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Innovations (Philadelphia, Pa.) 2021In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly...
OBJECTIVE
In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly defined. This study evaluated the relationship between leaflet size and annular diameter to predict adequate annular sizing in remodeling AVr.
METHODS
Under regulatory supervision, 74 patients with chronic tri-leaflet AI underwent AVr using ring annuloplasty and leaflet reconstruction. Fifty-four (73%) had ascending aortic ( = 25) and/or root ( = 29) aneurysms, and aortic grafts were sized 5 to 7 mm larger than the rings. Intraoperatively, leaflet free-edge length (FEL) was measured with special ball sizers positioned in the coronary sinus, and "normal" annular diameter was predicted from the validated formula: Required "normal" diameter = FEL/1.5. "Normal" annular diameters predicted from FEL were compared with pathologic diameters measured intraoperatively with Hegar dilators, and both were correlated with gender, age, and BSA.
RESULTS
Average age was 62.1 ± 13.3 years (mean ± SD), 73% (54/74) were male, and 96% (71/74) had moderate-to-severe AI. All patients had annular dilatation, with a pathologic diameter 26.6 ± 2.3 mm before repair, and a predicted "normal" diameter of 21.7 ± 1.7 mm ( < 0.001). Both predicted and pathologic annular diameters were larger in men ( < 0.001), but no relationship existed with age. BSA correlated with both predicted and pathologic diameters, although variability was large.
CONCLUSIONS
Based on a simple validated method to predict "normal" annular diameter, all patients with chronic AI have some degree of annular dilatation. This finding implies that most AVr should include annuloplasty, with adequate and precise annular reduction based on leaflet size.
Topics: Aged; Aorta; Aortic Valve; Aortic Valve Insufficiency; Cardiac Valve Annuloplasty; Dilatation, Pathologic; Humans; Male; Middle Aged
PubMed: 33734902
DOI: 10.1177/1556984521997422 -
BMC Ophthalmology Feb 2023This study aimed to compare anterior scleral thicknesses (ASTs) in people with emmetropia and myopia to explore the effect of myopia on AST.
BACKGROUND
This study aimed to compare anterior scleral thicknesses (ASTs) in people with emmetropia and myopia to explore the effect of myopia on AST.
METHODS
In this cross-sectional study, 93 participants (i.e., 93 eyes) with emmetropia and myopia underwent ocular imaging via anterior segment optical coherence tomography. We acquired raw B-scan OCT images along each of the four meridians (superior, inferior, nasal, and temporal), The AST was estimated from the limbus to a distance of 6 mm. The participants were aged between 20 and 50 years (mean age: 30.2 ± 8.8 years). The axial length (AL) was 22.50 ~ 33.04 mm (mean AL: 26.51 ± 2.65 mm), and the spherical equivalent (SE) was + 0.50 ~ 27.5 D (mean SE: -7.20 ± 6.5 D). The selected sample comprised 37 males and 56 females who were categorized as emmetropes, mild-moderate myopes, or high myopes. The four meridians of AST, AL, and refractive error were observed.
RESULTS
The AL was significantly negatively correlated with the four meridians of AST (the r value ranged between - 0.511 and - 0.228, P < 0.05). There was no significant correlation between age and inferior diameter (r = 0.113, P = 0.314), but age was positively correlated with the average AST of the superior, temporal, and nasal diameters (the r value ranged between 0.452 and 0.552, P < 0.05). There was no significant correlation between sex and AST (the T value ranged between - 1.816 and - 0.130, P > 0.05). Except for the inferior diameters of 1 mm, 5 mm, and 6 mm and the temporal diameter of 1 mm, the four diameters in the emmetropia group and the high myopia group were statistically significant at a distance of 0 ~ 6 mm from the limbus (P < 0.05).
