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A Computed Tomographic (CT) and Pathological Study of Equine Cheek Teeth Infundibulae Extracted From Asymptomatic Horses. Part 1: Prevalence, Type and Location of Infundibular Lesions on CT Imaging.

ter, 05/21/2019 - 09:46
Related Articles

A Computed Tomographic (CT) and Pathological Study of Equine Cheek Teeth Infundibulae Extracted From Asymptomatic Horses. Part 1: Prevalence, Type and Location of Infundibular Lesions on CT Imaging.

Front Vet Sci. 2019;6:124

Authors: Horbal A, Smith S, Dixon PM

Abstract
Background: Equine maxillary cheek teeth infundibulae are frequently affected by developmental and acquired disorders, but the computed tomographic (CT) imaging features of normal and abnormal infundibulae remain incompletely understood. Objective: To examine infundibulae with various grades of occlusal caries and control teeth by standard CT in order to assess the prevalence, type and location of subocclusal infundibular lesions present. Study design: Ex vivo original study. Methods: One hundred maxillary cheek teeth, including 82 with, and 18 without infundibular occlusal caries, were extracted from horses of different ages and imaged by standard CT; 8 teeth were also imaged by MicroCT. Images were later assessed by Osirix® and the prevalence, characteristics and sites of infundibular lesions were assessed. Results: Teeth with shorter infundibulae (i.e., Triadan 09 position and older teeth) were more likely to have occlusal caries, as were the rostral infundibulae. Subocclusal developmental infundibular lesions, including cemental hypoplasia and caries, were present in 72% of infundibulae without occlusal caries. CT imaging confirmed two main patterns of developmental cemental hypoplasia, i.e., apical cemental hypoplasia usually involving the full width of the apical aspect of the infundibulum and central linear hypoplasia involving the central aspect of the infundibulum over most of its length, and combinations of these types. These developmental lesions could later be affected by (acquired) infundibular caries once occlusally exposed due to normal wear. Some "normal-sized" (i.e., circa 1 mm diameter) occlusal central vascular channels expanded subocclusally to the dimensions of central linear defects. Main Limitations: No clinical histories or accurate ages were available for these teeth. Conclusions: Hypoplastic cemental lesions, including at central linear, and apical sites, are common even in clinically normal maxillary cheek teeth infundibulae and caries can occur when these lesions contact the occlusal surface. Central linear defects are not always clearly distinguishable from "normal" central vascular channels.

PMID: 31106213 [PubMed]

The Nasopharyngeal Airway: Estimation of the nares-to-mandible and nares-to-tragus distance in young children to assess current clinical practice.

qua, 05/08/2019 - 07:23

The Nasopharyngeal Airway: Estimation of the nares-to-mandible and nares-to-tragus distance in young children to assess current clinical practice.

Resuscitation. 2019 May 04;:

Authors: Johnson M, Miskovic A, Ray S, Chong K, Hickson M, Bingham B, Skellett S

Abstract
BACKGROUND: Nasopharygeal airways are used in urgent situations to alleviate airway obstruction. Guidelines for measuring the length of the NPA differ between national and international guidelines, and the evidence base for these measurements is lacking. The purpose of this study was to measure the nares-epiglottis and nares-vocal cord distances in young children (neonates to 12 years) on 3D reconstructed Magnetic Resonance Imaging (MRI) brain volume scans, and to examine the relationship of these distances with the nares-tragus and nares-mandible distances.
METHOD: One-hundred and seventy-six scans were reviewed. All patients had undergone MRI 3D brain volume imaging. The Anatomical landmarks were identified and the nares-tragus, nares-mandible distances measured and compared to nares-epiglottis and nares-vocal cord distance using Osirix.
RESULTS: The nares-epiglottis and nares-vocal cords distances significantly correlated (p-value <0.05). The nares-tragus distance showed strong correlation with the nares-epiglottis and nares-vocal cord distance compared to the nares-mandible distance (p-value<0.05).
CONCLUSION: In conclusion, the length of a nasopharyngeal airway in children under the age of twelve years can be predicted using the nares-tragus external anatomical distance minus 10 mm.

