Usable Length Research Articles

Modified basilic vein transposition surgery for vascular access: Lengthening the basilic vein.

Basilic vein transposition (BVT) surgery is a crucial option for vascular access in hemodialysis patients when other alternatives are unavailable. One of the primary complications affecting the long-term function of arteriovenous fistulas (AVFs) is the development of pseudoaneurysms, often caused by repeated punctures at the same site. This study aims to evaluate whether increasing the length of the basilic vein available for cannulation during the second stage of BVT surgery reduces the risk of puncture-related pseudoaneurysms, thereby improving fistula longevity and functionality. We selected 39 hemodialysis patients unsuitable for cephalic vein AVF creation or who had failed brachiocephalic fistulas. Eligibility criteria included a basilic vein diameter of more than 2.5mm with appropriate venous anatomy confirmed via ultrasound. In the first stage of surgery, the median basilic vein was anastomosed to the superior surface of the brachial artery. One month later, once the vein had matured (diameter ≥4mm), a second stage was performed, which involved liberating an extended segment of the basilic vein down to the forearm. The basilic vein was then anastomosed end-to-end with the median basilic vein to increase the cannulation area. Patients were followed for 1year to evaluate outcomes. All 39 patients successfully underwent the modified BVT technique. Over the 1-year follow-up period, none experienced significant AVF complications, particularly pseudoaneurysm formation. By increasing the usable length of the basilic vein for cannulation, multiple puncture sites were available, reducing the risk of repeated needle insertions at the same site. The modified BVT technique shows promise in reducing the risk of pseudoaneurysm formation and improving AVF patency, potentially enhancing the longevity and functionality of AVFs in hemodialysis patients. Further studies are necessary to confirm the efficacy of this technique in larger patient populations.

Liposuction for Superficialization of Deep Hemodialysis Vascular Access: A Novel Application.

More than 65% of patients with end-stage renal disease (ESRD) use arteriovenous fistulas (AVFs) for hemodialysis. The increasing incidence of comorbid ESRD and obesity (body mass index, >35 kg/m2) precludes patients from kidney transplantation, resulting in a need for long-term, durable AVF access. Compared with traditional superficialization techniques for overlying adiposity, liposuction is minimally invasive and well-tolerated, allowing for earlier fistula use with lower complications. We present the detailed surgical technique for superficialization of AVFs using liposuction. Fourteen patients with well-matured but difficult-access fistulas due to adiposity were selected. Preoperative ultrasound mapped depth of fistulas. Tumescent liposuction was completed in a cross-hatched manner. Intraoperative ultrasound confirmed cannula positioning and measured fistula depth. A palpable thrill remained throughout superficialization. Cannulation began 4 weeks postoperatively. Mean access depth preoperatively was 10.8 mm (8-15 mm), immediately postoperative was 7 mm (6-9 mm), and at 4 weeks was 5.3 mm (4-8 mm). The average usable access length was 12.7 cm (10-15 cm) after surgery. Thirteen fistulas were successfully accessed after liposuction superficialization. All patients were discharged home the same day. There were no postoperative infections or hemorrhage. Early experience with liposuction for superficialization of deep hemodialysis access is promising. This innovative solution has the possibility to improve outcomes and quality of life for patients living with ESRD and obesity. Our experience shows that this is a safe and effective technique to increase patient eligibility, enable successful and early cannulation, and decrease recovery time.

A critical assessment of the onset strain of densification in the evaluation of energy absorption for additively manufactured cellular materials

A critical assessment of the onset strain of densification in the evaluation of energy absorption for additively manufactured cellular materials

Towards reducing the capital cost of manufacturing Laminated Veneer Lumbers: Investigating finger jointing solutions

Towards reducing the capital cost of manufacturing Laminated Veneer Lumbers: Investigating finger jointing solutions

Urethral length and its relationship with anthropometric parameters in adult male Nigerians

