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Ignore anatomy at your peril, and your patients’: a knowledge of relevant anatomy frequently makes procedures more comfortable and safer for patients and easier for their clinicians. This chapter therefore surveys the structures relevant to the rest of the book. It covers the mouth, tongue and teeth, nasal spaces, pharynx, glottis and epiglottis, trachea and more distal airway, as well as the cervical spine. Its emphasis throughout is determinedly practical, rather than obsessively topological.
This chapter turns to medical writing in order to probe the relationship between literary taste and taste as an object and faculty of empirical investigation. In anatomical textbooks – notably Crooke’s Mikrokosmographia – ‘taste’ slides referentially between gustation and readerly discrimination. Against a conventional scholarly supposition that anatomical history follows a trajectory away from classical authorities towards the empirical certainties of sense experience, I contend that this semantic flexibility emblematises an early modern insistence on the productive complementarity of proto-scientific empiricism and philological erudition, bodily sensation and mental judgement. The complementarity also has implications for our understanding of early modern subjectivities, pointing to a notion of selfhood that is simultaneously sensorially and textually inscribed, grounded both in physical experience and in the acquisition of knowledge.
This study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease.
Computed tomography head scans from 1700 patients aged 0–16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex.
Petrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule.
In children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.
Schizophrenia is a highly heritable disorder with undetermined neurobiological causes. Understanding the impact on brain anatomy of carrying genetic risk for the disorder will contribute to uncovering its neurobiological underpinnings.
To examine the effect of rare copy number variants (CNVs) associated with schizophrenia on brain cortical anatomy in a sample of unaffected participants from the UK Biobank.
We used regression analyses to compare cortical thickness and surface area (total and across gyri) between 120 unaffected carriers of rare CNVs associated with schizophrenia and 16 670 participants without any pathogenic CNV. A measure of cortical thickness and surface area covariance across gyri was also compared between groups.
Carrier status was associated with reduced surface area (β = −0.020 mm2, P < 0.001) and less robustly with increased cortical thickness (β = 0.015 mm, P = 0.035), and with increased covariance in thickness (carriers z = 0.31 v. non-carriers z = 0.22, P < 0.0005). Associations were mainly present in frontal and parietal areas and driven by a limited number of rare risk alleles included in our analyses (mainly 15q11.2 deletion for surface area and 16p13.11 duplication for thickness covariance).
Results for surface area conformed with previous clinical findings, supporting surface area reductions as an indicator of genetic liability for schizophrenia. Results for cortical thickness, though, argued against its validity as a potential risk marker. Increased structural thickness covariance across gyri also appears related to risk for schizophrenia. The heterogeneity found across the effects of rare risk alleles suggests potential different neurobiological gateways into schizophrenia's phenotype.
Previous reports have identified risk factors associated with development of post-Fontan protein-losing enteropathy. Less is known about the economic impact and resource utilisation required for post-Fontan protein-losing enteropathy in the current era. We conducted a single-centre retrospective study to assess the impact of post-Fontan protein-losing enteropathy on transplant-free survival. We also described resource utilisation and treatment variations among post-Fontan protein-losing enteropathy patients. Children who received care at our centre between 2009 and 2017 after the Fontan surgery were eligible. Initial admissions for the Fontan operative procedure were excluded. Demographics, hospital admissions, resource utilisation, medications and charges were reviewed. Patients were divided into two groups based on the presence of post-Fontan protein-losing enteropathy. Of the 343 patients screened, 147 met the eligibility criteria. Of these, 28 (19%) developed protein-losing enteropathy. After adjusting for follow-up duration, the protein-losing enteropathy group had higher number of encounters (2.15 ± 2.16 versus 1.47 ± 2.56, p 0.002), hospital length of stay (days) (25 ± 51.3 versus 11.4 ± 41.7, p < 0.0001) and total charges (2018US$) (388,489 ± 759,859 versus 202,725 ± 1,076,625, p < 0.0001). Encounters for patients with protein-losing enteropathy utilised more therapies. Among those with protein-losing enteropathy, use of digoxin was associated with slightly decreased odds for mortality and/or transplant (0.95, confidence interval 0.90–0.99, p 0.021). The 10-year transplant-free survival for patients with/without protein-losing enteropathy was 65.7/97.3% (p 0.002), respectively. Post-Fontan protein-losing enteropathy is associated with reduced 10-year transplant-free survival, higher resource utilisation, charges and medication use compared with the non-protein-losing enteropathy group. Practice variation among post-Fontan protein-losing-enteropathy patients is common. Further larger studies are needed to assess the impact of standardisation on the well-being of children with post-Fontan protein-losing enteropathy.
