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Spinelli C, Ghionzoli M, Bertocchini A, Sanna B, Plessi C, Strambi S, De Napoli L, Frustaci G, Materazzi G, Antonelli A, Morganti R, Gennari F, Inserra A, Bisogno G, Gamba P, Ferrari A, Massimino M. Factors associated with postoperative hypocalcemia following thyroidectomy in childhood. Pediatr Blood Cancer 2022; 69:e29576. [PMID: 35129296 DOI: 10.1002/pbc.29576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population. PROCEDURE A retrospective multicenter study analyzing 326 patients was carried out. We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively. RESULTS We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or > 15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P = 0.014), in larger tumors (P < 0.001), in case of extrathyroidal extension (P = 0.037), and in central compartment (P = 0.020) and bilateral lymph node dissection (P = 0.030). PtHP was more frequent in older patients (P = 0.014), in case of thyroiditis (P < 0.001), and extrathyroidal extension (P < 0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17 mg/dL value with 14% pre/postoperative decrease (ΔCa ), whereas in PtHP patient group calcium level was 7.91 mg/dL with 16.7% ΔCa . CONCLUSIONS The risk of postoperative hypoparathyroidism is related to younger age, tumor size, central compartment and bilateral lymph node dissection, extrathyroidal extension, and decrease in postoperative calcium levels. The risk of PtHP is related to older age, thyroiditis, extrathyroidal extension, and decrease in postoperative calcium levels.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Alessia Bertocchini
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Beatrice Sanna
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Carlotta Plessi
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Luigi De Napoli
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Gianluca Frustaci
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Division of statistical support to clinical studies, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabrizio Gennari
- Division of Pediatric Surgery, "Regina Margherita Hospital,", Turin, Italy
| | - Alessandro Inserra
- General Pediatric and Thoracic Surgery, Bambino Gesù Children's Hospital-Research Institute, Rome, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Andrea Ferrari
- Department of Pediatrics, National Cancer Institute, Milan, Italy
| | - Maura Massimino
- Department of Pediatrics, National Cancer Institute, Milan, Italy
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Valentini L, Pacini L, Errante F, Morchio C, Sanna B, Rovero P, Morabito A. Peptide-Functionalized Silk Fibers as a Platform to Stabilize Gelatin for Use in Ingestible Devices. Molecules 2022; 27:molecules27144605. [PMID: 35889483 PMCID: PMC9318617 DOI: 10.3390/molecules27144605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022] Open
Abstract
The combination of pharmacologic and endoscopic therapies is the gold standard for treating intestinal failures. The possibility of chemical solubility in water is mandatory for intelligent capsules. Functionalised silk fibroin with peptides and covalently linking different molecular entities to its structure make this protein a platform for preparing gels dissolving in the small and large intestine for drug delivery. In the present study, we linked a peptide containing the cell-adhesive motif Arginine–Glycine–Aspartic acid (RGD) to degummed silk fibres (DSF). Regenerated silk fibroin (RS) films obtained by dissolving functionalised DSF in formic acid were used to prepare composite gelatin. We show that such composite gelatin remains stable and elastic in the simulated gastric fluid (SGF) but can dissolve in the small and large intestines’ neutral-pH simulated intestine fluid (SIF). These findings open up the possibility of designing microfabricated and physically programmable scaffolds that locally promote tissue regeneration, thanks to bio-enabled materials based on functionalised regenerated silk.
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Affiliation(s)
- Luca Valentini
- Civil and Environmental Engineering Department, University of Perugia, Strada di Pentima 4, 05100 Terni, Italy
- Correspondence:
| | - Lorenzo Pacini
- Interdepartmental Research Unit of Peptide and Protein Chemistry and Biology, Department of Chemistry “Ugo Schiff”, University of Florence, 59100 Sesto Fiorentino, Italy;
| | - Fosca Errante
- Interdepartmental Research Unit of Peptide and Protein Chemistry and Biology, Department of NeuroFarBa, University of Florence, 50019 Sesto Fiorentino, Italy; (F.E.); (P.R.)
| | - Cecilia Morchio
- Dipartimento Neuroscienze, Psicologia, Area del Farmaco e della Salute del Bambino NEUROFARBA, Università degli Studi di Firenze, Viale Pieraccini 6, 50121 Firenze, Italy; (C.M.); (B.S.); (A.M.)
| | - Beatrice Sanna
- Dipartimento Neuroscienze, Psicologia, Area del Farmaco e della Salute del Bambino NEUROFARBA, Università degli Studi di Firenze, Viale Pieraccini 6, 50121 Firenze, Italy; (C.M.); (B.S.); (A.M.)
| | - Paolo Rovero
- Interdepartmental Research Unit of Peptide and Protein Chemistry and Biology, Department of NeuroFarBa, University of Florence, 50019 Sesto Fiorentino, Italy; (F.E.); (P.R.)
| | - Antonino Morabito
- Dipartimento Neuroscienze, Psicologia, Area del Farmaco e della Salute del Bambino NEUROFARBA, Università degli Studi di Firenze, Viale Pieraccini 6, 50121 Firenze, Italy; (C.M.); (B.S.); (A.M.)
