Change In Anteroposterior Diameter Research Articles

Pelvic floor status in opera singers. a pilot study using transperineal ultrasound

BackgroundControl of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction.MethodsCross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images.ResultsThe AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p < 0.01. The bladder neck had a non-significant descent of 3 mm during singing. The mean proportional change in AP diameter from rest to contraction was 24.2% (moderate to strong contraction) and from rest to singing was 15% (weak to moderate contraction).ConclusionsTransperineal ultrasound can be used to examine the PFM during singing. The classically trained singers had good voluntary PFM contraction and moderate contraction during singing. AP diameter was significantly shortened from supine to upright position, with further shortening during singing, confirming that female opera singers contracted their pelvic floor during singing.

Outcome of Patients with Antenatally Diagnosed hydronephrosis with Respect to Postnatal Diagnosis and Need for Surgical Intervention.

ABSTRACTAims:This study aims to determine the etiology of antenatal hydronephrosis (ANH) and predict need for surgical intervention based on antenatal renal pelvis anteroposterior diameter (APD).Materials and Methods:Combined prospective and retrospective study (2012–2018) of ANH cases with postnatal follow-up. Surgical intervention was correlated with the degree of hydronephrosis (HDN) and pelvis APD measured at the 2nd trimester, 3rd trimester, and postnatal 6-week follow-up.Results:One hundred and sixty-five patients were studied with a total of 219 ANH units. Transient HDN was seen in 116 units. Surgical intervention included pyeloplasty (n = 76), sub ureteric dextranomer injection (n = 8) and nephrectomy (n = 1). Chances of requiring surgery based on the degree of HDN in 2nd and 3rd trimester respectively were mild: 11.32% and 9.52%, moderate: 34.21% and 37.03% and severe: 85.71% and 86.27%. The mean increase in APD between the 2nd and 3rd trimester (n = 50) was lesser in conservatively managed (3.548 ± 4.219 mm) than surgically managed (8.261 ± 5.857 mm) patients (P = 0.002). In another subset (n = 37), the mean increase in APD between the 2nd trimester and postnatal period was less in conservatively managed (1.432 ± 0.612 mm) (P = 0.088) than surgically managed patients (12.91 ± 3.247 mm) (P = 0.004). The area under the receiver operating characteristic (ROC) curve showed that an APD of 8.2 mm in the 2nd trimester and 12.85 mm in the 3rd trimester correlated with the requirement of postnatal surgery.Conclusion:Apart from the degree of HDN, significant changes in APD between 2nd and 3rd trimester and cut off value suggested by the ROC curve will help during antenatal counseling with regard to requirement of postnatal surgery.

PD15-02 FUROSEMIDE-INDUCED CHANGES IN RENAL PELVIS ANTEROPOSTERIOR DIAMETER MEASURED WITH POINT OF CARE ULTRASOUND: PILOT STUDY OF A RADIATION-FREE STRATEGY TO DETECT OBSTRUCTION IN THE PEDIATRIC UROLOGY CLINIC

