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Pelvic Ultrasound for Endometriosis: General Features
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Caterina Exacoustos, Lucia Lazzeri
DIE of the vagina is seen as a nodular thickening of the vaginal wall that does not get thinner with probe compression. The lesion may be hypoechoic, homogeneous or inhomogeneous with or without cystic areas, and there may also be some vascularization at power Doppler (Figure 3.12). More frequently, the lesions are localized in the posterior vaginal fornix, and they can be misdiagnosed due to the compression of the probe. The insertion of saline solution in the vagina (sonovaginography) may improve the visualization of these lesions (41–44). Better detection of posterior vaginal DIE can be achieved also by increasing the amount of ultrasonographic gel inside the probe's cover, which creates an acoustic window between probe and vaginal wall, allowing a better visualization of the vaginal posterior and anterior fornices (45,46). This trick creates a sonographic stand‐off, in order to visualize the area near the posterior vaginal wall and rectovaginal septum with a reduction of the proximity of the lesion from the probe. Despite this, published studies have found that TVS devices have low accuracy in sonographically detecting vaginal endometriosis (39,46), thus confirming that the digital gynecological examination should be added to TVS to detect DIE in this area.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Sub-Tenon’s block (episcleral injection) (Figure 1.33)Ask patient to look up and out.Apply topical local anaesthetic and antiseptic to lower fornix.Using special forceps (Moorfield’s) to expose a thick fold of conjunctiva in the inferonasal quadrant, make a small 1–2 mm cut with round tip scissors (Westcott’s).Slowly advance a blunt, 25 mm 19G sub-Tenon’s cannula, following the curvature of the globe posteriorly.Confirm negative aspiration before injecting 2–5 ml of local anaesthetic solution depending on the surgical time.
Obstetric and Gynaecological Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Perform a pelvic examination. Be gentle to avoid the potential for traumatic tubal rupture.Examine for discomfort and swelling in the lateral fornix.
Lower eyelid malposition following repair of complex orbitofacial trauma
Published in Orbit, 2022
Victoria S. North, Edith R. Reshef, Nahyoung Grace Lee, Daniel R. Lefebvre, Suzanne K. Freitag, Michael K. Yoon
We suspect that the higher incidence of lower eyelid malposition in the complex group was due to increased tissue dissection and manipulation or, in the case of secondary revision, sequential trauma to tissues already in various stages of healing, all of which may have caused a more robust fibrotic response. Though all patients in the study underwent a fornix-based approach, other surgical factors varied between groups. The swinging eyelid technique, use of a combination of implant types that included titanium, and anterior orbital rim screws were all significantly more common in the complex group. However, none of these factors was associated with a higher incidence of postoperative eyelid malposition either in the entire study cohort or when analyzing each group separately. In addition, fracture type in the complex group was not associated with eyelid malposition. Interestingly, eight of the nine patients in the secondary revision group with pre-existing eyelid malposition after primary repair had multi-wall fractures, though this was too small a group to perform meaningful statistical analysis. Together these findings lend support to the hypothesis that increased tissue manipulation may cause eyelid malposition in patients with complex trauma.
Deep Brain Stimulation for Preclinical and Prodromal Alzheimer’s Disease: Integrating Beneficence, Non-Maleficence, and Autonomy Considerations Through Responsible Innovation
Published in AJOB Neuroscience, 2021
In deciding whether to include people with preclinical or prodromal AD in DBS clinical trials, it is crucial to determine if the benefits of DBS outweigh any potential risks. In the Phase 2 clinical trial of fornix DBS (Leoutsakos et al. 2018), older participants (>65 years old) who received DBS for two years had less cognitive worsening than those who received DBS a year later. Although the participants’ impairments were not reversed, DBS potentially delayed cognitive decline in participants >65, which could still have significant impacts on quality of life, relationships, and social functioning (Viaña and Gilbert 2019). Moreover, animal studies on DBS have shown that fornix stimulation can have neuroprotective effects and even enhance hippocampal neurogenesis (Viaña et al. 2017). These findings have warranted an ongoing follow-up study of fornix DBS for 210 participants with mild dementia and who are >65 (NCT03622905).
Investigation of dynamic deformation of the midbrain in rear-end collision using human brain FE model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Noritoshi Atsumi, Masami Iwamoto, Yuko Nakahira, Yoshitaka Asano, Jun Shinoda
To the best of our knowledge, there has been no report regarding the dynamic deformation of the midbrain in a rear-end crash scenario associated with mild TBI using a human FE model. In the present study, the analysis of shearing dynamics of the brain in mild TBI revealed that increases in MPS values occurred in the midbrain including cerebral peduncles regardless of the magnitude of the collision velocity. Higher MPS values were also observed in the corpus callosum even in mild TBI, which is in agreement with the results of previous studies using other human brain FE models (Viano et al. 2005; Giordano and Kleiven 2014). In all rear-end collision simulations with three different velocities in this study, the calculated MPS values in the midbrain were higher than those in the corpus callosum. (Bigler 2008) suggested that the fornix, medial temporal lobe, and base of the frontal lobe were also common regions of injury in concussions. In our results, calculated MPS values in the fornix and the lower regions of the hemispheres, which includes medial temporal lobe and base of the frontal lobe, were lower than those in the midbrain and corpus callosum. These findings would indicate the importance of the strain values in the midbrain, which has not been focused on until now, in the prediction of mild TBI in rear-end crash scenarios.