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Spinelli C, Sanna B, Ghionzoli M, Micelli E. Therapeutic challenges in metastatic follicular thyroid cancer occurring in pregnancy: A case report. World J Obstet Gynecol 2022; 11:33-39. [DOI: 10.5317/wjog.v11.i3.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/22/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hormones could play a role in the evolution of follicular thyroid cancer (FTC) for which we discuss an unusual presentation of FTC occurring during pregnancy.
CASE SUMMARY A pregnant woman was admitted with FTC metastasis resulting in a gluteal mass. Preoperative abdominal computed tomography revealed liver metastasis for which the patient underwent total thyroidectomy and liver resection, oral radioiodine therapy and radiotherapy, followed by embolization of the pelvic mass. The patient died of cerebral hemorrhage 16 mo after the initial diagnosis.
CONCLUSION Human chorionic gonadotropin and estrogen stimulation might have a role in cancer growth, especially during pregnancy. FTC management aims to stop disease progression and overcome hormonal imbalances after thyroidectomy thus reducing fetal complications. It is still under debate whether it is possible to combine optimal timing for treatment to ensure the best possible outcome with reduction of fetal complications and risk of cancer growth.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56100, Italy
| | - Beatrice Sanna
- Division of Pediatric and Adolescent Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56100, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56100, Italy
| | - Elisabetta Micelli
- Division of Gynecology and Obstetrics, University of Pisa, Pisa 56100, Italy
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Spinelli C, Strambi S, Masoni B, Ghionzoli M, Bertocchini A, Sanna B, Morganti R, Messina M, Molinaro F, Tursini S, Briganti V, Lisi G, Lelli Chiesa P. Surgical management of ovarian teratomas in childhood: a multicentric study on 110 cases and a literature review. Gynecol Endocrinol 2021; 37:950-954. [PMID: 34254550 DOI: 10.1080/09513590.2021.1948527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM OF THE STUDY To compare a multicentric surgical experience on ovarian teratomas in childhood with the current management trends. DESIGN A retrospective multicentric pediatric ovarian teratomas surgically treated between January 2000 and August 2020 at four Italian institutions. PubMed database was used to search for Reviews and Systematic Reviews published between January 2010 and August 2020: 15 manuscripts reported 3633 ovarian neoplasms in pediatric age, 1219 (33,5%) of which were ovarian teratomas. RESULTS A hundred-ten patients with a mean age at diagnosis of 11.8 years were enrolled. Mature cystic teratomas accounted for the 90% of the masses. At surgery, 78 were oophorectomies and 32 were ovary sparing surgeries. Laparoscopy occurred in 16.3% of the surgeries.As regarding the current management trends, the mean age at diagnosis was 11.9 years and 80.5% of the cases were represented by mature teratomas. Of 430 procedures, 331 were oophorectomies while 99 were ovary sparing surgeries and laparoscopy was performed in 23.8% of cases. CONCLUSIONS Ovary-sparing surgery with laparoscopic approach is increasingly offered as standard treatment for benign masses that fit the criteria for mature teratomas, in the attempt to achieve the best compromise between the preservation of fertility and the prevention of recurrences. Awareness should be raised among pediatric surgeons to reduce unnecessary radical surgery.
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Affiliation(s)
- Claudio Spinelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Silvia Strambi
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Benedetta Masoni
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Marco Ghionzoli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Alessia Bertocchini
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Beatrice Sanna
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Universita degli Studi di Pisa, Section of Statistics, Pisa, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Stefano Tursini
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | - Gabriele Lisi
- Department of Pediatric Surgery, 'Spirito Santo' Hospital, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Pescara, Chieti, Italy
| | - Pierluigi Lelli Chiesa
- Department of Pediatric Surgery, 'Spirito Santo' Hospital, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Pescara, Chieti, Italy
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Spinelli C, Cito G, Morelli G, Ghionzoli M, Bertocchini A, Sanna B, Galli L, Antonuzzo A, Morganti R, Strambi S. Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience. Arch Ital Urol Androl 2021; 93:301-306. [PMID: 34839629 DOI: 10.4081/aiua.2021.3.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate and compare the effectiveness of active surveillance versus post-surgical active treatment, in patients with testicular germ cells tumor (TGCT). MATERIALS AND METHODS We retrospectively analyzed 52 patients who underwent surgery for TGCT from January 2009 to December 2014. All the patients were divided into two age groups: the Group A included children-adolescents from 18 months to 21 years old, while the Group B comprised young adults from 22 to 39 years old. Clinical, histopathological, therapeutic and follow-up data were collected. RESULTS Overall, 22 patients (42,3%) were enrolled in the Group A and 30 patients (57.7%) were categorized in the Group B. Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed in 4 patients (7.7%). Post-surgical management differed based on clinical stage, resulting in active surveillance or adjuvant therapy. After an average 7 years follow-up period (range: 3.5-9.0 years), the overall survival rate is 100%. The relapse risk is significantly higher for the patients in the Group B, displaying a recurrence free-survival rate of 72% versus 95% (Group A); 11 relapses (21.1%) were recorded 2 years after surgery. Of these, 3 recurrences (12.0%) occurred in patients undergoing an active surveillance approach, while 8 (29.6%) in patients subjected to an active treatment. CONCLUSIONS The excellent prognosis in both age groups confirms the high curability of this neoplasia. The active surveillance could represent an optimal option for low recurrence risk tumors. However, post-surgical treatments should be taken into consideration for TGCT with high risk factors, including tumor size, lymphovascular and rete testis invasion.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence.