You have accessJournal of UrologyPediatric Urology I (PD15)1 Sep 2021PD15-02 FUROSEMIDE-INDUCED CHANGES IN RENAL PELVIS ANTEROPOSTERIOR DIAMETER MEASURED WITH POINT OF CARE ULTRASOUND: PILOT STUDY OF A RADIATION-FREE STRATEGY TO DETECT OBSTRUCTION IN THE PEDIATRIC UROLOGY CLINIC Jin Kyu Kim, Marisol Lolas, Michael Chua, Daniel T. Keefe, Joana Dos Santos, Armando J. Lorenzo, and Mandy Rickard Jin Kyu KimJin Kyu Kim More articles by this author , Marisol LolasMarisol Lolas More articles by this author , Michael ChuaMichael Chua More articles by this author , Daniel T. KeefeDaniel T. Keefe More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Armando J. LorenzoArmando J. Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001997.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Point of care ultrasound (POCUS) is an increasingly utilized resource that allows providers to obtain real-time imaging for clinical decision making. Hydronephrosis (HN) is a common condition seen in pediatric urology clinics, often assessed with serial ultrasounds (US) and Mercaptoacetyltriglycine (MAG3) furosemide nuclear studies. We hypothesized that for patients with obstruction, the anteroposterior diameter (APD) would increase post-furosemide administration, which can be identified with POCUS. METHODS: From June 2020 - Feb 2021, selected patients being evaluated for HN underwent a same-day standardized imaging sequence: pre-furosemide kidney/bladder US, MAG3 renogram, and post-furosemide in-clinic kidney/bladder POCUS. Variables captured included: pre-furosemide APD, T1/2 time and differential function, post-furosemide POCUS APD, and time from furosemide injection to POCUS. To account for anatomical and physiological effects of renal pelvis dilation, an index was created to represent the change in renal pelvis based on pre-APD and time to POCUS. To accomplish this, we performed a logarithmic Yeo-Johnson power transformation to the proportional change in APD of hydronephrotic kidney from pre-US to POCUS, adjusting for the time from furosemide injection to POCUS. Patients were divided into group 1: those who had a T1/2 < 20 mins, group 2: T1/2 > 20 mins, and group 3: no observable drainage. A correlation was drawn between T1/2 of the obstructed kidney and our index variable. RESULTS: 43 renal units were included in the analysis (7 group 1, 20 group 2, 16 group 3). There was a significant correlation between T1/2 of group 2 and our index variable(R=0.588, p=0.006, Figure 1). This correlation was not observed in group 1 patients(R=0.097, p=0.836) or group 3 patients (R=-0.261, p=0.329). CONCLUSIONS: This proof of concept investigation demonstrates that changes from pre-furosemide APD to post-furosemide APD may have value in estimating the degree of obstruction in patients with HN, particularly those who are in the “equivocal” range of T1/2 time. Further assessment may allow providers to determine the presence and degree of obstruction without the need to expose the child to a radiotracer. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e272-e272 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin Kyu Kim More articles by this author Marisol Lolas More articles by this author Michael Chua More articles by this author Daniel T. Keefe More articles by this author Joana Dos Santos More articles by this author Armando J. Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement Loading ...

The dynamic change of the anteroposterior diameter of the levator hiatus under Valsalva maneuver at term and labor outcome.

The aim of the present study was to evaluate the correlation between the proportional change of anteroposterior diameter (APD) of levator hiatus from rest to maximum Valsalva maneuver in nulliparous women at term and labor outcome. We prospectively recruited nulliparous women at term before the onset of labor. Women underwent a two-dimensional transperineal ultrasound, measuring the APD of the levator hiatus at rest and under maximum Valsalva's maneuver. APD change from rest to maximum Valsalva was described both in terms of absolute figures and proportional change. Correlation of APD change with the mode of delivery and with labor durations was assessed. Overall, 486 women were included in the analysis. No significant association between change in APD and the mode of delivery. We found a significant negative correlation between change of APD from rest to Valsalva and the duration of active second stage both in terms of absolute change (Pearson's r = -0.138, P = .009) and in terms of proportional change (Pearson's r = -0.154, P = .004). Survival outcomes based on Cox-regression model showed that APD was independently associated with the duration of active second stage of labor after adjusting for epidural analgesia, maternal age and body mass index (hazard ratio, 1.008; 95% confidence interval, 1.001-1.016; P = .04) CONCLUSION: Women with higher increase of the anteroposterior diameter of the levator hiatus from rest to Valsalva have a shorter active second stage of labor.

