INTRODUCTION: Paediatric epidurals can present technical challenges due to wide variations in age and weight among children, ranging from neonates to teenagers. This study evaluated the skin-to-epidural distance in the thoracic and lumbar regions to determine the relationship between age, weight and ethnicity and depth to the epidural space in our Singapore paediatric population. METHODS: Data from the Acute Pain Service was prospectively collected over 16 years. Details included patient demographics, level of epidural performed and distance from skin to epidural space. Multivariable regression analysis was performed to determine the association of weight, age, ethnicity and gender with the depths to the thoracic and lumbar epidural spaces. A simple linear regression was calculated to predict the depth to both thoracic and lumbar epidural spaces based on body weight. Equations were formulated to describe the relationship between weight and depth of epidural space. RESULTS: A total of 616 midline epidurals were studied. Regression analysis was performed for 225 thoracic epidurals and 363 lumbar epidurals. Our study revealed a clear correlation between skin-to-lumbar epidural distance and weight in children. The best correlation was demonstrated between skin-to-lumbar epidural distance and body weight (R = 0.729). This relationship was described by the formula: depth (mm) = (0.63 × weight [kg]) + 9.2. CONCLUSION Skin-to-lumbar epidural distance correlated with weight in children. Our results highlighted the clinical significance of differences between Southeast Asian paediatric populations when compared to other populations.
Adolescent ; Anesthesia, Epidural ; adverse effects ; methods ; Body Weight ; Child ; Child, Preschool ; Epidural Space ; anatomy & histology ; Female ; Humans ; Infant ; Infant, Newborn ; Lumbar Vertebrae ; anatomy & histology ; Male ; Multivariate Analysis ; Pain Management ; methods ; Pediatrics ; methods ; Regression Analysis ; Singapore ; Skin ; anatomy & histology ; Thoracic Vertebrae ; anatomy & histology

BACKGROUND: Gross anatomy and sectional anatomy of a monkey should be known by students and researchers of veterinary medicine and medical research. However, materials to learn the anatomy of a monkey are scarce. Thus, the objective of this study was to produce a Visible Monkey data set containing cross sectional images, computed tomographs (CTs), and magnetic resonance images (MRIs) of a monkey whole body. METHODS: Before and after sacrifice, a female rhesus monkey was used for 3 Tesla MRI and CT scanning. The monkey was frozen and sectioned at 0.05 mm intervals for the head region and at 0.5 mm intervals for the rest of the body using a cryomacrotome. Each sectioned surface was photographed using a digital camera to obtain horizontal sectioned images. Segmentation of sectioned images was performed to elaborate three-dimensional (3D) models of the skin and brain. RESULTS: A total of 1,612 horizontal sectioned images of the head and 1,355 images of the remaining region were obtained. The small pixel size (0.024 mm × 0.024 mm) and real color (48 bits color) of these images enabled observations of minute structures. CONCLUSION: Due to small intervals of these images, continuous structures could be traced completely. Moreover, 3D models of the skin and brain could be used for virtual dissections. Sectioned images of this study will enhance the understanding of monkey anatomy and foster further studies. These images will be provided to any requesting researcher free of charge.
Anatomy, Cross-Sectional ; Brain ; Dataset ; Female ; Haplorhini ; Head ; Humans ; Macaca mulatta ; Magnetic Resonance Imaging ; Primates ; Skin ; Tomography, X-Ray Computed ; Veterinary Medicine

OBJECTIVETo observe the effects of moxibustion with different temperatures on cholesterol and skin around "Shenque" (CV 8) in mice with acute hyperlipidemia, and to explore the correlation between moxibustion effect and transient receptor potential vanilloid 1 (TRPV1).

