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The Journal of Vascular Access Jul 2023The antecubital fossa is an important site for venepuncture and intravenous procedures. The size and location of a vein can affect the success of venepuncture and...
BACKGROUND
The antecubital fossa is an important site for venepuncture and intravenous procedures. The size and location of a vein can affect the success of venepuncture and intravenous access. Several studies have investigated the superficial vein morphometry, but they had small sample sizes or focused on specific populations or groups. Therefore, we conducted a prospective study with large participants in general population to analyse the morphology of the antecubital superficial vein and identify the association of sex, age and body mass index (BMI) with the size and location of the vein.
METHODS
This study collected images of superficial veins prospectively using autonomous robotic ultrasound on the antecubital area between October and November 2020. We measured the superficial vein depth, vertical diameter and horizontal diameter at the antecubital area, extracted population characteristics (sex, age and BMI), and analysed a relationship between the vein dimensions and the characteristics.
RESULTS
In this study, data from 461 participants (201 males and 260 females) with mean age of 41.1 years were produced. The mean vein depth, mean vertical diameter and mean horizontal diameter (±standard deviation) were 4.81 (±2.17), 3.01 (±1.10) and 4.46 (±1.60) mm, respectively. We found significant differences in vein dimensions between males and females, with males having larger vertical and horizontal diameters than females ( < 0.001). The study also revealed significant differences in vein depth and dimensions among age groups and BMI subgroups ( < 0.001).
CONCLUSIONS
These findings revealed that the superficial vein in the antecubital area was oval, with a larger horizontal diameter than vertical diameter. Morphometry revealed differences in sex, age and BMI. Understanding variations in vein dimensions among different subgroups can help medical professionals improve success rate of venous access and patient safety.
PubMed: 37448206
DOI: 10.1177/11297298231186651 -
Paediatric Anaesthesia Apr 2021Balloon-tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single-lung ventilation. In clinical practice, their balloons...
Inflation volume-balloon diameter and inflation pressure-balloon diameter characteristics of commonly used bronchial blocker balloons for single-lung ventilation in children.
BACKGROUND
Balloon-tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single-lung ventilation. In clinical practice, their balloons demonstrate sudden expansion when inflated with air. In addition, there are concerns related to the high inflation pressures required to expand the balloons.
METHODS
This in vitro study assessed inflation volume- and inflation pressure-balloon diameter characteristics of the Fogarty arterial embolectomy catheters and Arndt endobronchial blockers. Balloon diameters were photographically assessed during unrestricted volume- and pressure-guided inflation, using air up to the maximum allowed inflation volume as indicated by the manufacturers. Inflation pressures required to open the blocker balloons and inflation pressures needed to expand them to maximum indicated diameter were measured.
RESULTS
Volume-guided inflation demonstrated a late acute rise in diameter in Fogarty blocker balloons, whereas in the Arndt endobronchial blocker balloons almost linear inflation volume-to-diameter characteristics were observed. Pressure-guided inflation on the other hand demonstrated low-volume, high-pressure characteristics in the Fogarty blocker balloons, with inflation pressures required to expand the balloons to maximum diameters ranging from (mean (SD)) 636 (75) to 947 (152) cmH O. The inflation pressures required to open the Fogarty blocker balloons were even >1000 cmH O. Inflation pressures required to expand the 5 F, 7 F, and 9 F Arndt endobronchial blocker balloons to maximum indicated diameter were much lower, namely at 218 (15), 252 (28), and 163 (8) cmH O.
CONCLUSION
Based on these study findings, the balloons of Fogarty arterial embolectomy catheters represent high-pressure devices and do not permit stepwise controlled bronchial blockage. The Arndt endobronchial blockers have some advantages over the Fogarty blocker devices, but also represent high-pressure equipment and must be used with caution and limited duration. Manufacturers are asked to design pediatric endobronchial blocker catheters with truly high-volume, low-pressure balloons in accordance to age-related pediatric airway dimensions.
Topics: Bronchi; Catheterization; Child; Humans; Insufflation; One-Lung Ventilation
PubMed: 33406307
DOI: 10.1111/pan.14123 -
Journal of Anesthesia Apr 2022The bispectral index (BIS) value during general anesthesia with the newly developed anesthetic remimazolam is reported to be relatively high; however, the reason for...
BACKGROUND
The bispectral index (BIS) value during general anesthesia with the newly developed anesthetic remimazolam is reported to be relatively high; however, the reason for this and the appropriate indicator for assessing the sedation level during remimazolam anesthesia have not been determined. In this study, the level of sedation during general anesthesia with remimazolam was evaluated using several different indicators.
