CT facilitates improved diagnosis of adult intestinal malrotation: a 7-year retrospective study based on 332 cases

Abstract Objective To classify adult intestinal malrotation by CT. Methods This retrospective study enrolled adults diagnosed with intestinal malrotation who underwent abdominal CT at our institution between June 1, 2013, and August 30, 2020. All patients’ clinical information was recorded. Patients were divided into groups undergoing surgical and conservative management. The duodenum (nonrotation, partial rotation, and malrotation), jejunum, cecum, and the superior mesenteric artery/superior mesenteric vein relationship were reviewed on the CT images of each patient, and classification criteria developed based on the first three items. For each patient, each item was assessed separately by three radiologists. Consensus was required from at least two of them. Results A total of 332 eligible patients (218 men and 114 women; mean age 51.0 ± 15.3 years) were ultimately included and classified into ten types of malrotation. Duodenal partial rotation was present in most (73.2%, 243/332) with only 25% (83/332) demonstrating nonrotation. The jejunum was located in the right abdomen in 98.2% (326/332) of cases, and an ectopic cecum was found in only 12% (40/332, 29 cases with a left cecum, 7 pelvic, and 4 at midline). Asymptomatic patients comprised 56.6% (188/332) of cases, much higher than that in previous studies (17%, n = 82, p < .001), comprised mainly of patients with duodenal partial rotation (80.3%, 151/188). In 91 patients with detailed clinical data available (12 managed surgically and 79 conservatively), a significant difference in malrotation CT categorization was identified (p = .016). Conclusions CT enables greater detection of asymptomatic intestinal malrotation, enabling classification into multiple potentially clinically relevant subtypes.

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Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

Acta Orthopaedica Belgica ◽

10.52628/87.1.22 ◽

2021 ◽

Vol 87 (1) ◽

pp. 175-179

Author(s):

Thibault Dewilde ◽

Sebastiaan Schelfaut ◽

Sven Bamps ◽

Matthias Papen ◽

Pierre Moens

Keyword(s):

Retrospective Study ◽

Case Series ◽

Technical Note ◽

Coronal Alignment ◽

Level Of Evidence ◽

Coronal Balance ◽

Scoliotic Deformity ◽

Significant Difference ◽

The Mean ◽

The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

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Location of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Zone III Using External Landmark Without Fluoroscopy: A CTA-based Retrospective Study

10.21203/rs.3.rs-47921/v1 ◽

2020 ◽

Author(s):

Danlei Weng ◽

Anyu Qian ◽

Qijing Zhou ◽

Jiefeng Xu ◽

Shanxiang Xu ◽

...

Keyword(s):

Retrospective Study ◽

Average Length ◽

Safety Margin ◽

Balloon Occlusion ◽

University Hospital ◽

Xiphoid Process ◽

Significant Difference ◽

The Right ◽

External Landmark ◽

Endovascular Balloon Occlusion

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) can timely prevent the wounded from massive hemorrhage. We aim to study whether the combination of the xiphoid process and the umbilicus could guide the placement of REBOA in zone III without fluoroscopy. Methods We conducted a retrospective study in a university hospital that included 57 subjects who underwent contrast-enhanced computed tomography (CT) from April to December in 2019. External distances and intravascular lengths were measured by three-dimensional reconstruction CT images on the workstation, including the distances from the femoral artery to the xiphoid process (FA-Xi), the midpoint between the xiphoid process and the umbilicus (FA-mXU), the umbilicus (FA-Ui), the midpoint of the zone III (FA-mZIII), the lowest renal artery (FA-LRA), and aortic bifurcation (FA-AB). The relationship between external landmarks and REBOA catheter positioning in zone III was studied, involving the quartering distances between the xiphoid process and the umbilicus, the distance below the xiphoid process and that above the umbilicus. The predicted accuracy and safety margin of the balloon (distal and proximal) were calculated by curvature plane reconstruction. The probability of balloon positioning in zone III using these three methods was compared by Chi square test. Results The average length of aortic zone III was 9.4 cm (SD = 10.0), and that of FA-mZIII on the right and left sides were 24.4 cm (SD = 2.1) ,23.8 cm (SD = 2.1), respectively. FA-Xi was significantly longer than FA-LRA, and FA-Ui was significantly shorter than FA-AB (P < 0.05). Using the quartering distances between the xiphoid and the umbilicus, the distance below the xiphoid, the distance above the umbilicus to predict the length of REBOA catheter positioning in zone III showed no statistically significant difference. Using FA-mXU to predict the accuracy of catheter positioning in zone III on the left and right sides were 84.2% and 86%. Although there was a little difference between the left side of FA-mZIII and FA-mXU, there were no statistical differences on the right side. Conclusions The midpoint between the xiphoid process and the umbilicus is a good external landmark to guide the placement of REBOA in zone III without fluoroscopy.

