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The Anatomy of the Sigmoid-Transverse Junction According to the Tentorial Angle.

sex, 08/02/2019 - 09:25
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The Anatomy of the Sigmoid-Transverse Junction According to the Tentorial Angle.

J Craniofac Surg. 2019 Jul 31;:

Authors: Vatansever A, Mut M, Ergun KM, Oğuz KK, Gümeler E, Bulut E, Tatar I

Abstract
Dural sinuses have critical importance during intracranial approaches. Detailed anatomical knowledge of the dural sinuses is crucial for surgeons to reduce unexpected venous bleeding. The aim of this study was to investigate anatomical relation of sigmoid sinus and tentorium cerebelli according to clinically palpable landmarks and cranial morphometry. The authors evaluated 222 individuals' (94 women, 128 men) 3-dimensional computed tomography angiograms, retrospectively. The authors also studied on 12 mid-sagittal cut dried hemiskulls and 8 formalin fixed cadaver heads hemisected midsagitally. All measurements were completed using Osirix-Lite version 9 software. Craniometrical values were measured to define cranium morphology. Furthermore, level of the sigmoid sinus according to asterion and tentorial angle were evaluated in detail. Our results demonstrated that there were significant differences between parameters and genders, except vertical angle of the tentorium cerebelli. Distance between asterion and sigmoid sinus was statistically different between right and left sides in favor of the left side. This also varied depending on the position of the sigmoid sinus, as well. Only transverse angle between the upper point of external acoustic meatus and asterion demonstrated a significant correlation with age. This study evaluated the detailed 3D anatomy of sigmoid sinus and tentorium cerebelli related with the cranium morphology. Determining to sigmoid sinus anatomy according to clinically palpable landmarks has advantages for setting surgical protocols and reducing to unexpected injuries while surgery to these structures.

PMID: 31369515 [PubMed - as supplied by publisher]

Post-mortem computed tomography as part of dental identification - a proposed guideline.

qui, 08/01/2019 - 09:13
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Post-mortem computed tomography as part of dental identification - a proposed guideline.

Forensic Sci Med Pathol. 2019 Jul 30;:

Authors: Jensen ND, Arge S, Hansen NF, Lynnerup N

Abstract
PURPOSE: This paper presents a proposed guideline for the use of post-mortem computed tomography (PMCT) during forensic dental identification. Currently, whole-body PMCT is widely used prior to autopsies for the diagnosis of fractures, organ changes, hemorrhages, and for the localization of foreign bodies, but it may also facilitate the odontological identification process in single cases and in cases involving multiple fatalities. Several studies have described the use of PMCT in forensic odontological work, but we have not found any comprehensive set of guidelines on how to perform a forensic odontological examination using PMCT. The aim was to develop guidelines for creating post-mortem dental charts during forensic odontological identification examinations using the standard functions of PMCT.
METHODS: A proposed guideline was developed from 15 selected cases examined at the Section of Forensic Pathology, Department of Forensic Medicine at the University of Copenhagen in Denmark from October 2011 to May 2012. Using the functionalities and three-dimensional (3D) reconstructions of OsiriX DICOM-viewer software (Pixmeo Sarl, Bernex, Geneva, Switzerland) we adjusted the contrast and brightness settings and developed a proposed guideline for creating PMCT-based dental charts. A four-step guideline was produced.
CONCLUSION: In our casework, we are currently using the guidelines proposed herein. The use of PMCT has allowed us to target our clinical examinations, greatly improving their efficiency. Furthermore, PMCT allows the storage of data for later documentation and research. Further research is needed to validate the proposed guideline.

PMID: 31363909 [PubMed - as supplied by publisher]

Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging in African-American and White Patients and the Relationship of Lacrimal Gland Volume to Orbital Size.

sex, 07/26/2019 - 08:24
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Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging in African-American and White Patients and the Relationship of Lacrimal Gland Volume to Orbital Size.

