Morphometric analysis of the inferior vena cava and its clinical correlations using abdomino-pelvic computed tomography: Series from a Jordanian population.

INTRODUCTION AND IMPORTANCE: This study aimed to determine the impact of DM, HTN and age on IVC dimensions as measured by CT scan relevant to guide interventions in a Jordanian population. PRESENTATION OF CASES: Two hundred patients were selected from those referred to the Radiology Department, Jordan University Hospital, Amman, Jordan for clinical evaluation. Patients were divided into three age subgroups. Age, sex, and comorbidities such as DM and HTN were identified and saved for later use. All dimensions of the IVC were measured using an abdomino-pelvic CT scanner. CLINICAL DISCUSSION: A full morphometric analysis of the IVC would provide a better understanding of the dynamicity of the IVC in relation to its blood flow. Our results revealed that the length of the IVC was significantly shorter with age (P = 0.003). DM significantly affected the length of the IVC (P = 0.044). Hypertension also significantly affected the length of the IVC (P = 0.031), but it did not significantly affect the anterio-posterior or the transverse diameters of the IVC. CONCLUSION: The length of the IVC was significantly shorter with age, DM and hypertension. Morphometric measures of the IVC are of great clinical importance as they may assist in medical or surgical intervention and follow-up.

Development and validation of a scale to measure the gross anatomy preparedness of medical graduates / Desarrollo y validación de una escala para medir la preparación anatómica general de los graduados médicos

SUMMARY: Postgraduate refresher courses may address deficiencies in the gross anatomy preparedness of medical graduates. However, the literature does not offer a method to identify such deficiencies. Our aim is to develop and validate a scale to measure the gross anatomy preparedness of medical graduates. First, we defined gross anatomy preparedness (the construct) as "the benchmark of personal ability in gross anatomy against the standard required for clinical practice." Next, we conducted a literature search for extant items related to our definition. To develop our scale, we grouped the items under three headings: proficiency, preference, and pertinence. Finally, we constructed item-specific response anchors to "Likertize" the items. We recruited experts to validate the content and conducted cognitive interviews to validate the response process. To evaluate the internal structure and reliability of the scale, we invited a purposive sample of 120 surgery residents to complete the scale and explored the results of the pilot test using data reduction and reliability analysis. A total of 77 surgery residents completed the scale. Varimax-rotated principal components analysis revealed three components with eigenvalues greater than one, and the components explained 64 % of the total variance. The rotated solution was consistent with the original structure of the questionnaire. The components, which represented the proficiency, preference, and pertinence item sets, explained 25 %, 23 %, and 16 %, respectively, of the total variance. Cronbach's α coefficients for the item sets were 0.72, 0.71, and 0.61, respectively. We developed and validated a scale to measure the gross anatomy preparedness of medical graduates. In addition, we offer conceptual guidelines to help users interpret the results of the scale. Outcome data are required to substantiate the predictive validity of the scale.

RESUMEN: Los cursos de actualización de posgrado pueden abordar las deficiencias en la preparación de la anatomía macroscópica de los graduados médicos. Sin embargo, la literatura no ofrece un método para identificar tales deficiencias. Nuestro objetivo fue desarrollar y validar una escala para medir la preparación anatómica general de los graduados médicos. Primero, definimos la preparación para la anatomía macroscópica (el constructo) como "el punto de referencia de la capacidad personal en anatomía macroscópica frente al estándar requerido para la práctica clínica". A continuación, realizamos una búsqueda bibliográfica de elementos existentes relacionados con nuestra definición. Para desarrollar nuestra escala, agrupamos los ítems bajo tres encabezados: competencia, preferencia y pertinencia. Finalmente, construimos anclas de respuesta específicas del ítem para "dar me gusta" a los ítems. Reclutamos expertos para validar el contenido y realizamos entrevistas cognitivas para validar el proceso de respuesta. Para evaluar la estructura interna y la confiabilidad de la escala, invitamos a una muestra intencional de 120 residentes de cirugía a completar la escala y exploramos los resultados de la prueba piloto utilizando la reducción de datos y el análisis de confiabilidad. Un total de 77 residentes de cirugía completaron la escala. El análisis de componentes principales rotados con Varimax reveló tres componentes con valores propios mayores que uno, y los componentes explicaron el 64 % de la varianza total. La solución rotada fue consistente con la estructura original del cuestionario. Los componentes, que representaban los conjuntos de ítems de competencia, preferencia y pertinencia, explicaban el 25 %, el 23 % y el 16 %, respectivamente, de la varianza total. Los coeficientes de Cronbach para los conjuntos de elementos fueron 0,72, 0,71 y 0,61, respectivamente. Desarrollamos y validamos una escala para medir la preparación anatómica general de los graduados médicos. Además, ofrecemos pautas conceptuales para ayudar a los usuarios a interpretar los resultados de la escala. Se requieren datos de resultados para corroborar la validez predictiva de la escala.

