External Rhinoplasty
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The nasal septum can be accessed by division of the soft tissue between the medial crura of the lower lateral cartilages, effectively dividing the membranous septal area (see Figure 82.2f). This will, however, disrupt one of the minor tip support mechanisms so may be best avoided if no cartilaginous material is available to provide structural support to maintain post-operative tip projection. An alternative exposure can be gained by a traditional separate hemitransfixion or Killian’s incision.
Central Neuronal Pathways Involved in Psychotic Syndromes
Fuad Lechin, Bertha van der Dijs in Neurochemistry and Clinical Disorders: Circuitry of Some Psychiatric and Psychosomatic Syndromes, 2020
The diverse anatomical projections of DR and MR to septal area may explain why septal-lesion induced muricide depends on destruction of DR or MR projections. In effect, numerous experimental studies in this matter suggest the existence of two complex and opposing circuits passing through distinct septal regions. DR, MR, amygdala, OT, and lateral hypothalamus are proven to be among structures related to the two circuits dealing with muricidal behavior.50,83,110,111,116,124,125,143-145,159
Treatment of brief episodes of highly symptomatic supraventricular and ventricular arrhythmias: a methodological review
Published in Expert Review of Medical Devices, 2021
Rita B. Gagyi, Mark Hoogendijk, Sing-Chien Yap, Tamas Szili-Torok
A major limitation of the CardioInsight is represented by the lack of a 3D-mapping navigation system, which causes an imperfect agreement between driver areas and ablation sites [8]. Although image integration with the CARTO system is possible, it is not performed in all cases. Another possible limitation of the system is its inability to provide mapping of the septal area, therefore it is not feasible in localizing septal-source ATs and VTs [26]. The CT imaging and body surface mapping is coupled with the CardioInsight technology; therefore, it has to be acquired on the same day as the CA procedure. For an accurate result, the mapping period must not exceed 2–3 hours prior to CA procedure.
Predictors of adverse outcomes after transcatheter mitral valve replacement
Published in Expert Review of Cardiovascular Therapy, 2019
Pavel Overtchouk, Nicolo Piazza, Juan F. Granada, Thomas Modine
Perhaps more interestingly is the recent proposed approach of pre-emptive septal alcohol ablation in patients whose risk of LVOT obstruction has been estimated to be high (valve in MAC, small simulated neo-LVOT) and in whom septal alcohol ablation is expected to reduce the risk of LVOT obstruction (septal hypertrophic wall with available septal artery directed at the targeted septal area). Wang et al. reported a median increase of 111.2 mm2 (interquartile range 71.4–193.1 mm2) in neo-LVOT surface area post-alcohol septal ablation. However, this strategy comes with the specific risks of septal alcohol ablation and additional procedural morbidity, including the need for permanent pacemaker implantation [34]. Similarly, a recent cohort of 30 patients at prohibitive risk of LVOT obstruction during VIV, VIR or VIMAC procedures were treated with preventive LAMPOON technique. The prohibitive risk was based on MSCT-estimated neo-LVOT area<200 mm2 or skirt neo-LVOT <150 mm2, or long redundant anterior mitral leaflet. Patients were treated with a preventive LAMPOON transversal and midline laceration before being followed by the delivery of a transseptal TAVI-type Sapien 3 THV with a reported 93% 30-day survival. However, 8 out of 30 patients required complementary intervention with 4 being alcohol septal ablation to reduce LVOT gradient (failure of LAMPOON), 2 second valve implantations, 1 conversion to open surgery, 1 percutaneous closure of severe paravalvular leak. Hence, the primary success rate was 73% of patients [35]. Based on reported data the preventive alcohol septal ablation seems to be a better option since LAMPOON imposes immediate TMVR because of the torrential MR that it generates, while alcohol septal ablation can be performed as a separate procedure giving time to re-evaluate the patient. In the study by Wang et al. several patients actually improved enough to avoid TMVR as a result of the alcohol septal ablation procedure [34].
Therapeutic approaches to cholinergic deficiency in Lewy body diseases
Published in Expert Review of Neurotherapeutics, 2020
Matthew J. Barrett, Leslie J. Cloud, Harsh Shah, Kathryn L. Holloway
In addition to a shared proteinopathy, Lewy body diseases demonstrate neurodegeneration in the same vulnerable regions. Neurotransmitter systems are especially vulnerable and there is degeneration of noradrenergic, dopaminergic, serotonergic, and cholinergic neurons across these diseases. This review will focus on degeneration of the cholinergic basal forebrain in Lewy body diseases. There are three main sources of cholinergic innervation in the central nervous system: cholinergic neurons in the basal forebrain, cholinergic neurons in the pedunculopontine nucleus (PPN) and lateral tegmental area, and cholinergic interneurons in the striatum. In addition to cholinergic innervation from the PPN, the cerebellum also receives cholinergic afferents from the medial vestibular nucleus and other brainstem nuclei [6]. Cholinergic neurons in the basal forebrain are divided into four nuclei based on their location and primary projections. Cholinergic neurons in the medial septal area (cholinergic nucleus 1; Ch1) and vertical limb of the diagonal band of Broca (cholinergic nucleus 2; Ch2) project to the hippocampus. Cholinergic neurons in the horizontal limb of the diagonal band of Broca project to the olfactory bulb (cholinergic nucleus 3; Ch3), and cholinergic neurons in the nucleus basalis of Meynert (NBM) project to the neocortex and amygdala (cholinergic nucleus 4; Ch4). Not all cholinergic neurons in these nuclei correspond to these primary target regions. For example, the visual cortex and posterior cingulate receive cholinergic inputs from Ch2 and Ch3 in addition to Ch4 [7]. Following this naming scheme, cholinergic neurons in the PPN comprise cholinergic nucleus 5 and cholinergic neurons in the lateral tegmental area comprise cholinergic nucleus 6 [8,9]. Degeneration of Ch4 is of greatest interest because its degeneration results in cortical (and amygdalar) cholinergic denervation, and this is associated with some of the more disabling neuropsychiatric symptoms observed in Lewy body diseases. For this reason, cortical cholinergic denervation resulting from Ch4 degeneration is an important target for symptomatic therapies in Lewy body diseases.
Related Knowledge Centers
- Amygdala
- Cingulate Cortex
- Midbrain
- Olfactory Bulb
- Septum Pellucidum
- Frontal Lobe
- Hippocampus
- Thalamus
- Hypothalamus
- Medial Septal Nucleus