A cephalometric morphometric study of age- and gender-dependent shape patterns of the sella turcica

The sella turcica is an important anatomic and radiologic entity. The shape of the sella turcica varies among normal individuals and can be influenced by local factors. The normal shape of sella turcica has been categorized as circular, oval, and flat, and several variants have been described. The sella turcica increases in size with age, but there is no agreement upon significance of gender-related differences. The main objective of this study is to build up a normative database of the shape of the sella turcica in the Jordanian population with reference to age and gender. For this purpose 509 computed cephalograms: 252 males and 257 females, aged 10 to 40 years old healthy Jordanians were collected and divided into adolescent and adult age groups in both genders. Viewbox 3 software was used to determine width and height, and shape of the sella turcica was accordingly assessed. Variants of shape were also documented. Our results showed that females exhibit higher percentage of overall normal shape but lower relative percentages of oval and flat shapes, as compared with males. In contrast to males, females also show decreasing trend of normal shape as age advances. Females and males change obviously in favor of oval shape. In terms of variants, as individuals advance in age, bridging and irregular dorsum clearly predominate. In terms of width and height, significant differences were evident between adult male group on one hand and adolescent female group and adult female group on the other hand. Between age categories and within male and female groups, sella linear dimensions were significantly different between adolescent and adult age groups. The significant increase of linear parameters of sella turcica across age groups indicates that there is significant degree of growth in sella turcica across the studied age groups. However, this growth does not affect the shape of sella turcica as the shape seems to be preserved across the studied age groups. The obtained data are discussed in terms of age- and gender-related growth and degenerative bone changes.This work has been supported by Grant No: 89/2015 by the Faculty of Research at Jordan University of Science and TechnologyScopu

A cephalometric morphometric study of age- and gender-dependent shape patterns of the sella turcica

The sella turcica is an important anatomic and radiologic entity. The shape of the sella turcica varies among normal individuals and can be influenced by local factors. The normal shape of sella turcica has been categorized as circular, oval, and flat, and several variants have been described. The sella turcica increases in size with age, but there is no agreement upon significance of gender-related differences. The main objective of this study is to build up a normative database of the shape of the sella turcica in the Jordanian population with reference to age and gender. For this purpose 509 computed cephalograms: 252 males and 257 females, aged 10 to 40 years old healthy Jordanians were collected and divided into adolescent and adult age groups in both genders. Viewbox 3 software was used to determine width and height, and shape of the sella turcica was accordingly assessed. Variants of shape were also documented. Our results showed that females exhibit higher percentage of overall normal shape but lower relative percentages of oval and flat shapes, as compared with males. In contrast to males, females also show decreasing trend of normal shape as age advances. Females and males change obviously in favor of oval shape. In terms of variants, as individuals advance in age, bridging and irregular dorsum clearly predominate. In terms of width and height, significant differences were evident between adult male group on one hand and adolescent female group and adult female group on the other hand. Between age categories and within male and female groups, sella linear dimensions were significantly different between adolescent and adult age groups. The significant increase of linear parameters of sella turcica across age groups indicates that there is significant degree of growth in sella turcica across the studied age groups. However, this growth does not affect the shape of sella turcica as the shape seems to be preserved across the studied age groups. The obtained data are discussed in terms of age- and gender-related growth and degenerative bone changes

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely