A study on repair method of type Ⅱc injury in lateral meniscus popliteal tendon area of porcine knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the repair method of type Ⅱc injury in the lateral meniscus popliteal tendon area based on the porcine knee joint.@*METHODS@#Eighteen commercially available fresh porcine knee joints were randomly divided into 3 groups ( n=6). After preparing a type Ⅱc injury in the lateral meniscus popliteal tendon area, and the anterior (group A), posterior (group B), or anterior and posterior (group C) of the popliteal hiatus (PH) was sutured by vertical mattress. The tension meter was used to apply gradient tensions of 2, 4, 6, 8, and 10 N along the tibial plateau horizontally, respectively, to pull the midpoint of the lateral meniscus popliteal tendon area. The displacement values before modeling, after modeling, and after suture were recorded. The reduction value of lateral meniscus displacement and reduction rate after suture were calculated and compared between groups.@*RESULTS@#There was no significant difference between groups ( P>0.05) in the displacement values before modeling, after modeling, and after suture under different tensions. There was no significant difference between groups A and C ( P>0.05) in the reduction value of lateral meniscus displacement and reduction rate after suture under different tensions. The reduction value of lateral meniscus displacement and reduction rate after suture in group B were lower than those in groups A and C. The reduction value of lateral meniscus displacement under tension of 2 N and the reduction rates under tensions of 2, 4, and 6 N between groups A and B showed significant differences ( P<0.05). The reduction value of lateral meniscus displacement and the reduction rate under tensions of 2, 4, and 6 N between groups B and C showed significant differences ( P<0.05).@*CONCLUSION@#Suturing the anterior area of PH is the key to repairing type Ⅱc injury of lateral meniscus popliteal tendon area.

Ultrasound evaluation of the morphological characteristics of urogenital hiatus in patients with gestational diabetes mellitus after vaginal delivery / 中华超声影像学杂志

Objective:To observe the morphological characteristics of urogenital hiatus in patients with gestational diabetes mellitus (GDM) after vaginal delivery.Methods:This study included 192 pregnant patients from Henan Provincial People′s Hospital who met the conditions between Jan.2020 and Aug.2021. All participants were screened for GDM by oral glucose tolerance test (OGTT) or fasting blood glucose at 24-28 weeks of pregnancy, and were divided into GDM group (34 cases) and non-GDM group (158 cases) based on the presence or absence of GDM. All participants underwent pelvic floor ultrasonography at the first trimester (6-8 gestational weeks), 3 days postpartum, 6 weeks postpartum, 6 months postpartum, and 1 year postpartum. Area of urogenital hiatus (AUH), transversal diameter of urogenital hiatus (TDUH) and anteroposterior diameter of urogenital hiatus (APDUH) were measured using Smart Pelvic. The Logistic regression model was used to calculate and match the propensity score between the GDM group and the non-GDM group.Results:In the non-GDM group, TDUH during rest maneuver at 6 weeks postpartum( P=0.319), the indicators during rest and contract maneuver at 6 months postpartum( P=0.586, 0.877, 0.164, 0.226, 0.465, 0.097), and TDUH during tension maneuver at 1 year postpartum( P=0.643) returned to the level of early pregnancy. In the GDM group, the indicators during rest maneuver and TDUH during contract maneuver at 6 months postpartum recovered to the level of early pregnancy ( P=0.647, 0.584, 0.376, 0.440), while APDUH and AUH during contract maneuver ( F=7.784, 9.785; P=0.005, <0.001) and the indicators during tension maneuver at 1 year postpartum( F=15.343, 11.974, 17.981; P<0.001) did not recover to the level of early pregnancy. After propensity score matching, APDUH and AUH during tension maneuver at 1 year postpartum in the GDM group were significantly greater than those in the non-GDM group( t=2.810, 2.926; P=0.006, 0.004). Conclusions:The pelvic floor muscles of GDM patients after vaginal delivery are more severely damaged, and the recovery speed is slower. Pelvic floor muscle exercise during pregnancy and enhanced postpartum follow-up are needed to prevent, diagnose and treat pelvic floor dysfunction early.

