Distance Of Opening Research Articles

No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma.

Neurosurgical trainees should achieve competency in chronic subdural haematoma (CSDH) drainage at an early stage in training. The effect of surgeon seniority on recurrence following surgical drainage of CSDH was examined. All CSDH cases performed at St George's Hospital in London between March 2009 and March 2012 were analysed. Recurrence was defined as clinical deterioration with computed tomography evidence of CSDH requiring reoperation within six months. The following risk factors were considered: seniority of primary and supervising surgeons, timing of surgery (working hours, outside working hours), patient related factors (age, antiplatelets, warfarin) and operative factors (general vs local anaesthesia, burr holes vs craniotomy, drain use). For recurrent cases, we examined the distance of the cranial opening from the thickest part of the CSDH. A total of 239 patients (median age: 79 years, range: 33-98 years) had 275 CSDH drainage operations. The overall recurrence rate was 13.1%. The median time between the initial procedure and reoperation was 16 days (range: 1-161 days). The only statistically significant risk factor for recurrence was antiplatelets (odds ratio: 2.62, 95% confidence interval: 1.13-6.10, p<0.05). Warfarin, grade of surgeon, timing of surgery, type of anaesthesia, type of operation and use of drains were not significant risk factors. In 26% of recurrent CSDH cases, the burr holes or craniotomy flaps were placed with borderline accuracy. CSDH drainage is a suitable case for neurosurgical trainees to perform without increasing the chance of recurrence.

A FE parametric study of RWS beam-to-column bolted connections with cellular beams

In recent years, researchers study alternative connection designs for steel seismic-resistant frames by reducing the beam section in different ways including that of creating an opening in its web (RWS connections). A similar design is applied in the fabrication of perforated (i.e. cellular and castellated) beams mostly used to support the service integration, as well as the significant mass reduction in steel frames.This paper presents a comprehensive finite element (FE) analysis of extended end-plate beam-to-column connections, with both single and multiple circular web openings introduced along the length of the beam while subjected to the cyclic loading proposed by the SAC protocol from FEMA 350 (2000). The three-dimensional (3D) FE solid model was validated against FE and experimental results and the chosen configuration was capable of representing the structural behaviour of a partially restrained connection, without the necessity to be idealised as fully fixed. The study focuses in the interaction of such connections and the mobilisation of stresses from the column to the perforated beam. The parameters introduced were the distance from the face of the column, S, and the web opening spacing, So, with closely and widely spaced web openings. It is found that RWS connections with cellular beams behave in a satisfactory manner and provide enhanced performance in terms of the stress distribution when subjected to cyclic loading. The design of partially restrained RWS connections should be primarily based on the distance of the first opening from the face of the column.

Morphometric characteristics of caudal cranial nerves at petroclival region in fetuses.

Morphometric measurements of cranial nerves in posterior cranial fossa of fetus cadavers were carried out in an attempt to identify any asymmetry in their openings into the cranium. Twenty-two fetus cadavers (8 females, 14 males) with gestational age ranging between 22 and 38weeks (mean 30weeks) were included in this study. The calvaria were removed, the brains were lifted, and the cranial nerves were identified. The distance of each cranial nerve opening to midline and the distances between different cranial nerve openings were measured on the left and right side and compared. The mean clivus length and width were 21.2±4.4 and 13.2±1.5mm, respectively. The distance of the twelfth cranial nerve opening from midline was shorter on the right side when compared with the left side (6.6±1.1 versus 7.1±0.8mm, p=0.038). Openings of other cranial nerves did not show such asymmetry with regard to their distance from midline, and the distances between different cranial nerves were similar on the left and right side. Cranial nerves at petroclival region seem to show minimal asymmetry in fetuses.

PTU-196 Goodsall’s rule – past its sell-by date?