PMID: 31063843 [PubMed - as supplied by publisher]

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

seg, 05/06/2019 - 13:02

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

Clin Anat. 2019 May 06;:

Authors: Gregory LS, McGifford OJ, Jones LV

Abstract
INTRODUCTION: The adult vertebral level of the splanchnic branches of the abdominal aorta relies on a complex series of fusion and regression steps during embryological development, such that variation is common. Little is known however regarding the anatomy of the abdominal aorta in children. This study aimed to investigate the spatial relationship between the abdominal aorta and vertebral column during childhood development to inform clinical management of pediatric patients.
MATERIALS AND METHODS: Retrospective multi-slice computed tomography abdominopelvic angiograms of children aged neonate to 19 years (n=232), were used to examine vertebral levels of the celiac trunk (CoT), superior (SMA) and inferior mesenteric (IMA) arteries, and aortic bifurcation (AB) using multiplanar formatting views in OsiriXTM . The abdominal aorta length, AB angle, and displacement of the aorta from the midline were quantified with the effect of age and sex analyzed using multinomial logistic regression and general linear models.
RESULTS: The most frequent origins of CoT, SMA, IMA and AB were T12, L1, L3 and L4, respectively, with significant variation in vertebral level for each vessel. SMA level was significantly more proximal with age, and CoT and AB demonstrated marked sex differences in vertebral level. As the age of the child increased AB angle decreased, aortic displacement increased, and the length of the abdominal aorta increased at a slower velocity to the vertebral column (p<0.001).
CONCLUSIONS: Our study highlights the variation of the location and geometry of the abdominal aorta in children; this knowledge will positively impact pediatric surgical approaches and endovascular procedures. This article is protected by copyright. All rights reserved.

PMID: 31056783 [PubMed - as supplied by publisher]

Safety and Feasibility Assessment of the O-arm as an Intraoperative Angiography Device in Aneurysm Surgery: Technical Note.

qui, 04/18/2019 - 07:09

Safety and Feasibility Assessment of the O-arm as an Intraoperative Angiography Device in Aneurysm Surgery: Technical Note.

World Neurosurg. 2019 Apr 14;:

Authors: Torné R, García S, Sanroman L, Rodríguez-Hernández A, Reyes L, Tercero J, Enseñat J

Abstract
OBJECTIVE: To describe the technique and initial experience using a rotational 3D fluoroscopy system (O-arm, Medtronic) as intraoperative angiography (IA) in the surgery of cerebral aneurysms.
METHODS: The 3D IA with O-arm (IAWOA) was performed in a consecutive cohort of patients with unruptured intracranial aneurysms. Conventional microsurgical clipping was performed with the assistance of indocyanine green videoangiography (ICGVA). Then the O-arm chasis was brought in, ipsilateral internal carotid artery was catheterized and contrasted images acquired. Resulting data sets were exported in DICOM and processed using the Osirix software in an accessory computer. The 3D image reconstruction was evaluated intraoperatively to confirm aneurysm occlusion and parent vessels patency. Afterwards, agreement among IAWOA, ICGVA and standard postoperative angiography were analyzed.
RESULTS: The initial pilot study was performed in six patients with seven unruptured aneurysms. Aneurysms occlusion rate was 100%. The concordance of the IAWOA and the standard postoperative angiography was complete, both in terms of occlusion and parent vessels patency. No complications derived from the IAWOA were observed except in one patient, who presented a retroperitoneal hematoma without clinical consequences.
CONCLUSION: The 3D rotational fluoroscopy (O-arm) device could be safely and effectively used as an IA system in selected patients. To the best of our knowledge this is the first study reporting its use as an IA device. This technique seems to offer excellent image quality that could compare to that of the gold standard 3D digital subtraction angiography but with a lower cost and versatility of use for other subspecialties.

PMID: 30995551 [PubMed - as supplied by publisher]

Variations in Cochlear Size of Cochlear Implant Candidates.

ter, 04/09/2019 - 08:25
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Variations in Cochlear Size of Cochlear Implant Candidates.