CONCLUSION
The AST is negatively correlated with AL and positively correlated with age. Compared with emmetropic eyes, the AST is thinner in highly myopic eyes. Myopia affects AST, which may be useful for monitoring progression in cases of myopia.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Emmetropia; Sclera; Cross-Sectional Studies; Myopia; Refraction, Ocular; Tomography, Optical Coherence
PubMed: 36782174
DOI: 10.1186/s12886-023-02775-x -
Annals of Plastic Surgery Mar 2016Lymphaticovenular anastomosis (LVA) has become an important procedure for the surgical treatment of lymphedema. In the past, the anatomy of the lymphatic system of...
INTRODUCTION
Lymphaticovenular anastomosis (LVA) has become an important procedure for the surgical treatment of lymphedema. In the past, the anatomy of the lymphatic system of animal models has been reported. However, to our knowledge, there have been few reports of animal models of LVA including training model. In this study, we report on a relatively simple and ideal animal LVA model based on peritoneal lymph ducts and veins.
PATIENTS AND METHODS
For 10 rats, diameters of lumbar lymphatic ducts and iliolumbar veins in the peritoneal cavity on both sides were measured, and LVA was performed. In addition, we measured the diameters of 28 lymphatic ducts and veins in 8 patients who had previously undergone LVA and compared the results with those obtained in this rat model.
RESULTS
The mean diameter of the lymphatic ducts was 0.61 mm, and the iliolumbar veins were 0.81 mm. On the other hand, the mean diameters of the 28 lymphatic ducts and veins of the 8 patients in whom we performed LVA were 0.58 and 0.76 mm, respectively. The differences in the diameters of the lymph vessels and veins between the rats and patients were not statistically significant.
CONCLUSIONS
We report on an LVA model involving the use of the lumbar lymphatic duct and iliolumbar veins of rats. The diameter, nature, and placement of the anastomosis using this model are very similar to that noted during real human surgery. We believe that our rat model will be useful as a practical training model for LVA and in studies on postoperative changes in LVA.
Topics: Anastomosis, Surgical; Animals; Humans; Iliac Vein; Lymphatic Vessels; Lymphedema; Male; Microsurgery; Models, Animal; Peritoneum; Rats; Rats, Wistar; Vascular Patency
PubMed: 26207544
DOI: 10.1097/SAP.0000000000000571 -
The Annals of Thoracic Surgery May 2020We devised a novel trigone-based sizing method, setting the trigones at one-quarter of the annular circumference, and used it for mitral annuloplasty in patients with...
BACKGROUND
We devised a novel trigone-based sizing method, setting the trigones at one-quarter of the annular circumference, and used it for mitral annuloplasty in patients with mitral regurgitation (MR).
METHODS
Between 1999 and 2017, 436 patients with degenerative (n = 192), nonischemic functional (n = 124), or ischemic (n = 120) MR underwent mitral valvuloplasty at our institution using an incomplete ring. The intertrigonal distance and prerepair and postrepair annular diameter were measured. Then the diameters predicted from body surface area, the intertrigonal distance, and the ratios of these diameters to observed data were computed. We investigated the influence of these measurements on MR recurrence, transmitral pressure gradient, and systolic anterior motion.
RESULTS
Initial repair was successful in 433 patients (99%), but 3 patients with systolic anterior motion and MR required conversion to valve replacement. After 1, 5, and 10 years (mean follow-up, 6.3 years), the rate of freedom from grade 2 or higher recurrent MR was 96%, 92%, and 86% in the degenerative group, 99%, 97%, and 90% in the nonischemic functional group, and 95%, 90%, and 79%, respectively, in the ischemic group (P = .052). The observed/body surface area predicted diameter ratio was negatively correlated with the mean transmitral pressure gradient (mm Hg); 12.3 - 8.2 × (ratio) (R = -0.37, P < .001), despite a smaller ratio (<0.9) not being associated with less recurrence of MR. In the degenerative group, systolic anterior motion developed in 7 of 71 patients (10%) with an observed/intertrigonal distance predicted diameter ratio of less than 0.9 (P < .001).
CONCLUSIONS
Our trigone-based sizing method achieved satisfactory control of MR, while avoiding functional mitral stenosis and systolic anterior motion.