METHODSEight mice among 32 mice of C57BL/6J wild type (WT) were selected into a blank group, and the remaining 24 mice were made into the acute hyperlipidemia model by injection of egg yolk. After model establishment, the mice were randomly divided into a model group, a 38 °C moxibustion group and a 46 °C moxibustion group, 8 mice in each group. The temperature was (38 ± 1) °C in the 38 °C moxibustion group and (46 ± 1) °C in the 46 °C moxibustion group. "Shenque" (CV 8) and "Zusanli" (ST 36) were selected in the two groups; moxibustion was given for 10 min per time, once a day for 2 times. Mice in the blank group and model group were treated with immobilization and moxibustion was not given. After treatment, the level of serum cholesterol was tested by oxidase method; the morphology of skin around "Shenque" (CV 8) was observed by HE staining; the expression of TRPV1 in skin was measured by immunohistochemistry.

RESULTS(1) Compared with the blank group, the level of serum cholesterol was increased in the model group (P < 0.001); compared with the model group, the level of serum cholesterol was reduced in the 46 °C moxibustion group (P < 0.001); compared with the 38 °C moxibustion group, the level of serum cholesterol was reduced in the 46 °C moxibustion group (P < 0.01). (2) There was slight change of morphology and structure in skin tissue in the 38 °C moxibustion group, while obvious change was observed in the 46 °C moxibustion group, indicating specific change. (3) The difference of the expression of TRPV1 in skin was significantly different between 46 °C moxibustion group and blank group, model group (both P < 0.01); it was also different from the 38 °C moxibustion group (P < 0.05).

CONCLUSIONMoxibustion temperature is one of the important factors affecting the cholesterol and acupoint skin. The effects of moxibustion are related to TRPV1.

Acupuncture Points ; Animals ; Cholesterol ; blood ; Female ; Humans ; Hyperlipidemias ; blood ; therapy ; Mice ; Mice, Inbred C57BL ; Moxibustion ; Skin ; anatomy & histology ; metabolism ; TRPV Cation Channels ; metabolism ; Temperature

OBJECTIVETo investigate the curative effect of penile elongation with four differentoperative approaches.

METHODSThrough four different operative approaches (the coronary sulcus ringincision, Y or Z shaped incision or Z shaped incision combined with coronary sulcus ring incision), thepenile skin and fascia were degloved until the penile root. Then the superficial and deep dorsal penilesuspensory ligament were cut off. After electric coagulation of the residue ends, the two-side tissue at thefront of the pubic symphysis was sutured. Then the penile skin and fascia were repositioned and the incisionat the inner and outer plate was closed.

RESULTSThe increased penile static length was (2.9 ± 0.2) cmwith abdominal wall Y incision (12 cases); (3.1 ± 0.3) cm with transabdominal modified Z incision (260 cases); (3.9 ± 0.7) cm with coronary sulcus ring incision (363 cases); (3.4 ± 0.8) cm with combined incision (39 cases). The lengthening effect was significantly different between the coronary ring incision and abdominal wall Y/Z incision (P < 0.05). The postoperative follow-up period was 6 months to 5.5 years without serious complications. Only 3 cases of subcutaneous hematoma occurred with treatment of debridement and drainage. 4 cases with ischemic necrosis at distal penile skin, were treated with debridement, dressing and physiotherapy, leaving no scar.

CONCLUSIONSPenile lengthening surgery are safe and effective through different approaches. The coronal ring incision has the best therapeutic effect.

Bandages ; Debridement ; Drainage ; Electrocoagulation ; Fasciotomy ; Follow-Up Studies ; Humans ; Ligaments ; surgery ; Male ; Necrosis ; surgery ; Organ Size ; Penis ; anatomy & histology ; pathology ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Skin ; Time Factors

OBJECTIVETo explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.

METHODS(1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.

RESULTSThe facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.

CONCLUSIONSThe flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Anastomosis, Surgical ; methods ; Arteries ; anatomy & histology ; Cadaver ; Carcinoma, Basal Cell ; surgery ; Carcinoma, Squamous Cell ; surgery ; Face ; blood supply ; Facial Neoplasms ; surgery ; Humans ; Nevus ; surgery ; Nose ; blood supply ; Perforator Flap ; blood supply ; transplantation ; Skin Neoplasms ; surgery ; Skin Transplantation ; Software ; Tomography, Spiral Computed

OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.