Int Arch Otorhinolaryngol. 2019 Apr;23(2):184-190

Authors: Zahara D, Dewi RD, Aboet A, Putranto FM, Lubis ND, Ashar T

Abstract
Introduction  The cochlear anatomy varies in each individual, and that has an impact on decisions regarding the insertion of electrodes. The measurement of the cochlear size is the routine examination required to choose the proper cochlear implant (CI) electrodes. Objective  To acquire normative data on the size of the cochlea (length, width, height, scala timpani [ST] height, cochlear duct length [CDL]) of CI candidates in Medan, Indonesia. Methods  This descriptive study was conducted based on high-resolution computed tomography (HRCT) temporal bone data and on HRCT temporal data manipulated to reconstruct three-dimensional (3D) multiplanar images with OsiriX MD DICOM Viewer version 9.5.1 (Pixmeo SARL, Bernex, Geneva, Switzerland) viewer of 18 patients (36 ears) who were CI candidates in Medan, Indonesia, in order to determine cochlear length (A), cochlear width, cochlear height, ST height and CDL, calculated through a simple mathematical function. Results  The average cochlear length (A) was 8.75 mm (standard deviation [SD] = 0.31 mm); the average cochlear width was 6.53 mm (SD = 0.35 mm); the average cochlear height was 3.26 mm (SD = 0.24 mm) and the average ST height at the basal cochlea was 1.00 mm (SD = 0.1 mm); and 0.71 mm (SD = 0.1 mm) at the half turn of cochlea. The average total CDL was 32.45 mm (SD = 1.31 mm; range: 30.01-34.83 mm). Conclusion  The cochlear size varies in each individual; therefore, the temporal bone measurement of CI candidates using HRCT is essential: for the selection of suitable implant electrodes; to minimize cochlear damages at the insertion of the electrode arrays; and to maximize the hearing improvements.

PMID: 30956703 [PubMed]

Imaging in the Mobile Domain.

dom, 04/07/2019 - 08:00
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Imaging in the Mobile Domain.

Rheum Dis Clin North Am. 2019 May;45(2):291-302

Authors: Bird P

Abstract
This article outlines the current state of imaging software with an emphasis on mobile sharing of images and mobile sharing of imaged data. The second portion focuses on the mobility of imaging design devices, highlighting the accessibility and the wider application of mobile devices.

PMID: 30952399 [PubMed - in process]

Multislice Computed Tomography Assessment of Airway Patency Changes Associated with Mandibular Advancement Appliance Therapy in Supine Patients with Obstructive Sleep Apnea.

qui, 04/04/2019 - 07:28
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Multislice Computed Tomography Assessment of Airway Patency Changes Associated with Mandibular Advancement Appliance Therapy in Supine Patients with Obstructive Sleep Apnea.

Sleep Disord. 2019;2019:8509820

Authors: Matsumura Y, Ueda H, Nagasaki T, Medina CC, Iwai K, Tanimoto K

Abstract
The purpose of the present study was to measure the regional effects of the mandibular advancement appliance (MAA) on the upper airway of supine subjects with obstructive sleep apnea (OSA) using multislice computed tomography (MSCT). The subjects included 8 males and 5 females who were diagnosed with mild to moderate OSA and were referred to the Orthodontic Clinic of Hiroshima University Hospital, where they underwent MAA therapy. Using a CT scanner, baseline MSCT images were obtained from the subjects without the MAA for morphological analysis, and then the experimental images were obtained while wearing the MAA. To measure the anteroposterior diameter, width, and cross-sectional area of the oropharynx region of interest (ROI), five distance variables were first defined on each multiplanar reconstruction (MPR) image using OsiriX. Additionally, the volumes of the upper airway, bony hard tissue, and soft tissue (soft palate and tongue) in the oro-hypopharyngeal region were measured. In most of the assessed airway size variables, significant increases in the anteroposterior diameter and width were observed after MAA therapy. Regarding the upper airway cross-sectional area, all the upper airway size variables exhibited significant increases. In the volumetric analysis, a significant increase was observed in airway volume, whereas the soft tissue volume in the oro-hypopharyngeal region did not show the significant decrease after MMA therapy. However, from a different point of view, the volumes of the upper airway and soft tissue significantly increased and decreased, respectively, as demonstrated by the calculated ratio for the oro-hypopharyngeal region. We demonstrated that the proportional size of the soft tissue volume, i.e., the soft palate and tongue in the oro-hypopharyngeal region, significantly decreased during use of an MAA. This forward displacement of the soft tissue thereby increases the retroglossal airway space (except the nasopharynx) three-dimensionally.

PMID: 30941225 [PubMed]

CT-based anatomical features of large airway and heart volume in dogs of different body size.

seg, 03/25/2019 - 14:37
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CT-based anatomical features of large airway and heart volume in dogs of different body size.