BackgroundThe available literature on urethral length in adult males is limited. To the best of our knowledge, such measurement has never been carried out amongst Nigerian and African men. This study aimed to document average urethral length as well as the relationship between urethral length and age, and anthropometric parameters amongst the Nigerian male adult population to add to the database for urethral length.MethodsIt was a prospective cross-sectional study amongst adult male Nigerians who had an indication for urethral catheterization as part of their regular treatment at the urologic clinics as well as male adult patients who required urethral catheterization in the theatre and the wards for various reasons. All patients had anthropometric parameters measured or calculated. The total usable length (A) of the catheter was measured before catheterization and the unused catheter length (B) was measured after catheterization for each patient. The calculated urethral length (C) was obtained by subtracting B from A. Data were analyzed using SPSS version 26.0. Mean urethral length was determined while the correlation between urethral length and age as well as anthropometric parameters were determined using Pearson Correlation.ResultsA total of 450 adult males were recruited. The mean age of subjects was 63.58 years with a range of 22–91 years. The average total usable and unused catheter lengths were 30.01 and 8.97 cm respectively. The mean urethral length among participants was 21.32 cm (8.4 Inches) with a range of 16.5 to 28 cm (6.5–11.0 Inches). There were no statistically significant correlations between urethral length and age ([r (450) = − 0.029, p = 0.546]) as well as with anthropometric parameters (height: r (450) = − 0.088, p = 0.61; weight: [r (450) = − 0.047, p = 0.324 and BMI: r (450) = − 0.082, p = 0.08) in adult males.ConclusionThis study suggests that there may be racial differences in adult male urethral length but no relationship with age and anthropometric parameters. Further research is needed to explore these findings.

Letter: Transradial Flow-Diverting Stent Placement Through an Arteria Lusoria: 2-Dimensional Operative Video.

To the Editor: We read with great interest the article “Transradial Flow-Diverting Stent Placement Through an Arteria Lusoria: 2-Dimensional Operative Video” by Hackett et al.1 The authors present a case of a patient with an arteria lusoria who received effective flow-diverting stent therapy for a large left internal carotid artery (ICA) aneurysm using a large bore guide catheter through right transradial access (TRA). Diagnostic angiography showed that the left ICA could be accessed through the right TRA. A 6F radial sheath was introduced into the right radial artery, and the sheath was then exchanged over a 0.035″ guidewire for an 8F 90-cm guide catheter (Infinity; Stryker Neurovascular). After navigating a 5F 130-cm Simmons catheter into the left common carotid artery through the arteria lusoria, the 8F guide catheter was delivered into the left ICA using the telescoping technique. The large left ICA-ophthalmic artery aneurysm was successfully treated with a pipeline embolization device (Medtronic). The importance of evaluating transradial diagnostic angiography to determine whether a catheter system can safely track into the target supra-aortic vessels is critical for successful transradial neurointervention in patients with arteria lusoria, and we wholeheartedly concur with the authors' conclusion on this point. Cannulation into the supra-aortic vessels through right TRA can be extremely challenging in patients with arteria lusoria because of unfavorable catheter trajectory.2 In addition, the right TRA can cause fatal arteria lusoria dissection.3 Therefore, transfemoral access is frequently employed as first-line access if neurointerventionalists encounter arteria lusoria.2 Previous study reported that left TRA is a technically feasible alternative in neurointerventions for patients with arteria lusoria.4 Nevertheless, a guide catheter may result in a failed TRA that necessitates a crossover to transfemoral access because of a failed cannulation, a kinked catheter, or an unstable system. We have used transradial access as the first-line access for neurointerventions.5-18 The first-line TRA using a 6F preshaped Simmons guiding sheath (outer diameter, 2.70 mm; inner diameter, 0.088″; usable length, 90 cm; 6F Axcelguide Stiff-J; Medikit) offers a large bore working channel and a high procedural success rate without catheter kinking or system instability even in patients with an unfavorable steep supra-aortic take-off.5-7,13 The 6F Simmons guiding sheath is fully engaged into the target common carotid artery with a pull-back maneuver (the pull-back technique) after reforming the Simmons curve within the ascending aorta. The Simmons curve can be reformed by anchoring the 6F Simmons guiding sheath to the descending aorta (the descending aorta anchoring technique) or contralateral subclavian artery (the subclavian artery anchoring technique) through the left TRA. Transradial carotid cannulation with the pull-back technique is technically simple and promising. As a result, left TRA with the 6F Simmons guiding sheath can be a beneficial treatment choice for performing anterior circulation procedures in patients with arteria lusoria. Finally, we would like to express our appreciation to the authors for their interesting article that advances the transradial neurointerventional method.

