Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study

Purpose: Erector spinae plane (ESP) block is an interfascial blockade used in different clinical scenarios. This study investigated the ventral extent of dye diffusion in ESP block. Methods: The ultrasound-guided ESP block was bilaterally performed with an injection at the T5 vertebral level (21-Gauge, 50\ua0mm needle), using diluted black tissue marking dye (20\ua0mL; 1:4 ratio with standard saline solution) instead of local anesthetic on two fresh-frozen corpses within the body donation program of the University of Padova. Subsequently, the gross anatomical dissection was performed by a combined posterior plus anterior approach, and the histotopographic examination completed. Results: Macroscopically by gross anatomical dissection, the dye spreading ranged on the dorsal side of the chest from T2/3 to T10/11 with an extension up to 10\ua0cm laterally, and on the ventral side of the chest from T2/3\u2013T9/10. Microscopically by histotopographic examination, the dye diffused ventrally to the intercostal spaces (2\u20133 and 5\u20136 spaces on the right and left, respectively) by following the blood vessels coupled to the dorsal nerve passing through the costotransverse foramen. Conclusions: The anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block

A light on the dark side: In vivo endoscopic anatomy of the posterior third ventricle and its variations in hydrocephalus

Objective: Despite the technological advancements of neurosurgery, the posterior part of the third ventricle has always been the "dark side"of the ventricle. However, flexible endoscopy offers the opportunity for a direct, in vivo inspection and detailed description of the posterior third ventricle in physiological and pathological conditions. The purposes of this study were to describe the posterior wall of the third ventricle, detailing its normal anatomy and surgical landmarks, and to assess the effect of chronic hydrocephalus on the anatomy of this hidden region. Methods: The authors reviewed the video recordings of 59 in vivo endoscopic explorations of the posterior third ventricle to describe every identifiable anatomical landmark. Patients were divided into 2 groups based on the absence or presence of a chronic dilation of the third ventricle. The first group provided the basis for the description of normal anatomy. Results: The following anatomical structures were identified in all cases: adytum of the cerebral aqueduct, posterior commissure, pineal recess, habenular commissure, and suprapineal recess. Comparing the 2 groups of patients, the authors were able to detect significant variations in the shape of the adytum of the cerebral aqueduct and in the thickness of the habenular and posterior commissures. Exploration with sodium fluorescein excluded the presence of any fluorescent area in the posterior third ventricle, other than the subependymal vascular network. Conclusions: The use of a flexible scope allows the complete inspection of the posterior third ventricle. The anatomical variations caused by chronic hydrocephalus might be clinically relevant, in light of the commissure functions

Traumatic funicular phlebitis of the thoracic wall resembling Mondor's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Mondor's disease is a peculiar form of thrombophlebitis, involving a superficial vein in the subcutaneous fat of the breast or anterior chest wall.</p> <p>Case presentation</p> <p>The author presents a case of a 35-year-old male Japanese patient with cord-like induration in the right lateral thoracic wall. This lesion was diagnosed as traumatic funicular phlebitis, resembling Mondor's disease.</p> <p>Conclusion</p> <p>Traumatic funicular phlebitis, resembling Mondor's disease, is a clinical entity which may give suggestive insight to the etiology of Mondor's disease itself.</p

La TC multi-slice nella determinazione della distanza di sparo

Introduzione Ad oggi, tutte le procedure di analisi impiegate nella stima della distanza di sparo prevedono la valutazione della distribuzione, sulla superficie bersaglio, del gunshot residue (GSR). Presentiamo un approccio alla determinazione del firing range basato sull\u2019applicazione della TC spirale multi-slice su ferite d\u2019arma da fuoco prodotte sperimentalmente su cute umana. Materiali e metodi Campione casistico: 6 gambe umane di soggetti sottoposti in vita ad amputazione chirurgica, sezionate in segmenti di circa 6 cm di lunghezza. Prove di sparo: sono state eseguite utilizzando una pistola semiautomatica Beretta Mod.81 calibro 7.65mm; mediante supporti rigidi dell\u2019altezza di 5 cm, 15 cm e 30 cm, sono state effettuate 6 prove di sparo per distanza, per un totale di 18 prove. Ogni prova \ue8 stata eseguita su di un differente segmento di arto. Analisi radiologica: ogni segmento \ue8 stato scansionato con TC spirale multi-slice a 64 strati; le acquisizioni TC sono state ricostruite in 3D secondo diverse tecniche. Risultati: Nei colpi sparati a 5 cm di distanza \ue8 stato rilevato materiale radio-opaco localizzato concentricamente rispetto al foro d\u2019entrata; nei colpi sparati a 15 cm di distanza sono state rilevate aree radio-opache di aspetto puntiforme nell\u2019area circostante il foro d\u2019ingresso. Nei colpi sparati da 30 cm e in tutti i fori d\u2019uscita non sono stati rilevati residui radio-opachi. Le immagini 3D hanno permesso la ricostruzione dei tramiti prodotti dai proiettili. Conclusioni: L\u2019analisi con TC multi-slice consente di discriminare i colpi sparati a 5 cm da quelli sparati a 15 cm in base all\u2019entit\ue0 e alla morfologia dei depositi radio-opachi di GSR; costituisce, inoltre, un valido ausilio nell\u2019identificazione del foro d\u2019entrata. Tuttavia, gi\ue0 a 30 cm non e\u300 in grado di rilevare residui di sparo. Trattasi, pertanto, di una tecnica rapida e di facile esecuzione, spendibile nella determinazione della distanza di sparo per colpi d\u2019arma da fuoco esplosi da distanze ravvicinate, nonch\ue8 nella diagnosi differenziale tra foro d\u2019entrata e di uscita, sebbene presenti sensibilit\ue0 e specificit\ue0 inferiori rispetto ad analisi istochimiche, di microscopia elettronica e radiologiche

Environmental restoration by aquatic angiosperm transplants in transitional water systems: The Venice Lagoon as a case study

The paper reports the results obtained after 4 years of aquatic angiosperm transplants in areas of the Venice Lagoon (North Adriatic Sea, Mediterranean) where meadows almost disappeared due to eutrophication, pollution and overexploitation of clam resources. The project LIFE12 NAT/IT/000331-SeResto, funded by the European Union, allowed to recolonize the Habitat 1150* (coastal lagoons) in the northernmost part of the lagoon, by extensive manual transplants of small sods or single rhizomes of Zostera marina, Zostera noltei, Ruppia cirrhosa and, in some stations also of Cymodocea nodosa. Over the 4 years of the project more than 75,000 rhizomes were transplanted in 35 stations with the support of local stakeholders (fishermen, hunters and sport clubs). Plants took root in 32 stations forming extensive meadows on a surface of approx. 10 km2 even if some failures were recorded in areas affected by outflows of freshwater rich in nutrients and suspended particulate matter. The rapid recovery of the ecological status of the involved areas was the result of this meadow restoration, which was in compliance with Water Framework Directive (WFD 2000/60/EC) objectives. Moreover, the monitoring of environmental parameters in the water column and in surface sediments allowed to identify the best conditions for successful transplants. Small, widespread interventions and the participation of local stakeholders in the environmental recovery, make this action economically cheap and easily transposable in other similar environments