THE EFFECT OF ISOLATED SEGMENTAL CHIN OSTEOTOMY (SCO) ON THE PHARYNGEAL AIRWAY SPACE

The chin affects facial esthetics and the harmony between frontal and lateral views and is one of the most important anatomic structures of the lower third of the face. Chin osteotomy is aimed at ensuring the harmonization of the facial profile by balancing the size and form of the lower third of the face. It is assumed that the isolated genioplasty surgery will improve the pharyngeal airway space (PAS) by promoting muscle changes, specifically by pulling forward the hyoid bone and decompressing the hypopharynx region. Two patients without obstructive sleep apnea syndrome (OSAS) underwent isolated chin osteotomy for esthetic purposes. Forward movement of the chin by the Pg point was 7 mm in one case and 11 mm in another case. They were evaluated by preoperative and postoperative cone-beam computed tomography scans. The upper airway space was subdivided into retropalatal and retroglossal spaces. After this, the upper airway space was analyzed through the following criteria: 1) three-dimensional, high-altitude, cross-sectional surfaces; 2) transverse and anteroposterior diameter changes. Isolated segmental genioplasty was used after precise virtual planning and resulted in the PAS increase only in one case. There was a relevant correlation between the vertical and horizontal chin change and the hypopharynx. There was an average of a 1.6-fold increase in the total volume of the upper airway space. The retroglossal space was increased 1.5-fold. In another case, there was no relevant correlation between the vertical and horizontal chin change and the PAS. Isolated segmental chin osteotomy provides predictable esthetic results in the correction of different mandible anterior deformities and may contribute to an increased volume and a morphologic airway change. Further studies should be conducted to evaluate the effect of isolated segmental genioplasty on the pharyngeal airway space.

Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial.

To evaluate the effect of preoperative pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction, symptoms of pelvic organ prolapse (POP) and anatomical POP, 6 months after prolapse surgery, and to assess the overall changes in PFM contraction, POP symptoms and pelvic organ descent after surgery. This was a randomized controlled trial of 159 women with symptomatic POP, Stage 2 or higher, scheduled for surgery. Participants were randomized to intervention including daily PFMT from inclusion to surgery (n = 81) or no intervention (controls; n = 78). Participants were examined at inclusion, on the day of surgery and 6 months after surgery. PFM contraction was assessed by: vaginal palpation using the Modified Oxford scale (MOS; 0-5); transperineal ultrasound, measuring the percentage change in levator hiatal anteroposterior diameter (APD) from rest to maximum PFM contraction; vaginal manometry; and surface electromyography (EMG). POP distance from the hymen in the compartment with the most dominant prolapse and organ descent in the anterior, central and posterior compartments were measured on maximum Valsalva maneuver. POP symptoms were assessed based on the sensation of vaginal bulge, which was graded using a visual analog scale (VAS; 0-100 mm). Linear mixed models were used to assess the effect of PFMT on outcome variables. Of the 159 women randomized, 151 completed the study, comprising 75 in the intervention and 76 in the control group. Mean waiting time for surgery was 22 ± 9.7 weeks and follow-up was performed on average 28 ± 7.8 weeks after surgery. Postoperatively, no difference was found between the intervention and control groups with respect to PFM contraction assessed by vaginal palpation (MOS, 2.4 vs 2.2; P = 0.101), manometry (19.4 vs 19.7 cmH2 O; P = 0.793), surface EMG (33.5 vs 33.1 mV; P = 0.815) and ultrasound (change in hiatal APD, 20.9% vs 19.3%; P = 0.211). Furthermore, no difference between groups was found for sensation of vaginal bulge (VAS, 7.4 vs 6.0 mm; P = 0.598), POP distance from the hymen in the dominant prolapse compartment (-1.8 vs -2.0 cm; P = 0.556) and sonographic descent of the bladder (0.5 vs 0.8 cm; P = 0.058), cervix (-1.3 vs -1.1 cm; P = 0.569) and rectal ampulla (0.3 vs 0.4 cm; P = 0.434). In all patients, compared with findings at initial examination, muscle contraction improved after surgery, as assessed by palpation (MOS, 2.1 vs 2.3; P = 0.007) and ultrasound (change in hiatal APD, 17.5% vs 20.1%; P = 0.001), and sensation of vaginal bulge was reduced (VAS, 57.6 vs 6.7 mm; P < 0.001). In addition, compared with the baseline examination, POP distance from the hymen in the dominant prolapse compartment (1.9 vs -1.9 cm; P < 0.001) and sonographic descent of the bladder (1.3 vs 0.6 cm; P < 0.001), cervix (0.0 vs -1.2 cm; P < 0.001) and rectal ampulla (0.9 vs 0.4 cm; P = 0.001) were reduced. We found no effect of preoperative PFMT on PFM contraction, POP symptoms or anatomical prolapse after surgery. In all patients, PFM contraction and POP symptoms were improved at the 6-month follow-up, most likely due to the anatomical correction of POP. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

