scholarly journals The Tentorial Notch: Morphometric Analysis and its Clinical Relevance to Neurosurgery

2021 ◽  
Author(s):  
Ashima Das ◽  
Sudha Chhabra ◽  
Sibadatta Das ◽  
Pinki Rai ◽  
Nishtha Saini
Keyword(s):  
Clinical Relevance ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Axial Plane ◽  
Posterior Aspect ◽  
Maximum Width ◽  
Cross Sectional ◽  
Notch Width ◽  
Human Cadavers ◽  
Tentorial Notch

Introduction: The tentorial aperture is a complex space that varies considerably in size and shape. Although this space is defined by the free edges of the tentorium cerebelli, it has remained anatomically elusive. Modern neuroimaging methods routinely provide images of the tentorial notch but the literature so far available is remarkably devoid of extensive observations on the different types of tentorial notches. Dimensions of tentorial notch may determine the clinical sequelae and prognosis of many neurological conditions. Aim: To analyse the anatomical variations of tentorial notch, elucidating its clinical relevance in neurosurgery. Materials and Methods: A descriptive cross-sectional study was performed from August 2010-January2012. The midbrain was sectioned in an axial plane following the contour of the tentorial edge during medico-legal autopsies in 40 adult human cadavers, age ranging from 20 to 65 years. The parameters measured were: 1) Anterior Notch Width (ANW), the width of tentorial notch through the posterior aspect of the dorsum sellae; 2) Maximum Notch Width (MNW), the maximum width of the tentorial notch in axial plane; 3) Notch Length (NL), the distance between posterosuperior edge of the dorsum sellae in the mid-plane and the apex of notch; 4) Interpedunculoclival (IC) distance, the distance from the interpeduncular fossa to the posterosuperior edge of the dorsum sellae; 5) Apicotectal (AT) distance, the distance between the tectum of midbrain in the mid-plane and the apex of tentorial notch. The data obtained was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The quartile groups defined by MNW (mean 29.77±2.26 mm) were labeled as narrow, midrange and wide. Quartile groups defined by NL (mean 57.98±4.52 mm) were labeled as short, midrange and long. By combining these six groups into matrix formation, tentorial notches were classified into eight types. Applying quartile distribution technique to IC (mean 21.21±3.72 mm), brainstem positions within the tentorial notch were labeled as prefixed, midposition and postfixed. Conclusion: Variations in the dimensions of tentorial aperture may be implicated in the different clinical presentations related to transtentorial herniation, concussion and acceleration-deceleration injuries. The results of the present study provide a baseline data about tentorial notch which may facilitate neurosurgical decision making.

scholarly journals Should We Use Unilateral or Bilateral Tasks to Assess Maximal and Explosive Knee Extensor Strength in Patients with Knee Osteoarthritis? A Cross-Sectional Study

2021 ◽  
Vol 10 (19) ◽  
pp. 4353
Author(s):  
Jonas Pfeifle ◽  
David Hasler ◽  
Nicola Maffiuletti
Keyword(s):  
Knee Osteoarthritis ◽  
Clinical Relevance ◽  
Knee Extensor ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Strength Performance ◽  
Explosive Strength ◽  
Knee Extensor Strength ◽  
And Performance ◽  
Voluntary Contractions

Deficits in maximal and explosive knee extensor strength, which are usually assessed with unilateral tasks, are substantial in patients with knee osteoarthritis (KOA). The aim of this study was to investigate the clinical relevance of unilateral vs. bilateral tasks for assessing knee extensor strength in patients with KOA. This was achieved primarily by comparing unilateral and bilateral inter-limb strength asymmetries and secondarily by examining the relationship between unilaterally and bilaterally measured strength, and performance-based and self-reported function. Twenty-four patients with unilateral KOA (mean age: 65 ± 7 years) performed isometric gradual and explosive maximal voluntary contractions to assess, respectively their maximal and explosive strength. Performance-based and self-reported function were also evaluated with standard functional tests and questionnaires, respectively. Inter-limb asymmetries of maximal and explosive strength did not differ significantly between unilateral (mean asymmetry: 26 ± 15%) and bilateral tasks (22 ± 21%). In the same way, the relationships between knee extensor strength—measured either unilaterally or bilaterally—and performance-based or self-reported function were not influenced by the type of task. In conclusion, it does not seem to make a difference in terms of clinical relevance whether maximal and explosive knee extensor strength are evaluated with unilateral or bilateral tasks in KOA patients.

