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Medial Plantar Artery Flap for Reconstruction of Weight-bearing Sole Defect- A Series of Ten Cases 足底内侧动脉皮瓣修复负重足底缺损——附10例报告
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/61663.2913
S. G. Vaghani, G. Chaudhari
Weight-bearing areas of feet are at risk of developing ulcers due to various reasons like a neuropathic foot in diabetes mellitus, acute trauma, post-tumour excision etc., Various reconstructive options have been described in literature from split-thickness skin graft to free flap. This case series reports 10 patients with sole defects. Out of 10 patients, seven patients had heel defect and three patients had the plantar aspect of the forefoot defect. For patients with heel defect, authors used a proximally based medial plantar flap as a reconstructive tool while for forefoot sole defect distally based (reverse) Medial Plantar Artery (MPA) flap was used. The most common cause of heel defect was postdebridement defect in diabetic foot in five cases, postmelanoma excision defect in three cases, postsquamous cell carcinoma excision defect in one case and postelectric burn defect in one case. Flap size ranged from 5x5 cm to 10×7 cm. All flaps offered stable, durable, and cosmetically acceptable skin cover. No patient had a recurrent ulcer during follow-up period. Partial flap necrosis in one case was managed conservatively. The MPA flap offers excellent cover which is a sturdy, durable, cosmetically acceptable cover for medium size defect over the sole i.e., the weight-bearing part of forefoot and heel.
由于各种原因,如糖尿病神经性足、急性创伤、肿瘤后切除等,足部负重区域有发生溃疡的风险,文献中描述了各种重建选择,从裂厚皮肤移植到自由皮瓣。本病例系列报告了10例足底缺陷患者。10例患者中,7例患者有足跟缺损,3例患者有足底前足缺损。对于有足跟缺损的患者,作者采用近端为基础的足底内侧皮瓣作为重建工具,而对于前足缺损,则采用远端为基础的(反向)足底内侧动脉(MPA)皮瓣。导致足跟缺损最常见的原因是糖尿病足清创后缺损5例,黑色素瘤切除后缺损3例,鳞状细胞癌切除后缺损1例,电烧伤后缺损1例。皮瓣大小从5x5cm到10×7 cm不等。所有皮瓣提供稳定,耐用,美容可接受的皮肤覆盖。随访期间无溃疡复发。皮瓣部分坏死1例保守处理。MPA皮瓣提供了良好的覆盖,这是一个坚固,耐用,美观可接受的覆盖中型缺陷的鞋底,即前足和脚跟的负重部分。
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引用次数: 0
Barcelona Clinic Liver Cancer: A Narrative Review 巴塞罗那诊所肝癌:叙述性回顾
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/61875.2899
Nitin Kumar Patel, R. Desai, A. Majumdar
To plan therapies for Hepatocellular Carcinoma (HCC), staging methods are necessary. The most often employed HCC management recommendation is the Barcelona Clinic Liver Cancer (BCLC) staging system. Transarterial Chemoembolisation (TACE) is the go- to therapy for BCLC stage B (intermediate HCC). Numerous studies back the use of TACE in individuals with early and advanced HCC. TACE may be an option for individuals who are not candidates for Radiofrequency Ablation (RFA) or Hepatic Resection (HR) for BCLC stage 0 (very early HCC). TACE with RFA offers superior local tumour suppression than RFA alone in BCLC stage. Patients awaiting liver transplants may benefit from TACE as a bridging treatment. When compared to supportive care approaches, TACE improves survival for BCLC-B patients. Patients with BCLC-C stage HCC are treated in the first instance with sorafenib. The combination of sorafenib and TACE has demonstrated efficacy in slowing the development of tumours. Patients with HCC and portal venous thrombosis have superior survival results with TACE combined with radiation. Taking all of these facts into account, it is obvious that TACE, either alone or in conjunction with other therapies, plays a crucial part in the treatment of HCC at every stage. Patients with HCC should get a variety of treatments, and the best TACE candidates should be chosen using a more accurate patient classification approach.
