This study compared information obtained from standard computed tomographic angiography (s-CTA) scans and modified CTA (m-CTA) scans of the deep circumflex iliac artery (DCIA) flap to cadaver dissections. The m-CTA scans showed longer visible DCIA lengths, better visualization of branching patterns, and more detail on vessel course compared to s-CTA scans. However, s-CTA scans allowed bilateral evaluation while m-CTA only showed the injected side. Both CTA methods provided more information than cadaver dissections for preoperative planning of DCIA flaps.
Aims: Post-mortem pathological studies have shown that a “vulnerable” plaque is the dominant patho-physiological mechanism responsible for acute coronary syndromes (ACS). One way to improve our understanding of these plaques in vivo is by using histological “surrogates” created by intravascular ultrasound derived virtual histology (IVUS-VH). Our aim in this analysis was to determine the relationship between site-specific differences in individual plaque areas between ACS plaques and stable plaques (SP), with a focus on remodelling index and the pattern of calcifying necrosis.
Methods and results: IVUS-VH was performed before percutaneous intervention in both ACS culprit plaques (CP) n=70 and stable disease (SP) n=35. A total of 210 plaque sites were examined in 105 lesions at the minimum lumen area (MLA) and the maximum necrotic core site (MAX NC). Each plaque site had multiple measurements made including some novel calculations to ascertain the plaque calcification equipoise (PCE) and the calcified interface area (CIA). CP has greater amounts of positive remodelling at the MLA (RI@MLA): 1.1 (±0.17) vs. 0.95 (±0.14) (P<0.001);><0.001)>1.12; RI @ MAX NC >1.22; PCE @ MLA <47.1%;><47.3%;>2.6; CIA @ MAX NC >3.1.
Conclusions: Determining the stage of calcifying necrosis, along with the remodelling index can discriminate between stable and ACS related plaques. These findings could be applied in the future to help detect plaques that have a vulnerable phenotype.
Ann Vasc Surg 2012; 26: 141-148-Selected technique- Funnel Technique for EVAR: ‘‘A Way Out’’ for Abdominal Aortic Aneurisms With Ectatic Proximal Necks
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Aims: Post-mortem pathological studies have shown that a “vulnerable” plaque is the dominant patho-physiological mechanism responsible for acute coronary syndromes (ACS). One way to improve our understanding of these plaques in vivo is by using histological “surrogates” created by intravascular ultrasound derived virtual histology (IVUS-VH). Our aim in this analysis was to determine the relationship between site-specific differences in individual plaque areas between ACS plaques and stable plaques (SP), with a focus on remodelling index and the pattern of calcifying necrosis.
Methods and results: IVUS-VH was performed before percutaneous intervention in both ACS culprit plaques (CP) n=70 and stable disease (SP) n=35. A total of 210 plaque sites were examined in 105 lesions at the minimum lumen area (MLA) and the maximum necrotic core site (MAX NC). Each plaque site had multiple measurements made including some novel calculations to ascertain the plaque calcification equipoise (PCE) and the calcified interface area (CIA). CP has greater amounts of positive remodelling at the MLA (RI@MLA): 1.1 (±0.17) vs. 0.95 (±0.14) (P<0.001);><0.001)>1.12; RI @ MAX NC >1.22; PCE @ MLA <47.1%;><47.3%;>2.6; CIA @ MAX NC >3.1.
Conclusions: Determining the stage of calcifying necrosis, along with the remodelling index can discriminate between stable and ACS related plaques. These findings could be applied in the future to help detect plaques that have a vulnerable phenotype.
Ann Vasc Surg 2012; 26: 141-148-Selected technique- Funnel Technique for EVAR: ‘‘A Way Out’’ for Abdominal Aortic Aneurisms With Ectatic Proximal Necks
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Characteristics of coronary artery ectasia and its association with carotid i...Premier Publishers
This study was conducted to uncover the relation between coronary artery ectasia (CAE) and markers of atherosclerosis. A total of 1611 coronary angiograms were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with stenotic coronary artery disease (CAD) “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements. Out of examined angiograms, 35 subjects showed mixed CAE “group 1” and 26 showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of DM and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, P < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, P < 0.001 for both). We concluded that atherosclerosis may not be the only plausible explanation for CAE.