Variation in the vertebral levels of the origins of the abdominal aorta branches: a retrospective imaging study.

Our aim was to investigate the variation in the vertebral levels of the origins of the celiac artery, superior and inferior mesenteric arteries, paired renal arteries, and common iliac arteries. We conducted a retrospective imaging study in a large public secondary hospital on a nonrandom sample of 227 participants. We consecutively included adult patients who had undergone computed tomography angiography of the abdomen and excluded patients with a history of any vertebral abnormality or whose images revealed evidence of a vertebral abnormality or a congenital anomaly of any of the branches of the abdominal aorta. The primary outcome was the frequency distribution of the vertebral levels of the landmarks. The secondary outcomes were the intercorrelations of the vertebral levels of the landmarks and their relationships with age, sex, weight, height, and body mass index. The celiac artery originated at T11/T12-L1/L2, followed by the superior mesenteric artery at T12-L2, the paired renal arteries at T12/L1-L2/L3, the inferior mesenteric artery at L2-L4, and the common iliac arteries at L3-L5. The vertebral levels of the landmarks were positively intercorrelated and stronger between proximate pairs. In addition, the vertebral levels of the landmarks were related to age, but not sex, weight, height, or body mass index. The intercorrelations suggest that a considerable proportion of the variation is accounted for by 'trickle-down' variation; variation in the vertebral level of a proximal landmark results in variation in the vertebral level of the immediate distal landmark. The overarching parameter remains unidentified.

Normative values of the retinal macular thickness in a middle eastern population.

BACKGROUND: Since the normative value of the retinal macular thickness is undocumented in the Middle East, the aim of this work is to assess the normative values of the macular thickness in healthy eyes in a Middle Eastern population and its relationship with age, sex, and laterality. METHODS: One hundred sixteen individuals were randomly selected from volunteers visiting the Jordan University Hospital in Amman, Jordan. Measurements were obtained using the Fourier domain optical coherence tomography (OCT). Multivariate regression models were developed to obtain predicted normative values with adjustment to candidate variables. In addition, the effect of age, sex and laterality were evaluated. RESULTS: The average central fovea macular thickness was 229.5 (±30.85) um. The quadratic value of the retinal macular thickness decreased from the superior value of 299.71 (±23.67) um (P = .001) to the inferior value of 296.46 (±28.85) um(P = .001) and a nasal figure of 93.63 (±26.86) um(P = .001). The temporal area has the thinnest value of 293.43 (±30.78) um (P = 0.001). Central thickness was higher in males with a mean variation of 11.67 um (95% CI, 2.41 to 20.93) (p = 0.003). The thickness was highest within 3 mm diameter from the center and decreased towards the periphery Eye sidedness didn't contribute to variability of the macular thickness. Furthermore, we found a significant difference between age and central macular thickness (p = 0.001), as age was a positive predictor for macular thickness. CONCLUSION: Our set of predicted normative data may be used to interrupt measurement of the macular thickness in Middle Eastern population. The average fovea macular thickness among Jordanians is consistent with previously reported values. Normative values from additional Middle Eastern. Population are required to appraise our model.