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa.
| | - Marco Ghionzoli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Alessia Bertocchini
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Beatrice Sanna
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Luca Galli
- Medical Oncology II, University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Andrea Antonuzzo
- Medical Oncology I, National Health Service Department of Translational Medicine Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa.
| | - Silvia Strambi
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
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Taterra D, Wong LM, Vikse J, Sanna B, Pękala P, Walocha J, Cirocchi R, Tomaszewski K, Henry BM. The prevalence and anatomy of parathyroid glands: a meta-analysis with implications for parathyroid surgery. Langenbecks Arch Surg 2019; 404:63-70. [PMID: 30762091 PMCID: PMC6394670 DOI: 10.1007/s00423-019-01751-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
Abstract
Purpose The anatomy of parathyroid glands (PTG) is highly variable in the population. The aim of this study was to conduct a systematic analysis on the prevalence and location of PTG in healthy and hyperparathyroidism (HPT) patients. Methods An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the number of PTG per patient and location of PTG. The data was extracted from the eligible studies and pooled into a meta-analysis. Results The overall analysis of 26 studies (n = 7005 patients; n = 23,519 PTG) on the number of PTG showed that 81.4% (95% CI 65.4–85.8) of patients have four PTG. A total of 15.9% of PTG are present in ectopic locations, with 11.6% (95% CI 5.1–19.1) in the neck and 4.3% (95% CI 0.7–9.9) in mediastinum. The subgroup analysis of ectopic PTG showed that 51.7% of ectopic PTG in the neck are localized in retroesophageal/paraesophageal space or in the thyroid gland. No significant differences were observed between the healthy and HPT patients and cadaveric and intraoperative studies. Conclusions Knowledge regarding the prevalence, location, and anatomy of PTG is essential for surgeons planning for and carrying out parathyroidectomies, as any unidentified PTG, either supernumerary or in ectopic location, can result in unsuccessful treatment and need for reoperation. Electronic supplementary material The online version of this article (10.1007/s00423-019-01751-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominik Taterra
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Linda M Wong
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Przemysław Pękala
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Roberto Cirocchi
- Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy
| | - Krzysztof Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.
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Taterra D, Henry BM, Zarzecki MP, Sanna B, Pękala PA, Cirocchi R, Walocha JA, Tubbs RS, Tomaszewski KA. Prevalence and anatomy of the axillary arch and its implications in surgical practice: A meta-analysis. Surgeon 2018; 17:43-51. [PMID: 29801707 DOI: 10.1016/j.surge.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The following research aimed to investigate the prevalence and anatomical features of the axillary arch (AA) - a muscular, tendinous or musculotendinous slip arising from the latissimus dorsi and that terminates in various structures around the shoulder girdle. The AA may complicate axillary lymph node biopsy or breast reconstruction surgery and may cause thoracic outlet syndrome. METHODS Major electronic databases were thoroughly searched for studies on the AA and its variations. Data regarding the prevalence, morphology, laterality, origin, insertion and innervation of the AA was extracted and included in this meta-analysis. The AQUA tool was used in order to assess potential risk of bias within the included studies. RESULTS The AA was reported in 29 studies (10,222 axillas), and its pooled prevalence estimate in this meta-analysis was found to be 5.3% of the axillas: unilaterally (61.6%) and bilaterally (38.4%). It was predominantly muscular (55.1% of the patients with the AA), originated from the latissimus dorsi muscle or tendon (87.3% of the patients with the AA), inserted into the pectoralis major muscle or fascia (35.2% of the patients with the AA), and was most commonly innervated by the thoracodorsal nerve (39.9% of the patients with the AA). CONCLUSION The AA is a relatively common variant, hence it should not be neglected. Oncologists and surgeons should consider this variant while diagnosing an unknown palpable mass in the axilla, as the arch might mimic a neoplasm or enlarged lymph nodes.
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Affiliation(s)
- Dominik Taterra
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Michał P Zarzecki
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Roberto Cirocchi
- Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Italy
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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8
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Sanna B, Henry BM, Vikse J, Skinningsrud B, Pękala JR, Walocha JA, Cirocchi R, Tomaszewski KA. The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery. Injury 2018; 49:302-308. [PMID: 29241998 DOI: 10.1016/j.injury.2017.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/14/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Corona mortis is a highly variable vascular connection between the obturator and external iliac or inferior epigastric arteries or veins located behind the superior pubic ramus in the retropubic space (space of Retzius). Due to the significant variation in this collateral circulation, detailed anatomical knowledge of the corona mortis is vital to enhance the prevention of possible iatrogenic errors in hernia repair and other pubic surgical procedures. The aim of our meta-analysis was to provide comprehensive data on the prevalence, anatomical characteristics, and ethnic variations of the corona mortis vessel. METHODS An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included investigative method, prevalence of the corona mortis vessels among hemi-pelvises (overall, arterial only, venous only, and combined), distance from the corona mortis to pubic symphysis, and assessment of gender, side, laterality, and ethnicity subgroups. RESULTS A total of 21 studies (n=2184 hemi-pelvises) were included in the meta-analysis. The overall prevalence of the corona mortis in hemi-pelvises is high (49.3%). A venous corona mortis is more prevalent than an arterial corona mortis (41.7% vs. 17.0%). The corona mortis is more common in Asia (59.3%) than in Europe (42.8%) and North America (44.3%). CONCLUSIONS As a corona mortis is present in an about half of all hemi-pelvises, it is important to consider the possibilities of its presence when undertaking surgical procedures and plan accordingly to avoid injuries. All surgeons operating in the retropubic region should have a thorough understanding of the anatomical characteristics and surgical implications of a corona mortis.
