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PubMedDate not supplied

Ultrasonography of the equine shoulder: technique and normal appearance.

This study was intended to document normal ultrasonographic appearance of the equine shoulder and anatomic landmarks useful in clinical imaging. Both forelimbs of five equine cadavers and both forelimbs of six live adult horses were used. To facilitate understanding of the images, a zoning system assigned to the biceps brachii and to the infraspinatus tendon was developed. Ultrasonography was performed with a real-time B-mode semiportable sector scanner using 7.5- and 5-MHz transducers. On one cadaver limb, magnetic resonance imaging (MRI) was performed using a system at 1.5 Tesla, T1-weighted spin-echo sequence. Ultrasonography images were compared to frozen specimens and MRI images to correlate the ultrasonographic findings to the gross anatomy of the shoulder. Ultrasonography allowed easy evaluation of the biceps brachii and the infraspinatus tendon and their bursae, the supraspinatus muscle and tendons, the superficial muscles of the shoulder, and the underlying humerus and scapula. Only the lateral and, partially, the caudal aspects of the humeral head could be visualized with ultrasound. Ultrasonographic appearance, orientation, and anatomic relationships of these structures are described. Ultrasonographic findings correlated well with MRI images and with gross anatomy in the cadavers' limbs.

Animals↗
PubMed2002

[Three-dimensional imaging and cephalometry of cranio-facial asymmetry].

The 75th meeting of the French Orthodontics Society will be held in Biarritz May 8-9-10-11 2002. The main topic for discussion will be: "facial asymmetry". During the meeting, authors will present study of facial asymmetries using a new innovative three-dimensional cephalometry. The method combines CT scans data, anatomical landmarks and mathematical tools to create, using the "Cepha" software, a 3D model of the human face. Balance and symmetry of the model are stable enough to define normality for each individual even with different ethnic and cultural origins. Unbalance and asymmetry characterize pathologies. Follow up shape and size of models allows growth prediction and modeling. The model is in the process of becoming the indispensable reference for all those who are interested in studying the human face: Orthodontics, Surgery, Anatomy, Anthropology, Plastic surgery, Forensic Medicine.

Cephalometry↗
PubMed2001

Localization of sentinel nodes in head and neck tumours by combined lymphoscintigraphy and bone scintigraphy.

Sentinel node scintigraphy in tumours of the head and neck region was combined with bone scintigraphy to provide anatomical landmarks in order to better locate the lymph node uptake. 99Tc(m)-nanocolloid (40 MBq) was injected in the peritumour region 1 h after the administration of bone-seeking 99Tc(m)-methylene diphosphonate (200 MBq). After 5 min, A-P and lateral projections of the head and neck region were acquired. In all the 26 patients examined, the surrounding anatomy was clearly depicted. In 23 patients, the lymphatic drainage was identified within 30 min. In these patients, all hot spots appearing outside the deposited activity could be located according to the neck region classification system of the Memorial Sloan-Kettering Hospital. No lymphatic drainage was visualized in the remaining three patients. The injection of bone-seeking activity 1 h before deposition of the radiocolloid provided images visualizing soft tissues as well as skeletal structures, thus improving the topical diagnosis. Correlation with the results of surgery was not performed. The administration of a small amount of bone-seeking activity prior to sentinel node scintigraphy of head and neck tumours improves the anatomical localization of the lymph node activity.

Adult↗
PubMed1999

Hindfoot coronal alignment: a modified radiographic method.

