were distinguishable by thickness and transparency. These two parts were also identified on MR images and by light microscopy. [ABSTRACT FROM PUBLISHER]

The optimal treatment of posterior cruciate ligament ruptures remains controversial despite numerous recent basic science advances on the topic. The current literature on the anatomy, biomechanics, and clinical outcomes of posterior cruciate ligament reconstruction is reviewed. Recent studies have quantified the anatomic location and biomechanical contribution of each of the 2 posterior cruciate ligament bundles on tunnel placement and knee kinematics during reconstruction. Additional laboratory and cadaveric studies have suggested double-bundle reconstructions of the posterior cruciate ligament may better restore normal knee kinematics than single-bundle reconstructions although clinical outcomes have not revealed such a difference. Tibial inlay posterior cruciate ligament reconstructions (either open or arthroscopic) are preferred by many authors to avoid the “killer turn” and graft laxity with cyclic loading. Posterior cruciate ligament reconstruction improves subjective patient outcomes and return to sport although stability and knee kinematics may not return to normal. [ABSTRACT FROM PUBLISHER]

Objectives: Burow's solution, comprising aluminum sulfate and acetic acid, is an otic drug formulation applied to the tympanic cavity. We characterized the relationship between the auditory brain stem response (ABR) thresholds and the area of the capillary basement membrane anionic sites in the stria vascularis after the application of Burow's solution. Methods: We used cationic polyethylenimine (PEI) to observe changes in the capillary basement membrane anionic sites in the stria vascularis. Burow's solution was dropped directly onto the round window membrane and retained for 2 hours. The ABRs were recorded at 4, 8, and 20 kHz immediately before surgery and before decapitation. The cochlea was extirpated immediately or 2 days after the surgery and immersed in cationic PEI solution. The PEI distribution associated with the capillary basement membrane anionic sites was measured in the basal and third turns. Results: The ABR threshold shifts at 4, 8, and 20 kHz were significantly increased immediately after the surgery, whereas those at 4 and 8 kHz, but not at 20 kHz, had recovered 2 days after the surgery. Further, the PEI distribution was significantly decreased immediately after the surgery and had recovered 2 days after the surgery. Conclusions: Although Burow's solution may cause an acetic low pH in the stria vascularis and a temporary ABR threshold shift at 4 and 8 kHz, the permanent ABR threshold shift at 20 kHz cannot be attributed to the acetic low pH. [ABSTRACT FROM AUTHOR]

A review of the literature regarding the current state of knowledge of the anatomic and physiologic features of the female clitoris was conducted. Based on this evaluation, operations on the clitoris were reviewed. The anatomic and physiologic reconstruction problems of surgical techniques for female pseudohermaphroditism that have previously been reported were reviewed. The author suggests that clitoroplasty is essential for patients with ambiguous genitalia, but the decision regarding the correct procedure, taking into account anatomic and physiologic success, can be controversial. This may be because of unclear anatomic and physiologic definitions, even for healthy people. As a temporary solution, more conservative procedures for maximally effective treatment are suggested. [ABSTRACT FROM PUBLISHER]

Objectives: We sought to elucidate the 3-dimensional position and quantify the lower motor neurons (LMNs) of the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) in a rat model. Quantification and mapping of these neurons will enhance the usefulness of the rat model in the study of reinnervation following trauma to these nerves. Methods: Female Sprague-Dawley rats underwent microsurgical transection of the RLN, the SLN, or both the RLN and SLN or sham surgery. After transection, either Fluoro-Ruby (FR) or Fluoro-Gold (FG) was applied to the proximal nerve stumps. The brain stems were harvested, sectioned, and examined for fluorolabeling. The LMNs were quantified, and their 3-dimensional position within the nucleus ambiguus was mapped. Results: Labeling of the RLN was consistent regardless of the labeling agent used. A mean of 243 LMNs was documented for the RLN. The SLN labeling with FR was consistent and showed a mean of 117 LMNs; however, FG proved to be highly variable in labeling the SLN. The SLN LMNs lie rostral and ventral to those of the RLN. In the sham surgical condition, FG was noted to contaminate adjacent tissues -- in particular, in the region of the SLN. Conclusions: Fluorolabeling is an effective tool to locate and quantify the LMNs of the RLN and SLN. The LMN positions and counts were consistent when FR was used in labeling of either the RLN or the SLN. Fluoro-Gold, however, because of its tendency to contaminate surrounding structures, can only be used to label the RLN. Also, as previously reported, the SLN LMNs lie rostral and ventral to those of the RLN. This information results in further clarification of a rat model of RLN injury that may be used to investigate the effects of neurotrophic factors on RLN reinnervation. [ABSTRACT FROM AUTHOR]