METHODS
Thirty patients who underwent breast surgery under general anesthesia with remimazolam were included. BIS®, Sedline® and the pupil resting diameters were measured simultaneously. The intraoperative dose of remimazolam was adjusted to obtain a BIS in the range of 40-60; if a BIS < 60 could not be achieved, the intraoperative dose was increased up to the maximal dose of 2 mg/kg/h.
RESULTS
The mean intraoperative BIS and patient state index (PSI) in all patients was 50.6 ± 9.1 and 43.0 ± 11.8, respectively. Five patients showed a mean intraoperative BIS > 60 and eight patients showed mean intraoperative PSI > 50. The mean intraoperative spectral edge frequency (SEF) of BIS® or Sedline® was 15.3 ± 2.5 Hz or 10.6 ± 3.0 Hz, each. The mean intraoperative resting pupil diameter was 1.7 ± 0.2 mm. There were no patients with awareness during anesthesia.
CONCLUSIONS
Processed electroencephalograms (BIS and PSI), and SEF of BIS® were relatively high during anesthesia with remimazolam, but SEF of Sedline® or pupillary diameter could be a supportive indicator to confirm sedation level during remimazolam anesthesia.
Topics: Anesthesia, General; Anesthetics; Benzodiazepines; Electroencephalography; Humans; Hypnotics and Sedatives
PubMed: 34999964
DOI: 10.1007/s00540-021-03030-7 -
Journal of Personalized Medicine May 2022To investigate the association between Aorta (Ao), pulmonary artery (PA) diameters and the PA/Ao ratio with right (RV) and left ventricle (LV) volumetric properties in...
To investigate the association between Aorta (Ao), pulmonary artery (PA) diameters and the PA/Ao ratio with right (RV) and left ventricle (LV) volumetric properties in subjects free of cardiovascular diseases. In the KORA-MRI study, 339 subjects (mean age 56.3 ± 9.1 years; 43.7% female) underwent whole-body 3T-MRI. Ao and PA were measured on DIXON sequences. Cvi42 quantified cardiac functional parameters from a SSFP sequence. The relationship between ascending (AAo), and descending aorta (DAo), as well as PA diameters, and RV and LV function were assessed using linear regression models adjusted for age, sex, and cardiovascular risk factors. AAo and DAo diameter were associated with LV end-diastolic volume (β = 4.52, = 0.015; ß = 7.1, ≤ 0.001), LV end-systolic volume (β = 2.37, = 0.031; ß = 3.66, = 0.002), while DAo associated with RV end-diastolic volume (β = 6.45, = 0.006) and RV end-systolic volume (β = 3.9, = 0.011). PA diameter was associated with LV end-diastolic volume (β = 4.81, = 0.003). Interestingly, the PA/Ao ratio was only associated with RV end-diastolic and end-systolic volume (β = 4.48, = 0.029; ß = 2.82, = 0.037). Furthermore, we found different relationships between men and women. Ao and PA diameter were associated with LV and RV volumetric parameters in subjects free of cardiovascular diseases suggesting that ventricular volumetric performance directly relates to vascular diameter properties.
PubMed: 35743674
DOI: 10.3390/jpm12060889 -
Heliyon Apr 2023To explore the feasibility and accuracy of virtual reality (VR) derived from cardiac computed angiography (CCTA) data to predict left atrial appendage occlusion (LAAO)...
AIM
To explore the feasibility and accuracy of virtual reality (VR) derived from cardiac computed angiography (CCTA) data to predict left atrial appendage occlusion (LAAO) device size.
METHOD
Retrospective data of patients who underwent LAAO according to clinical indication were reviewed; all patients underwent a pre-procedural CCTA. Measurements of the left atrial appendage (LAA) orifice diameters by CCTA, VR, and transesophageal echocardiography (TEE) (acquired during the procedure) were compared to the implanted device size. The LAA perimeter was calculated using the Ramanujan approximation. Statistical analyses included Lin's Concordance Correlation Coefficient ( ), the mean difference, and the mean square error (MSE).
RESULTS
The sample was composed of 20 patients (mean age 75.7 ± 7.5 years, 60% males) who underwent successful LAAO insertion (ACP™ N = 8, Watchman™ N = 12). The CCTA, VR, and TEE maximal diameter was 0.52, 0.78 and 0.60, respectively with mean differences of +0.92 ± 4.0 mm, -1.12 ± 2.3 mm, and -3.45 ± 2.69 mm, respectively. The CCTA, VR, and TEE perimeter calculations were 0.49, 0.54, and 0.39 respectively with mean differences of +4.69 ± 11.5 mm, -9.88 ± 8.0 mm, and -16.79 ± 7.8 respectively.
