Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anaesthesia

BACKGROUND

Caudal epidural block (CEB) failure or complications are not unheard even among experienced anaesthesiologists and are usually due to sacral hiatus (SH) anatomy variations. The aim of the present study is to observe, record and analyse important anatomical features of SH and correlate them with potential CEB limitations.

MATERIALS AND METHODS

The SH of 155 complete and undamaged Greek adult dry sacra of known sex were included in the study. Three non-metric (shape of SH and location of hiatal apex and base in relation to level of sacral/coccygeal vertebra) and five metric parameters (height of the SH, transverse width of the SH at the base, anteroposterior diameter of the SH at the level of its apex and the distance from the sacral apex and base to the upper border of S2 foramina) were evaluated.

RESULTS

Inverted U (34.83%) and inverted V (26.45%) were the commonest shapes. Hiatal apex and base were most commonly related to the level of S4 (78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual distance were 19.05 ± 8.65 mm, 5.39 ± 1.84 mm and 12.41 ± 3.16 mm, respectively, whereas mean distance between the upper border of S2 foramen and the apex and base of the SH were 46.34 mm and 63.48 mm, respectively. Anatomical variations of SH that might be responsible for CEB failure, such as elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and narrowing (< 3 mm) at the apex of SH were found in 17.43% of sacra (male 10.94% and female 25.22%).

CONCLUSIONS

This study suggests a potential risk of failure of CEB in Greek patients, especially in females, which should be kept in mind while giving caudal epidural anaesthesia.

An aperture in the sagittal plane of the dorsal wall of the sacrum

The dorsal wall of the sacrum presents various anatomical variations, while the dorsal bony wall of the sacral canal suffers more. We report a case of a sacrum with a series of variants in the midline due to abnormal ossification and a bizarre aperture on the sagittal plane between the 1st and the 2nd sacral spinous processes. A failure of the ossification patter during embryological life, or an ossification of the supraspinous ligament may result in such an aperture. Sacrum variety is of great importance for the daily proper medical practice.

Inhaled Immunotherapy Administration for Lung Cancer; Efficient? Certainly Possible

Lung cancer is still diagnosed at a late stage in most lung cancer patients. Regarding Non-small Cell lung cancer there are novel therapies such as; tyrosine kinase inhibitors and immunotherapy. Currently we have two immunotherapies that can be used either as first-line treatment or second line treatment; pembrolizumab and nivolumab. A third one is being investigated as a combination of immunotherapy; ipilimumab. Aerosol treatment has been investigated for many diseases not only for the lung, but also for systematic diseases. The design of cups was found the most significant factor in producing significant effects. The comparison of cups reveals the design J as the most capable of reducing the droplets at a minimum size of mass median aerodynamic diameter (MMAD) MMAD=1.99. Drug effect comes second in sequence (F=62.04) showing that nivolumab is the most drastic preparation at low particle sizes (1.89), two drugs share an intermediate particle diameter (pembrolizumab and ipilimumab). In total drugs demonstrate a decreasing droplet size: Ipilimumab>Pembrolizumab> Nivolumab.

Hamman's syndrome (spontaneous pneumomediastinum presenting as subcutaneous emphysema): A rare case of the emergency department and review of the literature

Pneumomediastinum is a rare clinical entity that concerns the clinicians in the emergency department. We present a case of a patient with spontaneous pneumomediastinum (Hamman's syndrome) that presented to our hospital's emergency department with cervical subcutaneous emphysema. A conservative treatment with observation was performed. The patient after 24 hours of observation was discharged with a suggested follow-up.

Obstruction of the right stem bronchus due to ovarian local metastasis: a 5-year follow-up

Currently interventional bronchoscopy is used for debulking, desobstruction and airway patency stabilization. The interventional techniques are being used for both benign and malignant cases. There are two types of stents that are currently being used, silicon and self-expandable metallic. The method of application and stent remains for the treating physician to choose. In the current case we will present a case of metastatic disease from ovarian cancer in the airway lumen and a long term follow-up.

Comparative study of 5 different membranes for guided bone regeneration of rabbit mandibular defects beyond critical size

BACKGROUND

Although several studies have examined use of collagen membranes in guided bone regeneration (GBR), none has examined the use of human fascia temporalis as a bioabsorbable barrier. The majority of studies related to GBR have examined critical size defects. We sought to assess the human fascia temporalis and other well-documented membranes applied for GBR in mandibular osseous defects beyond critical size.