Abnormal platelet function may complicate the assessment and treatment of continuing blood loss, hypotension, and coagulation disorders during adult donor care. Antiplatelet drugs, such as aspirin, nonsteroidal anti-inflammatory drugs, clopidogrel (Plavix), ticlopidine (Ticlid), prasugrel (Effient), abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat) are commonly prescribed for older patients. These medications may be part of home therapy or may be given during acute cardiac or cerebrovascular crises that may lead to brain death and organ donation. This discussion reviews normal platelet formation and function, drug actions, methods to evaluate medication effects, pharmacological characteristics, treatment recommendations for platelet transfusion, and risks attendant with those infusions. [ABSTRACT FROM AUTHOR]

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of otitis media with effusion approaches 100% in infants with cleft palate (CP), and disease pathogenesis is believed to be caused by eustachian tube (ET) dysfunction. Objectives: Quantify the functional consequences of ET anatomy in infant CP specimens, and identify the relative importance of various tissue biomechanical properties on ET function in infants with CP. Methods: Finite element models of ET anatomy and physiology were developed by using image analysis and three-dimensional (3D) reconstruction techniques. Models were developed using histological images of ET structures obtained from five infant CP specimens. The models were parameterized, and the effects of varying model parameters, which included tensor veli palatini and levator veli palatini force, ET cartilage, periluminal mucosal compliance, and hamular position on resistance to airflow through the tubal lumen, were determined. Results: Of the evaluated parameters, only applied tensor veli palatini muscle force and compliance of the periluminal mucosa and cartilage tissues were significant predictors of resistance to airflow through the ET during muscle-assisted opening. Conclusions: Finite element models of ET function in the CP infant identified tensor veli palatini muscle force as a direct predictor and mucosal/cartilage compliance as an indirect predictor of ET opening during muscle-assisted lumen dilations. Hamular position and levator veli palatini force were not found to have an effect on ET function in CP infants. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the bulging and dehiscence of neurovascular structures in the sphenoid sinus and their relationships to the pneumatization of the sphenoid sinus. Methods: One hundred sagittally hemisected cadaveric heads were examined. The degree of pneumatization of the sphenoid sinus was determined. Bulging and dehiscence of the internal carotid artery (ICA), optic nerve, maxillary nerve, and vidian nerve were examined, and the distances between these structures and the anterior or superior wall of the sphenoid sinus were measured. Additionally, the degree of bony thickness over these structures was determined. Results: The prevalences of bulging of the optic nerve, segments 1 and 3 of the ICA, and the maxillary and vidian nerves were 56%, 34%, 65%, 41%, and 52%, respectively. The greater the degree of pneumatization. the more frequently did the structures bulge into the sphenoid sinus. The optic nerve was found to be in close proximity to the anterior and superior walls of the sphenoid sinus. The bone over the surrounding structures was very thin, especially for the complete sellar type. Conclusions: The prevalence of bulging of the optic nerve, the ICA, and the maxillary and vidian nerves increased in proportion to the degree of sphenoid sinus pneumatization. [ABSTRACT FROM AUTHOR]

Mediastinoscopy has been widely used by thoracic surgeons to evaluate the superior mediastinum since 1959. Large series of mediastinoscopy have been reported with very low morbidity and no mortality. Proper attention to surgical techniques and mediastinal anatomy are essential to maintain the safety of the procedure. Situs inversus totalis is exceedingly rare, but variations in mediastinal anatomy in this group of patients can render the procedure challenging for the thoracic surgeon. A case of mediastinoscopy in a situs inversus patient is presented with emphasis on anatomical variations of the mediastinum and technical pitfalls of the procedure in this rare group. [ABSTRACT FROM AUTHOR]

Background: Current surgical treatments for acromioclavicular separations do not re-create the anatomy of the acromioclavicular joint. Hypothesis: Anatomical acromioclavicular reconstruction re-creates the strength of the native acromioclavicular joint and is stronger than a modified Weaver-Dunn repair. Study Design: Controlled laboratory study. Methods: The native acromioclavicular joint in 6 fresh-frozen cadaveric upper extremities was stressed to failure under uniaxial tension in the coronal plane. A modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis graft were then performed sequentially. Each repair was stressed to failure. Load-displacement curves and mechanism of failure were recorded for each. Results: Loads at failure for the native acromioclavicular joint complex, modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus tendon graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft were 815 N, 483 N, 326 N, and 774 N, respectively. The strength of the native acromioclavicular joint complex was significantly different from the modified Weaver-Dunn repair (P < .001) and the anatomical acromioclavicular reconstruction using a palmaris longus tendon graft (P < .001) but not from the anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft (P = .607). Conclusion: The strength of the described anatomical acromioclavicular reconstruction is limited by the tendon graft used. Anatomical acromioclavicular reconstruction with a flexor carpi radialis tendon graft re-creates the tensile strength of the native acromioclavicular joint complex and is superior to a modified Weaver-Dunn repair. [ABSTRACT FROM AUTHOR]

