External jugular vein pierced by supraclavicular branches in a neonatal cadaver : a case report

Anatomical variations in the venous structure and drainage patterns in the neck are not uncommon. However, this is the first known report on the external jugular vein being pierced by supraclavicular branches. In the lateral cervical region of a neonatal cadaver, the supraclavicular branches penetrated the external jugular vein superior to the clavicle, resulting in a circular venous channel formed around the nerve trunk. Variations such as these are important to note in order to minimize possible intra-operative complications sustained during surgical interventions such as venous catherization or nerve grafts.http://link.springer.com/journal/12565hj2022Anatom

A cadaveric study of the erector spinae plane block in a neonatal sample

BACKGROUND : The aim of this article was to provide a detailed description of the neonatal anatomy related to the erector spinae plane block and to report the spread of the dye within the fascial planes and potential dermatomal coverage. METHODS : Using ultrasound guidance, the bony landmarks and anatomy of the erector spinae fascial plane space were identified. The erector spinae plane block was then replicated unilaterally in two fresh unembalmed neonatal cadavers. Using methylene blue dye, the block was performed at vertebral levels T5—using 0.5 mL in cadaver 1—and T8—using 0.2 mL in cadaver 2. The craniocaudal spread of dye was tracked within the space on the ultrasound screen and further confirmed on dissection. RESULTS : Craniocaudal spread was noted from vertebral levels T3 to T6 when the dye was introduced at vertebral level T5 and from vertebral levels T7 to T11 when the dye was introduced at vertebral level T8. Furthermore, the methylene blue spread was found anteriorly in the paravertebral and epidural spaces, staining both the dorsal and ventral rami of the spinal nerves T2 to T12. Small amounts of dye were also found in the intercostal spaces. CONCLUSION : In two neonatal fresh cadavers, the dye was found to spread to multiple levels and key anatomic locations.This study was funded by National Research Foundation (NRF).https://rapm.bmj.comhj2020Anatom

Clinical anatomy of the maxillary nerve block in pediatric patients

BACKGROUND : Anatomical landmarks in children are mostly extrapolated from studies in adults. Despite this, complex regional anesthetic procedures are frequently performed on pediatric patients. Sophisticated imaging techniques are available but the exact position, course and/or relationships of the structures are best understood with appropriate anatomical dissections. Maxillary nerve blocks are being used for peri-operative analgesia after cleft palate repair in infants. However, the best approach for blocking the maxillary nerve in pediatric patients has yet to be established. OBJECTIVE : To determine the best approach for blocking the maxillary nerve within the pterygopalatine fossa. METHODS : In an attempt to define an optimal approach for maxillary nerve block in this age group three approaches were simulated and compared on 10 dried pediatric skulls as well as 30 dissected pediatric cadavers. The needle course, including depth and angles, to block the maxillary nerve, as it exits the skull at the foramen rotundum within the pterygopalatine fossa, was measured and compared. Two groups were studied: Group 1 consisted of skulls and cadavers of neonates (0–28 days after birth) and Group 2 consisted of skulls and cadavers from 28 days to 1 year after birth. RESULTS : No statistically significant difference (P > 0.05) was found between the left and right side of each skull or cadaver. Only technique B, the suprazygomatic approach from the frontozygomatic angle towards the pterygopalatine fossa, exhibited no statistical significance (P > 0.05) when other measurements made on the skulls and cadavers were compared. Technique A, a suprazygomatic approach from the midpoint on the lateral border of the orbit, as well as technique C, an infrazygomatic approach with an entry at a point on a vertical line extending along the lateral orbit wall, showed statistical significant differences when measurements of the skulls and cadavers were compared. CONCLUSIONS : On the basis of these findings technique B produces the most consistent data for age groups 1 and 2 and supports the clinical findings recently reported.National Research Foundation (NRF)http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1460-95922015-07-30hb201

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Anaesthesia and Pentalogy of Cantrell: syndromic vignettes in anaesthesia

No Abstract Available Southern African Journal of Anaesthesia & Analgesia Vol.10(4) 2004: 5-