Introduction Successful treatment of an anal fistula requires correct identification of the internal opening and accurate delineation of the course of the fistula in relation to the anal sphincters. Goodsall’s rule states that a fistula with the external opening anterior to an imaginary transverse line across the anus has its internal opening at the same radial position and for an external opening posterior to this line, the internal opening is in the midline posteriorly with a horse-shoe track. The aim of this study was to determine the accuracy of Goodsall’s rule and the relationship between the distance of the external opening from the anal verge and the configuration of the fistula. Method We studied a consecutive series of 103 patients (20.4% female, 79.6% male) undergoing their first operation for cryptoglandular anal fistula between 2006 and 2014, by a single colorectal surgeon. The site of the internal and external openings were recorded by reference to hours on a clock (lithotomy position) and the radial distance of the external opening from the anal verge was measured with a thread. A horseshoe fistula was defined as one where the internal and external opening were separated by 2 or more hours. Anterior fistulas lay between 9 and 3 o’clock (58/103; 56.3%), posterior between 4 and 8 o’clock (45/103; 43.7%). Results The diagnostic accuracy of Goodsall’s rule was only 66.9%. Goodsall’s rule was correct in 25/58 (43.1%) anterior fistulas and 30/45 (66.8%) of posterior fistulas. Of the transsphincteric fistulas, 31/51 (60.8%) conformed to Goodsall’s rule. The distance between the external opening and the anal verge influenced the accuracy of Goodsall’s rule, being true in 92.9% of those 36 mm. Distance of the external opening from the anal verge influenced the likelihood of the fistula having a horseshoe course: 36 mm (57.9%). For fistulas with an external opening in the anterior half of the anus, 4/5 (80%) ≤20 mm from the anal verge had a radial course compared to 29/53 (54.7%) where the distance from the verge was ≥21 mm. For those with an external opening in the posterior half, 18/18 (100%) ≤20 mm from the anal verge had a radial course compared to 18/27 (66.7%) where the distance from the verge was ≥21 mm. Conclusion Goodsall’s rule is of limited use in predicting the site of the internal opening of a fistula. The closer the external opening is to the anal verge, the more likely a fistula conforms to the rule. The further a fistula is away from the anal verge, the more likely it follows a horseshoe course and less likely to conform to Goodsall’s rule. Disclosure of interest None Declared.

Sphenopalatine foramen: endoscopic approach with bony landmarks.

To establish whether nasal bony landmarks on computed tomography could be utilised reliably in endoscopic approaches to the sphenopalatine foramen. A prospective analysis of 102 consecutive helical computed tomography scans of the paranasal sinuses was carried out by 2 senior ENT surgeons. Distances from the sphenopalatine foramen to endoscopically palpable bony landmarks were measured. There were a total of 102 patients (45 females and 57 males), with a mean age of 62 years. The mean distance from the posterior fontanelle to the sphenopalatine foramen was 14.1 mm (standard deviation = 2.13). The average vertical distance of the sphenopalatine foramen opening from the bony attachment of the inferior turbinate was 14.13 mm. There were no statistically significant differences between any of these measurements (foramen width p-value = 0.714, distance from fontanelle p-value = 0.43 and distance from inferior turbinate p-value = 0.48). Determination of reliable bony landmarks is clinically useful in endoscopic surgery and can aid identification of the sphenopalatine foramen. The inferior turbinate concha and posterior fontanelle may be used as reliable computed tomography landmarks for endoscopic approaches to the sphenopalatine foramen.

Mallampati classification without tongue protrusion can predict difficult tracheal intubation more accurately than the traditional Mallampati classification

IntroductionThe modified Mallampati classification (m-MMT) is the most popular technique for predicting difficult tracheal intubation. However, tongue protrusion may sometimes hide the oropharynx when the distance of the mouth opening is short, and this may lead to false-positive (FP) estimations of difficulty. The purpose of this study is to determine whether the Mallampati classification with no tongue protrusion (NT-MMT) can predict difficult tracheal intubation more accurately than the traditional m-MMT method. MethodsA total of 748 patients requiring endotracheal intubation were enrolled in this study. They were evaluated by m-MMT and by NT-MMT prior to surgery. After induction of general anesthesia with muscle relaxation, all patients underwent direct laryngoscopy, and the best glottic view was recorded as defined by the grading system of Cormack and Lehane. The preoperative assessment data and the intubation findings were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the aforementioned tests in predicting difficult intubation. ResultsNT-MMT classification scored higher in all parameters than m-MMT. Similarly, the coefficient of reliability of Spearman's ρ test was higher with NT-MMT than with m-MMT. ConclusionNT-MMT is easy to perform and was more accurate in predicting difficult tracheal intubation than m-MMT.

