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The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our everyday lives and medical practice, including oncology treatment; thyroid cancer surgery is not an exception. The reported number of fine-needle aspirations performed during the first semester of 2020 was significantly reduced. Poorly differentiated, medullary and anaplastic thyroid tumors are considered important indications for immediate surgical intervention. By contrast, most well-differentiated carcinomas present slow growth, and thus surgery can be deferred for a short period of time during which patients are under active surveillance. Thyroid surgeries have decreased during the COVID-19 pandemic. Furthermore, prior to any intervention, negative COVID-19 status – with the use of a nasopharyngeal swab and reverse transcription PCR assay as the gold standard and chest CT scan as a complementary modality in some cases – must be confirmed to achieve a COVID-free pathway. Thorough preoperative assessment regarding both oncological and anatomical aspects should be performed to identify optimal timing for safe management.

Background/Objective: Carbon nanoparticles (CNs) are a novel injected suspension used during thyroidectomy in order to black stain the thyroid gland and the lymph nodes while maintaining the anatomic color of the parathyroid glands and the laryngeal nerves. The aim of this systematic review is to investigate the benefits of carbon nanoparticles in thyroid surgical procedures and examine their role in lymph node tracing, parathyroid preservation, and recurrent laryngeal nerve protection. Methods: A systematic review of the literature in the PubMed/Medline database was performed. Articles reporting randomized clinical trials, prospective, and retrospective studies that compared the use of carbon nanoparticles in one group of patients with a control-blank group were included. The article was reported in accordance with PRISMA guidelines (CRD42021243015). Results: The search strategy retrieved 22 studies of the literature. Fourteen studies calculated a greater number of lymph nodes detected/dissected in the central neck zone to the patients using CN solution and 1 article noted a higher rate of lymph nodes resected in the lateral neck zone in the same group of patients. A significant increase in the number of metastatic lymph nodes retrieved in the CN group was found in 7 studies. Twenty-one studies suggested that the use of CNs for the protection of the parathyroid glands was beneficial. Transient hypoparathyroidism and transient hypocalcemia were presented with a significantly lower incidence in the CN group in 13 and in 8 studies, respectively. Conclusion: Carbon nanoparticles may improve both central and lateral neck dissection and enhance parathyroid gland identification and preservation.

Background/Aim: Papillary Thyroid Cancer (PTC) is the most common type of endocrine malignancy. Although PTC has an excellent prognosis, the recurrent or metastatic disease could affect patients' survival. Recent studies show that Histone Deacetylase Inhibitors (HDACIs) might be promising anticancer agents against PTC. The aim of this review is to evaluate the role of HDACIs as an additional modality in PTC treatment and to depict the latest trends of current research on this field. Materials and Methods: This literature review was performed using the MEDLINE database. The search strategy included terms: “thyroid cancer”, “papillary”, “HDAC”, “histone”, and “deacetylase”. Results: Agents, such as Suberoyl Anilide Hydroxamic Acid, Trichostatin A, Valproic Acid, Sodium butyrate, Panobinostat, Belinostat, Romidepsin, CUDC907 and N-Hydroxy-7-(2-naphthylthio)-Hepanomide have shown promising anti-cancer effects on PTC cell lines but fail to trigger a major response in clinical trials. Conclusion: HDACIs have no significant effect as monotherapy against PTC, but further research needs to be conducted in order to investigate their potential effect when used as an additional modality.

Introduction: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.Areas covered: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. Forty-nine studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism was reported in 15 studies and 4 studies, respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism, respectively, and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.Expert opinion: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies, respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.

