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Heliyon Nov 2022To examine the tracheobronchial anatomy and its common variations after double-lumen tube (DLT) placement, and to determine the anatomical landmarks that can be easily...
BACKGROUND
To examine the tracheobronchial anatomy and its common variations after double-lumen tube (DLT) placement, and to determine the anatomical landmarks that can be easily identified by practitioners for DLT positioning.
METHOD
In total, 200 patients with American Society of Anesthesiologists I-II, who were aged 20-75 years and scheduled for video-assisted thoracic surgery (VATS), were prospectively enrolled. The types of DLT position in each patient was recorded [Type I, the DLT bronchial end was in the left main bronchus (LMB), and the primary carina could be observed; Type Ⅱ, the DLT bronchial end was in the right bronchus intermedius (RBI); and Type III, an unidentified trachea or bronchus wall was observed from the DLT tracheal lumen] and the main tracheobronchial tree images were collected using Flexible bronchoscopy (FB).
RESULT
Five patients were excluded due to excessive bronchus secretions impacting image collection. Type Ⅰ, II, and III positions of DLT were detected in 134 (68.7%) patients, 28 (14.4%) patients, and 33 (16.9%) patients, respectively. Examples of the tracheobronchial tree, common features, and variations in each lung lobe were demonstrated using FB. Furthermore, image analysis showed that each superior segment orifice of the right lower lobe (RLL) and the left lower lobe (LLL) was less variable and recognizable, determining it an important anatomical landmark for DLT positioning.
CONCLUSION
The tracheobronchial tree and its common variations after DLT placement were described. The superior segment orifice of the RLL and LLL can be considered as an important landmark for DLT positioning.
PubMed: 36439773
DOI: 10.1016/j.heliyon.2022.e11779 -
Surgical Innovation Apr 2013Transanal endoscopic microsurgery (TEM) is a minimally invasive technique affording full-thickness resection of rectal tumors and can also be used as a platform for...
Transanal endoscopic microsurgery (TEM) is a minimally invasive technique affording full-thickness resection of rectal tumors and can also be used as a platform for transrectal access to the peritoneal cavity for NOTES (natural orifice transluminal endoscopic surgery) procedures. The authors investigated the anatomical characteristics of the pelvis in Koreans to develop an ergonomically designed NOTES platform. A total of 256 patients (156 men and 100 women) who underwent pelvic magnetic resonance imaging for evaluating rectal neoplasms were enrolled for analysis. The authors retrospectively reviewed and calculated anatomical lengths and angles on pelvic magnetic resonance images and analyzed differences in pelvic anatomy in terms of patient gender, age, and body mass index. Various angulations were noted from the anal canal to the sacral promontory, attributable to the shape of the sacral bone. Minimal difference in pelvic anatomy was evident between men and women. In conclusions, the authors expect that their data will be useful in the development of ergonomic TEM-NOTES platforms.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Pelvis; Republic of Korea; Retrospective Studies
PubMed: 22696029
DOI: 10.1177/1553350612447692 -
Journal of Endourology Sep 2005Technological advances have increased the applicability of endoscopic treatment for upper-tract transitional-cell carcinoma (TCC). Percutaneous and ureteroscopic tumor... (Review)
Review
Technological advances have increased the applicability of endoscopic treatment for upper-tract transitional-cell carcinoma (TCC). Percutaneous and ureteroscopic tumor resection have become reasonable treatment options for patients with anatomically or functionally solitary kidneys, bilateral upper-tract tumors, significant renal insufficiency, or comorbid disease that would preclude standard open surgery. This approach also is being used increasingly on those with a normal contralateral kidney in whom nephroureterectomy and en bloc removal of the ipsilateral ureteral orifice and surrounding bladder cuff is considered the standard therapy. This paper reviews the current role of ureteroscopic management of upper-tract TCC.
Topics: Carcinoma, Transitional Cell; Chemotherapy, Adjuvant; Humans; Kidney Neoplasms; Kidney Pelvis; Laser Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Ureteroscopy
PubMed: 16190841
DOI: 10.1089/end.2005.19.841 -
The Journal of Contemporary Dental... Jul 2022The aim of this study is to identify the prevalence of C-shaped root canal systems in mandibular first and second molars in a Lebanese population, and to determine the...
AIM
The aim of this study is to identify the prevalence of C-shaped root canal systems in mandibular first and second molars in a Lebanese population, and to determine the relationship between C-shaped root canal systems and different factors (age, gender, and tooth location) and to examine the root canal system's morphology along the root.