为了计划肝细胞癌(HCC)的治疗,分期方法是必要的。最常用的HCC管理建议是巴塞罗那临床肝癌(BCLC)分期系统。经动脉化疗栓塞(TACE)是BCLC B期(中间型HCC)的首选治疗方法。许多研究支持在早期和晚期HCC患者中使用TACE。对于BCLC 0期(非常早期HCC)不适合射频消融(RFA)或肝切除术(HR)的患者,TACE可能是一种选择。在BCLC期,TACE联合RFA比单独RFA具有更好的局部肿瘤抑制作用。等待肝移植的患者可能受益于TACE作为桥接治疗。与支持治疗方法相比,TACE可提高BCLC-B患者的生存率。BCLC-C期HCC患者首先使用索拉非尼治疗。sorafenib和TACE的联合已被证明在减缓肿瘤发展方面有效。肝癌合并门静脉血栓患者采用TACE联合放疗有较好的生存效果。考虑到所有这些事实,很明显,TACE无论是单独使用还是与其他疗法联合使用,在HCC治疗的每个阶段都起着至关重要的作用。HCC患者应该接受多种治疗,并且应该使用更准确的患者分类方法来选择最佳的TACE候选患者。
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引用次数: 0
Association between BMI and Intraoperative Time and Length of Hospital Stay among Patients undergoing Laparoscopic Colorectal Surgery: A Retrospective Study 腹腔镜结直肠手术患者BMI与术中时间和住院时间的关系:一项回顾性研究
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/56941.2922
Navjot Brar, Maneshwar Singh Utaal, Amanjot Singh Sidhu, Amandeep Singh, Anmol Singh Ahluwalia
Introduction: Now-a-days, most surgeons are aware that obese patients face more difficulties during laparoscopic colorectal surgery compared to non obese patients, especially with the prevalence of advanced laparoscopic procedures. Aim: To investigate the association between Body Mass Index (BMI) and operative time, as well as the length of hospital stay after laparoscopic colorectal surgery. Materials and Methods: A retrospective observational study was conducted at Sri Guru Ram Das (SGRD) Charitable Hospital in Amritsar, Punjab, India, from January 2016 to January 2019. The study included 139 patients who underwent laparoscopic colorectal surgery. The dataset consisted of four variables: BMI (continuous), intraoperative time (continuous), diagnosis (nominal, including various diseases such as Crohn’s disease, colon cancer, ulcerative colitis, and diverticulitis), and length of stay (dichotomous, categorised as “yes” if the total length of stay in the hospital was greater than three days, and “no” if it was three days or under). Mean and standard deviations were calculated for both BMI and intraoperative time. The Pearson’s r correlation test was used to assess the association between BMI and intraoperative time. Results: A total of 139 patients were included in the study, with 72 (51.80%) having a length of stay less than three days and 67 (48.20%) having a length of stay greater than three days. Higher BMI was found to be associated with a prolonged length of stay (>three days) in the hospital following colorectal surgery, with a p-value of 0.007. However, the study did not find a statistically significant association between BMI and intraoperative time, with a p-value of 0.1795. Conclusion: Obese patients tend to spend a longer time in the hospital compared to non obese patients. Therefore, caution should be exercised when performing elective laparoscopic procedures on obese patients.