Computed tomography angiography (CTA) of the coronary arteries is a useful noninvasive tool to rule out significant coronary artery disease (CAD) in many clinical situations. Recent guidelines of stable CAD and non-ST segment elevation myocardial infarction endorse the use of CTA in symptomatic patients with low to intermediate likelihood of the disease, given the particularly high negative predictive value of the technique. However, in patients with high pre-test likelihood of CAD, the technique is not recommended, and one of the reasons is the high probability of coronary calcification in these patients, which interferes with the analysis of the images and reduces the specificity and negative predictive value of CTA.
(TOSHIBA CTEU140095) - Article from Toshiba's VISIONS Magazine#25, March 2015
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon
the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have
persistence or recurrence of angina after angiographically successful percutaneous coronary intervention
(PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from
its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing
in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance
of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Cardiac imaging in prosthetic paravalvular leaksPaul Schoenhagen
Abstract: Prosthetic paravalvular leaks (PVL) is an uncommon but serious complication after surgical valve replacement. Although surgery has been the traditional treatment of choice in hemodynamically significant PVL, percutaneous transcatheter closure is emerging as a novel and less invasive option for patients with high operative risk. Cardiac imaging, especially two- and three-dimensional transoesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. The aim of this manuscript is to review the role of cardiac imaging techniques in the interventional management of patients with symptomatic PVL.
Characteristics of coronary artery ectasia and its association with carotid i...Premier Publishers
This study was conducted to uncover the relation between coronary artery ectasia (CAE) and markers of atherosclerosis. A total of 1611 coronary angiograms were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with stenotic coronary artery disease (CAD) “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements. Out of examined angiograms, 35 subjects showed mixed CAE “group 1” and 26 showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of DM and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, P < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, P < 0.001 for both). We concluded that atherosclerosis may not be the only plausible explanation for CAE.
Computed tomography angiography (CTA) of the coronary arteries is a useful noninvasive tool to rule out significant coronary artery disease (CAD) in many clinical situations. Recent guidelines of stable CAD and non-ST segment elevation myocardial infarction endorse the use of CTA in symptomatic patients with low to intermediate likelihood of the disease, given the particularly high negative predictive value of the technique. However, in patients with high pre-test likelihood of CAD, the technique is not recommended, and one of the reasons is the high probability of coronary calcification in these patients, which interferes with the analysis of the images and reduces the specificity and negative predictive value of CTA.
(TOSHIBA CTEU140095) - Article from Toshiba's VISIONS Magazine#25, March 2015
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon
the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have
persistence or recurrence of angina after angiographically successful percutaneous coronary intervention
(PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from
its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing
in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance
of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Cardiac imaging in prosthetic paravalvular leaksPaul Schoenhagen
Abstract: Prosthetic paravalvular leaks (PVL) is an uncommon but serious complication after surgical valve replacement. Although surgery has been the traditional treatment of choice in hemodynamically significant PVL, percutaneous transcatheter closure is emerging as a novel and less invasive option for patients with high operative risk. Cardiac imaging, especially two- and three-dimensional transoesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. The aim of this manuscript is to review the role of cardiac imaging techniques in the interventional management of patients with symptomatic PVL.
Usefulness of Non-Enhanced 3-Dementional CT with Partial Maximum Intensity Pr...science journals
Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs).
FUNNEL TECHNIQUE, J ENDOVASC THER 2006;13:775–778- Case Report-Funnel Techniq...Salvatore Ronsivalle
FUNNEL TECHNIQUE: A WAY OUT IN ABDOMINAL AORTIC ANEURYSM WITH ECTATIC PROXIMAL NECK.
TECNICA FUNNEL: UNA SOLUZIONE ALTERNATIVA IN ANEURISMA DELL'AORTA ABDOMINALE CON COLLETTO PROSSIMALE ECTASICO.