DISCUSSION
A VR visualization of the LAA ostium in different perspectives allows for a better understanding of its funnel-shaped structure. VR measurement of the maximal ostium diameter had the strongest correlation with the diameter of the inserted device. VR may thus provide new imaging possibilities for the evaluation of complex pre-procedural structures such as the LAA.
PubMed: 37089380
DOI: 10.1016/j.heliyon.2023.e14790 -
Ophthalmic & Physiological Optics : the... Sep 2022To investigate the validity of Placido-based corneal topography parameters to predict corneoscleral sagittal heights measured by Fourier-based profilometry at various...
PURPOSE
To investigate the validity of Placido-based corneal topography parameters to predict corneoscleral sagittal heights measured by Fourier-based profilometry at various diameters.
METHODS
Minimal (Min ), maximal (Max ) sagittal height, toricity (Max - Min ) and axis of the flattest meridian (Min ) of 36 subjects (mean age 25.4 SD ± 3.2 years; 21 female) were measured using the Eye Surface Profiler and analysed for diameters (chord length) of 8 to 16 mm (in 2-mm intervals). Furthermore, corneal central radii, corneal astigmatism, eccentricity and diameter were measured using the Keratograph 5 M.
RESULTS
Using multiple linear regression analysis, the best equation for predicting the sagittal heights for 8 mm (r = 0.95), and 10 mm (r = 0.93) diameters included corneal central radii and eccentricity. The best equation for predicting sagittal heights for 12 mm (r = 0.86), 14 mm (r = 0.78) and 16 mm (r = 0.65) diameters included corneal central radii, eccentricity and corneal diameter. Corneal astigmatism was significantly correlated with sagittal height toricity for 8 and 10 mm diameters (r = 0.50 and 0.29; p < 0.01), while no correlation was observed for 12, 14 and 16 mm diameters (p = 0.18 to p = 0.76). The axis of the flattest corneal meridian measured by Placido-based topography was significantly correlated with the axis of the flattest meridian measured by Fourier-based profilometry for 8, 10 and 12 mm diameters (r = 0.17 to 0.44; p < 0.05), while there was no correlation for 14 and 16 mm diameters (p = 0.48 and p = 0.75). For a typical soft contact lens diameter of 14 mm, 78% of the variance could be determined with a corneal topographer and 68% with keratometry and corneal diameter measurement.
CONCLUSIONS
The combination of corneal central radii, eccentricity and corneal diameter measured by Placido-based topography is a valid predictor of the corneoscleral sagittal height in healthy eyes. Scleral toricity and axis of the flattest meridian seem to be independent from Placido-based corneal parameters and requires additional measuring tools.
Topics: Adult; Astigmatism; Contact Lenses, Hydrophilic; Cornea; Corneal Diseases; Corneal Topography; Female; Humans; Sclera
PubMed: 35703419
DOI: 10.1111/opo.13017 -
AJR. American Journal of Roentgenology Jun 2020The purpose of this study was to evaluate size criteria for retroperitoneal and pelvic lymph nodes in healthy children. We identified all trauma patients younger than...
The purpose of this study was to evaluate size criteria for retroperitoneal and pelvic lymph nodes in healthy children. We identified all trauma patients younger than 18 years old without underlying disease and with CT scans without abnormalities in the abdomen and pelvis during 2014-2015. Two pediatric radiologists reviewed the studies independently and recorded the number of retroperitoneal and pelvic lymph nodes with a long diameter 5 mm or greater and the size (two perpendicular diameters) of the largest lymph node in five anatomic locations. Discrepant results were reviewed in consensus. The relationship of short diameter to age and interobserver variability was evaluated. A total of 166 patients (86 boys) with a mean age of 7.2 years old (range, 0.1-18.0 years old) were identified. More than 95% of lymph nodes in the retroperitoneum and pelvis had a short diameter measuring at most 7 and 8 mm, respectively, by consensus. The size of the largest short diameter of lymph nodes did not vary with age. More than four lymph nodes were identified in any anatomic location in only three patients, by only one of the radiologists. Agreement for lymph nodes with largest diameter of 5 mm or greater between radiologists ranged from 70.5% to 97.6% for the five anatomic locations with poor interobserver agreement (κ, 0.2-0.3). The size and number of retroperitoneal and pelvic lymph nodes in children are less than in adults. A short diameter threshold of 7 mm (retroperitoneal) and 8 mm (pelvic) and more than four lymph nodes with long diameter of 5 mm or greater in one location may define disease.
Topics: Adolescent; Child; Child, Preschool; Contrast Media; Female; Humans; Infant; Lymph Nodes; Male; Pelvis; Reference Values; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 32228324
DOI: 10.2214/AJR.19.22316 -
European Journal of Ophthalmology Mar 2021The aim of this article was to study the lower punctum parameters in patients with acquired punctal stenosis using spectral-domain anterior segment optical coherence...