scholarly journals Clinical relevance of reporting fatty liver on ultrasound in asymptomatic patients during routine health checkups

2018 ◽  
Vol 46 (11) ◽  
pp. 4447-4454 ◽  
Author(s):  
Ajit Ramakant Mahale ◽  
Sonali Dattatray Prabhu ◽  
Muthiah Nachiappan ◽  
Merwyn Fernandes ◽  
Sonali Ullal
Keyword(s):  
Metabolic Syndrome ◽  
Early Detection ◽  
Fatty Liver ◽  
Clinical Relevance ◽  
Glycosylated Hemoglobin ◽  
Lipoprotein Metabolism ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Asymptomatic Patients

Objective Ultrasonography is an efficient technique for detecting fatty liver. Its sensitivity and specificity in detecting moderate to severe fatty liver are comparable to those of histology. Fatty liver is associated with abnormal lipid and lipoprotein metabolism and insulin resistance, metabolic syndrome, cardiovascular/renal disease, type 2 diabetes, and other conditions. This study was performed to compare the serum lipid profiles and serum glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), and glycosylated hemoglobin (HbA1c) levels in patients diagnosed with fatty liver on ultrasonography versus controls without fatty liver and evaluate the clinical relevance of an ultrasound diagnosis of fatty liver in routine health checkups. Methods This hospital-based cross-sectional study included 390 patients who underwent health checkups; 226 were diagnosed with fatty liver (cases) and 164 were not (controls). The lipid profile, serum GOT and GPT levels, and HbA1c level were compared between the cases and controls. Results The cases had considerably higher levels of lipids, liver enzymes (serum GOT and GPT), and HbA1c than controls. Conclusion Ultrasonography is a noninvasive simple tool for early detection of fatty liver in asymptomatic patients and can help clinicians achieve early detection of metabolic syndrome.

scholarly journals Clinical impacts of the Sudanese anatomical variations in a relation of the recurrent laryngeal nerve to the inferior thyroid artery

2020 ◽  
Vol 8 (2) ◽  
pp. 25
Author(s):  
Mohamed Elghazali Elhasan ◽  
Wael Mohialddin Doush
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Parathyroid Glands ◽  
Main Trunk ◽  
Cross Sectional ◽  
Relationship Of ◽  
The Relationship

Background: Until recently, the knowledge of the anatomical variations in the relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) combined with visual intraoperative RLN identification are essential for the protection of these life-important structures during surgical exposure and the mobilization of thyroid and parathyroid glands. This leads to the proper treatment of patients and improvement of the surgical techniques.Aim: To describe anatomical variations in the relationship of the recurrent laryngeal nerve to the inferior thyroid artery in the Sudanese population.Patients and methods: Following ethical committee approval, an observational descriptive prospective cross-sectional study in the period between March 2019 and February 2020, for anatomical variations in the relation of the recurrent laryngeal nerve to the inferior thyroid artery in seventy-two cervical sides of thirty-six well-dissected embalmed Sudanese cadavers. The RLN was investigated in three positions: posterior to the ITA main trunk, anterior to the ITA main trunk and between the ITA branches. Then, the results were analyzed according to the gender, age and dissection side.Results: We found that the anatomical variations were more frequent in males (97.2%) than females (2.8%). The age of these variations ranged between 31–45 years which represents (61.1%). On the right side of the neck, the commonest position of the RLN is posterior to the ITA (63.9%) followed by in decreasing order of frequency, the RLNs run between the ITA branches (30.6%) and anterior to the ITA (5.6%). On the left side of the neck, the commonest position of the RLN is posterior to the ITA (69.4%). It passed between the ITA branches in (30.6%) of specimens. There was no anterior location of the RLN to the ITA. Variations in a relationship of the RLN to the ITA on one side is significantly different from the opposite side.Conclusions: Although the risk of potential damage to the RLN during surgical neck procedures involving the thyroid gland and parathyroid glands is well recognized, pre-operative detailed surgeon’s knowledge for these frequent anatomical variations and the usage of the ITA as an anatomical landmark for intraoperative RLN recognition is important. This will lead to a reduction of iatrogenic RLN injury prevalence. Future studies are recommended to compare the findings on this cadaveric study with a larger sample size in the long-term period.  