Vet J. 2019 Apr;246:21-26

Authors: Uehara T, Orito K, Fujii Y

Abstract
Differences in the prevalence and clinical signs of cardiopulmonary diseases in dogs of different body sizes have been reported. It was hypothesized that the anatomical features of the heart and large airways varies by body size in dogs and might influence clinical manifestations of cardiopulmonary disease. The purpose of this study was to compare various anatomical features of the thoracic organs (heart, trachea, etc.) in dogs according to body size using computed tomography (CT) images. Dogs without clinically significant heart and lung disease (n=226) that underwent CT were divided into three groups on the basis of bodyweight: small (<7kg), medium (7-20kg), and large (>20kg). The following parameters were calculated from CT images using OsiriX and compared among groups: relative heart volume (heart volume/thoracic volume), relative distance from mainstem bronchi to vertebra (distance from mainstem bronchi to vertebra/heart length), longitudinal/transverse diameter ratio of trachea, and angle of bronchus. Small dogs had larger hearts relative to their thorax, a shorter distance from the heart to the vertebra, and laterally-elongated oval-shaped tracheas, compared to medium and/or large dogs. These differences in anatomical features according to body size may potentially contribute to different clinical manifestations when the heart is enlarged.

PMID: 30902185 [PubMed - in process]

Direct 3-Dimensional Diagnosis of Ex Vivo Facial Fractures.

qua, 03/20/2019 - 07:44

Direct 3-Dimensional Diagnosis of Ex Vivo Facial Fractures.

J Craniofac Surg. 2019 Mar 14;:

Authors: Sirin Y, Yildirimturk S, Horasan S, Guven K

Abstract
The aim of the present study is to assess the reliability and accuracy of different 3-dimensional (3D) reconstruction algorithms in detecting undisplaced condylar, zygomatic arc, and orbital rim fractures based on cone-beam computed tomography data set. Twenty sheep heads were used in the present study. Sixty fractured and 60 nonfractured (control) zones were randomly allocated. Three groups consisting of nondisplaced fractures of condyle (CF, n = 20), orbital (OF, n = 20), and zygomatic arc (ZF, n = 20) were created by using a diamond cutting disc. Soft tissues were only dissected and no fractures were generated in the control group (n = 60). The 3D reconstructions were created by using multiplanar reconstruction (MPR), surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) algorithms. Final 3D models were examined in Osirix software (Pixmeo SARL, Bernex, Switzerland) by 6 observers. Diagnostic accuracies of each algorithm were statistically compared by receiver operating characteristics (ROC) and area under the ROC curves (AUCs). For the detection of CF, AUC for VR algorithm was found to be statistically larger than that of MIP while AUCs for VR and MIP were larger than those of MPR and SR for OF detection. For the detection of ZF, AUCs for MPR and VR were significantly larger than those of MIP and SR (P < 0.05 for each). Within the limitations of this experimental study, it can be concluded that for maxillofacial surgeons, it is more likely to detect condylar, orbital, and zygomatic fractures by using VR algorithm in 3D reconstruction.

PMID: 30889064 [PubMed - as supplied by publisher]

Microsurgical Anatomy of the Jugular Process as an Anatomical Landmark to Access the Jugular Foramen: A Cadaveric and Radiological Study.

sab, 03/16/2019 - 07:12
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Microsurgical Anatomy of the Jugular Process as an Anatomical Landmark to Access the Jugular Foramen: A Cadaveric and Radiological Study.

Oper Neurosurg (Hagerstown). 2019 Apr 01;16(4):486-495

Authors: Komune N, Matsuo S, Miki K, Matsushima K, Akagi Y, Kurogi R, Iihara K, Matsushima T, Inoue T, Nakagawa T

Abstract
BACKGROUND: The jugular process forms the posteroinferior surface of the jugular foramen and is an important structure for surgical approaches to the foramen. However, its morphological features have not been well described in modern texts.
OBJECTIVE: To elucidate the microsurgical anatomy of the jugular process and examine its morphological features.
METHODS: Five adult cadaveric specimens were dissected in a cadaveric study, and computed tomography data from 31 heads (62 sides) were examined using OsiriX (Pixmeo SARL, Bernex, Switzerland) to elucidate the morphological features of the jugular process.
RESULTS: The cadaveric study showed that it has a close relationship with the sigmoid sinus, jugular bulb, rectus capitis lateralis, lateral atlanto-occipital ligament, and lateral and posterior condylar veins. The radiographic study showed that 9/62 sigmoid sinuses protruded inferiorly into the jugular process and that in 5/62 sides, this process was pneumatized. At the entry of the jugular foramen, if the temporal bone has a bulb-type jugular bulb, and if surgery concerns the right side of the head, the superior surface of the jugular process is more likely to be steep.
CONCLUSION: The jugular process forms the posteroinferior border of the jugular foramen. Resection of the jugular process is a critical step for opening the jugular foramen from the posterior and lateral aspects. Understanding the morphological features of the jugular process, and preoperative and radiographical examination of this process thus help skull base surgeons to access the jugular foramen.

