Posterior intercostal artery tortuosity and collateral branch points: a cadaveric study

Publications report observing tortuosity in the posterior intercostal arteries of elderly patients.  Studies also describe the size and course of the collateral intercostal arteries. This information is clinically significant when performing thoracentesis and video-assisted thorascopic surgery (VATS). To the best of our knowledge, no studies have examined arterial tortuosity or described collateral artery origins relative to boney landmarks. The purpose of this study was to define a safe surgical zone for thoracic access using palpable external boney landmarks. Three-hundred forty-eight intercostal spaces (3rd – 8th) of 29 male and female embalmed cadavers were dissected from the vertebral body to the mid-axillary line to observe the posterior intercostal artery and its collateral branch. The origins of the collateral intercostal arteries relative to the midline of thoracic spinous processes were measured. Mild to moderate tortuosity (arterial curves covering 25-50% of the intercostal space) was observed in at least one posterior intercostal artery in the majority of cadavers. The origins of the collateral intercostal arteries were variable relative to the midline. Additional collateral intercostal arteries distal to the primary collateral branch were observed, most commonly in the 5th intercostal space, which is used in VATS and thoracentesis. Tortuosity is common in the third through eighth posterior intercostal arteries, especially in individuals over the age of 60. Given the findings of this study, we recommend that any procedure involving placement of a surgical instrument into these intercostal spaces do so at least 120 mm lateral to the midline of the spinous processes. We also recommend pre-procedure ultrasound (intercostals scan) of the posterior and collateral intercostal arteries when performing non-emergent thoracentesis and video-assisted thorascopic surgery, particularly in patients over 60 years of age

Quantification of the distal radial artery for improved vascular access

Background: There is no consensus in the literature as to which point of the radial artery (RA) is the safest to attempt vascular access. The purpose of this study was to measure the diameter, tortuosity and branching patterns of the distal RA. Materials and methods: 140 cadaveric RAs (66 male, 74 female) were dissected and measured. The external diameter of the RA was measured at 2 cm increments starting at the radial styloid process (SP), moving proximally. The location and degree of 2-dimensional arterial tortuosity were recorded if > 35 degrees. Branches of the RA were recorded with respect to their distance from the SP. Results: We observed that the right RA significantly increased in diameter at distances beyond 4 cm proximal from the radial SP, regardless of the sex of the individual. This increase in size was not noted on the left RA’s. Muscular artery branches of the distal RA were noted on average 1.82 cm proximal from the SP. Clinically significant tortuosity was present on average 3.47 cm proximal from the radial SP. The left RA did not significantly change in size along its course, but its statistically similar diameter when compared to the right RA allows us to make a recommendation this is applicable bilaterally. Conclusions: Our data suggests that regardless of gender, vascular access of the RA could be safely performed at distances greater than 4 cm from the SP to yield a vessel with a larger diameter, less tortuosity, and fewer branches

Variability in the anterior extralaryngeal branch of the recurrent laryngeal nerve: clinical implications

Background: This study aimed to identify the anterior and posterior extralaryngeal branches (AELB, PELB) of the recurrent laryngeal nerve (RLN), measure these branches when present, and determine relationships between gender, sidedness and neck length. Materials and methods: Dissection was completed to level of the thyroid on 45 cadavers. The course of the RLN was then traced superiorly from its entry into the neck. Careful reflection of the thyroid and dissection of the lateral thyroid ligament permitted visualisation of the full course of the nerve. If extralaryngeal branching (ELB) was present, measurements were taken from the point of bifurcation of the RLN to the point of laryngeal entry through the cricothyroid membrane. Neck measurements, from the spinous process of C7 to the superior nuchal line, were taken. Gender of the specimen was noted. Data was analysed in SPSS. Results: Extralaryngeal branching was found in 77.78% of our sample, 77.14% on the left and 54.29% on the right. A significant difference was found between AELB length on the left and right, indicating that the left branch will be longer than the right when present. A significant difference in neck length between those with and without ELB was also found, indicating that people with longer necks more often display ELB. Neither neck length and AELB length, nor gender and AELB length were strongly correlated in this sample. Conclusions: Extralaryngeal branching can occur in all populations, but there are definite trends in its incidence and length. Surgeons should be aware of these trends before operating on patients

The spectrum of gastric cancer as seen in a large quaternary hospital in KwaZulu-Natal, South Africa

Background. Gastric cancer (GC) is the fifth most commonly diagnosed cancer in the world, with the third-highest associated mortality. It has a varying geographical, ethnic and socioeconomic distribution.Objective. To assess the presentation and management of GC in the Durban metropolitan area, South Africa.Methods. A retrospective review of 131 patients treated at the quaternary Inkosi Albert Luthuli Central Hospital in Durban from 2009 to 2014 was performed.Results. The 131 patients were predominantly black African (n=59, 45.0%) and Indian (n=63, 48.1%). Gender was evenly distributed, with 72 males (55.0%) and 59 females (45.0%). The average age of the patients was 60 years (standard deviation 13.3). More than 70% were in advanced stages of cancer and were treated conservatively. There was no significant relationship between body mass index (BMI) and the position of the tumour (p=0.175). Creatinine and albumin levels differed significantly between the genders (p<0.001 and p=0.01, respectively).Conclusions. GC appears to have a disproportionately high prevalence among Indians in Durban, and the prevalence of GC appears to be slightly higher among males. Both these observations may simply reflect referral patterns and warrant further investigation. More than 70% of patients presented with advanced-stage disease, and anaemia was common. No relationship was found between BMI and the location of the tumour, although most of the cancers were in the body and distal part of the stomach

