Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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The human costotransverse joint (CTJ) is the articulation between the posterior tubercle of the ribs with the first through tenth costal facet of the thoracic transverse processes. While the CTJ is well defined anatomically and considered a synovial joint, the human CTJ as a pain generating structure is controversial and not supported from a histological perspective. The objective of the present study was to investigate the histological pain producing properties of CTJ capsule tissue. ⋯ Immunoreactivity was confirmed for SP, CGRP, and NPY within the CTJ tissue samples of two unembalmed male cadavers. The presence of previously mentioned neuropeptides suggests that human CTJ is capable of producing pain through somatic and autonomic nervous systems. Therefore, clinicians should consider the CTJ as a differential diagnostic possibility when examining and treating painful thoracic conditions.
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Total hip replacement produces significant postoperative pain. Psoas compartment block is the most effective block of the lumbar plexus in terms of pain relief and reduced blood loss. It is a proven regional technique for analgesia and anaesthesia during and after total hip replacement conferring a number of benefits to the patient. ⋯ We present a surgeon-delivered technique for producing a lumbar plexus block using direct injection into the iliopsoas muscle when it is visible intraoperatively. This study shows a cadaveric model using methylene blue and radiopaque contrast produces injectate spread in a fashion which would produce a successful lumbar plexus block. This novel technique for lumbar plexus block affords the benefits of psoas compartment block with reduced complications and reduced administration time.
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An obturator hernia is an infrequent but significant cause of intestinal obstruction. The incidence of obturator hernias is between 0.05 and 1.4% of all hernias. The mortality rate can be as high as 70% when acutely incarcerated due to the difficulty in diagnosis and delay in surgical treatment Three progressive stages of obturator herniation have been classified and can be one of three different varieties depending on the pathway the herniated sac follows. ⋯ The abdominal surgical approach is most preferred when a diagnosis is uncertain and laparoscopy should be employed in elective early surgeries. This aim of this article is to review the diagnosis and treatment of obturator hernia by describing the anatomy, embryology, clinical presentation, diagnosis, and management currently in use. Increased awareness and proper management of this condition will result in decreased morbidity and mortality.
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Biography Historical Article
Henry Jacob Bigelow (1818-1890): his contributions to anatomy and surgery.
There have been many advances in the medical world over time that have greatly contributed to ameliorating and prolonging human life. The employment of surgical anesthesia is arguably one of the greatest medical discoveries of all time, and has immensely broadened our ability to treat the ill. While Dr. ⋯ He also impacted the field of neuropsychiatry in his publication regarding Phineas Gage. His contributions to the medical field have set him apart as one of the most influential and famous surgeons of America in the 19th century. Anatomically, he will be remembered eponymously for his iliofemoral ligament and septum in the femur.
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The pterygopalatine fossa (PPF) is accessed via the greater palatine canal (GPC) in an attempt to reduce bleeding during paranasal sinus surgery. This study aims to investigate the anatomy of the greater palatine foramen (GPF), GPC, and the PPF, with reference to PPF infiltration using three-dimensional reconstruction of computer tomographic (CT) scan measurements. The CT scans of 50 patients were retrospectively evaluated. ⋯ The mean thickness of the mucosa overlying the GPF was 10.7 ± 1.8 mm. We recommend that the PNS may be used as the bony landmark to locate the position of the GPF during PPF infiltration. The needle delivering the anesthetic should be bent 25 mm from the tip at a 45° angle, and a 1-ml injection of anesthetic should be administered in adults.