PMID: 30873560 [PubMed - in process]

Free DICOM-Viewers for Veterinary Medicine : Survey and Comparison of Functionality and User-Friendliness of Medical Imaging PACS-DICOM-Viewer Freeware for Specific Use in Veterinary Medicine Practices.

qua, 03/13/2019 - 09:46
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Free DICOM-Viewers for Veterinary Medicine : Survey and Comparison of Functionality and User-Friendliness of Medical Imaging PACS-DICOM-Viewer Freeware for Specific Use in Veterinary Medicine Practices.

J Digit Imaging. 2019 Mar 11;:

Authors: Brühschwein A, Klever J, Hoffmann AS, Huber D, Kaufmann E, Reese S, Meyer-Lindenberg A

Abstract
There is increasing prevalence of digital diagnostic imaging in veterinary medicine with a progressive need to use medical imaging software. As Digital Imaging and Communications in Medicine (DICOM)-viewers for veterinary use do not require medical device approval in many countries, freeware viewers might be a practical alternative. The aim of this study was to identify and evaluate free DICOM-viewer software for veterinary purposes. The functionality and user-friendliness of various DICOM-viewers from the internet were analyzed and compared. Inclusion criteria for the evaluation were free availability, PACS (picture archiving and communication system)-connectivity, and stand-alone and client-based software. Based on this, eight viewers were found: Ginkgo CADx, Horos, K-PACS, MAYAM, MITO, OsiriX Lite, RadiAnt, Synedra personal. In these DICOM-viewers, 14 core tools were tested and rated on a score from 1 to 10 by multiple observers with different levels of training, using studies of four imaging modalities. Criteria were functionality and user-friendliness. For each viewer, the total number of a predefined set of 47 important tools was counted. The ranking based on functionality and user-friendliness of 14 core tools (mean score in brackets) was as follows: 1. Horos/OsiriX Lite (8.96), 2. RadiAnt (8.90), 3. K-PACS (8.02), 4. Synedra (7.43), 5. MAYAM (6.05), 6. Ginkgo CADx (5.53), 7. MITO (3.74). The DICOM-viewers offered between 20 and 44 tools of the predefined important tool set and are sufficient for most veterinary purposes. An increasing number of tools did not necessarily impair user-friendliness, if the user interface is well designed. Based on the results of this study, veterinarians will find suitable free DICOM-viewers for their individual needs. In combination with PACS-freeware, this allows veterinary practices to run a low-budget digital imaging environment.

PMID: 30859340 [PubMed - as supplied by publisher]

Bone and cortical bone characteristics of mandibular retromolar trigone and anterior ramus region for miniscrew insertion in adults.

seg, 03/04/2019 - 08:05

Bone and cortical bone characteristics of mandibular retromolar trigone and anterior ramus region for miniscrew insertion in adults.

Am J Orthod Dentofacial Orthop. 2019 Mar;155(3):330-338

Authors: Nucera R, Bellocchio AM, Oteri G, Farah AJ, Rosalia L, Giancarlo C, Portelli M