导读:如今,大多数外科医生都意识到,与非肥胖患者相比,肥胖患者在腹腔镜结肠直肠癌手术中面临更多困难,特别是随着先进腹腔镜手术的普及。目的:探讨腹腔镜结直肠手术后体重指数(BMI)与手术时间及住院时间的关系。材料与方法:2016年1月至2019年1月,在印度旁遮普省阿姆利则的Sri Guru Ram Das慈善医院进行了一项回顾性观察研究。该研究包括139名接受腹腔镜结直肠手术的患者。数据集由四个变量组成:BMI(连续)、术中时间(连续)、诊断(名义上,包括各种疾病,如克罗恩病、结肠癌、溃疡性结肠炎和憩室炎)和住院时间(二分类,如果住院总时间大于3天,分类为“是”,如果住院时间小于或等于3天,分类为“否”)。计算BMI和术中时间的平均值和标准差。采用Pearson’s r相关检验评估BMI与术中时间的关系。结果:139例患者纳入研究,其中72例(51.80%)患者住院时间小于3天,67例(48.20%)患者住院时间大于3天。高BMI与结直肠手术后住院时间延长(3天)相关,p值为0.007。然而,本研究未发现BMI与术中时间存在统计学意义上的相关性,p值为0.1795。结论:肥胖患者比非肥胖患者住院时间更长。因此,在对肥胖患者进行选择性腹腔镜手术时应谨慎。
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引用次数: 0
Morphological and Morphometric Study of Coronary Sinus in Human Cadaveric Hearts in Gujarat Region, India: A Cross-sectional Study 印度古吉拉特邦地区人类尸体心脏冠状窦的形态学和形态计量学研究:一项横断面研究
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/58891.2909
Daxa Kanjiya, Mehul R. Tandel, Kuldeep N Suthar
Introduction: The major vein draining blood from the heart is the Coronary Sinus (CS). Its significance in facilitating numerous cardiac treatments such as biventricular pacing, and the placement of a variety of cardiac devices has made the CS a therapeutically essential structure. The development of advanced invasive and interventional cardiac procedures requires a thorough understanding of CS anatomy. Aim: To determine the location, shape, length, and width of the CS together with its left atrial muscular coverage in hearts of formalin-fixed cadavers. Materials and Methods: The present study was a cross- sectional study in which data was collected from 90 adult human cadaveric hearts preserved with formalin from both sexes. Forty cadaveric heart was obtained from Department of Anatomy, Pramukhswami Medical College, Karamsad and 50 from Dr. ND Desai Medical College and Hospital, Nadiad, Gujarat, India and study was conducted from August 2020 to July 2022. External Lengths (EL) of CS were measured using thread and Vernier Calliper at different levels (EL1-From the entry of oblique vein into CS and EL2-From the point of union of the great cardiac vein and left marginal vein upto its termination). CS width was measured: at the beginning, at the point where Middle Cardiac Vein (MCV) enters, and at the point where it terminates in the right atrium. CS walls were examined to see whether the muscles of the left atrium covered them or not. Using Statistical Package for the Social Sciences (SPSS) software, a descriptive analysis was conducted to determine the range, mean, and standard deviation. Results: In all 90 (100%) hearts, CS was found in the posterior atrioventricular sulcus. Tubular-shaped CS was found in 80 (88.9%) hearts, while 10 (11.1%) hearts had funnel-shaped CS. The EL1 of the CS was 43.75±4.68 mm and EL2 was 40.19±5.62 mm. The width of the CS was 6.71±1.47 mm at the beginning, 8.49±1.89 mm at the entrance point of MCV, the maximum width at termination in the right atrium was 8.14±2.16 mm and the minimum width was 5.16±1.70 mm. Muscles of the left atrium covered CS in all cases. Conclusion: The CS has a variable location, shape, length, and width despite being a constant component of the heart’s venous system. Its importance in giving access to various cardiac procedures has made it a clinically significant structure. The baseline data of this study can help the cardiologists performing various cardiac procedures in the Gujarat population.
导言:从心脏排出血液的主要静脉是冠状静脉窦。它在促进许多心脏治疗(如双心室起搏)和各种心脏装置的放置方面的重要意义使CS成为治疗上必不可少的结构。先进的侵入性和介入性心脏手术的发展需要对CS解剖有透彻的了解。目的:确定福尔马林固定尸体心脏左心房肌间室的位置、形状、长度、宽度及其左心房肌覆盖范围。材料和方法:本研究是一项横断面研究,收集了90具男女用福尔马林保存的成人尸体心脏的数据。从Karamsad Pramukhswami医学院解剖学系获得40具尸体心脏,从印度古吉拉特邦Nadiad Dr. ND Desai医学院和医院获得50具尸体心脏,研究于2020年8月至2022年7月进行。采用螺纹和游标卡尺在不同水平(el1 -从斜静脉进入椎弓根,el2 -从心大静脉与左缘静脉汇合点至其末端)测量椎弓根的外长度。测量CS宽度:开始时,心中静脉(MCV)进入点,以及它在右心房终止点。观察左心房的肌肉是否覆盖CS壁。使用社会科学统计软件包(SPSS)软件,进行描述性分析,以确定范围,平均值和标准差。结果:90例心脏(100%)均在房室后沟发现CS。管状CS 80例(88.9%),漏斗状CS 10例(11.1%)。CS的EL1为43.75±4.68 mm, EL2为40.19±5.62 mm。冠状动脉起始宽度为6.71±1.47 mm,冠状动脉入口宽度为8.49±1.89 mm,右心房终止宽度为8.14±2.16 mm,最小宽度为5.16±1.70 mm。所有病例均有左心房肌肉覆盖CS。结论:CS虽然是心脏静脉系统的一个固定组成部分,但其位置、形状、长度和宽度都是可变的。它在各种心脏手术中的重要性使其成为临床重要的结构。这项研究的基线数据可以帮助心脏病专家在古吉拉特邦人口中进行各种心脏手术。
