Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study

Prevalence and Clinical Significance of Left Atrial Remodeling in Competitive Athletes

One-lung ventilation in a patient with tracheobronchomegaly: a case report and literature review

Introduction: A known method for maxillary nerve block is through the greater palatine canal (GPC). Poor knowledge about the anatomy might result in undesired conditions such as perforation of the arteries, nerve damage and blindness. This study aimed at determining variations of the GPC and greater palatine foramen (GPF) on cone beam computed tomography (CBCT) images. Materials and Methods: This cross-sectional descriptive study was carried out at Islamic Azad University dental school and private clinics of Isfahan in 2018. A total of 92 CBCT images of adults over 18 years old were evaluated and GPC length, GPF diameter and its distance to the anterior nasal spine (ANS), posterior nasal spine (PNS) and mid-maxillary suture (MMS) were measured. The data were analyzed using SPSS 18. Results: The mean distance of GPF to ANS (47.96 mm in men and 45.36 mm in women), to PNS (18.9 mm in men and 17.21 mm in women), and to MMS (15.93 mm in men and 14.73 mm in women), as well as the diameter of the GPF (6.07 mm in men and 5.01 mm in women) were significantly higher in men on both right and left sides (P<0.05). The mean GPC length in men and women was 34.36±2.5 and 31.39±1.9 mm, respectively, which was significantly larger in men. The more common canal pathway in sagittal plane was inferior/inferior-anterior (70%) in both genders. The inferior/inferior-anterior pathways were more common in both genders in coronal plane; however, this difference was not significant (P>0.05). Conclusion: Since the maxillary nerve block technique might cause irreparable complications through GPC, it is very important to know the position of the foramen and the canal direction. Therefore, it is advisable to use CBCT in order to better understand the GPF and GPC anatomy.

A standard canulated screw may not fit up to 1/3 of the patients treated percutaneously for anterior column acetabular fractures—A pilot study

Background— Main pulmonary artery diameter (mPA) and ratio of mPA to ascending aorta diameter (ratio PA) derived from chest CT are commonly reported in clinical practice. We determined the age- and sex-specific distribution and normal reference values for mPA and ratio PA by CT in an asymptomatic community-based population. Methods and Results— In 3171 men and women (mean age, 51±10 years; 51% men) from the Framingham Heart Study, a noncontrast, ECG-gated, 8-slice cardiac multidetector CT was performed. We measured the mPA and transverse axial diameter of the ascending aorta at the level of the bifurcation of the right pulmonary artery and calculated the ratio PA. We defined the healthy referent cohort (n=706) as those without obesity, hypertension, current and past smokers, chronic obstructive pulmonary disease, history of pulmonary embolism, diabetics, cardiovascular disease, and heart valve surgery. The mean mPA diameter in the overall cohort was 25.1±2.8 mm and mean ratio PA was 0.77±0.09. The sex-specific 90th percentile cutoff value for mPA diameter was 28.9 mm in men and 26.9 mm in women and was associated with increase risk for self-reported dyspnea (adjusted odds ratio, 1.31; P =0.02). The 90th percentile cutoff value for ratio PA of the healthy referent group was 0.91, similar between sexes but decreased with increasing age (range, 0.82–0.94), though not associated with dyspnea. Conclusions— For simplicity, we established 29 mm in men and 27 mm in women as sex-specific normative reference values for mPA and 0.9 for ratio PA.