Clinical application of the full-stack smart pelvic floor ultrasound to acquire and measure the minimal levator hiatus plane / 中华超声影像学杂志

Objective:To evaluate the feasibility of Full-stack Smart Pelvic Floor Ultrasound (FSPFU) software in the acquisition and measurement of the minimal levator hiatus (LH).Methods:Transperineal pelvic floor ultrasonography was performed in 119 women of 6-month postpartum from Nov.2020 to Jan.2021 of Shenzhen Second People′s Hospital. Mid-sagittal plane of pelvic floor was set as the initial plane, and the three-dimensional volume data was acquired. The dataset was stored in the machine. The offline volume data was manually adjusted to obtain the minimal LH images and measured by four physicians (two junior physicians as the D1 group and two senior physicians as the D2 group). For comparison, the results were also obtained using the fully automated method—the FSPFU software by a junior physician (the D3 group). The obtained parameters of minimal LH included area, circumference, anterioposterior diameter, transverse diameter, left and right levator-urethral gap distance. Analysis time was recorded for each group. The contours of minimal LH were outlined by three groups and the overlapping rate was calculated. The quality of the resulted images was evaluated and scored by another two senior physicians(A and B) independently.Results:The D3 group had a significant shorter analysis time compared with the other two groups, and the D1 group took a longer time than the D2 group, regardless of the cystocele severity (D1: 82.97 s, D2: 62.51 s, D3: 2.71 s, all P<0.05). The intergroup agreements and correlations of the minimum LH area were good (all ICC>0.85, rs>0.70, P<0.001) and the outlined contours were largely overlapped (>92%). There was no significant difference in image quality among the three groups(all P>0.05). Conclusions:FSPFU software can automatically obtain and measure the minimum LH in an efficient and accurate way, which can improve the effectiveness of the present pelvic floor examination. FSPFU software can be an useful tool in the diagnosis of pelvic floor dysfunctional diseases.

Attach importance to the influence of obesity on disease treatment of hernia and abdominal wall surgery / 中华消化外科杂志

With the great improvement of living and material conditions in China, obesity concomitant with hernia and abdominal wall diseases become very common. As the particularities of obesity and associated metabolic diseases, a series of pathophysiological changes caused by obesity will significantly affect the treatment of hernia and abdominal wall diseases. In the authors' opinions, accurately evaluation the severity of obesity and associated metabolic diseases and effec-tively controlling are important prerequisites for determining the timing of surgery and surgical planning. Weight loss before surgery is the basic principle of the treatment and immediate or staged individualized surgical treatment is the guarantee of the successful treatment for obesity patients with hernia and abdominal wall disease.

Diagnóstico ecocardiográfico de una hernia de hiato. Reporte de un caso / Echocardiographic diagnosis of a Hiatus Hernia: A case report

The diagnosis of a hiatus hernia (HH) is typically confirmed with an upper gastrointestinal barium X-ray, gastroscopy or upper-intestinal endoscopy. In several cases, HH has been diagnosed with an echocardiogram. We here describe a case of an HH visible on an echocardiogram in a male patient with chest pain.

Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears / 北京大学学报(医学版)

OBJECTIVE@#To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries.@*METHODS@#This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears.@*RESULTS@#A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; n=86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; n=36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; n=24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (n=53, 61.6%), type Ⅰb: horizontal tear (n=27, 31.4%), and type Ⅰc: radial tear (n=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (n=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (n=20, 55.6%), and type Ⅱc: both tears (n=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (n=9, 37.5%), type Ⅲb: radial tear (n=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores (P > 0.01).@*CONCLUSION@#We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.

