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Turkish Journal of Anaesthesiology and... Feb 2022Debates continue about the cricoid pressure, which has been used for many years to prevent gastric aspiration during intubation. Using ultrasound, the effects of this...
OBJECTIVE
Debates continue about the cricoid pressure, which has been used for many years to prevent gastric aspiration during intubation. Using ultrasound, the effects of this maneuver and alternatives like paralaryngeal pressure are revealed. The aim of this observational study was to determine the effect of paralaryngeal pressure with an ultrasound probe on the esophageal diameter in patients with different body mass indexes and neck circumferences.
METHODS
After measuring the neck circumference at the level of the cricoid cartilage, the esophagus was visualized by ultrasonography. Compression was applied medially at a 45° angle toward the vertebral column by the ultrasound probe and esophageal anteroposterior outer diameters were measured. Correlations between body mass index, neck circumference, esophageal diameter, and esophageal diameter change ratio were evaluated with Pearson's r value.
RESULTS
One hundred ten volunteers (52 women and 58 men) with mean age 33.7 ± 8.02 years and mean body mass index 25.6 ± 4.65 kg m-2 were recruited. The esophagus was located 78.18% partially to the left, 4.54% completely to the left, 1.81% to the right of the cricoid ring. In 15.45%, esophagus could not be displayed. The mean diameter of the esophagus was 7.6 ± 1.1 mm before pressure and 5.6 ± 0.09 mm after pressure (P < .001). There was no significant correlation between diameter change percentage and body mass index (r=-0.22; P > .05). However, weak correlation was found between diameter change percentage and neck circumference (r=-0.33; P=.016).
CONCLUSIONS
Paralaryngeal pressure with an ultrasound probe has the potential to occlude the esophagus and may be effective in all patient groups.
PubMed: 35256340
DOI: 10.5152/TJAR.2021.1427 -
Resuscitation Apr 2021Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites...
AIM
Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia.
METHODS
The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1-39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system.
RESULTS
In term newborns, diameter of the cortex of the proximal humeral head is 12.1 ± 1.8 mm, distal end of the femur 11.9 ± 3.4 mm and the proximal tibial bone 12.0 ± 2.4 mm with cross-sectional diameter of 113.5 ± 19.7 mm, 120.6 ± 28.2 mm and 111.6 ± 29.5 mm, respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds.
CONCLUSION
Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.
PubMed: 33862177
DOI: 10.1016/j.resuscitation.2021.04.004 -
Clinical Oral Investigations Sep 2023To investigate the intraosseous arterial pathways and anastomoses in the alveolar aspects of the maxilla in order to better understand the arterial scattering pattern.
OBJECTIVES
To investigate the intraosseous arterial pathways and anastomoses in the alveolar aspects of the maxilla in order to better understand the arterial scattering pattern.
MATERIALS AND METHODS
Eleven cadavers were selected for macroscopic intraosseous arterial analyses by corrosion casting. The red-colored acrylic resin was injected into the external carotid arteries. The specimens were kept in an enzymatic solution at 36 °C for about 60 days, depending on the process progression. After removal of the soft tissues and drying, the bone was macerated by potassium hydroxide to analyze the course and the mean diameters of the intraosseous anastomoses.
RESULTS
Vertico-oblique and horizontal intraosseous arteries and anastomoses between the greater palatine-, posterior superior alveolar-, and infraorbital arteries were detected. The vertico-oblique anastomoses were found on the anterolateral wall of the maxilla and the alveolar crest with a mean diameter of 0.46 mm; nevertheless, the horizontal (transalveolar) anastomoses were identified in the interdental septum/alveolar crest with the mean diameter of 0.41 mm. From the horizontal anastomoses, small intraseptal branches supplied the territory of the alveolar socket in various directions.
CONCLUSIONS
The localization of intraosseous arterial anastomoses is critical in implant-related surgeries, predominantly to maintain proper circulation.
CLINICAL RELEVANCE
Based on vertico-oblique and transalveolar anastomoses, simultaneous buccal- and palatal flap elevation (particularly on the palatal side) should be avoided to minimize patient morbidity and intra- or postoperative complications. Moreover, preserving transverse loops in the interdental septum is essential during implant surgeries, which can significantly influence collateral periosteal and osteal circulation to prevent ischemia.
Topics: Humans; Maxilla; Dental Implants; Arteries; Cadaver
PubMed: 37460902
DOI: 10.1007/s00784-023-05141-9 -
Folia Morphologica 2022The foramen magnum (FM) is an important landmark because of its close relationship to key structures such as the brainstem and spinal cord, an extension of the medulla...
