Significant Differences In Visibility Research Articles

Comparison of WALANT versus locoregional nerve block in staged bilateral endoscopic carpal tunnel release

BackgroundCarpal tunnel release can be performed as open or endoscopic surgery. In WALANT (wide awake local anesthesia no tourniquet) a tourniquet is not used, ensuring less discomfort for the patient. In locoregional distal nerve block, on the other hand, a tourniquet is needed and can be painful. This raises the question as to which method of anesthesia is actually preferred for the patient and the surgeon. Patients undergoing staged bilateral carpal tunnel release present a unique opportunity to study this question. MethodsFifteen patients were included in this prospective study. The primary endpoint was the preference for anesthesia type in patients and surgeons. Surgeon preference was based on the visibility and fluency of the procedure. Secondary endpoints for patients comprised pain scores for performing surgery and anesthesia and pain caused by the tourniquet. ResultsBaseline demographic and clinical information was collected. There was no significant difference in pain for performing local anesthesia or surgery. Surgeons may find that performing endoscopic release under WALANT is more challenging, as visibility tends to be significantly poorer. The mean pain caused by the tourniquet used during the wrist block procedure was rated as 3.6. In both surgeries, 77% (10/13) of the patients preferred the WALANT anesthesia. ConclusionIn general, endoscopic carpal tunnel release was better tolerated under WALANT than locoregional distal nerve block. Although statistical analysis showed no significant difference in visibility and fluency for the surgeon between the two anesthesia techniques, we do not recommend endoscopic release under WALANT due to the consistent report of reduced visibility in the surgical field. This limitation, likely related to the presence of anesthetic fluid, may have failed to reach statistical significance due to small sample size, but is nevertheless a considerable challenge in practice. Level of evidence1B.

Safety and efficacy of autologous blood tattooing for preoperative colonic localization: a comparative study with conventional India ink tattooing.

India ink has been a popular choice for a tattooing agent in preoperative endoscopic localization but often results in unfavorable effects. Subsequently, autologous blood tattooing has arisen as an alternative option. Due to the limited availability of comparative studies on the matter, we conducted a study to compare the perioperative outcomes associated with India ink tattooing versus autologous blood tattooing. A total of 96 patients who underwent minimally invasive surgical procedures for left-sided colonic neoplasm following preoperative endoscopic localization were included in the study. These patients were categorized into two groups: 36 patients who received India ink tattooing and 60 patients who underwent autologous blood tattooing. The perioperative outcomes including procedure-related outcomes and postoperative outcomes were compared between the two groups. There was no significant difference in visibility and spillage of tattooing agent between India ink group and autologous blood group. However, India ink group showed a higher incidence of post-tattooing fever, higher level of postoperative C-reactive protein level, longer time to first flatus, resumption of surgical soft diet, and duration of hospital stay, and a higher occurrence of postoperative complications including ileus and surgical site infection compared with the autologous blood group. In the multivariate analysis, India ink tattooing was significantly associated with the occurrence of postoperative complications. In the subgroup analysis involving patients with intraperitoneal spillage, the autologous blood group demonstrated significantly favorable perioperative outcomes compared with India ink group. Autologous blood tattooing demonstrated comparable visibility and enhanced safety, establishing it as a potential alternative to India ink for preoperative endoscopic localization.

All along the Watchtower: Visibility analysis on Bronze Age Sardinian megalithic landscapes

In the present paper, the authors present the results of a GIS based analysis on the relationship between Sardinian nuraghi, megalithic dry stone buildings that represent the most common typology of monuments during the 2nd and the first centuries of the 1st millennium BC, and their landscape in terms of visibility. The adopted methodology focuses on the total viewshed concept, as a basic metric to assess visual properties. Four different Sardinian sub regions (Sinis, Siniscola, Marmilla, and Dorgali) and their nuraghi have been considered into the analysis, representing a significant – albeit partial – sample of the variability in locational choices found across the island. Results highlight a widespread interest in visibility from and to nuraghi, with the exception of the Sinis Peninsula, where nuraghi do not seem to act as landmarks. Moreover, no significant differences in visibility have been found between simple and complex nuraghi, while visibility data for nuraccheddus (generally considered to be unfinished nuraghi towers) seems to be compatible with a marginal landscape-level role.