El diafragma, el hiato y la unión gastroesofágica / The diaphragm, the hiatus and the gastroesophageal junction

RESUMEN La unión del tubo esofágico con el estómago en lo que denominamos el cardias, su tránsito y relacio nes con el hiato diafragmático, las estructuras fibromembranosas que la fijan y envuelven, la existencia de un esfínter gastroesofágico anatómico y su real morfología, así como la interacción de todos estos elementos, han sido materia de controversia por décadas y aún hoy. Este artículo actualiza la descrip ción de tales estructuras.

ABSTRACT The point where the esophagus connects to the stomach, known as the cardia, its transition and re lationship with the diaphragmatic hiatus, its fibromembranous attachments, the existence of an ana tomic gastroesophageal sphincter and its real morphology, and the interaction between all these ele ments, have been subject of debate for decades that still persist. The aim of this article is to describe the updated information of such structures.

Laparoscopic floppy Nissen fundoplication: evaluation of outcome in 34 patients operated without prior oesophageal pH and manometry

Background: Aim of the study was to evaluate prospectively the outcomes of laparoscopic floppy Nissen fundoplication in cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD) and hiatus hernia without pre-operative 24 hours oesophageal pH and manometry study. Methods: Thirty-four patients with typical symptoms of GERD, from March 2009 to November 2019, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by operating surgeon with typical symptoms (heartburn, regurgitation, and dysphagia) of GERD and hiatal hernia. Laparoscopic Nissen’s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery.Result: Laparoscopic Nissen’s fundoplication is an effective long-term treatment for GERD and may be performed in patients with typical symptoms of GERD and hiatus hernia and endoscopic findings suggestive of reflux esophagitis and patient who wants to get rid of life long proton-pump inhibitors (PPI) and antacids medication.Conclusions: Preoperative oesophageal manometry and 24-hour pH monitoring are not mandatory for laparoscopic fundoplication if the patient selection is appropriate but may be required in selected patients with atypical symptoms.

Gastric volvulus or just a large stomach? a case report with literature review of gastric volvulus and gastrointestinal pathology in acromegaly

Gastric volvulus is a surgical emergency that requires prompt recognition and management. The acromegalic patient has a number of pathophysiological factors that predispose to gastric volvulus and slow gastrointestinal (GI) transit. Authors aimed to present a case of hiatus hernia and gastric volvulus in a patient with acromegaly and review the current literature on GI anomalies in this population. A 70-year-old female presented to our institute with epigastric pain and coffee-ground vomiting on the background of acromegaly secondary to pituitary adenoma (resected in 1997). She was found to have a gastric volvulus and hiatus hernia which was repaired laparoscopically. She was discharged home but re-presented six days later with abdominal distension and vomiting. Computed tomography (CT) scan of abdomen showed recurrent gastric volvulus with involvement of the transverse colon. She underwent a laparotomy but no evidence of gastric or colonic volvulus was seen intra-operatively. The CT findings were attributed to a large stomach and coiled redundant transverse colon which could be misinterpreted as volvulus on imaging. Gastroparesis and slow bowel transit were the likely aetiology of this second presentation. This is consistent with literature reporting slow bowel transit and dolichocolon in acromegalic patients. Gastric volvulus is a rare finding associated with acromegaly. Structural anomalies in the anatomy of the acromegalic patient can make CT diagnosis challenging. This case demonstrates the need for caution when interpreting imaging in this cohort, as well as the need for further research on GI pathology associated with acromegaly.

The lymphadenectomy around esophageal hiatus in 4K laparoscopic gastrectomy with the surgeon on left position / 中华消化外科杂志

The lymphadenectomy around esophageal hiatus during the laparoscopic gastrectomy has been a conflict issue. The 4K laparoscopic technique take the advantages in recognition of vessel, nerve, lymph node and fat tissues. Therefore, the detailed anatomy under the 4K laparoscopy can significantly reduce the volume of intraoperative blood loss, and accurately the extent of lymph node dissection. The author discusses the extent and steps for lymphadenectomy around esophageal hiatus in 4K laparoscopic gastrectomy with the surgeon on left position.