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Affiliation(s)
- Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine & Surgery, University of Cagliari, Sardinia, Italy
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Bendik Skinningsrud
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Henry BM, Tomaszewski KA, Pękala PA, Graves MJ, Pękala JR, Sanna B, Mizia E. Oblique incisions in hamstring tendon harvesting reduce iatrogenic injuries to the infrapatellar branch of the saphenous nerve. Knee Surg Sports Traumatol Arthrosc 2018; 26:1197-1203. [PMID: 28573437 PMCID: PMC5876253 DOI: 10.1007/s00167-017-4590-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is associated with many surgical interventions to the medial aspect of the knee, such as anterior cruciate ligament (ACL) reconstruction. Different types of surgical incisions during hamstring tendon harvesting for ACL reconstruction are related to a variable risk of IPBSN injury. This study aimed to evaluate the risk of iatrogenic IPBSN injury during hamstring tendon harvesting for ACL reconstruction with different incision techniques over the pes anserinus. METHODS This study was performed on 100 cadavers. Vertical, horizontal, or oblique incisions were simulated on each cadaveric limb to determine the incidence of iatrogenic IPBSN injury. RESULTS The vertical incision caused the IPBSN injury during hamstring tendon harvesting in 101 (64.7%), the horizontal incision in 78 (50.0%), and the oblique incision in 43 (27.6%) examined lower limbs. The calculated odds ratios (OR) for risk of injury in vertical versus horizontal and horizontal versus oblique incisions were 2.4 (95% CI 1.5-3.6) and 1.8 (95% 1.2-2.8), respectively. CONCLUSIONS The vertical incision technique over the pes anserinus should be avoided during hamstring tendon harvesting for ACL reconstruction. The adoption of an oblique incision, with the shortest possible length, will allow for the safest procedure possible, thus minimizing the risk of iatrogenic IPBSN injury, and improving patient outcomes and postoperative quality-of-life.
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Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31–034 Krakow, Poland ,0000 0001 2162 9631grid.5522.0Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31–034 Krakow, Poland
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31–034 Krakow, Poland ,0000 0001 2162 9631grid.5522.0Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31–034 Krakow, Poland
| | - Przemysław A. Pękala
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31–034 Krakow, Poland ,0000 0001 2162 9631grid.5522.0Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31–034 Krakow, Poland
| | - Matthew J. Graves
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31–034 Krakow, Poland ,0000 0001 2162 9631grid.5522.0Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31–034 Krakow, Poland
| | - Jakub R. Pękala
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31–034 Krakow, Poland ,0000 0001 2162 9631grid.5522.0Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31–034 Krakow, Poland
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31–034 Krakow, Poland ,0000 0004 1755 3242grid.7763.5Faculty of Medicine and Surgery, University of Cagliari, S.S. 554 Bivio Sestu, 09042 Monserrato, CA, Sardinia Italy
| | - Ewa Mizia
- 0000 0001 2162 9631grid.5522.0Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31–034 Krakow, Poland
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Henry BM, Vikse J, Sanna B, Taterra D, Gomulska M, Pękala PA, Tubbs RS, Tomaszewski KA. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg 2017; 110:e965-e978. [PMID: 29203316 DOI: 10.1016/j.wneu.2017.11.148] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients' characteristics. METHODS A thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well. RESULTS A total of 141 studies (n = 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach. CONCLUSIONS CR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.
