Morphological Study on Shapes of Pterion.

Background: Pterion is defined as an H-shaped small circular area formed by the junction of four bones: frontal, parietal, temporal and sphenoid on norma lateralis of the skull, Pterion junction has been used as a common extra-cranial landmark for surgeons in microsurgical and surgical approaches towards important pathologies of this region. Pterion is an important landmark for anterior branch of middle meningeal artery, Broca’s motor speech area to the left, insula, the lateral cerebral fissure, for the pathologies of optic nerve, orbit, sphenoidal ridge and for the anterior circulation aneurysm and tumors, because of its clinical importance we focused our present study on morphology of shape of pterion. Materials and Methods: A total of 500 pterions were examined from 250 adult dry skulls. The present study was undertaken in adult south Indian skulls from different regions of south India, from different medical colleges. We have observed different shapes of pterion like sphenoparietal frontotemporal, stellate and epipteric. Results: The sutural morphology of the pterion and asterion is important in surgical approaches to the cranial fossae. 250 human skulls of known gender (148 male, 102 female) were examined on both sides. Four types of pterion were observed – sphenoparietal 72.8%, frontotemporal 16.4%, stellate 8.8% and epipteric 2%. Conclusion: The pterion is points of sutural confluence seen in the norma lateralis of the skull. The patterns of formation exhibit population based variations. The sutural morphology of the pterion is important in surgical approaches to the cranial fossae. These findings may helpful in surgical approaches and interventions via the pterion.

A study on complications in ultrasound guided catheterization of the internal jugular vein.

Background: With the advanced knowledge in medical monitoring, ever increasing value has been placed on the establishment of central venous catheter. During the past few years, monitoring of central venous pressure has become an important aid in the management of critically ill patients. Doppler ultrasound was first used to assist central venous catheter insertion in 1984. Ultrasound has been applied to describe the anatomy of the IJV and to evaluate various techniques for percutaneous cannulation. Real time sonography improves access to the vein compared with the traditional method. Ultrasound guided cannulation limits complications and also the decreases the cannulation time. For reducing the complication in traditional method we have conducted the study through ultrasound guide and observed the complications in new method. Methods: Thirty critical care patients were selected for IJV cannulation either by ultrasound guided technique. This study conducted in department of anesthesiology and critical care, M. S. Ramaiah medical college, Bangalore. Results: In our study there was 100% success rate for first attempt cannulation in USG technique. The mean access time in USG technique was 152.50 ± 63.90 sec. in USG technique arrhythmias were noted in 1 (3.3%) case during the study. No cases of haematoma, pneumothorax, haemothorax, nerve Injury, carotid artery puncture and catheter malposition were noted during the study in USG technique. Conclusion: Ultrasound guided technique improves the cannulation of the IJV with respect to safety, rapidity and comfort to the patient during the procedure.

study on complications in land mark technique catheterization of internal jugular vein.

Background: The traditional methods of using anatomic landmarks to guide cannulation of the IJV have yielded various rates of successful access and complications. Moreover, central venous catheterization requires considerable expertise. Cannulation of the IJV was first described in 1969. Various positions were used to access cannulation but they were frequently associated with complications such as arterial puncture, pneumothorax, neurological damage, infection, dysrhythmias, atrial thrombus, cardiac rupture. Methods: Thirty critical care patients were selected for IJV cannulation either by Land mark technique. This study conducted in department of anaesthesiology and critical care, M. S. Ramaiah medical college, Bangalore. India. Results: In our study there was 83.3% success in LMG technique. The mean access time was 323.23 ± 146.19 sec and the distribution of complications encountered during the study, Carotid artery was accidentally punctured in 1 (3.3%) cases. In LMG technique, there were no cases of arrhythmias, haematoma, pneumothorax, haemothorax, nerve injury and catheter malposition were noted during the study. Conclusion: Land mark technique catheterization of internal jugular vein was shown complications than newly developed ultrasound guided method.

A Comparative Study between Ultrasound Guided Catheterization of the Internal Jugular Vein and Classical Land Mark Technique.

Background: Catheterization of Internal Jugular Vein (IJV) is commonly attempted to obtain central venous access for hemodynamic monitoring, long term administration of fluids, total parenteral nutrition and hemodialysis in critical care patients. The safe puncture of the IJV is achieved by using anatomical land marks on skin surface. Ultrasound guidance could be beneficial in placing central venous catheters by improving the success rate, reducing the number of needle passes, decreasing access time and decreasing complications. Material andMethods: Sixty critical care patientswere selected for IJV cannulation either by landmark technique or by ultrasound guided technique in two groups of thirty each. Results: In our study there was 100% success rate for first attempt cannulation in USG technique and where as it was 83.3% in LMG technique. The mean access time in USG technique was 152.50 ± 63.90 sec as against 323.23 ± 146.19 sec in LMG group. Conclusion: Ultrasound guided technique improves the cannulation of the IJV with respect to safety, rapidity and comfort to the patient during the procedure.