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Find video protocols related to scientific articles indexed in Pubmed.
Unusual morphological pattern and distribution of the ansa cervicalis: a case report.
Rom J Morphol Embryol
PUBLISHED: 10-21-2014
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Ansa cervicalis presents great anatomic variability regarding its origin and formation, the number of its roots and its distribution, as well. In the current case, we report an aberrancy in the form and distribution of ansa cervicalis' branches to the infrahyoid muscles and the sternocleidomastoid muscle, which is unique, since, to the best of our knowledge, a similar case has not been recorded in the literature. During regular dissection, we detected that the ansa cervicalis' loop, which was formed underneath the superior belly of the omohyoid muscle, provided a branch for the sternothyroid muscle, from which two recurrent rami were arisen. These two rami joined together forming an unusual triangular nerve formation. The neural trunk formed by the union of the aforementioned two rami perforated the inferior belly of the omohyoid muscle and afterwards was directed towards the ipsilateral sternocleidomastoid muscle. The awareness of such an unusual variability to the surgeons of the head and neck region would be of great importance, since it is crucial not to damage the ansa cervicalis or its branches in order to prevent any possible phonation disorders. Additionally, ansa cervicalis is proved to be extremely useful in the re-innervation of the larynx following paralysis of the recurrent laryngeal nerve.
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Donepezil-induced myoclonus in a patient with Alzheimer disease.
Ann Pharmacother
PUBLISHED: 09-08-2014
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To report an uncommon adverse event in an elderly patient related to the cholinesterase inhibitor, donepezil.
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Multiple variations of the superficial jugular veins: case report and clinical relevance.
Acta Medica (Hradec Kralove)
PUBLISHED: 07-10-2014
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The jugular venous system constitutes the primary venous drainage of the head and neck. It includes a profundus or subfascial venous system, formed by the two internal jugular veins, and a superficial or subcutaneous one, formed by the two anterior and two external jugular veins. We report one case of unilateral anatomical variations of the external and anterior jugular veins. Particularly, on the right side, three external jugular veins co-existed with two anterior jugular veins. Such a combination of venous anomalies is extremely rare. The awareness of the variability of these veins is essential to anesthesiologists and radiologists, since the external jugular vein constitutes a common route for catheterization. Their knowledge is also important to surgeons performing head and neck surgery.
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From mild ataxia to huntington disease phenocopy: the multiple faces of spinocerebellar ataxia 17.
Case Rep Neurol Med
PUBLISHED: 07-04-2014
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Introduction. Spinocerebellar ataxia 17 (SCA 17) is a rare autosomal dominant cerebellar ataxia (ADCA) caused by a CAG/CAA expansion in the TBP gene, reported from a limited number of countries. It is a very heterogeneous ADCA characterized by ataxia, cognitive decline, psychiatric symptoms, and involuntary movements, with some patients presenting with Huntington disease (HD) phenocopies. The SCA 17 expansion is stable during parent-child transmission and intrafamilial phenotypic homogeneity has been reported. However, significant phenotypic variability within families has also been observed. Report of the Family. We presently report a Greek family with a pathological expansion of 54 repeats at the SCA 17 locus that displayed remarkable phenotypic variability. Among 3 affected members, one presented with HD phenocopy; one with progressive ataxia, dementia, chorea, dystonia, and seizures, and one with mild slowly progressive ataxia with minor cognitive and affective symptoms. Conclusions. This is the first family with SCA 17 identified in Greece and highlights the multiple faces of this rare disorder, even within the same family.
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Fascial entrapment of the sural nerve and its clinical relevance.
Anat Cell Biol
PUBLISHED: 04-28-2014
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Sural nerve presents great topographic variability and it is responsible for sensory innervation of the posterolateral side of the distal third of the leg and lateral aspect of the foot. Entrapment of the nerve could be caused by compression due to fascial thickening, while the symptomatology includes sensory alterations and deficits at the nerve distribution area. We report a cadaveric case of a variant sural nerve that presented a distinct entrapment site. A supernumerary sensory branch was encountered originating from the common peroneal nerve, while the peroneal component of the sural nerve was observed to take a course within a fibrous fascial tunnel 3.1 cm in length that caused nerve fixation and flattening. The tension applied to the aforementioned branch was shown to worsen during passive forcible foot plantaflexion and inversion. The etiology, diagnosis and the treatment options are discussed comprehensively.
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Accessory mental foramen: an anatomical study on dry mandibles and review of the literature.
Oral Maxillofac Surg
PUBLISHED: 04-08-2014
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Since numerous surgical procedures in oral and maxillofacial surgery as well as several aspects of dental practice involve the mental region, the knowledge of its anatomical variations is essential for the clinician. Therefore, the aim of the present study was to evaluate the incidence and the anatomical features of the accessory mental foramen, which is occasionally traced additionally to the main mental foramen.
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Proximal ulna morphometry: which are the "true" anatomical preshaped olecranon plates?
Surg Radiol Anat
PUBLISHED: 03-12-2014
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To define the optimum design of the anatomical preshaped olecranon plate.