The acromioclavicular joint is involved in four out of ten shoulder injuries. The joint is prone to injury due to its anatomy and relative lack of soft tissue cover. Sportsmen involved in contact sports are likely to suffer damage to the joint during their professional careers. Most subluxations of the joint can be treated nonoperatively whilst dislocations are generally treated operatively except in those individuals at significant risk of re-injury, for example, rugby players. This article looks at the anatomy and physiology of the acromioclavicular joint, injury classification and presents the current evidence regarding treatment options for these injuries. [ABSTRACT FROM AUTHOR]

Background: Variations in ankle mortise anatomy may be a predisposing factor to ankle instability. Hypothesis: A posteriorly positioned fibula associated with ankle instability may not be a true pathologic entity but rather the result of measuring off an internally rotated talus. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The authors reviewed 60 ankle computed tomography scans performed on patients from their institution for reasons unrelated to ankle instability. They also reviewed ankle computed tomography scans on 21 patients surgically treated for clini- cal ankle instability. The position of the fibula in relation to the talar articular surface was calculated and expressed as the axial malleolar index, as described by Scranton et al. They also calculated the intermalleolar index, a new method that references the medial malleolus, not the talus. Results: Using the method of Scranton et al, the axial malleolar index in the control and instability patients was similar to val- ues previously described, and there was a significant difference between control and instability patients (Pc .01). However, using the intermalleolar index method referencing the medial malleolus, there was not a significant difference between control and instability patients (P = .43). Conclusion: The new method of referencing the medial malleolus assesses fibular position independent of talar rotation. The data, when referencing the medial malleolus, do not show significant variation in fibular position in patients with and without ankle instability. [ABSTRACT FROM AUTHOR]

The advent of shoulder arthroscopy, as well as our improved understanding of shoulder anatomy and biomechanics, has led to the identification of previously undiagnosed lesions involving the superior labrum and biceps tendon anchor. Although the history and physical examination, as well as improved imaging modalities such as magnetic resonance arthrography, are extremely important in understanding the abnormalities, the definitive diagnosis of superior labrum, anterior and posterior lesions is best made through diagnostic arthroscopy. Treatment of these lesions is directed according to its type. In general, type I and III lesions are debrided, whereas type II and many type IV lesions are repaired. The purpose of this article is to review the anatomy, biomechanics, classification, diagnosis, and current treatment recommendations for these lesions, as well as to review the literature. [ABSTRACT FROM AUTHOR]

This report presents detailed information on age- and gender-related differences in the anatomical and physiological characteristics of reference individuals. These reference values provide needed input to prospective dosimetry calculations for radiation protection purposes for both workers and members of the general public.The purpose of this report is to consolidate and unify in one publication, important new information on reference anatomical and physiological values that has become available since Publication 23 was published by the ICRP in 1975. There are two aspects of this work. The first is to revise and extend the information in Publication 23 as appropriate. The second is to provide additional information on individual variation among grossly normal individuals resulting from differences in age, gender, race, or other factors.This publication collects, unifies, and expands the updated ICRP reference values for the purpose of providing a comprehensive and consistent set of age- and gender-specific reference values for anatomical and physiological features of the human body pertinent to radiation dosimetry. The reference values given in this report are based on: (a) anatomical and physiological information not published before by the ICRP; (b) recent ICRP publications containing reference value information; and (c) information in Publication 23 that is still considered valid and appropriate for radiation protection purposes.Moving from the past emphasis on ‘Reference Man’, the new report presents a series of reference values for both male and female subjects of six different ages: newborn, 1 year, 5 years, 10 years, 15 years, and adult. In selecting reference values, the Commission has used data on Western Europeans and North Americans because these populations have been well studied with respect to antomy, body composition, and physiology. When appropriate, comparisons are made between the chosen reference values and data from several Asian populations.The first section of the report provides summary tables of all the anatomical and physiological parameters given as reference values in this publication. These results give a comprehensive view of reference values for an individual as influenced by age and gender.The second section describes characteristics of dosimetric importance for the embryo and fetus. Information is provided on the development of the total body and the timing of appearance and development of the various organ systems. Reference values are provided on the mass of the total body and selected organs and tissues, as well as a number of physiological parameters.The third section deals with reference values of important anatomical and physiological characteristics of reference individuals from birth to adulthood. This section begins with details on the growth and composition of the total body in males and females. It then describes and quantifies anatomical and physiological characteristics of various organ systems and changes in these characteristics during growth, maturity, and pregnancy. Reference values are specified for characteristics of dosimetric importance.The final section gives a brief summary of the elemental composition of individuals. Focusing on the elements of dosimetric importance, information is presented on the body content of 13 elements: calcium, carbon, chloride, hydrogen, iodine, iron, magnesium, nitrogen, oxygen, potassium, sodium, sulphur, and phosphorus. [Copyright &y& Elsevier]