Clinical Evaluation of Single-Use, Fiber-Optic, and Digital Ureterorenoscopes in the Treatment of Kidney Stones

Introduction: Indication of ureteroscopy for the treatment of urolithiasis has expanded immensely over the last decade. Fiber-optic and digital reusable instruments present the standard in clinical practice, but various newly available single-use devices might offer an exciting alternative. To date, the evidence is limited to clinical evaluation and efficacy of single-use ureteroscopes (URS) compared to standard instruments. Therefore, we evaluate a single-use instrument’s clinical characteristics and efficacy in direct comparison with a fiber-optic and digital device. Methods: A prospective study was conducted for patients undergoing endoscopic therapy for urolithiasis at a tertiary care center. We evaluated the different instruments’ clinical performance in categories of visibility, the stability of visibility, irrigation flow, and surgeon’s satisfaction. Statistical analyses were performed by SPSS using the Chi-Quadrat and Kruskal-Wallis test. A p value of p ≤ 0.05 was defined as statistically significant. Results: A total number of 77 patients were included and distributed as follows: 35 (46.7%) single-use, 19 (25.3%) digital, and 23 (28%) fiber-optic URS. Patients’ characteristics were homogenous over the three cohorts in sex, stone amount, and localization. The stone-free rate was equal in all three cohorts (p = 0.31). We identify stability of visibility, irrigation flow, and satisfaction were equal in all cohorts (p = 0.73; p = 0.20; p = 0.20). We report a significant difference in visibility, with 100% rated excellent in the digital URS group (p = 0.028). Discussion/Conclusions: Single-use URS achieve comparable clinical outcomes with equal stone-free rates in direct comparison with fiber-optic and digital reusable instruments. Accordingly, single-use devices present an adequate alternative for endoscopic therapy of urolithiasis.

Spatial Variability of Lower Tropospheric Visibility and Meteorology of Urban centers in Nigeria

The study analyzed the spatial variability of atmospheric visibility and meteorological parameters over selected cities in Nigeria. This study employed the use of secondary data which includes a 36 years (1982-2017) visibility, rainfall, relative humidity, windspeed and temperature data which was gotten from the weather register of the selected meteorological stations. Descriptive statistics, analysis of variance (ANOVA) and student t-test were employed in the analysis of data. Research findings revealed that revealed that the coastal cities witnessed better visibility than the northern part of the study area especially during the dry season. The Analysis of Variance (ANOVA) revealed statistically significant variation in visibility, temperature, rainfall, relative humidity and windspeed at 95% probability level across the selected locations. The student t-test statistics also revealed that a statistically significant difference in visibility, rainfall, windspeed and relative humidity occurs between the wet and dry seasons in most of the selected cities. The study recommends that awareness campaigns and enlightenment programmes be undertaken by various meteorological authorities and other relevant government agencies to improve the awareness of members of the public on the need to adhere strictly to weather alerts and warning systems.

A prospective pilot study: Can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?

Magnetic resonance cholangiopancreatography (MRCP) could aid in the diagnosis of biliary atresia, a hepatic pathology with thin, irregular or interrupted biliary ducts. There is little published evidence of MRCP appearances in normal neonates and young infants. To assess the use of MR cholangiopancreatography in visualizing the biliary tree in neonates and infants younger than 3 months with no hepatobiliary disorder, and to assess this visibility in relationship to the child's age, weight, and sedation and fasting states. Between December 2008 and October 2010 our department performed MRI of the brain, orbits and face on 16 full-term neonates and infants. Each child was younger than 3 months (90 days) and without any hepatobiliary disorders. The children were scanned with a respiratory-gated 0.54 × 0.51 × 0.4-mm(3) 3-D MRCP sequence. We used a reading grid to assess subjectively the visibility of the extrahepatic bile ducts along with extrahepatic bile duct confluence. The visibility of the extrahepatic bile duct confluence was assessed against age, weight, and sedation and fasting states. The extrahepatic bile duct confluence was seen in 10 children out of 16 (62.5%). In the neonate sub-group (corrected age younger than 30 days), the MRCP was technically workable and the extrahepatic bile duct confluence was seen in four cases out of eight (50%). This visualization was up to 75% in the subgroup older than 30 days. However, statistically there was no significant difference in visibility of the extrahepatic bile duct confluence in relationship to age, weight or MRCP performance conditions (feeding, fasting or sedation). The complete normal biliary system (extrahepatic bile duct confluence included) is not consistently visualized in infants younger than 3 months old on non-enhanced MRCP. Thus the use of MRCP to exclude a diagnosis of biliary atresia is compromised at optimal time of surgery.