This study opts to investigate the thus far ill-defined intra-hemispheric topography, morphology, and connectivity of the extrapyramidal fibers that originate from the frontoparietal cortex and project to the tegmental area and to explore structural correlations to the pyramidal pathway. To this end, twenty normal adult, formalin-fixed cerebral hemispheres were studied through the fiber micro-dissection technique. Stepwise and in-tandem medial to lateral and lateral to medial dissections were carried out in all specimens. The cortical termination of the fibers under investigation was carefully defined, and their entry zone at the tegmental area was meticulously recorded. We consistently identified the corticotegmental tract (CTT) as a distinct fiber pathway lying in the white matter of the genu and posterior limb of the internal capsule and travelling medial to the corticospinal tract (CST) and lateral to the thalamic radiations. The CTT exhibits a fan-shaped configuration and can be classified into three discrete segments: a rostral one receiving fibers from BA8 (pre-SMA, frontal eye fields, dorsal prefrontal cortex), a middle one arising from areas BA4 and BA6 (primary motor cortex and premotor cortex), and a caudal one stemming from areas BA1/2/3 (somatosensory cortex). The anatomical location, configuration, trajectory, and axonal connectivity of this tract are attuned to the descending component of the extrapyramidal system, and therefore, it is believed to be implicated in locomotion, postural control, motor inhibition, and motor modification. Our results provide further support on the emerging concept of a dynamic, parallel, and delocalized theory for complex human motor behavior.

Background/aim Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. Materials and methods A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. Results Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. Conclusion Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.

Background: Papillary thyroid carcinoma is the most common type of thyroid cancer; despite its generally indolent course, patients often develop local post-operative recurrences. Re-operation, however, holds a high complication rate, while at the same time, not all patients benefit from radioiodine ablation. This systematic review investigates the application of laser ablation therapy (LAT) for cervical lymph node metastases as an additional treatment modality.Methods: This systematic review was conducted in accordance with the PRISMA Statement. Medline electronic database and Cochrane Library were searched for eligible articles.Results: Five studies were included in the systematic review. All studies included patients with metastatic lymph nodes from papillary thyroid carcinoma, that were unsuitable for further radioiodine or surgical treatment. Patients were treated with two different LAT devices. Regardless of the utilized assessment modalities, all researchers reported significant outcomes on local disease control. No permanent complications were observed.Conclusions: LAT is relatively safe and effective for the treatment of cervical metastatic lymph nodes in patients with papillary thyroid carcinoma.

Background There is a lack of definite anatomical landmarks for the inferior extension of the standard retrosigmoid approach. Objective To evaluate whether the posterior condylar emissary vein (PCEV) can be used as an intraoperative landmark for optimizing the surgical corridor. Methods We performed the standard retrosigmoid approach on 5 formalin fixed and latex injected cadaveric specimens and measured the distance between the PCEV near its bony canal and the vertebral artery (VA). In addition, vascular reconstructions of thin sliced preoperative CT scans were studied in 40 patients and the relationship between these two vessels was evaluated. An illustrative case is also included. Results The PCEV was consistently identified on both sides of cadaveric specimens and in 87, 5% and 82, 5% of the left and right sides of the included CT scans respectively. The average distance between the part of the PCEV near its osseous canal and the VA was measured to be between 8,4mm and 8,6mm in the specimens and between 9,2mm and 9,3mm in the CT scans. This distance offers a safe and effective plane of dissection during the standard retrosigmoid approach and allows easy access to the foramen magnum. Conclusion The PCEV near its bony canal proved to be an easy, straightforward, safe and effective operative landmark with which the surgeon can extend the soft tissue dissection and bony exposure towards the foramen magnum. This maneuver provides ample access to the cisterna magna for CSF drainage and increases visibility and surgical maneuvrebility to the entire CP angle.

Bochdalek hernias are usually diagnosed in newborns. However, they can occur in adults. Few reports exist regarding robotic repair of such hernias. We present a case of a female patient with symptomatic Bochdalek hernia, including the spleen. Patient was successfully treated by robotic-assisted surgical mesh with the use of indocyanine green (ICG). An 80-year-old female patient presented with dyspnea, angina and intermittent abdominal pain. She had loss of appetite and 15-kg weight loss within 3 months. Past medical history was unremarkable. Imaging revealed a left Bochdalek hernia. The patient underwent robotic-assisted surgery; hernia contents included stomach, parts of colon, omentum and remarkably the spleen. Sac was dissected free. Patency of organs was assessed with ICG. Diaphragmatic defect was repaired with mesh. Bochdalek hernias should be surgically repaired. Minimally invasive therapy is safe and effective. Intraoperative ICG use can provide excellent results with favorable clinical outcomes.

Objective. The aim of our paper is to present a rare variation of the suprascapular vein, its incidence and clinical significance. Case Report. A rare case of a double suprascapular vein was observed in a digi­talized human cadaver on Anatomage Table 5.0. The vein divided into two branches, one passing over the tr ansverse scapular ligament, while the other one coursed underneath the ligament, inside the notch. Conclusion. This variation has major clinical impor­tance as it is associated with the appearance of Supra­scapular nerve entrapment syndrome.

OBJECTIVE: To provide an educational, comprehensive, systematic and stepwise manual for the dissection and illustration of major limbic structures since there is a gap in the pertinent literature. Further, we aim to offer a thorough yet simplified roadmap for laboratory and intraoperative dissections.METHODS: Twenty (20) normal adult, formalin-fixed cerebral hemispheres were studied through the fiber dissection technique and under the microscope. Stepwise and in tandem medial to lateral and lateral to medial dissections were performed in all specimens aiming to reveal the morphology and spatial relationships of major limbic and paralimbic areas RESULTS: Twelve (12) consecutive, discrete and easily reproducible laboratory anatomical steps are systematically described to reveal the intricate anatomy of the structures of the limbic system.CONCLUSION: Surgical approaches for lesions or functional resections in and around limbic areas pose a challenging task for the neurosurgeon. By employing the fiber dissection technique, we were able to provide a stepwise and thorough laboratory guide for the gradual dissection and better comprehension of the morphology and spatial relationships of this specific system. Anatomical manuals like the present study raise interest and enrich anatomical knowledge on complex cerebral areas with the overarching goal to inform surgical practice.

It was our pleasure to read the systematic review and meta-analysis by Moro et al. (2021), who showed that the use of virtual reality (VR) and augmented reality (AR) in anatomy and physiology education did not lead to significant acquisition of knowledge in comparison with traditional two-dimensional (2D) methods. We consider that the findings are interesting and important, because other systematic reviews of anatomy education literature (Yammine and Violato, 2015; Triepels et al., 2020) showed that three-dimensional (3D) digital technologies were proven superior to 2D methods in terms of effectiveness. We would like to propose an alternative interpretation of the findings of the meta-analysis by Moro et al. (2021), taking into account the definitions which were provided for VR and AR and may cause confusion (Kurul et al., 2020; Chytas et al., 2021).

Background Recent studies advocate a connectivity pattern wider than previously believed of the uncinate fasciculus that extends to the ventrolateral and dorsolateral prefrontal cortices. These new percepts on the connectivity of the tract suggest a more expansive role for the uncinate fasciculus. Our aim was to shed light on this controversy through fiber dissections. Methods Twenty normal adult human formalin-fixed cerebral hemispheres were used. Focused dissections on the insular, orbitofrontal, ventromedial, ventrolateral, and dorsolateral prefrontal areas were performed to record the topography of the frontal terminations of the uncinate fasciculus. Results Three discrete fiber layers were consistently disclosed: the first layer was recorded to terminate at the posterior orbital gyrus and pars orbitalis, the second layer at the posterior two thirds of the gyrus rectus, and the last layer at the posterior one third of the paraolfactory gyrus. The insular apex was documented as a crucial landmark regarding the topographic differentiation of the uncinate and occipitofrontal fasciculi (i.e., fibers that travel ventrally belong to the uncinate fasciculus whereas those traveling dorsally are occipitofrontal fibers). Conclusions The frontal terminations of the uncinate fasciculus were consistently documented to project to the posterior orbitofrontal area. The area of the insular apex is introduced for the first time as a crucial surface landmark to effectively distinguish the stems of the uncinate and occipitofrontal fasciculi. This finding could refine the spatial resolution of awake subcortical mapping, especially for insular lesions, and improve the accuracy of in vivo diffusion tensor imaging protocols.