Accurate clinical evaluation of the alignment of the calcaneus relative to the tibia in the coronal plane is essential in the evaluation and treatment of hindfoot pathologic condition. Previously described radiographic views of the foot and ankle do not demonstrate the true coronal alignment of the calcaneus relative to the tibia. Some of these views impose on the patient an unnatural posture that itself changes hindfoot alignment, whereas other methods distort the coronal alignment by the angle of the x-ray beam. Our purpose was to develop a modified radiographic view and measurement method for determining an angular measurement of hindfoot coronal alignment based on a cadaver study of the radiographic characteristics of the calcaneus and motion analysis of standing subjects. The view was obtained by having the subject stand on a piece of cardboard to create a foot template. The template was then positioned so that each foot was x-rayed perpendicular to the cassette while still maintaining the natural base of support. A method using multiple ellipses was developed to determine more accurately the coronal axis of the posterior calcaneus. A study using cadavers was performed in which radio-opaque markers were placed on multiple bony landmarks on the calcaneus. The tibia was held fixed in a vertical position, and the foot was x-rayed using the above techniques in different degrees of rotation without changing the relation of the calcaneus to the tibia. The radiographs of the modified Cobey and our view were examined to verify which markers were visible at different angles of rotation and how the hindfoot alignment measurements changed with foot rotation. To define further the differences between the views, an analysis of postural stability was conducted while the subjects were standing with the feet in the positions for imaging both the Buck modification of the Cobey view and our hindfoot alignment view. The combined results of the cadaver, radiographic measurement, and postural stability segments of the study reveal that this coronal hindfoot alignment view and measurement method is reproducible, more closely measures "true" coronal hindfoot alignment, and is more clinically applicable because the alignment is measured while the patient is standing with a normal angle and base of stance. The modified radiographic measurement method relies on posterior calcaneal anatomic landmarks, is less affected by rotation of the foot and ankle, and is reproducible between observers.

Adult↗
PubMed1999

Defining the Role of FDG PET in Head and Neck Cancer.

The purpose of this article is to elucidate the role of 2-[18F] Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in evaluating patients with head and neck cancer. This will include background information on patient preparation and image acquisition. Normal patterns of uptake will be described in reference to computerized tomography (CT)/magnetic resonance imaging (MRI) to illustrate the relationship of physiology to the anatomic landmarks. Common clinical scenarios will be discussed, including staging, identifying recurrence, monitoring therapy, and secondary cancers.The fundamental basis of this imaging modality is the altered metabolism of tumor tissue, which includes an increase in glycolysis. FDG is a glucose analog, which is essentially trapped within tumor cells with increased glycolysis, and allows these malignant cells to be localized. Conventional methods, such as CT and MRI, are dependent on distortion of the normal anatomy in identifying the presence or absence of tumor. CT scanning for example is essentially dependent on nodal enlargement criteria for localizing lymph node metastasis and is less specific in identifying tumor in normal sized lymph nodes or in enlarged nodes not involved by tumor. Following surgery, radiation, and/or chemotherapy, the normal anatomy is distorted and these conventional methods become less specific in distinguishing recurrence from post treatment changes. FDG PET can provide more accurate information in identifying tumor before and after treatment. This improvement in specificity augments our current ability to stage the extent of disease at presentation and monitor response to therapy.(1) However, the anatomic resolution of these conventional methods are superior to FDG PET, and this advantage should be used to accurately localize both the normal and abnormal findings on FDG PET.

Journal Article↗
PubMed2007

A simple teaching tool for training the pelvic organ prolapse quantification system.

The pelvic organ prolapse quantification (POPQ) system is currently the most common and specific system describing different prolapse stages. Nevertheless, its use is not yet accepted worldwide in routine care. Our aim was to develop a simple teaching tool for the POPQ system capable of simulating different stages of uterovaginal prolapse for use in medical education with hands on training. We constructed a moveable and flexible tool with an inverted Santa Claus' cap, which simulated the vaginal cuff and the tassel at the end representing the cervix. A wooden embroidery frame fixed the cap and served as the hymen, the reference point for all measurements. Inside the cap, we sewed buttons to define the anatomic landmark points Aa and Ap located 3 cm distal from the frame. After explaining the device to the students, we used the three-by-three grid for recording the quantitative description of the pelvic organ support. First, each student had to demonstrate a specific prolapse with his cap device. Then, a prolapse was simulated on the cap, and the student had to take the relevant measurements and record them in the POPQ grid. The main training effect to understand the POPQ system seems to be the possibility for each trainee to simulate a three-dimensional prolapse with this flexible vagina model.

Disease Progression↗
PubMed2006

Usefulness of three-dimensional full-scale modeling of surgery for a giant cell tumor of the cervical spine.