Anatomy of the maxillary sinus ostium: a cadaveric study

Background: Recognition of the maxillary sinus position is tedious as it is small and not easily seen. A detailedknowledge of the anatomical variations of maxillary sinus opening is required for endoscopic surgeons toperform safe surgeries. The aim of the present study is to determine the anatomical location of the maxillaryostium in a cadaveric specimen. The position of the accessory maxillary sinus, if present is also noted to furtherbenefit the surgeons.Materials and Methods: Thirty bisected halves of the formalin fixed adult head and neck specimens were obtainedfrom the Department of Anatomy. The anterior part of the skull was divided in the midline and then the nasalseptum was removed taking care not to damage the osteomeatal components. Probes were used in identifyingthe location of maxillary sinus ostium. Various other parameters like vertical diameter, transverse diameter,distance between ostium and anatomical landmarks such as inferior concha and hard palate were measured.Results: In accordance to the parameters considered in the current study, the following results were observed.The maxillary sinus ostium was present in the posterior 1/3rd of the Hiatus semilunaris in 53% of the cadavers.The most common shape of maxillary sinus ostium was oval. The mean vertical and transverse diameters ofostium were 2mm and 2.6mm respectively. The perpendicular distance of the ostium from the lower border ofinferior concha was 14.6 mm and from the upper border of the hard palate was 17.5 mm.Conclusion: The knowledge about the variations in location of the maxillary sinus Ostium and the distances ofthe ostium from the major anatomical landmarks will help the maxillofacial surgeons and otolaryngeologists toperform the surgical procedures safely.

Laparoscopic Fundoplication for Gastro-esophageal Reflux Disease and Hiatus Hernia: A Short Term Outcome of First 8 Cases

Background:Acute gastro-esophageal reflux disease is a common ailment in kashmiripopulation. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD.Aims and Objectives:The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophagealrefluxdisease in termsof operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms.Materialsand Methods:The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the studyhad symptomatic gastro-esophageal reflux(documented by endoscopy) with either persistent symptomsdespite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informedconsent was taken before surgery in the language, the patients understood.Results:This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and postoperative complications. The postoperative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months).The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months. Conclusion:We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who areat a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by thesurgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring

Morphometric Measurements Of Sacral Hiatus In South Indian Dry Human Sacra For Safe Caudal Epidural Block

Introduction: The sacral hiatus is located on the posterior aspect of the lower end of the sacrum, where theextradural space ends . The clinically significant features of the posterior surface of the sacrum are the triangularor inverted ‘U’ shape sacral hiatus and the sacral cornua.The knowledge of Anatomical variations of Sacralhiatus is significant while administration of Caudal Epidural Anaesthesia and it may help to improve its successrate.Aim: The purpose of this study is to recognize anatomical variations and additional landmarks of sacral hiatusin cases where the sacral cornua could not be identified and to assess proportions that may magnify the locationof the apex of the sacral hiatus and thus to find a practical solution for Caudal epidural block (CEB).Materials and methods: The present study was conducted on unknown sixty one complete and undamaged adult,dry sacral bones . The material was of undetermined age and gender. Anatomical measurements was carried outon these bones using a vernier calliper to the accurate of 0.1mm.Results: Variations in the shapes and their percentages of Sacral hiatus were observed namely Elongated, InvertedU, Irregular, Inverted V, Dumbbell and Bifid along with their distances and Angles of use in detecting the Apexwere measured. The location of Apex of Sacral hiatus was found at varying levels from upper end of S2 to lowerpart of S5 vertebrae. Also we measured the angles between the margins of the triangle formed by the twosuperolateral sacral crests and the sacral hiatus. Our measurements reveal this to be an equilateral triangle.Conclusion: This knowledge of variations in Human sacral hiatus provides a safe caudal epidural block beforesurgery and complications can be avoided.We believe that the equilateral character of the sacral triangleformed connecting the two posterior superior iliac spines and the apex of the sacral hiatus will be practicaladvantage to the clinician in ascertaining the location of the sacral hiatus during CEB.

