scholarly journals Anatomic Study and Assembled Navigation Template-Assisted Implantation for Anterograde Transpubic Screws

2021 ◽  
Author(s):  
Chao Wu ◽  
Danwei Shen ◽  
Jiayan Deng ◽  
Bofang Zeng ◽  
Xiangyu Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Normal Subjects ◽  
Entry Point ◽  
Screw Placement ◽  
Incision Length ◽  
Screw Channel ◽  
Surface Distance ◽  
Inner Circle ◽  
The Difference ◽  
Navigation Template

Abstract Objective: Research the anatomical parameters of the anterograde transpubic screw corridor and evaluate the safety of anterograde transpubic screw placement assisted by the assembled navigation template.Methods: A total of 50 normal subjects, including 25 males and 25 females, underwent pelvic CT scanning in our hospital from January 2020 to September 2020. A 3D model of the ilium was established. The ilium was divided into zone Ⅰ, Ⅱ and Ⅲ according to Nakatani classification. The anterograde transpubic screw channel completely passes through zone Ⅰ and Ⅱ to form corridor A. The anterograde screw channel completely passes through zone Ⅰ, Ⅱ and Ⅲ to form corridor B. The diameter and length of the inner circle, the distance from the center of the inner circle to the posterior superior and to the inferior iliac spine of corridor A and corridor B were measured, respectively. A total of 9 patients underwent anterograde transpubic screw and transverse sacroiliac screw placement assisted by the assembled navigation template in our hospital, including 5 males and 4 females, were retrospectively analyzed. Operative time, blood loss, incision length and fluoroscopy times were recorded. Grading score and Matta score were evaluated after surgery.Results: In 50 normal subjects, the diameter of corridor A was 11.16±2.13 mm, and that of corridor B was 8.54±1.52mm, and the difference between the two corridors was statistically significant (P=0.000). The length of corridor A was 86.39±9.35 mm, and that of corridor B was 117.05±5.91 mm, with significant difference between the two corridors (P=0.000). The surface distance from the screw entry point to the posterior superior iliac spine in corridor A was 109.31± 11.06mm, and that in corridor B was 127.86± 8.23mm, the difference between the two corridors was statistically significant (P=0.000). The surface distance from the screw entry point to the posterior inferior iliac spine in corridor A was 91.16±10.34 mm, and that in corridor B was 106.92±7.91 mm. The difference between the two corridors was statistically significant (P=0.000). Nine patients successfully completed surgery, and a total of 18 sacroiliac transverse screws and 11 anterograde transpubic screws were inserted with the assistance of assembled navigation templates. The mean operation time of the 9 patients was 108.75±25.71 min, the blood loss was 141.11±50.21 ml, the incision length was 14±4.62 cm, and the intraoperative fluoroscopy was 17.89±4.01 times. Matta scores were excellent in 5 patients and good in 4 patients. One of the anterograde transpubic screw was in Grade 1, and 10 were in Grade 0. One S1 screw was in Grade 1, and 8 S1 screws were in Grade 0. Nine S2 screws were in Grade 0.Conclusions: Majority of the patients can accommodate anterograde transpubic screw s with diameter of 6.5 mm. Anterograde transpubic screw placement assisted by an assembled navigation template is clinically feasible, and with low cortical breaches.

scholarly journals Anatomical conditions and patient-specific locked navigation templates for TSS placement

2020 ◽  
Author(s):  
Chao Wu ◽  
jiayan deng ◽  
jian pan ◽  
tao li ◽  
Lun Tan
Keyword(s):  
Entry Point ◽  
Screw Placement ◽  
Patient Specific ◽  
Short Axis ◽  
Sacroiliac Screw ◽  
Nerve Root Injury ◽  
Significant Difference ◽  
Sacroiliac Screws ◽  
Ct Data ◽  
Navigation Template

