The fascial structure of the breast: New findings on the anatomy of the inframammary fold

xlomafota13 shared this article with you from Inoreader The fascial structure of the breast: New findings on the anatomy of the inframammary fold Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Dec 7:S1748-6815(21)00647-1. doi: 10.1016/j.bjps.2021.11.109. Online ahead of print. ABSTRACT The inframammary fold defines the shape and structure of the breast, especially in women. As the inframammary fold is placed between the fifth and sixth ribs, the ligaments or fascia are thought to attach from these ribs. However, the previous literature on what structures constitute the inframammary fold does not provide sufficient knowledge for reconstructing the natural form of the fold. This study aimed to clarify the structure that involves the inframammary fold. Ten sides of five formalin-fixed, adult Asian cadaveric breasts were studied. Upon dissection of the breast, including the ribs, the fat lobules were removed while preserving the septal structures under the microscope. The fascial structures were observed grossly and radiographically. A multilayered fascial structure was noted from the dermis n ear the inframammary fold, anchored to the deep fascia of the pectoralis major muscle mainly at the height of the fourth rib and partially of the fifth rib, from the outside of the nipple to the linea axillaris media, where the fold could be clearly observed. Additionally, the fat lobules around the inframammary fold were subdivided by thin septa closer to the dermis, and they fused posteriorly and upward to form this fascial structure. The inframammary fold was not formed by an adhesion directly under the sixth rib, but by the skin "hanging" from the height of the fourth and fifth ribs due to the multilayered fascial structure that repeatedly fused and dissociated and the changes in the size of the fat lobules. This new anatomical finding may help in inframammary fold reconstruction. PMID:34998682 | DOI:10.1016/j.bjps.2021.11.109 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebrospinal fluid leak repair: utility of intrathecal fluorescein for correct topographic identification of the skull base defects

xlomafota13 shared this article with you from Inoreader Cerebrospinal fluid leak repair: utility of intrathecal fluorescein for correct topographic identification of the skull base defects Via leak of cerebrospinal fluid World Neurosurg. 2022 Jan 6:S1878-8750(22)00007-9. doi: 10.1016/j.wneu.2022.01.004. Online ahead of print. ABSTRACT BACKGROUND: In the management of cerebrospinal fluid (CSF) leak the identification of the exact discharge spot is paramount. This can represent a challenge for the radiologist and the surgeon. In the present study, we analyzed a series of patients affected by endonasal CSF leak who underwent endoscopic surgical reconstruction aided by the use of intrathecal fluorescein (ITF). The purpose of this work is to assess the efficacy of intraoperative ITF in addition to computed tomography (CT) scan and magnetic resonance imaging (MRI) for correct topographic localization of the CSF leak. METHODS: Eighty-three patients were enrolled in the study. The main outcome was the concordance between the supposed radiological defect site and the actual one seen intraoperatively. The recurrence free survival (RFS) was evaluated as secondary outcome. RESULTS: ITF better defined the defect site allowing a change in the treatment in 21 cases (25.3%), in which a non-concordance was observed between the suspected radiological site and the actual surgical one. Good agreement was found between the specific topographic localization (k=0.737, p<0.0001), whereas fair agreement was observed considering the side of the defect (k=0.362, p=0.0009) and correct identification of multiple sites (k=0.044, p=0.666). The 10-year 96% estimate of RFS confirmed the correct repair of the fistula site in most of the cases. CONCLUSIONS: Our data demonstrate the utility and safety of intraoperative ITF for management of patients affected by endonasal CSF leak. ITF improved the topographical diagnosis of the leak site, ensuring the best target reconstruction and very low recurrence rate. PMID:34999266 | DOI:10.1016/j.wneu.2022.01.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Epidemiology, Clinical Features and Management of Rhino Orbital Mucormycosis in Post COVID 19 Patients

xlomafota13 shared this article with you from Inoreader Epidemiology, Clinical Features and Management of Rhino Orbital Mucormycosis in Post COVID 19 Patients Via Otolaryngology Indian Abstract COVID 19 infections may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is a fungal infection primarily affecting immunocompromised individuals. We have observed sudden rise of mucormycosis cases in post COVID 19 patients. Here we have reported 100 cases of mucormycosis associated with COVID 19. To study epidemiology and clinical features of rhino orbital mucormycosis in post COVID 19 patients. To evaluate efficacy of medical as well as surgical treatment in such patients. This was an observational mixed (retrospective + prospective) study with a duration of 2 months. After noting demographic data, necessary radiological investigation was advised and representative tissue was sent for KOH and histopathological examination. Medical and surgical treatment was planned accordingly. Most patients (55%) presented with complaint of headache and facial pain. Hard palate involvement was observed in 45% patients. Unilateral pr esentation (68%) was more common. Only 25% patients who presented early had normal vision. We reported 22 patients with complete loss of vision. Eye movements were restricted in 58% patients. Diabetes mellitus is most common predisposing factor (65%). 9 patients required orbital exentration. Only 18% patients required Amphotericin for more than 14 days. Immune dysregulation caused by COVID 19 infection in addition to widespread use of steroids and broad-spectrum antibiotics may lead to the development mucormycosis. Diabetes Mellitus type II is another important risk factor and the presence of both have additional effect in causing mucormycosis. Headache and facial pain should be considered highly suspicious of mucormycosis. Early diagnosis with efficient treatment can improve prognosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Brain Herniation Secondary to Cerebrospinal Fluid Leak Following Elective Lumbar Spine Surgery

xlomafota13 shared this article with you from Inoreader Brain Herniation Secondary to Cerebrospinal Fluid Leak Following Elective Lumbar Spine Surgery Via leak of cerebrospinal fluid Cureus. 2021 Dec 8;13(12):e20266. doi: 10.7759/cureus.20266. eCollection 2021 Dec. ABSTRACT Lumbar spine surgery can be complicated by perioperative cerebrospinal fluid (CSF) leak. However, development of brain herniation secondary to CSF leak following lumbar spine surgery has not been previously reported in the current literature. This case report describes a 48-year-old woman who, after a revision lumbar decompression and fusion, experienced CSF leak followed by development of brain herniation, which resulted in patient demise. The postoperative period was complicated by patient nonadherence to conservative management of CSF leak. PMID:35004068 | PMC:PMC8735843 | DOI:10.7759/cureus.20266 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.