Turnover Tendon Lengthening Does Not Alter Biomechanical Strength of Pronator Teres-to-Extensor Carpi Radialis Brevis Tendon Transfer.

The pronator teres (PT) to extensor carpi radialis brevis (ECRB) tendon transfer reestablishes wrist extension. Occasionally, the PT periosteal extension is of suboptimal quality to support a strong transfer. In these instances, turnover lengthening techniques can increase usable tendon length. This study characterized the optimal length of tendon turnover and the effect of lengthening on transfer strength. Twenty-seven cadaveric extensor tendons were lengthened using the turnover lengthening technique with 1 to 3 cm of tendon overlap. PT-to-ECRB tendon transfers were performed with native or lengthened ECRB tendons. Tensile testing was used to evaluate stress relaxation and load to failure. The median maximum load to failure increased with increasing overlap length, measuring 35.6 N (quartile 1, 30.2 N; quartile 3, 38.6 N) for 1 cm, 66.0 N (quartile 1, 59.1 N; quartile 3, 74.7 N) for 2 cm, and 96.6 N (quartile 1, 85.9; quartile 3, 114.9 N) for 3 cm of overlap ( P < 0.05). Failure occurred most frequently at the junction of the central overlap and native tendon. Tendons lengthened with 2 and 3 cm of overlap displayed greater stiffness than those with 1 cm ( P < 0.05). Lengthening the ECRB tendon with 2 or 3 cm of overlap did not disrupt the strength or stiffness of subsequent PT-to-ECRB tendon transfers. Turnover tendon lengthening does not detrimentally affect PT-to-ECRB tendon transfer. Greater overlap lengthening distance confers greater stiffness and resistance to rupture. When the periosteal extension of the PT tendon avulses or is of poor quality, the ECRB tendon can be lengthened using the turnover tendon lengthening technique to facilitate a robust transfer.

Consensus on Triple Endoscopy Data Elements Preparatory to Development of an Aerodigestive Registry.

This study defines essential data elements to be recorded during an aerodigestive "triple endoscopy" to form the foundation of a standardized multicenter registry and to clearly define measurement of each consensus item. Modified Delphi process. Modified Delphi consensus with six survey rounds. Twenty-four expert pediatric otolaryngology, pulmonology, and gastroenterology aerodigestive clinicians from eight large academic pediatric aerodigestive programs formed the Delphi panel. After achieving consensus through the Delphi process, outside validation was performed at 2019 national Aerodigestive Society conference. Consensus, near-consensus, or exclusion was obtained for each proposed data element. Concordance was then measured between expert panel conclusions and validation group conclusions. Overall response rate was 94.4%. 73/167 proposed items reached consensus in six domains (flexible bronchoscopy, bronchoalveolar lavage, microdirect laryngoscopy and bronchoscopy, esophagogastroduodenoscopy with biopsies, and esophageal impedance and pH probe). Measurement of all items was defined; classification/grading systems were selected for 11 items. Validation group endorsed importance of 82/167 data items; compared to expert consensus, overall, inclusion, and exclusion concordance rates were 94.5%, 98.7%, and 90.9%. Triple endoscopy is a central component of aerodigestive care. This study identifies and defines data elements to be recorded for all triple endoscopy procedures. The list is of usable length, and clear definitions were created for all items, with explicit classification/grading systems selected for 11 items. Face validity was confirmed with an independent multispecialty sample of aerodigestive providers. This consensus provides the foundation for a triple endoscopy registry but also is immediately applicable to standardize clinical documentation in aerodigestive care. 5 Laryngoscope, 132:2251-2258, 2022.