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引用次数: 0
Bilateral Duplication of Renal Artery in a Cadaver and Its Clinical Implications: A Case Report 尸体双侧肾动脉重复及其临床意义:1例报告
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/58500.2890
P. Pawar, Vavishali Anturlikar, Shivam Deepak Shivapuje, Smit N. Shah
In normal adult renal system, the renal artery originates from the abdominal aorta at the level of the lower border of L1 vertebrae, just below the origin of the superior mesenteric artery, one on each side. In 15-30% of the population, rare variation in origin and distribution pattern of renal artery can be seen. These variations may be attributed to anomalies in the development of the vascular system. These anomalies lead to the emergence of accessory or multiple renal arteries, causing significant variations in normal anatomical pattern. The aim of present study was to report the presence of double renal arteries on both sides, which has about 10% occurrence amongst all renal artery variations. Most commonly, double arteries are found unilaterally in approximately 30% of cases. Also, in the present case, the renal system was perfused by additional prehilar branches and polar arteries arising from either of the renal arteries. Hence, it is a rare entity. The occurrence of such variation in the vasculature of renal arteries has significant clinical implications. The knowledge of presence of aberrant or multiple renal arteries is significant for urologists, physicians, radiologists and surgeons, while performing surgeries related to kidneys, adrenal glands and associated structures.
在正常成人肾脏系统中,肾动脉起源于L1椎体下缘水平的腹主动脉,就在肠系膜上动脉起源的下方,每侧一个。在15-30%的人群中,可以看到肾动脉起源和分布模式的罕见变化。这些变化可能归因于血管系统发育的异常。这些异常导致副肾或多肾动脉的出现,导致正常解剖模式的显著变化。本研究的目的是报道双肾动脉的存在,双肾动脉在所有肾动脉变异中约占10%。最常见的是,约30%的病例单侧出现双动脉。此外,在本病例中,肾系统由肾动脉中的任何一个产生的额外门前分支和极动脉灌注。因此,它是一个罕见的实体。肾动脉血管变化的发生具有重要的临床意义。对于泌尿科医生、内科医生、放射科医生和外科医生来说,在进行与肾脏、肾上腺和相关结构相关的手术时,了解异常或多发肾动脉的存在是非常重要的。
{"title":"Bilateral Duplication of Renal Artery in a Cadaver and Its Clinical Implications: A Case Report","authors":"P. Pawar, Vavishali Anturlikar, Shivam Deepak Shivapuje, Smit N. Shah","doi":"10.7860/ijars/2023/58500.2890","DOIUrl":"https://doi.org/10.7860/ijars/2023/58500.2890","url":null,"abstract":"In normal adult renal system, the renal artery originates from the abdominal aorta at the level of the lower border of L1 vertebrae, just below the origin of the superior mesenteric artery, one on each side. In 15-30% of the population, rare variation in origin and distribution pattern of renal artery can be seen. These variations may be attributed to anomalies in the development of the vascular system. These anomalies lead to the emergence of accessory or multiple renal arteries, causing significant variations in normal anatomical pattern. The aim of present study was to report the presence of double renal arteries on both sides, which has about 10% occurrence amongst all renal artery variations. Most commonly, double arteries are found unilaterally in approximately 30% of cases. Also, in the present case, the renal system was perfused by additional prehilar branches and polar arteries arising from either of the renal arteries. Hence, it is a rare entity. The occurrence of such variation in the vasculature of renal arteries has significant clinical implications. The knowledge of presence of aberrant or multiple renal arteries is significant for urologists, physicians, radiologists and surgeons, while performing surgeries related to kidneys, adrenal glands and associated structures.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71263960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phenytoin versus Normal Saline Dressings in the Healing of Chronic Diabetic Foot Ulcers: A Longitudinal Study 苯妥英与生理盐水敷料在慢性糖尿病足溃疡愈合中的作用:一项纵向研究
