J.M. Boon

Anatomical considerations of the pediatric ilioinguinal/iliohypogastric nerve block

Background : The ilioinguinal/iliohypogastric nerve block is safe, effective and easy to perform in order to provide analgesia for a variety of inguinal surgical procedures in pediatric patients. A relatively high failure rate of 10–25% has been reported, even in experienced hands. The aim of this study was to determine the exact anatomical position of the ilioinguinal and iliohypogastric nerves in relation to an easily identifiable constant bony landmark, the anterior superior iliac spine (ASIS) in neonates and infants. The current ilioinguinal/iliohypogastric nerve block techniques were also evaluated from an anatomical perspective.

Dimensions of the neonatal cricothyroid membrane – how feasible is a surgical cricothyroidotomy?

Background : Airway management of the neonate remains a cornerstone in neonatal resuscitation which in most cases involves tracheal intubation. However, difficult intubations do occur. Cricothyroidotomy is recognized as an entry point below the vocal cords. This procedure becomes increasingly difficult in young children and is not recommended in children under the age of 5 years. Little is known about the anatomy of the neonatal airway, especially the size of the cricothyroid membrane. The aim of the study was to determine the dimensions of the cricothyroid membrane in neonates.

Pericardiocentesis: a clinical anatomy review.

The safe and successful performance of pericardiocentesis demands a working and specific knowledge of anatomy. Misunderstanding of anatomy may result in failure or serious complications. This review attempts to aid understanding of the anatomical framework, pitfalls, and complications of pericardiocentesis. Pericardiocentesis is carried out for aspiration of blood from the pericardial cavity in cases of cardiac tamponade and symptomatic pericardial effusion. In addition, this technique may be used for the diagnosis of neoplastic effusions, purulent pericarditis, and introduction of cytotoxic agents into the pericardial space. Most complications of the procedure are due to the needle penetrating the heart and surrounding structures such a coronary arteries, lungs, stomach, colon, and liver. These complications, if severe, may result in pneumothorax, hemothorax, arrhythmias, infections or arterial bleeding. Therefore, the more fluid or blood there is between the myocardium and pericardium—within the pericardial cavity— the less chance of complications. With a thorough knowledge of the complications, regional anatomy and rationale of the technique, and adequate experience, a pericardiocentesis can be carried out safely and successfully. Clin. Anat. 25:872–881, 2012.

Superficial Radial Nerve Injury During Standard K-wire Fixation of Uncomplicated Distal Radial Fractures

This study determines the incidence of superficial radial nerve injury after Kirchner wire insertion. An experienced orthopedic surgeon inserted the K-wires into the radii of 92 adult cadavers. Subsequent dissection of the area exposed the superficial radial nerve and any observed nerve injury was documented. It is clear from the results that nerve injury may still occur as a result of K-wire insertion; however, the current method of K-wire insertion still proves to be a reliable and safe procedure for fixation of distal radial fractures.

Lumbar puncture for the generalist

ABSTRACT The safe and successful performance of a lumbar puncture demands a working and yet specific knowledge as well as competency in performance. This review aims to aid understanding of the knowledge framework, the pitfalls and complications of lumbar puncture. It includes special reference to three dimensional relationships, functional anatomy, imaging anatomy, normal variation and living anatomy. A lumbar puncture is a commonly performed procedure for diagnostic and therapeutic purposes. Epidural and spinal anaesthesia, for example, are common in obstetric practice and involve the same technique as a lumbar puncture except for the endpoint of the needle being in the epidural space and subarachnoid space respectively. The procedure is by no means innocuous and some anatomical pitfalls include inability to find the correct entry site for placement of the lumbar puncture needle and lack of awareness of structures in relation to the advancing needle. Headache is the most common complication and it is important to avoid traumatic and dry taps, herniation syndromes and injury to the terminal end of the spinal cord. With a thorough knowledge of the contraindications, the regional anatomy and rationale of the technique and adequate prior skills practice, a lumbar puncture can be performed safely and successfully.

Cognitive and learning strategies for longstanding temporal lobe lesions in a child who suffered from Herpes simplex virus encephalitis: a case study over 10 years

This article presents a case study indicating that Herpes simplex virus (HSV) encephalitis may cause permanent learning disabilities due to damage to the temporal lobes as it discusses the results of a case study extending over 10 years to determine the long‐term effects on both the anatomy of the brain and the intellectual functioning of the subject. Magnetic resonance imaging (MRI) scans were taken of the subject during the initial HSV encephalitis infection and subsequently six months after recovery. Follow‐up MRI scans were taken 10 years later. At this time the Senior South African Individual Scale—Revised IQ test was administered to determine any residual neuropsychological impairment due to HSV encephalitis infection. Follow‐up MRI analysis indicated permanent bilateral necrotic areas in the medial temporal lobe, while the IQ test revealed marked impairment of the short‐term memory, verbal memory, visual memory, visual scanning abilities and gestalt formation, which can be ascribed to temporal lobe lesions.

Proximal great saphenous vein cut down: An evaluation of techniques and anatomical considerations

Cut‐down techniques by which emergency venous access can be achieved are important, particularly, in the resuscitation of haemodynamically depleted patients where percutaneous access to collapsed veins is a problem. The aim was to evaluate the efficacy of different methods that are used to locate the proximal great saphenous vein in the thigh and to describe the veins immediate course. A further component was to identify the position of the valves in the proximal great saphenous vein. Needles were placed in 42 cadaver thighs as defined by the techniques identified from the literature and surgical practice. After a detailed dissection, the veins relation to these needles was measured and the course of the vein and number of valves noted in relation to easily identifiable landmarks. Landmarks in 2.5‐cm intervals on a line from the pubic tubercle to the adductor tubercle of the femur were used. The rule of twos, an experimental method by one of the authors, along with Dronens second method localized the vein most successfully. The course of the vein was scrutinized and found to have a rather direct course as it proceeded medially toward the saphenous hiatus. The largest population of valves could be found in the proximal 5 cm (76%) with a valve in the confluence of the great saphenous vein and the femoral vein being the most common. Valve populations were found to decrease in number from proximal to distal, which would have implications with the placement of catheters into the vein for fluid resuscitation. Clin. Anat. 21:453–460, 2008.