Evaluating CO2 capture performance by adsorption using synthesized and commercial activated carbon

ABSTRACT The rising levels of pollutants has provoked the search for advanced technologies to minimize their effect on environments. The continuous adsorption column is applied to study CO2 adsorption using two types of adsorbents. The commercial activated carbon Norit-RB2 and developed activated carbon from economic date stone are utilized for the adsorption study. The morphological and surface characteristics have been examined by BET analyzer and scanning electron microscope. The effect of flow rate, temperature, and initial adsorbate volume on breakthrough performance has been investigated. The effectiveness of the CO2 capture was examined in terms of adsorbate capacity, column efficiency, usable bed length, LMTZ, and utilization factor. The very steep adsorption profiles specify acceptable adsorbent uptake utilization under a breakthrough state. The CO2 loading of 1.66 mmol/g was reached with a column efficiency of 94.9% for biomass-derived adsorbent at 298 K temperature. The lower CO2 loading of 0.99 mmol/g and column efficiency of 92.8% have been determined for commercial activated carbon. The reduced LMTZ equal 1.29 cm and enhanced f equals to 0.974 at 298 K and Co = 5% are observed for the biomass-derived adsorbent. The findings acclaim that activated carbon derived from date pits is decidedly promising to capture CO2 by adsorption.

A cadaveric morphometric analysis of coracoid process with reference to the Latarjet procedure using the "congruent arc technique".

Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population. 44 shoulders were dissected in 24 cadavers to measure usable length of coracoid process, width, height, ROC of coracoid and glenoid as well as ulnar length (as proxy of cadaver height). Critical coracoid height and length were estimated based on screw sizes of 2.7mm, 3.5mm, 4mm and 4.5mm, and pair concordance between height and length calculated. ROC of coracoid and glenoid were compared to measure extent of congruency. The mean usable length of coracoid process, width and height at mid-point were 21.8mm, 13.7mm and 8.6mm, respectively. Out of the different screw sizes, 2.7mm screws were found safe in 82% shoulders. 24 coracoid-glenoid pairs fulfilled the operational definition (≤ 5mm) of congruency while rest 20 were seemingly incongruent chiefly due to coracoid variations, with mean ROC difference 4.13mm (95% CI 1.51-6.74mm). The ulnar length was significantly smaller in the incongruent ROC group (p = 0.0002). The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.

Inventory constrained design of a timber funicular structure

This research investigates the development of a digital form finding model that combines the generation of funicular geometry with a material inventory constraint. The model provides a flexible design tool that facilitates exploration of structural form whilst simultaneously satisfying two rationalizing criteria. It maintains an equilibrated structure derived from funicular geometry; and optimises the assignment of a unique inventory of timber members having natural dimensional variation. The combined goal for the design outcome is to achieve material efficiency through both structurally rational form and minimization of material waste. The material chosen for the inventory is utility-grade sawn timber, being lightweight but with high levels of naturally occurring structural variability. Sawn timber boards that are rejected for structural applications due to frequent structural defects (knots, checks, splits etc.) represent up to 50% of the sawn product produced by Australian sawmills, and are destined for under-valued non-structural use, chipping or burning. Yet these boards can readily yield usable short length structural members, once defects are removed. In doing so, the process creates a unique inventory of random short members. These short members are well suited to articulated structures, which, by employing an inverted funicular geometry, only incur axial stresses and can employ simple (non-moment resisting) timber connections. This form finding tool and a first prototype pavilion are proofs of concept for viable structural application of what is otherwise a significant source of waste in the timber industry.

Liposuction used to treat deep vascular accesses for hemodialysis.

Oftentimes, obese dialysis patients develop a viable dialysis access but the access is too deep for cannulation and needs a superficialization procedure. We present our 14-patient cohort in whom we performed liposuction to superficialize viable but deep vascular accesses. Out of 14 patients, 12 had arteriovenous fistulas and 2 arteriovenous grafts. The primary end points were the ability to superficialize a completely unusable access and to remove the hemodialysis catheter (3patients), or to significantly extend the useful length of a deep access in which only a very short segment was used and to continue to use the access post-surgery without the need to place a dialysis catheter (11 patients). The study goal was met in 13 out of 14 patients. In two of three patients, the catheters were removed and their access usable length was 14 and 13 cm, respectively. The accesses could be used immediately after liposuction in all patients in which this applied-11 patients. The usable access length increased from a mean of 5 to 12.7 cm. The access mean depth decreased from 10.8 mm pre-surgery to 7 mm post-surgery and 5.3 mm 4 weeks after surgery. The mean volume of fat removed was 43.8 cc. We had only one surgical complication: bleeding that was readily controlled with manual pressure. All patients were discharged to home the same day. Postoperative pain was mild. Liposuction is effective, safe, and seems to be the least invasive technique of superficialization.