Surgical Anatomy of Nasolacrimal Duct and Sac in Human Cadavers

ABSTRACT Background Surgical importance of the nasolacrimal duct (NLD) for both otolaryngologists and ophthalmologists cannot be overemphasized. Injury to this structure can lead to iatrogenic epiphora, synechiae formation and need for secondary lacrimal diversion procedures. Materials and methods The present study was conducted on 27 mid-sagittal sections of head and neck of formalin fixed adult cadavers. The inferior opening of the NLD was identified and exposed. The duct and the lacrimal sac were dissected. Pertinent distances of the inferior opening of the NLD from the easily identifiable surgical landmarks were recorded, so as to accurately locate the inferior opening of the duct using a digital vernier calliper (accuracy 0.02 mm, Mitutoya, Japan). Various dimensions and angulation of the duct and lacrimal sac were measured. Results The average length of NLD was 11.42 ± 2.45 mm and it was making an angle of 20° with the vertical plane. The duct was narrowest in caliber in its upper 1/3rd in majority (82%) of the cases. The average diameter of the inferior opening of the NLD was 3.14 mm. In two cases (7.4%), the opening was only 1.8 mm wide. The mean distance of the inferior opening of the duct was 20.7 mm from the columella, 25.5 mm below the skull base and 16.5 mm above the hard palate. The average distance between the inferior opening of the NLD and anterior end of the inferior turbinate was 14.8 mm. The mean A-P diameter of superior opening of NLD was about 3 mm. The average length and width of nasolacrimal sac at its center was 6.95 and 3.24 mm respectively. Conclusion Detailed anatomical knowledge of the NLD is of great importance for safe and successful endonasal surgery. The present study attempts to provide useful surgical guidelines by using anatomic and positional relationships between the NLD and the major surrounding landmarks. How to cite this article Sahni SS, Goyal R, Gupta T, Gupta AK. Surgical Anatomy of Nasolacrimal Duct and Sac in Human Cadavers. Clin Rhinol An Int J 2014;7(3):91-95.

Fistulectomy versus fistulotomy with marsupialisation in the treatment of low fistula-in- ano: a prospective randomized controlled trial.

Low fistula-in-ano has traditionally been treated with fistulectomy and fistulotomy. Recent studies have shown that marsupialisation of the fistulotomy wounds can reduce the healing time. A randomized clinical trial was conducted at Bugando Medical Centre in north-western Tanzania between January 2008 and December 2012 to compare the efficacy of fistulectomy versus fistulotomy with marsupialisation in the treatment of low fistula in ano. Patients were randomized into two groups, namely Group A (fistulectomy) and Group B (fistulotomy with marsupialisation). A total of 162 patients were enrolled in the study and randomly assigned to Group A (n = 82) and Group B (n = 80). Both groups were comparable with respect to age, sex ratio, duration of symptoms, type of fistula and radial distance of the external opening from the anal verge. The mean healing time was statistically significantly longer in group A than in group B (P = 0.002). The duration of postoperative wound discharge was statistically significantly shorter in group B than in group A (P = 0.012). There was no statistically significant difference in the mean operating time, mean operation wound size, mean postoperative pain score, rate of surgical site infection and postoperative hospital stay between the two groups (P > 0.05). None of the patients in either group had recurrence or was found to have anal incontinence. No differences in the extent of adverse effects of surgery on the physical, social and sexual lives of the patients in the two groups. We conclude that in comparison to a fistulectomy, a fistulotomy with marsupialisation results in faster wound healing and a shorter duration of wound discharge and should therefore be recommended as a standard surgical procedure in the treatment of low fistula-in-ano.

Study on Traffic Flow Parameters Model of Expressway Interchanges Opening Distance

The operational safety and service quality of urban expressway are greatly affected by the distance of interchange opening. This paper definited the distance of 4 kinds of opening combination modes, showed the calculation models, and established a piecewise function model of opening distance, traffic volume and speed. It also proposed that, meeting the requirements of minimum distance, the opening distance should be determined with the consideration of actual road traffic conditions, by analyzing the relationship between the opening distance, traffic volume and speed. The results can be the references for the traffic management and the planning and designing of urban expressway interchange.