An understanding of form and function is important for examination of the male reproductive tract. A basic understanding of spermatogenesis and hormonal function in the reproductive tract is essential for the pathologists in this evaluation. Gross and histologic reproductive changes need to be distinguished from normal variation and correlated with the reproductive status of the animal. This is especially important when correlating histologic changes with organ weight and other reproductive parameters, such as seminal analysis data. Sexual maturity of animals and tissue handing can impact interpretation. Sexual immaturity of preclinical safety animals can present challenges for accurate identification of compound-related changes. Likewise, proper handling of unfixed reproductive tissues and appropriate selection of a fixation protocol are important in avoiding artifacts that may interfere with the microscopic evaluation. The histopathology technician needs to recognize testicular landmarks that allow for correct orientation at trimming so the pathologist can assess not only the morphology of seminiferous tubules but also the outflow tract. For the most effective evaluation of the male reproductive tract, the testes and epididymides should be examined concurrently. Although the term "staging" is often used inappropriately, the pathologist should review testicular tissues in a "stage-aware" manner. This article reviews gross and histologic changes of the male reproductive tract as well as tissue orientation and fixation to assist in accurate interpretation of potential treatment-related changes in male reproduction. [ABSTRACT FROM AUTHOR]

This study of the masticatory muscles of the primate showed that the temporal muscle contained 107 muscle spindles, 45 in the horizontal portion and 62 in the vertical portion; the masseter muscle contained 70, 58 in the profundus portion and 12 in the superficial portion; the medial pterygoid muscle contained 15; the lateral pterygoid muscle contained 6; and the zygomaticomandibular muscle contained 9. The muscle spindles were located around the coronoid process and mandibular ramus. [ABSTRACT FROM AUTHOR]

It is known that a high concentration of iron is deposited in the enameloid of some teleostean fish. Previously, Suga et al. (1989) pointed out that the iron concentration in the enameloid is related to the phylogeny of fish rather than to the feeding habits, according to the results of quantitative iron analyses on the teeth of marine teleost fish of the Tetraodontiformes. In the present study, in order for the previous idea to be verified, quantitative iron analysis was made with an electron microprobe on the enameloid of fish belonging to the Perciformes, which is the largest group of teleostean fish in the world and consists of both marine and freshwater species. The enameloid of all the fish examined (57 species) contained high iron concentrations ranging from 0.2% to 10.2% at the surface or middle layer, whereas that of an advanced suborder, Tetraodontoidei, of the Tetraodontiformes was very low in iron, at a level which could not be discriminated from the background value of the emission intensity. The distribution pattern of iron in the enameloid was classified into at least two types, namely, type A, in which a high iron concentration was observed mainly in the surface layer, and type B, in which iron was deposited throughout the entire layer, although there were differences in concentration. There were some differences in the concentration and distribution of iron in the enameloid for the families; for example, those of the Scaridae had a type A distribution, with about 0.2% iron only at the surface layer, whereas those of the Cichlidae, Centrarchidae, and Acanthuridae, which showed a type B distribution, contained iron ranging from 2.9% to 10.5% at the surface or middle layer of enameloid. Such differences seemed to be associated with the difference in timing of the commencement of the iron deposition into the developing enameloid, which is probably related to the phylogeny of fish. There was no evidence to support the idea that the iron concentration in the enameloid is associated with the feeding habits of fish, as proposed by previous investigators. [ABSTRACT FROM AUTHOR]

The article focuses on the historical background of orthopedics. The author provides overviews of early writings concerning orthopedics. It also offers information about the works and contributions of several philosophers in the field of both anatomy and physiology. They have also mentioned some evidences of the management of bony injuries.