To estimate the prevalence of, and explore the risk factors for, levator ani muscle (LAM) injury in women with clinically diagnosed obstetric anal sphincter injury (OASI). The secondary aim was to assess the association between LAM injury and pelvic floor muscle contraction, anal incontinence (AI) and urinary incontinence (UI) in women with OASI. This was a cross-sectional study of 250 women with OASI, recruited between 2013 and 2015 from a tertiary referral center at Croydon University Hospital, UK. AI symptoms were assessed using the modified St Mark's incontinence score and UI was assessed using the International Consultation on Incontinence modular Questionnaire for Urinary Incontinence-Short Form. All participants underwent three/four-dimensional transperineal ultrasound at rest and on maximum pelvic floor muscle contraction. Major LAM injury was defined as a unilateral or bilateral defect in all three central slices on tomographic ultrasound imaging. Muscle contraction was assessed using the modified Oxford scale (MOS) and measured on ultrasound as the proportional change in the anteroposterior (AP) levator hiatal diameter between rest and contraction. Multivariable logistic regression analysis was used to study risk factors for LAM injury. Differences in contraction and AI and UI symptoms between women with intact and those with injured LAM were studied using multivariable ANCOVA and the Mann-Whitney U-test. Of the 248 women with OASI for whom ultrasound volumes of adequate quality were available, 29.4% were found to have major LAM injury. The prevalence of LAM injury was 23.6% after normal vaginal delivery and 40.2% after operative vaginal delivery (adjusted odds ratio, 4.1 (95% CI, 1.4-11.9); P = 0.01). LAM injury was associated with weaker pelvic floor muscle contraction, with an adjusted mean difference for proportional change in AP diameter of 5.0 (95% CI, 3.0-6.9) and MOS of 0.6 (95% CI, 0.3-0.9) (P < 0.001 for both). AI and UI symptom scores were similar between women with intact and those with injured LAM. Operative vaginal delivery was a risk factor for LAM injury in women with OASI. LAM injury was associated with weaker pelvic floor muscle contraction. Special attention is recommended for women with OASI and LAM injury, as they are at high risk for future pelvic floor disorders. The benefits of implementation of an intensive, focused and structured pelvic floor rehabilitation program need to be evaluated in these women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Association between pelvic floor muscle trauma and contraction in parous women from a general population.

To study possible associations between pelvic floor muscle contraction, levator ani muscle (LAM) trauma and/or pelvic organ prolapse (POP) ≥ Stage 2 in parous women recruited from a general population. This was a secondary analysis of data from a cross-sectional study of 608 parous women from a general population examined using the POP quantification system (POP-Q) and three-dimensional/four-dimensional transperineal ultrasound for identification of LAM macrotrauma (avulsion) and microtrauma (distension of levator hiatal area > 75th percentile on Valsalva maneuver). Muscle contraction was assessed using the modified Oxford scale (MOS), perineometry and ultrasound measurement of proportional change of anteroposterior hiatal diameter and levator hiatal area at rest and on pelvic floor muscle contraction. The Mann-Whitney U-test was used to study associations between pelvic floor muscle contraction, LAM trauma and POP. Women with macrotrauma (n = 113) had significantly weaker median pelvic floor muscle contraction, as measured using MOS and perineometry, than did women with an intact LAM (n = 493) (contraction strength was 1.5 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, and vaginal squeeze pressure was 15.0 (range, 0.0-78.0) cmH2 O vs 28.0 (range, 0.0-129.0) cmH2 O on perineometry; P < 0.001). This was also demonstrated by ultrasound measurement, with a proportional change in hiatal area of 19.9% (range, 4.1-48.0%) vs 34.0% (range, 0.0-64.0%) (P < 0.001) and proportional change in anteroposterior diameter of 16.2% (range, -5.7 to 42.6%) vs 26.0% (range, -3.4 to 49.4%) (P < 0.001). No statistically significant difference between women with (n = 65), and those without (n = 378), microtrauma was found after excluding women with macrotrauma. Women with POP had weaker muscle contraction than those without; in those with POP-Q ≥ 2 (n = 275) compared with those with POP-Q < 2 (n = 333), muscle contraction strength was 3.0 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, vaginal squeeze pressure was 21.0 (range, 0.0-98.0) cmH2 O vs 28.0 (range, 3.0-129.0) cmH2 O on perineometry, proportional change in hiatal area was 29.6% (range, 0.0-60.9%) vs 33.8% (range, 0.0-64.4%) and proportional change in anteroposterior diameter was 22.8% (range, -5.7 to 49.4%) vs 25.7% (range, -3.4 to 49.4%) (P < 0.001 for all). LAM macrotrauma was associated with weaker pelvic floor muscle contraction measured using palpation, perineometry and ultrasound. Women with POP had weaker contraction than did women without POP. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Correlation Between Transperineal 3-Dimensional Ultrasound Measurements of Levator Hiatus and Female Sexual Function.

