Interventional cardiologists have traditionally relied upon fluoroscopic imaging for percutaneous coronary interventions. Transcatheter structural heart interventions, however, require additional imaging modalities such as echocardiography and multislice computed tomography (MSCT) for pre-, intra- and post-procedural assistance. During transcatheter structural heart interventions, interventional cardiologists and non-invasive cardiovascular imagers may use different terminologies to describe a certain structure, thus causing misunderstandings within the team. Herein, we present a modality- independent terminology for understanding volumetric images in the context of transcatheter heart valve therapies. The goal of this system is to allow physicians to readily interpret the orientation of fluoroscopic, MSCT, echocardiographic and MRI images, thus generalising their understanding of cardiac anatomy to all imaging modalities.
ObjectivesTo evaluate the reproducibility of Heidelberg retina tomograph (HRT) macular edema module(MEM) measuring the macular retinal thickness.MethodsSixty-two healthy volunteers (9-68 years old) were examined by HRT-II procedure. The retinal signal width (SW) at macula and fovea and macular edema index (E) were recorded for t-test, Pearson linear-correlation analysis. Intra-subject variation repeatedly measured was analyzed with coefficient of variation, 95% tolerance limits of change (TC), and intraclass coefficient of correlation (ICC).
ResultsIn healthy individuals, retinal SW was (0.734±0.236) mm at macula，and (0.781±0.243) mm at fovea; macular E was (1.169±0.619). The coefficient of variation repeatedly measured: retinal SW was (8.7±68)%，retinal SW at the fovea was (8.5±6.7)%, and the average was (15.6±13.9)%; 95%TC of intra-subject sequential repeated measurement was 0.131 (8.9%) of retinal SW, 0.137 (10.5%)of fovea SW，and 0.198 (7.4%) of average E. ICC of one individual repeatedly measured by one operator was 0.950 of macular SW, 0.949 of fovea SW, and 0.898 of average edema index.ConclusionsHRT-II MEM is noninvasive, fast and highly reproducible, which provides a new technique to monitor the objective quantification of macular diseases related to retinal thickness. ( Chin J Ocul Fundus Dis, 2005,21:103-105)
Objective
To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression.
Methods
Twelve formaldehyde-treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years (range, 27-52 years) and with an average height of 166 cm (range, 154-177 cm). The related data of the approach at T1-S1 levels were respectively measured: the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae.
Results
The distance between the lateral edge of the erector spinae and the spinous process ranged from (41.75 ± 3.29) mm to (74.54 ± 7.08) mm. The length of the approach ranged from (66.75 ± 10.81) mm to (97.13 ± 13.35) mm. The angle between the approach and the horizontal plane ranged from (38.38 ± 6.16)° to (53.67 ± 4.40)°. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from (9.50 ± 0.60) mm to (18.30 ± 1.56) mm. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process.
Conclusion
The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.
Objective To study the microsurgical anatomy of the facial nerve (FN ) trunk and provide some important morphometric data about facialhypoglossal nerve anastomosis (FHA). Methods Bilateral microsurgical dissection was performed on the heads of 9 cadarers fixed with formalinwith three different methods. In the first method, the posterior belly of the digastric muscle was used as a mark, and the FN trunk was identified on the medial side ofthis muscle. In the second method, dissection was initiated at the parotid gland, the FN trunk was identified at its entrance into the parotid gland. In the third method, the styloid process was identified and traced back to the stylomastoid foramen (SMF). The FN trunk was identified on its emergence from the SMF. In every dissection, the whole FN trunk was exposed; its diameter and depth at the the SMF and its length were measured; its relationship, with other structures was studied. Results The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.57±0.60mm. The mean minimal distance of the FN trunk from the skin surface in this area was 22.62±2.88 mm. The length of the FN trunk was 15.71±1.97 mm. The distance between the bifurcation and the mastoidale was 18.20±4.41 mm. The distance between the bifurcation and the mandibular angle was 39.91±8.38 mm. The distance between the mastoidale and the SMF was 17.91±2.68 mm. The branches fromthe FN trunk proximal to its bifurcation were the posterior auricular nerve, the digastric muscle nerve and the stylohyoid muscle nerve.Conclusion The third method to expose the FN trunk on its emergence from the SMFis safe and reliable. It is feasible to use only part of the hypoglossal nerve fibers for anastomosis with the FN trunk.