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/59287.2876
Bogarapu Chaithanya Babu, Ulala Kodanda Ramu, Budda Kanaka Mahalakshmi, Konkena Janardhana Rao, Jami Yaswanth Sai, Gopisetty Siri, M. Aishwarya, Devi Murali Manohar
Introduction: Chronic wounds, especially the non healing type, are among the foremost common conditions encountered by a surgeon. Currently, steady research is being pursued on the creation of fancy and indulgent topical growth factors for wound healing. One such agent is phenytoin which has a stimulatory effect on connective tissue. Several studies were conducted worldwide to study the effect of phenytoin on chronic ulcers. However, such studies are lacking in our geographical area. Aim: To compare the efficacy of topical phenytoin dressings with conventional saline dressings in the healing of chronic Diabetic Foot Ulcers (DFUs), in terms of the surface area of ulcer, granulation tissue formation as a percentage of the surface area of ulcer, duration of hospital stay, and side effects. Materials and Methods: This was a longitudinal study that included 100 patients with chronic DFUs admitted to a tertiary care hospital, in North Andhra Pradesh for a period of 1 year. The study population was divided into two groups based on the patient’s willingness for undergoing topical phenytoin therapy. Patients willing to undergo the topical phenytoin dressing therapy formed the study group (n=50) and those who were not willing were subjected to traditional saline dressings, which formed the control group (n=50). The variables of the surface area of the ulcer, granulation tissue formation as a percentage of the surface area of the ulcer, duration of hospital stay, and side effects of topical phenytoin dressings were compared using Paired, and Unpaired Student’s t-test, and the p-value of <0.05 was considered significant. Results: The mean age in the study group was 53.94 years and in the control group was 55.92 years. The male:female ratio in the study group was 5:1 and in the control group was 3:1. The mean ulcer surface area in the control group was 37.6 cm2 and in the study group was 40.4 cm2 (p-value=0.012). The mean area of granulation tissue formation in the control group was 36.07 cm2±5.7, and in the study group was 39.63 cm2±2.6 of the total ulcer surface area (p-value=0.001). The granulation tissue formation in the control group was 95.93% of the total ulcer surface area, and in the study group was 98.09% of the total ulcer surface area (p-value=0.001). The mean hospital stay in the control group was 31.3±4.2 days and in the study group was 27.8±2.4 days (p-value=0.001). Conclusion: Phenytoin is better alternative dressing agent with lesser side effects for diabetic foot ulcer care.
慢性伤口,尤其是不愈合型,是外科医生遇到的最常见的情况之一。目前,稳定的研究正在追求创造花式和放纵局部生长因子的伤口愈合。其中一种药物是苯妥英,它对结缔组织有刺激作用。在世界范围内进行了几项研究,以研究苯妥英对慢性溃疡的影响。然而,在我们的地理区域,缺乏这样的研究。目的:比较局部苯妥英敷料与常规生理盐水敷料在慢性糖尿病足溃疡(DFUs)愈合方面的疗效,包括溃疡表面积、肉芽组织形成占溃疡表面积的百分比、住院时间和副作用。材料和方法:这是一项纵向研究,包括100名慢性dfu患者,住在北安得拉邦的一家三级医院,为期1年。根据患者接受局部苯妥英治疗的意愿,将研究人群分为两组。愿意接受局部苯妥英敷料治疗的患者为研究组(n=50),不愿意接受传统生理盐水敷料治疗的患者为对照组(n=50)。溃疡表面积、肉芽组织形成占溃疡表面积的百分比、住院时间和局部苯妥英敷料的副作用等变量采用配对和非配对学生t检验进行比较,p值<0.05被认为是显著的。结果:研究组患者平均年龄53.94岁,对照组患者平均年龄55.92岁。研究组男女比例为5:1,对照组男女比例为3:1。对照组平均溃疡表面积为37.6 cm2,研究组平均溃疡表面积为40.4 cm2 (p值=0.012)。对照组的平均肉芽组织形成面积为36.07 cm2±5.7,研究组的平均肉芽组织形成面积为39.63 cm2±2.6 (p值=0.001)。对照组的肉芽组织形成占溃疡总面积的95.93%,研究组的肉芽组织形成占溃疡总面积的98.09% (p值=0.001)。对照组平均住院时间为31.3±4.2天,研究组平均住院时间为27.8±2.4天(p值=0.001)。结论:苯妥英是治疗糖尿病足溃疡较好的替代敷料,副作用小。
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引用次数: 0
Unusual Communication between Nerve to Mylohyoid and Lingual Nerve and, its Clinical Significance- A Cadaveric Study 骨舌骨神经与舌神经之间异常的沟通及其临床意义——一项尸体研究