Anatomy of the greater occipital nerve block in infants

BACKGROUND : Pain relief for posterior fossa craniotomies as well as occipital neuralgia, are indications for the use of the greater occipital nerve block in children. The greater occipital nerve originates from the C2 spinal nerve and is accompanied by the occipital artery as it supplies the posterior scalp. AIMS : The aim of this study was to develop a unique, yet simple technique for blocking the greater occipital nerve in children through the evaluation of the anatomy of this nerve and the accompanying occipital artery in the occipital region. METHODS : The greater occipital nerve and occipital artery were dissected and exposed in six formalin‐fixed cadavers (five infants [average age of 51.4 days] and one 2‐year‐old) from the Department of Anatomy, University of Pretoria. Measurements between the nerve and selected bony landmarks were obtained. The relationship between the greater occipital nerve and the occipital artery at the trapezius muscle hiatus was also evaluated. RESULTS : The greater occipital nerve is on average 22.6 ± 5.6 mm from the external occipital protuberance in infants. The average width of the medial three fingers measured at the proximal interphalangeal joint, for each respective cadaver is 20.4 ± 4.0 mm, with a strong correlation coefficient of 0.97 between the aforementioned distances. In 83.3% of the specimens, the occipital artery lies lateral to the greater occipital nerve at the trapezius muscle hiatus. CONCLUSION : In infants, the greater occipital nerve can be blocked approximately 23 mm from the external occipital protuberance, medial to the occipital artery. This distance is equal to the width of the medial three fingers at the proximal interphalangeal joint of the patient.http://wileyonlinelibrary.com/journal/pan2020-09-01hj2019Anatom

Anatomical description of the sciatic nerve block at the subgluteal region in a neonatal cadaver population

INTRODUCTION : Sciatic nerve blocks provide intraoperative and prolonged postoperative pain management after lower limb surgery (posterior knee, foot, skin graft surgery). Accurate needle placement requires sound anatomical knowledge. Anatomical studies on children are uncommon; most have been performed on adult cadavers. We studied the location of the sciatic nerve at the gluteal level in neonatal cadavers to establish useful anatomical landmarks. METHODS : We identified the sciatic nerve in the gluteal and thigh region of 20 neonatal cadavers. The skin covering the gluteal and thigh region was reflected laterally, and the underlying structures and muscles were identified. We located the sciatic nerve and measured the distance from the nerve to the greater trochanter of the femur and to the tip of the coccyx with a mechanical dial caliper. The total distance between the two landmarks was then recorded. RESULTS : We combined measurements from both sides to form a sample size n = 40. The sciatic nerve was 14.9 ± 2.4 mm lateral to the tip of the coccyx. The total distance between the greater trochanter and the tip of the coccyx was 27.3 ± 4.0 mm. CONCLUSION : Our results provide anatomical evidence that the optimal needle insertion point is approximately halfway between the greater trochanter and the tip of the coccyx—a landmark readily palpable in neonates and infants.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1460-95922018-06-30hj2017Anatom

The extent of cranio-caudal spread within the erector spinae fascial plane space using computed tomography scanning in a neonatal cadaver

BACKGROUND : The erector spinae plane block (ESP) is a novel approach for blockade of the spinal nerves in infants, children, and adults. Until recently, the gold standard for truncal procedures includes the paravertebral and epidural blocks. However, the exact mechanism by which this blockade is achieved is subject to debate. METHODS : 2.3 mL (1 mL/kg) of iodinated contrast dye was injected bilaterally into the erector spinae fascial plane of a fresh unembalmed preterm neonatal cadaver (weighing 2.3 kg), to replicate the erector spinae plane block and to track the cranio‐caudal spread of the contrast dye using computed tomography. The “block” was performed at vertebral level T8 on the right‐hand side and at vertebral level T10 on the left‐hand side. RESULTS : Contrast dye was spread over three dermatomal levels from T6 to T9 on the right‐hand side, while on the left‐hand side, the spread was seen over four dermatomal levels from T9 to T11/12. Contrast dye also spread over the costotransverse ligament, into the paravertebral space and further lateral from the lateral border of the erector spinae muscle into the intercostal space. However, no spread was seen in the epidural space. CONCLUSION : The erector spinae plane block is a versatile technique that can be part of the multimodal postoperative analgesic strategy for truncal surgery. In this study, contrast material dye was tracked over four vertebral levels in the paravertebral space (suggesting an approximate volume of 0.5‐0.6 mL per dermatome).The National Research Foundation (NRF)http://wileyonlinelibrary.com/journal/pan2021-04-08hj2020Anatom