BACKGROUND
The foramen magnum (FM) is an important landmark because of its close relationship to key structures such as the brainstem and spinal cord, an extension of the medulla oblongata. Because of the similarity in their shape, the existence of a relationship between cranial length and anteroposterior diameter of the FM, and between cranial width and transverse diameter of the FM may reveal the magnificent harmony of the skull and FM. Based on this idea, we investigated the existence of this harmony in skulls that we used in our study.
MATERIALS AND METHODS
In this study, 60 adult dry skulls belonging to the Turkish population were examined. The anteroposterior and transverse diameters of the foramen magnum and the length and width of the skull were measured. Measurements were made directly on the skull using a digital sliding calliper. New indices and ratios were applied with those measurements.
RESULTS
Our study suggests that FM width and FM length could be estimated by using the cranial length and cranial width measurements in the skull by accepting the mean of these coefficients (4.62) as the golden ratio. The average of the coefficients of cranial width to FM width ratio (4.62 ± 0.35 [95% CI: 4.52-4.70]) and the average of the coefficients of cranial length to the FM length ratio (4.62 ± 0.50 [95% CI: 4.49-4.76]) were found to be equal to each other. In order to check the accuracy of this hypothesis, FM width and FM lengths were estimated with the help of new equations.
CONCLUSIONS
In the present study, the ratio between the anteroposterior and transverse diameters of both FM and the cranium was estimated at 4.62, indicating a magnificent harmony between cranial and subcranial structures. With this ratio, it is easy to estimate FM's size based on simple cranial measurements.
Topics: Foramen Magnum; Head; Pilot Projects; Skull; Spinal Cord
PubMed: 33634836
DOI: 10.5603/FM.a2021.0018 -
BMC Medical Imaging Dec 2022Ultrasound imaging is used for diagnosis, treatment, and blood vessel visualization during venous catheter placement. However, various physiological factors (e.g., body...
BACKGROUND
Ultrasound imaging is used for diagnosis, treatment, and blood vessel visualization during venous catheter placement. However, various physiological factors (e.g., body temperature and exercise) influence vein diameters, which are expected to exhibit daily or diurnal fluctuations. Therefore, this study aimed to determine the intraday (short-term) and interday (long-term) reproducibility of repeated measurements of the depth and diameter of peripheral superficial veins.
METHODS
Twenty-three healthy young women (mean age, 21.7 ± 0.8 years) participated in the study to examine the short- and long-term reproducibility of the depth and diameter of the cutaneous vein in the left elbow fossa acquired by ultrasound imaging. Short-term measurement intervals were 10 s, and the probe was released from the skin for each acquisition, which was repeated five consecutive times. Long-term measurements were performed at the same time on the next day following the same procedure. The acquired images were analyzed for vein depth and diameter using ImageJ software. The intraclass correlation coefficient (ICC) was calculated to determine the short- and long-term reproducibility of the measurements. The relationship between the venous depth and venous diameter intra-individual variation was analyzed, as well as the influence of body composition (body fat and muscle mass) on the venous diameter and depth.
RESULTS
For vein depth measurements, the short- and long-term ICCs were 0.94-0.96 and 0.88, respectively. For the vein diameter, the short- and long-term ICCs were 0.94-0.97 and 0.67, respectively. The short-term ICCs for both vein depth and diameter exceeded 0.9, indicating that the ultrasound vascular measurement was sufficiently reliable. However, long-term reproducibility was slightly lower, especially for the vein diameter. No correlation was found between the intra-individual variation of the vein diameter and vein depth. Although the vein diameter and body fat mass uncorrelated, the vein depth and body fat mass significantly correlated (r = 0.675, 95% confidence interval = 0.281-0.830).
CONCLUSIONS
The long-term reproducibility of vein diameters was somewhat lower than that of the short-term reproducibility. This could be attributed to fluctuations in the physiological state of the participant rather than to the instability of the measurement. Therefore, ultrasound measurement of the peripheral superficial vein is sufficiently reliable.
Topics: Humans; Female; Young Adult; Adult; Reproducibility of Results; Ultrasonography; Adipose Tissue; Angiography; Body Composition
PubMed: 36461013
DOI: 10.1186/s12880-022-00945-9 -
The Korean Journal of Internal Medicine Jan 2022While distal radial artery (DRA) access is increasingly being used for diagnostic coronary angiography, limited information is available regarding DRA size. We aimed to...
BACKGROUND/AIMS
While distal radial artery (DRA) access is increasingly being used for diagnostic coronary angiography, limited information is available regarding DRA size. We aimed to determine the DRA reference diameters of Korean patients and identify the predictors of DRA diameter < 2.3 mm.
METHODS
The outer bilateral DRA diameters were assessed using a linear ultrasound probe in 1,162 consecutive patients who underwent transthoracic echocardiography. The DRA diameter was measured by the perpendicular angle in the dorsum of the hand, and the average values were compared by sex. DRA diameter < 2.3 mm was defined as unsuitable for routine diagnostic coronary angiography using a 5 Fr introducer sheath.