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
STUDY ON CEREBRAL ANEURYSMS: RUPTURE RISK PREDICTION USING GEOMETRICAL PARAME...mlaij
We modeled an SVM radial classification machine learning algorithm to determine the ruptured and unruptured risk of saccular cerebral aneurysms using 60 samples with 6 predictors as the gender, the age, the Womersley number, the Time-Averaged Wall Shear Stress (TAWSS), the Aspect Ratio (AR) and the bottleneck of the aneurysms, considering real cases of patients. We reconstructed computationally each geometry from an angiography image to realize a CFD simulations, where the TAWSS was computed by CFD analysis. A cross validation method was used in the training sample to validate the classification model, getting an accuracy of 92.86% in the test sample. This result may be used to help in medical decisions to avoid a complicated operation when the probability of rupture is low.
Physicians have used palpation to detect differences in tissue stiffness as an aid to diagnosis based on the fact that the mechanical properties of tissues are often dramatically affected by the presence of disease processes such as cancer, inflammation, and fibrosis. Elastography depends on the same differences in mechanical properties between healthy and abnormal tissues using imaging to detect these differences at depths not reachable by manual palpation and presents data in color-coded display, can be performed with ultrasound, using manual pressure or low frequency sonic waves, or by MR Elastography imaging.
Value of Contrast Enhanced CT in Detecting Active Haemorrhage in Patients wit...ijtsrd
To evaluate the use of contrast enhanced CT to show sites of active haemorrhage. To distinguish between active haemorrhage and clotted blood. Dr. Tapan Pandey | Dr. Atul T. Tayade | Dr.Sushilkumar Kale "Value of Contrast Enhanced CT in Detecting Active Haemorrhage in Patients with Blunt Abdominal or Pelvic Trauma" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd55038.pdf Paper URL: https://www.ijtsrd.com.com/medicine/radiology/55038/value-of-contrast-enhanced-ct-in-detecting-active-haemorrhage-in-patients-with-blunt-abdominal-or-pelvic-trauma/dr-tapan-pandey
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. SURGICAL ONCOLOGY AND RECONSTRUCTION
Patient-Specific Topographic Anatomy
of the Deep Circumflex Iliac Artery
Flap: Comparing Standard and
Modified Computed Tomographic
Angiography
Victoria Behrens, DMD,* Ali Modabber, MD, DDS, PhD,y Christina Loberg, MD,z
Andreas Herrler, MD, PhD,x Andreas Prescher, MD, PhD,k and
Alireza Ghassemi, MD, DDS, PhD{
Purpose: Computed tomographic angiography (CTA) is reported to give insight into patient-specific
anatomy of the flap pedicle preoperatively. We compared information available from standard CTA (s-
CTA) with that gained by modifying the conventional CTA technique (modified CTA [m-CTA]). Dissected
cadavers served as the control group.
Materials and Methods: We evaluated 16 s-CTA scans (32 deep circumflex iliac arteries [DCIAs]) and
12 m-CTA scans (17 DCIAs) using 3-dimensional software (Vesalius; ps-medtech, Amsterdam, The
Netherlands). We dissected 17 cadavers (n = 34 DCIAs) to serve as the control group. The positions of
4 landmarks (anterior superior iliac spine, origin of DCIA, origin of ascending branch, and crossing of hor-
izontal branch and iliac crest) were defined in a 3-dimensional coordinate system.
Results: We found significant differences concerning the distances from the origin of the DCIA to the
femoral bifurcation (P < .05) and the anterior superior iliac spine to the crossing point of the horizontal
branch with the iliac crest (P < .05) between CTA scans and cadaveric studies. The imaging quality of
the m-CTA scans was shown to be more consistent than and superior to that of the s-CTA scans. The visible
length of the DCIA was longer on m-CTA scans (mean, 134.32 mm) than on s-CTA scans (mean, 73.62 mm).
We could evaluate the branching off of perforators and the relation of the pedicle to the surrounding bone
and soft tissue in more detail on m-CTA scans. Standard CTA allowed the bilateral evaluation of the pedicle,
whereas m-CTA allowed the evaluation of the injected side only.