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Affiliation(s)
- Brandon Michael Henry
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Dominik Taterra
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Martyna Gomulska
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
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11
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Popieluszko P, Mizia E, Henry BM, PĘkala PA, Sanna B, Roy J, Loukas M, Tomaszewski KA. The surgical anatomy of the sural nerve: An ultrasound study. Clin Anat 2017; 31:450-455. [DOI: 10.1002/ca.22997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Patrick Popieluszko
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Ewa Mizia
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - PrzemysŁaw A. PĘkala
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Faculty of Medicine and Surgery, University of Cagliari; Sardinia
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
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12
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Vikse J, Sanna B, Henry BM, Taterra D, Sanna S, Pękala PA, Walocha JA, Tomaszewski KA. The prevalence and morphometry of an accessory spleen: A meta-analysis and systematic review of 22,487 patients. Int J Surg 2017; 45:18-28. [DOI: 10.1016/j.ijsu.2017.07.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
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13
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Pękala PA, Henry BM, Pękala JR, Hsieh WC, Vikse J, Sanna B, Walocha JA, Tubbs RS, Tomaszewski KA. Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects. J Neurosurg Spine 2017. [DOI: 10.3171/2017.1.spine161092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe foramen arcuale (FA) is a bony bridge located over the vertebral artery on the posterior arch of the atlas. The presence of an FA can pose a risk during neurosurgery by providing a false impression of a broader posterior arch. The aim of this study was to provide the most comprehensive investigation on the prevalence of the FA and its clinically important anatomical features.METHODSMajor electronic databases were searched to identify all studies that reported relevant data on the FA and the data were pooled into a meta-analysis.RESULTSA total of 127 studies (involving 55,985 subjects) were included. The overall pooled prevalence of a complete FA was 9.1% (95% CI 8.2%–10.1%) versus an incomplete FA, which was 13.6% (95% CI 11.2%–16.2%). The complete FA was found to be most prevalent in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%). In males (10.4%) the complete FA was more common than in females (7.3%) but an incomplete FA was more commonly seen in females (18.5%) than in males (16.7%). In the presence of a complete FA, a contralateral FA (complete or incomplete) was found in 53.1% of cases.CONCLUSIONSSurgeons should consider the risk for the presence of an FA prior to procedures on the atlas in each patient according to sex and ethnic group. We suggest preoperative screening with computerized tomography as the gold standard for detecting the presence of an FA.
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Affiliation(s)
- Przemysław A. Pękala
- 1International Evidence-Based Anatomy Working Group
- 2The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon M. Henry
- 1International Evidence-Based Anatomy Working Group
- 2The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub R. Pękala
- 2The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Wan Chin Hsieh
- 1International Evidence-Based Anatomy Working Group
- 3First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jens Vikse
- 1International Evidence-Based Anatomy Working Group
- 2The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Beatrice Sanna
- 4Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy; and
| | - Jerzy A. Walocha
- 1International Evidence-Based Anatomy Working Group
- 2The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Krzysztof A. Tomaszewski
- 1International Evidence-Based Anatomy Working Group
- 2The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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14
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Pękala PA, Henry BM, Pękala JR, Hsieh WC, Vikse J, Sanna B, Walocha JA, Tubbs SR, Tomaszewski KA. Prevalence of foramen arcuale and its clinical significance: A meta-analysis of 55,985 subjects: PS095. Porto Biomed J 2017; 2:190. [PMID: 32258648 DOI: 10.1016/j.pbj.2017.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Shane R Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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15
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Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pękala PA, Walocha JA, Tomaszewski KA. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg 2017; 68:298-306.e10. [PMID: 28865978 DOI: 10.1016/j.jvs.2017.06.097] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants. METHODS A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed. RESULTS A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations. CONCLUSIONS Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
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Affiliation(s)
- Patrick Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Krakow, Poland; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolina Saganiak
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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16
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Graves MJ, Henry BM, Hsieh WC, Sanna B, PĘkala PA, Iwanaga J, Loukas M, Tomaszewski KA. Origin and prevalence of the accessory phrenic nerve: A meta-analysis and clinical appraisal. Clin Anat 2017; 30:1077-1082. [DOI: 10.1002/ca.22956] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/17/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew J. Graves
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group; Krakow Poland
- First Faculty of Medicine; Charles University; Prague Czech Republic
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari; Sardinia Italy
| | - PrzemysŁaw A. PĘkala
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Joe Iwanaga
- Seattle Science Foundation; Seattle Washington
- Department of Anatomy; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada, West Indies
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
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17
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Henry BM, Pękala PA, Vikse J, Sanna B, Skinningsrud B, Saganiak K, Walocha JA, Tomaszewski KA. Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy. J Urol 2017; 198:345-353. [DOI: 10.1016/j.juro.2017.01.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A. Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Bendik Skinningsrud
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Saganiak
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A. Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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18
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Henry BM, Graves MJ, Vikse J, Sanna B, Pękala PA, Walocha JA, Barczyński M, Tomaszewski KA. The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses. Langenbecks Arch Surg 2017; 402:663-673. [PMID: 28378238 DOI: 10.1007/s00423-017-1580-y/figures/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/26/2017] [Indexed: 05/26/2023]
Abstract
PURPOSE Recurrent laryngeal nerve (RLN) injury is one of the most common and detrimental complications following thyroidectomy. Intermittent intraoperative nerve monitoring (I-IONM) has been proposed to reduce prevalence of RLN injury following thyroidectomy and has gained increasing acceptance in recent years. METHODS A comprehensive database search was performed, and data from eligible meta-analyses meeting the inclusion criteria were extracted. Transient, permanent, and overall RLN injuries were the primary outcome measures. Quality assessment via AMSTAR, heterogeneity appraisal, and selection of best evidence was performed via a Jadad algorithm. RESULTS Eight meta-analyses met the inclusion criteria. Meta-analyses included between 6 and 23 original studies each. Via utilization of the Jadad algorithm, the selection of best evidence resulted in choosing of Pisanu et al. (Surg Res 188:152-161, 2014). Five out of eight meta-analyses demonstrated non-significant (p > 0.05) RLN injury reduction with the use of I-IONM versus nerve visualization alone. CONCLUSIONS To date, I-IONM has not achieved a significant level of RLN injury reduction as shown by the meta-analysis conducted by Pisanu et al. (Surg Res 188:152-161, 2014). However, most recent developments of IONM technology including continuous vagal IONM and concept of staged thyroidectomy in case of loss of signal on the first side in order to prevent bilateral RLN injury may provide additional benefits which were out of the scope of this study and need to be assessed in further prospective multicenter trials.