Topics: Aged; Echocardiography, Transesophageal; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Retrospective Studies; Treatment Outcome
PubMed: 31586611
DOI: 10.1016/j.athoracsur.2019.08.085 -
The American Journal of Emergency... Dec 2023This study aimed to compare ultrasonography (US) measurements of the upper airway to computerized tomography (CT) measurements. Our study's primary outcome is to...
INTRODUCTION
This study aimed to compare ultrasonography (US) measurements of the upper airway to computerized tomography (CT) measurements. Our study's primary outcome is to research the accuracy of US measurements in the evaluation of upper airway diameters when CT is taken as the gold standard; the secondary outcome is to determine the time required to obtain US measurements.
METHODS
This prospective study included patients ≥18 years old that had undergone thoracic or neck CT due to current clinical necessity. The US measurement for each patient was performed by two researchers with different levels of experience, both of whom were blinded to each other and the CT measurements. Measurements were obtained from the vocal cords and subglottic region. The duration of the US performance was also recorded.
RESULTS
The US and CT measurements were obtained from 94 patients. Concordance between US and CT measurements was found in the Bland-Altman analysis, with a mean -0.05 mm difference for vocal cord diameter and -1.2 mm for subglottic diameter. The intra-class correlation coefficients (ICC) between the CT and US measurements were 0.993, and 0.609 for vocal cord and subglottic diameter measurements, respectively. The ICC between US performers was 0.992 for vocal cord diameter and 0.959 for subglottic diameter. The US's mean time for vocal cord diameter measurement was 38 ± 23 s, and the mean time for subglottic diameter measurement was 49 ± 30 s.
CONCLUSION
The concordance between US and CT measurements is high and the measurements of different practitioners with different experience levels are compatible with each other.
Topics: Humans; Adolescent; Prospective Studies; Larynx; Trachea; Ultrasonography; Tomography, X-Ray Computed; Intubation, Intratracheal
PubMed: 37738893
DOI: 10.1016/j.ajem.2023.09.013 -
Perfusion Mar 2020Aim of this study was to evaluate ascending aorta and aortic root dimension at acute type A dissection (acute aortic dissection) and to identify demographics elements...
OBJECTIVES
Aim of this study was to evaluate ascending aorta and aortic root dimension at acute type A dissection (acute aortic dissection) and to identify demographics elements being allied to the acute event.
METHODS
In a period between 2009 and 2017, 225 (n = 71, 32% female, mean age = 63 ± 12 years) patients eligible for analysis of ascending aorta and 223 (n = 70, 31% female, mean age = 63 ± 13 years) of aortic root were included in this study. Aortic diameter was assessed in preoperative computed tomography scan. The predissection diameters were modeled from the diameters obtained at diagnosis, assuming 30% augmentation of the diameter at acute event.
RESULTS
The mean diameter of the ascending aorta at dissection was 46 ± 8 mm and the modeled diameter was 32.3 ± 5.7 mm. The diameter of the aortic root at dissection was 42 ± 8 mm and modeled diameter was 29.5 ± 5.6 mm. In multivariate analysis, female gender (p = 0.026) and history of cerebrovascular event (p = 0.001) were associated with acute aortic dissection in small aortic root. Patient age (p < 0.001) and history of inguinal hernia (p = 0.001) in ascending aorta <55 mm correlated with acute aortic dissection.
CONCLUSION
Modeling indicates that more than 90% of patients had aortic root and ascending aorta diameter <45 mm. It seems that the aortic diameter expansion over the 55 mm in development of acute aortic dissection is overestimated. Parameters other than aortic size were identified, which may be considered when patients at high risk for dissection were identified.