OBJECTIVE: To study the anatomical basis for reconstruction of vertebral artery with neighboring non-trunk arteries. METHODS: Twenty preserved adult cadavers were used in this study to observe the morphology of superior thyroid artery, inferior thyroid artery, transverse cervical artery, thyrocervical trunk and extracerebral portion of vertebral artery, and reconstruction of vertebral artery with these arteries was simulated in two preserved cadavers. RESULTS: The calibers of superior or inferior thyroid artery, or transverse cervical artery were more than 2 mm in diameter, and the arteries had suitable free length for end-to-side anastomosis with vertebral artery. Thyrocervical artery had similar caliber to vertebral artery so that end-to-end anastomosis could be carried out between them, but only 38.5% of this artery had adequate artery trunk (more than 10 mm). It was proved from the simulated procedures that the reconstruction of vertebral artery with these neighboring non-trunk arteries was possible. CONCLUSION: Reconstruction of vertebral artery with neighboring non-trunk arteries has anatomical basis and can be used clinically for treatment of the lesion affecting the first or second portion of vertebral artery.
ObjectiveTo evaluate the repeatability and reproducibility of macular ganglion cell-inner plexiform layer (GCIPL) thickness measurement using spectral-domain optical coherence tomography (Cirrus HD-OCT).
MethodOne hundred and eight eyes of 54 normal subjects (26 males and 28 females) between 19 and 75 years of age were included. Each eye underwent macular scanning using Cirrus HD-OCT Macular Cube 512×128 protocol by two operators. Three scans of each eye were obtained by each operator. For the right eye of each subject, three extra scans were obtained using Macular Cube 200×200 protocol by one operator. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness was analyzed and the repeatability of GCIPL thickness measurement was evaluated with intra-operator, inter-operator, intra-protocol, and inter-protocol intraclass correlation coefficients (ICC). Ten extra scans were obtained from the left eyes of 10 randomly selected subjects for reproducibility assessment with coefficients of variation (CV).
ResultsThe intra-operator ICC of macular GCIPL measurement using Macular Cube 512×128 protocol by two operators were 0.959-0.995 and 0.954-0.997, respectively; and the inter-operator ICC were 0.944-0.993. All intra-and inter-operator ICC were > 0.800 with the highest and lowest records of the average and minimum GCIPL thickness, respectively. The intra-protocol ICC of Macular Cube 512×128 protocol and Macular Cube 200×200 protocol were 0.986-0.996 and 0.927-0.997, respectively; and the inter-protocol ICC were 0.966-0.994. All intra-and inter-protocol ICC were > 0.800. CV of GCIPL thickness measurement using Macular Cube 512×128 protocol were (0.70±0.31)%-(1.35±0.86)%.
ConclusionCirrus HD-OCT can measure macular GCIPL thickness in normal eyes with excellent repeatability and reproducibility.
ObjectiveTo provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienb?ck’s disease) by studying its morphology and blood supply pattern based on digital technique.MethodsTwelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. ResultsThere were significant differences in the longitudinal and transverse diameters between pisiform and lunate (t=6.653, P=0.000; t=6.265, P=0.000), but there was no significant difference in thickness (t= 1.269, P=0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side (P<0.05), but there was no significant difference in the diameter of nutrient foramina between different sides (P>0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch (P<0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch (P>0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch (P>0.05). But the differences between the other vascular pedicles were significant (P<0.05). ConclusionThere are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienb?ck’s disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.
PURPOSE:To evaluated the luminal characteristics of the elderly central retinal vessels in the anterior optic nerves.
METHODS:Serial sections of 15 central retinal arteries(CRA)and 23 central retinal veins (CRA)of 18 eyes of the aged 60 to 82 years old without anatomic malformation were examined by image analysis to investigate their luminal dimensional differences at the sites of lamina cribrosa and just anterior and posterior to it.
RESULTS:The average values of the mean area of the CRA in the prelaminar,laminar,retrolaminar portions were separately(12.70,17.40,18.00)times;10-3mm2 and the mean perimetric length 0.56,0.56,0.57mm.No significant difference was detected in these three sites.The average values of the mean area of the CRV were respectively(7.00,5.40,7.90)）times;10-3mm2 and the mean perimetric length 0.44,0.38,0.41mm.There were marked differences between the prelaminar value and the laminar one,and between the laminar value and retrolaminar one by comparison.
CONCLUSION:The CRA has a uniform radius from prelaminar to retrolaminar positions,and tube radius of the CRV at the level of the lamina cribrosa is the least.