Abstract Objective To analyse the anatomical conditions of transverse sacroiliac screws about the S1 and S2 segments in order to develop and validate a locked navigational template for transverse sacroiliac screw placement. Methods The CT data of 90 normal sacra were analysed. The long axis, short axis and lengths of transverse sacroiliac screw cancellous corridors were measured through 3D modelling. A patient-specific locked navigation template based on simulated screws was designed and 3D printed and then used to assist in transverse sacroiliac screw placement. The operative time, intraoperative blood loss, incision length, and radiation times were recorded. The Matta criteria and grading score were evaluated. The entry point deviation of the actual screw placement relative to the simulated screw placement was measured, and whether the whole screw was in the cancellous corridor was observed.Results S1 screws with a diameter of 7.3 mm could be inserted into 69 pelvises, and S2 screws could be inserted in all pelvises. The S1 cancellous corridor had a long axis of 25.44±3.32 mm in males and 22.91±2.46 mm in females, a short axis of 14.21±2.19 mm in males and 12.15±3.22 mm in females, a corridor length of 153.07±11.99 mm in males and 151.11±8.73 mm in females, and a proportional position of the optimal entry point in the long axis of the cancellous corridor of 35.96±10.31% in males and 33.28±7.2% in females. There were significant differences in the corridor long axis and corridor short axis between sexes (p<0.05), and there were no significant differences in corridor length and proportional position of the optimal entry point in the long axis of the cancellous corridor between sexes (p>0.05). The S2 cancellous corridor had a long axis of 17.58±2.36 mm in males and 16±2.64 mm in females, a short axis of 14.21±2.19 mm in males and 13.14±2.2 mm in females, a corridor length of 129.95±0.89 mm in males and 136.5±7.96 mm in females, and a proportional position of the optimal entry point in the long axis of the cancellous corridor of 46.77±9.02% in males and 42.25±11.95% in females. There were significant differences in the long axis, short axis and corridor length (p<0.05). There was no significant difference in the proportional position of the optimal entry point in the long axis of the cancellous corridor (p>0.05). A total of 20 transversal sacroiliac screws were successfully inserted into 10 patients with the assistance of locked navigation templates. Nineteen screws were grade 0, 1 screw was grade 1, and there were no postoperative complications of infection or nerve root injury. All screw entry point deviations were shorter than the short axis of the cancellous corridor, and all screws were located completely within the cancellous corridor.Conclusion Approximately 76% of males and females can accommodate screws with diameters of 7.3 mm in S1, and all persons can accommodate the same screw in S2. From the standard lateral perspective of the sacrum, the optimal entry point of the transverse screw is in the first 1/3 of the cancellous corridor for S1 and the centre of the cancellous corridor for S2. The patient-specific locked navigation template assisted in transverse sacroiliac screw placement with little trauma and fluoroscopy radiation and secure screw placement.

scholarly journals Bi-caudate ratio as a MRI marker of white matter atrophy in multiple sclerosis and ischemic leukocencephalopathy

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Dena Serag ◽  
Eman Ragab
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Surrogate Marker ◽  
Normal Subjects ◽  
Subjective Assessment ◽  
Linear Measurement ◽  
Control Group ◽  
Imaging Science ◽  
The Difference ◽  
Sensitivity Specificity

Abstract Background Brain atrophy measurement is now a cornerstone in basic neuro-imaging science. While assessment of white matter atrophy by visual inspection is subjective, volumetric approaches are time-consuming and not often feasible. Bi-caudate ratio represents a linear surrogate parameter of brain volume that can be derived from standard imaging sequences. This study highlights the value of the bi-caudate ratio (BCR) as a MRI marker of white matter atrophy in patients with multiple sclerosis and ischemic leukoencephalopathy and set a cut-off value to differentiate between patients with white matter atrophy and normal subjects. Results A total of 115 patients (54 males and 61 females) diagnosed with white matter leukoencephalopathy (MS in 51 patients and ischemic leukoencephalopathy in 64 patients) were included. Another group of 60 subjects with a normal white matter signal was recruited as a control group. BCR for the patient group ranged from 0.13 to 0.27 (mean (± SD) = 0.16 ± 0.02), while for the control group, it ranged from 0.05 mm to 0.13 (mean (± SD) = 0.09 ± 0.01). The difference between the two groups was statistically significant (P value < 0.001). A cut-off value of 0.13 was used to differentiate between the BCR in both patients and control groups with sensitivity, specificity, and accuracy of 99.2%, 100%, and 99%, respectively. The difference in BCR for patients diagnosed with MS and ischemic leukoencephalopathy was also statistically significant (P value < 0.001). Conclusion The bi-caudate ratio represents a linear measurement of subcortical atrophy that can be useful as a surrogate marker of global supra-tentorial white matter atrophy instead of the usually performed visual and therefore subjective assessment. It is an easily obtained measure that can be performed without complex time-consuming volumetric studies. Our findings also revealed that the BCR is higher in patients with ischemic leukoencephalopathy than in patients with MS.

