Μελέτη της δομής και των δεματίων της λευκής ουσίας του προσφηνοειδούς λοβίου: Η σχέση τους στις προσπελάσεις του τριγώνου της πλάγιας κοιλίας

Η ανατομία του ανθρώπινου προσφηνοειδούς λοβίου παρουσιάζει αρκετές παραλλαγές και παραμένει μία από τις λιγότερο χαρτογραφημένες περιοχές του ανθρώπινου εγκεφάλου. Αν και έχει αναφερθεί επανειλημμένα η λειτουργική συνδεσιμότητα του προσφηνοειδούς λοβίου καθώς και η σημασία της, το υποκείμενο κύκλωμα των δεματίων της λευκής ουσίας δεν έχει χαρακτηριστεί ακόμα. Η κατανόηση της υποκείμενης δομικής συνδεσιμότητας αυτών των δικτύων της λευκής ουσίας έχει μεγάλη σημασία για τον ακριβή χαρακτηρισμό των δεματίων, την αποσαφήνιση της λειτουργίας τους και την σχέση τους σε νευροχειρουργικές προσπελάσεις. Ο σκοπός αυτής της διατριβής ήταν η μελέτη της φλοιώδης επιφανειακής ανατομίας και των δεματίων της περιοχής του προσφεινοειδούς λοβίου σε ανατομικά παρασκευάσματα. Χαρτογραφώντας την επιφανειακή ανατομία του προσφηνοειδούς λοβίου και χρησιμοποιώντας την τεχνική διατομής λευκής ουσίας, αναδεικνύουμε τις παραλλαγές της υποβρεγμάτιας αύλακας και της βρεγματοϊνιακής σχισμής καθώς και την ανατομία και συνδεσιμότητα του Sledge Runner Fasciculus (SRF), ραχιαίου τμήματος του άνω επιμήκους δεματίου (SLF-1), του μέσου επιμήκους δεματίου (Mdlf), της κάτω μετωπιαία-ινιακής δεσμίδας, έξω κάψας και του πέμπτου τμήματος του προσαγωγείου (CB-V). Βρήκαμε ότι η επιφανειακή ανατομία του Precuneus εμφανίζει πολλές παραλλαγές. Επίσης καταγράψαμε ότι το MdLF-I συνδέει τον πόλο του κροταφικού λοβού και την άνω κροταφική έλικα με το προσφηνοειδές λοβίο, το SRF να μην συμμετάσχει στη συνδεσιμότητα του προσφηνοειδούς λοβίου αλλά να συνδέει τις φλοιώδεις περιοχές του πρόσθιου σφηνοειδούς λοβίου, του ισθμού του προσαγωγείου και του οπίσθιου τμήματος της παραϊοππόκαμπιας έλικας; το SLF- 1 να συνδέει το προσφηνοειδές λοβίο με περιοχές της έσω επιφάνειας του μετωπιαίου λοβού; το IFOF να συνδέει τον προσφηνοειδές λοβίο με τον μετωπιαίο λοβό και το CB-V να συνδέει το προσφηνοειδές λοβίο με τον έσω κροταφικό λοβό και την ατρακτοειδή έλικα.The anatomy of the human precuneus exhibits significant variability and has remained one of the less accurately mapped areas of the human brain. Although the functional connectivity of the precuneus and its significance have been repeatedly reported, the underlying structural circuit has not been characterized. Understanding the underlying structural connectivity of these networks is critical for refining their circuitry, clarifying their function and implementing safe neurosurgical approaches. The aim of this dissertation was to investigate the surface anatomy and fiber tracts of the precuneal region in cadaveric specimens. By mapping the sulcal anatomy of the precuneus and employing the fiber microdissection technique, we demonstrate the variations of the Subparietal sulcus (SpS) and the parietooccipital sulcus (POS) and the anatomy and connectivity of the Sledge Runner Fasciculus (SRF), dorsal component of the superior longitudinal fasciculus (SLF- 1), middle longitudinal fasciculus (Mdlf), inferior fronto-occipital fasciculus (IFOF), claustrocortical fibers and fifth component of the cingulum bundle (CB-V). We found the Precuneus surface anatomy to be considerably variable. We also found The MdLF-I, connecting the dorsolateral Temporal Pole and STG to the precuneus; SRF not to participate in the connectivity of the precuneus but connecting the cortical areas of the anterior cuneus, anterior lingula, isthmus of the cingulum and posterior parahippocampal gyrus; SLF- 1 connecting the precuneus with areas of the medial frontal lobe ; the IFOF connecting the precuneus with the frontal lobe; claustrocortical fibers connecting the precuneus with the claustrum and The CB-V connecting the precuneus with the regions of the temporal lobe

Desmoid tumor in Gardner's Syndrome presented as acute abdomen

BACKGROUND: Gardner's syndrome can occasionally be complicated with intra-abdominal desmoid tumor. These tumors usually remain asymptomatic but can exhibit symptoms due to intestinal, vascular and ureteral compression and obstruction. CASE PRESENTATION: A rare case of a 41-year-old male patient with Gardner's syndrome complicated with intra-abdominal desmoid tumor, which first presented as acute abdomen, is presented. CONCLUSION: Extra-abdominal manifestations of Gardner's syndrome along with a palpable abdominal mass would raise suspicion for the presence of a desmoid tumor in the majority of cases. In life-threatening cases, surgical treatment should be considered as a palliative approach, though the extent of excision remains debatabl

The first Anatomy professors in the Medical School of the University of Athens

The purpose of this historical review is to add new elements to the international literature in relation to the birth and progress of the science of anatomy in modern Greece. Step by step, it outlines the efforts of prominent Greek anatomists to establish the course of the basic science of anatomy in the newly founded Medical School, the laborious effort to collect cadaveric material, to compile museum anatomical collections and to gradually build the foundations of modern anatomy science at the Medical School of the Athenian University

The first Anatomy professors in the Medical School of the University of Athens

The purpose of this historical review is to add new elements to the international literature in relation to the birth and progress of the science of anatomy in modern Greece. Step by step, it outlines the efforts of prominent Greek anatomists to establish the course of the basic science of anatomy in the newly founded Medical School, the laborious effort to collect cadaveric material, to compile museum anatomical collections and to gradually build the foundations of modern anatomy science at the Medical School of the Athenian University

A Predictive Model of Failure to Rescue After Thoracolumbar Fusion

Objective Although failure to rescue (FTR) has been utilized as a quality-improvement metric in several surgical specialties, its current utilization in spine surgery is limited. Our study aims to identify the patient characteristics that are independent predictors of FTR among thoracolumbar fusion (TLF) patients. Methods Patients who underwent TLF were identified using relevant diagnostic and procedural codes from the National Surgical Quality Improvement Program (NSQIP) database from 2011–2020. Frailty was assessed using the risk analysis index (RAI). FTR was defined as death, within 30 days, following a major complication. Univariate and multivariable analyses were used to compare baseline characteristics and early postoperative sequelae across FTR and non-FTR cohorts. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory accuracy of the frailty-driven predictive model for FTR. Results The study cohort (N = 15,749) had a median age of 66 years (interquartile range, 15 years). Increasing frailty, as measured by the RAI, was associated with an increased likelihood of FTR: odds ratio (95% confidence interval [CI]) is RAI 21–25, 1.3 [0.8–2.2]; RAI 26–30, 4.0 [2.4–6.6]; RAI 31–35, 7.0 [3.8–12.7]; RAI 36–40, 10.0 [4.9–20.2]; RAI 41– 45, 21.5 [9.1–50.6]; RAI ≥ 46, 45.8 [14.8–141.5]. The frailty-driven predictive model for FTR demonstrated outstanding discriminatory accuracy (C-statistic = 0.92; CI, 0.89–0.95). Conclusion Baseline frailty, as stratified by type of postoperative complication, predicts FTR with outstanding discriminatory accuracy in TLF patients. This frailty-driven model may inform patients and clinicians of FTR risk following TLF and help guide postoperative care after a major complication

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020