Conclusions: The quality and quantity of information available from CTA could be improved by modifying
the s-CTA examination by injection as close as possible to the target vessel. Standard CTA delivered informa-
tion about both sides, whereas m-CTA may need an additional injection for contralateral-side imaging.
Ó 2018 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg -:1-7, 2018
*Dentist, Private Dental Office, Viersen, Germany.
yConsultant, Department of Oral and Maxillofacial Surgery,
University Hospital, RWTH Aachen, Aachen, Germany.
zConsultant, Department of Diagnostic and Interventional
Radiology, University Hospital, RWTH Aachen, Aachen, Germany.
xAssociate Professor, Department of Anatomy and Embryology,
FHML Maastricht University, Maastricht, The Netherlands.
kAssociate Professor, Department of Molecular and Cellular
Anatomy, University Hospital, RWTH Aachen, Aachen, Germany.
{Oral and Maxillofacial Surgery Consultant, Klinikum-Lippe,
Detmold, Germany; Teaching Hospital of Georg-August-University
G€ottingen, G€ottingen, Germany; and Medical Faculty, University
RWTH Aachen, Aachen, Germany.
Conflict of Interest Disclosures: None of the authors have any
relevant financial relationship(s) with a commercial interest.
Address correspondence and reprint requests to Dr Ghassemi:
Department of Oral and Maxillofacial Surgery, Teaching Hospital
Klinikum-Lippe, R€ontgenstrasse 18, 32756 Detmold, Germany;
e-mail: aghassemi@ukaachen.de
Received December 21 2017
Accepted January 20 2018
Ó 2018 American Association of Oral and Maxillofacial Surgeons
0278-2391/18/30091-0
https://doi.org/10.1016/j.joms.2018.01.025
1
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2. Microvascular bone flaps are the gold standard for the
reconstruction of extensive bony defects. The selected
flap should restore the function and provide an
optimal esthetic outcome. Vascularized iliac bone
flap, nourished by the deep circumflex iliac artery
(DCIA), offers excellent bone stock to achieve these
goals.1
The exact knowledge of the anatomy of the
flap is essential. So far, several studies, mostly based
on cadaveric dissection, have emphasized the high
variability of the vessel anatomy. The variable anatomy
of the DCIA makes the harvest of this flap difficult and
time consuming.2
Recently,preoperative imaging provedto be helpfulto
deliver insight into the anatomy and topography of the
flap pedicle.3,4
An ideal preoperative imaging modality
should show individual variations; the location; the
caliber and branching pattern of the pedicle; and the
existence, quality, and quantity of perforating vessels.
Fabricating preoperative templates helps to design the
flap more accurately.5,6
Different imaging techniques
are available including digital subtraction angiography,
computed tomographic angiography (CTA), magnetic
resonance angiography, and Doppler ultrasound. CTA
is noninvasive and was reported to provide accurate
anatomic information,3,7
allowing fast imaging of larger
body areas with the option of 3-dimensional (3D) recon-
struction. However, it involves radiation exposure and
the injection of an iodine-rich contrast agent with the
risk of an allergic reaction.
The aim of this study was to evaluate the informa-
tion attainable from standard CTA (s-CTA) and CTA im-
ages taken according to a modified CTA (m-CTA)
protocol. We evaluated and compared the visible
course of the DCIA, its branches, and its relationship
to key landmarks. We defined the position of impor-
tant landmarks in a 3D coordinate system to transfer
the obtained virtual 3D data to the intraoperative situ-
ation. Results from cadaveric studies (CSs) served as
the control group.