scholarly journals Assessment of the Quality of Recommendations from 161 Clinical Practice Guidelines Using the Appraisal of Guidelines for Research and Evaluation – Recommendations Excellence (AGREE-REX) Instrument Shows There Is Room for Improvement

2020 ◽  
Author(s):  
Ivan D Florez ◽  
Melissa C Brouwers ◽  
Kate Kerkvliet ◽  
Karen Spithoff ◽  
Pablo Alonso-Coello ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Relevance ◽  
Cross Sectional Study ◽  
Average Score ◽  
Response Scale ◽  
Agree Ii ◽  
Cross Sectional

Abstract Background: A new tool, the AGREE-REX, was recently developed to support the development, reporting, and assessment of clinical practice guidelines’ (CPGs) recommendations, and to complement the AGREE II tool. We assessed the credibility and implementability of 161 CPGs recommendations using the AGREE-REX draft tool. Methods: Cross sectional study. CPGs were assessed by two independent appraisers using the AGREE-REX draft tool. The CPGs were rated with the tool’s 7-point response scale for each item. Differences between CPGs according to country, year and type of organization (government-supported/professional society) were evaluated. One-way ANOVA tests were used to examine differences in the score. Results: Recommendations from 161 CPGs from 70 organizations were appraised by 322 participants from 51 countries, using the AGREE-REX draft tool. The total overall average score of the recommendations was 4.23 (standard deviation(SD)=1.14). AGREE-REX items that scored the highest were (mean; SD): Evidence (5.51; SD=1.14), Clinical relevance (5.95; SD=0.8), and Patients/population relevance (4.87; SD=1.33), while the lowest scores were observed for the Policy values (3.44; SD=1.53), Local applicability (3,56; SD=1.47) and Resources, tools and capacity (3.49; SD=1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX tool (p=0.01) than their comparators.Conclusions: We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.Contribution to the literature· We applied the AGREE II and the recently developed tool (AGREE-REX draft version), to assess quality, credibility and implementability of 161 international clinical practice guidelines (CPGs). The AGREE REX draft tool was applied by 322 guidelines’ developers, users and researchers from 51 countries.· The scores of the AGREE REX draft tool items were higher in those items related to the quality of the evidence and the clinical relevance. The items related to patients and population relevance and implementation relevance scored in the mid-range, while the items related to patients/population or policy values, the alignment of values, the local applicability, and the resouces, tools and capacity items scored low.· CPGs produced by government-supported organizations scored higher on all the items of the AGREE-REX draft tool than those produced by professional societies or other types of groups, and CPGs produced in United Kingdom and Canada scored higher in selected items in comparison to United States and international CPGs· The correlations between the overall AGREE-REX draft tool and AGREE II domains were low, except for the Applicability domain where the correlation was modest.

scholarly journals Anatomical variations of the anterior communicating artery complex: a multidetector CT angiographic study

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Soe Ei Phyu ◽  
Zunariah Buyong ◽  
Radhiana Hassan ◽  
Jamalludin A. Rahman ◽  
Siti Kamariah Che Mohamed
Keyword(s):  
Multidetector Ct ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Common Trunk ◽  
Anterior Communicating Artery ◽  
Typical Pattern ◽  
Cross Sectional ◽  
High Prevalence ◽  
Different Populations ◽  
The Brain