Gastro-oesophageal reflux disease (GORD) is a condition that develops as a result of retrograde flow (reflux) of gastro-duodenal contents into the oesophagus, with or without mucosal tissue damage. The main symptoms include heartburn without a specific frequency or duration. Histological mucosal changes include mild basal cell hyperplasia, scattered intraepithelial eosinophils, dilated intracellular spaces, and lamina propria papillae reaching the upper one-third of the squamous epithelium. Other histological findings that can be present in the setting of GORD are balloon cells, keratinocyte vacuolization, intraepithelial lymphocytosis, vascular lakes, and parakeratosis. Ulceration can also occur if GORD is severe. Barrett’s oesophagus (BO) is an acquired condition defined by endoscopically visible metaplastic columnar epithelium more than 1 cm above the gastro-oesophageal junction (GOJ) with biopsy confirmation of columnar metaplasia. Presence or absence of intestinal metaplasia (IM) should be documented as it harbours an increased risk of progression to oesophageal adenocarcinoma (OAC). The risk of progression of BO to OAC increases if there is dysplasia in addition to columnar metaplasia. Endoscopic examination in conjunction with histopathological evaluation and documentation of presence or absence of dysplasia is the current recommended method of surveillance.
Infectious diseases of the lower gastrointestinal tract are caused by a vast array of viral, bacterial, fungal, and parasitic organisms. Pathologists are often called upon to distinguish infectious enterocolitis from other inflammatory disorders and, when possible, identify the causative pathogen or group of pathogens. Thus, pathologists should be aware of the patterns of injury and morphologic features that suggest infectious enterocolitides and should be able to generate a reasonable but narrow differential diagnosis that guides clinical management. This chapter reviews the clinical, gross, and, microscopic features of common and emerging infectious diseases of the lower gastrointestinal tract and emphasizes the pathologic findings that aid the appropriate classification of these diseases in daily practice.
Little is know about COVID-19 outcome in specific populations such as Adult congenital heart disease (ACHD) patients. We report three cases of adult patients with similar underlying disease with completely different clinical severity at the time of COVID-19 infection. The patient with the most severe clinical course was obese and diabetic, suggesting that COVID-19 mortality and morbidity in Adult congenital heart disease patients might be independent of anatomic complexity.
Introduction: Spatial ability has been defined as a skill in representing, transforming, generating and recalling symbolic, non-linguistic information. Two distinct human spatial abilities have been identified: visualization and orientation. A sex difference in spatial abilities favouring male has been documented. A pattern of negative effects with increasing age on spatial abilities has also been demonstrated. Spatial abilities have been correlated to anatomy knowledge assessment using practical examination, three-dimensional synthesis from two-dimensional views, drawing of views, and cross-sections in a systematic review. Spatial abilities have also been correlated to technical skills performance in beginners and intermediate learners in a systematic review. The objective of this study was to conduct a systematic review of the interrelationship between spatial abilities, anatomy knowledge and technical skills. Methods: Search criteria included ‘spatial abilities’, ‘anatomy knowledge’ and ‘technical skills’. Keywords related to these criteria were identified. A literature search was done up to November 9, 2018 in Scopus and in several medical and educational databases on Ovid and EBSCOhost platforms. A bank of citations was obtained and was reviewed independently by two investigators. Citations related to abstracts, literature reviews, theses and books were excluded. Articles related to retained citations were obtained and a final list of articles was established. Methods relating spatial abilities testing, anatomy knowledge assessment and technical skills performance were identified. Results: A series of 385 titles and abstracts was obtained. After duplicates were removed and selection criteria applied, 11 articles were retained, fully reviewed, and subsequently excluded with reasons. Conclusion: No eligible articles were found in a systematic review of the interrelationship between spatial abilities, anatomy knowledge and technical skills. The outcome of future studies could help to further understand the cognitive process involved in learning a technical skill in Emergency Medicine.