J Craniofac Surg. 2019 Jul 22;:

Authors: Tenzel PA, Moffa D, Decilveo AP, Reddy HS

Abstract
PURPOSE: The aim of this study was to measure volumes of normal lacrimal glands (LGs) using magnetic resonance imaging in African-Americans (AAs) and whites and to evaluate relationships of LG volumes to demographic factors.
METHODS: A retrospective chart review was performed searching for "optic neuropathy" and "optic neuritis," cross-referencing patients who had orbital MRI with and without contrast. Cases were excluded with known history of orbital trauma or surgery, previous diagnoses known to affect LG size, and poor image quality. LGs were outlined in consecutive axial and coronal slices, and volumes were generated using OsiriX software; cross-sectional area of the orbit was measured by outlining the bony orbit in largest axial section.
RESULTS: One hundred orbits from 50 patients were included (26 AAs, 24 whites). Mean LG volumes as measured in coronal and axial section were 0.714 and 0.671 cm, respectively; mean orbital area was 10.42 cm. Axial orbital size was found to be highly correlated (P < 0.01) with LG volume. No significant correlation was found with LG volume and age, sex, race, or laterality.
CONCLUSIONS: This article presents normal values for LG volumes by MRI of AAs and whites. LG volumes were highly correlated with orbital size, a relationship which has not been explored in the recent literature. Such an assessment of LG size relative to patients' orbital dimensions may be more clinically useful than comparison to population-based measures of normal LG volume alone. We found no statistically significant relationship between LG volume and race, sex, age, or laterality.

PMID: 31343589 [PubMed - as supplied by publisher]

Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

dom, 07/14/2019 - 09:46

Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

J Craniofac Surg. 2019 Jul;30(5):e420-e424

Authors: Sirin Y, Yildirimturk S, Horasan S, Guven K

Abstract
The aim of the present study is to assess the reliability and accuracy of different 3-dimensional (3D) reconstruction algorithms in detecting undisplaced condylar, zygomatic arc, and orbital rim fractures based on cone-beam computed tomography data set. Twenty sheep heads were used in the present study. Sixty fractured and 60 nonfractured (control) zones were randomly allocated. Three groups consisting of nondisplaced fractures of condyle (CF, n = 20), orbital (OF, n = 20), and zygomatic arc (ZF, n = 20) were created by using a diamond cutting disc. Soft tissues were only dissected and no fractures were generated in the control group (n = 60). The 3D reconstructions were created by using multiplanar reconstruction (MPR), surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) algorithms. Final 3D models were examined in Osirix software (Pixmeo SARL, Bernex, Switzerland) by 6 observers. Diagnostic accuracies of each algorithm were statistically compared by receiver operating characteristics (ROC) and area under the ROC curves (AUCs). For the detection of CF, AUC for VR algorithm was found to be statistically larger than that of MIP while AUCs for VR and MIP were larger than those of MPR and SR for OF detection. For the detection of ZF, AUCs for MPR and VR were significantly larger than those of MIP and SR (P < 0.05 for each). Within the limitations of this experimental study, it can be concluded that for maxillofacial surgeons, it is more likely to detect condylar, orbital, and zygomatic fractures by using VR algorithm in 3D reconstruction.

PMID: 31299800 [PubMed - in process]

Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology?

dom, 07/07/2019 - 08:43
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Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology?

Neurourol Urodyn. 2019 Jul 06;:

Authors: Mukhtar BMB, Solomon E, Naaseri S, Aughwane P, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ

Abstract
AIMS: Functional obstruction secondary to a high-tone nonrelaxing sphincter (HTNRS) may lead to the formation of a proximal-to-mid-urethral diverticulum (pmUD) in patients without a history of anatomical obstruction, vaginal delivery, vaginal and/or urethral surgery, or periurethral gland infection, that is, a functional pmUD (fpmUD). We used measurements of the urethra-sphincter complex volume (USCv) as a proxy for the maximal urethral closure pressure to evaluate this potential etiological factor.
METHODS: We compared 17 consecutive women with fpmUD (mean age ± SD of 49.4 ± 13.2 years) with a control group consisting of 24 age-matched women (mean age: 50.8 ± 11.2 years) with no previous urological symptoms having MRI for posthysterectomy vesicovaginal fistula, and in all 71 women (mean age: 48.1 ± 11.6 years) with classical urethral diverticulum (cpmUD) referred in the same time period. The urethra-sphincter complex was measured using T2-weighted MRI and OsiriX© was then used to determine the USCv.
RESULTS: The mean USCv of the fpmUD group was 10.01 ± 6.97 cm3 . The mean USCv of the cpmUD was 5.19 ± 1.19 cm 3 and for the control group was 3.92 ± 1.60 cm 3 . There was a high statistically significant (P = .01) difference between the USCv in the fpmUD group and the USCv of both the cpmUD and the control groups.
CONCLUSIONS: Women with fpmUD demonstrated USCv that were significantly higher than those in women with cpmUD and the control group. These findings suggest that high pressure in the proximal urethra during voiding secondary to a HTNRS may contribute to the formation of urethral diverticula.

PMID: 31278796 [PubMed - as supplied by publisher]

Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable?

ter, 07/02/2019 - 07:51

Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable?

J Laparoendosc Adv Surg Tech A. 2019 Jun 28;:

Authors: van den Bos J, Schols RM, van Kuijk SMJ, Wieringa FP, Stassen LPS

Abstract
Aims: To investigate whether different calculation methods to express fluorescence intensity (FI) as target-to-background (BG) ratio are comparable and which method(s) match with human perception. Materials and Methods: Comparison of three calculation methods from current literature (OsiriX®, ImageJ®, and Photoshop®) to objectify FI during laparoscopic cholecystectomy measured at the exact same locations within recorded images of two categories: ex vivo and in vivo. Currently applied formulas to present FI in relation to the BG signal are compared with the subjective assessment by the human observers. These three formulas are Signal contrast = (FI in fluorescence regions-FI in BG)/255; Target-to-background ratio = (FI of target-FI of BG)/FI of BG; Signal-to-background ratio = FI of cystic duct/FI of liver and Target-to-background ratio = (FI of target-noise)/(FI of BG-noise). Results: In our evaluation OsiriX and ImageJ provided similar results, whereas OsiriX values were structurally slightly lower compared with ImageJ. Values obtained through Photoshop were less evidently related to those obtained with OsiriX and ImageJ. The formula Target-to-background ratio = (FI of target-noise)/(FI of BG-noise) was less corresponding with human perception compared with the other used formulas. Conclusions: FI results based on measurements using the programs OsiriX and ImageJ are similar, allowing for comparison of results between these programs. Results using Photoshop differ significantly, making direct comparison impossible. This is an important finding when interpreting study results. We propose to report both target and BG FI in articles, so that proper interpretation between articles can be made.

PMID: 31259650 [PubMed - as supplied by publisher]

Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging.

qui, 06/27/2019 - 10:02
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Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging.

Spinal Cord Ser Cases. 2019;5:20

Authors: Cummins DP, Connor JR, Heller KA, Hubert JS, Kates MJ, Wisniewski KR, Berliner JC, O'Dell DR, Elliott JM, Weber KA, Smith AC

Abstract
Study design: Retrospective study.
Objectives: To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI.
Setting: Academic university setting.
Methods: Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience.
Results: High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively.
Conclusions: Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.

PMID: 31240117 [PubMed - in process]

Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study.

sex, 05/31/2019 - 14:23
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Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study.

J Neurol Surg B Skull Base. 2019 Jun;80(3):295-305

Authors: Laleva L, Spiriev T, Dallan I, Prats-Galino A, Catapano G, Nakov V, de Notaris M

Abstract
Objective  The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods  Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results  The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion  The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.

PMID: 31143574 [PubMed]

S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection.

qui, 05/30/2019 - 08:09
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S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection.