Materials and Methods
The cadaveric specimens for this study were ob-
tained after institutional approval was received from
the Institute of Anatomy and Cell Biology of our univer-
sity hospital. Furthermore, 16 multiple-row s-CTA
scans (n = 32 DCIAs) obtained after intravenous injec-
tion of the nonionic contrast agent iopromide were
selected. In addition, we evaluated m-CTA images of
12 individuals (n = 17 DCIAs). The common femoral
artery was punctured in the inguinal region for injec-
tion of 40 mL of a nonionic iodine-containing contrast
medium (Ultravist 370; Bayer HealthCare, Leverkusen,
Germany) into the external iliac artery. A multislice
computed tomography (CT) scan with 1-mm slices
(Somatom Definition [128-slice CT system with Dual
Energy Body CT program]; Siemens, Erlangen, Ger-
many) was performed. It included bone and
soft tissue windows, maximum intensity projection,
and a multiplanar re-formation–volume rendering
technique. These CTA scans were performed for diag-
nostic and therapeutic purposes. They were provided
anonymized by the Department of Diagnostic and In-
terventional Radiology of the Medical Faculty, Univer-
sity RWTH Aachen, for further analysis. We evaluated
the visible length of the DCIA and analyzed the infor-
mation gained about several measured distances (Fig
1, Table 1). To display the CT images, we used 3D soft-
ware (Vesalius; ps-medtech, Amsterdam, The
Netherlands) and measured the distances between
landmarks and the lengths of vessels virtually. In addi-
tion, we defined the positions of the 4 following points
to visualize the course of the DCIA in a 3D coordinate
system: anterior superior iliac spine (ASIS), origin of
DCIA, origin of ascending branch (AB), and crossing
point of horizontal branch (HB) with iliac crest.
We defined a sagittal plane through the pubic sym-
physis, a frontal plane through the anterior rim of
the pubic symphysis, and a transverse plane through
the upper rim of the pubic symphysis. We measured
the perpendicular distances between each of the 4
chosen points and the 3 planes to obtain 3 coordinates
each, describing the position of the points in a 3D
coordinate system (Table 2). We dissected 17
formalin-preserved cadavers (n = 34 DCIAs) to serve
as the control group.
DATA ANALYSIS
We determined the mean, standard deviation, and
maximum and minimum values using Excel (Microsoft
Office 2007; Microsoft, Redmond, WA). The normal
distribution of the groups was determined, and
because of the non-normal distribution of the CTA
scans, the Wilcoxon test was performed using RStudio
(version 1.044; FOAS, Boston, MA) to determine the
significance of differences between the CTA and CS re-
sults, setting the border of significance as P < .05.
Results
We evaluated the course of the DCIA and its relation-
ship to the key landmarks (Fig 1) in 17 cadavers (n = 34
DCIAs; 11 women and 6 men), on 16 s-CTA scans
(n = 32 DCIAs; 7 women and 9 men), and on
12 m-CTA scans (n = 17 DCIAs; 7 women and
5 men). The distance between bone and vessel, as
well as the number and location of perforators to the
bone, could only be examined on the CTA
scans (Table 1).
The course of the DCIA could be evaluated bilater-
ally on all s-CTA scans (Fig 2) but only 5 of 12 m-CTA
scans (Fig 3). We could identify the division of the
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2 MODIFIED CT-ANGIOGRAPHY OF THE DCIA
3. DCIA into the HB and AB on 11 of 12 m-CTA scans
(92%). However, this was only possible on 4 of 16
s-CTA scans (25%). In addition, we observed a higher
standard deviation of the visible length of the DCIA
on s-CTA scans (Æ35.62 mm) than on m-CTA scans
(Æ30.95 mm) (Table 1).
The origin of the DCIA was as high as the inferior
epigastric artery in all groups. On 54% of the CTA
print&web4C=FPO
FIGURE 1. Artistic illustration of deep circumflex iliac artery (DCIA) and vein and their relationship to important key landmarks: origin of DCIA
and vein (a), anterior superior iliac spine (b), crossing point of DCIA and iliac crest (c), origin of superficial circumflex iliac artery and vein (d),
bifurcation of femoral vessel (e), and location of horizontal branch along medial iliac surface (f).
Behrens et al. MODIFIED CT-ANGIOGRAPHY OF THE DCIA. J Oral Maxillofac Surg 2018.