Abstract
INTRODUCTION: The aim of this study was to evaluate bone depth, cortical bone thickness, and vestibulolingual bone dimension of the mandibular retromolar trigone and anterior ramus region to evaluate what are its most suitable sites for miniscrew insertion in adults.
METHODS: The sample included cone-beam computerized tomography (CBCT) records of 60 adult subjects retrospectively evaluated. All CBCT examinations were performed with the use of an i-CAT CBCT scanner (Imaging Sciences International). Each exam was converted into DICOM format and processed with the use of Osirix Medical Imaging software. On reproducible sagittal scan views, bone depth and cortical bone thickness were evaluated on specific lines parallel and at a 45° angle to the occlusal plane, and at 3 mm and at 6 mm distance from it. Vestibulolingual bone dimension was computed in 4 different cross-section scans and at 3 different levels of depth (0, 6, and 11 mm).
RESULTS: All of the considered insertion sites showed on average more than 10 mm of bone depth. Inferential statistics showed significantly (P <0.05) greater bone depth (+3 mm) in cross-sectional scans parallel to the occlusal plane compared with those at a 45° angle to it. Cortical bone thickness showed average values from 3 mm to 5 mm. Vestibulolingual bone dimension showed a significant (P <0.05) reduction (-10 mm) in the posterior region of retromolar region. No significant differences were found between subjects with and without third molars.
CONCLUSIONS: The retromolar trigone and anterior ramus region showed enough bone quantity and adequate bone quality for safe miniscrew insertion in adults.

PMID: 30826035 [PubMed - in process]

Accuracy and reliability of virtual femur measurement from CT scan.

dom, 03/03/2019 - 10:52
Related Articles

Accuracy and reliability of virtual femur measurement from CT scan.

J Forensic Leg Med. 2019 Feb 21;63:11-17

Authors: Ismail NA, Abdullah N, Mohamad Noor MH, Lai PS, Shafie MS, Nor FM

Abstract
BACKGROUND: In the application of scientific human skeletal variation in medico-legal matters, virtual anthropology is the current technique performed to examine skeleton and its body parts. Hence, this study was conducted to assess the accuracy and reliability of virtual femur measurement through intra and inter-observer error analysis, and comparison was made between the virtual and conventional methods.
METHODS: A total of 15 femora were examined with four parameters i.e. maximum length of femur (FeMl), diameter of femoral head (FeHd), transverse diameter of midshaft (FeMd) and condylar breadth (FeCb). Osteometric board and vernier calipers were employed for the conventional method, while CT reconstructed images and Osirix MD software was utilised for the virtual method.
RESULTS: Results exhibited that there were no significant differences in the measurements by conventional and virtual methods. There were also no significant differences in the measurements by the intra or inter-observer error analyses. The intraclass correlation coefficients (ICC) were more than 0.95 by both intra and inter-observer error analyses. Technical error of measurement had displayed values within the acceptable ranges (rTEM <0.08 for intra-observer, <2.25 for inter-observer), and coefficient of reliability (R) indicated small measurement errors (R > 0.95 for intra-observer, R > 0.92 for inter-observer). By parameters, FeMl showed the highest R value (0.99) with the least error in different methods and observers (rTEM = 0.02-0.41%). Bland and Altman plots revealed points scattered close to zero indicating perfect agreement by both virtual and conventional methods. The mean differences for FeMl, FeHd, FeMd and FeCb measurements were 0.01 cm, -0.01 cm, 0.02 cm and 0.01 cm, respectively.
CONCLUSION: This brought to suggest that bone measurement by virtual method was highly accurate and reliable as in the conventional method. It is recommended for implementation in the future anthropological studies especially in countries with limited skeletal collection.

PMID: 30825771 [PubMed - as supplied by publisher]

Sex-dependent posterior fossa anatomical differences in trigeminal neuralgia patients with and without neurovascular compression: a volumetric MRI age- and sex-matched case-control study.

qua, 02/06/2019 - 09:28
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Sex-dependent posterior fossa anatomical differences in trigeminal neuralgia patients with and without neurovascular compression: a volumetric MRI age- and sex-matched case-control study.

J Neurosurg. 2019 Feb 01;:1-8

Authors: Hardaway FA, Holste K, Ozturk G, Pettersson D, Pollock JM, Burchiel KJ, Raslan AM

