Respiration parameter determination with non-obstructive methods

Measuring respiratory parameters like the breathing frequency or the tidal volume is essential in intensive care to ensure an optimal and lung protecting ventilation. A common practice in artificial ventilation of sensitive patients like infants or neonates is the use of uncuffed endotracheal tubes in combination with continuous positive airway pressure (CPAP). This comes with the disadvantage of an unknown leakage making it difficult to detect spontaneous breathing or to measure the tidal volume reliable. A novel non-obstructive method to determine respiratory parameters as well as dynamic changes of thoracic parameters has recently been presented and uses a pair of coupled UHF (ultra high frequency) antennae. In this paper, a respective setup is investigated numerically using finite difference time domain method and experimentally using an artificial lung phantom. Both approaches show that the investigated method seems capable of allowing a contactless triggering to synchronize natural and artificial breathing. The results are compared to derive a better understanding of influencing factors and opportunities for an optimisation

The Dens: A Review of its Diverse Nomenclature and a Recommended Simplified Terminology.

Pathology of the dens, such as fractures, demands precise terminology so that communication between physicians are succinct, diagnoses are accurate, and treatment strategies exact. This review aims to summarize the various terms used to describe the parts of the dens and recommend the ideal terminology. Using standard search engines, English language publications were searched for the many terms used to describe parts of the dens. A multitude of terms was identified with many demonstrating overlaps. Terms identified included apex, tip, apicodental, subdental, dentocentral and odontocentral junctions, peg, waist, base, neck, shaft, shoulder, and stem. Exact terminology is necessary when diagnosing or treating patients with pathology of or near the dens. The authors suggest simplified terminology for describing the parts of the dens that can be used in the future in order to be unequivocal and to avoid confusion when classifying and communicating fractures through its parts

A Previously Unreported Arterial Variant of the Suboccipital Region Based on Cadaveric Dissection.

Introduction Several arterial variants have been reported to occur around the posterior arch of the atlas. Understanding the various anomalies and diagnosing them preoperatively can dramatically reduce the risk of surgical insult during neurosurgical procedures. Herein we report a case of an arterial variant found just below the posterior arch of C1. Case Report During the routine dissection of the suboccipital region via a posterior approach, an unusual bulge was identified just inferior to the inferior capitis oblique muscle. With further dissection, the structure was identified as a tortuous internal carotid artery. Conclusion Arterial variants around the posterior arch of C1 are surgically significant and can result in catastrophic injuries if unappreciated. Most of these variants will be related to the vertebral artery. To our knowledge, an arterial variant of the internal carotid artery in this location, as reported herein, has not been previously reported

Internal Hernia of the Greater Omentum: Cadaveric Findings of a Previously Unreported Variant.

Transomental hernias (TOHs) are a rare finding, constituting a fraction of all intestinal hernias. Here, we report the cadaveric discovery of a spontaneous TOH involving the sigmoid colon in an 82-year-old female and discuss the relevant literature. To our knowledge, a TOH involving the sigmoid colon has not been previously reported

Relationship of the Median and Radial Nerves at the Elbow: Application to Avoiding Injury During Venipuncture or Other Invasive Procedures of the Cubital Fossa.

INTRODUCTION: The median and radial nerves are two important neural structures found in the cubital fossa. The trajectory and landmarks used to identify their location are important when procedures are done in this area. METHODS AND MATERIALS: Ten fresh-frozen cadavers were dissected (20 upper limbs) and measurements were taken from the medial epicondyle to the median and radial nerves as well as to the lateral epicondyle of each limb. RESULTS: The distance between the medial epicondyle and the median nerve was found to be three centimeters with a range of 2.1 to four centimeters and the distance from the medial epicondyle to the radial nerve had a mean distance of 5.5 cm and a range of 3.8 to seven centimeters. DISCUSSION: Damage to the median or radial nerves can lead to major complications including loss of extension, flexion, and sensation in the forearm and hand. Other studies have tried to identify the course of these nerves in order to prevent their injury during procedures. CONCLUSION: After identifying the medial epicondyle, using the results we obtained, physicians may have a better understanding of where the median and radial nerves lie within the cubital fossa when performing procedures in this area

Trends in Spinal Surgery for Pott\u27s Disease (2000-2016): An Overview and Bibliometric Study.