<h2>Abstract</h2><h3>Objective</h3> The objective was to determine whether there is a difference in aortic tortuosity between men and women who underwent elective surgery for abdominal aortic aneurysms (AAAs) using two-dimensional computed tomography imaging. <h3>Methods</h3> A retrospective review of a prospectively maintained database of male and female patients who underwent elective AAA repair from December 2014 to December 2019 was undertaken. Maximal aortic diameter was measured on preoperative computed tomography scans, and patients were categorized into two groups (<5.5 cm and ≥5.5 cm). The degree of aortic tortuosity, defined as the maximum lateral deviation from aortic centerline on coronal views (mm), was measured and compared between men and women for each group using the Student <i>t</i> test. <h3>Results</h3> A total of 378 patients were included in the study. Three-hundred and five patients (81%) were male with a mean age of 75 years; 73 (19%) were female with a mean age of 76 years. The average aneurysm diameter for each group was similar. The average aortic tortuosity was greater in females for both groups. In the <5.5 cm group, the average aortic tortuosity was 16.2 mm in women and 12.7 mm in men (<i>P</i> = .02). In the ≥5.5 cm group, the average aortic tortuosity was 25.2 mm in women and 15.5 mm in men (<i>P</i> < .01). <h3>Conclusions</h3> In patients with AAAs, greater aortic tortuosity was seen in women than in men regardless of the AAA diameter. Further studies are needed to explore the implications of this finding on the threshold for repair and the overall management plan.

PurposeExophthalmometry is a common examination in ophthalmology. For example it is relevant for diagnosis or follow-up of thyroid eye disease. However, exophthalmometry is affected by several factors such as ethnicity, sex and age. The purpose of this study was to determine the globe position by magnetic resonance imaging (MRI) and to investigate its correlates among the general Northeast German adult population.MethodsA total of 3030 subjects aged between 20 and 89 from the population-based Study of Health in Pomerania (SHIP) underwent a standardised whole-body MRI. Axial length and globe position were determined in axial T1-weighted images of the orbit. The image had to include the corneal apex as well as the optic nerve head. Study participants were excluded from imaging analysis if there was no plane available that included both structures. Further exclusion criterion was a lateral deviation of the subject’s viewing direction. Images with inadequate quality due to motion artefacts or other technical reasons were excluded as well. Globe position was defined as the perpendicular distance between the interzygomatic line and the posterior surface of the cornea (exophthalmometric value). The distance between the posterior surface of the cornea and the posterior pole of the eyeball, at the boundary with orbital fat, was defined as axial length. We used posterior surface of the cornea for our measurements, because it seemed to be less vulnerable for motion artefacts than the anterior one. Moreover body measurements including body mass index (BMI), waist and hip circumferences were determined. Associations between anthropometric measurements with exophthalmometric outcomes were analysed by linear regressions adjusted for age and stratified by sex. P-values <0.05 were considered as statistically significant. To assess intra-reader variability intra-class correlation coefficients (ICC) were computed for repeated measurements of the MRI scans of 25 subjects.ResultsAfter considering the exclusion criteria 1926 evaluable subjects remained. There was no significant difference between means of right and left eyes. The mean exophthalmometric value was significantly higher in men (16.5 +/- 2.2 mm) than in women (15.3 +/- 2.1 mm). The mean MRI-axial length was 23.4 +/- 0.8 mm for men and 22.8 +/- 0.9 mm for women. BMI, waist and hip circumferences were positively correlated with exophthalmometric value (p<0.001). Difference of mean MRI-based exophthalmometric value for obese subjects (BMI ≥30 kg/m2) and non-overweight (BMI <25 kg/m2) was 2.1 mm for men and 1.6 mm for women. ICC between 0.97 and 0.99 indicate excellent repeatability of our method.ConclusionWe conclude that MRI-based exophthalmometric values are positively correlated with BMI, waist- and hip-circumference among the general Northeast German adult population. This association is independent from age and axial length. Consequently bodyweight of patients should be regarded to interpret exophthalmometric values correctly. MRI-exophthalmometry seems to be a suitable method to determine globe position. Considering the large number of study participants, exophthalmometric values of our study could be used as comparative values for exophthalmometry of people of Western European descent in future.