The Roles of Vehicle Seat Cushion Stiffness and Length in Child Restraint System (CRS) Performance

&lt;div class="section abstract"&gt;&lt;div class="htmlview paragraph"&gt;The objective is to determine whether responses and injury risks for pediatric occupants in child restraint systems (CRS) are affected by vehicle seat cushion stiffness and fore/aft cushion length. Eighteen sled tests were conducted using the Federal Motor Vehicles Safety Standard (FMVSS) 213 frontal pulse (48 km/h). Seats from a recent model year vehicle were customized by the manufacturer with three different levels of cushion stiffness: compliant, mid-range, and stiff. Each stiffness level was quantified using ASTM D 3574-08 and all were within the realistic range of modern production seats. The usable length of each seat cushion was manipulated using foam spacers provided by the manufacturer. Two different seat lengths were examined: short (34.0 cm) and long (43.5 cm). Three different types of CRS were tested with size-appropriate anthropomorphic test devices (ATDs): rear-facing (RF) CRS with 12-month-old CRABI, forward-facing (FF) CRS with Hybrid III 3-year-old, and high-back booster with Hybrid III 6-year-old. Each CRS, vehicle seat (including cushion and frame), seat belt webbing and buckle were replaced after every test. ATD kinematic and kinetic data were compared across seat cushion lengths and cushion stiffness levels to determine which seat configurations were the most beneficial for each type of CRS. For RF CRS, short vehicle seats allowed more y-axis rotation (SAE J211) but reduced several injury metrics including HIC36. For FF CRS, long and short seats resulted in similar injury metrics across matched conditions. For boosters, short seats increased chest resultant acceleration but did not have a noticeable effect on other injury metrics. The range of cushion stiffness examined in this study did not have a consistent or relevant effect on any of the CRS or occupant responses.&lt;/div&gt;&lt;/div&gt;

Mode, dispersion, and loss analysis of a graded-index germanium-doped silicon buried strip waveguide

The mode, loss, and dispersion characteristics of a buried strip waveguide have been calculated for coarse wavelength division multiplexing wavelengths. Process simulation has been used to form the graded-index core by germanium implantation in silicon. Quasivectorial finite-difference method has been used to calculate the number of propagating modes, effective indices, material absorption, mode confinement, and the dispersion parameters. The scattering loss has been determined from the Payne–Lacey model. The zero dispersion for higher-order modes occurs in the O-band, which is suitable for short-reach multimodal applications. The usable waveguide length and number of modes have been characterized and are limited by the mode with highest propagation loss/dispersion and lowest mode confinement, respectively.

660. Extraction-Free 16S Ribosomal RNA (rRNA) Gene Amplification and Sequencing from Resected Cardiac Implantable Electronic Device (CIED) Sonicate Fluid