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Reliability of the posterolateral corner of the acromion as a landmark for the posterior arthroscopic portal of the shoulder.
J Shoulder Elbow Surg
PUBLISHED: 02-28-2014
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The present study aimed to evaluate the variability of the posterolateral corner of the acromion (PCA) position in relation to the glenohumeral joint, in a craniocaudal direction, to assess whether the universal use of a certain distance from that point will always lead to a consistent placement of the posterior arthroscopic portal of the shoulder.
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Morphology of the heart associated with its function as conceived by ancient Greeks.
Int. J. Cardiol.
PUBLISHED: 01-04-2014
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According to their writings, ancient Greek physicians had explored the anatomy of the heart. Although pre-Hippocratic medicine, which relied on religion and mysticism, has nothing more to present than implausible theories and speculations, younger physicians thanks to their animal dissections were able to depict the heart with detail. Hippocratic "On the Heart", Aristotle's, Herophilus', Erasistratus' and Galen's writings provide us with the necessary data to take a look at the anatomy of the heart as it was described back then. Despite of some confusing passages in their writings and some erroneous notions, the heart was described with relative accuracy. In the years after antiquity and in the Middle Age the only information about the anatomy of the heart could be derived from the ancient Greek works and only anatomists of the Renaissance managed to displace them. In this paper we present the knowledge of all known ancient Greek physicians about the heart, with emphasis on its anatomy.
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Variable origin and ramification pattern of the lateral femoral cutaneous nerve: a case report and neurosurgical considerations.
Turk Neurosurg
PUBLISHED: 12-07-2013
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Variations in the anatomy of the lateral femoral cutaneous nerve (LFCN) have been reported in the literature. LFCN is vulnerable to injury during several surgical operations, therefore any surgeon intervening in the area should be familiar to its topographic variability. Lesion of the nerve leads to a condition known as "meralgia paresthetica". We present a cadaveric case of a variant LFCN where two LFCN branches were encountered arising from the lumbar plexus. In specific the anterior LFCN branch originated from the femoral nerve, whereas at the level of the inguinal ligament, four nerve branches were present. The existence of multiple LFCN branches could lead to diagnostic confusion in case of "meralgia paresthetica", while if the neurosurgeon is not aware of the potential variability during surgical decompression of the nerve, postoperative complications may occur. The supernumerary LFCN branches could be identified by ultrasound imaging and be used as optimum vascularized grafts for sensory nerve repair.
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Potential entrapment of an accessory superficial peroneal sensory nerve at the lateral malleolus: a cadaveric case report and review of the literature.
J Foot Ankle Surg
PUBLISHED: 08-15-2013
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The superficial peroneal nerve presents great anatomic variability regarding its emergence from the crural fascia, course, branching pattern, and distribution area. Entrapment neuropathy of the superficial peroneal nerve has been documented in the published data, resulting in pain and paresthesia over the dorsum of the foot. We report a case of a female cadaver in which an accessory superficial peroneal sensory nerve was encountered. The nerve originated from the main superficial peroneal nerve trunk, proximal to the superficial peroneal nerve emergence from the crural fascia, and followed a subfascial course. After fascial penetration, the supernumerary nerve was distributed to the skin of the proximal dorsum of the foot and lateral malleolar area. A potential entrapment site of the nerve was observed at the lateral malleolar area, because the accessory nerve traveled through a fascial tunnel while perforating the crural fascia, and presented with distinct post-stenotic enlargement at its exit point. The likely presence of such a very rare variant and its potential entrapment is essential for the physician and surgeon to establish a correct diagnosis and avoid complications during procedures to the foot and ankle region.
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Evolution of the paranasal sinuses anatomy through the ages.
Anat Cell Biol
PUBLISHED: 05-15-2013
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Previously, anatomists considered paranasal sinuses as a mysterious region of the human skull. Historically, paranasal sinuses were first identified by ancient Egyptians and later, by Greek physicians. After a long period of no remarkable improvement in the understanding of anatomy during the Middle Ages, anatomists of the Renaissance period-Leonardo da Vinci and Vesalius-made their own contribution. Nathaniel Highmores name is also associated with the anatomy of paranasal sinuses as he was first to describe the maxillary sinus.
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Enlarged parietal foramina: a rare finding in a female Greek skull with unusual multiple Wormian bones and a rich parietal vascular network.
Anat Sci Int
PUBLISHED: 03-01-2013
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Enlarged parietal foramina (>5 mm) is an extremely rare developmental defect of the parietal bone, which is distinguished from the normal small parietal foramina, as genes associated with this entity have been identified, suggesting that it is hereditary in nature. We describe a dry skull of a 35-year-old female, with enlarged parietal foramina symmetrically situated bilaterally, oval in shape, measuring 4.5 × 9.3 mm (right) and 4.9 × 9.2 mm (left) in size. The foramina coexisted with multiple Wormian bones in several sites of the skull. On the inner parietal bone surface, the anterior, posterior and lateral foraminas rims carried grooves, which were continuous with the middle meningeal vessels branches, indicating that a rich vascular network existed around the foramina. These vascular grooves also notched the external table at the margin of the foramina, which suggests a potential communication between the meningeal and the scalp vessels. In addition, this vascular variation should be taken into consideration when performing surgical interventions in the area, because the large vascular supply to the foramina is a possible source of extensive bleeding. Moreover, the interaction of intracranial and extracranial veins and the fact that the blood flows in them in both directions, as they are valveless, could represent a possible pathway for infections to spread in the cranial cavity.