Reintervenciones por fallo de la cirugía antirreflujo / Reinterventions for Failed Antireflux Surgery

RESUMEN Introducción: En la actualidad, la fundoplicatura laparoscópica se considera el tratamiento de elección para la enfermedad por reflujo gastroesofágico con resultados excelentes en más del 90 por ciento de los pacientes. Sin embargo, a pesar de estos resultados, el 30 % de los pacientes presentan persistencia de los síntomas y del 3 por ciento al 10 por ciento requieren reintervención por fallo de la cirugía antirreflujo. Objetivo: Describir las causas del fracaso de la cirugía antirreflujo y las técnicas realizadas en la reintervención. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, de una serie de pacientes a los cuales se les realizo cirugía antirreflujo en el Centro Nacional de Cirugía de Mínimo Acceso desde enero de 1994 hasta diciembre de 2016. Las variables analizadas fueron: reintervenciones y sus causas, tratamiento quirúrgico, morbilidad y el índice de conversión. Resultados: De un total de 1 550 pacientes operados, 37 (2,3 por ciento) fueron reintervenidos. Las causas más frecuentes de reintervención fueron la recidiva de los síntomas y la presencia de disfagia. La herniación de la fundoplicatura fue el hallazgo transoperatorio más frecuente. El índice de conversión fue bajo y no hubo fallecidos en las reintervenciones. La morbilidad triplicó la del total de la serie, así como la estadía hospitalaria. Conclusiones: Las reintervenciones por fallo de la cirugía antirreflujo resultan de gran complejidad pues aumentan considerablemente la morbilidad y la estadía hospitalaria. Debe realizarse en centros que acumulen una alta experiencia en estas técnicas(AU)

ABSTRACT Introduction: Nowadays, laparoscopic fundoplication is considered the treatment of choice for gastroesophageal reflux disease, showing excellent results in more than 90 percent of patients. However, despite these results, 30 percent of patients present with persistent symptoms, while 3 percent to 10 percent require reintervention for failed antireflux surgery. Objective: To describe the causes of failed antireflux surgery and the techniques performed in the reintervention. Method: A descriptive, retrospective and longitudinal study was conducted with a series of patients who underwent antireflux surgery at the National Center for Minimally Access Surgery, from January 1994 to December 2016. The variables analyzed were reinterventions and their causes, surgical treatment, morbidity and the conversion rate. Results: From among 1550 patients operated on, 37 (2.3 percent) were reintervened. The most frequent causes of reintervention were the recurrence of symptoms and the occurrence of dysphagia. The fundoplication herniation was the most frequent transoperative finding. The conversion rate was low and there were no deaths in the reinterventions. The morbidity tripled that of the total of the series, as well as hospital stay. Conclusions: Reinterventions for failed antireflux surgery are very complex, since they increase morbidity and hospital stay considerably. It must be performed in centers that accumulate a high experience in these techniques(AU)

Morphometric Analysis Of The Sacral Hiatus In Indians: Its Clinical Importance

Introduction: Sacral hiatus (SH) is a significant landmark during caudal epidural block (CEB) which is employedfor analgesia and anaesthesia during a wide range of clinical conditions. This requires a thorough knowledge ofmorphometric characteristics of SH and surrounding landmarks, but variability in morphometric dimensionsexists among different populations.Aim: The aim of this study was to identify different anatomical landmarks to detect the location of SH andprovide a reference database for morphometric dimensions of SH in Indian population.Materials and Methods: The study was done on 108 dry adult human sacra. Linear measurements of the sacrawere taken with the help of digital vernier caliper and angular parameters were determined with a goniometer.Results: The most common shape of the sacral hiatus was inverted ’V’ shaped (59.3%) with the level of the apexat S4 in 66.7% and base at S5 in 86.1% cases. Morphometric dimensions of SH were found to be smaller in presentstudy as compared to reports by other researchers. Left crest-apex angle was observed to be significantly greaterthan the right crest-apex angle. (p 0.001).Conclusion: Multiple bony landmarks and their morphometric dimensions should be considered to locate the SHduring CEB. Values for various morphometric parameters of SH are less in Indians in comparison to otherpopulations, which should be contemplated during caudal epidural injections and trans-sacral thecaloscopy.