STUDY DESIGN: Case report. OBJECTIVES: To report a case with giant cell tumor (GCT) of C6 vertebra, in which three-dimensional (3-D) full-scale modeling of the cervical spine was useful for preoperative planning and intraoperative navigation. SETTING: A university hospital in Japan. CASE REPORT: A 27-year-old man with a GCT involving the C6 vertebra presented with severe neck pain. The C6 vertebra was collapsed and the tumor had infiltrated around both vertebral arteries (VAs). A single-stage operation combining anterior and posterior surgical procedures was scheduled to resect the tumor and stabilize the spine. To evaluate the anatomic structures within the surgical fields, we produced a 3-D full-scale model from the computed tomography angiography data. The 3-D full-scale model clearly showed the relationships between the destroyed C6 vertebra and the deviations in the courses of both VAs. Using the model, we were able to identify the anatomic landmarks around the VAs during anterior surgery and to successfully resect the tumor. During the posterior surgery, we were able to determine accurate starting points for the pedicle screws. Anterior iliac bone graft from C5 to C7 and posterior fixation with a rod and screw system from C4 to T2 were performed without any complications. Postoperatively, the patient experienced relief of his neck pain. CONCLUSION: The 3-D full-scale model was useful for simultaneously evaluating the destruction of the vertebral bony structures and the deviations in the courses of the VAs during surgery for GCT involving the cervical spine.

Adult↗
PubMed1999

Cranionavigator combining a high-speed drill and a navigation system for skull base surgery--technical note.

Drilling of the skull base bone without damaging the important inside structures and with the correct orientation is very difficult even with the help of the anatomical landmarks. Monitoring of the location and direction of the drill tip and indications of the removed part of the bone during the drilling procedure enhances safety and achieves less invasive neurosurgery. We have developed a novel cranionavigator by combining a high-speed drill with a neurosurgical navigation system. To reduce the positional error to less than 1.5 mm, the position sensor (magnetic field sensor) must be attached 5 cm from the metallic fan portion of the drill and the sensor kept at least 10 cm away from the operating microscope. Simulation studies with the cranionavigator using two dried skulls and three cadaver heads were performed before clinical application. Clinically, this surgical instrument was used in four patients with the skull base tumor. The cranionavigator helped to safely drill the skull base bone in a shorter time by dynamic and real-time display of the precise operating site and extent of bone drilling on the preoperative computed tomography scans or magnetic resonance images. The cranionavigator is a very helpful instrument for skull base surgery in the hands of neurosurgeons with extensive expertise and anatomical knowledge.

Craniotomy↗
PubMed2005

Vertebral axial rotation measurement method.

This study presents a new method for measuring axial rotation of vertebra. Anatomical landmarks of the vertebral body were first recognized in X-ray film. By employing appropriate geometrical relationships, vertebral body shape parameters and a computer iteration method, the rotation angle of vertebra on the transverse plane can rapidly be obtained. A cadaver lumbar spine axial rotation-fixation device was designed to confirm the accuracy of the proposed methodology. Rotation angles on CT images were adopted as the golden standard and compared with analytical results based on X-ray films. Analytical results demonstrated that the proposed method obtained more accurate and reliable results than previous methods.

Algorithms↗
PubMed1999

Duplex ultrasound insertion of inferior vena cava filters in multitrauma patients.