Objective. Trigeminal neuralgia is a long-term facial pain syndrome. Our aim was to review the anatomy of the trigeminal nerve and its anatomical relationship with the adjacent structures that may contribute to the pathogenesis of trigeminal neuralgiaMethods. Eligible articles were identified by a search of the Medline Embase, Pubmed Cinahl and Google Scholar bibliographical databases. We checked all the references of the relevant reviews and eligible articles that our search retrieved, in order to identify potentially eligible conference abstracts. Titles of interest were further reviewed by abstract. Case reports were excluded.Results. Trigeminal neuralgia syndrome seems to be caused by anatomical variations of the trigeminal nerve and its adjacent anatomical structures, mainly through compression. We depict the causes, the pathogenesis, and the clinical manifestations of the syndrome. The classification, diagnostic approach, differential diagnosis, and treatment modalities are also presented and they may be personalized according to the anatomical variations of the trigeminal nerve present, which may lead to trigeminal neuralgia syndrome.Conclusion. It is very important to be very careful in cases of new emerging neuralgia and to avoid the term “idiopathic” until proven otherwise by validating the newer and more appropriate tests and diagnostic criteria. Current data are insufficient and future research is needed in order to discover innovative and more effective treatments of trigeminal neuralgia, considering the anatomy and the anatomical variations of the trigeminal nerve.

The anatomy of the nasal cavities and paranasal sinuses is one of the most varied in the human body. The aim of this study is to review the prevalence of anatomical variations in the sinonasal area. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed on PubMed a literature search from October 2004 until May 2020. The search strategy included the following keywords: ('paranasal sinus' OR 'frontal sinus' OR 'maxillary sinus' AND ('anatomical variants' OR 'anomalies')). Fifty studies were eligible and included in the analysis. Overall, the studies encompassed a total of 18,118 patients included in this review. Most common anatomical variations include agger nasi cells, nasal septum deviation and concha bullosa. Other variations seen in this region are uncinate process variations, paradoxical middle turbinate, Haller, Onodi and supraorbital ethmoid cells, accessory ostia of maxillary sinus. Less common variations include any sinus aplasia, crista galli pneumatization and dehiscence of the optic or maxillary nerve, internal carotid artery and lamina papyracea. Anatomical variations of this region also differ among ethnic groups. This study highlights the amount, variability and significance of most anatomical variants reported in the literature in the last years. It is essential for the sinus surgeon to have a broad spectrum of knowledge not only of "the typical" anatomy but also all the possible anatomical variations. With modern imaging modalities, anatomical variations can be detected, and uneventful pitfalls might be prevented.

Neuro-anatomy of the perineum has gained renewed attention due to its significance in the transanal procedures for rectal cancer (eg TaTME). Surgeons embarking on this technique must have sophisticated knowledge and a precise anatomical understanding of the perineum before proceeding with this reversed rectal approach. We report anatomical observations deriving from a relevant experience in the colorectal surgery field. The collective multicenter experience of the present study is clinically relevant and based on the rectal and transanal resections performed in colorectal centers of excellence from Greece, UK, and Italy over the last 10years (2011–2020). From the original anatomical and intraoperative observations derived from collective cases operated by this multicenter group of colorectal surgical centers in three Europeancountries, data were retrieved and analyzed in collaboration with specialist researchers of human anatomy and interpreted for their clinical significance and potential use for preoperative planning and intraoperative guidance during TaTME. This descriptive article demonstrates in detail the neurogenic pathways encountered in the perineum and pelvic cavity during transanal procedures. Specific anatomical and topographic implications are also included serving as a guide for colorectal surgeons to perform a nerve-sparing procedure. transanal approach for rectal excision offers new insights into the complex pelvic and perineal neuroanatomy while the procedure itself remains a challenge for surgeons. Preoperative anatomical planning and 3D reconstruction may help in anticipating technical difficulties, resulting in more precise surgical dissections and decreased postoperative complications.

