Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia

Important structures involved in the pathogenesis of occipital headache include the aponeurotic attachments of the trapezius and semispinalis capitis muscles to the occipital bone. The greater occipital nerve (GON) can become entrapped as it passes through these aponeuroses, causing symptoms of occipital neuralgia. The aim of this study was to identify topographic landmarks for accurate identification of GON, which might facilitate its anaesthetic blockade. The course and distribution of GON and its relation to the aponeuroses of the trapezius and semispinalis capitis were examined in 100 formalin-fixed adult cadavers. In addition, the relative position of the nerve on a horizontal line between the external occipital protuberance and the mastoid process, as well as between the mastoid processes was measured. The greater occipital nerve was found bilaterally in all specimens. It was located at a mean distance of 3.8 cm (range 1.5–7.5 cm) lateral to a vertical line through the external occipital protuberance and the spinous processes of the cervical vertebrae 2–7. It was also located approximately 41% of the distance along the intermastoid line (medial to a mastoid process) and 22% of the distance between the external occipital protuberance and the mastoid process. The location of GON for anaesthesia or any other neurosurgical procedure has been established as one thumb’s breadth lateral to the external occipital protuberance (2 cm laterally) and approximately at the base of the thumb nail (2 cm inferior). This is the first study proposing the use of landmarks in relation to anthropometric measurements. On the basis of these observations we propose a target zone for local anaesthetic injection that is based on easily identifiable landmarks and suggest that injection at this target point could be of benefit in the relief of occipital neuralgia

EVALUATION OF STABILITY AND MATURITY OF COMPOSTED RICE STRAW, OLIVE POMACE AND SOME AGRICULTURAL WASTES

Composting technique is considered as one of the environmentlly friendly methods used for recycling the excess residues of rice straw ( RS) and solving the environmental problems of olive pomace (OP) by-product of the olive oil industry. For this purpose, three compost piles were made from mainly rice straw, different ratios of olive pomace and some agricultural wastes viz. tomato hallum, banana residues and farmyard manure to evaluate the stability and maturity of composted materials during 90-day composting period. The first pile (A) was made of 60% RS+10% OP+10% tomato hallum+10% banana residues+10% farmyard manure, the second pile (B) wase made of 50% RS +20% OP+10% tomato hallum+ 10% banana residues+ 10% farmyard manure while the  third pile (C) was made from 40% RS + 30% OP10% tomato hallum+ 10% banana residues+ 10% farmyard manure. Representative compost samples were taken after 15, 30, 45, 60 and 90 days of the composting process. The results revealed that slight increase in temperature occurred through the first 2-3 days of composting to reach  the maximum values at 30 days of composting (thermophilic stage). All the composts showed a more pronounced increase in pH, EC, bulk density and total nitrogen, while total organic carbon significantly declined with composting progress. Consequentially, the C/N ratios became narrowed during composting process where they reached 18.80 for pile C. At maturity stage, the greatest values of humification parameters (Humification index, Humification degree and Humification rate) were obtained by pile C followed by pile B. Meanwhile, the ratio of  NH4+/NO3- as an indicator to nitrification process, Extinction coefficient (E4/E6) as well as CO2 rate decreased gradually to reach the minimum values. Finally, the highest values of germination index (92.22 and 95.39%) were achieved with pile C for cress and barley seeds, respectivel

Geographic Variation in Surgical Practice Patterns and Outcomes for Resected Nonmetastatic Gastric Cancer in Ontario

Background: Gastrectomy with negative resection margins and adequate lymph node dissection is the cornerstone of curative treatment for gastric cancer (GC). However, gastrectomy is a complex and invasive operation with significant morbidity and mortality. Little is known about surgical practice patterns or short- and long-term outcomes in earlystage GC in Canada. Methods: We undertook a population-based retrospective cohort study of patients with GC diagnosed between 1 April 2005 and 31 March 2008. Chart review provided clinical and operative details such as disease stage, primary tumour location, surgical approach, operation, lymph nodes, and resection margins. Administrative data provided patient demographics, geography, and vital status. Variations in treatment and outcomes were compared for 14 local health integration networks. Descriptive statistics and log-rank tests were used to examine geographic variation. Results: We identified 722 patients with nonmetastatic resected GC. We documented significant provincial variation in case mix, including primary tumour location, stage at diagnosis, and tumour grade. Short-term surgical outcomes varied across the province. The percentage of patients with 15 or fewer lymph nodes removed and examined varied from 41.8% to 73.8% (p = 0.02), and the rate of positive surgical margins ranged from 15.2% to 50.0% (p = 0.002). The 30-day surgical mortality rates did not vary statistically significantly across the province (p = 0.13); however, rates ranged from 0% to 16.7%. Overall 5-year survival was 44% and ranged from 31% to 55% across the province. Conclusions: This cohort of patients with resected stages I–III GC is the largest analyzed in Canada, providing important historical information about treatment outcomes. Understanding the causes of regional variation will support interventions aiming to improve GC operative outcomes in the cancer system