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/60561.2903
Bali Sharma, Roma P. Patel, Swapna B. Parate, N. Saini
Introduction: The nerve to mylohyoid is a branch of inferior alveolar nerve which arises just above the mandibular foramen. There is occasionally communicating branch between nerve to mylohyoid and lingual nerve. Knowledge of such variations has significance during oral and submandibular surgery. Aim: To detect and describe the existence and occurrence of anatomical variations in the innervation pattern of the nerve to mylohyoid by using the dissection technique. Materials and Methods: An observational study was carried out from January 2022 to April 2022 in a total of 15 embalmed and formalin-fixed cadavers in the Laboratory of Anatomy of SMBT Medical College, Nashik, Maharashtra. The nerve to the mylohyoid and lingual nerve were cleared and observed for any unusual communication between the two, if any. Results: In 13 (86.67%) cadavers, classical (normal) anatomical presentation of the nerve to mylohyoid was observed, whereas, in two male (13.33%) cadavers, the presence of communicating branch between the nerve to mylohyoid and lingual nerve was observed. In both the cadavers, the communicating branch was unilateral, in one cadaver on the right-side, and in the second cadaver same variation was noted on the left-side. Conclusion: The existence of communication between the nerve to mylohyoid and the lingual nerve is thought to be responsible for inadequate mandibular anesthesia. Through this study, surgeons will be aware of this variance, to explain unexpected findings in nerve injury following oral procedures.
下颌舌骨神经是下牙槽神经的一个分支,位于下颌孔上方。下颌舌骨神经与舌神经之间偶有交通分支。了解这些变异在口腔和下颌手术中具有重要意义。目的:应用解剖技术检测和描述神经至下颌舌骨神经支配方式的解剖变异的存在和发生。材料与方法:于2022年1月至2022年4月在马哈拉施特拉邦纳西克SMBT医学院解剖实验室对15具经防腐处理并经福尔马林固定的尸体进行观察性研究。清除下颌舌骨神经和舌神经,观察两者之间是否有异常的联系。结果:13例(86.67%)尸体具有典型(正常)的骨舌骨神经解剖表现,2例(13.33%)男性尸体存在骨舌骨神经与舌神经之间的交通分支。在两具尸体中,交流分支都是单侧的,其中一具尸体在右侧,第二具尸体的左侧也有相同的变化。结论:下颌舌骨神经与舌神经之间存在交通可能是导致下颌骨麻醉不足的原因。通过这项研究,外科医生将意识到这种差异,以解释口腔手术后神经损伤的意外发现。
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引用次数: 0
Hamstring Tendon Autograft for Chronic Patellar Tendon Rupture- A Series of Ten Cases 自体腘绳肌腱移植治疗慢性髌骨肌腱断裂10例
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/62385.2904
Imran Sajid, Ashish Kumar, Radhika Sahni, Utkarsh Ravi Kant, Sabeel Ahmad
Patellar Tendon (PT) rupture is an uncommon injury of the knee extensors. Majority of the PT ruptures occur at the insertion site, on the inferior pole of the patella as an avulsion injury, mostly in males of <40 years of age and involving sports persons or accidental cases. A case series of 10 cases of neglected PT rupture were managed with primary repair along with augmentation with semitendinosus and gracilis (Hamstring tendons) graft. Patient follow-up was done postoperatively at 2nd week, 6th week, 3 months, 6 months, and then yearly. A knee brace was given to the patient postoperatively to immobilise the knee for two weeks. Static quadriceps strengthening exercises were started from postoperative day two. Assisted quadriceps strengthening exercises were allowed after two weeks postoperatively. Active quadriceps strengthening exercises were initiated after four weeks postoperatively. Partial weight bearing was allowed after four weeks and full weight bearing was allowed after eight weeks postoperatively. Postoperatively functional scoring was done using the International Knee Documentation Committee (IKDC) and Lysholm scores, simultaneously checking the knee range of motion, Insaal-Salvati ratio and quadriceps girth. Total of 8 males and 2 females were present with the mean age 43.9 years ranging from 38-53 years. The average period of follow-up was 25.5 months (range 12-39 months). Results were excellent with faster recovery and regain their normal physically active life around 8 months after reconstruction.
髌骨肌腱断裂是一种少见的膝关节伸肌损伤。大多数PT断裂发生在髌骨下极的插入部位,作为撕脱伤,主要发生在40岁以下的男性,涉及运动员或意外病例。我们对10例被忽视的腘绳肌断裂进行了初步修复,并采用半腱肌和股薄肌(腘绳肌腱)移植物进行了增强。术后随访时间分别为2周、6周、3个月、6个月,然后每年随访一次。术后给予患者膝关节支架固定膝关节两周。术后第2天开始进行静态股四头肌强化训练。术后两周进行辅助股四头肌强化训练。术后四周开始积极的股四头肌强化训练。术后4周允许部分负重,术后8周允许全部负重。术后功能评分采用国际膝关节文献委员会(International Knee Documentation Committee, IKDC)和Lysholm评分,同时检查膝关节活动范围、Insaal-Salvati比值和股四头肌围。男8例,女2例,平均年龄43.9岁,年龄38 ~ 53岁。平均随访时间25.5个月(12-39个月)。术后8个月左右患者恢复较快,恢复了正常的身体活动生活。
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引用次数: 0
Evaluation of Carotid Arteries in Stroke Patients using Colour Doppler Sonography: A Cross-sectional Study 彩色多普勒超声评价脑卒中患者颈动脉:一项横断面研究
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/62609.2888
Rakesh Vijaywargiya, Gaurav Bhandari, Vasudev Lodhi, Aksha Tanwani
Introduction: Cerebral ischaemic stroke is a neurological condition that can be fatal and debilitating and is one of the leading causes of morbidity and mortality. The major benefit of sonography is its capacity to describe plaque and identify plaques with increased risk of embolisation, in addition, to evaluate the degree of stenosis. Aim: To diagnose and characterise the plaque morphology in extracranial portion of carotid arteries using colour Doppler sonography in patients with stroke. Materials and Methods: A time-bound, hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, MGM Medical College and MY Hospital, Indore, Madhya Pradesh, India from August 2021 to July 2022. There were 80 stroke patients in the study. Risk factors like smoking, diabetes, hypertension, and family history were recorded. B- mode ultrasonography was used to assess carotid arteries and various Doppler parameters like Peak Systolic Velocity (PSV). Plaque characteristics and morphology like smooth margin, irregular margin, ulceration and haemorrhage were evaluated. Statistical parameters such as Student’s t-test were used for association between ICA PSV and ICA/CCA PSV with degree of stenosis. Results: Hypertension was the most common risk factor 57 (71.1%). A total of 54 (67%) stroke patients were found to have plaque in their carotid vasculature. A total of 21 (38.8%) of patients had type-3 plaque followed by type-1 plaque 14 (25.9%). Out of 67% of patients who had plaque, majority of patients 38 (47.5%) had <50% stenosis and 16 (29.6%) of patients had significant stenosis (>50%). Conclusion: It was shown that carotid Doppler ultrasonography can be used as a screening tool for patients, who have risk factors for stroke to find asymptomatic carotid disease.