Functional Outcomes of Nerve Root Sparing Posterior Corpectomy in Lumbar Vertebral Burst Fractures

2021 ◽  
pp. 219256822098412
Author(s):  
Abhinandan Reddy Mallepally ◽  
Nandan Marathe ◽  
Abhinav Kumar Shrivastava ◽  
Vikas Tandon ◽  
Harvinder Singh Chhabra
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Operating Time ◽  
Deformity Correction ◽  
Neurological Status ◽  
Height Loss ◽  
Vas Score ◽  
Post Surgery ◽  
Burst Fractures ◽  
The Difference

Study Design: Retrospective observational. Objectives: This study aimed to document the safety and efficacy of lumbar corpectomy with reconstruction of anterior column through posterior-only approach in complete burst fractures. Methods: In this retrospective study, we analyzed complete lumbar burst fractures treated with corpectomy through posterior only approach between 2014 and 2018. Clinical and intraoperative data including pre and post-operative neurology as per the ISNCSCI grade, VAS score, operative time, blood loss and radiological parameters, including pre and post-surgery kyphosis, height loss and canal compromise was assessed. Results: A total of 45 patients, with a mean age of 38.89 and a TLICS score 5 or more were analyzed. Preoperative VAS was 7-10. Mean operating time was 219.56 ± 30.15 minutes. Mean blood loss was 1280 ± 224.21 ml. 23 patients underwent short segment fixation and 22 underwent long segment fixation. There was no deterioration in post-operative neurological status in any patient. At follow-up, the VAS score was in the range of 1-3. The difference in preoperative kyphosis and immediate post-operative deformity correction, preoperative loss of height in vertebra and immediate post-operative correction in height were significant (p < 0.05). Conclusion: The posterior-only approach is safe, efficient, and provides rigid posterior stabilization, 360° neural decompression, and anterior reconstruction without the need for the anterior approach and its possible approach-related morbidity. We achieved good results with an all posterior approach in 45 patients of lumbar burst fracture (LBF) which is the largest series of this nature.

Effect of Acute Blood Loss on Glycosylated Hemoglobin Determinations in Normal Subjects

Diabetes Care ◽  
1983 ◽  
Vol 6 (3) ◽  
pp. 291-294 ◽  
Author(s):  
H. S. Starkman ◽  
M. Wacks ◽  
J. S. Soeldner ◽  
A. Kim
Keyword(s):  
Blood Loss ◽  
Glycosylated Hemoglobin ◽  
Normal Subjects ◽  
Acute Blood Loss

Somatosensory and Auditory Brain Stem Conduction after Head Injury: A Comparison with Clinical Features in Prediction of Outcome

Neurosurgery ◽  
1990 ◽  
Vol 26 (2) ◽  
pp. 278-285 ◽  
Author(s):  
Kenneth Lindsay ◽  
Aydin Pasaoglu ◽  
David Hirst ◽  
Gwen Allardyce ◽  
Ian Kennedy ◽  
...  
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Evoked Potential ◽  
Predictive Accuracy ◽  
Normal Subjects ◽  
Prediction Of Outcome ◽  
Prognostic Information ◽  
Additional Information ◽  
Auditory Brain Stem ◽  
The Difference

Abstract Evoked potential conduction times in brain stem auditory (BCT) and central somatosensory pathways (CCT) were recorded from 23 normal subjects and 101 patients with severe head injury. Abnormalities in the CCT and the BCT findings correlated with the clinical indices of brain damage (coma score, motor response, pupil response, and spontaneous and reflex eye movements) in the head-injured patients and each correlated with outcome at 6 months from the injury. The CCT in the “best” hemisphere produced the strongest correlation with outcome (P&lt;0.001). The correlation of the CCT with outcome was stronger in the 47 patients examined 2 to 3 days after the injury (P&lt;0.001) compared to the 34 patients examined within 24 hours after the injury (P&lt;0.02). No such difference was noted for the BCT. Serial studies within the first 2 weeks of injury did not show a consistent pattern and repetition of the investigation over this period did not provide any additional information. We used an INDEP-SELECT discriminant analysis program to determine whether information from the evoked potential data could improve prediction of outcome based on clinical data alone. With the addition of the CCT, the predictive accuracy (expressed as the correct classification probability) increased only slightly from 77 to 80%, and the difference was not significant. We conclude that central somatosensory and auditory brain stem conduction times provide useful prognostic information in paralyzed or sedated patients, but when neurological examination is feasible the benefits of evoked potential analysis do not justify the effort involved in data collection.