The best vein to be accessed based on descriptive study of dorsal metacarpal vein.

It is well known that the most common sites for venous access are the superficial veins of the upper limb, particularly dorsal metacarpal veins and median cubital vein. Although dorsal metacarpal veins are the first choice for venous cannulation, there is scarce information about their anatomic variation. Hence, detailed anatomical information about these veins will improve the anatomic knowledge of the health care providers. Subsequently, this study was designed to study the dorsal metacarpal veins and to determine the most prominent dorsal metacarpal vein. A cross sectional study of 402 subjects (804 hands), was prepared to study the superficial veins on the dorsum of the hand among Jordanian students and staff of one of the major governmental medical colleges in Jordan, by using infrared illumination system. The obtained data was analyzed according to sex, sidedness, and handedness. Six locations of the most prominent dorsal metacarpal veins were identified. There was a significant relation between both females and males and the most prominent dorsal metacarpal vein (P=0.01). For the first time this study identified the most common location of the most prominent dorsal metacarpal vein in the fourth intermetacarpal space.

Normative Values of Peripapillary Retinal Nerve Fiber Layer Thickness in a Middle Eastern Population.

PURPOSE: Peripapillary retinal nerve fiber layer (pRNFL) thickness is subject to high variability. Normative values of pRNFL thickness remain undocumented in the Middle East. The aim of our study is to assess the normative values of pRNFL thickness in a Middle Eastern population. METHODS: A retrospective chart review of 74 patients was conducted. Outpatients who had presented to the ophthalmology clinic at the Jordan University Hospital between January 2016 and July 2018 were consecutively sampled. Measurements had been recorded using Fourier-domain optical coherence tomography. Multivariable regression models were developed to generate predicted normative values with adjustments to candidate confounders. RESULTS: The mean global pRNFL thickness was 99 ± 11 µm. The mean quadrantic pRNFL thickness increased from the nasal quadrant (75 ± 16 µm) to the temporal (82 ± 20 µm), superior (114 ± 20 µm), and inferior (125 ± 20 µm) quadrants. Gender and eye sidedness did not contribute to the variability in pRNFL thickness. The relationship between aging and pRNFL thinning is independent of diabetes mellitus type 2 and systemic hypertension. Both systemic conditions significantly predicted pRNFL changes despite negative fundoscopic findings. CONCLUSIONS: Our set of predicted normative data may be used to interpret measurements of pRNFL thickness in Middle Eastern patients. Our findings suggest that systemic conditions with potential ocular manifestations may require consideration in predictive models of pRNFL thickness, even in the absence of gross fundoscopic findings. Normative data from additional Middle Eastern populations are required to appraise our models, which adjust for common clinical confounders.

Dorsal metacarpal veins: anatomic variation and potential clinical implications.

The dorsal metacarpal veins are frequently cannulated. Cannulation success is determined by several variable anatomic features. The objective of this study is to classify, for the first time, the anatomic variants of the dorsal metacarpal veins. In this cross-sectional study, 520 university students and staff were conveniently recruited. The dorsal metacarpal veins in 1040 hands were studied. Venous visibility was enhanced by either tourniquet application or near-infrared illumination. Variant patterns of the dorsal metacarpal veins were classified. The final analysis included 726 hands, for an exclusion rate of 30 %. Eight pattern types were identified. Three anatomic features informed the variation. Bilateral symmetry of the dorsal metacarpal veins was present in 352 participants (83 % of the total). The overall frequency distribution of variants in both hands was similar (P = 0.8). The frequency distribution of variants was subject to sexual dimorphism (P = 0.001), ethnic variation (P < 0.001), and technical variation (P < 0.001). The anatomic variants of the dorsal metacarpal veins were sorted into decreasingly frequent primary, secondary, and tertiary groups. The groups may signify a progressive increase in difficulty of peripheral cannulation, in the mentioned order. As such, primary patterns are the most common and likely the easiest to cannulate, while tertiary patterns are the least common and likely the most difficult to cannulate. The preceding premise, in tandem with the bilateral asymmetry of the veins, is clinically significant. With cannulation difficulty likely signifying an underlying tertiary pattern, the contralateral dorsal metacarpal veins are probabilistically characterized by a primary pattern and are, as such, the easier option for peripheral venous cannulation.