The history of how and why remains came to be in museums is important in understanding the points of view of both the scientific and claimant communities. Many remains within museums were collected under conditions that today we would find abhorrent and unethical. It is important to understand this process and that even when such remains seemed legitimate in their acquisition in the past, those from former colonial countries have to be viewed through the unequal power dynamics at the time. For a variety of reasons there may be limited knowledge of the acquisition stories of the remains the museums use in research or care for, the knowledge can be shocking and change the perspective of the staff involved. This is usually because this information has not been included in the basic record of the remains or is outside the information passed from curator to curator. There is a belief from those outside museums, from researchers to indigenous communities, that the records within a museum are complete and fully accurate. However, if information is missing, altered or misrepresented then errors will exist, often without the current curators being aware of this.
Lennox explores the role of cooling in the regulation of natural heat and the preservation of life with special interest in methodological questions about how Aristotle arrived at his views about the critical role of cooling in the lives of blooded animals and why he insists that both the brain and the lungs are involved in moderating the animal’s heat. Lennox concludes that Aristotle was somewhat perplexed by the brain, and that his changing views about its presence in the cephalopods may be an indication of that perplexity.
The effects of cold atmospheric plasma (CAP) of dielectric barrier discharges on the wettability, imbibition and germination of Leucaena leucocephala were investigated. It was established that CAP treatment markedly hydrophilized the seed coat, especially at longer treatment times. From the profile of the imbibition curve and visual observation, it was possible to verify that there are two resistance barriers to water penetration: integument surface and region of the macrosclereid cell wall (light line). Although the plasma interacts only in the integument, increasing the density of hydrophilic sites increases the capacity of water absorption, producing enough driving force to overcome the second resistance barrier. The existence of these two barriers changes the three-phase pattern generally observed during seed germination. Despite an increase in imbibition, the plasma treatment conditions used in this work, were not enough to overcome completely the dormancy barrier.
This chapter provides an overview of the anatomy of the primate pelvis, with a particular focus on the features of the hominoid (ape) and human pelvic morphologies. Underlying sources of morphological variation such as phylogenetic signals, sexual dimorphism and obstetric function are examined, as well as general patterns of pelvic anatomical variation within Homo sapiens.
This study attempts to investigate fiducial marker (FM) migration and calculate the prostate planning target volume (PTV) margin considering the setup errors after translation corrections alone (T) and translation plus rotational corrections (T+R) and anatomy variation with respect to the corrected fiducial position, analysed on cone beam computed tomography (CBCT) images.
Methods and materials:
CBCT images from 25 patients are analysed for FM movements, setup error and anatomy variation with respect to the seed match positions. Systematic and random components of setup error and prostate movements are used to calculate the PTV margin for CBCT-based FM localisation in two scenarios, translation corrections only and translation plus rotational correction. MTNW887825 soft tissue gold markers (Civco, Orange City, FL, USA) were used with the department-specific immobilisation system and rectal and bladder filling protocols.
The average directional inter-marker distance variation is −0·05 ± 0·90 mm. The systematic setup errors for T+R are 0·40, 0·63 and 0·80 mm in right–left (RL), anterior–posterior (AP) and superior–inferior (SI), respectively. The corresponding values for T only are 0·54, 0·69 and 0·90 mm. The systematic prostate movement from T+R corrected FM positions are 0·65, 1·27 and 1·32 mm in the RL, AP and SI directions.
Minimal FM movements are noted from the study. The PTV margins to incorporate the daily T+R corrected setup error and prostate deformation are found to be 2·5, 4·5 and 5·2 mm in the RL, AP and SI directions, respectively. The corresponding margins for T only corrected scenario are found to be 2·8, 4·8 and 5·7 mm.