Abstract
OBJECTIVEThe pathophysiology of trigeminal neuralgia (TN) in patients without neurovascular compression (NVC) is not completely understood. The objective of this retrospective study was to evaluate the hypothesis that TN patients without NVC differ from TN patient with NVC with respect to brain anatomy and demographic characteristics.METHODSSix anatomical brain measurements from high-resolution brain MR images were tabulated; anterior-posterior (AP) prepontine cistern length, cerebellopontine angle (CPA) cistern volume, nerve-to-nerve distance, symptomatic nerve length, pons volume, and posterior fossa volume were assessed on OsiriX. Brain MRI anatomical measurements from 232 patients with either TN type 1 or TN type 2 (TN group) were compared with measurements obtained in 100 age- and sex-matched healthy controls (control group). Two-way ANOVA tests were conducted on the 6 measurements relative to group and NVC status. Bonferroni adjustments were used to correct for multiple comparisons. A nonhierarchical k-means cluster analysis was performed on the TN group using age and posterior fossa volume as independent variables.RESULTSWithin the TN group, females were found to be younger than males and less likely to have NVC. The odds ratio (OR) of females not having NVC compared to males was 2.7 (95% CI 1.3-5.5, p = 0.017). Patients younger than 30 years were much less likely to have NVC compared to older patients (OR 4.9, 95% CI 1.3-18.4, p = 0.017). The mean AP prepontine cistern length and symptomatic nerve length were smaller in the TN group than in the control group (5.3 vs 6.5 mm and 8.7 vs 9.7 mm, respectively; p < 0.001). The posterior fossa volume was significantly smaller in TN patients without NVC compared to those with NVC. A TN group cluster analysis suggested a sex-dependent difference that was not observed in those without NVC. Factorial ANOVA and post hoc testing found that findings in males without NVC were significantly different from those in controls or male TN patients with NVC and similar to those in females (female controls as well as female TN patients with or without NVC).CONCLUSIONSPosterior fossa volume in males was larger than posterior fossa volume in females. This finding, along with the higher incidence of TN in females, suggests that smaller posterior fossa volume might be an independent factor in the pathophysiology of TN, which warrants further study.

PMID: 30717058 [PubMed - as supplied by publisher]

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study.

dom, 02/03/2019 - 09:00

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study.

Surg Endosc. 2019 Feb 01;:

Authors: van den Bos J, Jongen ACHM, Melenhorst J, Breukink SO, Lenaerts K, Schols RM, Bouvy ND, Stassen LPS

Abstract
OBJECTIVE: Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL.
METHODS: Patients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon's judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded.
RESULTS: Thirty patients (n = 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal-(n = 10), rectosigmoid-(n = 2), sigmoid-(n = 10), or more proximal colon carcinomas (n = 8). Five patients (16.7%) developed AL (n = 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P = 0.02) and a lower FI compared to background FI was measured at 1st assessment (P = 0.039). However, no relation between FI and postoperative inflammatory parameters could be found.
CONCLUSION: Both subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.

PMID: 30710314 [PubMed - as supplied by publisher]

Assessing the fusion of the ischiopubic synchondrosis using predictive modeling.

sex, 02/01/2019 - 08:36
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Assessing the fusion of the ischiopubic synchondrosis using predictive modeling.

Clin Anat. 2019 Jan 30;:

Authors: Gregory LS, Jones LV, Amorosi NM

Abstract
INTRODUCTION: Flaring of the ischiopubic synchondrosis at the time of fusion is a common clinical observation in pediatrics and represents a normal physiological process in skeletal maturation. When presenting unilaterally, this flaring can mimic a range of serious pathological conditions such as osteomyelitis, osteal tumors and traumatic injury. An improved understanding of ischiopubic synchondrosis fusion is therefore critical to avoid potential misdiagnosis.
MATERIALS AND METHODS: Retrospective multi-slice computed tomography pelvic scans of Australian individuals aged neonate to 24 years (n=184) were assessed using a novel five stage morphological classification system of the maturation and fusion of the ischiopubic synchondrosis. Maturation scoring was conducted using both multiplanar formatting views and volume-rendered reconstructions in OsiriXTM .
RESULTS: Maturational stage was strongly related to age (p<0.001) with fusion of the ischiopubic synchondrosis observed between the ages of 4 and 9 years in females and 7 and 13 years for males. The highest probability of fusion in our Queensland Australian population based on multinomial regression predictive modeling was between 7 and 10 years of age. We documented three variants of fusion: pubic and ischial outgrowths, appearance of a secondary ossification center and a fusiform-shaped enlargement.
CONCLUSIONS: This study provides the first predictive modeling of the timing of fusion of the ischiopubic synchondrosis using a reliable morphological classification system. The significant variation in timing and progression of fusion of the ischiopubic synchondrosis reported in this study, will aid in minimizing misdiagnosis and unnecessary treatment in children presenting with asymmetrical or delayed ischiopubic synchondrosis anomalies. This article is protected by copyright. All rights reserved.

PMID: 30701593 [PubMed - as supplied by publisher]