Sensation of dyspnea during hypercapnia, exercise, and voluntary hyperventilation

1990 ◽  
Vol 68 (5) ◽  
pp. 2100-2106 ◽  
Author(s):  
T. Chonan ◽  
M. B. Mulholland ◽  
J. Leitner ◽  
M. D. Altose ◽  
N. S. Cherniack
Keyword(s):  
Visual Analog Scale ◽  
Line Intensity ◽  
Time Course ◽  
Normal Subjects ◽  
Cycle Ergometer ◽  
Base Line ◽  
Analog Scale ◽  
Voluntary Hyperventilation ◽  
The Difference ◽  
End Tidal

To determine whether the intensity of dyspnea at a given level of respiratory motor output depends on the nature of the stimulus to ventilation, we compared the sensation of difficulty in breathing during progressive hypercapnia (HC) induced by rebreathing, during incremental exercise (E) on a cycle ergometer, and during isocapnic voluntary hyperventilation (IVH) in 16 normal subjects. The sensation of difficulty in breathing was rated at 30-s intervals by use of a visual analog scale. There were no differences in the level of ventilation or the base-line intensity of dyspnea before any of the interventions. The intensity of dyspnea grew linearly with increases in ventilation during HC [r = 0.98 +/- 0.02 (SD)], E (0.95 +/- 0.03), and IVH (0.95 +/- 0.06). The change in intensity of dyspnea produced by a given change in ventilation was significantly greater during HC [0.27 +/- 0.04 (SE)] than during E (0.12 +/- 0.02, P less than 0.01) and during HC (0.30 +/- 0.04) than during IVH (0.16 +/- 0.03, P less than 0.01). The difference in intensity of dyspnea between HC and E or HC and IVH increased as the difference in end-tidal PCO2 widened, even though the time course of the increase in ventilation was similar. No significant differences were measured in the intensity of dyspnea that occurred with changes in ventilation between E and IVH. These results indicate that under nearisocapnic conditions the sensation of dyspnea produced by a given level of ventilation seems not to depend on the method used to produce that level of ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals The Effectiveness of Endoscopic Surgery of Juvenile Angiofibroma Using Surgical Glue

2020 ◽  
Vol 8 (B) ◽  
pp. 150-154
Author(s):  
Seyed-Hadyi Samimi Ardesan ◽  
Mojtaba Mohammadi Ardehali ◽  
Najmeh Doustmohammadian
Keyword(s):  
Blood Loss ◽  
Endoscopic Surgery ◽  
Tumor Staging ◽  
Low Cost ◽  
Tumor Stage ◽  
Nasopharyngeal Angiofibroma ◽  
Group 3 ◽  
The Difference ◽  
Group 2 ◽  
Group 1

AIM: The current study aimed to provide a method for juvenile nasopharyngeal angiofibroma embolization using Glubran glue in patients with low stage tumor. This method not only has less blood loss and good visualization but also impose a low cost, where no pre-operative embolization complications were found for this procedure. METHODS: Between 2012 and 2014, 30 patients with angiofibroma undergoing endoscopic surgery. Age, sex, tumor stage, average blood loss, complications, length of hospitalization, and recurrence rate of the tumor were the main measured outcomes. Furthermore, 30 patients were divided into three groups with matched age, sex, and tumor staging. Group 1 received glue (Glubran), while Group 2 selected for study without glue and embolization and pre-operative embolization was considered for Group 3. RESULTS: Based on the amount bleeding, the mean blood hemorrhage in Groups 1, 2, and 3 was 510, 1655, and 800 ml, respectively, the difference of hemorrhage between Groups 1 and 2 was found to be statistically significant (p = 0.007). Blood loss in Group 1 was found to be less than Group 3, but the difference of hemorrhage between Group 1 and 3 was not statistically significant (p = 0.678). No blood transfusion and complication were recorded for individuals in Group 1. The recurrence was found in 1 patient (10%) in both groups of 2 and 3, and no patient (0%) in Group 1. CONCLUSIONS: The direct intraoperative embolization technique with glue was capable of providing a more complete and targeted embolization of the tumor. Some advantages can be mentioned for this technique, including decreased blood loss, less radiation exposure, lower rates of complications, and recurrence, as well as shorter hospitalization time, the ease of procedure with a spinal needle and low cost.