BACKGROUND: Techniques for placement of inferior vena cava (IVC) filters have undergone continued evolution from open surgical exposure of the venous insertion site to percutaneous insertion in most cases today. However, the required transport either to an operating room or interventional suite can be complex and potentially hazardous for the multiply injured trauma patient who may require ventilator support, controlled intravenous infusions, or skeletal immobilization. Increased experience with color-flow duplex scanning for routine IVC imaging and portability of ultrasound equipment have suggested the usefulness of duplex-guided IVC filter insertion (DGFI) in critically ill trauma and intensive care unit (ICU) patients. METHODS: A total of 25 multitrauma/ICU patients were considered for DGIF. Screening color-flow duplex scans were performed on all patients, and obesity or bowel gas prevented ultrasound imaging in 2 cases, leaving 23 patients suitable for DGFI. In each case, the IVC was imaged in the transverse and longitudinal planes. The right renal artery was identified as it passed posterior to the IVC and was used as a landmark of the infrarenal segment of the IVC. All procedures were performed at the bedside in a monitored ICU setting using percutaneous placement of titanium Greenfield filters. Duplex scanning after insertion was used to document proper placement, and circumferential engagement of the filter struts in the IVC wall. An abdominal radiograph was also obtained in each case to confirm proper filter location. Duplex ultrasound imaging was repeated within 1 week of insertion to assess IVC and insertion site patency. RESULTS: DGFI was successful in all cases. The filter was deployed at a suprarenal level in one case, as was recognized at the time of postprocedural scanning. Three patients died as a result of their injuries but there were no pulmonary embolism deaths. Repeat duplex scanning was obtained in 17 patients, and revealed no case of IVC or insertion site thrombosis. CONCLUSIONS: Vena caval interruption can be safely performed under ultrasound guidance in a monitored, ICU environment. In selected multiply injured trauma patients, this will reduce the risk, complexity and cost of transport for these critically ill patients. DGFI also reduces procedural costs compared with an operating room or interventional suite, and eliminates intravenous contrast exposure. Preprocedural scanning is essential to identify patients suitable for DGFI, and careful attention must be paid to the known ultrasonographic anatomical landmarks.

Adult↗
PubMed1992

Rationalization of kinematic descriptors for three-dimensional hand and finger motion.

Modelling joint motion in three dimensions is often based on techniques taken from classical dynamics, each analysis resulting in a set of six parameters describing the relative motion between two body segments. The literature on joint kinematics has been difficult to compare due to use of different anatomical landmarks, axis nomenclature, and analytical methods. It is here shown that with care in sequence definition, the three alignment-based systems (Euler, Cardan, floating axis) give identical results for angular parameters. While the equivalent screw displacement axis system can be related simply to the other methods only if the functional axis of motion is aligned with a coordinate axis, the basic matrix for relating rigid body positions before and after a motion can always be reconstructed. Therefore the changes in alignment angles may be obtained from screw displacement parameters, permitting the results of different analyses to be compared. Translation parameters are most difficult to interpret in any system. Examples of the way in which simple planar motions are characterized by the various analytical methods are given.

Biomechanical Phenomena↗
PubMed1996

[Clinical experience in interscalene brachial plexus block combined with Ho's method of C3-4 block for shoulder and proximal upper extremity surgeries].

BACKGROUND: Brachial plexus block, first performed in 1889 by Halsted, has been widely used for surgery of shoulder and upper third of upper extremity. But the level of block is inadequate for surgery of the deeper tissue. If high volume of local anesthetic (40 ml) is used to block C3-4, complications like Horner's syndrome and phenic nerve palsy would be frequent. The landmark of C-3 and C-4 nerve root is difficult to identify. The purpose of this study was to design a new method to block easily the C-3 and C-4 nerve roots for surgery of shoulder deep tissue. METHODS: Sixty-five patients with ASA physical status I-III and age from 15 to 65 yr were studied. They included 42 male and 23 female patients who received interscalene brachial plexus block together with Ho's method of C-3, C-4 block in the space of 10 mon since 1985. The Ho's point which circumscribes the landmark for C3-4 block is a point at which the outer margin of the external jugular vein intersects the sternocleidomastoid muscle. In this technique we punctured the skin with a needle vertically at the chosen point until it touched the anterolateral side of the C-4 transverse process, normally, not deeper than 1.25 cm. This block was usually done for surgery of the shoulder and upper third of upper extremity. We used 0.5% bupivacaine 10 ml combined with 2% lidocaine 10 ml for interscalene brachial plexus block and 2% lidocaine 10 ml only for C3-4 block. RESULTS: Only 3 out of total 65 blocks failed. For these 3 cases we shifted the regimen from nerve block to general anesthesia. The successful rate was 95.4%. One case was initially planned for general anesthesia. However, difficult intubation was encountered due to masseter muscle spasm/rigidity during anesthetic induction. Three days later, this case was successfully anesthetized with this block. BP, EKG, and SaO2 did not differ preoperatively and intraoperatively. If the operation time is limited to 3 h, the result has always been satisfactory. CONCLUSIONS: Interscalene brachial plexus block combined with Ho's method of C3-4 block is technically safe and economical for patients receiving shoulder and proximal third of upper extremity surgery. We must make selection of patients carefully and exclude those whose anatomical landmarks are difficulty identified. As such, good result is expected.

