Association between frontal sinus development and persistent metopic suture

Background: Frontal sinuses are 2 irregular cavities, placed between 2 lamina of frontal bone. Expansion continues during childhood and reaches full size after puberty. Persistent metopic suture is one of the factors that are related to abnormal frontal sinus development. In this study, we want to discuss about the coexistence of persistent metopic suture and abnormal frontal sinus development using radiological techniques.Materials and methods: In this retrospectively planned study, images of 631 patients were examined, 217 (34.4%) of them were men and 414 (65.6%) of them were women. Brain computed tomography and magnetic resonance images were retrieved from the electronic archive for analysis.Results: In this study, frontal sinus development is categorised as right side atrophy, left side atrophy, bilateral atrophy and bilaterally developed sinuses. The presence of metopic suture was accepted as persistent metopic suture. Frontal sinus atrophy was found in 22.7% and persistent metopic sutures were found in 9.7% of overall.Conclusions: In this study, no significant results were detected that were relatedto the frontal sinus agenesis or dismorphism associated with persistent metopicsuture. We conclude that, although publications propounding metopism thatleads to abnormal frontal sinus development are present in the literature, noreasonable explanation has been mentioned in these articles; and we believe thatthese findings are all incidental.

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Effects on visual function of glistenings and folding marks in AcrySof intraocular lenses

Purpose. To study the effects on visual function of glistenings and folding marks in AcrySofs (Alcon) intraocular lenses (IOLs). Setting. Department of Ophthalmology, Dokuz Eylul University, School of Medicine, Izmir, Turkey

The Prevalence And Distribution Of The Atherosclerotic Plaques In The Abdominal Aorta And Its Branches

Background: The aim of our study was to determine the existence, distribution, type and burden of the atherosclerotic plaques which are found in the abdominal aorta, its branches and the branching points. Materials and methods: Two hundred and sixty-one patients (117 female, 144 male; mean age 53.34 +/- 16.02, range 12-84) who underwent dual-source computed tomography angiography (CTA) were retrospectively analysed. The prevalence and distribution of the plaques in the proximal, middle and distal parts of abdominal aorta and its branches; coeliac trunk, superior and inferior mesenteric arteries, renal arteries, splenic artery and common, external and internal iliac arteries and in the aortic orifices, the type and severity of these plaques and their relations with age and gender were studied. Results: In our study, 69.3% of the patients had atherosclerotic plaques, mostly at the distal part of abdominal aorta. The existence of the plaques increased with age. The types of these plaques were mixed (43%), calcified (24%) and soft (3%). Mixed and calcified plaques were more common in the abdominal aorta and its branches, respectively. All of the arteries except for inferior mesenteric artery mostly had mild plaques. The plaques at the branching points, which were most frequently localised in the aortic bifurcation, were found in the 41.8% of the patients. The plaques in the branches were usually accompanied by atherosclerosis of abdominal aorta. Conclusions: Dual-source CTA enables mapping of atherosclerotic burden in abdominal arteries. Knowing the localisation, type and severity of the atherosclerotic plaques can be important to predict the clinical results and choose the proper treatment.WoSScopu

Revisiting the Relationship Between the Submandibular Duct, Lingual Nerve and Hypoglossal Nerve

Background: The aim of the study was to evaluate the relations between submandibular duct, lingual nerve and hypoglossal nerve for making a reassessment of this area in fresh frozen specimens. Also, the distance between the angle of the mandible and the vertical line drawn from the point where submandibular duct crossed lingual nerve to the base of the mandible was measured to determine a new landmark for neck surgeons. Materials and methods: Fourteen fresh frozen head and neck specimens were dissected and evaluated. A marginal mandibular incision was made from the mastoid process to the chin. Results: In 8 cases, lingual nerve was crossing the submandibular duct superiorly; in 5 cases, lingual nerve was crossing the duct infero-medially and in 1 case it was parallel to the duct. In 1 case, lingual nerve subdivided into anterior and posterior branches. In 2 cases, 2 parallel submandibular ducts were found and the lingual nerve was crossing the upper duct from superior. In 1 case, lingual nerve was crossing the duct infero-medially and then it was subdividing into branches superior to mylohyoid. In 12 cases, the course of hypoglossal nerve was classical. In 1 case, hypoglossal nerve crossed the submandibular duct medially and coursed parallel to the tendon of posterior belly of digastric. And in another case, hypoglossal nerve crossed the inferior branch of submandibular duct medially. The other structures in this area were as usual. Conclusions: The main factor for reducing nerve damage during surgery is the understanding of the anatomy of this area.WoSScopu

Soft Spot: The Important Zone At The Standard Posterior Portal Of Shoulder Arthroscopy

Background/aim: The localization of the standard posterior portal of shoulder arthroscopy and landmarks mentioned in the literature are unclear. The purpose of this prospective cadaveric study was to determine the localization of the standard posterior portal and its distance to the neural structures. Materials and methods: One fresh frozen and 10 formalin-fixed adult cadaveric shoulders were dissected. In the beach chair position, a 5-mm trocar was placed anteroposteriorly from the superior edge of the subscapularis muscle, superior to the tip of the coracoid process and tangent to the glenoid. The relevant distances of the posterior exit point were measured. Results: In all specimens, the exit point was a triangular fibrous area, between the posterior and lateral parts of the deltoid. Medial and inferior distances of the trocar to the posterolateral tip of the acromion were 1.88 +/- 0.53 cm and 1.35 +/- 0.34 cm and distances to the axillary and suprascapular nerves were 4.54 +/- 1.08 cm and 2.54 +/- 0.85 cm, respectively. Conclusion: The most important finding of this study was the superficial localization of the soft spot between the posterior and lateral parts of deltoid.WoSScopu