RESULTS
The mean DRA diameters were 2.31 ± 0.43 mm (right) and 2.35 ± 0.45 mm (left). The DRA was smaller in women than men (right: 2.15 ± 0.38 mm vs. 2.43 ± 0.44 mm, p < 0.001; left: 2.18 ± 0.39 mm vs. 2.47 ± 0.45 mm, p < 0.001). The DRA diameter was approximately 20% smaller than the radial artery diameter. A total of 630 (54.2%) and 574 (49.4%) patients had DRA diameter < 2.3 mm in the right and left hands, respectively. Female sex, low body mass index (BMI), and low body surface area (BSA) were significant predictors of DRA diameter < 2.3 mm.
CONCLUSION
We provided reference DRA diameters for Korean patients. Approximately 50% of the studied patients had DRA diameter < 2.3 mm. Female sex, low BMI, and low BSA remained significant predictors of DRA diameter < 2.3 mm.
Topics: Body Mass Index; Coronary Angiography; Female; Hand; Humans; Male; Radial Artery; Ultrasonography
PubMed: 35000375
DOI: 10.3904/kjim.2020.685 -
Cureus Jun 2023Background The inconsistent morphology of the scapula is based on variable dimensions of its glenoid cavity, in addition to its broadened and truncated lateral angle....
Background The inconsistent morphology of the scapula is based on variable dimensions of its glenoid cavity, in addition to its broadened and truncated lateral angle. Its variable shapes are attributed to the spinoglenoid cavity (superior and posterior aspect of the scapula), which appears oval, inverted comma-shaped, and piriform (pear-shaped). Traumatic conditions often lead to glenoid dislocation/fracture. The precise administration of total shoulder arthroplasty with glenoid component adjustment warrants a comprehensive knowledge of scapular morphology. This study aims to assess the glenoid cavity/scapula shapes (anthropometric assessment) among individuals located in Odisha, India. Methods This cross-sectional analysis was undertaken on 74 left-sided and 70 right-sided, dry, and undeteriorated scapulae of human adult specimens obtained from the anatomy department irrespective of their gender and age. Results The glenoid cavity was most commonly inverted comma-shaped (34.02%) and pear-shaped (48.61%) while 17.36% of scapulae had oval-shaped glenoid cavities. The mean scapular breadth and length dimensions were 98.12±7.87mm and 135.76±12.85mm, respectively. Statistically insignificant bilateral variations were observed between the glenoid cavity index (mean value: 68.44±7.98%), glenoid diameter-2 (anteroposterior; mean value: 16.17±2.24mm), glenoid diameter-1 (anteroposterior; mean value: 22.67±1.53mm), and glenoid diameter (superoinferior; mean value: 36.03±2.15mm). Conclusion The size and shape of the glenoid cavity are directly associated with the dislocation of the shoulder joint and may disturb the results of total shoulder arthroplasty and rotator cuff surgeries. The current study analyzed the morphological types and diameters of the glenoid cavity in the scapulae to improve efficiency and lessen the failure proportions in shoulder arthroplasty. The study shows that morphological measurement of scapulae plays a vital role in the effective maintenance of posture and shoulder functions.
PubMed: 37415989
DOI: 10.7759/cureus.39981 -
Radiography (London, England : 1995) May 2022To design a custom phantom of the coronary arteries to optimize CT coronary angiography (CCTA) protocols.
INTRODUCTION
To design a custom phantom of the coronary arteries to optimize CT coronary angiography (CCTA) protocols.
METHODS
Characteristics of the left and right coronary arteries (mean Hounsfield Unit (HU) values and diameters) were collected from consecutive CCTA examinations (n = 43). Four different materials (two mixtures of glycerine, gelatine and water, pig hearts, Ecoflex™ silicone) were scanned inside a Lungman phantom using the CCTA protocol to find the closest model to in vivo data. A 3D printed model of the coronary artery tree was created using CCTA data by exporting a CT volume rendering into Autodesk Meshmixer™ software. The model was placed in an acid bath for 5 h, then covered in Ecoflex™, which was removed after drying. Both the Ecoflex™ and pig heart were later filled with a mixture of contrast (Visipaque 320 mg I/ml), NaCl and gelatin and scanned with different levels of tube current and iterative reconstruction (ASiR-V). Objective (HU, noise and size (vessel diameter) and subjective analysis were performed on all scans.