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Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome.
Surg Radiol Anat
PUBLISHED: 02-27-2013
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To detect the variable relationship between sciatic nerve and piriformis muscle and make surgeons aware of certain anatomical features of each variation that may be useful for the surgical treatment of the piriformis syndrome.
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Metachronous early gastric adenocarcinoma presenting coinstantaneously with complete remission of stage IV gastric MALT lymphoma.
Arab J Gastroenterol
PUBLISHED: 01-29-2013
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Adenocarcinoma and lymphoma represent the two most common malignant tumours of the stomach, with both neoplasms being associated with infection by Helicobacter pylori. However, the presence of lymphoma and adenocarcinoma in the same patient is a rare entity with synchronous neoplasms being more common than metachronous types. We report a case of stage IV gastric MALT lymphoma of the gastric angle with infiltration of the bone marrow successfully treated with chemotherapy and the occurrence of metachronous early gastric adenocarcinoma of the fundus presenting 1 year after the diagnosis of the lymphoma.
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The thyroid foramen: a systematic review and surgical considerations.
Clin Anat
PUBLISHED: 01-26-2013
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This study presents an analytic review about the trait of the thyroid foramen. A detailed description about the demographics, frequency, embryology, morphometry, possible content, topography, clinical and surgical considerations is provided. The overall frequency was 28.3% in adults, 15% in children and neonates, 40.6% in embryos and fetuses. The content of the thyroid foramina was a neurovascular bundle in 41.2% of studies. An equal number of studies define a nerve as the common content, while only in 17.6% the usual content was a vessel. Interestingly, in 11.8% the content was just connective tissue or a pit. An updated classification is presented taking into account all the possible content that can cross through a thyroid foramen. The variant is of high interest for surgeons intervening in the larynx due to potential complications such as local bleeding and unwanted neural impairment. The oblique line of the thyroid lamina acts as the best topographical landmark to identify any aberrant anatomy related to a thyroid foramen.
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Plasma homocysteine levels in patients with multiple sclerosis in the Greek population.
J Chin Med Assoc
PUBLISHED: 01-14-2013
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In recent years, there has been increasing interest in the role of plasma homocysteine (Hcy) as a possible risk factor for several diseases of the central nervous system. The aim of this study was to determine the plasma levels of Hcy in a group of multiple sclerosis (MS) patients from a Greek population and the possible correlation with age, disability status, activity or duration of disease, sex, and treatment.
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The Diagnostic Value of CSF ?-Synuclein in the Differential Diagnosis of Dementia with Lewy Bodies vs. Normal Subjects and Patients with Alzheimers Disease.
PLoS ONE
PUBLISHED: 01-01-2013
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The detection of ?-synuclein (?-syn) in the cerebrospinal fluid (CSF) of patients with synucleinopathy has yielded promising but inconclusive results. The aim of the present study was to determine the diagnostic value of ?-syn as a biological marker for Dementia with Lewy bodies (DLB) vs. normal subjects and patients with Alzheimers disease (AD), after strict control of several recognized confounders. Sixteen patients with DLB, 18 patients with AD and 22 age- and sex-matched normal controls (CTRL) were recruited. The levels of total ?-syn in CSF were measured using a novel enzyme-linked immunosorbent assay. There was a significant increase of CSF ?-syn levels in DLB patients as compared to the CTRL and AD groups (P= 0.049 and 0.01 respectively). ROC analysis revealed that increased ?-syn was 81.8% specific for the discrimination of DLB vs. CTRL and 90% vs. AD. However, sensitivity was lower (56.2 % and 50% respectively). These findings provide evidence for a possible diagnostic role of ?-syn as a surrogate biomarker for DLB.
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Omega 3 fatty acids supplementation has an ameliorative effect in experimental ulcerative colitis despite increased colonic neutrophil infiltration.
Rev Esp Enferm Dig
PUBLISHED: 11-08-2011
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omega 3 polyunsaturated fatty acids have anti-inflammatory properties and can be beneficial in the treatment of inflammatory diseases, such as ulcerative colitis. Dextran sodium sulphate (DSS) colitis in rats appears to mimic nearly all of the morphological characteristics and lesion distributions of ulcerative colitis. The purpose of the current study was to investigate the efficacy of omega 3 fatty acids in the treatment of experimental ulcerative colitis.
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Accessory muscles around the superior radioulnar joint: a morphological study.