Topics: Aortic Dissection; Aorta; Echocardiography, Transesophageal; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors
PubMed: 31364492
DOI: 10.1177/0267659119858848 -
The Spine Journal : Official Journal of... Jun 2022Posterior spinal fusion with pedicle screws is commonly used for the treatment of adolescent idiopathic scoliosis (AIS). To reduce radiation exposure, methods other than... (Observational Study)
Observational Study
Comparison of differences and random errors in pedicle diameter measurements between MRI and CT: observational study of 315 pedicles in Lenke type 1 adolescent idiopathic scoliosis patients.
BACKGROUND CONTEXT
Posterior spinal fusion with pedicle screws is commonly used for the treatment of adolescent idiopathic scoliosis (AIS). To reduce radiation exposure, methods other than computed tomography (CT) are desirable for preoperative determination of pedicle diameter.
PURPOSE
Investigate the differences between magnetic resonance imaging (MRI) and CT measurements of pedicle diameter.
STUDY DESIGN
Cross-sectional research.
PATIENT SAMPLE
Twenty-one AIS Lenke type 1 patients (19 female and 2 males, mean age at surgery: 15.4 years) who underwent posterior spinal fusion between April 2009 and October 2019.
OUTCOME MEASURES
Gap between CT and MRI pedicle diameters.
METHODS
The inner and outer diameters of the right and left pedicles from T1 to L3 were measured separately by two spine surgeons for statistical comparisons.
RESULTS
The respective minimum and maximum CT-MRI values were -3.7 mm and 4.7 mm for inner diameter and -4.6 mm and 5.3 mm for outer diameter. Regarding inter-examiner error, the probability of a 2 mm difference in measurement was less than 5% for both modalities. The probability of a 1 mm difference was also less than 5%, and that of a 3 mm or more difference was 2.1% for the inner diameter and 2.9% for the outer diameter. Whereas low body weight was significantly associated with measurement differences, pedicle laterality was not.
CONCLUSIONS
MRI does not have the reliability to measure pedicle size in AIS patients at present. However, with advancements in image processing technology, the accuracy of pedicle size measurement by MRI may soon improve.
Topics: Adolescent; Cross-Sectional Studies; Female; Humans; Kyphosis; Magnetic Resonance Imaging; Male; Pedicle Screws; Reproducibility of Results; Retrospective Studies; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 35017052
DOI: 10.1016/j.spinee.2022.01.006 -
Medicine Jul 2022To assess the most influential factor for pupil diameter changes among age, illuminance, and refractive state and reestablish the optimal procedures for clinical... (Observational Study)
Observational Study
To assess the most influential factor for pupil diameter changes among age, illuminance, and refractive state and reestablish the optimal procedures for clinical applications based on refractive state and illuminance for different age groups. The study was an observational study (repeated measure study). Participants included 219 Korean adults aged 20 to 69 years. Pupil diameters were measured using a pupilometer under scotopic, mesopic-low, and mesopic-high lighting conditions. Factor interactions among age, illuminance, and refractive state were evaluated using mixed linear model and chi-square automated interaction detection. Illuminance mainly contributed to variations in pupil diameter of participants over 50 years, whereas the refractive state was the dominant controlling factor for the pupil variation in participants below 50 years. For more generalized application, the pupil diameter decreased with older age and brighter illuminance (P < .001, inverse correlation, all comparisons). The mean pupil diameter was significantly higher in myopes and emmetropes than in hyperopes (P < .001). Pupil diameter variation modeled using the mixed model confirmed age, illuminance, and refractive error as significant factors (P < .001). Accounting for the interactions among age, illuminance, and refractive error and establishing their hierarchical dominance can be generalized using the chi-square automated interaction detection method and mixed model. Promoting age-dependent consideration for both illuminance and refractive state is necessary when pupil diameters play significant roles in clinical and manufacturing circumstances.
Topics: Adult; Age Factors; Humans; Lighting; Myopia; Pupil; Refractive Errors
PubMed: 35801739
DOI: 10.1097/MD.0000000000029859 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Dec 2022This study focused on the anatomical characteristics and variations of intercostobrachial (ICBN) nerve and median nerve to investigate the possible use of ICBN in...
