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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 -
Hand (New York, N.Y.) Jul 2023Intramedullary screw fixation of the proximal ulna can be used for fixation of the ulnar component in total elbow arthroplasty. Our purpose was to use computed...
BACKGROUND
Intramedullary screw fixation of the proximal ulna can be used for fixation of the ulnar component in total elbow arthroplasty. Our purpose was to use computed tomography (CT) to characterize proximal ulna anatomy with respect to intramedullary screw fixation, and then to validate this templating process by inserting intramedullary screws into 3-dimensional (3D)-printed models.
METHODS
Thirty elbow CT scans were reformatted in the axis of the proximal ulna. Screw placement was templated by fixing a length at 78 mm distal to the centerline of ulnohumeral rotation and measuring diameter, and then fixing the screw pitch diameter to 5.5 mm and measuring length. Three-dimensional models were printed for 5 patients, and intramedullary screws were advanced as distal as possible until endosteal fit was achieved.
RESULTS
All patients had an anatomic limit for intramedullary screw fixation, due to dorsal angulation, varus angulation, or both. At 78 mm distal to the centerline of rotation, mean screw diameter was 5.4 mm (range, 3.2-8.0). When fixing screw diameter to 5.5 mm, the mean screw length was 79.9 mm (range, 64.2-107.9). All intramedullary screws were placed in the 3D models within 3 mm of the templated length, with correlation coefficient 0.992.
CONCLUSION
This study characterized proximal ulna anatomy in the context of intramedullary screw fixation. Templating allows surgeons to predict intramedullary screw sizing, and a broad range of screw lengths and diameters is required when attempting intramedullary screw fixation for placement of the ulnar component in uncemented total elbow arthroplasty.
PubMed: 37458253
DOI: 10.1177/15589447231184894 -
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 -
Journal of Ayub Medical College,... 2022It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has... (Observational Study)
Observational Study
BACKGROUND
It is a common observation that the aortic size of Pakistani population is relatively less as compared to western population. Till now there is no study which has measured the dimensions of abdominal aorta in local population.The standard diameter of an artery across the body is critical for clinicians to recognize when an artery has become aneurysmal. This study aims to present the results of a local population's normal diameter of an infrarenal aorta and how it varies by age, gender, weight, height, body mass index (BMI) and body surface area (BSA).
METHODS
This cross-sectional observational study was conducted in Vascular Surgery Department, at Combined Military Hospital (CMH), Peshawar, from July 2020 to November 2021.Participants in the study included all patients who underwent a contrast-enhanced computed tomography (CT) scan of the abdomen for any reason other than cardiovascular disease.The infrarenal abdominal aorta's mean internal diameter (anteroposterior and transverse diameter) was assessed. SPSS v 23 was used to analyze the data and present it as frequency and percentages. The Pearson correlation coefficient assessed the correlation between aortic diameters, weight, height, BMI, and BSA.
RESULTS
Recruitment of a total of 250 patients was done in this study. Males were 194 (77.6%), while the rest were female patients. The patients' mean age was 39.6±12.8 years. The mean anteroposterior (AP) diameter of the infrarenal aorta was 16.13±2.32 mm. The mean transverse diameter (TD) was 15.96±2.34 mm. The infrarenal diameter of the aorta was smaller in women when compared to men, and the calibre of the aorta increased with the increasing age of the patients. There was a statistically significant positive relationship between their age and the average diameter of the infrarenal aorta (p<0.001) among both men and women.
CONCLUSIONS
Clinicians and vascular surgeons will benefit from the findings in diagnosing and treating abdominal aortic aneurysms. Hence, thoughtful consideration should be made before formulating intervention protocols.
Topics: Male; Humans; Female; Adult; Middle Aged; Cross-Sectional Studies; Pakistan; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Tomography, X-Ray Computed
PubMed: 36566410
DOI: 10.55519/JAMC-04-10969 -
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 -
The Knee Jun 2023The purpose of this study was to investigate the effect of growth on the ultrastructural characteristics of the quadriceps tendon (QT).
BACKGROUND
The purpose of this study was to investigate the effect of growth on the ultrastructural characteristics of the quadriceps tendon (QT).
METHODS
Eighteen included patients were classified into three groups based on age and epiphyseal plate condition: the 'immature group' consisted of patients with open epiphyseal plates (11.5 ± 1.6 years old; mean ± standard deviation), the 'young group' consisted of patients aged <20 years with closed epiphyseal plates (15.8 ± 1.0 years), and the 'adult group' consisted of all patients aged >20 years (29.8 ± 11.3 years) irrespective of epiphyseal plate condition. Tendon tissue samples were used for ultrastructural analysis by transmission electron microscopy. Minimum collagen fibril diameters were measured from the cross sections of collagen fibril images using Image J software. The average number of collagen fibers per sample was 797 ± 109, and the average collagen fibril diameter of each sample was compared using one-way analysis of variance.
RESULTS
The mean collagen fibril diameter was 89.7 ± 14.4 nm in the immature group, 94.8 ± 16.4 nm in the young group, and 107.2 ± 12.1 nm in the adult group, with significant differences between the immature and adult groups, and between the young and adult groups (P = 0.001 and P = 0.021, respectively); however, no significant differences were observed between the immature and young adult groups (P = 0.49).