BackgroundWe recently demonstrated that 16S rRNA PCR/sequencing performed on biofilms dislodged from extracted CIEDs into a salt solution—referred to as “sonicate fluid’ (SF)—may be used to detect pathogens in culture-negative CIED infection (Clinical Infectious Diseases, ciz266, doi:10.1093/cid/ciz266). The method we described included a DNA extraction/purification step, which can be time consuming and costly. Here, we evaluated an extraction-free approach to 16S rRNA gene PCR/sequencing.Methods28 SF samples derived from explanted clinically-infected CIEDs were tested. Cases were categorized as “culture-positive” (C-P) if ≥20 cfu/10 mL were recovered, and as “culture-negative” (C-N), if <20 cfu/10 mL were detected in SF culture. The extraction-free method consisted of a single step of lysis at 1,000 rpm, 95°C for 5 minutes using an Eppendorf ThermoMixer®. DNA extraction (the comparator method) was performed using the ZymoBIOMICSTM Kit with modifications. Samples were processed using both methods, followed by amplification of the 16S rRNA gene and bidirectional Sanger sequencing. Crossing points (CPs) generated by the two approaches were compared. Organisms detected by the two PCR methods were compared with those detected with culture.ResultsOf the 28 samples tested, 13 were C-N and 15 C-P. The extraction-free method generated an amplicon in 13/15 C-P cases, with CPs ranging from 26 to 36 cycles vs. 100% (15/15) detected with the DNA extraction method and Cps of 19 to 32. Usable sequence length for the extraction-free method was of 359 (interquartile range, 307–390) vs. 390 (interquartile range, 308–396) base pairs with DNA extraction. Genus-level concordance between bacteria detected by culture in C-P samples and those found using the extraction-free and extraction methods was 92% (12/13) and 93% (14/15), respectively. Bacteria were detected by the extraction method in 2/13 C-N specimens, with none detected with an extraction-free method.ConclusionThe described extraction-free method may be suitable for testing SF derived from CIEDs using 16S rRNA gene PCR/sequencing, saving time and cost. More studies are needed to establish clear cutoffs for interpretation of results and to assess for PCR inhibitors in the studied specimen-type.DisclosuresRobin Patel, MD, ASM and IDSA: Other Financial or Material Support, Travel reimbursement, editor’s stipends; CD Diagnostics, Merck, Hutchison Biofilm Medical Solutions, Accelerate Diagnostics, ContraFect, TenNor Therapeutics Limited, Shionogi: Grant/Research Support; Curetis, Specific Technologies, NextGen Diagnostics, PathoQuest, Qvella: Consultant; NBME, Up-to-Date, the Infectious Diseases Board Review Course: Honorarium recipient, Other Financial or Material Support; Patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued: Other Financial or Material Support, Patents.

Chronic anterior cruciate ligament insufficiency results in inferior quality hamstring autografts.

Availability of a good quality autograft of adequate length is the first step towards a successful knee ligament reconstruction. Being able to predict the quality and length of hamstring autograft can go a long way in making the surgeon's pre-operative planning a lot easier. The purpose of this study was to find out if any correlation existed between the duration of ACL injury with history of repeated instability episodes and the quality and length of Hamstring graft that was harvested. Forty consecutive patients who underwent ACL reconstruction using quadrupled Hamstring tendon graft were evaluated with regard to the duration of injury, number of instability episodes and graft characteristics like difficulty in harvesting the graft, quality and length of the graft. We found a statistically significant difference between the usable length of harvested Hamstring tendon in patients with acute and chronic injury (p = 0.004). There was a significantly high risk of the graft being shorter and of poor quality in patients with chronic injury (odds ratio = 5.7). Chronicity of ACL injury with repeated strains can cause fibrosis at the musculotendinous junction and result in harvest of a poor quality and short hamstring autograft. A detailed history with regard to duration of injury and repeated instability episodes will help a surgeon plan better when anticipating a sub-optimal graft.

Propagation Effects in the Characterization of 1.5-Cycle Pulses by XPW Dispersion Scan

Few-cycle pulse characterization methods face a serious challenge in providing sufficient signal-to-noise ratios together with superior spectral fidelity, as imposed by phase-matching conditions and linear dispersion effects. Here we investigate the effect of linear dispersion inside the nonlinear medium inherently present in such arrangements. We demonstrate that pulse characterization using a cross-polarized wave generation dispersion scan is surprisingly insensitive to the group-velocity dispersion itself. We characterize sub-4 fs pulses at 780 nm center the wavelength utilizing crystals of different thicknesses, yielding nearly identical pulse shapes. Numerical simulations shed light on this behavior indicating practical limits of usable medium lengths.