Background The suprascapular notch (SN) represents the point along the route of the suprascapular nerve (SSN) with the greatest potential risk for injury and compression. Thus, factors reducing the area of the notch have been postulated for suprascapular neuropathy development. Methods Thirty-one fresh-frozen shoulders were dissected. The contents of the SN were described according to four types as classified by Polguj et al and the middle-transverse diameter of the notch was measured. Also, the presence of an ossified superior transverse scapular ligament (STSL) was identified. Results The ligament was partially ossified in 8 specimens (25.8%), fully ossified in 6 (19.35%), and not ossified in the remaining 17 (54.85%). The mean middle-transverse diameter of the SN was 9.06 mm (standard deviation [SD] = 3.45). The corresponding for type-I notches was 8.64 mm (SD = 3.34), 8.86 mm (SD = 3.12) was for type-II, and 14.5 mm (SD = 1.02) was for type III. Middle-transverse diameter was shorter when an ossified ligament was present (mean = 5.10 mm, SD = 0.88 mm), comparing with a partially ossified ligament (mean =7.67 mm, SD = 2.24 mm) and a nonossified one (mean = 11.12 mm, SD = 2.92 mm). No statistically significant evidence was found that the middle-transverse diameter depends on the number of the elements, passing below the STSL. Conclusion Our results suggest that SSN compression could be more likely to occur when both suprascapular vessels pass through the notch. Compression of the nerve may also occur when an ossified transverse scapular ligament is present, resulting to significant reduction of the notch's area.

The advent of laparoscopic surgery has radically changed surgical management of many diseases. Soon after the first laparoscopic procedures, the development of more complex laparoscopic operations began, including laparoscopic colon surgery. However, the adoption of laparoscopic colon surgery created new educational challenges. Add to this the medical demands for increased patient safety, fewer complications from surgery, and less time in the hospital. These are strong forces towards the development of training tools and modalities that teach the types of skills needed in laparoscopic surgery. New and older educational modalities such as box and video trainers, high-fidelity laparoscopic simulators, and cadaveric and animal models are useful because they shorten the training period and minimize costs. Their appropriate use allows acquisition of basic and advanced laparoscopic surgical skills outside the operating theatre. Training time within the operating theater can be reserved for training integration and practicing on real tissue. Increasing knowledge of the advantages and limitations of different educational and training modalities is necessary so best practices can be implemented. As laparoscopic colon surgery is relatively new, it is also important to acknowledge the population of trainees is not homogenous, ranging from novice to experienced surgeons. The diverse group that comprise the surgical community, plus limitation in financial resources, make flexible and economical educational programs a necessity.

Introduction The brachiocephalic artery (BCA) is the largest branch that arises from the aortic arch, which varies in length. The present study focuses on BCA length and its probable correlation with height and torso length. Methods The BCA length (from the artery's origin to the arcus aortae), the length of the torso, and height were measured in 76 embalmed adult human cadavers of Caucasian (Hellenic) origin. Results A total of 74 arteries were measured (36 females and 38 males). The mean length was found to be 3.82 cm (SD=±0.947, SE=0.110). In male cadavers, the mean BCA length was 3.94 cm (SD=±0.980, SE=0.159) and in females, it was found to be 3.69 cm (SD=±0.905, SE=0.151). No statistically significant difference was found (p=0.248, p>0.05) The mean torso length was 62.27 cm (SD=±4.325, SE=0.496) and the mean height was 155.3 cm (SD=±10.124, SE=1.161). The BCA length was correlated with body height and torso length in both sexes. A statistically significant correlation was found only between BCA length and body height in male cadavers (r=0.267, p=0.021). Conclusion The morphometric characteristics of the BCA are of great importance in a number of surgical procedures, such as stenting and catheterization in cases of aneurysms. One statistically significant correlation was observed in our study, which could be considered an important finding, as it could lead to the plausible assumption that greater height leads to the formation of larger arteries.

Edward Delos Churchill, one of the most notorious American surgeons of the 20th century, influenced countless surgeons and set medical practices that were used for decades. His scope of interests included surgery of the lungs, heart, thyroid, parathyroid glands, and military surgery among others. Churchill was one of the first to expand the field of the newly found parathyroid bodies by performing several experimental excisions of the glands and publishing numerous guidelines based on his innovative work. Additionally, he aspired to address many of the literature gaps that led him to conclusions that would benefit both the surgeons and patients throughout the country. Most importantly, his deep interest in endocrinology and his aggregate approach of medicine led him to discoveries that paved the way to the modern endocrine surgery practices.