RESULTS
The gelatine mixtures had HU values of 130 and 129, Ecoflex™ 65 and the pig heart 56. At the different mA/ASiR-V levels the contrast filled Ecoflex™ had a mean HU 318 ± 4, noise 47±7HU and diameter of 4.4 mm. The pig heart had a mean HU of 209 ± 5, noise 38±4HU and a diameter of 4.4 mm. With increasing iterative reconstruction level the visualisation of the pig heart arteries decreased so no measurements could be performed.
CONCLUSION
The use of a 3D printed model of the arteries and casting with the Ecoflex™ silicone is the most suitable solution for a custom-designed phantom.
IMPLICATIONS FOR PRACTICE
Custom designed phantoms using 3D printing technology enable cost effective optimisation of CT protocols.
Topics: Animals; Coronary Vessels; Humans; Printing, Three-Dimensional; Radiation Dosage; Silicones; Swine; Tomography, X-Ray Computed
PubMed: 34556417
DOI: 10.1016/j.radi.2021.09.001 -
Journal of Neurotrauma Feb 2017The severe muscle weakness and atrophy measured after human spinal cord injury (SCI) may relate to chronic muscle denervation due to motoneuron death and/or altered...
The severe muscle weakness and atrophy measured after human spinal cord injury (SCI) may relate to chronic muscle denervation due to motoneuron death and/or altered muscle use. The aim of this study was to estimate motoneuron death after traumatic human SCI. The diameter and number of myelinated axons were measured in ventral roots post-mortem because ventral roots contain large diameter (> 7 μm) myelinated axons that typically arise from motoneurons and innervate skeletal muscle. In four cases (SCI levels C7, C8, T4, and L1) involving contusion (n = 3) or laceration (n = 1), there was a significant reduction in the number of large diameter myelinated axons at the lesion epicenter (mean ± standard error [SE]: 45 ± 11% Uninjured), one level above (51 ± 14%), and one (27 ± 12%), two (45 ± 40%), and three (54 ± 23%) levels below the epicenter. Reductions in motoneuron numbers varied by side and case. These deficits result from motoneuron death because the gray matter was destroyed at and near the lesion epicenter. Muscle denervation must ensue. In seven cases, ventral roots at or below the epicenter had large diameter myelinated axons with unusually thin myelin, a sign of incomplete remyelination. The mean ± SE g ratio (axon diameter/fiber diameter) was 0.60 ± 0.01 for axons of all diameters in five above-lesion ventral roots, but increased significantly for large diameter fibers (≥ 12 μm) in three roots at the lesion epicenter. Motoneuron death after human SCI will coarsen muscle force gradation and control, while extensive muscle denervation will stifle activity-based treatments.
Topics: Adult; Back Muscles; Cell Death; Cervical Vertebrae; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Motor Neurons; Muscle Weakness; Spinal Cord Injuries; Spinal Nerve Roots; Thoracic Vertebrae
PubMed: 27349409
DOI: 10.1089/neu.2015.4374 -
Revista Portuguesa de Cardiologia :... Jul 2023Several studies comparing optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have revealed that OCT consistently provides smaller area and diameter...
INTRODUCTION AND OBJECTIVES
Several studies comparing optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have revealed that OCT consistently provides smaller area and diameter measurements. However, comparative assessment in clinical practice is difficult. Three-dimensional (3D) printing offers a unique opportunity to assess intravascular imaging modalities. We aim to compare intravascular imaging modalities using a 3D-printed coronary artery in a realistic simulator and to assess whether OCT underestimates intravascular dimensions, exploring potential corrections.
METHODS
A standard realistic left main anatomy with an ostial left anterior descending artery lesion was replicated using 3D printing. After provisional stenting and optimization, IVI was obtained. Modalities included 20 MHz digital IVUS, 60 MHz rotational IVUS (HD-IVUS) and OCT. We assessed luminal area and diameters at standard locations.
RESULTS
Considering all coregistered measurements, OCT significantly underestimated area, minimal diameter and maximal diameter measurements in comparison to IVUS and HD-IVUS (p<0.001). No significant differences were found between IVUS and HD-IVUS. A significant systematic dimensional error was found in OCT auto-calibration by comparing known reference diameter of guiding catheter (1.8 mm) to measured mean diameter (1.68 mm±0.04 mm). By applying a correction factor based on the reference guiding catheter area to OCT, the luminal areas and diameters were not significantly different compared to IVUS and HD-IVUS.
CONCLUSION
Our findings suggest that automatic spectral calibration method for OCT is inaccurate, with a systematic underestimation of luminal dimensions. When guiding catheter correction is applied the performance of OCT is significantly improved. These results may be clinically relevant and need to be validated.
Topics: Humans; Coronary Artery Disease; Predictive Value of Tests; Ultrasonography, Interventional; Heart; Coronary Vessels; Tomography, Optical Coherence
PubMed: 36893842
DOI: 10.1016/j.repc.2023.03.001