The aim of this study is to investigate the association of sexual functions with levator hiatus biometry measurements and levator ani muscle defect. In 62 heterosexual, sexually active premenopausal women without pelvic floor disorders or urinary incontinence, 3-dimensional transperineal ultrasound imaging was used. Two 3-dimensional volumes were recorded, one at rest and one on Valsalva maneuver. Levator biometry measurements and levator defect were evaluated in an axial plane. Sexual function was assessed by a validated questionnaire, Female Sexual Function Index (FSFI). The primary outcome measure was correlation of sexual functions with the levator hiatus area, transverse and anteroposterior diameters, levator ani muscle thickness, vaginal length, and changes in measurements with Valsalva and levator defect. Forty-two women (67.7%) had low total FSFI scores (<26.55). Levator defect rates were similar in female sexual dysfunction (7/42, 16.7%) and women without female sexual dysfunction (5/20, 25%). The FSFI was negatively and weakly correlated with Δhiatal anteroposterior diameter (r = -0.33, P < 0.009) in the study population. There was a weak and inverse correlation between Δhiatal anteroposterior diameter and arousal (r = -0.35, P < 0.002), desire (r = -0.38, P < 0.001), and orgasm (r = -0.33, P < 0.007). Pain and lubrication did not correlate with any measurement. Hiatal area and diameters at rest are not related to sexual functions. Changes in anteroposterior diameter of the levator hiatus during Valsalva, which may be a sign of pelvic floor laxity or levator muscle weakness, are weakly associated with sexual functions, particularly desire, arousal, and orgasm domains.

An initial differential renal function between 35% and 40% has greater probability of leading to normal after pyeloplasty in patients with unilateral pelvic-ureteric junction obstruction.

We compared the outcomes in patients who were <1 year old and had hydronephrosis with SFU grade 3-4 PUJ obstruction to observe the potential recovery of renal morphology and DRF after successful pyeloplasty. All children younger than 1 year old with SFU grade 3-4 PUJ obstruction from January 2013 to June 2015 were retrospectively analyzed. A total of 92 children were grouped according to their DRF value at pyeloplasty as follows: DRF from 30 to ≤35% (group I) and DRF from 35 to ≤40% (group II). We evaluated changes in anteroposterior diameter and differential renal function using ultrasound and diuretic renography. Outcomes were compared using Student t test. Group I comprised 45 patients, and group II included 47 patients. No significant difference was observed in the initial APD, final APD and the improvement of APD after pyeloplasty between two groups. Significant differences were observed between the initial and final DRF values in both groups. The difference in DRF improvement after pyeloplasty between groups I and II was significant. The DRF improved to a normal stage significantly more frequently in group II (21/47; 44.7%) than in group I (13/45; 28.9%). The improvement in DRF after pyeloplasty was significant for patients with an initial DRF from 30 to ≤35%. However, patients with an initial DRF from 35 to ≤40% had a greater probability of achieving normal renal function. Patients with severely impaired initial renal function had a marginal probability of achieving a normal value.

Functional and Morphological Outcomes of Pyeloplasty at Different Ages in Prenatally Diagnosed Society of Fetal Urology Grades 3-4 Ureteropelvic Junction Obstruction: Is It Safe to Wait?