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Determining the Size of the Mental Foramen: A Cone-Beam Computed Tomography Study

International Dental Research ◽

10.5577/intdentres.2017.vol7.no2.1 ◽

2017 ◽

Vol 7 (2) ◽

pp. 20

Author(s):

Seda Falakaloglu ◽

Artemisa Veis

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Cone Beam Computed Tomography ◽

Mental Foramen ◽

Axial Plane ◽

Cone Beam ◽

Coronal Image ◽

Significant Difference ◽

Student’S T ◽

The Right

Aim: Knowledge of the position of the mental foramen is important to prepare strategy when administering regional anesthesia, performing dental surgical procedures, endodontic treatments. Also, it is critical to analyze diameter of mental foramen in sagittal, coronal, and axial images. The aim of this retrospective study was to determine the diameter of the MF in different planes from CBCT images. Methodology: This study was designed at Department of Endodontics, Dicle University, Diyarbakır, Turkey. One hundred twenty three (67 female, 56 male) CBCT scans that met the study criteria were obtained. All images were obtained from i-CAT (Imaging Sciences International, Hatfield, PA). Data were analyzed using Student’s t-tests and Tukey HSD tests. Results: For the analysis of age, data were divided into four groups: 12–17, 18–29, 30–49, and ≥50 years. The data were also divided into two groups by gender. Axial and coronal image measurements were also divided into right and left. There was a statistical difference compared with females and males (p<0.05). In the coronal plane, the right region showed significant differences in measurements between the groups (p<0.05). In the axial plane, there was no statistically significant difference between them (p>0.05). The differences between the groups in the left region in the axial plane measurements were significant (p<0.05). Conclusions: Using CBCT imaging superimposition of anatomical structures can be eliminated. It is important that determine that the size of the mental foramen. This study is a retrospective study using CBCT from patient and find that the size of the mental foramen. How to cite this article: Falakaloglu S, Veis A. Determining the size of the mental foramen: A cone-beam computed tomography study. Int Dent Res 2017;7:20-25.

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Feasibility study of relative renal function assessment by contrast-enhanced abdominal CT in comparison to 99mTc-MAG3 renal scintigraphy

Insight Urology ◽

10.52786/isu.a.25 ◽

2021 ◽

Vol 42 (1) ◽

pp. 46-50

Author(s):

Jittapat Kalapong ◽

◽

Tanet Thaidumrong ◽

Seksan Chitwiset ◽

◽

...

Keyword(s):

Renal Function ◽

Retrospective Study ◽

Strong Correlation ◽

Renal Scintigraphy ◽

Manual Segmentation ◽

Post Processing ◽

Abdominal Ct ◽

Contrast Enhanced ◽

Significant Difference ◽

Function Assessment

Objective: To determine the feasibility of using contrast-enhanced abdominal CT to assess relative renal function. Materials and Methods: This retrospective study reviewed data from 32 patients who had had investigations by contrast-enhanced abdominal CT and 99mTc-MAG3 renal scintigraphy, within a period of not more than 30 days. Post-processing CT images of kidneys were by manual segmentation and calculated to interpret the relative renal function. Results: There was strong correlation between CT derived relative renal function and 99mTc-MAG3 renal scintigraphy (r = 0.971, p < 0.001) and no statistically significant difference in renal function between the two techniques (p = 0.572). Conclusion: Contrast-enhanced abdominal CT can determine relative renal function as accurately as renal scintigraphy. It is an appropriate alternative method, especially in hospitals where renal scintigraphy is not available.