Benchmarking Malaysian Youth Work Practitioner Ethics

AbstractEthics are a core component of professionalism in youth work, and yet little research has been done in this area. Given the growing demand for greater standards of youth work, there is an urgent need for research in work ethics among contemporary youth development workers. The current self-administered survey was designed to investigate self perception in the area of work ethics among 813 government and non-government youth workers from Malaysia. The results showed that the samples fared well in terms of ethics as defined by respect for others, responsibility, and honesty, with respect for others more pronounced than the other two. Comparative analysis by selected personal attributes revealed significant differences in visibility of these three areas of ethical behaviour. Recommendations for work ethics training and development are discussed.

SU‐GG‐I‐53: The Impact of Scan Angles On the Visibility of Anatomy in On‐Board Digital Tomosynthesis (DTS) Images for Head and Neck Cancer Patients: A Single‐Observer Study

Purpose: To assess the impact of scan angles on the visibility of anatomy in on‐board digital tomosynthesis (DTS) images as a means to optimize this technique. Method and Materials: Head and neck cancer patients undergoing intensity‐modulated radiotherapy (IMRT) were enrolled onto this study. For each session, the patient was positioned using laser marks. On‐board imaging data sets including CBCT scans as reference, and DTS with 20° and 40° scan angles in the coronal or sagittal directions, respectively, were obtained. Visibility of selected anatomic structures (1=much better, 2=slightly better, 3=comparable, 4=slightly worse, 5=much worse) were assessed by a single observer. Wilcoxon Signed Ranks Test was performed to analyze the statistical significance. Results: Image data sets were collected from 30 treatment fractions for 12 patients. Overall, in coronal direction, there was no statistically significant difference in visibility between the DTS scan angles of 20° and 40° for base of tongue and cervical vertebral body (p = 0.083, 0.157, respectively), except for thyroid cartilage (p =0.025). In sagittal direction, only the hyoid was found to have a statistically significant difference in visibility (p = 0.025), while no significant difference was found for the rest of anatomic structures (p = 0.317, 0.157, 0.317 for base of tongue, cervical vertebral body, and epiglottis, respectively). However, when assessments for multiple fractions were averaged, no statistically significant difference was found for all anatomic structures in either coronal or sagittal directions. Conclusion: This single‐observer study shows that visibility of anatomy is roughly equal for the scan angle of 40° than 20° in both coronal and sagittal direction. Due to the limitations of single‐observer study, more definitive conclusion could not be drawn. Further analysis with a multiple‐observer study of more patients is needed to confirm this preliminary result.

The effects of phacoemulsification on intraocular pressure and ultrasound biomicroscopic image of filtering bleb in eyes with cataract and functioning filtering blebs

To evaluate the effects of phacoemulsification on intraocular pressure (IOP) and ultrasound biomicroscope (UBM) images of filtering bleb in eyes with cataract and a previous functioning filtering bleb. The IOPs and UBM images of filtering bleb of 24 patients (27 eyes) who underwent phacoemulsification after successful trabeculectomy were recorded at each follow-up examination and at the 12 months after phacoemulsification, respectively. Preoperative IOP and two parameters of the UBM images, including visibility of a route under the scleral flap and reflectivity inside the bleb were evaluated for an association with postoperative success rate using Kaplan-Meier survival analysis. The mean IOP increased 5.50, 3.85, 3.11, 3.05, 2.79, and 2.58 mmHg after 1 day, 1 week, 1, 3, 6, and 12 months, and it was significantly higher than the preoperative IOP (P=0.000, 0.000, 0.000, 0.000, 0.000, and 0.000 respectively). There was no statistically significant difference in visibility of the route under the scleral flap and reflectivity inside the bleb before and after phacoemulsification (P=0.398, 0.096). An IOP greater than 10 mmHg, a bleb with an invisible route under the scleral flap and stronger intrableb reflectivity before phacoemulsification were associated with postoperative antiglaucomatous failure (P=0.025, 0.000, and 0.000 respectively). Phacoemulsification significantly increased IOP, but had less effect on intrableb features in UBM image. Eyes with higher IOP, invisible route under scleral flap and stronger intrableb reflectivity in UBM image before phacoemulsification had greater postoperative antiglaucomatous failure.