Functional outcome after different oncological interventions in head and neck cancer patients

Patient-reported outcomes following head and neck cancer are of great importance given the functional, psychological, and social impacts of the disease and its treatment. With an increasing number of publications on HRQOL following head and neck cancer and a growing awareness of the potential role of HRQOL in practice, it was our aim to investigate head and neck functional mobility that is often not taking into account in HRQOL scores. In this prospective study, three different groups of 32 patients each were included. Any patient who had histologically confirmed invasive OSCC in the anterior floor of the mouth was eligible. All patients were examined by a standardized test assessing function, including the distance of mouth opening, extension, flexion, and rotation of the head. A total of 96 patients were included in this study. The mean age was 62.79 ± 8.93 years. Head and neck mobility measured in patients is presented and analyzed. Compared to the baseline, a significant reduction of mouth opening and head and neck mobility was noted in all groups. Although both treatment options (surgery and surgery with radiotherapy) were performed according to the tumor stage of patients, there are significant differences in the functional outcome of these patients as observed in this study. There is a lack of a measuring instrument that will be the "gold standard" in the assessment of head and neck functional mobility. This study will allow the reflection of our current practice and may stimulate further well-designed prospective studies.

Neonatal injections of methoxychlor decrease adult rat female reproductive behavior

Methoxychlor (MXC), a commonly used pesticide, has been labeled as an endocrine disruptor. To evaluate the impact of neonatal exposure to MXC on female reproduction, female Sprague-Dawley rats were given subcutaneous injections on postnatal days 1, 3, and 5. The injections contained 1.0mg MXC, 2.0mg MXC, 10μg 17β-estradiol benzoate (positive control), or sesame oil (vehicle). The injections of MXC had no effect on anogenital distance or day of vaginal opening. Treatment with either 2.0mg MXC or estradiol significantly increased the total number of days with vaginal keratinization. Treatment with MXC had no effect on ability to exhibit a mating response as an adult female, although the high dose MXC (2.0) and the positive control (estradiol) animals demonstrated a decrease in degree of receptivity, a decrease in proceptive behavior and an increase in rejection behavior. These data suggest that higher doses of MXC given directly to pups during the neonatal period can act as an estrogen and alter aspects of the nervous system, impacting adult reproductive characteristics.

Occlusal force, electromyographic activity of masticatory muscles and mandibular flexure of subjects with different facial types

ObjectiveThe aim of this study was to evaluate whether vertical facial patterns influence maximal occlusal force (MOF), masticatory muscle electromyographic (EMG) activity, and medial mandibular flexure (MMF).Material and MethodsSeventy-eight dentate subjects were divided into 3 groups by Ricketts's analysis: brachyfacial, mesofacial and dolychofacial. Maximum occlusal force in the molar region was bilaterally measured with a force transducer. The electromyographic activities of the masseter and anterior temporal muscles were recorded during maximal voluntary clenching. Medial mandibular flexure was calculated by subtracting the intermolar distance of maximum opening or protrusion from the distance in the rest position. The data were analyzed using ANOVA followed by Tukey's HSD test. The significance level was set at 5%.ResultsData on maximum occlusal force showed that shorter faces had higher occlusal forces (P<0.0001). Brachyfacial subjects presented higher levels of masseter electromyographic activity and medial mandibular flexure, followed by the mesofacial and dolychofacial groups. Additionally, dolychofacial subjects showed significantly lower electromyographic temporalis activities (P<0.05).ConclusionWithin the limitations of the study, it may be concluded that maximum occlusal force, masticatory muscle activity and medial mandibular flexure were influenced by the vertical facial pattern.

Anography: a technique for determining the location of the internal opening in perianal fistula

Anography is a radiological investigation for fistula-in-ano that identifies the primary fistula track through the internal opening. The efficacy of anography as a radiological method of identifying the location of the internal opening was investigated. A retrospective study of 50 patients with a clinical diagnosis of fistula-in-ano of criptoglandular aetiology was performed. During anography, the location of the internal opening was recorded with respect to the quadrant of anal canal and distance from the anal verge. These data were compared with the findings during examination under anaesthesia (EUA), which was used as the gold standard for the identification of the internal opening. The sensitivity of anography for identifying a patent internal opening was 91% and specificity 100%. There was complete agreement between anography reports and findings at EUA regarding the quadrant of anal canal in which the internal opening was located. In more than 90% of patients, the internal opening was found at EUA within 1 cm from the site described on anography. Anography is an accurate test for predicting the exact quadrant of the anal canal in which the internal opening is located, as well as the distance of the internal opening from the anal verge. This inexpensive and simple radiological investigation should be the test of first choice in the evaluation of patients with fistula-in-ano when difficulty is anticipated in identifying the internal opening.