MATERIALS AND METHODS
The presence of C-shaped root canal systems in 648 mandibular molars from 257 patients was analyzed using cone-beam computed tomography (CBCT). The sample included 296 and 352 mandibular first and second molars, respectively. The frequency of C-shaped canals, their relationship to gender, age, and tooth location, and unilateral or bilateral occurrences were noted. A 3D Slicer 4.10.1 was then used to classify teeth with identified C-shaped anatomy according to Fan's configuration and to determine the distance between the orifice and the cementoenamel junction (CEJ).
RESULTS
C-shaped root canal systems were detected in 1.01 and 9.09% of mandibular first and second molars, respectively. In mandibular second molars, the most prevalent configurations were as follows: C1 at the orifice level, C3 at orifice-2 mm, C2 and C3 in the middle third, and C3 at the apical level. There was no correlation with age, gender, and tooth position. The bilateral occurrence happened in 60% of cases. Orifices were at a mean distance of 3.32 mm below the CEJ. The deepest groove was mostly lingual.
CONCLUSION
The prevalence of C-shaped root canal systems in the Lebanese population is 1.01 and 9.09% in the first and second mandibular molars, respectively. The CBCT slices showed that the configuration varies along the root and that the orifices are at various distances below the CEJ. Therefore, pre-operatory scans can be beneficial for better understanding and preparation of root canal treatment.
CLINICAL SIGNIFICANCE
In the Lebanese population, C-shaped mandibular molars are not a rare finding. Clinicians should consider the different configurations and the possible changes along the root.
Topics: Humans; Dental Pulp Cavity; Tooth Root; Spiral Cone-Beam Computed Tomography; Molar; Cone-Beam Computed Tomography
PubMed: 36440518
DOI: No ID Found -
Surgical Endoscopy Mar 2015Surgical training in virtual, animal and cadaver models is essential for minimally invasive surgery. Thiel cadavers are suitable for laparoscopy, but there are few data...
BACKGROUND
Surgical training in virtual, animal and cadaver models is essential for minimally invasive surgery. Thiel cadavers are suitable for laparoscopy, but there are few data about the use of embalmed (Tutsch method) and slightly embalmed (Thiel method) cadavers in procedures of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which are usually developed and learned on swine models and fresh frozen cadavers. The aim of this study was thus to assess the use of these cadavers for NOTES approaches.
METHODS
The following surgical procedures were evaluated: transanal total mesorectal excision (four cadavers: one Tutsch, two Thiel, one fresh frozen), transanal ileorectal bypass (five cadavers: one Tutsch, three Thiel, one fresh frozen), and transvaginal appendectomy (two Tutsch cadaver).
RESULTS
The Thiel method ensured tissue flexibility and consistency suitable for performing the above surgical procedures with good results and without complications, with only a small increase in rigidity with respect to fresh specimens. Cadavers embalmed with higher formalin concentrations (Tutsch method) were more difficult to use, due to high tissue rigidity and resistance of the abdominal wall to pneumoperitoneum, although NOTES accesses were possible.
CONCLUSIONS
Thiel cadavers are suitable for transanal/transrectal and transvaginal NOTES approaches, for training surgical residents/specialists and also for surgical research. In minimally invasive surgery (and particularly in NOTES), integration between cadaver (fresh frozen and/or Thiel) and animal models would represent the gold standard, allowing guaranteed knowledge of and respect for human surgical anatomy and correct management of surgery on living subjects. NOTES approaches to human cadavers may also be proposed for the anatomical education of medical students.
Topics: Anal Canal; Anatomy; Appendectomy; Cadaver; Education, Medical; Feasibility Studies; Female; Humans; Male; Natural Orifice Endoscopic Surgery; Vagina
PubMed: 25060684
DOI: 10.1007/s00464-014-3734-0 -
European Journal of Echocardiography :... Jan 2009Understanding the anatomy of the aortic root is particularly relevant in the current era of evolving management strategies including percutaneous and transcatheter... (Review)
Review
AIMS
Understanding the anatomy of the aortic root is particularly relevant in the current era of evolving management strategies including percutaneous and transcatheter therapeutic techniques for valve or device implantations.
METHODS AND RESULTS
This review describes the aortic root as a composite structure of several elements, not only the valvar leaflets. The valvar leaflets have a unique shape with deep closure lines buttressed by the nodule of Arantius. The scalloped configuration of the hingelines of the leaflets crosses the ventriculo-arterial junction, leaving interleaflet fibrous triangles between the sinuses that are anatomically aortic but haemodynamically ventricular. The fibrous triangle between the right and the non-coronary leaflets is the guide to the location of the atrioventricular conduction bundle. The coronary orifices are located close to the level of the sinutubular junction. Variations in leaflet structure and their arrangements result in valvar stenosis or regurgitation, or both. Often, diseases of the aortic root involve more than one structural element.