Ital J Anat Embryol
PUBLISHED: 09-09-2011
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During anatomical dissections on 36 human elbow joints, we observed the presence of three muscles around the superior radioulnar joint usually neglected by the classical anatomical literature, the lateral tensor muscle of the annular ligament (with an incidence of 16.6%), the medial tensor muscle of the annular ligament (11.1%) and the accessory supinator muscle (16.6%). We could not establish any association between the subject handedness and the sidedness of these aberrant muscles, neither we found a predominance in sidedness or in gender. Furthermore, we did not notice any significant predominance related to the occupation and specifically to heavy labor occupations. On the contrary we found these muscles to be more common in non-laborers, which supports the assumption that these variants constitute rather genetic than epigenetic traits. The knowledge of such anatomical variants facilitate the surgeon operating in the elbow region to better interpret supernumerary muscular bundles in the operative field.
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Duplicated gallbladder: surgical application and review of the literature.
Ital J Anat Embryol
PUBLISHED: 08-11-2011
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Duplicated gallbladder is a rare congenital anomaly, usually asymptomatic and occurring as incidental radiographic or surgical finding during upper abdomen, liver and extrahepatic biliary tract surgery. We report on a case of two separate gallbladders, one main and one accessory, each one with its own cystic duct. The main cystic duct drained into the common bile duct while the accessory bile duct extruded into the left side of common bile duct just inferior to the main cystic duct termination. Imaging advances such as computerized tomography, intraoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography may aid in the establishment of accurate diagnosis. The anomaly is of great importance because the surgeon may miss the main or the accessory gallbladder and the patient may need to be re-operated in case of cholelithiasis.
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Sesamoid ossicles within the nuchal ligament: a report of two cases and review of the literature.
J Radiol Case Rep
PUBLISHED: 08-01-2011
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Sesamoid ossicles are ovoid or round nodular small bones found usually within a joint or tendon of the upper and lower limb and rarely at other regions. They are usually asymptomatic, resulting in an increased propensity to injuries. We report on two cases where sesamoid ossicles were detected within the nuchal ligament. The first one was a 55-years-old Caucasian male office employee, complaining of chronic pain in the cervical spine region accompanied by numbness of the left upper limb. During the routine lateral X-ray imaging two sesamoid ossicles were found within the nuchal ligament at the C4 and C5 spinous processes level. The second case was a 64-years-old Caucasian female store employee, complaining of chronic cervical spine pain. The routine lateral X-ray exhibited two sesamoid ossicles within the nuchal ligament at the C5 and C6 spinous processes level. Sesamoid ossicles found in the nuchal ligament in rare cases may become symptomatic and the pathogenesis mechanism should be differentially diagnosed by the physician. We discuss the precise morphology of the trait, the possible etiological mechanisms for their appearance, the histological features, as well as differential diagnosis.
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Emphysematous cellulitis of the left thigh caused by sigmoid diverticulum perforation.
Ann Ital Chir
PUBLISHED: 07-26-2011
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Necrotizing fasciitis and gas gangrene of the lower extremities are two life-threating emergencies and are the most common causes of gas presence in the lower extremity. Rarely the gas presence is secondary to a perforated viscus and especially the colon. Large bowel diverticula are a quiet common disease in western countries and their prevalence increases with age. Also, the possibility of complications is greater in older patients. However, perforated colonic diverticulum seldom presents only with the presence of gas in the lower extremity. We report a case of emphysematous cellulitis of the left thigh caused by a sigmoid diverticulum perforation in a patient with peritoneal carcinomatosis.
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Pathologic Rupture of the Spleen as the Presenting Symptom of Primary Splenic Non-Hodgkin Lymphoma.
J Gastrointest Cancer
PUBLISHED: 04-27-2011
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Pathologic splenic rupture is defined as the spontaneous rupture of a diseased spleen and is quite rare. It is usually associated with oncologic, infectious, and hematologic diseases and more seldom with other rare causes. Pathologic splenic rupture related to hematologic malignancy seems to be rare with only 136 cases reported from 1861 until 1996 and a few cases thereafter. Non-Hodgkin lymphoma and acute myeloid leukemia are most frequently reported followed by chronic myeloid leukemia and lymphoblastic acute leukemia. However, even in cases of non-Hodgkin lymphoma, pathologic splenic rupture as the presenting symptom of the disease is rare as is the presence of primary splenic lymphoma. Conservative treatment is not an option, while operative intervention and emergency splenectomy is the only feasible treatment. We present a very rare case of pathologic rupture of primary splenic lymphoma which was the presenting symptom of the disease.
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Nutritional modulation of the inflammatory bowel response.
Digestion
PUBLISHED: 04-14-2011
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Crohns disease and ulcerative colitis represent distinct phenotypic forms of inflammatory bowel disease and continue to be a common cause of morbidity. The corticosteroids and the immunomodulatory drugs, which are the basis of treatment for the inflammatory bowel diseases, do not assure always satisfactory outcomes. Nutrition has been used in order to modify the inflammatory response of various chronic inflammatory diseases, including Crohns disease and ulcerative colitis. In the pathogenesis of inflammatory bowel diseases, the intestinal microflora and the intestinal mucosal disorders play a crucial role. Also, the release of reactive oxygen species is a significant factor of initiation and preservation of the inflammatory reaction in these diseases. The advantages of the nutritional treatment derive from the sequestration of intraluminal agents which may promote the inflammatory bowel response or, alternatively, nutrition is able to modify the immune response, reducing the uncontrolled inflammatory reaction. Furthermore, nutrition can enhance the mucosal barrier function and consists a significant source of antioxidants. This review focuses on certain nutritional components that modulate the inflammatory response of the bowel and aims to present a rational thesis regarding the use of nutritional agents in the management of inflammatory bowel diseases.