Surg Endosc. 2019 May 28;:

Authors: Kim HJ, Choi GS, Park JS, Park SY, Cho SH, Seo AN, Yoon GS

Abstract
BACKGROUND: Lateral pelvic lymph node dissection (LPND) is a technically demanding procedure. Consequently, there is a possibility of incomplete dissection of lateral pelvic lymph nodes (LPNs). We aimed to identify metastatic LPNs intraoperatively in real-time under dual guidance of fluorescence imaging and 3D lymphovascular reconstruction, and then to remove them completely.
METHODS: Rectal cancer patients who were scheduled to undergo LPND after preoperative chemoradiotherapy (CRT) were prospectively enrolled. We traced changes in suspected metastatic LPNs during preoperative CRT and defined them as index LPNs on post-CRT imaging studies. For fluorescence imaging, indocyanine green (ICG) at a dose of 2.5 mg was injected transanally around the tumor before the operation. For 3D reconstruction images, each patient underwent preoperative axial CT scan with contrast (0.6 mm slice thickness). These images were then manipulated with OsiriX. Index LPNs and essential structures in the pelvic sidewall, such as the obturator nerve, were reconstructed with abdominal arteries from 3D volume rendering. All surgical procedures were performed via laparoscopic or robotic approach.
RESULTS: From March to July 2017, ten rectal cancer patients underwent total mesorectal excision with LPND after preoperative CRT under dual image guidance. Bilateral LPND was performed in five patients. All index LPNs among ICG-bearing lymph nodes were clearly identified intraoperatively by matching with their corresponding 3D images. Pathologic LPN metastasis was confirmed in four patients (40.0%) and in five of the 15 dissected pelvic sidewalls (33.0%). All metastatic LPNs were identified among index LPNs. Four (80.0%) of the five metastatic LPNs were located in the internal iliac area.
CONCLUSION: Index LPNs among ICG-bearing lymph nodes in pelvic sidewall were clearly identified and completely removed by matching with their corresponding 3D reconstruction images. Further studies and long-term oncologic outcomes are required to determine the real impact of dual image guidance in LPND.

PMID: 31139999 [PubMed - as supplied by publisher]

A Computed Tomographic (CT) and Pathological Study of Equine Cheek Teeth Infundibulae Extracted From Asymptomatic Horses. Part 1: Prevalence, Type and Location of Infundibular Lesions on CT Imaging.

ter, 05/21/2019 - 09:46
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A Computed Tomographic (CT) and Pathological Study of Equine Cheek Teeth Infundibulae Extracted From Asymptomatic Horses. Part 1: Prevalence, Type and Location of Infundibular Lesions on CT Imaging.

Front Vet Sci. 2019;6:124

Authors: Horbal A, Smith S, Dixon PM

Abstract
Background: Equine maxillary cheek teeth infundibulae are frequently affected by developmental and acquired disorders, but the computed tomographic (CT) imaging features of normal and abnormal infundibulae remain incompletely understood. Objective: To examine infundibulae with various grades of occlusal caries and control teeth by standard CT in order to assess the prevalence, type and location of subocclusal infundibular lesions present. Study design: Ex vivo original study. Methods: One hundred maxillary cheek teeth, including 82 with, and 18 without infundibular occlusal caries, were extracted from horses of different ages and imaged by standard CT; 8 teeth were also imaged by MicroCT. Images were later assessed by Osirix® and the prevalence, characteristics and sites of infundibular lesions were assessed. Results: Teeth with shorter infundibulae (i.e., Triadan 09 position and older teeth) were more likely to have occlusal caries, as were the rostral infundibulae. Subocclusal developmental infundibular lesions, including cemental hypoplasia and caries, were present in 72% of infundibulae without occlusal caries. CT imaging confirmed two main patterns of developmental cemental hypoplasia, i.e., apical cemental hypoplasia usually involving the full width of the apical aspect of the infundibulum and central linear hypoplasia involving the central aspect of the infundibulum over most of its length, and combinations of these types. These developmental lesions could later be affected by (acquired) infundibular caries once occlusally exposed due to normal wear. Some "normal-sized" (i.e., circa 1 mm diameter) occlusal central vascular channels expanded subocclusally to the dimensions of central linear defects. Main Limitations: No clinical histories or accurate ages were available for these teeth. Conclusions: Hypoplastic cemental lesions, including at central linear, and apical sites, are common even in clinically normal maxillary cheek teeth infundibulae and caries can occur when these lesions contact the occlusal surface. Central linear defects are not always clearly distinguishable from "normal" central vascular channels.