Parallel imaging technique for the external carotid artery and its branches: Comparison of balanced turbo field echo, phase contrast, and time‐of‐flight sequences

To evaluate the parallel imaging technique in the external carotid artery and its branches using 3D balanced turbo field echo (3D bTFE), 3D phase-contrast (3D PC), and 3D time-of-flight (3D TOF) MR angiography (MRA) sequences. A total of 26 healthy volunteer subjects underwent 3D bTFE, 3D PC, and 3D TOF MRA with the parallel imaging sensitivity encoding (SENSE) technique. The obtained images were read in a blinded fashion by three radiologists. Interreader and intersequence statistical analyses were performed to compare the visibility of the arteries. Friedman's ranking test demonstrated that there was no significant difference in visibility between any two pairs of sequences for the external carotid artery and its first branches. However, of the three techniques, 3D PC MRA performed the best for the second-order branches (P < 0.01) and for overall visibility of the external carotid artery and its branches (P < 0.01). The 3D bTFE sequence is superior to 3D TOF; however, an effective means of separating arteries from veins and salivary ducts is needed. The combination of parallel imaging and the 3D PC technique is a promising approach for face and neck MRA.

Abdominal spiral CT in children: which radiation exposure is required?

We decided to test to what extent dose reduction is possible in abdominal spiral computed tomography (CT) in young children without loss of anatomic diagnostic information. A retrospective study was performed of 30 abdominal CT examinations of children aged 3 months to 7 years. These were divided into two groups: group A with reduced radiation exposure (tube current 50 mA, CT dose index CTDIFDA < or =0.83 mGy) and group B with standard radiation exposure (tube current > or =100 mA, CTDIFDA > or =1.66 mGy). Image quality was assessed using a four-part scale ('excellent', 'good', 'sufficient', 'poor') on visual image impression and visibility of 32 anatomical details. Five experienced radiologists read the CT scans independently who were blinded to the examination parameters. Differences in ranked data were evaluated with Wilcoxon's rank sum test. No difference between groups A and B was observed in visual image impression. Detail visibility was significantly lower in group A, but the differences were limited to right upper quadrant structures (portal vein, common bile duct, pancreatic head, adrenals) and to arterial branches. Significant differences in visibility rated as 'poor' were only found for the hepatic, splenic and renal arteries; all other structures showed no difference between groups A and B. A protocol with reduced radiation exposure (50 mA, CTDIFDA < or =0.83 mGy) allowed the demonstration of most anatomic structures in abdominal spiral CT in young children. For the precise demonstration of small details (e.g. structures of the right upper quadrant), a protocol with standard radiation exposure (> or =100 mAs) was superior.

Doppler sonography of the deep lingual artery.

To clarify the Doppler sonographic features of the lingual artery in normal subjects and to evaluate those of patients with cancer of the tongue. Sixty-seven volunteers and 12 patients with cancer and/or leukoplakia of the tongue were examined with an intraoral sonographic probe. The visibility of the deep lingual artery was determined on transverse and anteroposterior images. On the transverse images, the vascular index, which was defined as the number of colored pixels, was measured on bilateral lingual arteries. Thereafter, the degree of symmetry was evaluated for normal subjects and patients. In normal subjects, between younger and older volunteers, there were no significant differences in visibility of the trunk but differences were found between the two groups for the dorsal branches. The vascular indices of the right and left sides were not different. The characteristic Doppler sonographic feature was vasculature in and around the tumors in the patients with cancer of the tongue. The symmetry indices of the cancer patients were significantly different from those of normal subjects. Doppler sonography should be an important procedure for evaluation of tongue neoplasms.

DOPPLER SONOGRAPHY OF THE DEEP LINGUAL ARTERY

To clarify the Doppler sonographic features of the lingual artery in normal subjects and to evaluate those of patients with cancer of the tongue. Sixty-seven volunteers and 12 patients with cancer and/or leukoplakia of the tongue were examined with an intraoral sonographic probe. The visibility of the deep lingual artery was determined on transverse and anteroposterior images. On the transverse images, the vascular index, which was defined as the number of colored pixels, was measured on bilateral lingual arteries. Thereafter, the degree of symmetry was evaluated for normal subjects and patients. In normal subjects, between younger and older volunteers, there were no significant differences in visibility of the trunk but differences were found between the two groups for the dorsal branches. The vascular indices of the right and left sides were not different. The characteristic Doppler sonographic feature was vasculature in and around the tumors in the patients with cancer of the tongue. The symmetry indices of the cancer patients were significantly different from those of normal subjects. Doppler sonography should be an important procedure for evaluation of tongue neoplasms.