Morphometric analysis of the foramen magnum / Análisis morfométrico del foramen magno

SUMMARY: The foramen magnum is morphometrically typified by two perpendicular diameters and a distinct margin. This important anatomical landmark is subject to high interindividual variation. The objective of this study was to evaluate the dimensions and morphology of the foramen magnum in a Jordanian population. In this retrospective study, 247 individuals were consecutively sampled using the institutional picture archiving and communication system. The anteroposterior and transverse diameters of the foramen magnum were measured; the foramen magnum index was calculated; and, the shape of the foramen magnum was visually assessed. The sex-pooled anteroposterior and transverse diameters were 35.1 ± 3.2 mm and 29.3 ± 2.5 mm, respectively. The sex-pooled foramen magnum index was 1.20 ± 0.10. The diameters were significantly different (P<0.001) and positively correlated (r=0.52, P<0.001). Participant age was negatively correlated with the anteroposterior (rs=-0.15, P=0.02) and transverse (rs=-0.14, P=0.03) diameters. After controlling for participant age, there was a statistically significant difference in the anteroposterior diameter (P<0.001), the transverse diameter (P<0.001), and the foramen magnum index (P=0.02) between sexes. The foramen magnum was most commonly irregular in shape (36 % of all cases). In contrast to previous studies, we report, for the first time, a negative correlation between age and the diameters of the foramen magnum. In addition, a predominance of irregularly shaped foramen magnum was found. The finding makes an already heterogenous group of published data even more variable, prompting reconsideration of the role of visual assessment in morphometric studies.

RESUMEN: El foramen magno está morfométricamente tipificado por dos diámetros perpendiculares y un margen. Este punto importante de referencia anatómica está sujeto a una alta variación interindividual. El objetivo del estudio fue evaluar las dimensiones y la morfología del foramen magno en una población jordana. En este estudio retrospectivo, 247 individuos fueron muestreados consecutivamente utilizando el sistema institucional y de comunicación de imágenes. Se midieron los diámetros anteroposterior y transversal del foramen magno; Se calculó el índice del foramen magno y se evaluó visualmente la forma dede éste. Los diámetros anteroposterior y transversal agrupados por sexo fueron 35,1±3,2 mm y 29,3±2,5 mm, respectivamente. El índice del foramen magno, agrupado por sexo, fue 1,20±0,10. Los diámetros fueron significativamente diferentes (P <0,001) y positivamente correlacionados (r = 0,52, P <0,001). La edad de los participantes se correlacionó negativamente con los diámetros anteroposterior (rs = -0,15, P = 0,02) y transversal (rs = -0,14, P = 0,03). Después de verificar la edad de los participantes, hubo una diferencia estadísticamente significativa entre el diámetro anteroposterior (P <0,001), el diámetro transversal (P <0,001) y el foramen magno (P = 0,02) entre ambos sexos. El foramen magno era más comúnmente de forma irregular (36 % de todos los casos). A diferencia de estudios anteriores, se informa por primera vez de una correlación negativa entre la edad y los diámetros del foramen magno. Además, se encontró un predominio de forámenes de forma irregular. El hallazgo indica que un grupo heterogéneo de datos ya publicados, sea aún más variable, lo que lleva a reconsiderar el papel de la evaluación visual en los estudios morfométricos.