To evaluate changes in functional and morphological outcomes in children with prenatally diagnosed Society of Fetal Urology (SFU) grades 3-4 ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty at different ages. We also examined the effect of surgical wait time on recovery of renal function. All patients (aged 0-12 months) with prenatally diagnosed SFU grades 3-4 UPJO who underwent pyeloplasty in a single center between January 2013 and December 2015 were reviewed. One hundred thirty-three children were enrolled in this study. The children were divided into 2 groups according to their age at the time of surgery (group I: 0-3 months, group II: 3-12 months). We evaluated changes in parenchymal thickness, anteroposterior diameter (APD), and differential renal function (DRF) using ultrasound and diuretic renography. Functional and morphological outcomes were compared using Student t test. A total of 133 patients were included in the study. We found a significant difference in the change of DRF (difference between before and after pyeloplasty) between the 2 groups (P < .05). There were no significant differences in changes in parenchymal thickness and APD. Patients who waited 1-2 months had a significantly lower functional improvement compared with those who waited less than 1 month. Early surgery leads to a significant improvement in DRF. Wait times greater than 1 month can decrease functional improvement. For patients with prenatally diagnosed SFU grades 3-4 UPJO, early pyeloplasty is recommended in those with increasing renal pelvic APD and an obstructed renogram with differential renal function <40%.

Assessment of pelvic floor muscle contraction with palpation, perineometry and transperineal ultrasound: a cross-sectional study.

To study the correlation between palpation, perineometry and transperineal ultrasound for assessment of pelvic floor muscle contraction and to define a contraction scale for ultrasound measurements. This was a cross-sectional study of 608 women examined with palpation of pelvic floor muscle contraction, using the Modified Oxford Scale, and measurement of the vaginal squeeze pressure with a vaginal balloon connected to a fiber-optic microtip transducer (perineometry). Transperineal ultrasound was used for measurements of levator hiatal area and anteroposterior (AP) diameter in the plane of minimal hiatal dimensions, at rest and on contraction. The pelvic floor muscle contraction was expressed as the percentage difference between values at rest and on contraction. Spearman's rank was used to test for correlation between the different methods of assessment. Significant correlations were found between all assessment methods (P < 0.001). Palpation correlated with perineometry (rs = 0.74) and with proportional change in hiatal area (rs = 0.67) and AP diameter (rs = 0.69) on ultrasound. Perineometry correlated with proportional change in hiatal area (rs = 0.60) and AP diameter (rs = 0.66) on ultrasound. We defined a contraction scale based on the proportional change in AP diameter. In this population, a change in AP diameter of < 7% corresponded to absence of contractions, 7-18% corresponded to weak contractions, 18-35% corresponded to normal contractions and > 35% corresponded to strong contractions. We found moderate to strong correlation between ultrasound measurements, palpation and perineometry for assessing pelvic floor muscle contraction. The proportional change in levator hiatal AP diameter was the ultrasound measurement with strongest correlation to palpation and perineometry and formed the basis for the contraction scale for ultrasound measurements. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Is decreased diameter of renal pelvis in prone position an indicator of successful pyeloplasty?

Objective:To evaluate patients who had undergone pyeloplasty for pelviureteric junction obstruction, by measuring the anteroposterior diameter (APD) of the renal pelvis in supine and prone positions, and determine whether a decrease in APD in prone position can exclude obstruction in dilated renal system.Materials and Methods:From January 2012 to December 2013, patients who had undergone pyeloplasty were evaluated by ultrasound in two centers. The difference of APD of the renal pelvis in supine and prone positions was obtained. Correlation was made with the pre- and post-pyeloplasty renal function by radionuclide renogram.Results:There were 42 patients (31 males, 11 females; age range 5 months to 18 years). Residual hydronephrosis was detected in 41 patients of whom 35 patients (85%) showed decrease in APD by >10% in prone position. These patients and the one without hydronephrosis showed either no deterioration or improvement in renal function. Six patients (15%) showed either no change or increase in APD in prone position. Three patients (7.5%) were confirmed to have decrease in renal function indicating obstruction. Three patients (7.5%) showed no deterioration of renal function, but sluggish drainage on radionuclide renogram.Conclusion:Demonstration of decreased APD of renal pelvis in prone position by ultrasound is useful to differentiate obstructed from non-obstructed dilated renal system, and it correctly identified 85% candidates with successful pyeloplasty. In patients with no decrease or increase in APD at prone position, further follow-up is recommended to rule out obstruction.

Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment

Airway size increases are associated with maxillomandibular advancement (MMA) surgery and improvement or elimination of obstructive sleep apnea (OSA). The 3-dimensional morphologic, volumetric, height, cross-sectional surface area, and diameter changes of the upper airway in patients with OSA after MMA, however, are not well understood. Patients with moderate or severe OSA who underwent MMA surgery were evaluated by preoperative and postoperative cone-beam computed tomography scans and polysomnograms. The upper airway space was also divided into retropalatal and retroglossal spaces and was analyzed for volumetric, height, cross-sectional surface area, transverse, and anteroposterior diameter changes. Ten consecutive OSA patients with an average preoperative apnea/hypopnea index of 46 and treated with MMA surgery were included in this study. There were 8 men and 2 women, with an average age of 46years and an average body mass index of 28. There was an average of a 2.5-fold increase in the total volume of the upper airway space. The retropalatal space increased by 3.5-fold. The retroglossal space increased by 1.5-fold. The greatest change in a cross-sectional area occurred in the transverse axis in both the retroglossal and retropalatal spaces. The average apnea/hypopnea index was 4 postoperatively. MMA surgery results in a significant increase in the volume and a morphologic airway change from a round to an elliptical f shape in the upper airway space in patients with OSA. The combination of these actions reduces the collapsibility of the upper airway space, hence improving or resolving the OSA.

In-Vivo Analysis of Selectively Flexible Mitral Annuloplasty Rings Using Three-Dimensional Echocardiography

Selectively flexible rings, Colvin-Galloway (CG) Future and Carpentier-Edwards (CE) Physio II, are used for annuloplasty during mitral valve repair to facilitate dynamic annular motion while preventing annular dilation. In this study, we assessed the extent and nature of the flexibility of these rings invivo, which has not been objectively demonstrated. Three-dimensional transesophageal echocardiography was used intraoperatively to acquire data regarding dynamic motion of mitral annuli and annuloplasty rings in 33 patients undergoing mitral repair (15 CG Future and 18 CE Physio II) and in 15 control patients. Data were analyzed to assess the dynamic changes in annular geometry after implantation of selectively flexible rings. After annuloplasty, there was an immediate and significant decrease in annular displacement (p < 0.001) and annular displacement velocity (p < 0.01). Dynamic change in multiple variables including anteroposterior diameter (p < 0.001) and annular area (p < 0.001) was also significantly depressed. In comparison with normal mitral valves, partially flexible rings allowed limited dynamic motion: percentage changes in anteroposterior diameter (p < 0.001), anterolateral posteromedial diameter (p < 0.001), and total circumference (p < 0.001) were significantly lower. Compared with each other, the two rings resulted in similar changes in anterior annulus length (p= 0.93), posterior annular length (p= 0.82), and annular area (p= 0.31). Mitral annular dynamics were uniformly depressed after implantation of these rings. Selective flexibility could not be demonstrated invivo using echocardiographic data.

Anterior Mediastinal Fat Changes in Idiopathic Pulmonary Fibrosis: A Preliminary Study

Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally. There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis (IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.

Upper airway changes in obstructive sleep apnea suffers after H-uvulopalatopharyngoplasty and H-uvulopalatopharyngoplasty combined with transpalatal advancement pharyngoplasty

To compare the different postoperative changes of the pharynx in obstructive sleep apnea hypopnea syndrome (OSAHS) patients treated with H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) surgery or H-UPPP alone. The upper airway in 43 patients with OSAHS were scanned during the end of normal respiration before and after treatment. There were 17 patients undergoing H-UPPP alone, 26 patients undergoing H-UPPP combined with PA, with PSG before and after treatment. To compare the efficacy of H-UPPP with PA surgery or H-UPPP alone, upper airway characteristics were measured following each procedure in 43 patients using a quantitative 3-D CT. The 3-D CT measurement were made in lateral and anterior-posterior diameters, cross-section areas and volumes of retropalatal and retroglossal region. The changes in the structure of OSAHS patients treated with H-UPPP combined with PA surgery and H-UPPP alone were compared preoperatively and postoperatively, and the correction features that were presented in AHI and structural changes were analysed. The difference between H-UPPP combined with PA (n = 26) and H-UPPP (n = 17) in the changes in apnea hypopnea index (AHI) were (67.5 ± 18.9, 38.7 ± 42.0, t = 2.84, P < 0.05), hard palate lengths were (4.50 ± 3.72) mm and (0.06 ± 0.22) mm (t = 5.55, P < 0.01); anteroposterior diameters of the hard palate level were (3.5 ± 4.3) mm and (-1.7 ± 4.4) mm (t = 3.90, P < 0.01); the minimum anteroposterior diameters of retropalatal were (1.2 ± 2.2) mm and (-1.2 ± 2.3) mm (t = -3.49, P < 0.01); the minimum lateral diameters of retroglossal area were (4.9 ± 9.6) mm and (13.1 ± 9.1) mm (t = 2.80, P < 0.01) preoperatively and postoperatively. The changes in the hard palate lengths were positively correlated to the change in AHI (r = 0.407, P < 0.01), also the change in anteroposterior diameter of the hard palate level (r = 0.351, P < 0.05), the minimum anteroposterior diameter of retropalatal area (r = 0.381, P < 0.01), and the minimum cross-section area of retropalatal (r = 0.312, P < 0.05). H-UPPP combined with PA offers benefit over H-UPPP alone in OSAHS patients, which may be achieved by increased retropalatal airway size. Both the anteroposterior dimensions and the cross-area size are related with the efficacy of surgery.