CONCLUSIONS
The collagen fibril diameter of the QT was found to have increased with growth. The study provided insights into graft selection.
Topics: Young Adult; Humans; Child; Adolescent; Collagen; Tendons; Quadriceps Muscle
PubMed: 37150023
DOI: 10.1016/j.knee.2023.04.014 -
Journal of Shoulder and Elbow Surgery May 2022Little is known about the optimal tension in arthroscopic rotator cuff repair (ARCR). This study aimed to identify preoperative, intraoperative, and postoperative...
BACKGROUND
Little is known about the optimal tension in arthroscopic rotator cuff repair (ARCR). This study aimed to identify preoperative, intraoperative, and postoperative factors that correlate with the tension in ARCR and to determine the optimal intraoperative tension using Grasper Tensioning Attachment, a tension meter attached to the common arthroscopic surgical grasper.
METHODS
This study included 63 patients with a mean age at surgery of 65.3 years (range, 45-83 years) who underwent ARCR. The mean follow-up period was 24.1 months (range, 24-28 months). We investigated the patients' demographic data, Japanese Orthopaedic Association score, DeOrio and Cofield classification, and Goutallier stage of the supraspinatus and infraspinatus muscles. We also evaluated cuff integrity based on the Sugaya classification via magnetic resonance imaging. The free edge of the torn retracted tendon was grasped, and the passive tension to the footprint was then measured with Grasper Tensioning Attachment with the arm at the side. The anteroposterior (AP) and mediolateral (ML) diameters were also measured.
RESULTS
The preoperative Goutallier stage of the supraspinatus muscle was stage 0 in 7 cases, stage 1 in 34, stage 2 in 20, and stage 3 in 2. The mean intraoperative rotator repair tension was 10.0 ± 2.5 N (range, 7.5-17 N). The mean AP diameter of the rotator cuff tear was 22 ± 10 mm (range, 8-50 mm), and the mean ML diameter was 24 ± 10 mm (range, 10-50 mm). Age, DeOrio and Cofield classification, Goutallier stage, AP diameter, and ML diameter correlated with rotator repair tension. The rotator repair tension in Sugaya classification type III or IV cases (n = 12, 11.4 ± 2.4 N) was significantly larger than that in type I or II cases (n = 51, 9.7 ± 2.4 N; P = .03). Tension ≥ 10 N as a cutoff value from receiver operating characteristic curve analysis was a risk factor for poor cuff integrity (95% confidence interval, 0.53-0.88).
CONCLUSIONS
Rotator repair tension ≥ 10 N was a risk factor for poor cuff integrity. Thus, care should be taken when performing intraoperative procedures and administering postoperative regimens.
Topics: Arthroscopy; Humans; Magnetic Resonance Imaging; Retrospective Studies; Rotator Cuff; Rotator Cuff Injuries; Treatment Outcome
PubMed: 34687919
DOI: 10.1016/j.jse.2021.10.004 -
Einstein (Sao Paulo, Brazil) 2019To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements.
OBJECTIVE
To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements.
METHODS
Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter.
RESULTS
The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube.
CONCLUSION
This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance.
Topics: Airway Resistance; Computer Simulation; Equipment Design; Intubation, Intratracheal; Respiration, Artificial
PubMed: 31644676
DOI: 10.31744/einstein_journal/2020AO4805 -
Asian Journal of Neurosurgery Dec 2022The posterior condylar canals (PCCs), posterior condylar veins (PCVs), occipital foramen (OF), and occipital emissary vein (OEV) are potential anatomical landmarks...
The posterior condylar canals (PCCs), posterior condylar veins (PCVs), occipital foramen (OF), and occipital emissary vein (OEV) are potential anatomical landmarks for surgical approaches through the lateral foramen magnum. We performed the study to make morphometric and radiological analyses of the various emissary foramens and vein in the posterior cranial fossa. Morphometric study were performed on 95 dry occipital bones and radiological analyses on computed tomography (CT) angiography images of 150 patients. The number of OFs on both sides was recorded and PCC length and mean diameters of the internal and external orifices of PCC were measured for bony specimens. Prevalence of PCV and PCV size was investigated using CT angiography. Mean PCC length was higher in the left side (9.85 ± 2.5). Mean diameter of the internal orifice and the external orifice diameter were almost the same. The majority of PCCs (75-79.33%) had 2 to 5 mm diameter; only 4 to 9.2% were small in size (< 2 mm). In CT angiography, PCV was not identified in 23 (15.33%) patients. PCVs were located bilaterally in 105 (70%) and unilaterally in 22 (20.5%) patients. Only 11.3% of PCVs were large in size (> 5 mm), 80% of PCVs were medium sized (2-5 mm), and 8.6% were small sized (< 2 mm). Normal values of OF, PCC, PCV, and OEV could serve as a future reference for the understanding of the physiology of craniocervical venous drainage, which is necessary to avoid surgical complications and can also serve as a guide to surgical interventions for pathologies of the posterior cranial fossa, such as tumors and injuries.
PubMed: 36570755
DOI: 10.1055/s-0042-1757429 -
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