Adolescent↗
PubMed1997

[Complications of endonasal surgery of the paranasal sinuses. Incidence and strategies for prevention].

BACKGROUND: Complications of endonasal surgery continue to occur despite improved optical instruments and surgical techniques. The clinical course of our patients was analysed to develop strategies for a safer surgical technique. PATIENTS: At the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, 1172 patients (2010 operated sides) were treated between 1986 and 1990 for chronic sinusitis by endonasal paranasal sinus surgery. RESULTS: The following intraoperative complications were observed: dural injury in 0.8% of the patients (0.5% of the operated sides), retrobulbar hematomas in 0.25% of the patients (0.15% of the operated sides), and hemorrhages requiring transfusion in 0.8% of the patients (0.5% of the operated sides). No injuries of the orbital muscles, the optic nerve, or the carotid artery were observed. Endonasal dacryocystorhinostomy was performed in 195 patients, 15% of whom had previously had paranasal sinus surgery. Endonasal frontal sinus surgery type II or III was performed in 40 patients between 1953 and 1993. A past surgical history-mostly extranasal frontal sinus surgery according to Ritter-Jansen and Lathrop-was found in 80% of these patients. Of 12 mucoceles of the frontal sinuses, 10 had developed after extranasal procedures whereas two developed spontaneously. CONCLUSION: This analysis shows that the occurrence of severe intraoperative complications can be minimized if certain guidelines are followed. When operating in an anterior-posterior direction, one should, to the extent possible, preserve the ethmoid bulla and the middle turbinate as anatomical landmarks as long as possible. The ethmoid bulla indicates the upper margin of the infundibulum even after removal of the uncinate process. There is no danger of injuring orbital structures if one identifies the maxillary ostium on a line going parallel to the floor of the main nasal cavity from the lowest point of the bulla in a posterior direction. The anterior wall of the bulla also forms the posterior wall of the frontal recess. As long as it is preserved it protects the base of the skull when identifying the frontal ostium. The endonasal enlargement of the frontal sinus ostium as a frontal sinus drainge type II or III is safe if the spina nasalis frontalis and the base of the frontal sinus are removed with a drill in an anterior direction. When opening the ethmoid sinus in an anteroposterior direction, an additional imaginary line through the ethmoid bulla running parallel to the floor of the nasal cavity and therefore also to the base of the skull should be observed and not crossed cranially. The medial blade of the middle turbinate represents an important guide to protect the rima olfactoria. It must therefore be preserved. Exposure of the sphenoid sinus should always be performed transnasally near to the septum and below the sphenoid ostium but never through the ethmoid to prevent damage of the optic nerve or the carotid artery. Observation of these guidelines and anatomical structures will prevent mistakes and wrong approaches in the context of endonasal surgery.

Chronic Disease↗
PubMed1995

Generic model for the localization of the cerebral cortex and preoperative multimodal integration in epilepsy surgery.

In cerebral cortex neurosurgery and particularly in epilepsy surgery, the recognition of individual cortical anatomic landmarks is necessary for presurgical evaluation and planning. To overcome the classical great variability in the superficial aspect of the human cerebral cortex, we have developed an original generic description of the cerebral cortex in a three-dimensional structure. The result is a generic model matching the cortical topography of each brain regardless of inter- and intra-individual variability. In this model, sulcal roots (fundi) are separated by more or less superficial annectent gyrus, and buried by operculization during the gyrification. This original generic model of the cerebral cortex enabled us to develop a mathematical methodology for the construction of a structural representation of the cortical topography from a T1-weighted three-dimensional MR image. This program can provide automatic detection and recognition of the main cortical sulci.

Algorithms↗
PubMed2005

Defining vascular supply and territory of thinned perforator flaps: part I. Anterolateral thigh perforator flap.