METHODSIn the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.

RESULTSThe blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.

CONCLUSIONSIt is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Arteries ; anatomy & histology ; Cadaver ; Female ; Foot ; blood supply ; innervation ; Forefoot, Human ; injuries ; surgery ; Humans ; Male ; Muscle, Skeletal ; anatomy & histology ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Transplant Donor Site ; surgery

OBJECTIVE: To explore the effects of allergic factores in eosinophilic nasal polyps. METHOD: Clinical characters of 67 eosinophilic nasal polyps patients and 26 lymphocyte nasal polyps patients were restrospeetively analyzed. Allergic factors, allergens and nasal anatomic variations were compared between two groups. RESULT: Allergic factors are proned to present in eosinophilic nasal polyps group compared with lymphocyte nasal polyps group; The positive rates of allergen skin test between eosinophilic nasal polyps group and lymphocyte nasal polyps group showed significant difference; Allergens in eosinophilic nasal polyps group are different from lymphocyte nasal polyps group; Nasal anatomic variations are different between two groups. CONCLUSION Different pathogenesis maybe exist in different pathological type nasal polyps. Allergic factors are closely relative to eosinophilic nasal polyps and nasal anatomic variations play a more important role in the formation of lymhocyte nasal polyps.
Allergens ; immunology ; Eosinophils ; pathology ; Humans ; Hypersensitivity ; immunology ; Nasal Polyps ; immunology ; physiopathology ; Nose ; anatomy & histology ; Skin Tests

The cupping spot is considered as one kind of skin change due to cupping treatment. With literature regarding cupping spot, the influencing factors and value of cupping spot in clinical diagnosis and treatment were analyzed, which could make a further exploration on the action mechanism of cupping treatment. The literature showed that the formation of cupping spot was related with cupping temperature, pressure, cup-retaining time, cupping area, individual difference and health condition, etc; cupping spot had the ability to assist diagnosis, prevent disease, cure disease and evaluate clinical efficacy. Previous studies on cupping spot have already made some progress, and played a positive significance on finding cupping rule and studying its mechanism. However, the research for this area is still in the primary stage, which needed deeper study to reveal scientific connotations of cupping spot.
Acupuncture Therapy ; instrumentation ; Humans ; Skin ; anatomy & histology ; blood supply

The diagnostic evidence on clinical diseases and theoretic basis of moving cupping therapy were ex- plored in the paper. By the observation of the local reaction, such as skin appearance and color, the affected location, duration of sickness and nature of disease were judged. Different moving cupping methods were selected for different disorders. It was discovered that the property of syndromes should be recognized by the palpation on skin and muscle in the moving cupping therapy so that the pathogenesis and treating principle could be carefully determined. The moving cupping therapy is the important component of body surface therapy. Skin reaction observation and syndrome differentiation is the essential guidance of the moving cupping therapy.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Meridians ; Skin ; anatomy & histology ; blood supply

A perianal tick and the surrounding skin were surgically excised from a 73-year-old man residing in a southwestern costal area of the Korean Peninsula. Microscopically a deep penetrating lesion was formed beneath the attachment site. Dense and mixed inflammatory cell infiltrations occurred in the dermis and subcutaneous tissues around the feeding lesion. Amorphous eosinophilic cement was abundant in the center of the lesion. The tick had Y-shaped anal groove, long mouthparts, ornate scutum, comma-shaped spiracular plate, distinct eyes, and fastoons. It was morphologically identified as a fully engorged female Amblyomma testudinarium. This is the third human case of Amblyomma tick infection in Korea.
Aged ; Anal Canal/*injuries/parasitology/*pathology/surgery ; Animals ; Female ; Histocytochemistry ; Humans ; Ixodidae/anatomy & histology/*growth & development ; Korea ; Male ; Microscopy ; Skin/parasitology/pathology ; Tick Bites/*diagnosis/*pathology/surgery ; Tick Infestations/*diagnosis/*pathology/surgery