Unique variation of the left testicular artery passing through a vascular hiatus in renal vein / 대한해부학회지

Surgeons should have a thorough knowledge regarding the morphologic variations of the testicular arteries as any injury to this artery during surgery might cause testicular atrophy. We report in here an unusual course of left testicular artery and discuss its embryological basis and its clinical implications. The left testicular artery had a high origin from the anterior aspect of the abdominal aorta at the level of origin of renal artery. In its further course, the left testicular artery passed through a hiatus present in the left renal vein. This unusual course of the testicular artery through the vascular hiatus might lead to its entrapment and is worth reporting in efforts to educate clinicians involved in abdominal and urogenital surgical procedures.

Study on the practicality of the semi‐automatic measurement for the urogenital hiatus / 中华超声影像学杂志

Objective To determine the consistency of urogenital hiatus ( U H ) data between the semi‐automatic measurement and manual measurement using transperineal pelvic floor ultrasonography . Methods Total of 286 three‐dimensional images of minimal U H dimension were obtained . And they were divided into study group ( 100 images) and test group ( 186 images) randomly . T hree experts traced and created the w hole profile of the U H of those images in the study group by M AT LAB . T hen the semi‐automatic software was obtained through machine learning algorithms . In the test group , 6 parameters of U H ( including anterioposterior diameter , transverse diameter ,circumference , area ,left and right levator urethral gap distance) were measured by two experts ( D 1 and D2 ) both manually and semi‐automatically . T he time experts spent on measuring was also recorded and compared . Results T he time used for semi‐automatic measurement was significantly shorter than that for manual measurement [ ( 7 .49 ± 1 .51 ) s vs ( 42 .42 ± 11 .08) s ,( 7 .52 ± 1 .37) s vs ( 43 .45 ± 9 .09) s for D1 and D2 , t ＝ －12 .09 ,－13 .64 ,all P＝0 .00] . T he Pearson correlation coefficients between semi‐automatic and manual measurements of 6 parameters were 0 .857 －0 .985 ( P ＜ 0 .01) ,0 .853 －0 .979 ( P ＜ 0 .01 ) in D1 and D2 ,respectively . T he interclass correlation coefficients ( ICC) of six parameters were ranged from 0 .846 －0 .985 for D1 and 0 .843～0 .979 for D2 ( all P ＜ 0 .01 ) . T he Bland Altman plot also showed good agreement between two methods . Conclusions Intellectual recognition and semi‐automatic measurement has simplified the process for U H measurement ,and it is proved to be a reliable and timesaving method that is practical for clinical use .

Clinical value of three-dimensional ultrasound in the diagnosis of female pelvic floor dysfunction disease / 中国基层医药