脑缺血性中风是一种神经系统疾病,可致死性和衰弱性,是发病率和死亡率的主要原因之一。超声检查的主要好处是它能够描述斑块和识别栓塞风险增加的斑块,此外,还可以评估狭窄程度。目的:应用彩色多普勒超声诊断脑卒中患者颈动脉颅外区斑块形态。材料和方法:2021年8月至2022年7月,在印度中央邦印多尔市米高梅医学院放射诊断科和MY医院进行了一项有时限的、基于医院的横断面研究。研究中有80名中风患者。吸烟、糖尿病、高血压和家族史等危险因素被记录下来。B超检查颈动脉及各多普勒参数,如峰值收缩速度(PSV)。观察斑块的形态特征,如光滑边缘、不规则边缘、溃疡和出血。ICA PSV和ICA/CCA PSV与狭窄程度的相关性采用Student’s t检验等统计参数。结果:高血压是最常见的危险因素57(71.1%)。共有54例(67%)中风患者在颈动脉血管中发现斑块。3型斑块21例(38.8%),1型斑块14例(25.9%)。在67%有斑块的患者中,大多数38例患者(47.5%)有50%。结论:颈动脉多普勒超声可作为有卒中危险因素的患者发现无症状颈动脉病变的筛查工具。
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引用次数: 0
Umbilical and Juxtaumbilical Chronic Discharging Sinus as a Delayed Complication of Caesarean Section: A Case Series 剖宫产迟发性并发症脐及脐旁慢性排出窦:一个病例系列
Pub Date : 2023-01-01 DOI: 10.7860/ijars/2023/60327.2931
Sukumar Mitra, Shyamali Dutta, Krutika Sandeep Sawant, Sohini Sen, MD Mohsin
Cutaneous or uterocutaneous sinus or fistula following caesarean section is a rare complication that can occur after the primary wound has healed. Only a few cases have been reported where a fistula or sinus tract forms after a caesarean section. These tracts can communicate externally through the scar line or the skin near the umbilicus (juxtaumbilical) and internally to the uterine scar or an unhealthy abnormal cavity. It is a delayed complication that presents with discharge from the skin opening and can be diagnosed using imaging techniques such as Ultrasonography (USG), Magnetic Resonance Imaging (MRI), Fistulogram, or Sinogram. These tracts often seek weak areas to establish external or internal connections with other organs. The management of these abnormal tracts can vary from conservative approaches to surgical excision. Herein, the authors presented a series of three cases of cutaneous and uterocutaneous fistula following caesarean section. In case 1, a 19-year-old female patient presented with a discharging sinus from the umbilicus, which was found to be a sinus tract communicating inside the abdominal wall to the external skin on imaging. The patient underwent surgery, which involved excision of the sinus tract and necrotic debridement. Two similar cases (cases 2 and 3) were infra and paraumbilical regions that presented with chronic discharges in the infra and para umbilical region following Lower Segment Caesarean Section (LSCS) delivery. Both cases were diagnosed with cutaneous sinus tracts in the juxtaumbilical region using USG and other imaging modalities. They were managed conservatively with appropriate antibiotics and achieved complete healing without any residual infection during follow-up.
剖宫产术后皮肤或子宫皮窦或瘘是一种罕见的并发症,可在原发伤口愈合后发生。只有少数病例被报道在剖宫产后形成瘘管或窦道。这些小束可以通过瘢痕线或脐附近的皮肤(近脐)与外部联系,并在内部与子宫瘢痕或不健康的异常腔相连。这是一种延迟的并发症,表现为皮肤开口有分泌物,可以使用超声(USG)、磁共振成像(MRI)、瘘管图或Sinogram等成像技术进行诊断。这些神经束经常寻找薄弱的区域与其他器官建立外部或内部的联系。这些异常尿道的处理可以从保守方法到手术切除。在此,作者提出了一系列的三例皮肤和子宫皮瘘后剖宫产。病例1,19岁女性患者,表现为脐排出性窦,影像学显示为腹壁内与外皮肤相通的窦道。患者接受手术,包括窦道切除和坏死性清创。两个类似的病例(病例2和病例3)是脐下区和脐旁区,在下段剖宫产(LSCS)分娩后出现脐下区和脐旁区慢性放电。两例均经超声心动图及其他影像学检查诊断为脐旁区皮肤窦束。在随访期间,患者均采用适当的抗生素保守治疗,完全愈合,无任何残留感染。
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引用次数: 0
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International Journal of Anatomy Radiology and Surgery
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