（Chin J Ocul Fundus Dis,1997,13: 213-214 ）
Objective To measure the position of patellar high point and the shape of the osteotomy surface, and to analyze their relationship, distribution, and gender differences. Methods A total of 127 patients who needed anterior cruciate ligament reconstruction or meniscus repair due to trauma between September 2020 and September 2021 were selected as the research subjects. There were 71 males and 56 females, with an average age of 30.5 years (range, 19-43 years). There were significant differences in height and body weight between male and female patients (P<0.05), but no significant difference in age and body mass index (P>0.05). The three-dimensional model of the patella was reconstructed in Mimics software based on the CT images of the knee joint, and then imported into Geomagic Studio software for virtual osteotomy of the patella. The horizontal axis and vertical axis of the osteotomy surface represented the total width (W) and total height (H) of the osteotomy surface, respectively. Then the osteotomy surface was divided into four quadrants with the two axes: inner proximal, inner distal, outer proximal, and outer distal, and the inner width (W1), proximal height (H1), outer width (W2), and distal height (H2) were measured. The midpoint of the patellar ridge was selected as the patellar high point, and the point projected onto the osteotomy surface was defined as the optimal point for patellar prosthesis positioning (OPPP). The distances of OPPP on the horizontal axis (L1) and vertical axis (L2) relative to the center of the osteotomy surface were measured and L1/W1 and L2/H1 were also calculated; the quadrant distribution of OPPP was recorded. The patients were grouped according to gender, and the morphological parameters of the osteotomy surface (W, W1, W2, H, H1, H2) and the parameters related to the position of the OPPP (L1, L2, L1/W1, L2/H1) were analyzed between groups. Results The width and height of each osteotomy surface of the patella in males were significantly larger than those in females (P<0.05). As for the relationship between OPPP and osteotomy surface, the L1 of both male and female patients was 1-7 mm, and there was no significant difference in the distribution between the two groups (χ2=8.068, P=0.149); L1/W1 in both male and female patients was mainly 1/10-3/10. The L2 of male patients was 0-5 mm, and that of female patients was –1-4 mm; the difference in distribution between the two groups was significant (χ2=15.500, P=0.006); L2/H1 in both male and female patients was mainly 0-1/5. The OPPP of male patients was mainly distributed in the inner proximal (98.59%) and outer proximal (1.41%) quadrants, while the female patients were distributed in the inner proximal (91.07%), inner distal (7.14%), and outer proximal (1.79%) quadrants. There was significant difference in the OPPP quadrant distribution between the two groups (χ2=5.186, P=0.036). Conclusion The OPPP points are widely distributed but mainly concentrated on around 1/5 of the medial patella surface and around 1/10 of the superior patella surface. A small portion of females’ OPPP were inferior while all males’ OPPP were superior to the center of the patella.
To evaluate the possibil ity of collateral outflow tract of arterial sclerosis obstruction （ASO）and the prospect of cl inical appl ication. Methods The red emulsion was infused into the arteries of the above knee amputation of 10 fresh specimens. Then the pathological changes of the anterior tibial artery, posterior tibial artery and the popl iteal artery, and the contribution of these bole artery branch were observed. From September 2005 to April 2007, 5 patients with ASO were treated, unilateral lower l imb was involved in all cases. There were 3 males and 2 females, aged 68-81 years. The arteriography and Color Doppler ultrasound of lower l imbs showed that the femoral artery and the popl itealartery and the branches had no development. The exploratory operation on the popl iteal artery and the branches was carried out. Results The walls of the anterior tibial artery, posterior tibial artery, and the popl iteal artery were stiff and the lumens were filled with atheromatous plaque. The sural arteries opening to the bole artery was frequent. The collateral circulation at the knee perimeter was raritas rather affluent at the muscle group. All of the operations were successful, the skin temperature increased gradually after operation, and the degrees of blood oxygen saturation increased to 90%-100% at 6 hours from 0 before operation . After a follow-up of 3 to 12 months, the symptom improved obviously, rest pain disappeared, lower l imb ulcer healed. The Color Doppler ultrasound showed that most of the blood flow at the anastomotic stoma ejected into bypass circuit, and the blood flow at the distally posterior tibial artery and anterior tibial artery was l ittle. Conclusion The collateral outflow tract construction is feasible, it is an effective path after cl inical verification to solve the advanced stage ASO