The healing of a tendon wound is accompanied by a vascular reaction consisting of formation and later transformation of new vessels in the peritendinous tissue. The vascular anatomy is restored to normal in about 8 weeks. The vascular system of the tendon itself plays only u minor role in the healing, but it is affected by the method of suture used. In autologous tendon transplantation, the original vascular system of the graft survives the operation and is not subjected to any changes during the healing process. In homologous tendon transplantation, the original vascular system of the graft survives the operation until the 14th postoperative day. Then a rejection of the grafts vessels takes place. Revaseularization of the graft is brought about by ingrowth of newly formed vessels from the peritendinous tissue. The vascular anatomy is restored to normal in 12 weeks. [ABSTRACT FROM AUTHOR]

A case of complete interruption of the aortic arch is reported. Early recognition of this potentially curable lesion is necessary. Selective left atrial cardioangiography appears to be the technique of choice in diagnosing the defect and precisely defining the anatomy. [ABSTRACT FROM AUTHOR]

A case of paradoxic embolism is presented and the anatomic and physiologic factors in its occurrence are discussed. About 85 cases of this unusual phenomenon have been reported. In the majority of instances peripheral thrombo-phlebitis and pulmonary embolism and infarction precede para- doxic embolism. There is then an increase in pressure in the right auricle and and a fight to left shunt is produced. This opens an otherwise physiologically closed foremen ovale and permits an embolus to by-pass the pulmonary circulation and to be carried peripherally. In patients with congenital heart disease with fight to left shunts the same lack of the filtering effect of the pulmonary circulation is present. Bacteria are less completely removed from the blood stream because they, like the clots, can pass from the right to the left side of the heart. Organisms carried into the cerebral circulation may result in abscess either because brain tissue has poor resistance to infection primarily or secondarily due to previous vascular disturbance. The salient features of both brain abscess and peripheral embolism are presented to emphasize the differences between these two conditions which are often considered together for no other reason apparently than the fact that the term paradoxic is used in describing both. [ABSTRACT FROM AUTHOR]

The article focuses on the study of animals vital in science to understand the fundamentals of anatomy and physiology and comprehension in health and disease. The widespread use of animals brought potential benefits of animal research contributing to humanity in terms of disease research, development of medicines, and safety testing. An independent organization was set up for supporting experimentation in animals by application of the principles of replacement, refinement, and reduction (3Rs).

Effective cardiac resynchronization therapy (CRT) requires an accurate atrio-biventricular pacing system. The innovative Quartet lead is a quadripolar, over-the-wire left ventricular lead with four electrodes and has recently been designed to provide more options and greater control in pacing vector selection. A lead with multiple pacing electrodes is a potential alternative to physical adjustment of the lead and may help to overcome high thresholds and phrenic nerve stimulation (PNS). [ABSTRACT FROM AUTHOR]

Galen's teaching on anatomy and physiology was generally accepted in the Middle Ages and this applies to the part he thought was played by the pneuma in the functions of the body. In this essay I have outlined the advances made after Galen in the study of the nervous system leading eventually to a time when the soul and the pneuma were no longer thought necessary for the proper functioning of the brain and nerves. [ABSTRACT FROM AUTHOR]

The article presents the author's views on how to teach pathology. According to the General Medical Council, pathology should be taught as a clinical science in a way that helps a medical student to understand the mechanism of disease processes. According to the author, pathology is a discipline in which a person should have good knowledge of the anatomy, biochemistry, and physiology of the human body. Expert pathologists should be involved in the courses of clinical teaching.

The definition of fascia includes tissues of mesodermal derivation, considered as specialized connective tissue: blood and lymph. As water shapes rocks, bodily fluids modify shapes and functions of bodily structures. Bodily fluids are silent witnesses of the mechanotransductive information, allowing adaptation and life, transporting biochemical and hormonal signals. While the solid fascial tissue divides, supports, and connects the different parts of the body system, the liquid fascial tissue feeds and transports messages for the solid fascia. The focus of this article is to reconsider the model of biotensegrity because it does not take into account the liquid fascia, and to try to integrate the fascial continuum with the lymph and the blood in a new model. The name given to this new model is RAIN—Rapid Adaptability of Internal Network. [ABSTRACT FROM AUTHOR]

The article focuses on the association of medicine and art which is visible in the Michaelangelo's statue David. Michaelangelo passion the practice of anatomy and his works correctly demonstrated numerous anatomical structures. His mastery of human anatomy possesses certain anatomical imperfections. It depicts the symbol of his courage and physical power. David's eyes seem to manifest an exodeviation reflecting power, cunning and intelligence.