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Distal Chevron Osteotomy without Fixation for Correction of Hallux Valgus: A Ten Year Retrospective Study

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.05.02.01 ◽

2020 ◽

Vol 5 (2) ◽

Keyword(s):

Retrospective Study ◽

Hallux Valgus ◽

Study Group ◽

Radiographic Parameters ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Radiographic Measurements ◽

Surgical Methods ◽

Significant Difference ◽

The Right

Introduction: More than eighty surgical methods have been proposed to correct Hallux Valgus Deformity. This study evaluates the efficacy of Distal Chevron Osteotomy by means of assessing pre-operative and post-operative radiographic parameters and clinical results. Methods: The authors performed a ten-year retrospective study, on patients treated with Chevron Osteotomy alone without internal fixation, by the senior author, at the Toronto Western Hospital, between the years 2000-2009. The association of Hallux Valgus with demographics, other pre-operative foot pathology, etiology, intra-op pathology, complications (late and early) and radiographic parameters (pre-operative and post-operative IMA and HVA’s) were studied. Results: Two hundred and eight-five Chevron osteotomies were performed, on one hundred and seventy-eight patients with Hallux Valgus. In the study group 89% were female, the average age was 44 years ± 14 (range 16 to 77), 60% were bilateral. Radiographic measurements of the Hallux Valgus angle (HVA) and Intermetatarsal angle (IMA) demonstrated a statistically significant difference in pre-operative and post-operative measurements (p <0.05) t-test. The mean correction in the HVA for the left foot was 14.94 degrees compared with 14.98 degrees for the right foot. A mean correction of 1.99 degrees in the IMA for the left foot and 2.05 degrees for the right foot was obtained. The recurrence rate for Hallux Valgus was 0.70% (2 feet). In 12.36% of the study group, unexpected intra-operative findings such as EHL tendon contracture, bursae, intra-osseous ganglion cysts, and osteoporosis or capital osteophytes resulted in adding to, or modifying, the standard operative procedure. Conclusion: Despite minor and largely reversible post-operative complications, this study demonstrates that with distal Chevron osteotomy excellent radiographic and cosmetic correction of the deformity was achieved with a high level (99.30%) of patient satisfaction. Patients should be advised pre-operatively about their risk for developing Keloids 5.61%, transfer metatarsalgia 4.56% and recurrence 0.70% when treated by Chevron osteotomy.

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Left- sided Acute Appendicitis with Intestinal Malrotation in an Adult:a Diagnostic Challenge

Nepalese Journal of Radiology ◽

10.3126/njr.v7i1-2.19357 ◽

2018 ◽

Vol 7 (1-2) ◽

pp. 27-30

Author(s):

Rupesh Gautam ◽

U De Lima Gemma ◽

Bhawana Adhikari

Keyword(s):

Acute Appendicitis ◽

Ct Scan ◽

Mesenteric Artery ◽

Lower Abdominal Pain ◽

Sudden Onset ◽

Intestinal Malrotation ◽

Diagnostic Challenge ◽

Diagnostic Modality ◽

The Right ◽

Ct Features

A 28-yr-old male presented with sudden onset pain at the epigastric region followed by left lower abdominal pain. CT scan of the abdomen revealed reverse relation of the superior mesenteric artery and superior mesenteric vein with large bowel loops including the cecum on the left side and small bowel loops on the right. An inflamed appendix arising from the base of left sided cecum was identified. The intraoperative findings were consistent with CT features. This is a rare case of left sided acute appendicitis with intestinal malrotation in an adult patient. CT scan is diagnostic modality of choice and excludes other possible disease presenting with similar clinical features.