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Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland.
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland.
| | - Matthew J Graves
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
- Division of Medicine, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011, Stavanger, Norway
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Sardinia, Italy
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, 35-37 Pradnicka St, 31-202, Krakow, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
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19
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Sanna B, Bereza K, Paradowska D, Kucharska E, Tomaszewska IM, Dudkiewicz Z, Golec J, Bottomley A, Tomaszewski KA. A large scale prospective clinical and psychometric validation of the EORTC colorectal (QLQ-CR29) module in Polish patients with colorectal cancer. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28497549 DOI: 10.1111/ecc.12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
Abstract
The purpose of our study was to assess if the Polish translation of the European Organisation for Research and Treatment of Cancer (EORTC) Colorectal Cancer (CRC)-Specific Quality of Life Questionnaire (QLQ-CR29) is an acceptable and psychometrically valid measure to collect quality of life (QoL) data in Polish patients with CRC for use in clinical trials and clinical practice. A total of 150 patients undergoing treatment for CRC were prospectively enrolled in the study. Psychometric assessment of the translated QLQ-CR29 structure, reliability, convergent and divergent validity, and clinical validity was subsequently performed. The Cronbach's alpha coefficient ranged from 0.70-0.89, indicating acceptable internal consistency. For test-retest reliability, the ICCs for each item ranged from 0.59-0.91, with exceptions for urinary incontinence and dysuria, indicating good to excellent reproducibility. In multi-trait scaling analyses, the criterion for item convergent and divergent validity was satisfied. The correlations between the EORTC QLQ-CR29 and QLQ-C30 scales were mostly low (r < .40), with a few items demonstrating higher correlations. The known group comparisons analyses demonstrated the ability of the questionnaire to distinguish between patients' differing age, stoma status, and treatment intent. The Polish translation of the QLQ-CR29 is a psychometrically reliable and valid tool. The results of this study are congruent with that of EORTC validation.
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Affiliation(s)
- B Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - K Bereza
- Department of Gynaecological Care, Jagiellonian University Medical College, Krakow, Poland
| | - D Paradowska
- Department of Clinical Oncology, John Paul II Specialist Hospital, Krakow, Poland
| | - E Kucharska
- Department of Gerontology, Geriatrics and Social Work, Ignatianum Academy, Krakow, Poland
| | - I M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Z Dudkiewicz
- Faculty of Physiotherapy, Lodz Medical University, Lodz, Poland
| | - J Golec
- Department of Clinical Rehabilitation, Bronislaw Czech University of Physical Education, Krakow, Poland
| | - A Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - K A Tomaszewski
- Health Outcomes Research Unit, Department of Gerontology, Geriatrics and Social Work, Faculty of Education, Ignatianum Academy, Krakow, Poland
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Henry BM, Sanna B, Vikse J, Graves MJ, Spulber A, Witkowski C, Tomaszewska IM, Tubbs RS, Tomaszewski KA. Zuckerkandl's tubercle and its relationship to the recurrent laryngeal nerve: A cadaveric dissection and meta-analysis. Auris Nasus Larynx 2017; 44:639-647. [PMID: 28377109 DOI: 10.1016/j.anl.2017.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/23/2017] [Accepted: 03/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Zuckerkandl's tubercle (ZT), when present, is an anatomical landmark by which surrounding structures such as the recurrent laryngeal nerve (RLN) can be identified intraoperatively. This study aimed to investigate the prevalence and anatomical characteristics of Zuckerkandl's tubercle by combining cadaveric dissection with a meta-analysis. METHODS Through October 2016, an extensive search of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science was completed. Extracted data, along with the findings from our cadaveric dissections, were pooled into a meta-analysis to assess the prevalence and size of ZT and its relationship to the RLN. RESULTS The pooled prevalence estimate of a ZT was 70.2% in the general population, 65.0% of which were considered Grade 0 tubercles (<1.0cm) and 35.0% Grade 1 (≥1.0cm). The RLN ran posteromedially to the ZT in 82.7% of cases, laterally to it in 8.7%, and on top of it in 8.6% of hemilarynges. CONCLUSION RLN palsy is a common postoperative complication and cause for litigation following neck surgery. The ZT is a common component of the thyroid gland and with proper knowledge, surgeons can use it to reliably and quickly identify the RLN during operative procedures.
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Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, S.S. 554, Bivio Sestu, 09042 Monserrato, CA, Sardinia, Italy
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Division of Medicine, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway
| | - Matthew J Graves
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Alexandru Spulber
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Cecylia Witkowski
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, 16 św. Łazarza Street, 31-530 Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA 28122, USA
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034 Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
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Henry BM, Sanna S, Graves MJ, Vikse J, Sanna B, Tomaszewska IM, Tubbs RS, Walocha JA, Tomaszewski KA. The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations. PeerJ 2017; 5:e3012. [PMID: 28344898 PMCID: PMC5363258 DOI: 10.7717/peerj.3012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/22/2017] [Indexed: 11/20/2022] Open
Abstract
Background The Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery. Methods Through March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi2 test and the I2 statistic. Results Fifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6–0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases. Conclusion The NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.
