Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

Background We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. Methods A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients’ radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden’s index corresponded to an optimal cut-off value. Results Ten variables exhibited significant statistical differences between two groups (P < 0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). Conclusions Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

Neuropathy, Claw Toes, Intrinsic Muscle Volume, and Plantar Aponeurosis Thickness in Diabetic Feet

Background: The objective of this study was to explore the relationship between claw toe deformity, peripheral neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness using computed tomography (CT) images of diabetic feet. Methods: Forty randomly-selected subjects with type 2 diabetes were selected for each of the following four groups (n = 10 per group): 1) peripheral neuropathy with claw toes, 2) peripheral neuropathy without claw toes, 3) non-neuropathic with claw toes, and 4) non-neuropathic without claw toes. The intrinsic muscles of the foot were segmented from processed CT images. Plantar aponeurosis thickness was measured in the reformatted sagittal plane at 20% of the distance from the most inferior point of calcaneus to the most inferior point of the second metatarsal. Five measurement sites in the medial-lateral direction were utilized to fully characterize the plantar aponeurosis thickness. A linear mixed effects analysis on the effect of peripheral neuropathy and claw toe deformity on plantar aponeurosis thickness and intrinsic muscle volume was performed. Results: Presence of claw toe deformity ( p = 0.008) and presence of neuropathy ( p = 0.039) were both associated with decreased intrinsic muscle volume. Subjects with both neuropathy and claw toe deformity had significantly thicker plantar aponeurosis tissue compared with the other three permutation subgroups ( p < 0.001). A negative correlation was observed between plantar aponeurosis thickness and intrinsic muscle volume ( R 2 = -0.3233, p < 0.001). Conclusions: In subjects with claw toe deformity, there were strong relationships between smaller intrinsic foot muscle volumes and thicker plantar aponeurosis tissue. Intrinsic muscle atrophy and plantar aponeurosis thickening may be related to the development of claw toes.

MORFOMETRIA DO RAMO MANDIBULAR EM DIFERENTES TIPOS CRANIOMÉTRICOS

INTRODUCTION: The jaw is one of the facial bone most susceptible to fracture and deformities that must be treated with surgical procedures. On the sagittal split osteotomy of mandibular ramus technique (SSOMR) the horizontal cut is done on ramus medial aspect immediately above the lingula. OBJECTIVE: The aim of this study was to verify the possible correlation of the height and width of the ramus with the gender and cephalic index. MATERIALS AND METHODS: 48 adult, dentate, human mandibles were used, being dolicho- (16), meso- (16) and brachycephalic (16) specimens. The anatomic references on the ramus were: the most inferior point of the mandibular notch (I), the highest point of the inferior board (B), the most posterior point of the anterior margin, (P) the most anterior point of the posterior margin. RESULTS: The mean of the height and width of the mandibular ramus showed no difference compared with the cephalic index (dolicho – 47,05/ 32,09mm; meso – 47,27/ 32,57mm; brachicephalic – 46,41/ 29,58mm). Assessing the dimensions in light of the individuals gender showed that there was a height difference of the ramus in male individuals (49,08mm) that was higher than in female individuals (42,76mm). CONCLUSIONS: We believe our results should be used as reference in mandibular ramus surgical procedures, forensic investigations and morphometric comparisons with results of further studies in individuals from other nations.

A New Concept of Indexing Tibiofibular Torsion

A newly developed clinical method of indexing tibial torsion uses the medial surface of the tibia as the proximal reference; however, the selection of a specific landmark on the medial surface has not been justified. Three different surfaces relating to the tibial tuberosity were tested using 24 dry tibial bones to determine which provides the most accurate and reliable landmark for use as the proximal reference. The medial surface of the tibia at the inferior point of the tibial tuberosity was the most reliable proximal reference that yielded the highest level of association between the newly developed clinical method and true tibial torsion (r = 0.77). The new method has the potential to describe the anatomy of the leg and to improve the clinical measurement of tibiofibular torsion. (J Am Podiatr Med Assoc 95(5): 481–485, 2005)