A preliminary study of jaw movement in Arrernte consonant production

This study presents jaw movement data from Central Arrernte, an Australian Aboriginal language with six places of articulation in the stop series, including four coronal places of articulation. The focus of the study is on jaw consonant targets, and on the opening and closing movements of the jaw. As a point of comparison, data are also presented for English, a language with three places of articulation in the stop series. In line with previous results for English, jaw position in Arrernte is lowest for the velar /k/. The apico-post-alveolar (retroflex) /ʈ/, which is not found in English, has a jaw position almost as low as /k/. By contrast, the lamino-alveo-palatal /c/, which is also not found in English, has the highest jaw position. The remaining coronal consonants in Arrernte, /t/ (apico-alveolar and lamino-dental, respectively), show intermediate jaw positions, with differences between speakers. In terms of the kinematic measures examined (namely, variability in distance, duration and velocity of opening and closing movements), results show no consistent differences between English and Arrernte jaw movement.

The distance of the main and auxiliary openings from the top of medial and distal root of the first lower permanent molar

The main prerequisite for a successful treatment of pulp disease in apex periodontium is knowledge of morphological characteristics of root canal system, especially one third of his apex. The aim of this work was to define the exact distance of the main and auxiliary openings from the top of medial and distal roots of the first lower permanent molars. Methods: as a research material it was used a hundred extracted first lower molars of the patients of both gender, divided into three age groups. The analysis of the one third of apex was done with the help of binocular magnifying glass and digital roentgenography analysis half of the samples, which were filed with capillary contrast. Results: The results obtained showed that the longest average distance of the main opening from the top of medial root was 0.84mm, and the shortest was 0.61mm; while for the distal root the longest average distance was 0.89mm, and the shortest was 0.62mm. Maximum distance of the auxiliary openings from the top of medial root in the first group was 3.5mm, and the maximum distance of the auxiliary openings from the top of distal root was 2, 5 mm. The results obtained with digital rentgenography showed that the longest average distance of the main opening from the top of medial root was the one noticed in the second age group (0.91mm) then the one from the first group (0,83), and the shortest one in the third age group (0,71mm); as for the distal root: the longest average distance of the main opening from the top of the root was noticed in the third age group (0,95mm) then in the first (0,90mm) and than shortest in the second age group (0,89mm). Conclusion: The distance of the main and auxiliary openings from the top of medial and distal root of the first lower molar varies in the range from 0 to 3,5mm and it depends on the tooth age. .

The distance of the main and auxiliary openings from the top of medial and distal root of the first lower permanent molar

The main prerequisite for a successful treatment of pulp disease in apex periodontium is knowledge of morphological characteristics of root canal system, especially one third of his apex. The aim of this work was to define the exact distance of the main and auxiliary openings from the top of medial and distal roots of the first lower permanent molars. Methods: as a research material it was used a hundred extracted first lower molars of the patients of both gender, divided into three age groups. The analysis of the one third of apex was done with the help of binocular magnifying glass and digital roentgenography analysis half of the samples, which were filed with capillary contrast. Results: The results obtained showed that the longest average distance of the main opening from the top of medial root was 0.84mm, and the shortest was 0.61mm; while for the distal root the longest average distance was 0.89mm, and the shortest was 0.62mm. Maximum distance of the auxiliary openings from the top of medial root in the first group was 3.5mm, and the maximum distance of the auxiliary openings from the top of distal root was 2, 5 mm. The results obtained with digital rentgenography showed that the longest average distance of the main opening from the top of medial root was the one noticed in the second age group (0.91mm) then the one from the first group (0,83), and the shortest one in the third age group (0,71mm); as for the distal root: the longest average distance of the main opening from the top of the root was noticed in the third age group (0,95mm) then in the first (0,90mm) and than shortest in the second age group (0,89mm). Conclusion: The distance of the main and auxiliary openings from the top of medial and distal root of the first lower molar varies in the range from 0 to 3,5mm and it depends on the tooth age. .