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Effect of diabetes on vascular smooth muscle function in normotensive and spontaneously hypertensive rat mesenteric artery

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y87-360 ◽

1987 ◽

Vol 65 (11) ◽

pp. 2274-2280 ◽

Cited By ~ 26

Author(s):

D. K. Agrawal ◽

J. H. McNeill

Keyword(s):

Mesenteric Artery ◽

Spontaneously Hypertensive Rat ◽

Functional Responses ◽

Spontaneously Hypertensive ◽

Wky Rats ◽

Rat Mesenteric Artery ◽

Significant Difference ◽

Adrenoceptor Agonists ◽

Wistar Kyoto ◽

The Right

We have examined the functional responses to α-adrenoceptor agonists (α1-selective: methoxamirte and phenylephrine; α2-selective: clonidine and B-HT 920; non-selective: norepinephrine, serotonin and K+ in ring segments of mesenteric artery of control and streptozotocin-induced diabetic spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) rats. Systolic blood pressure and contractile responses were examined after 12 weeks of diabetes. There was no significant change in the diabetic WKY rats as compared with the control WKY rats. However, diabetic SHR had significantly less hypertension than control SHR. Responses to serotonin and α2-adrenoceptor agonists were augmented significantly in arteries from control SHR animals as compared with vessels from WKY animals. There was no significant difference in the force of contraction generated by other agonists in both nondiabetic groups. Responses to all agonists in WKY diabetic and to methoxamine and K+ in SHR diabetic arteries were increased as compared with their respective controls. ED50 values for each agonist were similar in all groups. Indomethacin (5 μM) shifted the dose–response curve to norepinephrine to the right in arteries from all groups of animals. However, in the diabetic SHR and WKY, there was a significant reduction in norepinephrine maximum response. Nifedipine was more potent in inhibiting the contraction to K+ and serotonin in WKY diabetic arteries as compared with WKY controls. However, nifedipine inhibited the responses to all agonists with equal potency in the control and diabetic SHR vessels. These results suggest the involvement of α2-adrenoceptors and serotonin receptors in the development and (or) the maintenance of hypertension. Furthermore, the hyperresponsiveness of the diabetic vessels could be due to an alteration in the postreceptor excitation–contraction coupling, possibly involving prostaglandin and an increased activity of calcium channels.

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Anatomical change of SMV branches after the Cattell Braasch maneuver facilitates safe resection around the uncinated process in pancreatoduodenectomy

BMC Surgery ◽

10.1186/s12893-021-01338-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masayuki Akita ◽

Eri Maeda ◽

Tohru Nishimura ◽

Koichiro Abe ◽

Akihito Kozuki ◽

...

Keyword(s):

Computed Tomography ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Superior Mesenteric Vein ◽

Anatomical Changes ◽

Mesenteric Vein ◽

Anterior Aspect ◽

Anatomical Change ◽

The Right ◽

Enhanced Computed Tomography

Abstract Background The aims of the present study were to demonstrate the anatomical change of superior mesenteric vein (SMV) branches and to show how the Cattell Braasch maneuver facilitates a safer ligation of these venous branches during a pancreatoduodenectomy (PD). Methods Between January 2010 and December 2019, 97 patients with peripancreatic tumors underwent pancreatectomy. We retrospectively reviewed preoperative triple-phase enhanced computed tomography (CT) images and analyzed variations in SMV branches. Anatomical changes in SMV branches after the Cattell Braasch technique were observed using our operation video and illustrations. Results The first jejunal vein (J1v) in 75% of patients ran posterior to the superior mesenteric artery (SMA), while the remainder (25%) ran anterior to it. The inferior pancreatoduodenal vein (IPDV) was preoperatively detected in 91% of patients. The IPDV drained into the J1v in 74% of patients and into the SMV in 37%. After the Cattell Braasch maneuver, the J1v which ran posterior to the SMA now was found to lie to the right anterolateral side the SMA and the visualization of both the J1v and the IPDV were much more clearly visualized. Conclusions The most frequent venous variation was the IPDV draining into the J1v posterior to the SMA. After the Cattell Braasch maneuver, the IPDV was now located to the right anterolateral anterior aspect of the SMA which facilitates its visualization and should allow a safer ligation.

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Pancreaticoduodenectomy in a patient with intestinal malrotation and distal cholangiocarcinoma: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-020-02468-9 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Nassir Alhaboob Arabi ◽

Areej Abdalla Abdoun ◽

Mohamed Osama Ali ◽

Saria Kabashi Elhaj ◽

Sawsan Abuelgassim Mohd.