BACKGROUND: The anterolateral thigh perforator flap is increasingly being used for trauma and reconstructive surgical cases. With the thinned flap design, greater survivability and a decrease in donor-site morbidity are observed. To increase our knowledge of the vascular territories in these flaps, an anatomic study was performed to determine pedicle number, location, and diameter; accompanying veins; vascular territory; and where surgical incisions can be made safely during thinning, as opposed to the "danger zone." METHODS: Thirteen anterolateral thigh perforator flaps were harvested from seven adult cadavers. The largest perforator arteries were cannulated, and flaps were thinned to a thickness of 6 to 8 mm, with a 2.5-cm radius from the perforator retained. Vascular territories were quantified before and after thinning by nonradiographic and radiographic methods. A series of dyes were injected: red dye for skin (photography) followed by Omnipaque for the whole flap (radiography) before thinning, and blue dye for skin (photography) and lead oxide for the whole flap (radiography) after thinning. Pedicle locations were determined by ratios of anatomical landmarks. Danger zone measurements were derived at specific thicknesses using lateral radiographs of each flap. RESULTS: In anterolateral thigh perforator flaps, the mean perforator artery diameter at the fascia level was 1.00 +/- 0.08 mm (range, 0.84 to 1.11 mm) and the mean number of perforator arteries was 1.69 +/- 1.03 (+/-SD). Perforator pedicles were located near the midpoint of the line between the anterior superior iliac spine and the lateral aspect of the patella in the vertical axis. The mean vascular territories were 256 +/- 52.5 cm2 (photography) and 351 +/- 72.8 cm2 (radiography) in unthinned flaps and 211 +/- 65.7 cm2 (photography) and 289 +/- 106.6 cm2 (radiography) in thinned flaps. Differences in overall vascular territories after thinning were 83.3 percent (photography) and 81.8 percent (radiography) compared with unthinned flaps. Four respective vascular territory maps were drawn showing surgical territories using percentile confidence intervals (98th and 90th) and averages. From the skin at thicknesses of 4, 6, and 8 mm, the 98th percentile danger zones were 33 to 37 mm (proximal to distal), 30 to 35 mm, and 27 to 31 mm from the pedicle in the vertical axis, respectively; in the horizontal axis, they were 30 to 34 mm (medial to lateral), 28 to 31 mm, and 25 to 29 mm. CONCLUSIONS: These data define anterolateral thigh perforator flap pedicle location, number, and diameter before harvesting, surgical danger zones during thinning, and vascular territories after thinning. The authors' guidelines provide surgeons with anatomical vascular territory maps to design and harvest specific flaps for optimal results.

Aged↗
PubMedDate not supplied

Percutaneous electrode guidance: a noninvasive technique for prelocation of peripheral nerves to facilitate peripheral plexus or nerve block.

BACKGROUND AND OBJECTIVES: Typically, peripheral nerve block is done by approximating nerve location, usually by use of anatomical landmarks. Precise nerve location has been done by needle exploration. A new method, percutaneous electrode guidance (PEG) of the block needle, was performed. A transcutaneous stimulating cylindrical electrode was used to indent the skin, locate the underlying nerve, and guide a block needle near it. METHODS: PEG was used to prelocate the desired nerve or neural plexus by use of a shielded cylindrical electrode with a 1-mm-diameter conductive area of skin contact at the distal end, the center of which contained a 22-gauge (1/2 mm) hole, which precisely matched a shielded conventional block needle. Transcutaneous stimulation began at less than 10 mA and was decreased to minimal amperage that elicited the desired motor response. Electrode position was fixed, and electrode current was discontinued. A shielded 22-gauge block needle was advanced through the electrode guide to near the underlying nerve. Initial needle current was only 0.5 mA. Local anesthetic was injected to block the targeted nerve or nerves. Standard sensory/motor testing was performed at 20 minutes. RESULTS: Nine upper or lower extremity blocks were performed on 7 patients. All were successful. Minimal stimulating currents were 1.3 to 8.2 mA for transcutaneous electrode stimulation and 0.20 to 0.70 for needle stimulation. Needle depth was 0.4 to 1.1 cm beyond the electrode tip and correlated with minimal electrode stimulating current. CONCLUSIONS: A smooth, metal-tipped electrically shielded skin electrode probe can be used to comfortably and accurately indent the skin over a desired nerve or plexus, define its anatomical course, and subsequently guide a block needle near it.