Johann Friedrich Horner is remembered in ophthalmology due to his brief report in the German scientific journal 'Klinische Monatsblatter fur Augenheilkunde', in which emphasized the clinical value of a cluster of external signs of damage to the cervical sympathetic nerve. Although J .F .Horner was not the first to describe such a syndrome, he was credited with the nomination. For the French, Francois Pourfour du Petit was the pioneer in that case. Born in Zurich, travelled Europe to be further educated, becoming later on Professor and Director of the University Clinic of Ophthalmology in his native city. In conclusion, J .F .Horner's adamantine character, hard work, assiduous teaching and skills in eye surgery made him one of the main contributors for the evolution of ophthalmology in the nineteenth century Central Europe.

In the seventh century AD, a native of the island of Aegina, a brilliant surgeon, Paulus Aegineta, practiced surgery in Byzantium. Able to perform a wide variety of surgical operations, he summarized his experience and gathered the available knowledge to compose his masterpiece "Medical Compendium." He was credited as the first to operate on the tonsils and the lymphatic system of the lower cervical region and as one of the pioneers to cut the abdominal wall. Fond of the cauterization method, an expert in disinfection and pain palliation, he had presented supreme skills, becoming one of the most important figures in the history of medicine.

Limb length discrepancy (LLD) is a frequent complication after elastic stable intramedullary nailing (ESIN) of femoral shaft fractures in children. It is the result of either shortening or lengthening of the affected limb. A shorter limb is usually observed when there is no strict adherence to the main indication of the technique, which is a transverse or short oblique fracture of the diaphysis. A longer limb may be the result of either improper reduction and significant dissociation of fracture fragments, or stimulation of growth of the fractured bone of the child, known as overgrowth. We describe a potential third cause of limb lengthening after treating femoral shaft fractures with the ESIN technique. LLD may be the result of acute femur lengthening due to the loss of normal femoral antecurvatum.

Objective. The aim of our paper is to depict an anatomical variation of the brachial plexus, concerning a communicating branch between the median and the musculocutaneous nerve and its clinical significance. Anatomical variations of the brachial plexus and especially those of the musculocutaneous nerve are quite common. Awareness of these variations is of paramount importance in clinical practice, mainly in achieving best results in minimal invasive or surgical procedures.Case Report. After dissection in upper extremities in a 89-year-old male cadaver, a communicating branch between the median and the musculocutaneous nerve was found. This communicating branch was formed before the musculocutaneous nerve perforated the coracobrachialis muscle. It also derived from the level of the ansa medianis and its course was of an approximately 2cm length.Conclusion. The clinical significance of our study is the entrapment of the musculocutaneous nerve that may cause clinical findings similar to those of the carpal tunnel syndrome.

The purpose of the present study was to evaluate special features and probable correlations between symptoms, laboratory findings, treatment, and outcomes of COVID-19 in children and adolescents, through a systematic review and pooled analysis. Following database (Pubmed, Google Scholar, Scopus and Embase) search, forty articles were considered eligible identifying a total of 2,971 confirmed pediatric COVID-19 patients. Fever was reported in 55.1% of the cases, while 28.4% were asymptomatic. Radiological signs of pneumonia were observed in more than half of the cases and in 40.7% of asymptomatic patients. Fever showed the highest sensitivity (sensitivity: 60.3%, specificity: 48.8%), followed by cough (sensitivity: 47.4%, specificity: 76.7%), rhinorrhea (sensitivity: 21.1%, specificity: 88.4%) and diarrhea (sensitivity: 10.3%, specificity: 88.4%), in differentiating cases with positive radiological signs for pneumonia. Compared to school age children, preschoolers (adjusted OR=6.01, 95%CI: 1.73-20.91) were more prone to pneumonia findings. Various combinations of treatments were used across studies, without following any strict guidelines. Most children (>90%) had full recovery and rarely presented complications. Fever seems to be the most frequent symptom in pediatric COVID-19, but pediatricians should additionally evaluate cough, rhinorrhea, and diarrhea as indicators of SARS-CoV-2 infection. Asymptomatic cases were common, but not the majority, and a significant percentage had developed radiologic findings of pneumonia. Thorough reassessment of treatment and management guidelines should be helpful.

