scholarly journals Simplified paravertebral anesthesia technique and its application

2021 ◽  
Vol 25 (11) ◽  
pp. 1235-1235
Author(s):  
I. Tsimkhes
Keyword(s):  
Differential Diagnosis ◽  
Vertebral Body ◽  
Spinous Process ◽  
Transverse Process ◽  
Lower Edge ◽  
Diagnosis And Therapy ◽  
Spinous Processes ◽  
Thoracic Part ◽  
Anesthesia Technique

C. Fervers (Zentralbl. F. Chir. No. 37, 1929), in order to avoid complications, inserts the needle with paravertebral anesthesia one finger away from the spinous processes towards the angle formed by the transverse process and the edge of the vertebral body (the outer end of the needle with the midline forms an angle of 20 -30 ). The designated angle is located normally in the thoracic part of the spine near the upper edge of the spinous process, in the lumbar part, in the middle of the lower edge of the spinous process. In this way, the needle easily reaches the vertebral wall, and the injected fluid washes the ramus anter. ram. communicans. During operations, the author recommends using paravertebral anesthesia only for unilateral processes, such as appendicitis, cholelithiasis, kidneys and ureters and hernias. For the purposes of differential diagnosis and therapy, paravertebral anesthesia can be used.

FINITE ELEMENT ANALYSIS OF THE SPACE CREATED BY SPLIT SPINOUS PROCESSES IN DOUBLE-DOOR LAMINOPLASTY TO OPTIMIZE SHAPE OF AN ARTIFICIAL SPACER

2000 ◽  
Vol 04 (01) ◽  
pp. 47-54 ◽  
Author(s):  
Shigeru Hirabayashi ◽  
Kiyoshi Kumano
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Vertebral Body ◽  
Clinical Case ◽  
Spinous Process ◽  
Lateral Deviation ◽  
Element Analysis ◽  
Spinous Processes ◽  
Inner Surface ◽  
The Difference

In double-door laminoplasty, several types of artificial spinous process spacers have been used instead of grafted bone from the iliac crest. However, inadequate contact between the spacer and the spinous process has recently been reported. From the observation during operation, we suspect that the main cause of the inadequate contact is the difference in shape between the spacer and the widened space created by the split spinous processes. The purpose of this study was to investigate the shape of the widened space by means of a finite element analysis in order to confirm our observation objectively and to provide a shape design of a spacer adapting to the space. Half-sectioned finite element models of the second cervical (C2) vertebra and the C6 vertebra were made from both the computed tomography (CT) of a clinical case and a plastic model of a cervical spine. The finite element model was designed to have almost the same size and shape as those of the genuine vertebra in the clinical case. Since cancellous bone and soft tissues were thought not to meaningfully influence the rigidity of the model, the model was made of only cortical bone with a thickness of 1.5 mm. The x-axis was defined as the lateral direction of the vertebral body, the y-axis as the anteroposterior direction of the vertebral body and the z-axis as the craniocaudal direction along the posterior margin of the vertebral body. The boundary conditions were fixed at the inner surface of the half-sectioned vertebral body. A force of 100 N was applied to the inner surface of the half-sectioned spinous process (to the cranial side and the caudal side, 50 N each) in the direction of the x-axis. The lateral deviation of each split spinous process was defined as the degree of deviation in the x-axis direction. The degree of lateral deviation of each split spinous process was analyzed in two types of models with and without making a lateral gutter 4 mm wide along the z-axis direction. The lateral deviation at the cranial side was larger than that at the caudal side in both the C2 and C6 vertebrae. The difference between the lateral deviation at the cranial side and the caudal side of each vertebra was larger in the type of model with the lateral gutter than in the type of model without it. It was confirmed that the shape of the widened space is trapezoidal in not only the axial but also frontal sections. In conclusion, the optimal shape of a spacer adapting to the widened space in double-door laminoplasty is trapezoidal in not only the axial but also frontal sections.

The thoracic wall and diaphragm

2013 ◽  
Author(s):  
Martin E. Atkinson
Keyword(s):  
Vertebral Column ◽  
Spinous Process ◽  
Transverse Process ◽  
Intervertebral Discs ◽  
Thoracic Wall ◽  
Thoracic Vertebrae ◽  
Thoracic Cage ◽  
Straight Line ◽  
Thoracic Part ◽  
Intervertebral Foramina