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Sternalis muscle: a new crossed subtype, classification, and surgical applications.
Ann Plast Surg
PUBLISHED: 03-17-2011
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The sternalis muscle is an anatomic variation well known to anatomists, but relatively unknown to clinicians and surgeons. It is localized superficially to the pectoralis major and can cause a diagnostic dilemma during breast surgery, mammography, and computed tomography and magnetic resonance imaging scans, as its appearance mimics tumor pathology of the region. We studied the presence of longitudinally placed muscles in the anterior thoracic wall in 45 cadavers (90 hemithoraces). In an 83-year-old white male, a rare case of crossed-type sternalis was detected on the left side. The muscle originated from the sternal head of the right sternocleidomastoid, crossed into the opposite parasternal half, and split into 2 tendons and 2 muscle bellies that inserted into the left subcostal arch region. This variant was not included in the available sternalis classifications, and an update is suggested. The muscle is of utmost importance and diagnostic value in routine mammogram screening. Moreover, it is of great value for the plastic surgeon, because identification of the variant can aid the differential diagnosis among other regional lesions. Likewise, its superficial location makes it an ideal candidate for utilization as a muscular flap in plastic reconstruction of the head and neck region.
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Sternalis muscle: an underestimated anterior chest wall anatomical variant.
J Cardiothorac Surg
PUBLISHED: 03-04-2011
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Over the recent years, an increased alertness for thorough knowledge of anatomical variants with clinical significance has been recorded in order to minimize the risks of surgical complications. We report a rare case of bilateral strap-like sternalis muscle of the anterior chest wall in a female cadaver. Its presence may evoke alterations in the electrocardiogram or confuse a routine mammography. The incidental finding of a sternalis muscle in mammography, CT, and MRI studies must be documented in a patients medical records as it can be used as a pedicle flap or flap microvascular anastomosis during reconstructive surgery of the anterior chest wall, head and neck, and breast. Moreover, its presence may be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumors.
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High origin of a testicular artery: a case report and review of the literature.
J Med Case Rep
PUBLISHED: 02-23-2011
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Although variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance.
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Headache during airplane travel ("airplane headache"): first case in Greece.
J Headache Pain
PUBLISHED: 02-21-2011
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Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15-20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.
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Topographic anatomy of the internal laryngeal nerve: surgical considerations.
Head Neck
PUBLISHED: 01-25-2011
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This study is focused on the topographic features of the internal branch of the superior laryngeal nerve (ibSLN) at the thyrohyoid membrane area using as anatomic landmarks the posterior border of the thyrohyoid muscle and the superior border of the thyroid cartilage.
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Acute respiratory failure caused by neglected giant substernal nontoxic goiter.
Arq Bras Endocrinol Metabol
PUBLISHED: 01-12-2011
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Substernal goiter is usually defined as a goiter in which the thyroid mass has descended the plane of the thoracic inlet or if more than 50% of the thyroid mass is located below the thoracic inlet. Substernal goiters may be asymptomatic or may present with symptoms caused by compression of adjacent organs. Acute respiratory failure is rare in cases of substernal goiter. In cases of symptomatic substernal goiter the treatment is surgical by thyroidectomy. We present a rare case of a giant substernal nontoxic goiter which caused acute respiratory failure which was treated by urgent thyroidectomy through a T-incision.
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Giant bilateral symptomatic adrenal myelolipomas associated with congenital adrenal hyperplasia.
Pathol. Oncol. Res.
PUBLISHED: 01-11-2011
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Adrenal myelolipoma is an uncommon, benign, biochemically non-functioning and endocrinologically inactive tumor composed of variable amounts of mature adipose tissue and scattered islands of haemopoietic elements, including erythroid, myeloid and lymphoid series, as well as megakaryocytes. Diagnosis of myelolipomas is based on imaging, with ultrasonography, CT and MRI being effective in more than 90% of cases. Differential diagnosis includes other containing fat adrenal masses such as teratoma, lipoma and liposarcoma. The optimal treatment depends on the size and symptoms of the myelolipoma. For incidentally discovered, asymptomatic adrenal myelolipomas smaller than 4 cm surveillance seems to be enough while symptomatic, complicated, hormonally active and larger than 7 cm myelolipomas, should be surgically removed. We present a case of giant bilateral symptomatic adrenal myelolipomas associated with congenital adrenal hyperplasia. A 34 year old female, with congenital adrenal hyperplasia because of 21-hydroxylase deficiency, presented with diffuse abdominal pain and vomiting. Physical examination revealed hirsutism, pronounced virilization and palpable masses both on the right and left abdominal area. The abdominal CT demonstrated bilateral large masses in the anatomical position of the adrenal glands with densities indicating adipose tissue. The differential diagnosis was between myelolipoma and liposarcoma. For diagnostic and also therapeutical reasons, as the masses were large and symptomatic and causing pressure to the surrounding structures, the patient was submitted to laparotomy for bilateral excision. Histopathological examination established the diagnosis of adrenal myelolipoma.