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BEHRENS ET AL 3
4. scans, the HB was shown to be the same size as the AB;
it was larger than the AB on 31% and smaller on 15%.
On a level with the ASIS, a horizontal distance of
26.24 mm (vs 15.05 mm in CSs) was measured be-
tween the HB and ASIS. At this point, the HB showed
a minimum distance of 11.78 mm to the inner surface
of the iliac bone (Table 1).
We observed a similar distribution of vessel types
based on the classification of Ghassemi et al.8
(2013)
(Table 3). On m-CTA scans, we could identify up to
5 perforators running to the medial bone surface.
However, we could not detect any perforators on the
s-CTA scans.
Comparing the results of CTA analysis with CSs, we
observed that the horizontal distance between the
ASIS and HB was significantly higher on CTA scans
(P < .0001). The distance between the origin of the
DCIA and the bifurcation of the femoral artery was
significantly longer in the CSs compared with the
CTA scans (P < .05). The distance between the ASIS
and crossing point of the HB with the iliac crest was
significantly longer on CTA scans compared with CSs
(P < .05) (Table 1).
The positioning of the 4 landmarks in a 3D coordi-
nate system (triangulation) showed that the DCIA
had its origin at a distance of 68.49 mm from the
sagittal plane, 39.77 mm from the transverse plane,
and 6.29 mm posterior to the frontal plane (Table 2).
On the m-CTA scans, we observed detailed anatomy
including anastomosis of the DCIA and adjacent ves-
sels such as the iliolumbar artery (n = 4).
Discussion
The DCIA flap offers excellent bone quality and
quantity required for the reconstruction of extensive
bony defects. However, the anatomy of the DCIA has
been shown to be highly variable.9-11
The knowledge
Table 1. COMPARISON BETWEEN CADAVERIC DISSECTIONS, S-CTA, AND M-CTA
Mean Æ SD (Min-Max)
P ValueCadavers (n = 34) s-CTA (n = 32) m-CTA (n = 17)
Age, yr 83.82 Æ 6.56 (71-92) 63.69 Æ 12.14 (21-78) 50.18 Æ 10.54 (23-66) —
Visible length of DCIA, mm — 73.62 Æ 35.62 (0-151.4) 134.32 Æ 30.95 (53.1-198) —
a to b, mm 68.63 Æ 7.51 (50-90) 72.72 Æ 6.67 (59.3-83.8) P > .05
a to origin HB, mm 47.41 Æ 17.15 (15-105) 33.88 Æ 9.64 (17-62.8) P > .05
a to d, mm 23.73 Æ 9.45 (0-78) 19.34 Æ 3.14 (9.6-23.9) P > .1
a to e, mm 57.08 Æ 11.99 (21-100) 48.44 Æ 12.06 (23.2-90.8) P < .05
b to HB (horizontal), mm 15.05 Æ 6.11 (2-40) 26.24 Æ 4.61 (18.4-36.4) P < .01
b to c, mm 41.49 Æ 18.76 (0-91) 56.73 Æ 15.17 (35.4-85.8) P < .05
DCIA to inner surface of iliac
bone,* mm
Not measurable because
of tissue collapse
11.78 Æ 2.54 (5.9-19) —
Abbreviations: a, origin DCIA; b, anterior superior iliac spine; c, dorsal crossing point of HB with iliac crest, d, origin of super-
ficial circumflex iliac artery; DCIA, deep circumflex iliac artery; e, bifurcation of femoral artery; HB, horizontal branch; m-CTA,
modified computed tomographic angiography; Max, maximum; Min, minimum; n, number of DCIAs; s-CTA, standard computed
tomographic angiography; SD, standard deviation.
* Measured level with anterior superior iliac spine.
Behrens et al. MODIFIED CT-ANGIOGRAPHY OF THE DCIA. J Oral Maxillofac Surg 2018.