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Affiliation(s)
- Brandon Michael Henry
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; International Evidence-Based Anatomy Working Group, Kraków, Poland
| | - Silvia Sanna
- Department of Surgical Sciences, University of Cagliari , Monserrato , Sardinia , Italy
| | - Matthew J Graves
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; International Evidence-Based Anatomy Working Group, Kraków, Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari , Monserrato , Sardinia , Italy
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College , Kraków , Poland
| | - R Shane Tubbs
- Seattle Science Foundation , Seattle , WA , United States
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; International Evidence-Based Anatomy Working Group, Kraków, Poland
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; International Evidence-Based Anatomy Working Group, Kraków, Poland
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Henry BM, Graves MJ, Pękala JR, Sanna B, Hsieh WC, Tubbs RS, Walocha JA, Tomaszewski KA. Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer. Cureus 2017; 9:e1101. [PMID: 28428928 PMCID: PMC5393909 DOI: 10.7759/cureus.1101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life. PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis. A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating pattern in 42.2%. In the latter cases, the bifurcation was usually unequal (63.4%). Additionally, the ICBN presented with anastomosing communication to the brachial plexus in 41.3% of cases. The ICBN is a prevalent and variable structure at significant risk for injury during operative procedures of the axilla. In view of the postoperative pain and paresthesia experienced by patients following injury, surgeons need to exercise caution and aim to preserve the ICBN when possible. Ultimately, careful dissection and knowledge of ICBN anatomy could allow postoperative complications to be reduced and patient's quality of life increased.
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Affiliation(s)
| | - Matthew J Graves
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | | | | | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Henry BM, Pękala PA, Sanna B, Vikse J, Sanna S, Saganiak K, Tomaszewska IM, Tubbs RS, Tomaszewski KA. The Anastomoses of the Recurrent Laryngeal Nerve in the Larynx: A Meta-Analysis and Systematic Review. J Voice 2016; 31:495-503. [PMID: 27939121 DOI: 10.1016/j.jvoice.2016.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/03/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The recurrent laryngeal nerve and its branches form a great variety of anastomoses. These nerve communications can alter the innervation patterns of the laryngeal muscles and can affect both the diagnosis and treatment of paralyzed vocal cords. The aim of this study was to assess the prevalence and anatomical characteristics of the laryngeal nerve connections, and to review their function and clinical significance. STUDY DESIGN Meta-analysis and systematic review. METHODS The major electronic databases were thoroughly searched to identify all studies reporting data on the anastomoses of the laryngeal nerves. Data on the prevalence of each type of anastomosis were extracted and pooled into a meta-analysis using MetaXL version 3.0 (EpiGear International Pty. Ltd., Wilston, Queensland, Australia). RESULTS Twenty-two cadaveric studies (n = 1404 hemilarynges) were included in the meta-analysis. The two most common communications were Galen's anastamosis and the arytenoid plexus. The pooled prevalence estimate for Galen's anastamosis was 76.7% (95% confidence interval [CI]: 59.0-90.0), of which the single trunk type was most common (92.3%). The arytenoid plexus had a pooled prevalence estimate of 79.7% (95% CI: 41.1-100). CONCLUSIONS Owing to the high prevalences and variability of nerve connections in the larynx, detailed anatomical knowledge of these anastomoses can be crucial for the accurate interpretation of laryngoscopy results, reducing iatrogenic injury during surgical procedures, and facilitating the development of novel strategies for treating laryngeal paralyses.