Introduction: The anterior communicating artery (ACoA) complex of the cerebral circulation, an area with great anatomical diversity, forms part of the communicating arterial supply to the brain. As brain tissues are susceptible to ischemic death, knowledge of this variability is important in diagnosis and management of diseases affecting brain circulation. The aim of the study is to measure the prevalence and to describe these variations. Methods: All patients who underwent CT angiography (CTA) scanning in HTAA from January 2009 to August 2015 were selected. A cross-sectional study was done to study these variations in 81 reconstructed CTA images. Results: Eleven types of variations were described (typical pattern; hypoplasia, aplasia, and duplication of ACoA; hypoplasia, and aplasia of A1 segment of the anterior cerebral artery (ACA); hypoplasia, and aplasia of A2 segment of ACA; A2 segments of ACA arising from a common trunk; the third A2 segment; bihemispheric ACA). A1 segment is the part of ACA from the internal carotid artery to ACoA, and A2 segment is the part of ACA from ACoA to the junction between the rostrum and genu of the corpus callosum. The typical pattern was seen in 35.8%, and the cases with other variation types constituted 64.2%, which is higher compared to previous studies. The variations in ACoA alone were 43.2%, and the most common variation was the ACoA aplasia, accounting for 28.4%. Conclusions: This study shows the high prevalence of anatomical variations in the ACoA complex, and the probable difference of this figure in different populations.

scholarly journals Anatomical Variations of Frontal Sinuses Among The Male and Female Genders Living in Karachi

2019 ◽  
Vol 10 (1) ◽  
pp. 44-48
Author(s):  
Quratulain Javaid ◽  
Ambreen Usmani ◽  
Aisha Qamar
Keyword(s):  
Demographic Data ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Radiology Department ◽  
Research Subjects ◽  
Cross Sectional ◽  
Male And Female ◽  
Frontal Sinuses ◽  
The Right ◽  
Study Participants

Objective: To determine morphology and variation in dimensions of frontal air sinuses in male and female genders living in Karachi. Study Design and Setting: It was a cross sectional study and was conducted at Radiology Department, JPMC. Methodology: The total number of study participants were 216. The research subjects were divided into two equal groups of males and females each having 108 members. The mean age of the participants was calculated to be 35.14 ± 8.68 years. The study subjects were recruited from Radiology Department, JPMC, Karachi. After taking written informed consent, Water’s (occipito-mental) view radiography was done to measure the parameters of height, width and area of the frontal air sinuses. The included variables were the demographic data and the physical examination to exclude facial anomalies. All the measurements were recorded and the measurements were saved by the help of Radiant DICOM digital software. Results: The parameters of height, width and the area of frontal sinuses showed highly significant variability on both the right and the left sides. All the dimensions were highly significantly greater in the males as compared to the female study participants (p=0.000). The Independent-Samples T Test was applied to compare the two gender groups. Conclusion: The parameters of height, width and area of frontal sinuses were greater in the males as compared to the females on both the left and the right sides

scholarly journals Evaluation of occurrence of sesamoid bones in the lower extremity radiographs

2017 ◽  
Vol 7 (2) ◽  
pp. 11-14 ◽  
Author(s):  
Indu Ghimire ◽  
Surendra Maharjan ◽  
Ganesh Bahadur Pokharel ◽  
Kamal Subedi
Keyword(s):  
Knee Joint ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Sesamoid Bone ◽  
Posterior Aspect ◽  
Cross Sectional ◽  
First Metatarsal ◽  
Sesamoid Bones ◽  
Mean Size ◽  
The Mean

The purpose of this study was to examine the plain AP radiograph of foot and lateral radiograph of knee in order to determine the prevalence and size of sesamoid bone in different part of foot and on the posterior aspect of the knee joint. A cross-sectional study was performed in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to September 2014. A total of 206 radiographs of foot (55) and knee (155) were collected. 121 (58.7%) were female and 85 (41.3%) were male. The most common site of sesamoid bone in foot was in the first metatarsal joint (96.4%) whereas the sesamoid bone in knee joint, fabella was found in 12.3% of total cases. The prevalence is more common in female than in male. The length and breadth of the sesamoid bones were measured and then area of bones was calculated. The size of medial and lateral sesamoid bone in the first MTP Joint was measured 0.6225 cm2 and 0.8261 cm2 respectively. The mean size of sesamoid bone of knee, fabella was 0.2818 cm2.

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