Introduction. Fractures are quite common, especially among the elderly. However, they can increase in prevalence in younger ages too if the bone health is not good. This may happen as a result of bad nutrition.Methods. A customized, retrospective review of available literature was performed using the following keywords: bone health, nutrition, and fractures.Results. Insufficient intake of certain vitamins, particularly A and D, and other nutrients, such as calcium, may affect bone health or even the time and degree of bone healing in case of fracture. The importance of different nutrients, both dietary and found in food supplements, is discussed concerning bone health and fracture healing.Conclusion. A healthy diet with adequate amounts of both macro- and micronutrients is essential, for both decreasing fracture risk and enhancing the healing process after fracture.

Right or subtotal colectomy either open or laparoscopic may be a challenging operation owing to technical difficulties. One of these, is to identify a safe and adequate dissection plane, ligating and dissecting lymph nodes around middle colic vessels. The purpose of this study was to depict a rare anatomic variation of middle colic vein (MCV) draining to splenic vein. We report the case of a 55-year-old male patient, who was subjected to a right hemicolectomy for an adenocarcinoma in the ascending colon. During dissecting the transverse mesocolon from the greater omentum, for complete mesocolic excision (CME), we encountered that the MCV drained in the splenic vein. With respect of this rare anatomic variability, CME was completed without hemorrhage. Our aim is to depict that deep knowledge of MCV anatomy and its variations is of paramount importance to achieve CME and to avoid dangerous or massive bleeding.

The arc of Buhler, an anastomotic vessel between celiac artery and superior mesenteric artery, is a rare anatomic variation. Various radiologic and surgical procedures can be affected by its existence. We aim to review all available information and identify possible clinical implications. A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The following terms were utilized in various combinations: “Buhler”, “arc of Buhler”, “visceral aneurysm”, “pancreaticoduodenal arcades”. Only 53 cases have been described until today in the literature. The arc of Buhler enhances collateral circulation between celiac artery and superior mesenteric artery alongside with pancreaticoduodenal arcades and dorsal pancreatic artery. Computerized tomography and angiography are the main studies used for its detection and evaluation. Aneurysms of Buhler’s arc have been rarely described and seem to share common pathophysiological mechanisms with aneurysms of the pancreaticoduodenal arcades. Various radiologic and surgical procedures such as embolization or pancreaticoduodenectomy are potentially affected by its existence.

Sir William Arbuthnot Lane (1856-1943) is considered a pioneer in orthopedic surgery, especially for his breakthrough for the time technique for bone and mainly femoral surgery, the so-called screw and plates technique, which was also accompanied by his aseptic surgical approach. Apart from his innovations in colon, nose, ear, throat, and reconstructive surgery, his treatises on orthopedic surgery were considered as masterpieces. Femoral anatomy and surgical anatomy attracted mainly his interest as seen in his treatises.

Lateral calcaneal flap is an established surgical option for coverage of lateral calcaneum and posterior heel defects. Lateral calcaneal flap vascularization and innervations are based on lateral calcaneal artery neurovascular bundle, that is, lateral calcaneal artery, small saphenous vein, and sural nerve. Anatomical research has allowed exploration of its many advantages but can also lead to its various modifications, permitting a wide variety of clinical applications. In this paper the authors report an anatomical and clinical study on lateral calcaneal artery course and lateral calcaneal flap clinical applications. Anatomic part of our study focused on lateral calcaneal artery course and optimization of surgical technique for flap harvesting. Data were used for design of lateral calcaneal flap in 5 patients. Our results were satisfactory in terms of coverage adequacy, perioperative morbidity, and functional and aesthetical outcome.