BACKGROUND/OBJECTIVES
The aim of this article was to study the lower punctum parameters in patients with acquired punctal stenosis using spectral-domain anterior segment optical coherence tomography.
SUBJECTS/METHODS
This was a prospective nonrandomized study that included two groups. Group 1 was composed of 32 puncta from 32 subjects (11 males and 21 females, aged 40-62 years) with epiphora and clinically diagnosed punctal stenosis. Group 2 (control group) included 30 puncta from 30 normal subjects (10 males and 20 females, aged 43-63 years). Anterior segment optical coherence tomography was employed to evaluate lower punctum parameters in all subjects; the inner and outer punctal diameters as well as punctal depth were measured.
RESULTS
External punctal diameter (mean: 466.1 ± 120.3 μm), internal punctal diameter (mean: 173.4 ± 55.6 μm) and punctal depth (mean: 188.4 ± 67 μm) values in Group 1 were statistically significantly lower than those in Group 2 (mean: 745.7 ± 156.9 μm, mean: 384 ± 119.1 μm, and mean: 284.9 ± 57.7 μm, respectively).
CONCLUSION
Anterior segment optical coherence tomography could possibly be used as a noncontact and noninvasive diagnostic modality for evaluating and measuring the lower punctum in patients with punctal stenosis. Further research is required to develop a normative database and grading system for stenosed puncta and to correlate the degree of stenosis with the severity of epiphora.
Topics: Adult; Constriction, Pathologic; Databases, Factual; Eyelid Diseases; Eyelids; Female; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Male; Middle Aged; Prospective Studies; Tomography, Optical Coherence
PubMed: 31736360
DOI: 10.1177/1120672119871396 -
Animals : An Open Access Journal From... Dec 2021Circular exercise can be used at varying gaits and diameters to exercise horses, with repeated use anecdotally relating to increased lameness. This work sought to...
Circular exercise can be used at varying gaits and diameters to exercise horses, with repeated use anecdotally relating to increased lameness. This work sought to characterize mean area, mean vertical force, and mean pressure of the front hooves while exercising in a straight line at the walk and trot, and small (10-m diameter) and large circles (15-m diameter) at the walk, trot, and canter. Nine mature horses wore Tekscan Hoof Sensors on their forelimbs adhered with a glue-on shoe. Statistical analysis was performed in SAS 9.4 with fixed effects of leg, gait, and exercise type (PROC GLIMMIX) and < 0.05 as significant. For all exercise types, the walk had greater mean pressure than the trot ( < 0.01). At the walk, the straight line had greater mean area loaded than the large circle ( = 0.01), and both circle sizes had lower mean vertical force than the straight line ( = 0.003). During circular exercise at the canter, the outside front limb had greater mean area loaded than at the walk and trot ( = 0.001). This study found that gait is an important factor when evaluating circular exercise and should be considered when exercising horses to prevent injury.
PubMed: 34944357
DOI: 10.3390/ani11123581 -
Cureus Sep 2021Purpose Variation among aqueous humor outflow from venting slits performed on glaucoma drainage device tubing often occurs even when physician technique and equipment...
Purpose Variation among aqueous humor outflow from venting slits performed on glaucoma drainage device tubing often occurs even when physician technique and equipment are held constant. Our hypothesis is that there are dimensional differences within the tubing, even among the same make and model of glaucoma drainage device (GDD) implants. Methods Prior to surgical implantation, excess glaucoma drainage tubing was collected for analysis. The tubing samples were sliced horizontally, and the external tube, internal lumen, and wall dimension measurements were collected microscopically. Groups were divided based upon brand and model and then statistically analyzed using an independent t-test. A total of 28 tubes were analyzed, consisting of 7 Molteno and 21 Baerveldt implants. Results The mean external diameter for the Molteno group was 656 ± 20µm, significantly larger than the Baerveldt external diameter of 620 ± 13µm (P<0.05). The mean internal diameter among Molteno lumens was 344 ± 13µm, also statistically larger than the mean internal diameter of 309 ± 18µm for Baerveldt tubes (P<0.05). The Molteno luminal wall width varied significantly less than the Baerveldt wall, 18% versus 28%, respectively (P<0.05). The tubings' wall widths variation translated into highly significant off-centered lumens among both brands. Conclusion Our findings suggest that there are significant variations among glaucoma implant dimensions between and within the multiple makes and models. The discrepancies among tubal wall thickness and off-centered lumens are undetectable to the naked eye. Importantly, this may result in significant aqueous humor outflow variation following the creation of venting slits secondary to the found irregular luminal diameters and tube wall thicknesses.
PubMed: 34659982
DOI: 10.7759/cureus.17771