The thoracic wall is made up of skeletal elements that form the thoracic cage (or more commonly, but less accurately, the rib cage) and muscles that move the components of the thoracic cage relative to each other for ventilation and postural movement. The thoracic cage is made up posteriorly by the thoracic part of the vertebral column, laterally and anteriorly by the ribs and costal cartilages, and by the sternum in the anterior mid-sternal area. The thoracic vertebral column is made up of 12 thoracic vertebrae and their intervertebral discs. The thoracic vertebrae are not arranged in a straight line, but are concave anteriorly as shown in Figure 9.2. All vertebrae have the following general configuration as shown in Figure 10.1A: • A heart-shaped body with two backward projections, the pedicles, either side of the vertebral foramen. The foramen forms the spinal canal with the foramina of other vertebrae. Note in Figure 10.1C that the pedicles are slightly shallow above and strongly grooved below to form intervertebral foramina with adjacent vertebrae for the passage of spinal nerves; • Two stout transverse processes running laterally and slightly posteriorly; • Two flat plates called laminae which join to form a long spinous process—you can feel the tips of the spinous processes very easily under the skin in the midline of your back; • Superior and inferior articular processes at the junction of the pedicles and laminae. In thoracic vertebrae, the superior facets are set vertically with the facets on the superior processes facing posterolaterally and those on the inferior processes anteromedially; the relative movement of the vertebrae is thus mainly rotary, but there is very little actual movement in the thoracic part of the vertebral column. The thoracic vertebrae are modified from this basic pattern to articulate with the ribs through several more articular facets as shown in Figure 10.1 A, B, and C. They carry on each side: • Shown most clearly in Figure 10.1 C, a superior and inferior demifacet (a half facet) on each side of the body for the heads of two ribs in the case of T2–T9 or a single complete facet for the head of one rib in the case of T1 and T10–T12; • Shown in Figure 10.1 A and B, a facet near the tip of each transverse process for the tubercle of a rib (except T11 and T12).

Stroke due to isolated angiitis ot the central nervous system (CNS) – differential diagnosis and therapy

2004 ◽  
Vol 35 (01) ◽  
Author(s):  
S Springer ◽  
S Bechthold ◽  
A Jansson ◽  
K Kurnik ◽  
T Pfluger ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Differential Diagnosis ◽  
Diagnosis And Therapy ◽  
The Central Nervous System

scholarly journals Combining 3D Structured Light Imaging and Spine X-ray Data Improves Visualization of the Spinous Lines in the Scoliotic Spine

2020 ◽  
Vol 11 (1) ◽  
pp. 301
Author(s):  
Sławomir Paśko ◽  
Wojciech Glinkowski
Keyword(s):  
Radiation Exposure ◽  
Surface Topography ◽  
Structured Light ◽  
Spinous Process ◽  
Three Dimensional ◽  
Diagnostic System ◽  
Measurement Tool ◽  
Adequate Treatment ◽  
X Ray ◽  
Spinous Processes

Scoliosis is a three-dimensional trunk and spinal deformity. Patient evaluation is essential for the decision-making process and determines the selection of specific and adequate treatment. The diagnosis requires a radiological evaluation that exposes patients to radiation. This exposure reaches hazardous levels when numerous, repetitive radiographic studies are required for diagnostics, monitoring, and treatment. Technological improvements in radiographic devices have significantly reduced radiation exposure, but the risk for patients remains. Optical three-dimensional surface topography (3D ST) measurement systems that use surface topography (ST) to screen, diagnose, and monitor scoliosis are safer alternatives to radiography. The study aimed to show that the combination of plain X-ray and 3D ST scans allows for an approximate presentation of the vertebral column spinous processes line in space to determine the shape of the spine’s deformity in scoliosis patients. Twelve patients diagnosed with scoliosis, aged 13.1 ± 4.5 years (range: 9 to 20 years) (mean: Cobb angle 17.8°, SD: ±9.5°) were enrolled in the study. Patients were diagnosed using full-spine X-ray and whole torso 3D ST. The novel three-dimensional assessment of the spinous process lines by merging 3D ST and X-ray data in patients with scoliosis was implemented. The method’s expected uncertainty is less than 5 mm, which is better than the norm for a standard measurement tool. The presented accuracy level is considered adequate; the proposed solution is accurate enough to monitor the changes in the shape of scoliosis’s spinous processes line. The proposed method allows for a relatively precise calculation of the spinous process lines based on a three-dimensional point cloud obtained with a four-directional, three-dimensional structured light diagnostic system and a single X-ray image. The method may help reduce patients’ total radiation exposure and avoid one X-ray in the sagittal projection if biplanar radiograms are required for reconstructing the three-dimensional line of the spinous processes line.

scholarly journals The descending thoracic aorta morphological characteristics

2016 ◽  
Vol 22 (3) ◽  
pp. 186-191
Author(s):  
S. Malik ◽  
P. Bordei ◽  
A. Rusali ◽  
D. M. Iliescu
Keyword(s):  
Thoracic Aorta ◽  
Vertebral Body ◽  
Vertebral Column ◽  
Morphological Characteristics ◽  
Male Gender ◽  
Thoracic Vertebra ◽  
Thoracic Vertebrae ◽  
Lower Edge ◽  
Descending Thoracic Aorta ◽  
Left Flank