CONCLUSION
The leaflets and their hingelines, aortic sinuses, interleaflets triangles sinutubular junction, and ventriculo-arterial junction and their structures adjoining the junctions should be taken into account when considering the aortic root. Owing to its central location, the aortic root is in close proximity to all the cardiac chambers, the atrial septum, ventricular septum and the atrioventricular conduction bundle.
Topics: Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Echocardiography; Heart Valve Prosthesis Implantation; Humans; Risk Assessment; Sensitivity and Specificity
PubMed: 19131496
DOI: 10.1093/ejechocard/jen243 -
Clinical and Experimental Nephrology Oct 2018Acute renal infarction (ARI) is a rare disease with atrial fibrillation being its main cause. The possible laterality of ARI is controversial. This study aimed to...
BACKGROUND
Acute renal infarction (ARI) is a rare disease with atrial fibrillation being its main cause. The possible laterality of ARI is controversial. This study aimed to evaluate the association between anatomical features of the renal arteries and ARI.
METHODS
This was a single-center cross-sectional study that evaluated the anatomical and clinical features of renal arteries. The anatomical features of the renal arteries were assessed using computed tomography.
RESULTS
A total of 46 patients (mean age 71.3 ± 14.0 years; men, 59%) were enrolled. ARI involved the left kidney in 63%, right kidney in 28%, and both kidneys in 9% of patients. The right renal artery orifice was often higher than that of the left renal artery (71%). The angle of divergence from the abdominal aorta was similar on both sides. The left renal artery orifice was larger than that of the right (83 ± 24, 72 ± 24 mm; p = 0.03, respectively). A larger left orifice was present in 72% of all cases. ARI involved the side with the larger orifice in 64% of patients.
CONCLUSION
The size of the renal artery orifice may be a factor that contributes to the laterality of ARI. Assessment of anatomical features is important when considering the laterality of the disease.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Infarction; Japan; Kidney; Male; Middle Aged; Renal Artery; Tokyo
PubMed: 29572750
DOI: 10.1007/s10157-018-1566-2 -
Journal of Conservative Dentistry : JCD 2020Comprehensive knowledge of the entire root canal system is an essential prerequisite for successful routine endodontic treatments. The internal and external... (Review)
Review
Comprehensive knowledge of the entire root canal system is an essential prerequisite for successful routine endodontic treatments. The internal and external morphological configurations of roots and root canals are quite complex. Thus, several classifications have been put forth by researchers to appropriately understand the distinguishable features of root and root canal systems of multirooted teeth. Until now, the researchers have proposed new classification systems for a thorough understanding of the root canal systems, mainly concentrating on the root canal anatomy and anomalies. Moreover, with the advent of newer digital imaging systems, these classifications are more reproducible and relevant. They have further gained importance for the clinicians by acting as an aid in decision-making based on evidence-based dentistry. However, these classifications are primarily focused on the root canals, but none have assessed the anatomy of the pulp chamber floor. This review article delineates a novel Pawar and Singh molar pulp chamber floor classification© for the anatomy of maxillary and mandibular molars to ease the clinician's skills and further increase the prevailing literature for the benefit of researchers.
PubMed: 33911348
DOI: 10.4103/JCD.JCD_477_20 -
BMC Cardiovascular Disorders Feb 2021The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical...
BACKGROUND
The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures.
METHODS
Data were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured.
RESULTS
The anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001).
CONCLUSIONS
The right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.
Topics: Adult; Aged; Anatomic Landmarks; Atrial Fibrillation; Bronchial Arteries; Catheter Ablation; Computed Tomography Angiography; Cryosurgery; Female; Humans; Male; Middle Aged; Multidetector Computed Tomography; Predictive Value of Tests; Pulmonary Artery; Pulmonary Veins
PubMed: 33568060
DOI: 10.1186/s12872-021-01881-2 -
Clinical Anatomy (New York, N.Y.) Jan 2012Transoral robotic surgery provides a mechanism to approach tumors of the upper aerodigestive tract through a natural body orifice--the mouth. The technique has been... (Review)
Review
Transoral robotic surgery provides a mechanism to approach tumors of the upper aerodigestive tract through a natural body orifice--the mouth. The technique has been applied most often to malignant tumors of the oropharynx. The use of this technique, however, forces the surgeon to view the anatomy from a different vantage point. Head and neck surgeons are accustomed to the oropharynx from lateral to medial. The transoral approach forces surgeons to consider the anatomy from the oral cavity and oropharynx medial perspective. This article will discuss the relevant anatomy, operative goals, robotic technique, and clinical considerations of transoral robotic surgery of the oropharynx.
Topics: Humans; Natural Orifice Endoscopic Surgery; Oropharyngeal Neoplasms; Oropharynx; Robotics; Tongue
PubMed: 22109715
DOI: 10.1002/ca.22008