PMID: 31106213 [PubMed]

The Nasopharyngeal Airway: Estimation of the nares-to-mandible and nares-to-tragus distance in young children to assess current clinical practice.

qua, 05/08/2019 - 07:23

The Nasopharyngeal Airway: Estimation of the nares-to-mandible and nares-to-tragus distance in young children to assess current clinical practice.

Resuscitation. 2019 May 04;:

Authors: Johnson M, Miskovic A, Ray S, Chong K, Hickson M, Bingham B, Skellett S

Abstract
BACKGROUND: Nasopharygeal airways are used in urgent situations to alleviate airway obstruction. Guidelines for measuring the length of the NPA differ between national and international guidelines, and the evidence base for these measurements is lacking. The purpose of this study was to measure the nares-epiglottis and nares-vocal cord distances in young children (neonates to 12 years) on 3D reconstructed Magnetic Resonance Imaging (MRI) brain volume scans, and to examine the relationship of these distances with the nares-tragus and nares-mandible distances.
METHOD: One-hundred and seventy-six scans were reviewed. All patients had undergone MRI 3D brain volume imaging. The Anatomical landmarks were identified and the nares-tragus, nares-mandible distances measured and compared to nares-epiglottis and nares-vocal cord distance using Osirix.
RESULTS: The nares-epiglottis and nares-vocal cords distances significantly correlated (p-value <0.05). The nares-tragus distance showed strong correlation with the nares-epiglottis and nares-vocal cord distance compared to the nares-mandible distance (p-value<0.05).
CONCLUSION: In conclusion, the length of a nasopharyngeal airway in children under the age of twelve years can be predicted using the nares-tragus external anatomical distance minus 10 mm.

PMID: 31063843 [PubMed - as supplied by publisher]

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

seg, 05/06/2019 - 13:02

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

Clin Anat. 2019 May 06;:

Authors: Gregory LS, McGifford OJ, Jones LV

Abstract
INTRODUCTION: The adult vertebral level of the splanchnic branches of the abdominal aorta relies on a complex series of fusion and regression steps during embryological development, such that variation is common. Little is known however regarding the anatomy of the abdominal aorta in children. This study aimed to investigate the spatial relationship between the abdominal aorta and vertebral column during childhood development to inform clinical management of pediatric patients.
MATERIALS AND METHODS: Retrospective multi-slice computed tomography abdominopelvic angiograms of children aged neonate to 19 years (n=232), were used to examine vertebral levels of the celiac trunk (CoT), superior (SMA) and inferior mesenteric (IMA) arteries, and aortic bifurcation (AB) using multiplanar formatting views in OsiriXTM . The abdominal aorta length, AB angle, and displacement of the aorta from the midline were quantified with the effect of age and sex analyzed using multinomial logistic regression and general linear models.
RESULTS: The most frequent origins of CoT, SMA, IMA and AB were T12, L1, L3 and L4, respectively, with significant variation in vertebral level for each vessel. SMA level was significantly more proximal with age, and CoT and AB demonstrated marked sex differences in vertebral level. As the age of the child increased AB angle decreased, aortic displacement increased, and the length of the abdominal aorta increased at a slower velocity to the vertebral column (p<0.001).
CONCLUSIONS: Our study highlights the variation of the location and geometry of the abdominal aorta in children; this knowledge will positively impact pediatric surgical approaches and endovascular procedures. This article is protected by copyright. All rights reserved.

PMID: 31056783 [PubMed - as supplied by publisher]