The Size of the Rotator Cuff and the Positional Relationship of Bony Landmarks: An Anatomical Study / 체질인류학회지

For treatment of the rotator cuff, locating the structure and position of the rotator cuff is crucial. The aim of this study is to identify the size of each rotator cuff and the locational relationship with bony landmarks, and to provide superficial landmarks for locating the tendon from the surface. Fifty-two shoulders from 26 cadavers were dissected and measured in a supine position. The central point was set as the most protrusive point on the greater tubercle of the humerus. The measurement of angles was described ventral as positive (+) and dorsal as negative (-) placing the long axis of the humeral shaft at 0degrees. The range of the angle which each rotator cuff tendon is attached to the humerus head was: 53.8~103.3 degrees for the subscapularis, -17.1~25.7 degrees for the supraspinatus, -68.4~-1.9 degrees for the infraspinatus, and -117.1~-75.7 degrees for the teres minor. The vertical inferior point drawn from the anterior edge of the acromion to the humerus was 7.5+/-11.7 degrees from the central point. The average position of the point was the midpoint of insertion of the supraspinatus tendon. The lateral horizontal point drawn from the acromial angle to the humerus was -49.4+/-14.3 degrees away and located at an average of 30% inferior to the infraspinatus tendon. Also the lateral horizontal point drawn from the most protrusive point of the coracoid process to the humerus was 63.1+/-14.7 degrees away and located at an average of 20% superior to the subscapularis tendon. Lastly, the most protrusive point of the lesser tubercle of the humerus was located at a range of 80.8+/-11.1 degrees and an average of 60% superior to the insertion of the subscapularis tendon. For the measurements of the size of the rotator cuff, there was no statistical difference between the left and right. However, the four measurements - the proximal width of the teres minor tendon, the proximal and distal width, and the length of the subscapularis tendon - showed statistically significant difference between the sexes (P<0.05). Therefore, to identify the location of the tendon structures by palpation for shoulder treatment, using the lesser tubercle for the subscapularis, the anterior edge of the acromion for the supraspinatus, and the acromial angle for the infraspinatus as landmarks is regarded to be effective.

Optimal Length of a Right Subclavian Venous Catheter in Koreans and the Usefulness of Echocardiography for Evaluation of the Central Venous Catheter Position

PURPOSE: We evaluated the proper length of a central venous catheter (CVC) during subclavian vein catheterization and the usefulness of transthoracic echocardiography in identifying the position of the CVC. METHODS: From August 2002 to September 2002, we studied prospectively 30 consecutive patients who had a CVC inserted. The right subclavian vein was punctured by using the Seldinger method, and the patients were divided into two groups according to the method used to identify the position of the central venous catheter. In the radiology group, after central venous catheterization, we identified the position of the CVC by using a plain chest X-ray; then, we adjusted the length of the catheter. In the echocardiography group, during central venous catheterization, we inserted it deeply enough to observe the tip of the catheter in the right atrium by using echocardiography; then, we withdrew the catheter slowly until it was no longer observed in the right atrium, and we fixed the catheter at that position. We measured the heights, weights, and chest circumferences of the patients. RESULT: The maximal lengths of CVCs were 15.9+/-2.0 cm in the radiology group and 15.9+/-1.7 cm in the echocardiography group. There was no difference between the two groups (p=0.98). The maximal length of the CVC correlated to the height of the patient (Y=0.154X-9.8: Y=the length of the CVC, X=height, p<0.001, R2=0.394) and to the weight of the patient (Y=0.076X+11.2: Y = the length of the CVC, X=weight, p=0.042, R2=0.140), but not to the chest circumference (p=0.371). CONCLUSION: Echocardiography was a useful method in identifying the optimal positioning in central venous catheterization. The maximal length of the CVCs was 15.9 +/-1.9 cm via the subclavian vein approach in Koreans and correlated to the height of the patients.

Availability of Troponin I and T and CK-MB for Diagnosis of Acute Myocardial Infarction in Patients of Renal Failure Admited to an Emergency Medical Center

PURPOSE: Generally, if a patient suffers from chest pain and shows a specific EKG pattern, it is easy to determine a clinical diagnosis, thus it is but in many cases, patients show nonspecific chest pain and a nonspecific EKG pattern. So it's important to consider the serological labaratory exam for cardiac enzymes for a definite diagnosis. Until now, cTnI has been considered to be different from CK-MB and cTnT in that it shows a specific elevation in early myocardiac injury and rare nonspecific elevation in renal-failure patients. Therefore, to affirm a sufficient relation between cTnI elevation and myocardiac injury, are carried out this study. METHODS: The number of patients in the study was 58. No one had shown any evidence of myocardiac injury during the recent 2 years or any of the risk factors for AMI, such as smoking, obesity, and hypercholesterolemia. They showed specific symptoms like chest pain or nonspecific ones like dyspnea, indigestion, or a nonspecific EKG abnormality, including nonspecific ST-T change. Their serum creatinine level was above 2.0 mg/dL and qualitative results of cTnI was obtained by using a Troponin I rapid assay kit. The definite diagnosis of AMI was made by a cardiologist based on an intergrated result of EKG, clinical symptoms and signs and regional cardiac wall-motion abnormality on a echocardiogram. RESULTS: The sensitivity of CK-MB, cTnT, and cTnI were 100%, 100%, and 100%, respectively, and the specificities were 75%, 85%, 100%. CONCLUSION: In cases of patients with a high serum-creatinine level, particularly, those with positive serum CK-MB and cTnT, the measurement of cTnI is considered to be significant for the differential diagnosis of AMI as it shows both a high sensitivity and a high specificity in early myocardiac injury.