A not very well known anastomotic system was described between uterine and vaginal arteries. This system explains some reported failures, complications, and hemodynamic changes after uterine devascularization procedures.
The duration of untreated psychosis (DUP) is a key determinant in the severity of symptoms in patients with schizophrenia. DUP is a modifiable factor that if reduced can improve patient outcome and treatment response. We sought to decrease DUP in rural Argentina by instituting annual training of local health agents to better identify signs of mental illness and offer earlier intervention. DUP was estimated using Schedules of Clinical Assessment in Neuropsychiatry (SCAN). Ongoing training was correlated with a reduction in DUP. Reducing DUP through better screening can decrease the psychosocial burden of disease and improve the trajectory of psychosis.
Numerous procedures to expose the anterior clival region have been described, including the transoral, transcervical, transseptal-transsphenoidal, transantral, transnasal, bilateral Le Fort I maxillotomy, transbasal, transpalatal, and modifications of the Caldwell-Luc approach. Despite the large number of surgical options available, it may be necessary to have wider access to the midline skull base than these approaches provide. We have developed a microsurgical transmaxillary-transnasal approach to the anterior clivus that has been studied in both dry skull and cadaveric preparations and used clinically. The surgical technique has four stages: 1) antromaxillary; 2) nasal; 3) sphenoidal; and 4) clival. The wider access of this approach is achieved mainly by an osteotomy of the frontal process of the maxilla, which transforms the nasal cavity and the antrum into a single cavity while preserving the functional anatomy of the nose. Cosmesis is preserved by replacement of the cartilaginous nasal septum and the frontal process at the end of the procedure. The technique provides the good cosmetic results of the sublabial approaches and prevents vascular and neural injury in the same way that other anterior approaches do. This transmaxillary-transnasal technique may be used in combination with other approaches for extensive tumors.
The transgluteal approach is useful in the operative repair of lesions of the proximal sciatic nerve. It is a less invasive technique than classical complete sectioning of the gluteus maximus muscle, and yields better aesthetic results and a faster return to normal daily activities. Complex lesions, like nerve trauma requiring grafts and nerve tumours, can be treated with minimal risk. Nevertheless, it is less comfortable for the surgeon, and the entire extent of the exposed nerve might not be visualized simultaneously during surgery.
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