LONGITUDINAL EEG-CLINICAL CORRELATIONS IN CHILDREN FROM BIRTH TO 4 YEARS OF AGE

PEDIATRICS ◽  
1968 ◽  
Vol 41 (5) ◽  
pp. 945-954
Author(s):  
Fernando Torres ◽  
Michael E. Blaw
Keyword(s):  
Statistical Significance ◽  
Newborn Infants ◽  
Normal Subjects ◽  
First Year ◽  
Advanced Stages ◽  
The Difference ◽  
Focal Abnormality ◽  
First Year Of Life ◽  
Single Focus

One hundred-thirty children who had an EEG during their first days of life and who were registered in a clinical longitudinal study were followed with concurrent clinical and EEG examinations every 4 months for the first year of life and at 2, 3, and 4 years of age. Thirty children had EEG characteristics which are frequently considered abnormal in their neonatal record. Twenty-three children had clinical abnormalities during the 4-year period covered by the study. There was no significant correlation between a single EEG and clinical abnormalities at any age. Newborn infants with more than one focal abnormality in their EEG presented clinical abnormalities more frequently than those with a single focus. The difference, however, did not attain statistical significance. Children with an abnormal EEG at birth and an additional abnormal record later, had a higher incidence of clinical abnormalities than those with only an abnormal neonatal EEG. However, this finding is of questionable significance because the children who had clinical abnormalities had a larger number of EEG's than the normal subjects. It is expected that continued follow-up of these children at more advanced stages of their development may give a positive EEG-clinical correlation which was not found in this study.

scholarly journals Radiographic parameters and a novel fluoroscopic control view for posterior screw fixation of coracoid base fractures

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 9
Author(s):  
Hatem Galal Said ◽  
Tarek Nabil Fetih ◽  
Hosam Elsayed Abd-Elzaher ◽  
Simon Martin Lambert
Keyword(s):  
Sagittal Plane ◽  
Coracoid Process ◽  
Entry Point ◽  
Coronal Plane ◽  
Screw Placement ◽  
Posterior Fixation ◽  
Screw Insertion ◽  
Screw Length ◽  
Scapular Spine ◽  
The Mean

Introduction: Coracoid fractures have the potential to lead to inadequate shoulder function. Most coracoid base fractures occur with scapular fractures and the posterior approaches would be utilized for surgical treatment. We investigated the possibility of fixing the coracoid through the same approach without an additional anterior approach. Materials and methods: Multi-slice CT scans of 30 shoulders were examined and the following measurements were performed by an independent specialized radiologist: posterior coracoid screw entry point measured form infraglenoid tubercle, screw trajectory in coronal plane in relation to scapular spine and lateral scapular border, screw trajectory in sagittal plane in relation to glenoid face bisector line and screw length. We used the results from the CT study to guide postero-anterior coracoid screw insertion under fluoroscopic guidance on two fresh frozen cadaveric specimens to assess the reproducibility of accurate screw placement based on these parameters. We also developed a novel fluoroscopic projection, the anteroposterior (AP) coracoid view, to guide screw placement in the para-coronal plane. Results: The mean distance between entry point and the infraglenoid tubercle was 10.8 mm (range: 9.2–13.9, SD 1.36). The mean screw length was 52 mm (range: 46.7–58.5, SD 3.3). The mean sagittal inclination angle between was 44.7 degrees (range: 25–59, SD 5.8). The mean angle between screw line and lateral scapular border was 47.9 degrees (range: 34–58, SD 4.3). The mean angle between screw line and scapular spine was 86.2 degrees (range: 75–95, SD 4.9). It was easy to reproduce the screw trajectory in the para-coronal plane; however, multiple attempts were needed to reach the correct angle in the parasagittal plane, requiring several C-arm corrections. Conclusion: This study facilitates posterior fixation of coracoid process fractures and will inform the “virtual visualization” of coracoid process orientation.

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