Double inferior vena cava detected by CT venography and confirmed by magnetic resonance venography: embryogenesis and literature review / Doble vena cava inferior detectada a través de venografía por tomografía computada y confirmada con venografía por resonancia magnética: embriogénesis y revisión de la literatura

A hospital based prospective study was conducted from July 2001 to July 2015 at the Department of Radiology, Jordan University Hospital, Amman, Jordan. During that period, five cases of double inferior vena cava (DIVC) were discovered among a cohort of 7722 patients (3861 men and 3861 women, 49.5±16.9 years, range 16­78 years). Cases were diagnosed by contrast-enhanced Spiral CT venography (CTV) and confirmed by turbo three-dimensional (3D) time-of-flight contrast-enhanced MR venography. The majority of patients 3166 (41 %) were referred for staging and follow-up of malignancy, postoperative complications 1777 (23 %), non-specific abdominal pain 1467 (19 %), preoperative assessment 849 (11 %) and trauma 463 (6 %). Magnetic resonance venography showed higher sensitivity, diagnostic accuracy and noninvasive modality for assessment of IVC map. MRV is a more useful, noninvasive modality for assessment of IVC map. DIVC is a common anomaly, its incidence in our study found to be 0.064 %. The incidence, literature review, embryogenesis, and importance of this anomaly are discussed. In addition, sample figures of relevant cases are provided.

En el Departamento de Radiología del Hospital de la Universidad de Jordania, Amman, Jordania, se llevó a cabo un estudio prospectivo entre el mes de julio de 2001 al mes de julio del 2015. Durante ese período se descubrieron cinco casos de vena cava inferior doble (VCID) en una cohorte de 7722 pacientes (3861 hombres y mujeres 3861, de 49,5 ± 16,9 años, con un rango de edad de 16-78 años). Los casos fueron diagnosticados por medio de venografía por tomografía computada espiral con contraste (TCV) y confirmados por medio de venografía por estudio tridimensional turbo. La mayoría de los pacientes (3166, 41 %) fueron remitidos para estadificación y seguimiento de tumores malignos. Se presentaron complicaciones postoperatorias en 1777 pacientes (23 %), dolor abdominal no especificado en 1467 (19 %), evaluación preoperatoria en 849 (11 %) y traumatismo en 463 pacientes (6 %). La venografía por resonancia magnética (RMV) mostró una mayor sensibilidad, precisión diagnóstica, y resultando no invasiva para la evaluación de la vena cava inferior (VCI). RMV es una modalidad más útil, no invasiva para la evaluación de la VCI. VCID es una anomalía frecuente, encontrándose en nuestro estudio una incidencia de 0,064 %. Además se realizó una revisión de la literatura, la embriogénesis, y la importancia de esta anomalía. También, se proporcionaron cifras de muestras de los casos relevantes.

Ultrasonographic assessment of splenic volume and its correlation with body parameters in a Jordanian population.

OBJECTIVES: To estimate normal linear dimensions and volume of spleen in Jordanians using ultrasonography, and to correlate splenic volume with age and body parameters: height, weight, body surface area (BSA), and body mass index (BMI). METHODS: A prospective pilot study was conducted on 205 volunteers (115 males and 90 females) not known to have any conditions likely to be associated with splenomegaly. The study was performed at the Radiology Department, Jordanian University Hospital, Amman, Jordan, between December 2013 and August 2014. All linear dimensions of spleen were measured, and splenic volume (index) was calculated using the standard prolate ellipsoid formula (length × width × depth × 0.523). The splenic volume was then analyzed with age and body parameters using the Pearson's correlation coefficient. RESULTS: The mean (± SD) splenic dimensions were 10.72±1.37 cm in length, 7.40±1.52 cm in width, 4.40±1.47 cm in depth, and 184.15±79.56 cm3 in volume. Men had larger spleens than women (p less than 0.0001). Age had no significant effect on spleen volume (r=0.11, p=0.12). There was a significant moderate positive correlation (p less than 0.0001), using Pearson's correlation coefficient, between the spleen volume, and other parameters (height, weight, BSA, and BMI), with correlation coefficients exceeding 0.3. CONCLUSION: A local reference of spleen dimensions was established with a different range of values reported previously.