Occlusal phase of gum-chewing strokes.

The occlusal phase of chewing is especially interesting because food particles are being pulverized in this phase. For efficient chewing the upper and lower teeth must come together in a congruent fashion with less variation than in other phases. To examine this expectation the chewing motions of 28 women were recorded optoelectrically, and their frontal and sagittal angles of the closing and following opening strokes were measured at 3.0 mm (3-D linear distance) of opening. Closing strokes were more stable than opening strokes. The frontal angle was correlated with the sagittal angle during closing. The opening and closing sagittal angles were moderately correlated, and the opening and closing frontal angles were negatively correlated at the intersubject level. No direct association was found between the closing strokes and following opening strokes at the intra-subject level. These results suggest that closing strokes are more stable than opening strokes, resulting in efficient mastication.

顎関節症患者における上関節腔内麻酔後の時間経過がとう痛評価に及ぼす影響

Clinically, the location of pain in patients with temporomandibular disorders (TMD) is diagnosed by palpation and interview of the patient during mandibular movement. However, some patients cannot clearly indicate the location of the pain. Local anesthesia of the painful region described by the patient is often recommended to block nociceptors and to diagnose the source of pain. However, this method does not consider the time after anesthesia or infiltration of anesthesia into the surrounded tissue with the passage of time.Aims: The aim of this study was to investigate the influence of the time after superior joint cavity anesthesia on the evaluation of pain in patients with unilateral TMD who have both temporomandibular joint (TMJ) and musculature pain.Methods: Thirty-five patients (aged 14-75 years) who had TMD with unilateral TMJ and musculature pain were included. Lidocaine was injected directly into the superior cavity. A set of 13 tests was performed before anesthesia, and 1 and 5 minutes after anesthesia: 3 muscle palpation tests, 2 TMJ palpation tests, 6 comprehensive pain tests, and 2 other evaluations.Results: The pain of the muscle and TMJ significantly decreased in response to joint anesthesia. Joint anesthesia did not affect the results of muscle palpation tests in 14% to 39% of the patients, those of TMJ palpation tests in 29% to 36% of the patients, and those of comprehensive pain tests in 32% to 50% of the patients 1 minute after anesthesia. However, these tests showed no significant pain between 1 minute and 5 minutes after anesthesia except for two of the comprehensive pain tests (chin compression and the distance of mouth opening without pain). Numbness of the front of the pinna, used as an index of the infiltration of anesthetic into the surrounding TMJ, did not differ significantly between before anesthesia and 1 minute after anesthesia, but increased significantly 5 minutes after anesthesia.Conclusion: Tests designed to locate the source of pain in TMD by the direct injection of an anesthetic into the superior cavity should be carried out 1 minute after anesthesia, before the anesthetic has infiltrated into the surrounding tissue.

Where does the vocal tract end?

During rounded vowels the outer end of the vocal tract may be modeled as an ellipse in the plane perpendicular to the midline. But in other vowels the termination of the vocal tract has a more complex shape because the corners of the lips are not in the same plane as the opening in the midline. in order to investigate appropriate ways of modeling lip actions, three trained subjects were recorded and photographed while saying pairs of vowels such as [i, y; e, ø; Ɯ, u]. In saying each pair subjects took care to hold the tongue position steady and to move only the lips. For each of the rounded vowels a computer model was set up with the observed lip opening and the vocal tract shape that produced the best match to the observed formant frequencies. With this vocal tract shape maintained, the lip opening was then set to that observed in the corresponding unrounded vowel. By varying the distance of the lip opening from the glottis, a program found the best acoustic match to the unrounded vowel. The results indicate the way in which the apparent location of the termination of the vocal tract varies with lip opening.

Contiguity to male fetuses influences ano-genital distance and time of vaginal opening in mice

Female mice located in utero adjacent to 2 male fetuses had longer ano-genital distances and exhibited vaginal opening later than did females proximate to no male fetuses. Females adjacent to one male fetus were intermediate on both measures.