When is it necessary to perform nuclear renogram in patients with a unilateral neonatal hydronephrosis?

To examine whether anteroposterior(AP) pelvic diameter on postnatal renal ultrasound scan (US) can predict both initial differential renal function (DRF) and deterioration in DRF in patients with prenatally diagnosed hydronephrosis. One hundred and thirty-three patients diagnosed with a unilateral prenatal hydronephrosis, confirmed postnatally, were evaluated. We tried to find the cutoff values for initial AP diameter and change in AP diameter based on initial DRF and renal outcome. Reduction of 5% or more was considered as deterioration in function. All patients had an initial US scan at a mean age of 1.62weeks (1-4) and nuclear renogram at 13.24weeks (7-21). All patients had a second US at a mean age of 10.58weeks (6-19). 119 patients had a second renogram. Initial mean pelvic diameter was 20.86 (11-49)mm. When AP pelvic diameter was less than 20mm, 98.6% of all renal units had a function of ≥40%. The cutoff point for AP pelvic diameter was 19.05 when DRF was ≥45% (P<0.001). When the reduction in hydronephrosis in pelvic diameter was analyzed to predict the initial renal function, a cutoff point of 1.3mm decrease was found when initial renal function was ≥40% (P<0.001). The reduction in AP pelvic diameter was 2.1mm when initial DRF was ≥45% (P=0.009). For all patients except 3 individuals, if there was a reduction in AP diameter or the AP diameter was stable, then no reduction in function was observed. When the AP pelvic diameter is less than 20mm at presentation, DRF is normal. If the AP diameter is stable or decreases, there is unlikely to be a significant deterioration in renal function. Consequently, in selected patients, congenital unilateral hydronephrosis can be followed with serial ultrasounds.

Changes in anteroposterior patellar tendon diameter support a continuum of pathological changes

ObjectivesA continuum of pathological ultrasound patellar tendon changes from normal tendons, followed by diffuse and then focal change in echogenicity has been proposed. The anteroposterior (AP) diameter of each pathological...

Cognitive-linguistic demands and speech breathing.

This investigation examined the influence of cognitive-linguistic processing demands on speech breathing. Twenty women were studied during performance of two speaking tasks that were designed to differ in cognitive-linguistic planning requirements. Speech breathing was monitored with respiratory magnetometers from which recordings were made of the anteroposterior diameter changes of the rib cage and abdomen. Results indicated that speech breathing was similar across speaking conditions with respect to nearly all measures of lung volume, rib cage volume, and abdomen volume. Task-related differences were found for certain fluency-related measures. Specifically, the number of syllables produced per breath group was smaller, average speaking rate was slower, and average lung volume expended per syllable was greater under a higher cognitive-linguistic demand condition than under a lower-demand condition. These differences were explained by the fact that silent pauses, particularly those associated with expiration, were more prevalent and longer in duration under the higher-demand condition. It appears that the mechanical behavior of the breathing apparatus during speaking generally is unaffected by variations in cognitive-linguistic demands of the type investigated; however, fluency-related breathing behavior appears to be highly sensitive to such demands.