Table 2. TRIANGULATION (N = 24): DISTANCE TO PLANE
Mean Æ SD (Min-Max), mm
Sagittal Transversal Frontal
ASIS 121.70 Æ 9.12 (102.6-154.7) 88.08 Æ 8.42 (63.1-103.1) À2.97 Æ 11.89 (À23.1 to 23)*
Origin of DCIA 68.49 Æ 5.48 (51.7-78) 39.77 Æ 8.29 (20.6-72.5) 6.29 Æ 7.88 (À9.8 to 21.4)
Origin of AB 94.87 Æ 11.42 (65.5-118.1) 77.45 Æ 17.35 (36-117) 4.08 Æ 8.29 (À14.4 to 22.1)
Crossing point with crest 117.73 Æ 7.27 (98.1-132.2) 128.08 Æ 16.09 (78.5-165.4) 31.85 Æ 15.86 (À2.6 to 126.5)
Abbreviations: AB, ascending branch; ASIS, anterior superior iliac spine; DCIA, deep circumflex iliac artery; Max, maximum;
Min, minimum; SD, standard deviation.
* The ASIS lies mainly posterior to the frontal plane.
Behrens et al. MODIFIED CT-ANGIOGRAPHY OF THE DCIA. J Oral Maxillofac Surg 2018.
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4 MODIFIED CT-ANGIOGRAPHY OF THE DCIA
5. print&web4C=FPO
FIGURE 2. Standard computed tomographic angiography scan. A, anterior.
Behrens et al. MODIFIED CT-ANGIOGRAPHY OF THE DCIA. J Oral Maxillofac Surg 2018.
print&web4C=FPO
FIGURE 3. Modified computed tomographic angiography scan. A, anterior.
Behrens et al. MODIFIED CT-ANGIOGRAPHY OF THE DCIA. J Oral Maxillofac Surg 2018.
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BEHRENS ET AL 5
6. of pedicle variations and the exact course of the
pedicle and its relationship to intraoperatively
identifiable landmarks can expedite the dissection,
reduce complications, and increase the success rate.
In addition, the location and number of perforators,
the type of vessel, the topographic relationship of
the ASIS and iliac crest, and the crossing point with
the iliac crest and its pathway into the soft tissue are
important for successful flap harvesting.
CSs deliver only general anatomic information and
do not give any information regarding the spatial rela-
tionship of the DCIA to the surrounding structures.
Currently, CTA is reported as the gold standard for
3D topography, and it has been shown to be accurate
and superior in imaging abdominal wall perforators as
compared with ultrasound or magnetic resonance
angiography.12
CTA imaging allows more realistic visu-
alization of the topographic anatomy and is hence
more useful for preoperative planning.
We compared the information gained from the CTA
scans with the extent of information available from
CSs. For m-CTA, the contrast agent was injected as close
as possible to the DCIA pedicle. We analyzed the course
of the DCIA on s- and m-CTA scans and used CSs as the
control group (Table 1). The data from the triangulation
were used to display the course of the DCIA in a 3D co-
ordinate system on preoperative planning. We found
that by modifying the CTA protocol as described, we
could evaluate the DCIA more thoroughly than with
conventional CTA. In addition, using 3D software facili-
tated an extensive study regarding the patients’ specific
topographic anatomy of the DCIA and its relationship to
important landmarks.
We observed a higher variability of the measure-
ments, as expressed by the standard deviation, in CSs
compared with CTA studies. One explanation could
be that using the Vesalius equipment in CTA delivered
an unaltered 3D topography as compared with CSs. In
CSs, the horizontal distance between the ASIS and HB
was significantly smaller than that measured on CTA
scans (Table 1). This could be due to the shrinkage
and collapse of the tissue after preservation of the
cadaver.13
However, the distance between the origin
of the DCIA and the bifurcation of the femoral artery
was longer in CSs (57.08 mm) than on CTA scans
(48.44 mm). The distance between the ASIS and the
crossing point of the HB with the iliac crest was longer
on CTA scans than in CSs (56.7 mm vs 41.5 mm). The
reason could be that, using the 3D software, we were
able to follow the vessel course and the curvature of
the iliac crest more precisely with the measuring tool.
Using a cord and ruler in the CSs’ surrounding struc-
tures distorted the measurement. The CTA data seemed
to match the in vivo situation better than the CSs.