A Retrospective Study at Two Level One Trauma Centers on the Association of Internal Injuries with Femoral Fractures

Abstract: Injuries capable of fracturing the femur often involve concurrent internal organ damage. However, up to 25% of injuries are initially missed. Prior studies evaluating the association of femur fractures with internal injury included only automobile trauma, were skewed toward more severe injuries, and were broad database studies. To our knowledge, there are no studies of this kind that include bicycle, motorcycle, and motor vehicle-pedestrian trauma, excluding those deceased at the scene, and which included chart reviews. We hypothesized that in the trauma setting, the presence of a femur fracture would correlate with an increase in concomitant internal organ injuries. Data was retrospectively queried from two Level I Trauma Centers. Patients presenting between January 1, 2005 and December 31, 2012 with trauma activation met inclusion criteria. Patients were stratified based on presence of a femur fracture, open/closed fracture status, and shaft versus non-shaft fractures. Internal organ injuries were documented. Logistic regression analysis was used to determine if the presence of a femur fracture, open fractures, or shaft fractures were predictive of internal injuries. Results were reported as odds ratios with 95% confidence intervals (CI). A p-value \u3c 0.05 was statistically significant. Femur fracture and open fracture were associated with additional internal injury. Shaft fractures were not associated with additional injury. Subjects ≤18 years with femur fracture were more likely to sustain additional injury compared to older age groups. The current study reveals that fractures of the femur in this setting may be associated with additional internal injuries. Open fractures may portend more severe organ injury compared to closed fractures. Femoral fracture in age ≥65 may not be as predictive for associated internal injuries. Development of a standardized grading system may aid in alerting the provider to the potential for these life-threatening injuries. Level of evidence: IV

Coral recruitment is impacted by the presence of a sponge community

© 2019 Peng Luo et al., published by De Gruyter, Berlin/Boston. C23H13NO4, monoclinic, P21/n (no. 14), a = 11.6537(6) Å, b = 5.1315(2) Å, c = 26.8047(13) Å, β = 96.266(3)°, V = 1593.4(13) Å3, Z = 4, Rgt(F) = 0.0531, wRref(F2) = 0.1432, T = 90.0(5) K

Fighting Ebola with novel spore decontamination technologies for the military

AbstractRecently, global public health organizations such as Doctors without Borders (MSF), the World Health Organization (WHO), Public Health Canada, National Institutes of Health (NIH), and the U.S. government developed and deployed Field Decontamination Kits (FDKs), a novel, lightweight, compact, reusable decontamination technology to sterilize Ebola-contaminated medical devices at remote clinical sites lacking infra-structure in crisis-stricken regions of West Africa (medical waste materials are placed in bags and burned). The basis for effectuating sterilization with FDKs is chlorine dioxide (ClO2) produced from a patented invention developed by researchers at the US Army – Natick Soldier RD&E Center (NSRDEC) and commercialized as a dry mixed-chemical for bacterial spore decontamination. In fact, the NSRDEC research scientists developed an ensemble of ClO2 technologies designed for different applications in decontaminating fresh produce; food contact and handling surfaces; personal protective equipment; textiles used in clothing, uniforms, tents, and shelters; graywater recycling; airplanes; surgical instruments; and hard surfaces in latrines, laundries, and deployable medical facilities. These examples demonstrate the far-reaching impact, adaptability, and versatility of these innovative technologies. We present herein the unique attributes of NSRDEC’s novel decontamination technologies and a Case Study of the development of FDKs that were deployed in West Africa by international public health organizations to sterilize Ebola-contaminated medical equipment. FDKs use bacterial spores as indicators of sterility. We review the properties and structures of spores and the mechanisms of bacterial spore inactivation by ClO2. We also review mechanisms of bacterial spore inactivation by novel, emerging, and established nonthermal technologies for food preservation, such as high pressure processing, irradiation, cold plasma, and chemical sanitizers, using an array of

Inventory extension at the Nuclear Materials Storage Facility

The planned renovation of the Nuclear Material Storage Facility (NMSF) at Los Alamos National Laboratory will be a significant addition to the plutonium storage capacity of the nuclear weapons complex. However, the utility of the facility may be impaired by an overly conservative approach to performing inventories of material in storage. This report examines options for taking advantage of provisions in Department of Energy orders to extend the time between inventories. These extensions are based on a combination of modern surveillance technology, facility design features, and revised operational procedures. The report also addresses the possibility that NMSF could be the site of some form of international inspection as part of the US arms control and nonproliferation policy

Universal criterion for the breakup of invariant tori in dissipative systems

The transition from quasiperiodicity to chaos is studied in a two-dimensional dissipative map with the inverse golden mean rotation number. On the basis of a decimation scheme, it is argued that the (minimal) slope of the critical iterated circle map is proportional to the effective Jacobian determinant. Approaching the zero-Jacobian-determinant limit, the factor of proportion becomes a universal constant. Numerical investigation on the dissipative standard map suggests that this universal number could become observable in experiments. The decimation technique introduced in this paper is readily applicable also to the discrete quasiperiodic Schrodinger equation.Comment: 13 page