The burrower bug Scaptocoris castanea Perty, 1830 (Hemiptera: Cydnidae) is an agricultural pest feeding on roots of several crops. The histology and ultrastructure of the salivary glands of S. castanea were described. The salivary system has a pair of principal salivary glands and a pair of accessory salivary glands. The principal salivary gland is bilobed with anterior and posterior lobes joined by a hilus where an excretory duct occurs. The accessory salivary gland is tubular with a narrow lumen that opens into the hilus near the excretory duct, suggesting that its secretion is stored in the lumen of the principal gland. The cytoplasm of the secretory cells is rich in the rough endoplasmic reticulum, secretory vesicles with different electron densities and mitochondria. At the base of the accessory gland epithelium, there were scattered cells that do not reach the gland lumen, with the cytoplasm rich in the rough endoplasmic reticulum, indicating a role in protein production. Data show that principal and accessory salivary glands of S. castanea produce proteinaceous saliva. This is the first morphological description of the S. castanea salivary system that is similar to other Hemiptera Pentatomomorpha, but with occurrence of basal cells in the accessory salivary gland.
Needles of Juniperus rigida are used in Chinese traditional medicine for the treatment of brucellosis, dropsy, skin disease, and rheumatoid arthritis. This is the first study that reports anatomical structures of the J. rigida needles collected at different altitudes. The most common anatomical, phytochemical, and histochemical techniques and methods are used. The results show that anatomical structures and chemical composition change significantly at different altitudes. The main anatomical characters are significant xeromorphic structures (thick epidermis, hypodermis, and cuticle), a stomatal band, a developed vascular bundle, and a marginal resin duct. The xeromorphic structures become more pronounced with increasing altitude. The phytochemical and histochemical results demonstrate that the content of the main chemical compounds (phenols and terpenoids) basically increases at a higher elevation. Histochemical analysis localizes the phenols in epidermal cells, sponge tissue, endothelial layer cells, and stomatal bands, and the terpenoids in palisade tissue, sponge tissue, and the edge of the resin duct. This work reveals the relation between anatomy and chemistry in J. rigida needles, contributes to the quality control of its ethno-medicine, and provides the evidence to develop the commercial cultivation.
The anatomy of the membranous labyrinth within the vestibule has direct implications for surgical intervention. The anatomy of the otoliths has been studied, but there is limited information regarding their supporting connective tissue structures such as the membrana limitans in humans.
One guinea pig and 17 cadaveric human temporal bones were scanned using micro computed tomography, after staining with 2 per cent osmium tetroxide and preservation with Karnovsky's solution, with a resolution from 1 µm to 55 µm. The data were analysed using VGStudio Max software, rendered in three-dimensions and published in augmented reality.
In 50 per cent of ears, the membrana limitans attached directly to the postero-superior part of the stapes footplate. If attachments were present in one ear, they were present bilaterally in 100 per cent of cases.
Micro computed tomography imaging allowed three-dimensional assessment of the inner ear. Such assessments are important as they influence the surgical intervention and the evolution of future innovations.
Cor triatriatum sinister is a rare congenital abnormality, with varying signs and symptoms related to the anatomic features and the components of the accompanying cardiac abnormalities. We present a 3-year-old girl who underwent successful simultaneous operation with complete loss of the membrane and ligation of vertical vein by anomalous venous return. The principles for surgical management of cor triatriatum can be summarised as radical resection of the membrane and correction of other intracardiac anomalies.
In order to improve a large posterior glottal gap and/or aspiration, injections of augmentation substances should not only be administered at the mid-membranous vocal fold in the thyroarytenoid muscle, but also at the cartilaginous portion of the vocal fold to make adduction arytenopexy possible.
Ten adult human larynges were investigated using the whole-organ serial section technique.
Vertical thickness of the posterior aspect of the thyroarytenoid muscle was relatively thin (3.4 ± 0.4 mm), especially in females (3.2 ± 0.3 mm). Consequently, care should be taken to ensure the correct depth of needle placement. If the needle is placed too deep, augmentation substances are injected into the lateral cricoarytenoid muscle, located beneath the thyroarytenoid muscle, or into the paraglottic space, located inferolateral to the thyroarytenoid muscle.
The injection location and the amount of injected material should be modified based on the pathological conditions of the voice disorder and aspiration.