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Etiopathogenesis of hyperostosis frontalis interna: a mystery still.
Ann. Anat.
PUBLISHED: 01-04-2011
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Hyperostosis frontalis interna is a morphological pattern characterized by single or multiple bony nodules situated on the inner lamina of the frontal bone. It is seldom found in males, but it is a common phenomenon among post-menopausal females in modern societies but relatively rare in antiquity. The etiopathogenesis of the trait is a matter of debate and ranges from genetic predisposition to epigenetic, while endocrine disturbances, aging, and dietary factors are also listed among the causes. We studied the frequency, characteristic features, and etiopathogenesis of the disease in recent cadaveric and dry skull specimens. The frequency of hyperostosis frontalis interna in cadavers and dry skull materials was almost identical, 12.5% and 12.3%, respectively. In cadavers, 87.5% of severe hyperostosis frontalis interna cases were found in females over 65 years-old. Interestingly, in two cadavers we found hyperostotic lesions spreading onto adjacent tissues such as the dura and falx cerebri. We provide some new aspects that may help in better understanding of the etiopathogenesis of hyperostosis frontalis interna. Thereby, we discuss the various etiopathogenesis models found in the literature.
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The supratrochlear foramen of the humerus and its relation to the medullary canal: a potential surgical application.
Med. Sci. Monit.
PUBLISHED: 04-02-2010
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The supratrochlear foramen of the humerus is located at the septum separating the coronoid from the olecranon fossa. Beyond its anthropologic interest, that trait seems to have clinical significance as well.
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Osteopoikilosis: a case report of a symptomatic patient.
J Radiol Case Rep
PUBLISHED: 12-01-2009
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Osteopoikilosis (OP) is a very rare benign sclerosing bony dysplasia with an autosomal dominant inheritance. We describe the morphology of an osteopoikilosis male patient, associated with severe pain on wrist and hand joints, report on the relative literature and focus on clinical significance, due to mimicking capability of other more severe conditions such as bone metastases.
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Neurofilament ELISA validation.
J. Immunol. Methods
PUBLISHED: 05-03-2009
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Neurofilament proteins (Nf) are highly specific biomarkers for neuronal death and axonal degeneration. As these markers become more widely used, an inter-laboratory validation study is required to identify assay criteria for high quality performance.
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Unilateral elongated styloid process: a case report.
Cases J
PUBLISHED: 01-07-2009
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An unusual case of a unilaterally elongated styloid process with a length of 5.8 cm was found on a dry skull of a male cadaver. During his life the subject was complaining for reported ipsilateral otalgia presumably due to nerve compression from the elongated styloid process. The symptomatology appeared by such an anatomical variant as well as relative literature is discussed in this paper.
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Humeral septal aperture associated with supracondylar process: a case report and review of the literature.
Ital J Anat Embryol
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The supracondylar process is usually a beak-like osseous prominence located at the anteromedial aspect of the distal portion of the humerus. It is usually asymptomatic but occasionally may compress underlying structures such as the median or ulnar nerve, the brachial artery or its branches. The term septal aperture defines an oval or round shaped bony defect of the septum that separates the olecranon from the coronoid fossa of the humerus. It is of significance for surgeons because it may alter the fracture pattern at the region and thus their management. We present a rare case of coexistence of supracondylar process and septal aperture in a macerated left humerus. The reported incidence of the supracondylar process alone varies from 0.28% to 2.78%, while that of the septal aperture from 6.9% to 60%. We have reviewed the literature and emphasized the radiological and surgical significance of the findings.
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Intra-abdominal heterotopic ossification of the peritoneum following traumatic splenic rupture.
J Res Med Sci
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Intra-abdominal heterotopic ossification is extremely rare with only approximately 30 cases having been reported. While most reported cases have involved the mesentery, ossification of the peritoneum is even rarer. The pathogenesis remains undetermined but is generally considered a reactive process in response to various stimuli. Histologically, it is composed of a peripheral area with bone formation and a central area of reactive hypercellular fibrous tissue. We report a rare case of intra-abdominal heterotopic ossification of the parietal peritoneum following traumatic splenic rupture.
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Trail Making Test error analysis in classic motor neuron disease.
Neurol. Sci.