The aim of the study: Corticotomy-facilitated orthodontics is a modern approach to resolve complicated orthodontic cases that may increase the pace of tooth movement. The study's goal was to assess the changes that occurred at the root level following orthodontic treatment when corticotomy was used. Material and methods: Based on Cone Beam Computer Tomography, measurements of the root length at T0 (before corticotomy) and T1 (after corticotomy) were taken after splitting the individuals into two groups (maxillary and mandibular corticotomy) (6 months after surgery). For statistical analysis of the data, many tests were utilized. Results: The root length values obtained at T1 showed minimal changes in length, with statistically insignificant values (for the maxillary arch, the values obtained were 13.36 ± 2.41 mm for women and 14.26 ± 2.06 mm for men; for the lower arch, the measured values were 12.38 ± 2.09 mm for women and 11.56 ± 2.29 mm for men). The canine on the left hemiarcade had the most significant change in root length following treatment, with a value assessed at T1 of 16.72 ± 1.78 mm, which was statistically significant, p 0.05. Conclusion: According to the data obtained in this study, when orthodontic therapy is associated with corticotomy, there is a decrease in root resorption that may occur in the case of conventional orthodontic treatments.

BackgroundCertain variables reportedly are associated with a change in left ventricular ejection fraction (LVEF) in heart failure (HF) with reduced ejection fraction (HFrEF). However, literature describing the association between the recovery potential of LVEF and parameters of ventricular remodeling in echocardiography remains sparse.MethodsWe recruited 2,148 HF patients with LVEF < 35%. All patients underwent at least two echocardiographic images. The study aimed to compare LVEF alterations and their association with patient characteristics and echocardiographic findings.ResultsPatients with “recovery” of LVEF (follow-up LVEF ≥ 50%) were less likely to have prior myocardial infarction (MI), had a higher prevalence of atrial fibrillation (Af), were less likely to have diabetes and hypertension, and had a smaller left atrium (LA) diameter, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), both in crude and in adjusted models (adjustment for age and sex). LVEDD cutoff values of 59.5 mm in men and 52.5 mm in women and LVESD cutoff values of 48.5 mm in men and 46.5 mm in women showed a year-to-year increase in the rate of recovery (follow-up LVEF ≥ 50%)/improvement (follow-up LVEF ≥ 35%), p-value < 0.05 in Kaplan–Meier estimates of the cumulative hazard curves.ConclusionsOur study shows that LVEDD and LVESD increments in echocardiography can be predictors of changes in LVEF in in HF patients with LVEF < 35%. They may be used to identify patients who require more aggressive therapeutic interventions.

서 론비강 및 부비동은 해부학적으로 두개저에 인접하고 그 주위 에는 중요한 혈관과 신경들이 존재한다

To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage. In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation. Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage.

Modified lateralized head sign: An accurate marker in diagnosing adult hip dysplasia

Background: Thoracic paravertebral blockade (TPVB) can be effective in many clinical settings. However, many clinicians are reluctant to use this technique due to its adverse effects such as pneumothorax. The aim of this study was estimate the appropriate depth and width for safe needle positioning. Methods: The depth from skin to the paravertebral space (PVS) and the width from the spinous process (SP) to the PVS and the lateral tip of the transverse process (LTTP) were measured in all available sections from 84 patients examined by chest computed tomography (CT). The correlation between age, gender, body mass index (BMI) and each measured value was analyzed. Results: All 828 sections from the 84 patients aged between 19 and 65 years old were evaluated. The minimum and maximum values of the mean depth from the skin to PVS were 40.3-52.4 mm in men and 41.2-55.9 mm in women. The minimum and maximum values of the mean width from the SP to LTTP were 29.2-34.6 mm in men and 23.7-31.0 mm in women. At every thoracic level, the depth to PVS was similar in both genders but the width from the SP to the NEP in men was significantly higher than in women. Weight significantly influenced the width from the SP to LTTP in men but height and BMI did not. Also weight and BMI significantly influenced the depth from skin to PVS in almost all of the thoracic region at both sex, but height did not influence the depth from skin to PVS in both sex. Conclusions: We report clinically useful estimates that may be used to help avoid side effects such as pneumothorax and achieve a successful thoracic paravertebral blockade.

72. Static vs expandable TLIF cage: a comparison of predicted and achieved restoration of intervertebral disc height

Reliability of radiographic intervertebral disc height measurement for in vivo rat-tail model