MATERIAL/METHODS

Fifty adult male New Zealand white rabbits were used in this study. Five groups of 10 animals each were used: HFL (human fascia lata membrane), HP (human pericardium), HFT (human fascia temporalis), BP (bovine pericardium), and PTFE (expanded polytetrafluoroethylene). Animals were killed 10 weeks after membrane application. In each animal, 9-mm circular mandibular defects were created bilaterally. On 1 side of the jaw, the defect was covered with 1 of the test membranes; the defect on the other side served as a control. Harvested specimens were examined histologically.

RESULTS

Membranes were significantly superior to the controls in all animals (P<0.001). Paired comparisons showed that groups HFL, HP, BP, and PTFE were significantly superior to HFT (P<0.05). Conversely, comparisons of HFL-HP, HFL-BP, HFL-PTFE, HP-BP, HP-PTFE, and BP-PTFE, showed no significant differences (P>0.05).

CONCLUSIONS

According to our results, the fascia temporalis is not recommended for GBR techniques. The fascia lata, human pericardium, bovine pericardium, and e-PTFE advance bone regeneration and can be successfully used as GBR membranes for osseous defects beyond the critical size.

Oral complaints caused from metastases to the mandible and maxilla

Jaw bone disorders causing oral complaints are common in primary care settings. Most of these conditions are of a chronic and benign nature. However they also may be the symptoms of a primary or secondary malignant process in the bone. The most common malignant bone tumor is metastatic carcinoma, and tumors arising in the breast, prostate, thyroid, lung and kidney have a special propensity to spread to bone. Yet metastases to the bones are rare; less than one per cent of all neoplasms metastases to the maxillofacial area. We describe four cases of metastatic tumours to the jaws. Two cases originated from the thyroid gland while the rest were from the oesophagus and the liver respectively. Three lesions occurred in the mandible and one in the maxilla. Patients presented with oral discomforts disregarding the primary tumor. Physicians who frequently advise patients with oral complaints should keep in mind that whereas these symptoms are mostly of a chronic and benign nature, metastases from a malignant tumor must be included in the differential diagnosis.

Clinical, radiological and histological correlation in the diagnostic work-up of cemento-ossifying fibroma of the maxilla: case report

Cemento-ossifying fibroma is a relatively rare tumor classified between fibro-osseous lesions. This lesion appears within the bone although in some occasions it involves the gingivae soft tissues. It is a slow growing and well-defined tumorous lesion, because of this, it is considered as a benign lesion. We report a case of a young female presenting a mass in the right cheek. The evolution of the process was 4 years. She was treated with surgical resection via a Weber-Fergusson approach. The histology was that of a benign fibro-osseous proliferation composed of bony spicules and spherules admixed with a fibrous stroma. Clinical and radiological information was essential for the final diagnosis. The histologic findings alone may be similar to other pathologies such as osteoblastoma, low-grade osteosarcoma and particularly to fibrous dysplasia. An accurate diagnosis requires careful clinical, radiological and histological correlation in order to make an optimal treatment and an excellent outcome.

Branchial cysts. A report of 4 cases

OBJECTIVE

Cysts presented in the lateral aspect of the neck are relatively uncommon anomalies. Many theories have been proposed to explain the aetiology of these cysts, grouped in two main categories: the congenital and the cervical lymph nodes cystic transformation hypotheses.

SETTINGS

In this paper we present 4 patient-cases documented in the department of Maxillofacial Surgery, and try to trace the profile of these lesions and investigate their origin.

RESULTS

All lesions were well circumscribed by Computed Tomography, and prior to surgery they were assessed by means of fine needle aspiration cytology. Neutrophils, debris and mature squamous epithelial cells including degenerate forms, were the key-features in the cytological diagnosis. Histologic examination of the excised surgical specimen established the diagnosis in all cases.

CONCLUSIONS

Our findings, compatible with the congenital theory lead us to the conclusion that the branchial cysts are the result of imperfect obliteration of the branchial clefts, arches, and pouches.

Odontogenic tumor with prominent clear cell component misdiagnosed as pleomorphic adenoma by fine-needle aspiration. A case report

Clear cell tumors in the maxillofacial region, are usually originated in salivary or odontogenic tissues, or may be metastatic. They include calcifying epithelial odontogenic tumors, ameloblastoma and odontogenic carcinoma. Clear cell odontogenic tumor has been classified in the last WHO classification as a benign tumor, but current opinion is that it should be designated as a carcinoma. We report a case of clear cell odontogenic tumor documented by histology, in a 82 year-old female, misinterpreted as pleomorphic adenoma by fine-needle aspiration cytology.