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Complete Blood Count ◽

Uncinate Process ◽

Oral Feeding ◽

Intestinal Malrotation ◽

Lateral Side ◽

Elevated Alkaline Phosphatase ◽

Distal Cholangiocarcinoma ◽

The Right

Abstract Background A combination of intestinal malrotation and distal cholangiocarcinoma is considered a rare condition and poses some difficulties in surgical management. We present a case of a patient with asymptomatic nonrotation of the midgut with a concomitant distal cholangiocarcinoma who underwent successful pancreaticoduodenectomy. Case presentation A 52-year-old Sudanese man presented to our hospital with progressive painless jaundice associated with dark urine, pale stool, and itching for the last 2 months. He had no other complaint or significant previous medical history apart from being an ex-smoker. His clinical examination revealed a palpable gallbladder and scratch mark. His other systems were unremarkable. His blood test results showed a normal complete blood count, elevated total bilirubin (mainly direct bilirubin), elevated alkaline phosphatase, and normal cancer antigen 19-9 and carcinoembryonic antigen. Ultrasound, computed tomography of the abdomen, and magnetic resonance cholangiopancreatography showed a dilated intrahepatic and extrahepatic biliary system down to the distal part, where the lumen was obstructed by a periampullary mass measuring 2.4 by 2.1 cm. The patient’s gallbladder was distended. He had no liver metastases or ascites and few lymph nodes. Inversion of the superior mesenteric artery and superior mesenteric vein but no invasion was seen, and malrotation of the bowel was observed with the large bowel on the left side and the small bowel to the right of the abdomen. Endoscopic retrograde cholangiopancreatography showed a fleshy ampulla that was stented. Laparotomy showed malrotation, with the duodenum straight on the right side of the midline, and Ladd’s band crossed the second portion of the duodenum. The vessels were approached from the lateral side meticulously after kocherization of the duodenum and pancreas, dissection along an extended portion of the superior mesenteric artery to assure preservation of the superior mesenteric artery and branches going to the jejunum, Ladd’s procedure, division of the jejunum 10 cm below the uncinate process of pancreas, and modified pancreaticoduodenectomy were performed, and anastomoses were performed in the standard fashion. The patient had an uneventful postoperative course, started oral feeding after 5 days, and discharged to home on day 10 for regular follow-up. Histopathology confirmed distal cholangiocarcinoma, and the patient was referred for further oncological management. Conclusions Pancreaticoduodenectomy can be safely performed in patients with intestinal malrotation with some modifications of the standard approach. Meticulous dissection after preoperative identification of vascular anomaly and a lateral approach are of great help to reduce morbidity.

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The Physiological Significance of A-Waves in Early Diabetic Neuropathy: Assessment of Motor Nerve Fibers by Neurophysiological Techniques

Frontiers in Systems Neuroscience ◽

10.3389/fnsys.2021.633915 ◽

2021 ◽

Vol 15 ◽

Author(s):

Qiong Cai ◽

Guliqiemu Aimair ◽

Wen-Xiao Xu ◽

Pei-Yao Xiao ◽

Lie-Hua Liu ◽

...

Keyword(s):

Conduction Velocity ◽

Type Ii Diabetes ◽

Motor Nerve ◽

Clinical Information ◽

Nerve Fibers ◽

Diabetic Patients ◽

Healthy Controls ◽

Type Ii ◽

Significant Difference ◽

The Right

Objective: This study aimed to investigate how early A-waves could occur in type II diabetes, and what it implied functionally.Methods: We performed conduction velocity distribution (CVD) test in peroneal nerves of 37 type II diabetic patients with normal nerve conduction study (NCS) and 22 age-matched controls. The electrophysiological data and clinical information were analyzed.Results: A-waves were observed in 45.9% of diabetic patients and only in 1 person in healthy controls, all detected in the tibial nerves. The diabetic patients with A-waves showed faster conduction velocity in all quartiles in the motor peroneal nerves compared to the patients without A-waves, and their CVD histograms were shifted to the right side, consisting of a significantly larger percentage of fast conducting fibers. There was no significant difference in the CVD values of the upper extremity nerves among the patients with and without A-waves and the healthy controls.Conclusion: A-waves could occur in type II diabetes as early as when NCS showed normal, and represented as a sign of neuropathy as well as a sign of rescued motor nerve function.

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