BACKGROUND
This study focused on the anatomical characteristics and variations of intercostobrachial (ICBN) nerve and median nerve to investigate the possible use of ICBN in restoration of sensory damage of hand after traumatic median nerve injury and to evaluate the feasibility of ICBN neurotization to median nerve.
METHODS
Variations of ICBN were noted in 16 axillary region dissections of eight cadavers. Measurements for ICBN's suitability in terms of neurotization to brachial plexus were done with millimetric devices. The distance of ICBN to the distal end of the lateral (LCMN) and medial (MCMN) contributions of the median nerve and the diameters of ICBN, LCMN, and MCMN were measured.
RESULTS
Fifteen axillary dissections exhibited ICBN, whereas it was absent on the left side of one of the cadavers. The mean diameter of ICBN at its origin was 2.0±0.7 mm and the mean diameter of ICBN at its coaptation point was 3.1±0.9 mm. The mean diameter of the LCMN was 3.9±2.0 mm, the mean diameter of MCMN was 3.5±0.9 mm. The length of ICBN was found to be adequate at both 45 and 90° of shoulder abduction to be extended to both LCMN and MCMN. The diameters of LCMN and MCMN were not significantly correlated with the diameter of ICBN both at origin and at coaptation point (LCMN: p=0.55-0.63 and MCMN: p=0.89-0.85). There is no significant difference between the diameter of LCMN and the diameter of ICBN at its coaptation point (p=0.168) and also between the diameter of MCMN and the diameter of ICBN at its coaptation point (p=0.232).
CONCLUSION
All ICBNs dissected showed adequate length to reach the lateral and medial contribution of the median nerve directly. The ICBN could be a feasible candidate since its diameter was close to LCMN and MCMN according to the descriptive and inferential statistics.
Topics: Humans; Nerve Transfer; Median Nerve; Intercostal Nerves; Brachial Plexus; Cadaver
PubMed: 36588508
DOI: 10.14744/tjtes.2022.68622 -
PloS One 2018Pupil diameter measurement is crucial for physical assessment and disease monitoring in a health and nursing care situation. A general penlights (GPLs) is frequently...
Pupil diameter measurement is crucial for physical assessment and disease monitoring in a health and nursing care situation. A general penlights (GPLs) is frequently used and allow for an approximate and indirect measurement of the pupil diameter. Health caregivers or nurses generally have less confidence in the value of the pupil diameter measured using the GPL. The Advanced Penlight (APL) is a new device designed for accurate measurement of the pupil diameter. The purpose of the presented research was to compare the accuracies and operational times of the pupil diameter measurements by means of the GPL and APL. One-group post-test and single-blind study designed was used in this study. The innovation of the APL is the addition of a perspective measurement ruler (PMR) attached to one side of the penlight that allows precise measurement of the pupil diameter before and after pupillary contraction. The PMR can be rotated by any angle for adaptation to the measurement conditions. After standard pupil diameter measurements by a refractometer (RM) were performed on a subjects, ninety study participants measured the pupil diameters of the same subject separately by the GPL and APL. A self-administered questionnaire was used to assess the opinions of the participants after using the GPL compare to the APL. The mean age of the participants was 20.01 (SD = 0.47) years and 83% of them were female senior nursing students. There were no statistically significant differences between the average values of pupil diameters measured by the APL and the RM. Compared to the GPL, the pupil diameter measured by APL was much similar to the RM measurement. The average operational time was 8.72 seconds shorter (t = -3.81, p = 0.001) for the APL measurement compared to the GPL measurement. The average scores of convenience and confidence on pupil diameter measurements of questionnaire were higher for the APL compared to the GPL. The APL can increase the accuracy and save operating time of pupil diameter measurement and thereby promote the quality of health assessment and nursing care practice.
Topics: Attitude; Female; Humans; Male; Ophthalmology; Printing, Three-Dimensional; Pupil; Refractometry; Time Factors; Young Adult
PubMed: 30403695
DOI: 10.1371/journal.pone.0205978