Adult↗
PubMed2004

The sizes of internal jugular veins in Turkish children aged between 7 and 12 years.

OBJECTIVE: In this study, we aimed at searching for internal jugular vein (IJV) diameters in Turkish children in order to learn about anatomic details of IJV diameters and to supplement the diagnostic criteria in vascular pathologies such as phlebectasia. METHODS: A total of 92 children within the age range of 7-12 years were included in this study. In order to provide a consistent anatomical landmark in all subjects, all of the children were imaged by ultrasonography (USG) at the level of the cricoid cartilage. The measurements consisted the maximal antero-posterior (AP) and transverse (T) cross-sectional internal diameters of the internal jugular veins during both regular breathing and Valsalva maneuver. For the statistical purposes, the following analyses were performed: the relationship between the IJV diameters obtained at rest and those obtained during Valsalva maneuver, with the paired t-test; the relationship between the age groups and the IJV diameters, with the unpaired test. The significance was set at P < 0.05. RESULTS: During regular breathing, the mean transvers diameters of the right and left IJVs were 11.26 and 10.01 mm, respectively, while they were 16.28 and 13.61 mm during straining phase of the Valsalva maneuver. The mean antero-posterior diameters of the right and left IJVs before and during Valsalva maneuver were 7.64 and 6.8 mm versus 11.53 and 9.84 mm. The IJV diameters were larger on the right side than those on the left and also there were significant increases in the diameters by Valsalva maneuver. CONCLUSION: As a result, in this study performed among Turkish children aged between 7-12 years, it was shown that there was no correlation between the IJV diameters and the age groups (P > 0.05), while there was a significant increase in the IJV diameters on Valsalva maneuver (P < 0.05). We think that the results we obtained in this study may be useful and important for comparison in the patients with phlebectasia and also for the required knowledge of the anatomic details in medical interventions performed through IJV. However, since children aged between 0 and 6 years were not included in this study and the lack of relation found in our study may not be the same among 0-6 years, a further study is needed to show any interrelationship between former age group and size.

Child↗
PubMed2003

Clinical usefulness of fusion of 131I SPECT and CT images in patients with differentiated thyroid carcinoma.

UNLABELLED: Precise localization of the foci of (131)I uptake for management of patients with differentiated thyroid carcinoma can be difficult because of a lack of anatomic landmarks. The objective of the present study was to demonstrate the clinical usefulness of (131)I SPECT/CT fusion images in patients with differentiated thyroid carcinoma. METHODS: CT and SPECT were performed 7 d after administration of a therapeutic dose of (131)I to 17 patients with differentiated thyroid carcinoma. External markers were placed at 3 locations on the skin of the patient to adjust the sections of CT and SPECT in the same geometric plane. Fusion images were constructed by combining the digital CT and SPECT images on a computer workstation. The data from both planar and SPECT (131)I images and CT images were first separately assessed by 2 nuclear medicine physicians. (131)I SPECT/CT fusion images were then interpreted. Fusion images were considered to improve image interpretation in comparison with CT and scintigraphy separately when they provided better localization of sites of increased radiopharmaceutical uptake. RESULTS: Both CT and (131)I SPECT showed the pathologic sites in 5 of 17 patients (29%). Fusion images were considered to be of benefit in 15 of 17 patients (88%). In 4 patients, CT showed normal-sized lymph nodes, whereas (131)I SPECT showed abnormal findings. In 3 patients with bone metastasis, fusion images confirmed the precision of the localization of abnormal (131)I uptake. Five bone metastases and 1 muscle metastasis were occult and were not seen on the CT images. Finally, (131)I scintigraphy findings were abnormal for 2 patients for whom the CT findings were initially considered normal. Fusion images confirmed the precision of the localization of physiologic (131)I uptake. CONCLUSION: For registration of anatomic and functional images in fusion imaging, the method using external markers was simple and practical. (131)I SPECT/CT fusion images using this technique may improve anatomically limited interpretation of (131)I scintigraphy alone in patients with differentiated thyroid carcinoma.

Adenocarcinoma, Follicular↗