The Role of Tomographic Ultrasonography in Conduit Mapping before Coronary Artery Bypass Grafting

Objective To assess the performance of tomographic ultrasonography (TUS) in providing images that will enable optimum choice of vein segment to harvest for coronary artery bypass grafting (CABG). Methods This was a prospective study of diagnostic accuracy. The index test was tomographic ultrasonography. The reference standard was intraoperative observation. The study was performed at the Vascular Imaging and Cardiothoracic Department at Wythenshawe Hospital, Manchester. Patients undergoing CABG who require vein mapping were included in the study. The main outcome measures were the number of tributaries identified in harvested vein segments, presence of varicosities, and usable length of vein. Results The TUS correctly identified 89 out of 111 vein tributaries in 10 patients resulting in a sensitivity of 80.2%. This resulted in a p value of 0.000001 using an exact binomial test, with a prior probability of 0.5. TUS had a sensitivity of 66.7% and a specificity of 100% in the identification of varicosities over 14 patients. TUS had 90% agreement with intraoperative observation in assessing usable length of vein over 14 patients. Conclusions Our results show that TUS has a high sensitivity in identifying vein tributaries. This can be used to select veins with fewer tributaries for harvesting should TUS be used for preoperative vein mapping before CABG.

Πρόταση δημιουργίας πρωτοκόλλου κοκκομετρικής ανάλυσης με τη μέθοδο του σιφωνίου (πιπέτας) με υποδε- καπλάσιο χρόνο ανάλυσης

In this article, the author suggests the creation of a protocol for grain size distribution analysis by pipette method, using specialized software and hardware for minimizing the time needed for analysis. The suggested protocol needs less than 45 minutes for analyzing the size distribution 4Φ to 8Φ sizes since it uses short setting distances, in relation to small pipetting volume, with increased volumetric accuracy and weighting. An Eppendorf Multipette® Stream, electronic pipette, was used with syringe type tips of 2.5 ml. The tip of this electronic pipette was modified and extended, to create a usable length of 6 cm. Small cylindrical setting tubes, 170 ml, were constructed from transparent Plexiglas, with a special cap on the top, to help smooth insertion of the pipette tip. The electronic pipette was programmed to disperse exactly 2000 μl out of 2500 μl of the total tip. Each 2000 μl pipetting had and accuracy in the order of +/- 4 μl. The samples were placed into small metallic containers and placed on top of heating plates with temperature of 65ο C, for drying. The small volume of the samples accelerates further the whole process. The weighting was performed by an electronic balance with a resolution of 0.1 μl. Using Folk (1980) equation, for setting time calculation and tables for temperature dependence of the setting time, the author created an equation that approximates the settling time for each grain size with temperature. The equation is:

Coracoclavicular ligament reconstruction with the autogenous anterior half of the peroneus longus tendon for acromioclavicular joint dislocations

Objective To report the clinical and radiological outcomes of coracoclavicular ligament reconstruction with an autogenous anterior half of the peroneus longus tendon (AHPLT) for acromioclavicular (AC) joint dislocations. Methods Between June 2013 and April 2015, a total of 24 patients with AC joint dislocation of Rockwood types Ⅲ to Ⅴ underwent surgical repair using coracoclavicular ligament reconstruction with an autogenous AHPLT graft. They were 20 men and 4 women, aged from 22 to 68 years (average, 50.7 years). The left side was affected in 15 cases and the right in 9. According to Rockwood classification, there were 5 cases of type Ⅲ, 5 ones of type Ⅳ and 14 ones of type Ⅴ. Twenty of them had acute injury and 4 chronic injury. They were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively in terms of the Constant score, American Orthopedic Foot and Ankle Society(AOFAS) ankle-hindfoot score,visual analogue scale (VAS) score, and loss of reduction on radiographs. Results Twenty patients completed clinical and radiographic follow-ups at 6 and 12 months postoperatively while the other 4 did not. At postoperative 6 and 12 months, the Constant scores were 81and 96 for the affected side and both 96 for the healthy side, respectively. The Constant score at 6 months for the affected side was significantly lower than that for the healthy side (P 0.05). At postoperative 6 and 12 months, the VAS scores for the affected side were 2 and 0 respectively, significantly lower than the preoperative one (5) (P 0.05). One patient complained of shoulder pain at postoperative 12 months. No surgical site infection or perioperative fracture was observed. Conclusions Coracoclavicular ligament reconstruction with an autogenous AHPLT proves effective for AC joint dislocations. Since it is easy and safe to harvest an autogenous AHPLT and the usable length of AHPLT graft is sufficient for reconstruction, autogenous AHPLT may be a reliable alternative to the present tendon graft sources for coracoclavicular ligament reconstruction. Key words: Shoulder joint; Dislocation; Ligaments, articular