Analyzing the m-CTA scans, we could easily measure
the distance between the HB and the medial surface of
the iliac bone and examine the number and location of
perforators to the bone, as well as the diameter of the
HB and AB. The preserved cadavers could not deliver
this information. Information regarding the perfora-
tors was scarce on s-CTA scans (Fig 2). However, we
could observe multiple penetrating periosteal vessels
originating from the HB on the m-CTA scans (Fig 3).
Such information is helpful in selecting the suitable
part of the iliac bone with a reliable blood supply.
Furthermore, the osteotomy can be planned on preop-
erative templates, and donor-site morbidity can be
reduced by harvesting only the necessary bone stock.5
Although Ting et al (2009)14
stated that CTA imaging
offers high-resolution images, we could analyze only
6 of 32 s-CTA scans to obtain the sought information.
In addition, the quality and dimension of visualization
of the DCIA on s-CTA scans are subject to high vari-
ability. On m-CTA scans, we could track the DCIA far
into the periphery with clear illustration of the perfora-
tors to the bone in 24%, as compared with 0% on s-CTA
scans. While analyzing the m-CTA scans, we also could
trace the anastomosis of the DCIA with other vessels
such as the iliolumbar vessel, as described by Taylor
and Watson15
(1978). The application of contrast agent
close to the DCIA, as performed on m-CTA, was shown
to increase the illustration quality.
By using 3D software, we could clearly differentiate
between the HB and AB by virtual 3D rotation of the
CTA images and observe their relationship to neigh-
boring structures more realistically. This reduced
superimposition and false interpretation, which are
disadvantages of 2-dimensional imaging. The 3D visu-
alization also allowed the description of relevant parts
of the DCIA within a 3D coordinate system in relation
to intraoperative identifiable landmarks. This will facil-
itate the intraoperative orientation and identification
of the DCIA’s branches and simplify the dissection.
Nevertheless, not all the m-CTA scans showed the
same good quality. This should be evaluated in further
Table 3. TYPE OF VESSEL OBSERVED ACCORDING TO
CLASSIFICATION OF GHASSEMI ET AL
8
Cadavers CTA (s-CTA or m-CTA)
Type Ia 82% (n = 31) 57% (n = 8)
Type Ib 5% (n = 2) 14% (n = 2)
Type Ic 8% (n = 3) 7% (n = 1)
Type II 5% (n = 2) 7% (n = 1)
Type III 0% (n = 0) 14% (n = 2)
Abbreviation: CTA, computed tomographic angiography;
m-CTA, modified computed tomographic angiography;
n, number of types of classification; s-CTA, standard
computed tomographic angiography.
Behrens et al. MODIFIED CT-ANGIOGRAPHY OF THE DCIA. J Oral
Maxillofac Surg 2018.
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6 MODIFIED CT-ANGIOGRAPHY OF THE DCIA
7. studies by improving the examination technique.
A frequently changing time span between injection
and CTA imaging could be one reason. The technique
of injection or catheter positioning needs to be opti-
mized. Nonetheless, we also should consider the inva-
sive nature and potential morbidity caused by catheter
angiography.16
Standard CTA requires a less invasive
peripheral intravenous injection and allows bilateral
examination. If we apply the m-CTA technique, a sec-
ond injection may be needed to select the suitable
side. This can increase the rate of possible complica-
tions such as hematoma and allergic reaction.16
In summary, we performed a retrospective study
comparing the information gained by s-CTA with that
gained by m-CTA. Modified CTA delivered more abun-
dant and detailed information important for flap harvest-
ing and preoperative planning. However, we also should
consider the higher rate of possible complications, as
knownindigital subtraction angiography. Using 3D visu-
alization allowed more accurate and detailed measure-
ments as compared with CSs. Further studies with a
larger sample size and matched groups are needed to
illuminate and refine the technique presented.
Acknowledgment
We are grateful to those who donated their bodies to science. We
express our sincere thanks to Dirk Traufelder for his contribution in
drafting the illustration.
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