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The use of non-traditional scores in neuropsychological assessment allows for pattern analysis of test performance, commonly referred to as Quantified Process Approach (QPA). In the present study, the QPA was taken to study error rates on the Trail Making Test (TMT) in 26 non-demented patients with classic motor neuron disease (cMND), who commonly present with impaired cognitive flexibility, and 26 matched healthy controls. Between-group comparisons revealed that cMND patients exhibited higher total error rates on the TMT Part B (TMT-B) relative to controls (p < 0.001), though no significant associations were noted between TMT errors and measures of attention and executive function obtained using the Stroop Neuropsychological Screening Test, the Wechsler Adult Intelligence Scale Digit Symbol and Digit Span subtests and the Wisconsin Card Sorting Test. Moreover, the percentage of cMND patients with normal TMT-B time-to-completion who committed at least one error (either sequential or perseverative errors) in TMT-B was significantly higher compared to controls (p = 0.005). These findings suggest that error analysis using the QPA may increase the clinical utility of TMT and should be considered in addition to time-to-completion scores, in the neuropsychological assessment of patients with cMND.
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Coexistence of multiple omphalomesenteric duct anomalies.
J Coll Physicians Surg Pak
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The omphalomesenteric duct is an embryonic structure which connects the yolk sac to the midgut. The omphalomesenteric duct attenuates between the 5th and 9th week of gestation. Failure of the omphalomesenteric duct involution, either partial or complete, results in various omphalomesenteric duct remnants including Meckels diverticulum, patent vitelline duct, fibrous band, sinus tract, umbilical polyp and cyst. Omphalomesenteric duct remnants are present in 2% of the population but related diseases have seldom been reported in adults. The simultaneous presence of sinus tract, omphalomesenteric cyst, fibrous ligament and Meckels diverticulum has, according to authors knowledge, never been reported. We present a case of a 23 years old male with persisting umbilical discharge for 2 years in whom there was coexistence of the above mentioned anomalies of the omphalomesenteric duct.
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Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations.
J Cardiothorac Surg
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An unusual case of left internal thoracic artery (ITA) origin from the thyrocervical trunk (TCT) was detected during routine cadaver dissection. The variability of origin and course of ITA has less or more frequently been documented in the literature. However, the ITA origin from the TCT on the left side has been detected less commonly, making its dissection and preparation during coronary artery bypass grafting surgery more difficult. We discuss the ITA origin and course variability as well as clinical significance of the present variant, reviewing the relative literature. The objective of our study is to exhibit a rare ITA origin in order to provide a more accurate knowledge of such variations.
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Surgical management of severe spontaneous hemorrhage of the abdominal wall complicating acenocoumarol treatment.
Acta Medica (Hradec Kralove)
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Acenocoumarol is a vitamin K antagonist that is used for the treatment of acquired and congenital, both arterial and venous, thrombotic diseases. Its use is complicated by the narrow therapeutic range. Bleeding following oral anticoagulation, despite rare, remains the major complication. Most cases of hemorrhagic episodes usually require short hospitalization and transfusion, while surgical drainage of the hematoma is not recommended. However, in cases that conservative treatment isnt successful, surgical intervention remains an option. We present a case of severe spontaneous bleeding of the rectus abdominis muscle which was successfully managed surgically.
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Pseudomyxoma retroperitonei: report of 2 cases and review of the literature.
Rev Esp Enferm Dig
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Pseudomyxoma peritonei is a rare clinical condition that is characterized by the presence of mucinous ascitis. It is believed to originate predominately from a mucinous neoplasm of the appendix including a heterogeneous group of tumours ranging from indolentto malignant. It was first described in the late 19th century. Pseudomyxoma retroperitonei is extremely rare with only 33 cases having been reported since the first description in the middle of the 20th century. We report two additional cases of pseudomyxoma retroperitonei and present a review of the literature.
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Hypoglycemia-induced hemichorea in a patient with Fahrs syndrome.
Neurol. Sci.
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Non-ketotic hyperglycemia may be a cause of hemiballism-hemichorea. We present an elderly female type II diabetic patient with right-sided hemiballism-hemichorea of acute onset during hypoglycemia following insulin overtreatment of non-ketotic hyperglycemia. Brain computerized tomography and magnetic resonance imaging scans revealed characteristic hyperdensity and T1 hyperintensity, respectively, in the left basal ganglia, in addition to pallido-dentate calcifications, suggestive of Fahrs syndrome. Although extremely rare, hypoglycemia may be a cause of hemiballism-hemichorea especially in the presence of predisposing factors such as previous hyperglycemic episodes and Fahrs syndrome.
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Cerebrospinal fluid ?-amyloid 1-42 correlates with rate of progression in Alzheimers disease.
J Neural Transm
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Emerging treatment options targeting the pathogenetic mechanisms in Alzheimers disease (AD) and the need to monitor efficacy during treatment trials necessitate the use of biomarkers, which not only may facilitate early and reliable diagnosis, but may also assist in the stratification of patient populations according to their rate of progression. The objective of the present study is to examine whether demographic and cerebrospinal fluid (CSF) parameters at initial evaluation [total tau, tau phosphorylated at threonine-181 and amyloid-beta(1-42) (A?42)] can be used to discriminate between slow and rapid progressors in patients with AD. A total of 74 AD patients were included in the study. Patients recruited were divided into slow and rapid progressors according to their Mini-Mental Status Examination (MMSE) score decline before evaluation. Patients with a drop rate of >4/year were considered rapid progressors. Commercially available ELISA kits were used for measuring CSF biomarkers. Comparisons were performed using analysis of covariance. Significantly lower A?42 levels in the CSF were found in rapid (mean 392 pg/ml) as compared to slow progressors (mean 453 pg/ml), with a p value of 0.042. The results of the present study suggest that levels of the A?42 peptide may be related to the rate of disease progression. Further studies with a prospective design are needed in order to test the possible predictive value of CSF A?42 analysis.