Background and aim of the study We have previously reported that the neocortex is selectively vulnerable to injury in an acute porcine model of hypothermic circulatory arrest (HCA) at 18°C. In view of recent evidence showing that pharmacologic preconditioning with a single dose of erythromycin induces tolerance against transient global cerebral ischemia in rats, we hypothesized that erythromycin would reduce the number of apoptotic neurons in the neocortex in an acute porcine model of HCA at 18°C. Methods Fourteen piglets underwent 75 min of HCA at 18°C following pretreatment with erythromycin (25 mg/kg, IV) (n = 8) or vehicle (Normal Saline 0.9%) (n = 6), applied 12 hr before arrest. Three served as normal controls. After gradual rewarming to a temperature of 36°C, treatment animals were sacrificed and brains were perfusion-fixed and cryopreserved. Neuronal apoptosis after HCA was observed morphologically with hematoxylin and eosin staining, and characterized by in situ DNA fragmentation using terminal deoxynucleotidyl-transferase-mediated biotin-dUTP nick end-labeling (TUNEL) histochemistry. Results Pre-ischemic conditioning with a single dose of the antibiotic erythromycin reduced neuronal apoptosis in the neocortex of the porcine brain. TUNEL-positive cells indicating DNA fragmentation and neuronal injury were significantly greater in the neocortex of animals treated with 18°C HCA (2.55 ± 1.17) compared to animals undergoing HCA after erythromycin preconditioning (1.76 ± 0.91) (p ≤ 0.001). Conclusions These results suggest that cerebral protection during HCA may be achieved with erythromycin pharmacological preconditioning in the porcine model. doi: 10.1111/jocs.12544 (J Card Surg 2015;30:525–531)

Poroma is a rare benign neoplasm that derives from eccrine sweat glands epithelium. Its histological subtypes, with respect to its position within skin layers, are eccrine poroma, hidroacanthoma simplex, poroid hidradenoma, and dermal duct tumor. Poromas commonly exhibit benign clinical behavior as they are usually small and asymptomatic and do not exhibit malignant behavior. Although their histological subtypes share similar histological characteristics, they rarely coexist in the same tumor. In this report we present the case of an unusual poroma in terms of histological and clinical behavior as it was large and presented histological characteristic of both eccrine poroma and poroid hidradenoma. Coexistence of different histologic subtypes in the same tumor indicates simultaneous tumorigenesis, differentiation from one cell type to another, or parallel differentiation from a common progenitor cell. Implications in treatment remain unknown partly due to the rarity of such cases.

Background: Skin spot biopsy is the gold standard for diagnosis of small fibre neuropathy. Here we systematically approached intraepidermal nerve fibre density (IENFD) with the aim of precisely estimating its value in healthy and neuropathic subjects. The present findings will serve as a guidance model for further use of IENFD, as an indicator of neuropathy predisposition. We also investigated how IENFD was influenced by age, gender, and neuropathy. Methods: We conducted a systematic search of PubMed, Web of Science, and ScienceDirect to identify clinical studies published during the last twenty years (1997-2017), which investigated IENFD in healthy and neuropathic adult population. Data were retrieved from longitudinal cohort studies including 5-188 healthy adult subjects and 6-40 neuropathic adult patients. We used meta-analysis techniques including multilevel meta-regression. Findings: In the healthy population, the estimated (95% CI) IENFD values (in fibres/mm) were 21.4 (19.9, 22.9) in the thigh, 17*7 (15.3, 20.1) in the forearm, 12*9 (11.8, 14.0) in the distal leg, 11*3 (6.1, 16.5) in the fingers, and 6*5 (4.4, 8.6) in the toes. The corresponding estimates in the neuropathic population were 17*2 (15.2, 19.2) in the thigh, 6*3 (2.3, 10.2) in the forearm, 5*1 (3.8, 6.4) in the distal leg, and 2*0 (0.0, 5.7) in the toes. In the healthy population, IENFD decreased with ageing, by 1*4 fibres/mm every 5 years (p

Normal breast development is a complex process extending from the earliest stages of embryogenesis to beyond menopause. This process is driven by intrinsic genetic information, regulated by complex and tightly controlled hormonal mechanisms, and is affected by external events. Schematically, breast development is separated into prenatal, perinatal, peripubertal, adult and postmenopausal stages. Complete breast maturation does not occur until pregnancy and lactation, and thus the breast never evolves completely in nulliparous woman. Many breast diseases, benign and malignant, including breast cancer, can be better examined and explained through the spectrum of normal – or abnormal – breast development. Research is difficult due to the limited availability of human breast tissue. For this, much of our knowledge derives from mouse model studies. This information, while valuable, should be considered with caution since analogy between the mouse and human models is not perfect. Still since understanding of breast development allows better understanding of pathophysiological processes driving diseases of the breast, constant research and education is necessary not only in the sphere of basic science but also for clinicians as it allows better diagnosis and treatment for their patients.