Dorsal lumbar hernias are rare pathologies of the abdominal wall. Such hernias may manifest within the superior lumbar triangle of Grynfeltt (TG) or the triangle of Petit. The aim of our study was to identify and describe variations in the size and anatomy of the TG. The triangle was studied in 50 adult human cadavers, and dimensions and surface area were measured. The TG was identified in 82% of cases. Based on surface area parameters, we were able to classify the triangles into four distinct types. Type I (50%), or small triangles, had a surface area of <5 cm(2). Type II (22%, n=22) were defined as triangles intermediate in size with surface areas of 5-15 cm(2). Type III (10%, 10) were large triangles with surface areas of >15 cm(2). Finally, Type 0 (18%, 18) did not exhibit a triangle; instead, the aponeurosis of the transversus abdominis was enclosed by the external abdominal oblique muscle and the sacrospinalis muscle. We present these data with the hope that after further investigation in a clinical setting, they may serve practitioners in predicting which morphometric variations of the TG most predispose patients to posterior wall herniation.

Object Intradural intercommunications between adjacent nerve roots have received scant attention in the literature. Moreover, the pattern of these connections among individuals harboring normal, pre-, and postfixed brachial plexuses, to the authors' knowledge, has not been explored. Methods Sixty adult cadavers were evaluated for the presence of a normal, prefixed, or postfixed brachial plexus. Next, with the cadaver placed prone, laminectomies of all cervical and the upper thoracic vertebrae were performed. The dura mater was opened and observations were made for the presence of neural intercommunications between the roots of adjacent spinal levels. Any correlations between such root communications and pre- and postfixed brachial plexuses were explored. Results Among the cadavers, 28% harbored prefixed and 5% harbored postfixed brachial plexuses. Intercommunications between adjacent dorsal roots were more or less equally distributed between left and right sides. A total of 134 interconnections were identified between C-1 and T-2 levels. No interconnection spanned more than one spinal segment. When all sides were included, in ascending order based on the number of interconnections present, interconnections between roots were found between T-1 and T-2, C-1 and C-2, C-8 and T-1, C-2 and C-3, C-3 and C-4, C-4 and C-5, C-7 and C-8, C-6 and C-7, and C-5 and C-6. In this same order, the percent of total connections for each of these levels was 0, 0.8, 2, 7, 13, 15, 16, 20, and 25%. For left and right sides, a total of 73 and 61 interconnections were identified, respectively. This order of concentration was found to have no statistical difference between cadavers that had a normal arrangement of the brachial plexus, a prefixed brachial plexus, or a postfixed brachial plexus. No specimen was found to have interconnections between adjacent ventral roots. Conclusions Such variations as intradural interconnections may lead to misinterpretation of spinal levels harboring pathological entities of the spinal axis and should be considered during surgical procedures of this region such as rhizotomy. However, the present study did not find a correlation between the level of these interconnections and whether the brachial plexus was pre- or postfixed (that is, there were no observable shifts intradurally that corresponded to the extradural segmental contributions to the brachial plexus).

Richard Lower, in 1669, first described the tubercle that now bears his name, calling it the intervenous tubercle located between the fossa ovalis and the superior vena cava. The aim of the study was to confirm the existence of the tubercle as described initially by Lower, adding details of its location, dimensions, and prevalence. We examined 100 formalin-fixed human hearts. In no heart did we find any discrete tubercle or elevation of the right atrial wall superior to the superior limbus (rim) of the fossa ovalis. In addition, we could find no morphometric differences in the thickness of the area superior to the superior limbus of the fossa. Dissections revealed that very little of the extensive musculature can be removed without opening the right atrial wall and arriving outside the heart. This is the essential criterion in distinguishing folds from "true" septal structures. When viewed in this light, it is only the flap valve of the fossa ovalis, and its immediate muscular infero-anterior rim, the so-called lower limbus, that can be removed so as to create communications between the cavities of the atrial chambers, and not exiting at the same time from the cavities of the heart. This is because the larger part of the muscular borders of the fossa ovalis is no more than an infolding of the atrial walls, which incorporates extracardiac adipose tissue within the fold. Although this process of folding unequivocally produces an intracardiac buttress, namely, the limbuses (rims) of the fossa, the buttress, being an infolding, does not constitute, according to our definition, a true septum. On this basis, we suggest that it is the superior limbus of the fossa ovalis, or the superior interatrial fold, that previously has been considered to represent the intervenous tubercle of Lower.

During the COVID-19 pandemic, patients were apprehensive to seek acute care resulting in delayed diagnoses of serious conditions and reduction in emergency room (ER) visits by 50% in the Fraser Health Authority. Patients who did present to the ER left prior to their results being available and some refused admission and critical treatments.At the Chilliwack General Hospital ER, a virtual care clinic was established to follow-up on patients after their initial ER visit, providing test results and ensuring patients are not clinically deteriorating at home. Specific criteria were created for safe referral to virtual follow-up. For 2 hours daily, an ER physician contacts selected patients by telephone to provide a virtual follow-up based on the patients’ needs.Through the emergency department virtual care (EVC) pilot project, from May 14 to August 31, 2020, on average 58 telehealth visits were conducted weekly, with 19% of visits reaching unattached patients without a regular primary care provider. A patient survey revealed that 75% of respondents were very satisfied or satisfied with telephone virtual care as a follow-up to their emergency department (ED) visit, while 95% would like to continue to receive telephone follow-up care. Additionally, based on a physician survey, 80% of providers were satisfied or very satisfied with the overall EVC experience. The majority (80%) would like to continue to provide the service. One patient was referred for a virtual care follow-up for imaging results that did not meet the referral criteria; the patient was diagnosed with a perforated appendicitis. They had an atypical presentation of abdominal pain and their care was delayed by several hours than if they were to present to the ED for in-person follow-up. The process and referral criteria may require minor modification and must be followed strictly to ensure safety and efficiency in providing telehealth follow-up in the acute care setting.

Such information may be valuable in elucidating other functions of the HN and may aid in the histological diagnosis of this nerve. Additionally, pathology involving HN such as paragangliomas, are supported by our findings of the presence of autonomic ganglion cells in some HN specimens.