Abstract Our study was conducted by consulting angioCT sites made on a CT GE LightSpeed VCT64 Slice CT and a CT GE LightSpeed 16 Slice CT, following the path and relationships of the descending thoracic aorta against the vertebral column, outside diameters thereof at the thoracic vertebrae T4, T7, T12 and posterior intercostal arteries characteristics. The origin of of the descending thoracic aorta we found most commonly on the left flank of the lower edge of the vertebral body T4, but I have encountered cases where it had come above the lower edge of T4 on level of intervertebral disc T4-T5 or even at the upper edge of T5 vertebral body. At thoracic vertebra T4, on a total of 30 cases, the descending thoracic aorta present a diameter of 20.0 to 32.6 mm, values that correspond to male gender and to females diameter ranging from 25.5 to 27, 4 mm. At level of T7 thoracic vertebra, thoracic aorta present a diameter of 19.6 to 29.5 mm, values found in men, in women the diameter being from 21.9 to 25.2 mm. At thoracic vertebra T12, on a total of 27 cases, the descending thoracic aorta present a diameter of 17.6 to 27.7 mm, in males the diameter was from 17.6 to 27.7 mm and females diameter ranging from 21.1 to 25.2. The length of the descending thoracic aorta was from 18.40 to 19.41 cm.

scholarly journals Differential diagnosis of vertebral spinous process deviations in archaeological and modern domestic dogs

2016 ◽  
Vol 9 ◽  
pp. 54-63 ◽  
Author(s):  
Dennis F. Lawler ◽  
Chris Widga ◽  
David A. Rubin ◽  
Jennifer A. Reetz ◽  
Richard H. Evans ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Spinous Process ◽  
Domestic Dogs

scholarly journals Copeptin for the differential diagnosis and therapy management of hyponatremia in hospitalized patients - 'The Co-MED-Study'

2014 ◽  
Author(s):  
Nicole Nigro ◽  
Bettina Winzeler ◽  
Isabelle Suter-Widmer ◽  
Philipp Schuetz ◽  
Birsen Arici ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Hospitalized Patients ◽  
Therapy Management ◽  
Diagnosis And Therapy

Medical Epitome

2020 ◽  
pp. 105-138
Author(s):  
Petros Bouras-Vallianatos
Keyword(s):  
Differential Diagnosis ◽  
Case Studies ◽  
Close Reading ◽  
Non Invasive ◽  
Diagnosis And Therapy ◽  
Invasive Techniques

This chapter examines John’s Medical Epitome. The focus here is on the first four of its six books. In contrast to the established view that this work was intended for physicians, it is argued that it was primarily written for philiatroi, intellectuals who were deeply interested in medicine, but not practising physicians themselves. The Medical Epitome, unlike John’s other two works, mainly consisted of material from earlier sources. The analysis of the text starts with a close reading of John’s proem and a discussion of the background of his dedicatee, the Byzantine statesman Alexios Apokaukos. It then shifts to an examination of the work’s structure with the aim of emphasizing John’s intentions in putting together his material. The analysis proceeds by way of a number of case studies focusing on diagnosis and therapy, and goes on to show that John intentionally condensed his material, removing specialized advice, so as to make it appeal to non-expert readers. Thus it is shown, for example, that the absence of details on invasive operations is consistent with the character of his intended readers, who were only able to use non-invasive techniques, such as phlebotomy and arteriotomy. Finally, the particular attention John paid to differential diagnosis, especially as regards eye affections, which is often supplemented with his own advice, is highlighted.

Bad breath — aetiology, differential diagnosis and therapy

2008 ◽  
Vol 65 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Thomas Imfeld
Keyword(s):  
Differential Diagnosis ◽  
Diagnosis And Therapy ◽  
Bad Breath

Rund jede vierte Person hat Mundgeruch. Dabei muss zwischen Foetor ex ore (90%) und Halitosis (10%) unterschieden werden. Ersterer ist nur im Mundatem perzeptierbar und hat seine Ursache in der Mundhöhle. Halitosis ist im Mund- und/oder Nasenatem feststellbar und die Ursache liegt entweder nasal/pharyngeal (lokale Halitosis nur im Nasenatem), pulmonal oder selten gastrointestinal (systemische Halitosis im Mund- und Nasenatem). Eine entsprechende Differenzialdiagnose ist Voraussetzung für die Kausaltherapie. Verantwortlich für den Foetor ex ore sind flüchtige Schwefelverbindungen, welche durch proteolytische Mikroorganismen in der Mundhöhle produziert werden. Prophylaxe und Therapie basieren auf der mechanischen und chemischen Reduktion dieser Erreger. Mundgeruch kann ein nachhaltiges soziales Handikap sein, weshalb das Thema nicht tabuisiert werden darf.

Sign in / Sign up

Export Citation Format

Share Document