Study Design: Systematic review. Objectives: (1) What are the surgical indications? Have they changed over time since the year 2000? (2) What is the current surgical approaches of choice? Have they changed over time since the year 2000? Do they vary by geographical region? (3) What are the most common outcome measures following surgery? Methods: Electronic databases and reference lists of key articles were searched from database inception from January 1, 2000 to December 31, 2016 to identify studies specifically evaluating surgical indications, current surgical approaches, and outcome measures for spinal tuberculosis. Results: Six randomized controlled trials were identified from our search (1 excluded: no surgical arm identified after review) Neurological deficit, instability and deformity were common indications identified. Surgical approach included predominantly anterior for cervical spine and posterior for thoracic and lumbar spine. Combined approach was preferred in pediatric cases. Degree of deformity correction, neurological outcomes, and fusion formed the main bases of assessing surgical outcomes. Conclusions: Majority of the current literature is from South Asia. The presence of neurological compromise, deformity, and instability were the primary criteria for surgical intervention. The preferred approach varied with the anatomical region of the spine in adults. Outcome measures predominantly involved deformity correction, neurological deficit, and fusion

Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine.

Study Design: Anatomical cadaver study. Objectives: Postoperative dysphagia is a significant complication following anterior approaches to the cervical spine and the etiology of this complication is poorly understood. Herein, we studied the esophageal branches of the recurrent laryngeal nerves to improve understanding of their anatomy and potential involvement in dysphagia. Methods: Ten fresh frozen cadaveric human specimens were dissected (20 sides). All specimens were adults with no evidence of prior surgery of the anterior neck. The recurrent laryngeal nerves were identified under a surgical microscope and observations and measurements of their esophageal branches made. Results: For each recurrent laryngeal nerve, 5-7 (mean 6.2) esophageal branches were identified. These branches ranged from 0.8 to 2.1 cm (mean 1.5 cm) in length and 0.5 to 2 mm (mean 1 mm) in diameter. They arose from the recurrent laryngeal nerves between vertebral levels T1 and C6. They all traveled to the anterior aspect of the esophagus. No statistical differences were seen between left and right sides or between sexes. Conclusion: The esophageal branches of the recurrent laryngeal nerve have been poorly described and could contribute to complications such as swallowing dysfunction following anterior cervical discectomy and fusion procedures. Therefore, a better understanding of their anatomy is important for spine surgeons. Our study revealed that these branches are always present on both sides and the anterior surface of the esophagus should be avoided while retracting it in order to minimize the risk of postoperative dysphagia

Undetected Small Accessory Mental Foramina Using Cone-Beam Computed Tomography.

INTRODUCTION: The accessory foramina could not be identified on some imaging modalities such as surface-rendered images. The purpose of this study was to investigate the ability of surface-rendered images in detecting these foramina. MATERIALS AND METHODS: We analyzed 20 accessory mental foramina (AMF) in nine mandibles removed from cadavers with cone-beam computed tomography (CBCT) and assessed in surface-rendered images. All AMF were divided into three groups depending on their visibility. RESULTS: Group 1 included AMF that were clearly visible as foramina, Group 2 were not clearly visible but could be recognized with concave parts, and Group 3 were not visible and the smooth surface of the bone was observed. Group 1 ranged from 1.3 to 5.1 mm CONCLUSIONS: The clinician should be aware that smaller foramina might not be detected on these images

Iatrogenic Bowel Injury Following Minimally Invasive Lateral Approach to the Lumbar Spine: A Retrospective Analysis of 3 Cases.

Study Design: Retrospective cohort study. Objective: Anterior approaches are often used during lumbar interbody fusion procedures. Visceral injuries (bowel injuries) are rare but represent a primary risk during anterior approaches to the lumbar spine. Left untreated, these injuries can result in significant complications. The aim of this study was to investigate the presentation and management of bowel injury cases following anterior approaches to the lumbar spine to raise the surgeon\u27s awareness of this rare complication. Methods: All direct anterior, oblique anterior, and transpsoas lumbar interbody fusion surgeries performed at our institution between 2012 and 2016 were analyzed retrospectively. Charts were screened for cases requiring return to the operating room owing to a suspected bowel injury and details of the case were extracted for illustrative purposes. Results: A total of 775 anterior lumbar surgeries were conducted at a single tertiary care institution between July 2012 and June 2017. A total of 590 transpsoas lumbar interbody fusion (TPIF) surgeries were performed. Four patients, each having undergone TPIF, were suspected of bowel injury and underwent an exploratory laparotomy. At surgery, 3 patients were confirmed to have a bowel injury, giving a procedure-specific incidence of 0.51% and overall incidence of 0.39%. Among the 3 confirmed bowel injury cases, average delay between surgery and visceral injury diagnosis was 4.7 days (range 3-7 days). Conclusions: We noted abdominal pain, distention, and fever as the most common findings in the setting of a visceral injury. A high index of suspicion and computed tomography imaging remain critical for identifying postoperative bowel injuries