Objective To analyze the clinical value of three-dimensional ultrasound in the diagnosis of pelvic floor dysfunction disease.Methods From June 2016 to December 2017,95 cases of female pelvic floor dysfunction disease in the People's Hospital of Dongyang were selected as observation group.And 90 healthy women received physical examination during the same period were selected as control group.Both two groups were subjected to three-dimensional ultrasonography,and the results were analyzed.Results In the observation group,the anteroposterior diameter and area in resting period,anteroposterior diameter and area in tension period,anteroposterior diameter and area in anus period of the anal pelvic diaphragmatic hiatus were (65.58 ± 6.38)cm,(20.01 ± 3.98) cm2,(68.40 ± 5.54) cm,(22.50 ± 3.12) cm2,(60.17 ± 5.55) cm and (19.28 ± 2.52) cm2,respectively,which were significantly higher than those in the control group [(51.84 ± 3.46) cm,(13.93 ± 2.09) cm2,(53.65 ± 4.23) cm,(14.60 ± 2.95) cm2,(48.95 ± 3.48) cm,(13.45 ± 1.76) cm2] (t =18.066,12.903,20.272,13.200,16.369,18.150,P =0.000,0.000,0.000,0.000,0.000,and 0.000).But the pubic rectal muscle thickness of resting period,tension period,anal contraction period in the observation group were (10.28 ± 1.96) cm,(10.63 ± 1.57) cm,and (10.01 ± 1.13) cm,respectively,which were lower than those in the control group [(10.28 ± 1.96)cm,(10.63 ±1.57)cm,(10.35 ±1.49)cm] (t =1.015,1.940,1.741,P =0.311,0.053,0.083).The observation group was asymmetrical,asymmetrical on both sides and interrupted continuously.In the control group,the echo was uniform,bilateral symmetry,without interruption.Conclusion The use of three-dimensional ultrasound in the diagnosis of female pelvic floor dysfunction disease has good clinical value.

The Study On Morphological And Morphometric Analysis Of Sacral Hiatus In Dry Human Sacra

This study was carried out on 80 dry human sacra in meenakshi medical college Anatomical variations inmorphology and morphometry of sacral hiatus. Various shapes of sacral hiatus were observed which includedinverted U (66.3%), inverted V (11.3%), irregular (11.3%), dumbbell (3.8%) Agenesis Of the dorsal (6.3%) and bifid(1.3%). The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 76.0%. the meanlength of sacral hiatus was 22.9 mm. The mean anteroposterior diameter of sacral canal at the apex of sacralhiatus was 4.97 mm. Narrowing of sacral canal at the apex of sacral hiatus, diameter less than 4mm, wasobserved to be significantly high, (36%). The knowledge of anatomical variations of sacral hiatus is significantwhile administration of caudal epidural anaesthesia and it may help to improve its success rate

Study Of Frontal Air Sinus Opening In Hiatus Semilunaris Of Nasal Cavity

Background: Frontal air sinus opens in Hiatus semilunaris of middle meatus of Nasal cavity. Nowadays plentyof endoscopic surgeries are happening at Middle meatus; so there is need to explore more about detail anatomyof opening of sinuses. So Present study was undertaken to note the exact site of opening of Frontal air sinus inHiatus semilunaris of Nasal cavity.Context and Purpose of study: Study was conducted on 50 specimens. Out of that 27 were from Right side & 23were from Left side. The specimens were the sagittal sections of adult cadavers in the department ofAnatomy,Krishna Institute of Medical sciences University, Karad. The parameters measured were, Distance ofFrontal air sinus opening from Anterior end of Hiatus semilunaris (nasal bone). Distance of Frontal air sinusopening from Posterior end of Hiatus semilunaris(Inferior surface of Body of Spenoid bone). Diameter of Frontalair sinus opening. Shape of Frontal air sinus opening. All these measurements were taken by Sliding VernierCaliper of 30cm length & 0.001 accuracy.Results: The mean Distance of Frontal air sinus opening from Anterior end of Hiatus semilunaris (nasal bone)was- 1.63cms on Left side & 1.52cms on Right side. The mean Distance of Frontal air sinus opening fromPosterior end of Hiatus semilunaris(Inferior surface of Body of Spenoid bone) was- 4.26 cms on Left side &4.17cms on Right side. The mean Diameter of Frontal air sinus opening – 0.19cms on Left side & 0.18cms on Rightside. The shape of Frontal sinus opening is mainly Circular.Conclusion and Summary: Knowledge of the anatomy of the Frontal air sinus opening is basically helpful for theAnatomists, to know where exactly is the site of the opening of Frontal air sinus in the middle meatus of nasalcavity; And secondarily it might be helpful to ENT surgeons during the performance of endonasalcystorhinostomies.