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Multiple desmoid tumors in a patient with familial adenomatous polyposis caused by the novel W421X mutation.
Rev Esp Enferm Dig
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Familial adenomatous polyposis (FAP) is a rare syndrome characterized by the presence of hundreds to thousands of colorectal adenomas and is responsible for less than 1% of all colorectal cancers. The syndrome is also characterized by extra-colorectal features including amongst others upper gastrointestinal tract polyps and desmoid tumors. The syndrome is inherited by an autosomal dominant gene, the adenomatous polyposis coli (APC) gene. We present the physical history, clinical presentation, diagnosis and treatment of a patient with a novel germline APC mutation, the W421X mutation, which resulted in FAP presenting with about a hundred colorectal polyps, gastric hyperplastic polyps and multiple aggressive intra-abdominal and extra-abdominal desmoid tumors.
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Spontaneous cholecystocutaneous fistula draining from an abdominal scar from previous surgical drainage.
Ann Ital Chir
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We present a rare case of cholecystocutaneous fistula draining from an old surgical scar in the right upper abdominal quadrant following chronic calculous cholecystitis. A 71 year old male presented to the emergency department with a persistent bilious drainage from an old surgical scare, from surgical drainage, of the right upper abdominal quadrant for about a week. Cultures from the draining fluid grew Staphylococcus hominis, Escherichia coli and Klebsilla pneumoniae and tigecycline 50 mg twice a day was administrated intravenously to the patient according to sensitivity results. An abdominal US revealed the presence the gallbladder with calculi in a superficial position and the fistulogram revealed a cholecystocytaneous fistula arising from the fundus of the gallbladder. At laparotomy a fistula track was found connecting the gallbladder fundus to the skin, which was dissected and a cholecystectomy was performed. Spontaneous cholecystocutaneous fistula is rarely observed today, mostly as a complication of chronic calculous cholecystitis. Most often it arises from the gallbladder fundus and the clinical presentation is that of a painless draining sinus tract in the right upper quadrant. Diagnosis is aided by abdominal CT scan and ultrasound and treatment is with elective cholecystectomy and excision of the fistula.
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Recurrent small intestine intussusception in a patient with Peutz-Jeghers syndrome.
Rev Esp Enferm Dig
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Peutz-Jeghers syndrome is a rare hereditary autosomal dominant disease caused by a mutation of the tumor suppressor gene serine/threonine kinase 11 located in chromosome 19p13.3. It is characterized by the presence of extensive mucocutaneous pigmentation, especially of the lips and the occurrence of hamartomatous polyps throughout the gastrointestinal tract. Gastrointestinal hamartomas occur predominantly in the small intestine and can become symptomatic leading usually to intestinal obstruction and abdominal pain.We present a case of recurrent intestinal obstruction caused by small bowel intussusception treated by reduction, enterotomy and polypectomy and followed by intraoperative enteroscopy and endoscopic polypectomy.
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Effect of moxifloxacin on the survival, lipid peroxidation and inflammation of immunosuppressed rats with soft tissue infection from Stenotrophomonas maltophilia.
Microbiol. Immunol.
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In order to Investigate the effect of moxifloxacin on the survival, lipid peroxidation and inflammation of immunosuppressed rats with soft tissue infection from Stenotrophomonas maltophilia, 144 white male Wistar rats were randomized into six groups: groups A and B received saline and moxifloxacin once per day respectively, group C and D received saline and moxifloxacin twice per day respectively, group E and F received saline and moxifloxacin three times per day respectively. Blood samples were taken at 6 hours and 30 hours after the administration of S. maltophilia. Malonodialdehyde, white blood cells counts, bacterial tissue overgrowth, serum levels of moxifloxacin and survival were assessed. Survival analysis proved that treatment with moxifloxacin every 8 hours was accompanied by prolonged survival compared with all other groups. Tissue cultures 30 hours after bacterial challenge showed considerable reduction of bacterial overgrowth in the spleen and in the lung of moxifloxacin-treated animals but not in the liver. At six hours no statistically significant differences were observed between groups, but, at 30 hours, MDA concentrations showed statistically significant elevations (p?=?0,044) and white blood cell counts statistically significant reductions (p?=?0,026) in group D compared to C. In the other groups no statistically significant variations were observed. Moxifloxacin possibly stimulates lipid peroxidation and enhances phagocytosis, as depicted by MDA production and survival prolongation, without being toxic as depicted by white blood cell count. Therefore, moxifloxacin should take its place, under conditions, for the treatment of infections in immunosuppressed patients as well as infections caused by S. maltophilia.
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