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Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Silvia Sanna
- Department of Surgical Sciences, University of Cagliari, Sardinia, Italy
| | - Karolina Saganiak
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Henry BM, Vikse J, Graves MJ, Sanna S, Sanna B, Tomaszewska IM, Hsieh WC, Tubbs RS, Tomaszewski KA. Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta-analysis and surgical implications. Head Neck 2016; 39:177-186. [DOI: 10.1002/hed.24582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/20/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Matthew J. Graves
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Silvia Sanna
- Department of Surgical Sciences; University of Cagliari; Sardinia Italy
| | - Beatrice Sanna
- Faculty of Medicine and Surgery; University of Cagliari; Sardinia Italy
| | - Iwona M. Tomaszewska
- Department of Medical Education; Jagiellonian University Medical College; Krakow Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group; Krakow Poland
- First Faculty of Medicine; Charles University; Prague Czech Republic
| | | | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
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Tomaszewski KA, Graves MJ, Vikse J, Pękala PA, Sanna B, Henry BM, Tubbs RS, Walocha JA. Superficial fibular nerve variations of fascial piercing: A meta-analysis and clinical consideration. Clin Anat 2016; 30:120-125. [DOI: 10.1002/ca.22741] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/19/2016] [Accepted: 06/02/2016] [Indexed: 11/07/2022]
Affiliation(s)
- K. A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - M. J. Graves
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - J. Vikse
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - P. A. Pękala
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - B. Sanna
- Faculty of Medicine and Surgery; University of Cagliari; Sardinia Italy
| | - B. M. Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - R. S. Tubbs
- Seattle Science Foundation; Seattle Washington
| | - J. A. Walocha
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
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Henry BM, Vikse J, Graves MJ, Sanna S, Sanna B, Tomaszewska IM, Tubbs RS, Tomaszewski KA. Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves. Langenbecks Arch Surg 2016; 401:913-923. [PMID: 27251487 PMCID: PMC5086344 DOI: 10.1007/s00423-016-1455-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/24/2016] [Indexed: 01/02/2023]
Abstract
Introduction The recurrent laryngeal nerves (RLN) are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. Historically, the RLN has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extralaryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. We aimed to assess the anatomical characteristics of ELB comprehensively. Methods Articles on the ELB of the RLN were identified by a comprehensive database search. Relevant data were extracted and pooled into a meta-analysis of the prevalence of branching, branching pattern, distance of ELB point from the larynx, and presence of positive motor signals in anterior and posterior ELB branches. Results A total of 69 articles (n = 28,387 nerves) from both intraoperative and cadaveric modalities were included in the meta-analysis. The overall pooled prevalence of ELB was 60.0 % (95 % CI 52.0–67.7). Cadaveric and intraoperative subgroups differed with prevalence rates of 73.3 % (95 % CI 61.0–84.0) and 39.2 % (95 % CI 29.0–49.9), respectively. Cadavers most often presented with a ELB pattern of bifurcation, with a prevalence of 61.1 %, followed by no branching at 23.4 %. Branching of the RLN occurred most often at a distance of 1–2 cm (74.8 % of cases) prior to entering the larynx. A positive motor signal was most often noted in anterior RLN branches (99.9 %) but only in 1.5 % of posterior branches. Conclusions The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications. Electronic supplementary material The online version of this article (doi:10.1007/s00423-016-1455-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland.
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - Matthew J Graves
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - Silvia Sanna
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Sardinia, Italy
| | - Beatrice Sanna
- Faculty of Medicine and Surgery, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Sardinia, Italy
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, 16 św. Łazarza Street, 31-530, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA, 28122, USA
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
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Tomaszewski KA, Popieluszko P, Henry BM, Roy J, Sanna B, Kijek MR, Walocha JA. The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis. Hernia 2016; 20:649-57. [PMID: 27115766 PMCID: PMC5023748 DOI: 10.1007/s10029-016-1493-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/13/2016] [Indexed: 02/06/2023]
Abstract
Purpose Several variations in the anatomy and injury of the lateral femoral cutaneous nerve (LFCN) have been studied since 1885. The aim of our study was to analyze the available data on the LFCN and find a true prevalence to help in the planning and execution of surgical procedures in the area of the pelvis, namely inguinal hernia repair. Methods A search of the major medical databases was performed for LFCN anatomy. The anatomical data were collected and analyzed. Results Twenty-four studies (n = 1,720) were included. The most common pattern of the LFCN exiting the pelvis was medial to the Sartorius as a single branch. When it exited in this pattern, it did so on average 1.90 cm medial to the anterior superior iliac spine (ASIS). Conclusions The LFCN and its variations are important to consider especially during inguinal hernia repair, abdominoplasty, and iliac bone grafting. We suggest maintaining a distance of 3 cm or more from the ASIS when operating to prevent injury to the LFCN. Electronic supplementary material The online version of this article (doi:10.1007/s10029-016-1493-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland.
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland.
| | - P Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - B M Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - J Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - B Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - M R Kijek
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - J A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
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Bonfirraro G, Sanna B, De Marco A, Chieffi O, Bonfirraro PP, Orlando V. [Use of a GnRH analogue in the treatment of certain forms of endometrial hyperplasia associated with menometrorrhagia]. Minerva Ginecol 1995; 47:467-70. [PMID: 8559438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hyperestrogenism is a powerful factor inducing the development of endometrial hyperplasia that in its turn may represent the first step in the natural history of endometrial carcinoma. During menopause it is possible to have a condition to relative hyperestrogenism induced by a residual hormonal activity and by aromatisation of androgens in the adipose tissue. Therapeutical approach in this pathology aims to control hyperplastic development of the endometrial mucosa and to exclude menometrorrhagia. This study has been performed according to an open uncontrolled design in 14 women (4 menopausal women) with abnormal uterine bleeding and hysteroscopic endometrial cystic or adenomatous hyperplasia. At the beginning and at the end of treatment all patients underwent routine biohumoral blood-tests, hysteroscopy and diagnostic curretage. The GnRH analogue (tryptorelin) 3.75 mg 1 ampoule i.m. every 28 days was administered during a 6-month treatment cycle. At the end of therapy bleeding had disappeared in all menopausal women; in the premenopausal group 8 patients have shown a normal menstrual cycle while 2 are still amenorrhoic. The final hysteroscopic evaluation displayed atrophic endometrium in 9 patients and simple proliferative endometrium in 5 cases. Safety was excellent: 3 cases of slight increase of systolic blood pressure and 1 case of slight increase of weight took place. Our results demonstrate therapeutic efficacy of GnRH analogues in the treatment of endometrial hyperplasia with menometrorrhagia either in premenopausal or menopausal women.
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